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  1. Article ; Online: Acute kidney injury contributes to worse physical and quality of life outcomes in survivors of critical illness.

    Mayer, Kirby P / Ortiz-Soriano, Victor M / Kalantar, Alborz / Lambert, Joshua / Morris, Peter E / Neyra, Javier A

    BMC nephrology

    2022  Volume 23, Issue 1, Page(s) 137

    Abstract: Objectives: Survivors of critical illness and acute kidney injury (AKI) are at risk of increased morbidity. The purpose of this study was to compare physical, emotional, and cognitive health in survivors of critical illness with and without AKI.: ... ...

    Abstract Objectives: Survivors of critical illness and acute kidney injury (AKI) are at risk of increased morbidity. The purpose of this study was to compare physical, emotional, and cognitive health in survivors of critical illness with and without AKI.
    Methods: Retrospective cohort study of adult (≥ 18 years old) survivors of critical illness due to sepsis and/or acute respiratory failure who attended follow-up in a specialized ICU Recovery Clinic. Outcomes were evaluated during 3-month visit and comprised validated tests for evaluation of physical function, muscle strength, cognitive and emotional health, and self-reported health-related quality of life (HRQOL). Descriptive statistics and group comparisons were performed.
    Results: A total of 104 patients with median age of 55 [49-64] years, 54% male, and median SOFA score of 10 [8-12] were analyzed. Incidence of AKI during ICU admission was 61 and 19.2% of patients required renal replacement therapy (RRT). Patients with AKI stage 2 or 3 (vs. those with AKI stage 1 or no AKI) walked less on the 6-min walk test (223 ± 132 vs. 295 ± 153 m, p = 0.059) and achieved lower of the predicted walk distance (38% vs. 58%, p = 0.041). Similar patterns of worse physical function and more significant muscle weakness were observed in multiple tests, with overall worse metrics in patients that required RRT. Patients with AKI stage 2 or 3 also reported lower HRQOL scores when compared to their counterparts, including less ability to return to work or hobby, or reengage in driving. There were no significant differences in cognitive function or emotional health between groups.
    Conclusions: Survivors of critical illness and AKI stage 2 or 3 have increased physical debility and overall lower quality of life, with more impairment in return to work, hobby, and driving when compared to their counterparts without AKI or AKI stage 1 at 3 months post-discharge.
    MeSH term(s) Acute Kidney Injury/epidemiology ; Acute Kidney Injury/therapy ; Adolescent ; Adult ; Aftercare ; Critical Illness ; Female ; Humans ; Intensive Care Units ; Male ; Middle Aged ; Patient Discharge ; Quality of Life ; Renal Replacement Therapy ; Retrospective Studies ; Survivors
    Language English
    Publishing date 2022-04-07
    Publishing country England
    Document type Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 2041348-8
    ISSN 1471-2369 ; 1471-2369
    ISSN (online) 1471-2369
    ISSN 1471-2369
    DOI 10.1186/s12882-022-02749-z
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: A Multidisciplinary Approach for the Management of Severe Hyponatremia in Patients Requiring Continuous Renal Replacement Therapy.

    Neyra, Javier A / Ortiz-Soriano, Victor M / Ali, Dina / Morris, Peter E / Johnston, Clayton M

    Kidney international reports

    2018  Volume 4, Issue 1, Page(s) 59–66

    Abstract: Introduction: Hyponatremia is a common electrolyte disorder in critically ill patients. Rapid correction of chronic hyponatremia may lead to osmotic demyelination syndrome. Management of severe hyponatremia in patients with acute or chronic kidney ... ...

    Abstract Introduction: Hyponatremia is a common electrolyte disorder in critically ill patients. Rapid correction of chronic hyponatremia may lead to osmotic demyelination syndrome. Management of severe hyponatremia in patients with acute or chronic kidney disease who require continuous renal replacement therapy (CRRT) is limited by the lack of commercially available hypotonic dialysate or replacement fluid solutions.
    Methods: This was a single-center quality improvement project that consisted of the development and implementation of a multidisciplinary protocol for gradual correction of severe hyponatremia in patients who were admitted to the intensive care unit (ICU) and required CRRT. The protocol utilized a simplified method based on single-pool urea kinetic modeling and a hybrid technique of volume exchange, and addition of sterile water for sodium dilution of commercially available dialysate and replacement fluid solutions.
    Results: We report data of the first 3 ICU patients who required CRRT for acute kidney injury management, had severe hyponatremia (serum sodium <120 mEq/l), and were treated under the protocol. Targeted and gradual hyponatremia correction was achieved in all 3 patients. The observed versus the predicted serum sodium correction in each patient was concordant. No complications related to the protocol were reported. We detailed facilitators of and hindrances to the development and successful implementation of our multidisciplinary protocol.
    Conclusion: We demonstrated gradual and individualized rates of severe hyponatremia correction utilizing customized (sodium dilution) dialysate/replacement fluid solutions in ICU patients who required CRRT. It is not known whether the use of customized solutions to prevent hyponatremia overcorrection has a significant impact on patient outcomes. Further research in this susceptible population is needed.
    Language English
    Publishing date 2018-09-13
    Publishing country United States
    Document type Journal Article
    ISSN 2468-0249
    ISSN (online) 2468-0249
    DOI 10.1016/j.ekir.2018.09.001
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Development, implementation and outcomes of a quality assurance system for the provision of continuous renal replacement therapy in the intensive care unit.

    Ruiz, Eloy F / Ortiz-Soriano, Victor M / Talbott, Monica / Klein, Bryan A / Thompson Bastin, Melissa L / Mayer, Kirby P / Price, Emily B / Dorfman, Robert / Adams, Brandi N / Fryman, Lisa / Neyra, Javier A

    Scientific reports

    2020  Volume 10, Issue 1, Page(s) 20616

    Abstract: Critically ill patients with requirement of continuous renal replacement therapy (CRRT) represent a growing intensive care unit (ICU) population. Optimal CRRT delivery demands continuous communication between stakeholders, iterative adjustment of therapy, ...

    Abstract Critically ill patients with requirement of continuous renal replacement therapy (CRRT) represent a growing intensive care unit (ICU) population. Optimal CRRT delivery demands continuous communication between stakeholders, iterative adjustment of therapy, and quality assurance systems. This Quality Improvement (QI) study reports the development, implementation and outcomes of a quality assurance system to support the provision of CRRT in the ICU. This study was carried out at the University of Kentucky Medical Center between September 2016 and June 2019. We implemented a quality assurance system using a step-wise approach based on the (a) assembly of a multidisciplinary team, (b) standardization of the CRRT protocol, (c) creation of electronic CRRT flowsheets, (d) selection, monitoring and reporting of quality metrics of CRRT deliverables, and (e) enhancement of education. We examined 34-month data comprising 1185 adult patients on CRRT (~ 7420 patient-days of CRRT) and tracked selected QI outcomes/metrics of CRRT delivery. As a result of the QI interventions, we increased the number of multidisciplinary experts in the CRRT team and ensured a continuum of education to health care professionals. We maximized to 100% the use of continuous veno-venous hemodiafiltration and doubled the percentage of patients using regional citrate anticoagulation. The delivered CRRT effluent dose (~ 30 ml/kg/h) and the delivered/prescribed effluent dose ratio (~ 0.89) remained stable within the study period. The average filter life increased from 26 to 31 h (p = 0.020), reducing the mean utilization of filters per patient from 3.56 to 2.67 (p = 0.054) despite similar CRRT duration and mortality rates. The number of CRRT access alarms per treatment day was reduced by 43%. The improvement in filter utilization translated into ~ 20,000 USD gross savings in filter cost per 100-patient receiving CRRT. We satisfactorily developed and implemented a quality assurance system for the provision of CRRT in the ICU that enabled sustainable tracking of CRRT deliverables and reduced filter resource utilization at our institution.
    MeSH term(s) Acute Kidney Injury/drug therapy ; Acute Kidney Injury/therapy ; Blood Coagulation/drug effects ; Citric Acid/therapeutic use ; Continuous Renal Replacement Therapy/methods ; Critical Illness ; Female ; Humans ; Intensive Care Units ; Male ; Middle Aged ; Quality Improvement
    Chemical Substances Citric Acid (2968PHW8QP)
    Language English
    Publishing date 2020-11-26
    Publishing country England
    Document type Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 2615211-3
    ISSN 2045-2322 ; 2045-2322
    ISSN (online) 2045-2322
    ISSN 2045-2322
    DOI 10.1038/s41598-020-76785-w
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article: Continuous renal replacement therapy in critically ill patients with acute on chronic liver failure and acute kidney injury: A retrospective cohort study
.

    Saraiva, Ivan E / Ortiz-Soriano, Victor M / Mei, Xiaonan / Gianella, Fabiola G / Woc, Winnie Sheu / Zamudio, Rodrigo / Kelly, Andrew / Gupta, Meera / Grigorian, Alla Y / Neyra, Javier A

    Clinical nephrology

    2020  Volume 93, Issue 4, Page(s) 187–194

    Abstract: Background: Incident acute kidney injury (AKI) in critically ill patients with acute on chronic liver failure (ACLF) is associated with poor prognosis. The role of continuous renal replacement therapy (CRRT) is not well established for patients with ... ...

    Abstract Background: Incident acute kidney injury (AKI) in critically ill patients with acute on chronic liver failure (ACLF) is associated with poor prognosis. The role of continuous renal replacement therapy (CRRT) is not well established for patients with ACLF and AKI.
    Materials and methods: We conducted a retrospective cohort study to examine clinical outcomes in 66 patients with ACLF and AKI requiring CRRT.
    Results: All-cause hospital mortality was 89.4%. Five (7.6%) patients were listed for liver transplantation, of whom 1 (1.5%) was eventually subjected to transplantation. Etiology of AKI included type 1 hepatorenal syndrome (HRS) with or without some degree of acute tubular necrosis (ATN) in 20 (30.3%) patients, and primarily ATN in 46 (69.7%) patients. When evaluated at the time of CRRT initiation, Child-Pugh-Turcotte (CPT) and Model for End-stage Liver Disease (MELD) (area under the receiver operating characteristics curve (AUROC) 0.67 for both) had fair performance for prediction of mortality, whereas Sequential Organ Failure Assessment (SOFA) and Chronic Liver Failure (CLIF)-SOFA performed better for the prediction of mortality (AUROC 0.87 for both). SOFA and CLIF-SOFA also performed well when determined at the time of ICU admission (AUROC 0.86 and 0.85, respectively). Etiology of liver disease or AKI did not influence prognosis.
    Conclusion: Critically ill patients with ACLF and AKI requiring CRRT have poor hospital survival, even with provision of extracorporeal support therapy. SOFA and CLIF-SOFA are good prognostic tools of mortality in this susceptible population.
    MeSH term(s) Acute Kidney Injury/mortality ; Acute Kidney Injury/therapy ; Acute-On-Chronic Liver Failure/mortality ; Acute-On-Chronic Liver Failure/therapy ; Adult ; Aged ; Continuous Renal Replacement Therapy ; Critical Illness ; Female ; Hospital Mortality ; Humans ; Male ; Middle Aged ; Retrospective Studies
    Language English
    Publishing date 2020-02-26
    Publishing country Germany
    Document type Journal Article
    ZDB-ID 185101-9
    ISSN 0301-0430
    ISSN 0301-0430
    DOI 10.5414/CN109983
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular
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  5. Article ; Online: Kidney Biomarkers and Major Adverse Kidney Events in Critically Ill Patients.

    Flannery, Alexander H / Bosler, Katherine / Ortiz-Soriano, Victor M / Gianella, Fabiola / Prado, Victor / Lambert, Joshua / Toto, Robert D / Moe, Orson W / Neyra, Javier A

    Kidney360

    2020  Volume 2, Issue 1, Page(s) 26–32

    Abstract: Background: Several biomarkers of AKI have been examined for their ability to predict AKI before serum creatinine. Few studies have focused on using kidney biomarkers to better predict major adverse kidney events (MAKE), an increasingly used composite ... ...

    Abstract Background: Several biomarkers of AKI have been examined for their ability to predict AKI before serum creatinine. Few studies have focused on using kidney biomarkers to better predict major adverse kidney events (MAKE), an increasingly used composite outcome in critical care nephrology research.
    Methods: Single-center prospective study collecting blood and urine samples from critically ill patients with AKI Kidney Disease Improving Global Outcomes stage 2 or above, and matched controls from a single, tertiary care intensive care unit (ICU). Samples were collected at 24-48 hours after AKI diagnosis (patients) or ICU admission (controls), 5-7 days later, and 4-6 weeks after discharge for patients with AKI. The primary outcome of interest was MAKE at hospital discharge (MAKE-DC), consisting of the composite end point of death, RRT dependence, or a decrease in estimated glomerular filtration to <75% of baseline.
    Results: Serum/urinary neutrophil gelatinase-associated lipocalin (NGAL), serum/urinary cystatin C, and urinary kidney injury molecule-1 early in the AKI or ICU course were all significantly higher in patients with MAKE-DC compared with those not experiencing MAKE-DC. Additionally, serum/urinary NGAL and serum cystatin C measurements at the first time point remained significantly associated with MAKE events at 3, 6, and 12 months. Serum cystatin C, and to a lesser extent serum NGAL, significantly improved upon a logistic regression clinical prediction model of MAKE-DC (AUROC 0.94 and 0.87 versus 0.83;
    Conclusions: Early measures of kidney biomarkers in patients who are critically ill are associated with MAKE-DC. This relationship appears to be greatest with serum NGAL and cystatin C, which display additive utility to a clinical prediction model. Trending serum NGAL may also have utility in predicting MAKE-DC.
    MeSH term(s) Acute Kidney Injury/diagnosis ; Acute-Phase Proteins ; Biomarkers ; Critical Illness ; Humans ; Kidney ; Lipocalins ; Models, Statistical ; Prognosis ; Prospective Studies ; Proto-Oncogene Proteins
    Chemical Substances Acute-Phase Proteins ; Biomarkers ; Lipocalins ; Proto-Oncogene Proteins
    Language English
    Publishing date 2020-11-04
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
    ISSN 2641-7650
    ISSN (online) 2641-7650
    DOI 10.34067/KID.0003552020
    Database MEDical Literature Analysis and Retrieval System OnLINE

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