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Article ; Online: Innovations of renal replacement techniques at the intersection of clinical trial and real-world data.

Schiffl, Helmut

2023 Volume 56, Issue 3, Page(s) 1195–1196

MeSH term(s)	Humans ; Kidney ; Renal Replacement Therapy
Language	English
Publishing date	2023-08-15
Publishing country	Netherlands
Document type	Letter
ZDB-ID	204048-7
ISSN	1573-2584 ; 0301-1623 ; 0042-1162
ISSN (online)	1573-2584
ISSN	0301-1623 ; 0042-1162
DOI	10.1007/s11255-023-03738-3
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Article ; Online: Inflammation-Based Prognostic Markers and Outcome of CAPD Patients: Fact or Fiction?

Schiffl, Helmut

Blood purification

2021 Volume 51, Issue 3, Page(s) 296–297

MeSH term(s)	Cohort Studies ; Humans ; Inflammation ; Lymphocytes ; Neutrophils ; Peritoneal Dialysis ; Peritoneal Dialysis, Continuous Ambulatory ; Prognosis
Language	English
Publishing date	2021-05-28
Publishing country	Switzerland
Document type	Letter ; Comment
ZDB-ID	605548-5
ISSN	1421-9735 ; 0253-5068
ISSN (online)	1421-9735
ISSN	0253-5068
DOI	10.1159/000515889
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Zs.A 1872: Show issues

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Article ; Online: Platelet-to-lymphocyte ratio and prediction of progressive IgA nephropathy: myth or fact?

Schiffl, Helmut

International urology and nephrology

2021 Volume 53, Issue 11, Page(s) 2421–2422

MeSH term(s)	Blood Platelets ; Glomerulonephritis, IGA ; Humans ; Kidney ; Lymphocytes
Language	English
Publishing date	2021-03-26
Publishing country	Netherlands
Document type	Letter ; Comment
ZDB-ID	204048-7
ISSN	1573-2584 ; 0301-1623 ; 0042-1162
ISSN (online)	1573-2584
ISSN	0301-1623 ; 0042-1162
DOI	10.1007/s11255-021-02807-9
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Article ; Online: Intensity of renal replacement therapy and outcomes in critically ill patients with acute kidney injury: Critical appraisal of the dosing recommendations.

Schiffl, Helmut

Therapeutic apheresis and dialysis : official peer-reviewed journal of the International Society for Apheresis, the Japanese Society for Apheresis, the Japanese Society for Dialysis Therapy

2020 Volume 24, Issue 6, Page(s) 620–627

Abstract: The current care of critically ill patients with severe acute kidney injury requiring dialysis (AKI-D) is limited to supportive management in which renal replacement therapy (RRT) plays a central role. Renal replacement techniques are invasive ... ...

Abstract	The current care of critically ill patients with severe acute kidney injury requiring dialysis (AKI-D) is limited to supportive management in which renal replacement therapy (RRT) plays a central role. Renal replacement techniques are invasive bioincompatible procedures and are therefore associated with complications that may prove harmful to fragile patients. Inexperience with the standards and lacking or misinterpreted recommendations for the delivery of the RRT dose increases the risk of serious complications. Neither the optimal doses of intermittent or continuous RRTs nor the minimal or maximal effective doses are known. The Kidney Disease Improving Global outcomes (KDIGO) AKI guidelines for RRT dosing recommendations are inflexible, based on limited research, and may be at least partially outdated. High-intensity therapy may be associated with clinically relevant alterations in systemic and renal hemodynamics, profound electrolyte imbalances, the loss of nutrients or thermal energy, and underdosing of antimicrobial agents. However, higher doses of continuous renal replacement therapy (CRRT) may confer a survival benefit for certain subgroups of intensive care patients with severe AKI. Lower CRRT doses than the recommended adequate dosage may not lead to negative health outcomes, at least in Asian patients. Future research should evaluate the demand-capacity concept, recognizing that the delivery of the RRT dose is dynamic and should be modified in response to patient-related factors. There is a need for large-scale studies evaluating whether precision RRT dose modifications may improve patient-centered outcomes in subgroups of critically ill patients.
MeSH term(s)	Acute Kidney Injury/therapy ; Critical Care/standards ; Critical Illness ; Humans ; Outcome Assessment, Health Care ; Renal Replacement Therapy/adverse effects ; Renal Replacement Therapy/methods ; Renal Replacement Therapy/standards ; Risk Adjustment/methods
Language	English
Publishing date	2020-02-08
Publishing country	Australia
Document type	Journal Article ; Review
ZDB-ID	2119809-3
ISSN	1744-9987 ; 1091-6660 ; 1744-9979
ISSN (online)	1744-9987
ISSN	1091-6660 ; 1744-9979
DOI	10.1111/1744-9987.13471
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Zs.A 5208: Show issues

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Article ; Online: Gender differences in the susceptibility of hospital-acquired acute kidney injury: more questions than answers.

Schiffl, Helmut

International urology and nephrology

2020 Volume 52, Issue 10, Page(s) 1911–1914

Abstract: Hospital-acquired acute kidney injury (HA-AKI) is a heterogeneous renal syndrome which occurs in different clinical settings. It is characterized by multiple aetiologies, various pathogeneses and unpredictable outcomes. HA-AKI, once predominantly viewed ... ...

Abstract	Hospital-acquired acute kidney injury (HA-AKI) is a heterogeneous renal syndrome which occurs in different clinical settings. It is characterized by multiple aetiologies, various pathogeneses and unpredictable outcomes. HA-AKI, once predominantly viewed as a self-limited and reversible short-term condition, is now recognized as a harbinger for chronic kidney disease and a cause of long-term morbidity with an increased risk of cardiovascular, renal and cancer mortality. Recent clinical studies contradict the generally held belief that female sex is a risk factor for HA-AKI. They show, consistent with basic research performed with experimental models of AKI, that only male sex is associated with HA-AKI. The presence of testosterone, more likely than the absence of estrogen, plays a critical role in sex differences in the susceptibility of ischemia/reperfusion kidney injury. The conflicting data in epidemiological studies related to sex as susceptibility variable for human AKI, underscore the need for more rigorous, well designed observational studies taking into account the menopausal status and hormone therapy.
MeSH term(s)	Acute Kidney Injury/epidemiology ; Animals ; Disease Models, Animal ; Disease Susceptibility ; Female ; Hospitalization ; Humans ; Male ; Risk Factors ; Sex Factors
Language	English
Publishing date	2020-07-13
Publishing country	Netherlands
Document type	Comparative Study ; Journal Article ; Review
ZDB-ID	204048-7
ISSN	1573-2584 ; 0301-1623 ; 0042-1162
ISSN (online)	1573-2584
ISSN	0301-1623 ; 0042-1162
DOI	10.1007/s11255-020-02526-7
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Article ; Online: High-volume online haemodiafiltration treatment and outcome of end-stage renal disease patients: more than one mode.

Schiffl, Helmut

International urology and nephrology

2020 Volume 52, Issue 8, Page(s) 1501–1506

Abstract: The reduction of the dismally high mortality of current end-stage renal disease patients maintained on conventional standard haemodialysis (HD) remains an unmet medical need. Online haemodiafiltration (HDF) modes with various sites of fluid substitution ( ...

Abstract	The reduction of the dismally high mortality of current end-stage renal disease patients maintained on conventional standard haemodialysis (HD) remains an unmet medical need. Online haemodiafiltration (HDF) modes with various sites of fluid substitution (post-, pre-, mixed- and mid-dilution) are increasingly used worldwide as promising alternatives to conventional HD. Large scale cohort studies, post hoc analyses of randomized trials, and individual participant meta-analyses suggest that post-dilution and pre-dilution, especially with high substitution volumes, improve outcomes compared with conventional standard HD. However, there is no definitive proof of a survival advantage of HDF over standard HD. The different modes of high-volume HDF should be considered a therapeutic platform allowing to personalize and tailor routine HDF treatment. The selection of the HDF mode should be made according to individual patient characteristics. Utilizing high retention onset membranes, expanded haemodialysis (HDx) can achieve the same solute removal performance as HDF. Subgroups of high-volume OL-HDF patients could benefit from HDx. Ongoing and future trials should provide definitive proof for the superiority of high-volume OL-HDF over conventional HD or HDx to give guidance for the most favourable mode of dialytic therapy for clinical use.
MeSH term(s)	Hemodiafiltration/methods ; Humans ; Kidney Failure, Chronic/therapy ; Treatment Outcome
Language	English
Publishing date	2020-06-02
Publishing country	Netherlands
Document type	Journal Article ; Review
ZDB-ID	204048-7
ISSN	1573-2584 ; 0301-1623 ; 0042-1162
ISSN (online)	1573-2584
ISSN	0301-1623 ; 0042-1162
DOI	10.1007/s11255-020-02489-9
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Article: Dimorphic Response of Sex and Hospital-acquired Acute Kidney Injury.

Schiffl, Helmut / Lang, Susanne M

Saudi journal of kidney diseases and transplantation : an official publication of the Saudi Center for Organ Transplantation, Saudi Arabia

2023 Volume 33, Issue 4, Page(s) 574–581

Abstract: The risk of hospital-acquired acute kidney injury (HA-AKI) depends on a person's intrinsic susceptibility, the presence of risk factors, and on the type and extent of exposure to kidney insults. Older cohort studies have focused on male-only or mostly ... ...

Abstract	The risk of hospital-acquired acute kidney injury (HA-AKI) depends on a person's intrinsic susceptibility, the presence of risk factors, and on the type and extent of exposure to kidney insults. Older cohort studies have focused on male-only or mostly male populations, assuming a lower incidence of HA-AKI in women. Insufficient statistical power suggested that female sex was a shared susceptibility factor for HA-AKI. It was included as a risk factor in risk prediction models of HA-AKI. With the inclusion of women in clinical research studies, this presumption was challenged. Recent meta-analyses of sex-stratified studies showed that the risk for HA-AKI was significantly higher in men. These results suggested a protective role of female sex hormones. However, these studies were complicated by the inclusion of women across an age spectrum that includes the menopausal shift. Preliminary clinical and basic research data suggest that postmenopausal women lose their protection from HA-AKI. The number, size, and quality of reported clinical studies are low. There is an unmet need to characterize the susceptibility factor sex, to assess its clinical relevance and to evaluate renoprotection by sex hormone administration.
MeSH term(s)	Humans ; Male ; Female ; Risk Factors ; Cohort Studies ; Acute Kidney Injury/diagnosis ; Acute Kidney Injury/epidemiology ; Acute Kidney Injury/prevention & control ; Incidence ; Hospitals
Language	English
Publishing date	2023-11-06
Publishing country	Saudi Arabia
Document type	Journal Article ; Review
ZDB-ID	1379955-1
ISSN	1319-2442
ISSN	1319-2442
DOI	10.4103/1319-2442.388192
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Article ; Online: Long-term interplay between COVID-19 and chronic kidney disease.

Schiffl, Helmut / Lang, Susanne M

International urology and nephrology

2023 Volume 55, Issue 8, Page(s) 1977–1984

Abstract: Purpose: The COVID-19 pandemic may have an impact on the long-term kidney function of survivors. The clinical relevance is not clear.: Methods: This review summarises the currently published data.: Results: There is a bidirectional relationship ... ...

Abstract	Purpose: The COVID-19 pandemic may have an impact on the long-term kidney function of survivors. The clinical relevance is not clear. Methods: This review summarises the currently published data. Results: There is a bidirectional relationship between chronic kidney disease and COVID-19 disease. Chronic kidney diseases due to primary kidney disease or chronic conditions affecting kidneys increase the susceptibility to COVID-19 infection, the risks for progression and critical COVID-19 disease (with acute or acute-on-chronic kidney damage), and death. Patients who have survived COVID-19 face an increased risk of worse kidney outcomes in the post-acute phase of the disease. Of clinical significance, COVID-19 may predispose surviving patients to chronic kidney disease, independently of clinically apparent acute kidney injury (AKI). The increased risk of post-acute renal dysfunction of COVID-19 patients can be graded according to the severity of the acute infection (non-hospitalised, hospitalised or ICU patients). The burden of chronic kidney disease developing after COVID-19 is currently unknown. Conclusion: Post-acute COVID-19 care should include close attention to kidney function. Future prospective large-scale studies are needed with long and complete follow-up periods, assessing kidney function using novel markers of kidney function/damage, urinalysis and biopsy studies.
MeSH term(s)	Humans ; Pandemics ; COVID-19/complications ; Renal Insufficiency, Chronic/complications ; Kidney ; Prospective Studies ; Acute Kidney Injury/epidemiology ; Acute Kidney Injury/etiology ; Retrospective Studies
Language	English
Publishing date	2023-02-24
Publishing country	Netherlands
Document type	Journal Article ; Review
ZDB-ID	204048-7
ISSN	1573-2584 ; 0301-1623 ; 0042-1162
ISSN (online)	1573-2584
ISSN	0301-1623 ; 0042-1162
DOI	10.1007/s11255-023-03528-x
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Article: Online hemodiafiltration and mortality risk in end-stage renal disease patients: A critical appraisal of current evidence.

Schiffl, Helmut

Kidney research and clinical practice

2019 Volume 38, Issue 2, Page(s) 159–168

Abstract: The life expectancy of end-stage renal disease patients undergoing regular hemodialysis (HD) remains significantly lower than in the general population. Reducing excess mortality by improving renal replacement options is an unmet medical need. Online ... ...

Abstract	The life expectancy of end-stage renal disease patients undergoing regular hemodialysis (HD) remains significantly lower than in the general population. Reducing excess mortality by improving renal replacement options is an unmet medical need. Online post-dilution hemodiafiltration (HDF) has been promoted as the gold standard, offering improved clinical outcomes, based on numerous observational studies that suggest a reduced mortality risk and lower morbidity with HDF compared with standard HD. However, most randomized controlled trials (RCTs) have failed to demonstrate a significant beneficial effect of HDF on all-cause mortality. The effects on secondary outcomes were often negligible or absent. Unfortunately, these RCTs were characterized by a moderate to high risk of bias. In post-hoc analyses of the largest RCTs and meta-analysis of individual participant data from four RCTs, HDF patients receiving the highest convection volume consistently and dose-dependently saw superior outcomes. However, as these studies were not designed a priori to clarify this issue, and there are no indisputable mechanisms underlying reduced mortality risks, we cannot exclude the possibility that the health status of patients (with vascular access as a proxy) may affect outcomes more than the convective technique itself. There is currently insufficient evidence to support the contention that high-volume HDF confers relevant benefits to patients over standard HD. The conflicting data of published RCTs reduce confidence in the superiority of high-volume convective therapy. Hopefully, ongoing large RCTs (for example, CONVINCE) may supply an indisputable answer to the crucial question of high-volume HDF.
Language	English
Publishing date	2019-05-27
Publishing country	Korea (South)
Document type	Journal Article
ZDB-ID	2656420-8
ISSN	2211-9132
ISSN	2211-9132
DOI	10.23876/j.krcp.18.0160
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Article: Obesity and the Survival of Critically Ill Patients with Acute Kidney Injury: A Paradox within the Paradox?

Schiffl, Helmut

Kidney diseases (Basel, Switzerland)

2019 Volume 6, Issue 1, Page(s) 13–21

Abstract: The obesity epidemic is reflected by the rising number of obese patients requiring intensive care. Obesity is a recognized risk factor for the development of acute kidney injury (AKI) in critically ill patients. Both acute critical illness and AKI are ... ...

Abstract	The obesity epidemic is reflected by the rising number of obese patients requiring intensive care. Obesity is a recognized risk factor for the development of acute kidney injury (AKI) in critically ill patients. Both acute critical illness and AKI are associated with higher in-hospital mortality rates, and intensive care unit (ICU) patients suffering from AKI have an elevated risk of death. The relationships between obesity and mortality in critically ill paediatric and adult patients with or without AKI are less clear. Conflicting evidence exists regarding the potential impact of body mass index on the mortality of ICU patients with AKI. Some studies looking at the ICU outcomes of critically ill obese patients with AKI show reduced mortality and others show either no association or elevated mortality. Despite a high biologic plausibility of the proposed causal mechanisms, such as a greater haemodynamic stability and the protective cytokine, adipokine, and lipoprotein defence profiles associated with obesity, the inconsistency of the data suggests that the obesity paradox is a statistical fallacy and the result of chance, bias, and residual confounding variables in retrospective cohort analyses. Further prospective randomized trials are essential to elucidate the role of obesity and the mechanisms underlying a potential survival benefit of obesity in critically ill patients with AKI.
Language	English
Publishing date	2019-10-08
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2817963-8
ISSN	2296-9357 ; 2296-9381
ISSN (online)	2296-9357
ISSN	2296-9381
DOI	10.1159/000502209
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