2011 October 27

Acute kidney injury: definition, epidemiology, and outcome.

Curr Opin Crit Care Start a Discussion »

Oct 272011

Acute kidney injury: definition, epidemiology, and outcome.

Curr Opin Crit Care. 2011 Oct 24;

Authors: Srisawat N, Kellum JA

Abstract
PURPOSE OF REVIEW: Acute kidney injury (AKI) is a common clinical syndrome whose definition has standardized as a result of consensus by leading experts around the world. As a result of these definitions, reported AKI incidences can now be compared across different populations and settings. Evidence from population-based studies suggests that AKI is nearly as common as myocardial infarction, at least in the western world. This review aims to highlight the recent advances in AKI epidemiology as well as to suggest future directions for prevention and management. RECENT FINDINGS: This review will focus on the recent studies exploring the AKI epidemiology in and outside the ICU. In particular, the risk of AKI in less severe sepsis is notable as is evidence linking AKI to chronic kidney disease. New emphasis on renal recovery is shaping current thinking as is the use and utility of new biomarkers. SUMMARY: This article reviews the recent information about the definition, classification, and epidemiology of AKI. Although new biomarkers are being developed, the 'tried and true' markers of serum creatinine and urine output, disciplined by current criteria, will be important components in the definition and classification of AKI for some time to come.

PMID: 22027404 [PubMed - as supplied by publisher]

Link to Article at PubMed

Timing, dose and mode of dialysis in acute kidney injury.

Curr Opin Crit Care Start a Discussion »

Oct 272011

Timing, dose and mode of dialysis in acute kidney injury.

Curr Opin Crit Care. 2011 Oct 24;

Authors: Ricci Z, Ronco C

Abstract
PURPOSE OF REVIEW: In the past 3 years substantial progress has been made in the field of renal replacement therapy (RRT) for critically ill patients. RECENT FINDINGS: Two important multicenter randomized clinical trials have been recently published and extensively discussed: the randomized evaluation of normal versus augmented level (RENAL) replacement therapy study and the VA/NIH Acute Renal Failure Trial Network (ATN) study. The RENAL and ATN studies were designed to compare 'normal' or 'less intensive' renal support to an 'augmented' or 'intensive' therapy: both studies showed no benefit in outcomes by increases in intensity of RRT dose. The definition of 'normal dose' is now recommended in a range of 20-30?ml/kg per h for continuous therapies and/or thrice weekly intermittent hemodialysis. On the contrary, the complex issue of RRT optimal timing still remains uncertain and controversial. SUMMARY: Wide variations in clinical practice still require RRT for critically ill patients to be optimized. The ideal prescription does not exist; however, continuous hemofiltration at a dose of 30?ml/kg/h meets many requirements of optimal care. In order to shed some light in the issue of RRT timing, furthermore, in the near future a standardized and clinically relevant definition of 'early' RRT should be provided. Great expectations currently rely on the utilization of acute kidney injury severity classifications and on new biomarkers of renal function.

PMID: 22027405 [PubMed - as supplied by publisher]

Link to Article at PubMed

Dysnatremia in the ICU.

Curr Opin Crit Care Start a Discussion »

Oct 272011

Dysnatremia in the ICU.

Curr Opin Crit Care. 2011 Oct 24;

Authors: Pokaharel M, Block CA

Abstract
PURPOSE OF REVIEW: Dysnatremias, disorders of sodium concentration, are exceedingly common in critically ill patients and confer increased risk for adverse outcomes including mortality. The physiology that underpins the diagnosis and management of these disorders is complex. This review seeks to discuss current literature regarding the pathophysiology, diagnosis, epidemiology, and management of these disorders. RECENT FINDINGS: The role of arginine vasopressin in the maintenance of normal and pathologic plasma osmolality increasingly is refined, improving our ability to diagnose and understand dysnatremia. Identified recent epidemiologic studies highlight the frequent hospital acquisition or exacerbation of dysnatremia, confirm the recognized adverse consequences and explore the potential causality. Despite the complex nature of these disorders, simple consensus treatment strategies have emerged. SUMMARY: Dysnatremia remains a common disorder across the spectrum of critically ill patients. It is frequently hospital acquired. Simplified treatment regimens are proposed and the potential for prevention or earlier recognition and intervention is emphasized. Future directions of interest include further exploration of how dysnatremia contributes to adverse outcomes and new treatment strategies.

PMID: 22027406 [PubMed - as supplied by publisher]

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New oncolytic virus shows improved effectiveness in preclinical testing

Uncategorized Start a Discussion »

Oct 272011

A new fourth-generation oncolytic virus designed to both kill cancer cells and inhibit blood-vessel growth has shown greater effectiveness than earlier versions when tested in animal models. The virus is being developed as a treatment for glioblastoma, the most common and deadly form of brain cancer. The new virus improved survival of mice with transplanted human glioblastoma tumors by 50 percent in a majority of cases compared with the previous-generation oncolytic virus. Link to Article at PubMed

Continuous versus intermittent infusion of vancomycin for the treatment of Gram-positive infections: systematic review and meta-analysis.

J Antimicrob Chemother Start a Discussion »

Oct 272011

Continuous versus intermittent infusion of vancomycin for the treatment of Gram-positive infections: systematic review and meta-analysis.

J Antimicrob Chemother. 2011 Oct 25;

Authors: Cataldo MA, Tacconelli E, Grilli E, Pea F, Petrosillo N

Abstract
ObjectivesTo summarize available evidence on the effect of continuous infusion (CoI) of vancomycin compared with intermittent infusion (InI) in adult patients with Gram-positive infections.MethodsMEDLINE, EMBASE and Cochrane databases were searched. Randomized clinical trials (RCTs) and observational studies that comparatively assessed CoI and InI of vancomycin in terms of mortality, clinical cure, toxicity rates and serum drug exposure [trough concentration (C(min)) for InI and steady-state concentration (C(ss)) for CoI; area under the curve at 24 h (AUC(24)) for both] were included. Meta-analysis was conducted combining and analysing the relative risk (RR) and computing a summary RR of the effects with 95% confidence interval (CI). The standardized mean difference was calculated for continuous outcomes. The I(2) test was calculated to assess heterogeneity across studies.ResultsOne RCT and five observational studies were included in the analysis. Compared with InI, CoI of vancomycin was associated with a significantly lower risk of nephrotoxicity (RR 0.6, 95% CI 0.4-0.9, P?=?0.02; I(2?)=?0). Overall mortality was not different between the two groups (RR 1.03, 95% CI 0.7-1.6, P?=?0.9; I(2?)=?0).ConclusionsOur meta-analysis suggests that administration of vancomycin for the treatment of Gram-positive infections by CoI is associated with a significantly lower risk of nephrotoxicity when compared with InI of the drug. RCTs are needed to define the impact on mortality rate and on the pharmacodynamic activity in terms of AUC/MIC ratio.

PMID: 22028203 [PubMed - as supplied by publisher]

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Acute infections and venous thromboembolism.

J Intern Med Start a Discussion »

Oct 272011

Acute infections and venous thromboembolism.

J Intern Med. 2011 Oct 25;

Authors: Schmidt M, Horvath-Puho E, Thomsen RW, Smeeth L, Toft Sørensen H

Abstract
Objective:? The aim of the study was to examine whether various hospital-diagnosed infections or infections treated in the community are associated with an increased risk of venous thromboembolism (VTE). Design and subjects:? We conducted this population-based case-control study in Northern Denmark (population 1.8 million) using medical databases. We identified all patients with a first hospital diagnosed VTE during the period 1999-2009 (n=15,009). For each case, we selected 10 controls from the general population matched on age, gender and county of residence (n=150,074). We identified all hospital-diagnosed infections and community prescriptions for antibiotics one year predating VTE. We used odds ratios from a conditional logistic regression model to estimate incidence rate ratios (IRRs) of VTE within different time intervals of the first year after infection, controlling for confounding. Results:? Respiratory tract, urinary tract, skin, intra-abdominal and bacteraemic infections diagnosed in hospital or treated in the community were associated with a >2-fold increased VTE risk. The association was strongest within the first 2 weeks after infection onset, gradually declining thereafter. Compared with individuals without infection during the year before VTE, the IRR for VTE within the first 3 months after infection was 12.5 (95% confidence interval (CI): 11.3-13.9) for patients with hospital-diagnosed infection and 4.0 (95% CI: 3.8-4.1) for patients treated with antibiotics in the community. Adjustment for VTE risk factors reduced these IRRs to 3.3 (95% CI: 2.9-3.8) and 2.6 (95% CI: 2.5-2.8), respectively. Similar associations were found for unprovoked VTE, and for deep venous thrombosis and pulmonary embolism individually. Conclusions:? Infections are a risk factor for VTE.

PMID: 22026462 [PubMed - as supplied by publisher]

Link to Article at PubMed

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