Long-term outcomes of end-stage renal disease patients admitted to the ICU.

Nephrol Dial Transplant. 2011 Feb 15;

Authors: Sood MM, Miller L, Komenda P, Reslerova M, Bueti J, Santhianathan C, Roberts D, Mojica J, Rigatto C

BACKGROUND: End-stage renal disease (ESRD) patients admitted to the intensive care unit (ICU) have poor survival and high rates of readmission; however, little evidence exists on long-term outcomes. We set out to investigate the long-term (6 and 12 months) survival of ESRD patients admitted to the ICU and whether differential survival could be explained by dialysis modality and vascular access. METHODS: We compared the admission characteristics, outcomes and readmission rates of 619 ESRD [95 peritoneal dialysis (PD), 334 hemodialysis with a catheter (HD CVC), 190 hemodialysis with an AV fistula (HD AVF)] patients admitted to 11 ICU’s in Winnipeg, Manitoba, Canada. Parametric and nonparametric tests were used as appropriate to determine differences in baseline characteristics. Multivariable Cox and logistic regression was used to assess outcomes between the groups. RESULTS: The 6- and 12-month crude survival was 62 and 52%, respectively. In a univariate model, modality and vascular access were associated with an increased hazard ratio (HR) of death [PD HR 1.60 95% confidence interval (CI) 1.20-2.13, HD CVC HR 1.55 95% CI 1.25-1.93] compared to patients on HD with an AVF. In three different multivariate adjusted models, this association persisted with HRs for death of 1.63-1.75 for PD and 1.50-1.58 for HD CVC. CONCLUSIONS: Overall long-term survival of ESRD patients after admission to the ICU is poor. Being on PD or being dialyzed with a catheter was independently associated with an increased mortality.

PMID: 21324978 [PubMed - as supplied by publisher]

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Epidemiology, clinical features and outcomes of pneumonia in patients with chronic kidney disease.

Nephrol Dial Transplant. 2011 Jan 27;

Authors: Viasus D, Garcia-Vidal C, Cruzado JM, Adamuz J, Verdaguer R, Manresa F, Dorca J, Gudiol F, Carratalà J

BACKGROUND: Although infection remains among the most common causes of morbidity and mortality in patients with chronic kidney disease (CKD), data on epidemiology, clinical features and outcomes of pneumonia in this population are scarce. METHODS: Observational analysis of a prospective cohort of hospitalized adults with pneumonia, between 13 February 1995 and 30 April 2010, in a tertiary teaching hospital. CKD patients, defined as patients with a baseline glomerular filtration rate <60 mL/min/1.73m(2), were compared with non-CKD patients. RESULTS: During the study period, 3800 patients with pneumonia required hospitalization. Two-hundred and three (5.3%) patients had CKD, of whom 46 were on dialysis therapy. Patients with CKD were older (77 versus 70 years; P < 0.001), were more likely to have comorbidities (82.3 versus 63.3%; P < 0.001) and more commonly classified into high-risk pneumonia severity index classes (89.6 versus 57%; P < 0.001) than were the remaining patients. Streptococcus pneumoniae was the most frequent pathogen (28.1 versus 34.7%; P = 0.05). Mortality was higher in patients with CKD (15.8 versus 8.3%; P < 0.001). Among CKD patients, age [+1 year increase; adjusted odds ratio, 1.25; 95% confidence interval (CI) 1.07-1.46] and cardiac complications during hospitalization (adjusted odds ratio, 9.23; 95% CI 1.39-61.1) were found to be independent risk factors for mortality, whereas prior pneumococcal vaccination (adjusted odds ratio, 0.05; 95% CI 0.005-0.69) and leukocytosis at hospital admission (adjusted odds ratio, 0.10; 95% CI 0.01-0.64) were protective factors. CONCLUSIONS: Pneumonia is a serious complication in CKD patients. Independent factors for mortality are older age and cardiac complications, whereas prior pneumococcal vaccination and leucokytosis at hospital admission are protective factors. These findings should encourage physicians to increase pneumococcal vaccine coverage among CKD patients.

PMID: 21273232 [PubMed - as supplied by publisher]

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Survival of elderly patients with stage 5 CKD: comparison of conservative management and renal replacement therapy.

Nephrol Dial Transplant. 2010 Nov 22;

Authors: Chandna SM, Da Silva-Gane M, Marshall C, Warwicker P, Greenwood RN, Farrington K

Background. Elderly patients with end-stage renal disease and severe extra-renal comorbidity have a poor prognosis on renal replacement therapy (RRT) and may opt to be managed conservatively (CM). Information on the survival of patients on this mode of therapy is limited. METHODS: We studied survival in a large cohort of CM patients in comparison to patients who received RRT. RESULTS: Over an 18-year period, we studied 844 patients, 689 (82%) of whom had been treated by RRT and 155 (18%) were CM. CM patients were older and a greater proportion had high comorbidity. Median survival from entry into stage 5 chronic kidney disease was less in CM than in RRT (21.2 vs 67.1 months: P < 0.001). However, in patients aged >?75 years when corrected for age, high comorbidity and diabetes, the survival advantage from RRT was ~?4 months, which was not statistically significant. Increasing age, the presence of high comorbidity and the presence of diabetes were independent determinants of poorer survival in RRT patients. In CM patients, however, age >?75 years and female gender independently predicted better survival. CONCLUSIONS: In patients aged >?75 years with high extra-renal comorbidity, the survival advantage conferred by RRT over CM is likely to be small. Age >?75 years and female gender predicted better survival in CM patients. The reasons for this are unclear.

PMID: 21098012 [PubMed - as supplied by publisher]

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Renal transplantation for nephrogenic systemic fibrosis: a case report and review of the literature.

Nephrol Dial Transplant. 2010 Nov 15;

Authors: Cuffy MC, Singh M, Formica R, Simmons E, Abu Alfa AK, Carlson K, Girardi M, Cowper SE, Kulkarni S

Nephrogenic systemic fibrosis (NSF) is a rare fibrosing disorder described among patients with renal disease. Currently, no standard therapy exists, although therapeutic modalities have included plasmapheresis, extracorporeal photopheresis, sodium thiosulphate, imatinib and renal transplantation. We describe a patient with NSF who was physically debilitated and underwent renal transplantation. After transplantation, the patient’s lesions improved clinically, and the patient was ambulatory. Despite developing worsening renal function, her lesions remained unchanged. We conclude that renal transplantation improves symptoms of NSF, and believe that in patients with NSF, careful consideration should be made for early renal transplantation.

PMID: 21079195 [PubMed - as supplied by publisher]

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The MDRD formula does not reflect GFR in ESRD patients.

Nephrol Dial Transplant. 2010 Nov 5;

Authors: Grootendorst DC, Michels WM, Richardson JD, Jager KJ, Boeschoten EW, Dekker FW, Krediet RT,

Background. The Modification of Diet in Renal Disease (MDRD) equation is widely used for the estimation of glomerular filtration rate (GFR) from plasma creatinine. It has been well validated in patients with various degrees of impaired kidney function, but not in patients with end-stage renal disease (ESRD). Plasma creatinine is determined by GFR and muscle mass. Importance of the latter may increase at low GFR. Our aim was to firstly compare estimated GFR (eGFR by MDRD equation) with measured GFR (mGFR, mean of creatinine and urea clearance) just before the start of dialysis. Secondly, the relationship of eGFR and mGFR with mortality and muscle mass was analysed. Methods. ESRD patients with 24-h urine collections and a plasma sample available at the start of dialysis [n = 569, 61% male, mean (standard deviation) age 58 (15) years] were selected from the Netherlands Cooperative Study on the Adequacy of Dialysis. Incident dialysis patients were followed until death, transplantation or end of study. RESULTS: mGFR was 6.0 (2.6) and eGFR was 6.8 (2.4) mL/min/1.73 m(2). Although eGFR overestimated mGFR with only 0.8 mL/min/1.73 m(2), limits of agreement ranged from -?4.1 to +?5.6 mL/min/1.73 m(2). The highest eGFR values were associated with the highest mortality rates [adjusted hazard ratio 1.4 (1.0, 1.9)]. eGFR but not mGFR was associated with muscle mass (P = 0.001). CONCLUSIONS: These data imply that estimation of GFR by equations using plasma creatinine in the denominator cannot be used for this purpose in patients with ESRD because the effect of GFR on plasma creatinine is overruled by that of muscle mass.

PMID: 21056944 [PubMed - as supplied by publisher]

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Impaired renal function modifies the risk of severe hypoglycaemia among users of insulin but not glyburide: a population-based nested case-control study.

Nephrol Dial Transplant. 2010 Oct 25;

Authors: Weir MA, Gomes T, Mamdani M, Juurlink DN, Hackam DG, Mahon JL, Jain AK, Garg AX

BACKGROUND: Little evidence justifies the avoidance of glyburide in patients with impaired renal function. We aimed to determine if renal function modifies the risk of hypoglycaemia among patients using glyburide. METHODS: We conducted a nested case-control study using administrative records and laboratory data from Ontario, Canada. We included outpatients 66 years of age and older with diabetes mellitus and prescriptions for glyburide, insulin or metformin. We ascertained hypoglycaemic events using administrative records and estimated glomerular filtration rates (eGFR) using serum creatinine concentrations. RESULTS: From a cohort of 19,620 patients, we identified 204 cases whose eGFR was ??60 mL/min/1.73 m(2) (normal renal function) and 354 cases whose eGFR was <?60 mL/min/1.73 m(2) (impaired renal function). Compared to metformin, glyburide is associated with a greater risk of hypoglycaemia in patients with both normal [adjusted odds ratio (OR) 9.0, 95% confidence interval (95% CI) 4.9-16.4] and impaired renal function (adjusted OR 6.0, 95% CI 3.8-9.5). We observed a similar relationship when comparing insulin to metformin; the risk was greater in patients with normal renal function (adjusted OR 18.7, 95% CI 10.5-33.5) compared to those with impaired renal function (adjusted OR 7.9, 95% CI 5.0-12.4). Tests of interaction showed that among glyburide users, renal function did not significantly modify the risk of hypoglycaemia, but among insulin users, impaired renal function is associated with a lower risk. CONCLUSIONS: In this population-based study, impaired renal function did not augment the risk of hypoglycaemia associated with glyburide use.

PMID: 20974644 [PubMed - as supplied by publisher]

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National survey of the current provision of specialist palliative care services for patients with end-stage renal disease.

Nephrol Dial Transplant. 2010 Sep 2;

Authors: Hobson K, Gomm S, Murtagh F, Caress AL

BACKGROUND: Patients with end-stage renal disease (ESRD) experience a significant symptom burden and have complex needs. However, involvement of specialist palliative care (SPC) services with these patients has previously been shown to be limited. This study assesses the current provision of and access to SPC services for ESRD patients in the UK and considers how the provision has evolved over recent years. METHODS: A questionnaire was sent to the lead clinician for all UK adult hospital, hospice and community SPC services, identified from the Hospice and Palliative Care Directory 2008. Non-responders were mailed again after 5 weeks. Descriptive statistics and qualitative thematic analysis were performed. RESULTS: Three hundred and eighteen of 611 (52%) questionnaires were returned. Ninety-six per cent stated that SPC services have a role in caring for patients with ESRD. Two hundred and eighty-one of 318 (88%) accepted referrals, and 185 of 281 (66%) reported that ‘none or few were referred’. Only 7% and 17% of respondents used specific ESRD referral and treatment guidelines, respectively; whereas 79% used the Liverpool Care Pathway for the Dying Patient. Seven per cent undertook joint renal and SPC multi-disciplinary team (MDT) meetings, and 3% held joint out-patient clinics. Forty percent of respondents proposed initiatives to improve palliative care for ESRD patients, with mutual education and collaborative working being key themes for improvement. CONCLUSIONS: The majority of SPC services accept ESRD patients, but limited numbers are referred. Respondents indicated that this barrier could be addressed by closer collaboration and better communication and education between renal and SPC services. Other initiatives to enable delivery of SPC to increased numbers of ESRD patients include the use of specific referral and clinical care guidelines and expansion of joint MDT meetings and out-patient clinics.

PMID: 20813768 [PubMed - as supplied by publisher]

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Osteopontin predicts survival in critically ill patients with acute kidney injury.

Nephrol Dial Transplant. 2010 Aug 23;

Authors: Lorenzen JM, Hafer C, Faulhaber-Walter R, Kümpers P, Kielstein JT, Haller H, Fliser D

BACKGROUND: The cytokine osteopontin is involved in the pathophysiology of experimental acute kidney injury. We have tested the hypothesis that osteopontin levels might serve as a biomarker predicting outcome in critically ill patients requiring renal replacement therapy after acute kidney injury. METHODS: We measured circulating plasma osteopontin levels in 109 critically ill patients with acute kidney injury at inception of renal replacement therapy and 4 weeks thereafter. Critically ill patients without acute kidney injury served as controls. Osteopontin was measured with ELISA. RESULTS: Baseline osteopontin levels in patients with acute kidney injury were significantly higher compared with controls (P < 0.0001). Baseline osteopontin levels in patients recovering from acute kidney injury were significantly elevated compared with patients with permanent loss of kidney function after acute kidney injury (P = 0.01). In addition, in patients recovering from acute kidney injury without further need for renal replacement therapy, osteopontin levels were significantly lower 4 weeks after initiation of renal replacement therapy (P = 0.0005). Moreover, multivariate Cox analysis revealed osteopontin levels at renal replacement therapy inception as an independent and powerful predictor of mortality (P < 0.0001). In the ROC-curve analysis, an osteopontin cut-off value of 577 ng/mL separated survivors from non-survivors with a sensitivity of 100% and a specificity of 61% (AUC 0.82; 95% confidence interval: 0.74-0.89; P < 0.0001). CONCLUSIONS: Osteopontin may serve as a novel biomarker for both, overall survival and renal outcome in critically ill patients with acute kidney injury, that require renal replacement therapy.

PMID: 20732925 [PubMed - as supplied by publisher]

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Troponin I levels in asymptomatic patients on haemodialysis using a high-sensitivity assay.

Nephrol Dial Transplant. 2010 Jul 23;

Authors: Kumar N, Michelis MF, Devita MV, Panagopoulos G, Rosenstock JL

BACKGROUND: Troponin I (TnI) is an effective marker for detecting myocardial injury, but the interpretation of levels in the setting of end-stage renal disease (ESRD) is still unclear. TnI levels have been noted to be increased in 5-18% of asymptomatic haemodialysis (HD) patients with standard assays, but newer-generation, high-sensitivity assays have not been examined. In addition, there is limited data on the variability of TnI levels in patients over time as well as the effect of HD on TnI levels. The aim of this study was to prospectively explore the incidence of TnI with a high-sensitivity assay, the variability of TnI levels over time and the effect of HD on levels. METHODS: We enrolled 51 asymptomatic HD patients and checked TnI levels using a high-sensitivity assay. Levels were drawn pre-HD monthly for three consecutive months. As per manufacturer guidelines, levels were considered normal up to 0.034 ng/mL, indeterminate elevation (IE) if between 0.035 and 0.120 ng/mL and consistent with myocardial infarction (MI) if > 0.120 ng/mL. In the third month, post-HD TnI was also drawn to determine change with dialysis. RESULTS: At baseline, median TnI level was 0.025 ng/mL (range, 0-0.461 ng/mL). Baseline TnI levels were normal in 63% and elevated (>/= 0.035 ng/mL) in 37%. Of those with elevations, 79% were in the IE range and 21% in the acute myocardial infarction range. Higher TnI levels at baseline were associated with a history of coronary artery disease, left ventricular hypertrophy, lower cardiac ejection fraction and higher serum phosphate levels. Average incidence of elevated TnI was 41% over the 3 months. Thirty-six patients had stable levels without a change in classification over 3 months. Twelve varied over time. Forty-five (94%) had no change in classification pre- and post-HD. CONCLUSION: Using a new-generation, high-sensitivity assay, over a third of asymptomatic ESRD patients have an elevated TnI. The significance of these low-level elevations is unclear at this time. TnI levels remain stable over a 3-month period in most patients. HD treatment does not appear to affect the TnI level.

PMID: 20656755 [PubMed - as supplied by publisher]

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Nephrogenic syndrome of inappropriate antidiuresis.

Nephrol Dial Transplant. 2010 Jun 13;

Authors: Levtchenko EN, Monnens LA

The nephrogenic syndrome of inappropriate antidiuresis (NSIAD) is a rare, recently recognized disorder in water balance affecting not only infants but also adults. A new molecular mechanism responsible for NSIAD has recently been identified: a gain of function of the arginine vasopressin (AVP) receptor type 2 (V2R), causing the constitutive activation of the receptor. Clinical presentation and laboratory findings of NSIAD resemble those of the syndrome of inappropriate secretion of antidiuretic hormone and consist of hyponatraemia, seizures and the lack of urinary dilution; however, the AVP levels in plasma are undetectable or very low. An elucidation of the pathophysiology of this syndrome will provide more insight into the action of AVP. An effective treatment of NSIAD is available. It consists of fluid restriction and administration of oral urea. Reported experience with furosemide treatment in NSIAD is still lacking.

PMID: 20543212 [PubMed - as supplied by publisher]

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PREFABL: predictors of failure of antibiotic locks for the treatment of catheter-related bacteraemia.

Nephrol Dial Transplant. 2010 May 25;

Authors: Onder AM, Billings A, Chandar J, Francoeur D, Simon N, Abitbol C, Zilleruelo G

Background. Antibiotic lock (ABL) solutions can effectively treat catheter-related bacteraemia (CRB) without the need for catheter exchange. This approach does not increase secondary infectious complications. We evaluated the risk factors that contribute to failure when CRB is treated with ABLs and systemic antibiotics in paediatric haemodialysis patients. Methods. A retrospective chart review of 72 children on haemodialysis between January 2004 and June 2006 was performed. We evaluated risk factors for ABL treatment using patients' characteristics, CRB/catheter characteristics and patients' biochemical profiles. The first CRB of each catheter was included in the statistical analysis. Our end points were outcome at 2 weeks of treatment and at 6 weeks following treatment. Compound symmetry covariance structure was employed for statistical analysis. Results. We treated 149 CRB in 50 patients. The incidence was 3.4 CRB/1000 catheter days. Thirty CRB failed to be cleared with the use of ABL and systemic antibiotics at 2 weeks of treatment (30/149, 20 vs 80%, P < 0.001). Twenty-four of these catheters required exchange. Thirty-nine of the treated catheters got re-infected within the next 6 weeks (39/125, 31 vs 69%, P < 0.001). CRB aetiology was the only statistically significant independent variable for 2-week outcome (P = 0.033). Coagulase-negative Staphylococcus CRB had higher odds of being cleared at 2 weeks compared with other CRB aetiologies. For the 6-week outcome, the statistically significant independent variables in the final model included age (P = 0.048) and serum phosphorous level (P < 0.001). Younger age and higher serum phosphorous levels were independent risk factors for failure at 6 weeks with re-infection. Area under the receiver operating characteristic (ROC) curve for the model of the 2-week outcome was 0.736 with the percentage of correct predictions at 81.2%. Area under the ROC curve for the model of the 6-week outcome was 0.689 with the percentage of correct predictions at 75.5%. Conclusions. CRB can effectively be treated with ABLs and systemic antibiotics. CRB aetiology is the only independent variable of early treatment failure. Younger age and higher serum phosphorous levels are independent risk factors for re-infection at 6 weeks.

PMID: 20501464 [PubMed - as supplied by publisher]

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Chronic kidney disease and venous thromboembolism: a prospective study.

Nephrol Dial Transplant. 2010 Mar 29;

Authors: Folsom AR, Lutsey PL, Astor BC, Wattanakit K, Heckbert SR, Cushman M,

BACKGROUND: The incidence of venous thromboembolism (VTE) is increased with severe kidney disease, but whether less-severe chronic kidney disease (CKD) increases the risk of VTE is less certain. METHODS: We studied this in a prospective cohort of 10 700 whites and African Americans, aged 53-75 years, attending Visit 4 (1996-98) of the Atherosclerosis Risk in Communities Study. Estimated glomerular filtration rate (eGFR) values were estimated from prediction equations based on serum creatinine (eGFR(creat)) or cystatin C (eGFR(cys)). Normal kidney function was defined as eGFR >/=90 ml/min/1.73 m(2), mildly decreased kidney function as eGFR between 60 and 89 ml/min/1.73 m(2) and Stage 3 to 4 CKD as eGFR between 15 and 59 ml/min/1.73 m(2). VTE occurrence (n = 228) was ascertained over a median of 8.3years. RESULTS: For eGFR(cys), the age-, race- and sex-adjusted hazard ratios of total VTE were 1.0, 1.40 and 1.94 (P trend = 0.003) for normal kidney function, mildly impaired kidney function and Stage 3 to 4 CKD, respectively. These respective hazard ratios were moderately attenuated to 1.0, 1.26 and 1.60 (P trend = 0.04) with adjustment for hormone replacement therapy, diabetes and body mass index. Associations between CKD based on eGFR(cys) and VTE were slightly stronger for idiopathic VTE than for secondary VTE. In contrast, CKD based on eGFR(creat) was not associated with total VTE occurrence. CONCLUSIONS: Stage 3 to 4 CKD, based on eGFR(cys) but not eGFR(creat), was associated with an approximately 1.6-fold increased risk of VTE.

PMID: 20353958 [PubMed - as supplied by publisher]

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Rapid detection of acute kidney injury by plasma cystatin C in the intensive care unit.

Nephrol Dial Transplant. 2010 Mar 28;

Authors: Nejat M, Pickering JW, Walker RJ, Endre ZH

Background. Plasma cystatin C (pCysC) has been proposed as an alternative to plasma creatinine (pCr) as a measure of renal function. We compared the detection of functional change by both biomarkers in critically ill patients. Methods. pCysC and pCr were measured on admission to one of two intensive care units (ICU) and then daily over 7 days. Patients were classified according to the analyte that first increased by either >/=25 or >/=50% above the admission value. The proportion of patients in each class was compared using McNemar's chi-square test. Sustained acute kidney injury (AKI, a >/=50% increase in pCr from baseline for >/=24 h), dialysis and death within 30 days were recorded. The ability of pCysC and pCr on admission to predict sustained AKI, dialysis or death was assessed from the area under the receiver operator characteristic curve (AUC). Results. Of 442 patients, 83 had a >/=50% increase in one analyte, 17 in both and 342 in neither. Comparable numbers for a >/=25% increase were 163 in one analyte, 45 in both and 234 in neither. pCysC increased prior to pCr more frequently than vice versa in both the cohort with a >/=50% increase (P < 0.0001) and with a >/=25% increase (P < 0.0001). pCysC predicted sustained AKI with an AUC of 0.80 [95% confidence interval (CI) = 0.71-0.88]. pCysC and pCr were similarly moderately predictive of death or dialysis with AUCs of 0.61 [95% CI = 0.53-0.68] and 0.60 [95% CI = 0.51-0.67], respectively. Conclusion. pCysC was an effective and earlier surrogate marker of decreased renal function than pCr in a general ICU population.

PMID: 20350927 [PubMed - as supplied by publisher]

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Definition and classification of Cardio-Renal Syndromes: workgroup statements from the 7th ADQI Consensus Conference.

Nephrol Dial Transplant. 2010 Mar 12;

Authors: House AA, Anand I, Bellomo R, Cruz D, Bobek I, Anker SD, Aspromonte N, Bagshaw S, Berl T, Daliento L, Davenport A, Haapio M, Hillege H, McCullough P, Katz N, Maisel A, Mankad S, Zanco P, Mebazaa A, Palazzuoli A, Ronco F, Shaw A, Sheinfeld G, Soni S, Vescovo G, Zamperetti N, Ponikowski P, Ronco C,

PMID: 20228069 [PubMed - as supplied by publisher]

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Acute kidney injury in sickle patients with painful crisis or acute chest syndrome and its relation to pulmonary hypertension.

Nephrol Dial Transplant. 2010 Feb 22;

Authors: Audard V, Homs S, Habibi A, Galacteros F, Bartolucci P, Godeau B, Renaud B, Levy Y, Grimbert P, Lang P, Brun-Buisson C, Brochard L, Schortgen F, Maitre B, Mekontso Dessap A

BACKGROUND: The association between chronic kidney involvement and sickle cell disease (SCD) has been well characterized, but our knowledge on acute kidney injury (AKI) in relation to SCD remains limited. METHODS: We retrospectively assessed 254 episodes of vaso-occlusive complication in 161 SCD patients who were admitted to our hospital: these included 174 episodes of painful crisis (PC), 58 episodes of moderate acute chest syndrome (ACS) and 22 episodes of severe ACS. RESULTS: The overall incidence of AKI [defined according to Acute Kidney Injury Network (AKIN) criteria] during vaso-occlusive complications was low (4.3%) but seemed to be related to its severity: 2.3% for PC vs 6.9% for moderate ACS and 13.6% for severe ACS (P = 0.03). This finding led us prospectively to look at specific risk factors for AKI occurrence in SCD patients admitted to our intensive care unit for severe ACS and, in particular, the possible link between AKI and haemodynamic status (transthoracic echocardiography). Among patients with severe ACS, those with AKI displayed significantly greater aminotransferases, bilirubin and lactate dehydrogenase levels than patients without AKI. Echocardiography identified higher systolic pulmonary artery pressure in patients with AKI than in those without, whereas the cardiac index was similar between groups. Conclusions. AKI incidence during vaso-occlusive complications of SCD is relatively low (<5%) and appears to be confined to patients with ACS and pulmonary hypertension. These findings suggest a pathophysiological process involving right ventricular dysfunction and venous congestion.

PMID: 20179008 [PubMed - as supplied by publisher]

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