Dissertations / Theses on the topic 'Kidney replacement therapy (KRT)'
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Khan, Izhar H. "Outcomes and management in renal replacement therapy." Thesis, University of Aberdeen, 1995. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.295796.
Full textOh, Weng Chin. "Micronutrient losses during renal replacement therapy for acute kidney injury." Thesis, University of Nottingham, 2017. http://eprints.nottingham.ac.uk/41567/.
Full textArgaw, Peniel N. (Peniel Neway). "Effect of renal replacement therapy on acute kidney injury in sepsis patients." Thesis, Massachusetts Institute of Technology, 2018. http://hdl.handle.net/1721.1/119740.
Full textThis electronic version was submitted by the student author. The certified thesis is available in the Institute Archives and Special Collections.
Cataloged from student-submitted PDF version of thesis.
Includes bibliographical references (pages 39-40).
According to the Centers for Disease Control and Prevention, there are approximately 1.5 million cases of sepsis and over 250,000 resultant deaths each year [1]. One of the major effects of sepsis is organ failure, notably in the kidneys, lungs, liver, and brain. In the case where the kidneys fail, renal replacement therapy (RRT) may be performed in order to sustain the functionality of the kidneys and overall ameliorate patients' outcomes. The goal of this work is to determine the relationship between undergoing RRT and patient outcome. The Philips-MIT eICU Collaborative Research Database was used to identify patients with sepsis and acute kidney injury, and split the cohort into those who had undergone RRT and those who did not. Multivariate logistic regression and propensity score analysis were utilized to evaluate the treatment effect on mortality. The patients who underwent RRT had a significantly better outcome than those who did not (odds ratio = 0.260465, 95% confidence interval = 0.211568 to 0.320664, p<0.001). From the filtered patients, the percentage of men to women increased with those who underwent RRT (55.08% vs. 53.78%) as well as the percentage of African Americans (25% vs. 15.63%) and Other (5.86% vs. 4.04%) ethnicities. In addition to gender and ethnicity, other covariates such as Sequential Organ Failure Assessment score, cirrhosis, and metastatic cancer had a great impact on patient outcomes. This work concludes that RRT does in fact benefit the patient outcome and dialysis is a statistically significant feature within the dataset.
by Peniel N. Argaw.
M. Eng.
Mapiye, Darlington Shingirirai. "Computational genomics approaches for kidney diseases in Africa." University of the Western Cape, 2015. http://hdl.handle.net/11394/4958.
Full textEnd stage renal disease (ESRD), a more severe form of kidney disease, is considered to be a complex trait that may involve multiple processes which work together on a background of a significant genetic susceptibility. Black Africans have been shown to bear an unequal burden of this disease compared to white Europeans, Americans and Caucasians. Despite this, most of the genetic and epidemiological advances made in understanding the aetiology of kidney diseases have been done in other populations outside of sub-Saharan Africa (SSA). Very little research has been undertaken to investigate key genetic factors that drive ESRD in Africans compared to patients from rest of world populations. Therefore, the primary aim of this Bioinformatics thesis was twofold: firstly, to develop and apply a whole exome sequencing (WES) analysis pipeline and use it to understand a genetic mechanism underlying ESRD in a South African population of mixed ancestry. As I hypothesized that the pipeline would enable the discovery of highly penetrate rare variants with large effect size, which are expected to explain an important fraction of the genetic aetiology and pathogenesis of ESRD in these African patients. Secondly, the aim was to develop and set up a multicenter clinical database that would capture a plethora of clinical data for patients with Lupus, one of the risk factors of ESRD. From WES of six family members (five cases and one control); a total of 23 196 SNVs, 1445 insertions and 1340 deletions, overlapped amongst all affected family members. The variants were consistent with an autosomal dominant inheritance pattern inferred in this family. Of these, only 1550 SNVs, 67 insertions and 112 deletions were present in all affected family members but absent in the unaffected family member. Following detailed evaluation of evidence for variant implication and pathogenicity, only 3 very rare heterozygous missense variants in 3 genes COL4A1 [p.R476W], ICAM1 [p.P352L], COL16A1 [p.T116M] were considered potentially disease causing. Computational relatedness analysis revealed approximate amount of DNA shared by family members and confirmed reported relatedness. Genotyping for the Y chromosome was additionally performed to assist in sample identity. The clinical database has been designed and is being piloted at Groote Schuur medical Hospital at the University of Cape Town. Currently, about 290 patients have already been entered in the registry. The resources and methodologies developed in this thesis have the potential to contribute not only to the understanding of ESRD and its risk factors, but to the successful application of WES in clinical practice. Importantly, it contributes significant information on the genetics of ESRD based on an African family and will also improve scientific infrastructure on the African continent. Clinical databasing will go a long way to enable clinicians to collect and store standardised clinical data for their patients.
Nicholas, Pauline. "Impaired cognition in end stage kidney disease: Prevalence, predictors and differences between treatment." Thesis, Queensland University of Technology, 2020. https://eprints.qut.edu.au/203098/1/Pauline_Nicholas_Thesis.pdf.
Full textAlasmari, Hajar Ali M. "Examining intensive care nurses' clinical decision-making associated with acute kidney injury and continuous renal replacement therapy in Saudi Arabia." Thesis, Queensland University of Technology, 2018. https://eprints.qut.edu.au/122877/1/Hajar%20Ali%20M_Alasmari_Thesis.pdf.
Full textLima, Andréia Barbosa de [UNESP]. "Estresse, depressão e suporte familiar em pacientes em diálise peritoneal e hemodiálise." Universidade Estadual Paulista (UNESP), 2016. http://hdl.handle.net/11449/138927.
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As doenças crônicas na atualidade têm recebido atenção especial das organizações que tratam da saúde. Essas doenças repercutem de diversas maneiras no cotidiano do indivíduo, envolvendo seus aspectos físico, psicológico e social. Uma das doenças crônicas que está incidindo de forma negativa na vida do sujeito é a Doença Renal Crônica (DRC), a qual se refere à alteração na função do rim, de modo que, quando avançada leva o paciente a iniciar a Terapia Renal Substitutiva (TRS). Os dois métodos de TRS são a hemodiálise (HD) e a diálise peritoneal (DP), o primeiro é realizado em ambiente ambulatorial e o segundo em domicílio. Nesse sentido, o objetivo deste estudo foi relacionar a presença de estresse e depressão considerando a percepção de suporte familiar em pacientes em diálise peritoneal e hemodiálise, associada a dados demográficos. Participaram da pesquisa 77 sujeitos que realizam TRS, esses foram divididos em dois grupos, 47 pacientes que realizam HD ambulatorial e 30 pacientes em DP domiciliar de dois centros de diálise. Os instrumentos foram Questionário Sociodemográfico, Inventário de Sintomas de Stress para Adultos de Lipp (ISSL), Inventário de Percepção de Suporte Familiar (IPSF) e Escala Baptista de Depressão (EBADEP-Hosp-Amb). A análise dos dados foi realizada pelos testes Mann Whitney e Kruskal Wallis. Os resultados desse estudo apontaram que os pacientes em DP apresentam maior sintomatologia de estresse do que os que realizam HD, no que se refere à sintomatologia de depressão, os dois grupos apresentaram baixa sintomatologia, e em relação a percepção do suporte familiar, os pacientes em DP mantiveram a classificação Alta e os em HD Médio-Alto. No que tange aos cruzamentos dos dados com os sociodemográficos, houve ocorrência de significância estatística para o grupo de HD em relação ao gênero, estado civil, satisfação com a religião, suporte religioso e tempo de tratamento. Os achados referentes ao grupo de DP contrariaram a hipótese, apresentando maior frequência de estresse comparado aos pacientes que realizam HD. Este trabalho apresentou algumas limitações como o número de pacientes e possibilidade de comparação com outros estudos com a mesma amostra e instrumentos utilizados. No entanto, sua relevância na área da Psicologia e interface com outras áreas da saúde pode ser a semente para outros projetos a fim de minimizarem a dor pela qual tantos pacientes estão expostos diante da doença e tratamento.
Chronic diseases nowadays are receiving special attention from the health organizations. These diseases reverberate in different ways in the daily life of the individual, involving its physical, psychological and social aspects. One of the chronic diseases that is incurring in a negative way on the person’s life is the Chronic Kidney Disease (DRC), which refers to the kidney’s function alteration, in such way that, when advanced, it takes the patient to start Kidney Replacement Therapy (TRS). The two TRS methods are hemodialysis (HD) and peritoneal dialysis (DP); the first is done in an ambulatory ambient and the second at home. In these terms, the purpose of this study was to relate the presence of stress and depression considering the perception of family support in patients in peritoneal dialysis and hemodialysis, associated to demographic data. 77 people who passed through TRS were part of this research, those were divided in two groups, 47 patients who did ambulatory HD and 30 patients who did DP at home from two dialysis center. The instruments were the Sociodemographic Questionnaire, Lipp's Inventory of Symptoms of Stress for Adults (ISSL), Perception of Family Support Inventory (IPSF) and Baptista's Depression Scale (EBADEP-Hosp-Amb). This study’s results pointed the patients in DP presented bigger symptomatology of stress than the ones in HD. In the matter of depression’s symptomatology, both groups presented low symptomatology, and in relation to the family’s support perception, the patients in DP maintained a High classification and the ones in HD, Medium-High. Concerning the crossing of the data with the Sociodemographics, there was an occurrence of statistical significance for the group in HD in regarding the genre, marital status, fulfillment with religion, religious support and time of treatment. What was found in relation to the group in DP contradicted the hypothesis, presenting more frequency of stress compared to the patients in HD. This study presented some limitations such as the number of patients and possibility of comparison to other studies with the same sample and instruments used. However, its importance on the Psychology field and interface with other health areas can be a seed for other projects in order to minimize the pain to which so many patients are exposed before the disease and treatment.
Ulldemolins, Gómez Marta. "Optimization of meropenem and piperacillin dosing in critically ill patients with septic shock and acute kidney injury requiring continuous renal replacement therapy: a pharmacokinetic and pharmacodynamic study." Doctoral thesis, Universitat de Barcelona, 2017. http://hdl.handle.net/10803/585924.
Full textL’administració precoç d’antibioteràpia apropiada ha demostrat ser la intervenció més eficaç per reduir la mortalitat en pacients crítics amb xoc sèptic i síndrome de disfunció multiorgànica (SDMO). Malgrat la seva rellevància, però, la dosificació antibiòtica en els pacients amb SDMO incloent insuficiència renal aguda (IRA) que requereixen teràpia continua de suport renal (TCSR) encara representa un repte diari pels professionals de la salut. Al nostre medi, els antibiòtics beta[lactàmics d’ampli espectre meropenem i piperacilelina (en combinació amb tazobactam) són els antibiòtics més prescrits a aquests pacients d’altíssima complexitat i gravetat. L'impacte del xoc sèptic, la IRA i la TCSR en els requeriments de dosis d'aquests fàrmacs és vital, ja que tant la pròpia malaltia com les intervencions mèdiques produeixen alteracions significatives en la seva farmacocinètica (FC), que duen a variacions en els perfils concentració[temps i, conseqüentment, comprometen l'assoliment de concentracions del fàrmac dins del rang terapèutic. No obstant això, individualitzar la dosificació de meropenem i piperacilelina en pacients amb xoc sèptic, IRA i requeriment de TCSR és encara molt complex. HIPÒTESI: La dosificació de meropenem i piperacilelina en pacients crítics amb xoc sèptic i IRA que requereixen TCSR és sub[òptima degut a les variacions en el comportament FC dels fàrmacs produïdes tant per la malaltia com pel maneig mèdic d’aquesta. Aquestes variacions FC poden comprometre l'assoliment de concentracions terapèutiques. OBJECTIUS: 1. Avaluar la idoneïtat de les recomanacions actuals sobre dosificació de meropenem i piperacilelina en pacients crítics amb xoc sèptic i IRA que requereixen TCSR; 2. Identificar les fonts de variabilitat que comprometen l’exposició òptima a aquests antibiòtics en la nostra població de pacients; i 3. Desenvolupar noves recomanacions per individualitzar la dosificació d’aquests antibiòtics tenint en compte aquestes fonts de variabilitat. METODOLOGIA: En base a la hipòtesi i els objectius, s’han desenvolupat els tres estudis següents: Estudi 1: Revisió de la literatura. S’ha realitzat una revisió sistemàtica i avaluació crítica de l'evidència disponible sobre la dosificació de meropenem i piperacilelina en pacients crítics amb xoc sèptic, IRA i requeriment de TCSR. Estudis 2 i 3: Caracterització de la FC de meropenem i piperacilelina en pacients crítics amb xoc sèptic i IRA que requereixen TCSR. S’han realitzat dos estudis farmacocinètics multicèntrics, oberts, prospectius observacionals, a les Unitats de Medicina Intensiva de tres hospitals espanyols de tercer nivell. S’han inclòs a l’estudi 30 pacients amb xoc sèptic, IRA i TCSR que rebien meropenem i 19 pacients que rebien piperacilelina. Amb les dades procedents d’aquests pacients, s’han desenvolupat i validat dos models FC poblacionals, a partir dels quals s’han realitzat simulacions de Monte Carlo de diferents esquemes terapèutics (mitjançant el software NONMEM v.7.3®). RESULTATS: La principal troballa de l'estudi 1 és que les recomanacions actuals de dosificació de meropenem i piperacilelina en pacients crítics amb xoc sèptic i IRA que requereixen TCSR es basen en estudis amb algunes limitacions, com ara: 1) diferents nivells de gravetat de la malaltia i de disfunció renal, 2) diferents diagnòstics d’ingrés (mèdic versus quirúrgic versus trauma), 3) diferents maneigs clínics, principalment referent a les característiques de la TCSR, 4) metodologies heterogènies d’anàlisi FC, i 5) diferents objectius farmacodinàmics (FD) en base als quals es fan les recomanacions de dosificació. Això compromet l'extrapolació dels resultats d’aquests estudis a la nostra població de pacients. Posteriorment, els estudis 2 i 3 han identificat importants fonts de variabilitat en la FC de meropenem i piperacilelina, que si es consideren en el moment de la dosificació poden ser útils per individualitzar el tractament antibiòtic. Pel que fa a meropenem, la principal conclusió de l'anàlisi FC poblacional és la relació existent entre la diüresi acumulada de 24h i l’aclariment total de meropenem (CL). Els pacients amb diüresi conservada (>500ml/24h) presenten un increment d’almenys el 30% sobre el CL total de meropenem en comparació amb aquells pacients anúrics (<100mL/24h), sent aquest augment en el CL del fàrmac directament proporcional al volum d'orina. Posteriorment, les simulacions de Monte Carlo basades en aquest model FC poblacional han demostrat que per tal de mantenir les concentracions de meropenem per damunt de la concentració mínima inhibitòria (CMI) dels bacteris durant un 100% de l'interval de dosificació (100% FuT>CMI), els pacients oligo[anúrics (diüresi residual de 0[500mL/24h) requereixen 500mg/q8h administrats en un bolus de 30 minuts per al tractament de microorganismes susceptibles (CMI <2 mg/L), mentre que els pacients amb diüresi conservada (>500mL/24h) requereixen la mateixa dosi administrada mitjançant una perfusió de 3h. Pel tractament de microorganismes amb una CMI propera al límit de susceptibilitat (2[ 4mg/L) és necessària una dosi de 500mg/q6h: administrada en un bolus de 30 minuts de en pacients oligo[anúrics i mitjançant una perfusió de 3h en pacients amb una diüresi conservada. Si s’escull un objectiu FD més conservador, (40% FuT>CMI), una dosi de 500mg/q8h administrada en un bolus de 30 minuts és suficient amb independència de la diüresi residual. Pel que fa a la piperacilelina, la principal conclusió de l'anàlisi FC poblacional és la relació existent entre el tipus de membrana utilitzada per la TCSR, el pes del pacient i el CL total de piperacilelina; per a un pes de 80 kg, el CL total de piperacilelina es duplica quan es fa servir una membrana d’1,5m2 de copolímer d’acrilonitril i sulfat sòdic de metalelil amb un recobriment d’heparina i polietilenimina (AN69ST) en comparació amb el CL total observat quan es fa servir un filtre AN69 convencional de 0,9m2. Posteriors simulacions de Monte Carlo han demostrat que per a un objectiu FD de 100% FuT>CMI, els pacients que reben TCSR amb membranes AN69ST d’1,5m2 requereixen dosis de 4000mg/q8h per al tractament de microorganismes amb CMI properes al límit de susceptibilitat (CMI = 8[ 16mg/L). Per contra, 2000mg/q8h són suficients per als pacients que reben TCSR amb membranes AN69 de 0,9 m2. Per al tractament de soques d’alta susceptibilitat a la piperacilelina (CMI ≤ 4mg/L), o per l’assoliment d'un objectiu FD més conservador (50% FuT>CMI), 2000mg/q8h són suficients en tots els casos.
Galiyeva, Dinara. "Cardiovascular risk factor prevalence, mortality and cardiovascular disease incidence in patients who initiated renal replacement therapy in childhood : systematic review and analyses of two renal registries." Thesis, University of Edinburgh, 2017. http://hdl.handle.net/1842/28837.
Full textLeusin, Fabiane. "Farmacocinética do Meropenem infundido por 3 horas em pacientes criticamente enfermos em terapia renal substitutiva contínua." reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2012. http://hdl.handle.net/10183/48990.
Full textContinuous renal replacement therapy (CRRT) is widely used in critically ill patients with acute kidney injury (AKI). Meropenem is a carbapenem used in critically ill patients, which has a time dependent antibacterial activity. The aim of the study was to assess the pharmacokinetics of meropenem on a 3-hour infusion in patients undergoing CRRT due to AKI. We studied the plasmatic and effluent concentrations in five patients undergoing CRRT. The samples were collected at moments 0, 30 minutes, and 1, 2, 4, 6 and 8 hours after the beginning of the 3-hour infusion. The meropenem determinations were made through high performace efficiency liquid chromatography (HPLC). Four male patients and one female patient, with a mean age of 53,0 ± 19,7 (23 to 80 years), weighing 62,1 ± 10,6 kgs were studied. Pharmacokinetic parameters presented in medians (range): plasmatic concentrations, 34.86mg / L (10,08-139,27); half-life (t ½), 1,8 h (1,4-3,0); volume of distribution (Vd), 8,29 L (5,8-15,3); total clearance (CLT) 3,98 L / h (2,51-4,35); (Cmax) (maximum plasma concentration), 48,5 mg / L (37,0-105,8); Cmin (minimum plasma concentration)20,1 mg / L (14,0-16,6); elimination constant (Kel), 0,38 (0,34-0,43); area under the concentration versus time curve (AUC 0 a 8 h), 251,1 mg / Lh (229,7-398,4); (AUC 0 a ∞) 275,1 mg / Lh (263,8-453,6). In the effluent, the maximum concentrations varied from 24,35 to 74,81 mg/L, and the clearance from the therapy varied from 8,46 to 18,33 ml/min. The elimination of meropenem through CRRT is similar to that of a normal kidney, given a 3-hour infusion every 8 hours. Plasmatic levels were always above the necessary MICs. We can conclude there was no need for dose adjustment of meropenem with the prescribed CRRT dose.
Benites-Flores, Irwing R., Renzo P. Valdivia-Vega, Susan F. Alcalde-Ruiz, and Hugo J. Espinoza-Rojas. "Clinical characteristics of acute kidney injury in the first 13 critically ill patients infected with SARS-CoV-2 (COVID-19) at a peruvian hospital; a preliminary report." Society of Diabetic Nephropathy Prevention, 2021. http://hdl.handle.net/10757/655813.
Full textRevisión por pares
Chiella, Bianca Paula Mentz. "Avaliação da função tubular renal de pacientes sobreviventes de insuficiência renal aguda severa submetidos à diálise." reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2012. http://hdl.handle.net/10183/61255.
Full textBackground: About 30 to 50% of the critically ill patients develop acute renal failure (ARF) and the progression leads to the need of renal replacement therapy. Between the survivors 15 to 23% has the need of dialysis after discharge. The severity of the ARF is a robust predictor for the development of a future chronic kidney disease. The occurrence of acute renal failure has been associated with future progression of chronic kidney disease. Objective: Compare β2-microglobulin, the urinary enzymes N-acetyl-β- D-glucosaminidase, lactate dehydrogenase, alkaline phosphatase fractional excretion of magnesium, phosphorous, potassium and uric acid transtubular potassium gradient, including the presence of microalbuminuria and proteinuria between subjects with normal renal function without any previous history of acute renal injury or any kind of renal dysfunction with survivors of severe ARF with the needed of hemodialysis that recovered renal function in order to evaluate if there are differences between the 2 groups. Methods: It was enrolled patients that presented acute renal failure with the need of hemodialysis hospitalized on intensive care unit (ICU) and discharged on the period of 2007 to 2010 at Hospital de Clínicas de Porto Alegre, without the following co-morbidities chronic renal failure, chronic hepatopathy, positive HIV, transplants, severe vascular disease, diabetes with chronic complications and single functioning kidney that presented normal renal function defined as glomerular filtration rate (GFR) > 60 mL/min/1.73m2 calculated by CKD EPI formula The subjects were compared with healthy volunteers and paired by sex and age (+/- 4 years). To evaluate fractional excretions and transtubular potassium gradient, analyses were made excluding subjects that were taken diuretic medication, ACE inhibitors and angiotensin block receptors. Results: The fractional excretion of magnesium was finding increased on the previous ARF group followed by a lower transtubular potassium gradient and elevated lactate dehydrogenase. The previous ARF group showed proteinuria and microalbuminuria and although without statistical significance (p=0.052) an elevated phosphorous excretion. Conclusion: Although normal glomerular filtration rate, the subjects with previous ARF, showed suggested tubular alterations reflected by a higher fractional excretion of magnesium, elevated lactate dehydrogenase and a lower transtubular potassium gradient, microalbuminuria and proteinuria that reflects a possible renal damage. Those findings lead to the hypothesis that subjects with previous severe ARF with the need of renal replacement therapy present a possible sequel related to previous ARF or a predisposition to chronic kidney disease.
Ополонська, Наталія Олексіївна, Наталия Алексеевна Ополонская, Nataliia Oleksiivna Opolonska, О. В. Ковальова, and А. О. Кучма. "Особливості етіологічних чинників та частота хвороб пацієнтів з хронічною хворобою нирок." Thesis, Сумський державний університет, 2017. http://essuir.sumdu.edu.ua/handle/123456789/55493.
Full textParentin, Torsten. "Kontinuierliche Nierenersatztherapie mit regionaler Citrat-Antikoagulation bei Schwerbrandverletzten." Doctoral thesis, Universitätsbibliothek Leipzig, 2013. http://nbn-resolving.de/urn:nbn:de:bsz:15-qucosa-114384.
Full textLeblondel, Gérard. "Influences hormonales sur la distribution de 14 éléments chez le rat : contribution à l'étude de l'homéostasie des éléments." Angers, 1988. http://www.theses.fr/1988ANGE0001.
Full textTupper, Haley. "Confronting the growing burden of kidney disease: the sub-Saharan landscape." Thesis, 2016. https://hdl.handle.net/2144/19210.
Full textCastro, Inês Gomes Ribeiro de. "Early versus late initiation of renal replacement therapy in critically ill patients with acute kidney injury: a systematic review and meta-analysis." Master's thesis, 2021. https://hdl.handle.net/10216/134473.
Full textRenal replacement therapy (RRT) is consensual in the presence of life-threatening complications associated with acute kidney injury (AKI). In the absence of urgent indications, the optimal timing for RRT initiation is still under debate. This systematic review and meta-analysis aims to compare early and late RRT initiation strategies in critically ill patients with AKI. The selected primary outcome was 28-day mortality. Secondary outcomes included overall mortality, recovery of renal function (RRF) and several RRT associated-adverse events. Studies were obtained from three databases (MEDLINE, CENTRAL and SCOPUS), searched from inception to September 2020.Thirteen randomized controlled trials (RCTs) were included, with 5193 patients in total. No significant difference was found between the two groups regarding 28-day mortality (Risk Ratio (RR) 1.00; 95% confidence interval (CI) 0.89 to 1.12; P = 1.00, I²=30%), overall mortality (RR 1.00; 95% CI 0.90 to 1.12; P = 0.98, I² = 42%) and RRF (RR 1.02, 95% CI 0.92 to 1.13, P = 0.75, I² =53%). However, early RRT initiation was associated with a significantly higher incidence of hypotensive (RR 1.34; 95% CI 1.17 to 1.53, P < 0.0001, I²=6%) and infectious events (RR 1.83; 95% CI 1.11 to 3.02, P = 0.02, I²=0%).In general, early RRT initiation does not seem to significantly improve the 28-day and overall mortality, neither the likelihood of RRF in critically ill patients with AKI. Moreover, it is associated with an increased risk for RRT-associated adverse events, namely hypotension and infection.
Castro, Inês Gomes Ribeiro de. "Early versus late initiation of renal replacement therapy in critically ill patients with acute kidney injury: a systematic review and meta-analysis." Dissertação, 2021. https://hdl.handle.net/10216/134473.
Full textRenal replacement therapy (RRT) is consensual in the presence of life-threatening complications associated with acute kidney injury (AKI). In the absence of urgent indications, the optimal timing for RRT initiation is still under debate. This systematic review and meta-analysis aims to compare early and late RRT initiation strategies in critically ill patients with AKI. The selected primary outcome was 28-day mortality. Secondary outcomes included overall mortality, recovery of renal function (RRF) and several RRT associated-adverse events. Studies were obtained from three databases (MEDLINE, CENTRAL and SCOPUS), searched from inception to September 2020.Thirteen randomized controlled trials (RCTs) were included, with 5193 patients in total. No significant difference was found between the two groups regarding 28-day mortality (Risk Ratio (RR) 1.00; 95% confidence interval (CI) 0.89 to 1.12; P = 1.00, I²=30%), overall mortality (RR 1.00; 95% CI 0.90 to 1.12; P = 0.98, I² = 42%) and RRF (RR 1.02, 95% CI 0.92 to 1.13, P = 0.75, I² =53%). However, early RRT initiation was associated with a significantly higher incidence of hypotensive (RR 1.34; 95% CI 1.17 to 1.53, P < 0.0001, I²=6%) and infectious events (RR 1.83; 95% CI 1.11 to 3.02, P = 0.02, I²=0%).In general, early RRT initiation does not seem to significantly improve the 28-day and overall mortality, neither the likelihood of RRF in critically ill patients with AKI. Moreover, it is associated with an increased risk for RRT-associated adverse events, namely hypotension and infection.
"Antibiotic adsorption by haemofilters /cTian, Qi." Thesis, 2007. http://library.cuhk.edu.hk/record=b6074456.
Full textAn in vitro model was utilized to examine adsorption of antibiotics onto haemofilters. In order to test antibiotics from a range of classes, levofloxacin, amikacin, vancomycin, telavancin, and oseltamivir carboxylate were studied.
In summary, the antibiotic adsorption by haemofilters is a complex process. Both characteristics of antibiotics and haemofilters may determine adsorption. Among the studied antibiotics, in vitro adsorption of amikacin by PAN filters may have clinical significance, thus the routine monitoring of amikacin peak concentration in vivo during CRRT is recommended.
In the in vitro model, blood was pumped from an agitated, glass mixing chamber (heated using an automatic water bath), around a circuit and returned to the mixing chamber using a haemofiltration machine. Ultrafiltrate was also returned to the mixing chamber to constitute a closed circuit. As a result any decrease in drug concentration could only be due to adsorption to the filter and extracorporeal circuit, spontaneous degradation or metabolism by red cells.
The main findings were: (1) low adsorption of levofloxacin and vancomycin by haemofilters at clinically relevant concentrations; (2) significant absolute adsorption of amikacin by polyacrylonitrile haemofilters; (3) the adsorption of antibiotics was membrane-material dependent with greater adsorption by polyacrylonitrile filters; (4) lack of relationship between membrane surface area and amikacin adsorption; (5) the adsorption of levofloxacin is reversible, contrary to irreversibility of vancomycin and amikacin; (6) sieving coefficient of oseltamivir is very near to 1.0.
This thesis investigated: (1) the extent of antibiotic adsorption (levofloxacin, vancomycin, amikacin, telavancin and oseltamivir carboxylate) by haemofilters; (2) the time course of antibiotic adsorption by haemofilters; (3) the effects of plasma albumin concentration, initial dosage, pH, filter membrane material, filter membrane surface area and repeated dosing on adsorption; (4) the reversibility or irreversibility of adsorption; (5) clearance of oseltamivir carboxylate and telavancin by ultrafiltration.
Up to 25% of critically ill patients develop acute renal failure with sepsis being the most common cause. Outside of North and South America, these patients usually receive continuous renal replacement therapy (CRRT) which utilizes high flux haemofilter membranes. Thus it is common for these patients to be concurrently receiving antibiotics and CRRT. However, information about the adsorptive capacity of various haemofilters for most drugs is lacking.
"September 2007."
Advisers: Charles Gomersall; Tony Gin.
Source: Dissertation Abstracts International, Volume: 69-08, Section: B, page: 4659.
Thesis (Ph.D.)--Chinese University of Hong Kong, 2007.
Includes bibliographical references (p. 147-164).
Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web.
Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web.
Abstract in English and Chinese.
School code: 1307.
Parentin, Torsten. "Kontinuierliche Nierenersatztherapie mit regionaler Citrat-Antikoagulation bei Schwerbrandverletzten." Doctoral thesis, 2012. https://ul.qucosa.de/id/qucosa%3A11954.
Full textSirmaiová, Anna. "Návrat do života po post intensive care syndromu, na podkladě akutního renálního selhání." Master's thesis, 2020. http://www.nusl.cz/ntk/nusl-414989.
Full textDatta, Rabi Raj. "L-FABP und H-FABP als neue prognostische Biomarker für den Beginn einer Nierenersatztherapie im Falle eines akuten Nierenversagens." Doctoral thesis, 2012. http://hdl.handle.net/11858/00-1735-0000-0006-B305-6.
Full textMorissette, Geneviève. "Facteurs de risque de mortalité des enfants à l’initiation de la thérapie de remplacement rénal aux soins intensifs." Thèse, 2016. http://hdl.handle.net/1866/18875.
Full textIntroduction: Mortality rate associated with acute kidney injury (AKI) in pediatric intensive care units (PICU) exceeds 50%. Prior studies on renal replacement therapy (RRT) have highlighted different mortality risk factors including the presence of a multiple organ dysfunction syndrome (MODS) and fluid overload ≥ 10 to 20% before starting RRT. The aim of this study was to identify most important risk factors of 28-day mortality in patients with AKI at RRT initiation in PICU. Methods: We conducted a retrospective cohort study in a tertiary care pediatric center. All critically ill children who underwent acute continuous RRT or intermittent hemodialysis for AKI between January 1998 and December 2014 were included. A case report form was developed and specific risk factors were identified by a panel of four pediatric intensivists and two nephrologists. Risk factors analysis was made using logistic regression in SPSS and SAS software. Results: Ninety patients were included. The median age was 9 [2-14] years. The most common indication for RRT initiation was fluid overload (FO) (64.2%). The median PICU length of stay was 18.5 [8.0-31.0] days. Forty of the 90 patients (44.4%) died within 28 days after RRT initiation and forty-five (50.0%) died before PICU discharge. In a multivariate logistic regression analysis, a PELOD score ≥ 20 (OR 4.66; 95%CI 1.68-12.92) and percentage of FO ≥ 15% (OR 9.31; 95%CI 2.16-40.11) at RRT initiation were independently associated with mortality. Conclusion: This study suggests that fluid overload and severity of MODS measured by PELOD score are two risk factors of 28-day mortality in PICU patients on RRT.