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Matheis, G., M. Scholz, A. Simon, D. Henrich, G. Wimmer-Greinecker y A. Moritz. "Timing of leukocyte filtration during cardiopulmonary bypass". Perfusion 16, n.º 1_suppl (enero de 2001): 31–37. http://dx.doi.org/10.1177/026765910101600i105.
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de Vries, AJ, YJ Gu y W. van Oeveren. "TIMING OF LEUKOCYTE FILTRATION DURING CARDIAC SURGERY". Anesthesia & Analgesia 88, Supplement (abril de 1999): 15SCA. http://dx.doi.org/10.1097/00000539-199904001-00015.
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Berlot, Giorgio, Stefano Falini, Virginia Negro, Antoinette Agbedjro, Ariella Tomasini, Fulvio Iscra, Francesco Bianco, Ugo Gerini y Giuliano Boscutti. "Influence of Timing of Initiation and Volume of Processed Plasma on the Outcome of Septic Shock Patients Treated with Coupled Plasma Filtration and Adsorption". Blood Purification 46, n.º 4 (2018): 274–78. http://dx.doi.org/10.1159/000490611.
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Background: The extracorporeal removal of mediators is a rescue strategy for septic shock patients, which is still under investigation. Several techniques are available: coupled plasma filtration and adsorption (CPFA) combines plasma processing with renal replacement therapy. Methods: The study aimed to elucidate the role of both timing of initiation and intensity of treatment on the outcome, for which we retrospectively studied 52 patients. We collected the overall pre-CPFA time interval, starting from the first episode of hypotension in the wards and the volume of processed plasma (Vp), which we used as a proxy for intensity of treatment. Results: Timing of initiation did not significantly differ between survivors and non-survivors (25 vs. 27 h), while the Vp did (0.25 vs. 0.17 L/kg/session, p < 0.05). The significance of Vp was confirmed by a multiple logistic regression model. Conclusion: Our study confirms that intensity of CPFA, but not its timing of initiation, correlates with survival of septic shock patients.
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Chiu, J. M. Y., H. Wang, V. Thiyagarajan y P. Y. Qian. "Differential timing of larval starvation effects on filtration rate and growth in juvenile Crepidula onyx". Marine Biology 154, n.º 1 (2 de febrero de 2008): 91–98. http://dx.doi.org/10.1007/s00227-007-0902-y.
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Ferrer, F., J. Rivera, J. Corral, R. Gonzalez-Conejero, M. L. Lozano y V. Vicente. "Evaluation of pooled platelet concentrates using prestorage versus poststorage WBC reduction: impact of filtration timing". Transfusion 40, n.º 7 (julio de 2000): 781–88. http://dx.doi.org/10.1046/j.1537-2995.2000.40070781.x.
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Rauf, Syarifuddin y Husein Akbar. "A simple estimation of glomerular filtration rate in children". Paediatrica Indonesiana 42, n.º 5 (30 de octubre de 2002): 193. http://dx.doi.org/10.14238/pi42.5.2002.193-6.
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Background The estimation of glomerular filtration rate (GFR) is routinely used in the assessment of renal function in children. An accurate measurement of GFR is very helpful in detecting renal disease.Objective The aim of this study was to compare GFR calculated by Schwartz's formula and that assessed by creatinine clearance measurement.Methods A study to evaluate GFR calculated by the Schwartz's fonnula and by the conventional creatinine clearance method was done on 114 (57%) boys and 86 (43%) girls aged 6-13 years hospitalized in the Department of Child Health, Hasanuddin University, Wahidin Sudirohusodo Hospital, Makassar in 1996.Results This study showed that there was no significant difference between the value of GFR determined by the conventional creatinine clearance method and that calculated by the Schwartz's fonnula according to age and sex. Our findings also did not show any difference of GFR assessed by both methods according to nutritional status of children. In regard to the accuracy of Schwartz's fonnula, the sensitivity, specificity, positive, and negative predictive values were 87.5%, 98.86%, 9 1.3%, and 98.3%, respectively.Conclusion It seems that Schwartz's fonnula might be used for assessing GFR in children particularly if either there is no facility for measuring creatininuria or there is difficulty in collecting complete and accurate-timing urine samples. The formula is a very simple and inexpensive method for determining GFR in children compared to the conventional creatinine clearance method.
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de Vries, Adrianus J., Y. John Gu, Wendy J. Post, Paulien Vos, Ietse Stokroos, Harm Lip y Willem van Oeveren. "Leucocyte depletion during cardiac surgery: a comparison of different filtration strategies". Perfusion 18, n.º 1 (enero de 2003): 31–38. http://dx.doi.org/10.1191/0267659103pf643oa.
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The results of leucocyte filtration during cardiac surgery are conflicting. This may be due to timing and duration of the filtration procedure, and to flow and pressure conditions in the filter. Therefore, we prospectively compared three major leucocyte filtration strategies in cardiac surgical patients. Forty patients were randomly divided into four groups. Group I: leucofiltration of arterial blood throughout cardiopulmonary bypass (CPB) (associated with high-flow and pressure gradients), Group II: leucofiltration of a part of the venous return blood in the re-warming phase during CPB (associated with intermediate flow, but high pressure), Group III: leucofiltration of residual heart-lung machine blood during transfusion into the patient after CPB (associated with low flow and low pressure), Group IV: control group without leucofiltration. We measured circulating leucocyte counts, plasma elastase levels and arterial blood oxygenation. Filters were postoperatively examined using scanning electronmicroscopy (SEM). Leucocyte counts increased over time and oxygenation decreased in all groups, without significant differences between the groups. SEM demonstrated extensive protein deposits and damaged leucocytes in the deeper layers of the filters from Group I. This was not observed in the filters from Group III. The postoperative plasma elastase levels increased in Groups II and IV and decreased in Groups I and III. In conclusion, we could not demonstrate a clinical difference among the three leucocyte depletion strategies. However, our laboratory results suggest that leucocyte filtration at low flow and pressure conditions is associated with less leucocyte damage and less release of elastase.
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Grams, Morgan E., Yingying Sang, Shoshana H. Ballew, Juan Jesus Carrero, Ognjenka Djurdjev, Hiddo J. L. Heerspink, Kevin Ho et al. "Predicting timing of clinical outcomes in patients with chronic kidney disease and severely decreased glomerular filtration rate". Kidney International 93, n.º 6 (junio de 2018): 1442–51. http://dx.doi.org/10.1016/j.kint.2018.01.009.
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van der Meer, Pieter F., Ruby N. I. Pietersz y Hendrik W. Reesink. "Influence of temperature, filter wettability, and timing of filtration on the removal of WBCs from RBC concentrates". Transfusion 41, n.º 4 (abril de 2001): 540–44. http://dx.doi.org/10.1046/j.1537-2995.2001.41040540.x.
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McDermott, Eoghan y Roseline Agyekum. "Supporting the transition from pre-dialysis to end-stage renal failure". Journal of Kidney Care 5, n.º 5 (2 de septiembre de 2020): 206–10. http://dx.doi.org/10.12968/jokc.2020.5.5.206.
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Renal replacement therapy (RRT) is a life-saving therapy for those with chronic kidney disease (CKD) stage 5 or end-stage renal failure (ESRF)—defined as an estimated Glomerular Filtration Rate of less than 15 ml/min/1.73 m2. RRT has a profound impact on quality of life (QoL), dependent on the preparation for and timing of therapy initiation; the mode of RRT selected; and the individual's age, health, and priorities. This article explores the transition to RRT, directed by the research question, ‘How does the evidence base inform clinical decision-making when supporting CKD patients’ transition from pre-dialysis to management of ESRF?'. The discussion of these critical decisions, including timing, modality and potential of dialysis to benefit the individual, is framed by their effect on QoL as dialysis is established. There are many other aspects concerning the transition to RRT, which are not discussed, but the reader is signposted to additional information sources.
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Oksen, Yevhen. "METHOD OF FORECASTING THE TERMS OF SETTLING OF STRUCTURES ON SOILS WITH SILT LAYERS". ACADEMIC JOURNAL Series: Industrial Machine Building, Civil Engineering 2, n.º 53 (31 de octubre de 2019): 107–14. http://dx.doi.org/10.26906/znp.2019.53.1900.
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The method of forecasting the size and timing of sedimentation of structures on soils with silt layers, based on the results offield observations, has been developed. It is suggested to use a set of exponential dependencies with a constant component.The algorithm and software for calculation of the envelope by experimental data by a stepwise approximation are developed.The process of consolidation of soils is considered as a combination of simultaneous and independent flow of phases of primary filtration consolidation and secondary consolidation of creep. According to the results of data processing of observations by direct iterative calculations by finding the minimum nonconnectedness by the method of least squares.
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Mastropasqua, Leonardo, Luca Agnifili, Rodolfo Mastropasqua, Vincenzo Fasanella, Mario Nubile, Lisa Toto, Paolo Carpineto y Marco Ciancaglini. "In Vivo Laser Scanning Confocal Microscopy of the Ocular Surface in Glaucoma". Microscopy and Microanalysis 20, n.º 3 (27 de febrero de 2014): 879–94. http://dx.doi.org/10.1017/s1431927614000324.
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AbstractOver the past decade, knowledge about the ocular surface in glaucoma has significantly increased through the use of in vivo laser scanning confocal microscopy (LSCM). This in vivo imaging method can show modifications at the cellular level induced by anti-glaucoma drugs on ocular surface structures and adnexa in the eye. High-quality images of the conjunctiva, cornea, limbus, meibomian glands, and lymphoid structures during therapy can be obtained. In addition, LSCM opened new fields of research on the patho-physiology of aqueous humor (AH) hydrodynamics in untreated, and in medically or surgically treated glaucomatous patients. In these conditions, an enhancement of the trans-scleral AH outflow contributed to clarification of the mechanism of action of different anti-glaucoma medications and surgical approaches. Finally, the use of LSCM represented a huge advance in evaluation of bleb functionality after filtration surgery, defining the hallmarks of AH filtration through the bleb-wall and distinguishing functional from nonfunctional blebs. Thus, signs seen with LSCM may anticipate clinical failure, guiding the clinician in planning the appropriate timing of the various steps in bleb management. In this review we summarize the current knowledge about in vivo LSCM of the ocular surface in glaucoma.
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Richardson, William, Tamzen K. Stringham, Wade Lieurance y Keirith A. Snyder. "Changes in Meadow Phenology in Response to Grazing Management at Multiple Scales of Measurement". Remote Sensing 13, n.º 20 (9 de octubre de 2021): 4028. http://dx.doi.org/10.3390/rs13204028.
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Riparian and ground-water dependent ecosystems found in the Great Basin of North America are heavily utilized by livestock and wildlife throughout the year. Due to this constant pressure, grazing can be a major influence on many groundwater dependent resources. It is important for land managers to understand how intensity and timing of grazing affect the temporal availability of these commodities (i.e., biodiversity, water filtration, forage, habitat). Shifts in forage or water availability could potentially be harmful for fauna that rely on them at specific times of the year. Seven meadow communities, each consisting of three distinct vegetative communities, were grazed at three intensities to determine the relationship between grazing management and phenological timing of vegetation. The agreement of on-the-ground measurements, near-surface digital cameras (phenocams), and satellite-based indices of greenness was examined for a two-year period (2019–2020) over these grazing and vegetative community gradients. Field determined phenology, phenocam Green Chromatic Coordinate (GCC), and Landsat Normalized Difference Vegetation Index (NDVI) were all highly correlated and the relationship did not change across the treatments. Timing of growth varied in these ecosystems depending on yearly precipitation and vegetative type. Communities dominated by mesic sedges had growing seasons which stopped earlier in the year. Heavier grazing regimes, however, did not equate to significant changes in growing season. Ultimately, shifts in phenology occurred and were successfully monitored at various spatial and temporal scales.
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Nakayama, Takashin, Ken Nishioka, Kiyotaka Uchiyama, Kohkichi Morimoto, Ei Kusahana, Naoki Washida, Shintaro Yamaguchi, Tatsuhiko Azegami, Tadashi Yoshida y Hiroshi Itoh. "Late Dialysis Modality Education Could Negatively Predict Peritoneal Dialysis Selection". Journal of Clinical Medicine 11, n.º 14 (13 de julio de 2022): 4042. http://dx.doi.org/10.3390/jcm11144042.
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Patients with end-stage renal disease are less likely to choose peritoneal dialysis (PD) as renal replacement therapy (RRT). The reasons for this biased selection are still poorly understood. In this study, we evaluated the effect of the timing of RRT education on PD selection. This single-center retrospective observational study included patients who initiated maintenance dialysis at our hospital between April 2014 and July 2021. A logistic regression analysis was performed to investigate the association of RRT education timing with PD selection. Among the 355 participants (median age [IQR] 70 (59–79) years; 28.7% female), 53 patients (14.9%) and 302 patients (85.1%) selected PD and hemodialysis, respectively. Multivariate analysis demonstrated that high estimated glomerular filtration (eGFR) at RRT education positively predicted PD selection (p < 0.05), whereas old age (p < 0.01) and high Charlson comorbidity index (p < 0.05) were negative predictors of PD selection. Female sex (p = 0.44), welfare public assistance (p = 0.78), living alone (p = 0.25), high geriatric nutritional risk index (p = 0.10) and high eGFR at first visit to the nephrology department (p = 0.83) were not significantly associated with PD selection. Late RRT education could increase the biased selection of dialysis modality.
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Su, Facheng, Hsiharng Yang, Wenchieh Wu y Yukai Chen. "An Electrolyte Life Indicator for Plasma Electrolytic Polishing Optimization". Applied Sciences 12, n.º 17 (27 de agosto de 2022): 8594. http://dx.doi.org/10.3390/app12178594.
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This work shows that electrolyte current-density as an indicator can assist in the optimized timing of the addition of the electrolyte to plasma electrolytic polishing (PEP) to keep it active and in operation. In this experiment, 2 wt% ammonium sulfate was used as an electrolyte to polish 1 cm × 1 cm stainless steel SUS304. The hot-bath heating method was successfully used to heat it from 60 to 90 °C, followed by suction filtration. The cathode was fixed at the beaker edge in the electrolyte and the input voltage was 340 volts. Once the gas-phase layer formed stably around the workpiece, the plasma went through the electrolyte to polish the workpiece surface. Then, the anode was slowly immersed into the electrolyte and the current-density measured. It was found that based on the current-density–temperature curve, for the timing of the addition of the electrolyte, the current-density difference could be used to decide whether it needed to be supplemented or not. When the temperature was from 75 to 80 °C and 85 to 90 °C, it was found that the 2 wt% ammonium sulfate solution should be supplemented. The result showed that the electrolyte life indicator, using the current-density, is a feasible method of practical technology for PEP.
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Gao, Zhan, Zhihao Yu, Xiaoli Zhang, Shougang Fan, Huiyu Gao, Caini Liu, Qixing Zhou, Huaiqi Shao, Lan Wang y Xiaoyan Guo. "Exploration on Optimized Control Way of D-Amino Acid for Efficiently Mitigating Membrane Biofouling of Membrane Bioreactor". Membranes 11, n.º 8 (11 de agosto de 2021): 612. http://dx.doi.org/10.3390/membranes11080612.
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The thorny issue of membrane biofouling in membrane bioreactors (MBR) calls for new effective control measures. Herein, D-amino acid (DAA) was employed to mediate MBR membrane biofouling by inhibiting biofilm information and disintegrating formed biofilm. Different DAA control ways involving membrane property, DAA-adding timing, and DAA-control mode were explored through experiments and the multiple linear regression model and the response surface methodology. The optimized DAA control ways were acquired, involving DAA used as an active agent, and the DAA-adding timing of 4 h cultured before running, as well as both hydrophilic and hydrophobic membrane, resulting in an approximately 40.24% decrease in the membrane biofouling rate in comparison with the conventional MBR. DAA is an efficient membrane biofouling mediating approach for MBR under optimized control ways combination and a facile solution for solving membrane biofouling in actual membrane systems.
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Kim, Hyung Wook, Su-Hyun Kim, Young Ok Kim, Dong Chan Jin, Ho Chul Song, Euy Jin Choi, Yong-Lim Kim et al. "The Impact of Timing of Dialysis Initiation on Mortality in Patients with Peritoneal Dialysis". Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis 35, n.º 7 (diciembre de 2015): 703–11. http://dx.doi.org/10.3747/pdi.2013.00328.
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BackgroundThe impact of timing of dialysis initiation on mortality is controversial in patients with peritoneal dialysis (PD). In this study, we analyzed the impact of timing of dialysis initiation on mortality in the incident PD population.MethodsIncident patients with PD were selected from the Clinical Research Center (CRC) registry for end-stage renal disease (ESRD), a prospective cohort study on dialysis in Korea. Patients were categorized into 3 groups according to the estimated glomerular filtration rate (eGFR) at the initiation of PD using the Modification of Diet in Renal Disease (MDRD) equation. Group A was defined as eGFR < 5 mL/min/1.73m2, group B as eGFR 5 – 10 mL/min/1.73m2, and group C as eGFR > 10 mL/min/1.73m2. Cox regression analysis was used to calculate the adjusted hazard ratio (HR) of mortality with group B as the reference. The primary outcome was all-cause mortality.ResultsA total of 495 incident PD patients were included. The number of patients in group A was 109, group B was 279, and group C was 107. The median follow-up period was 23 months. Multivariate Cox regression analysis showed that group A had a significantly higher risk of all-cause mortality compared with group B (HR 4.13, 95% confidence interval [CI], 1.55 – 11.03, p = 0.005) after adjustment for age, gender, cause of ESRD, serum albumin level, diabetes mellitus, and cardiovascular disease. There was no significant difference in mortality between group C and group B (HR 1.50, 95% CI, 0.59 – 3.80, p = 0.398) after adjustment for clinical variables.ConclusionAn eGFR < 5 mL/min/1.73m2at the initiation of PD was a significant risk factor for death, while an eGFR >10 mL/min/1.73m2at the initiation of PD was not associated with improved survival compared with an eGFR of 5 – 10 mL/min/1.73m2at the initiation of PD.
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Antonova, E. E., I. A. Kornilov, T. A. Kornilova, O. I. Kornilov y M. V. Stepanova. "Features of auroral breakup obtained using data of ground-based television observations: case study". Annales Geophysicae 27, n.º 4 (1 de abril de 2009): 1413–22. http://dx.doi.org/10.5194/angeo-27-1413-2009.
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Abstract. The knowledge about the relative timing of events during the substorm expansion phase onset is very important for understanding the physics of substorms. In this work ground-based television (TV) imaging technique was used for observations of the first auroral arc brightening near zenith of TV chamber for the case of an isolated substorm. The method of the TV image filtration was used giving the possibility to analyze motion of sub visual auroral arcs. The analysis of the connection between the first auroral arc brightening and the beginning of magnetic disturbance was carried out. It was shown that luminosity disturbance is absent to the pole of breakup arc before the breakup and there exist a delay time between the brightening and start of intense magnetic fluctuations in the Pi1–Pi2 frequency ranges. The results obtained have been compared with predictions of theories of auroral breakup.
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Gaigals, Gatis y Juris Roberts Kalniņš. "MODELLING OF AN A+B → A REACTION KINETICS IN CASE OF PARTICLES BIG FREE MEAN PATH". Environment. Technology. Resources. Proceedings of the International Scientific and Practical Conference 2 (3 de agosto de 2015): 249. http://dx.doi.org/10.17770/etr2009vol2.1021.
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The aim of the work is to develop model and program for particle simulations working on laws of particle diffusion in expansion mode and, using approach of MonteCarlo, allows analyzing regularity in two-dimensional A+B → A reactions in case of B particle large mean free path, providing visualization of results and handy further processing of results, using data export ability. In the work are examined regularities in A+B → A reactions, special issues of these reactions, found approximate formula to determine velocity of reaction on centre of absorption surface using simulated data, developed program and made a lot of simulations of different reaction environments. Examined specific features of processed data and ways to enhance credibility and precision of results, also performed filtration of processed data to decrease specific of MonteCarlo method. Found out, that in comparison with nowadays personal computers, there is need for higher performance computing power to process simulation of particle interaction in acceptable timing.
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Ratcliffe, P. J., C. T. W. Moonen, J. G. G. Ledingham y G. K. Radda. "Timing of the Onset of Changes in Renal Energetics in Relation to Blood Pressure and Glomerular Filtration in Haemorrhagic Hypotension in the Rat". Nephron 51, n.º 2 (1989): 225–32. http://dx.doi.org/10.1159/000185290.
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Karim, Helmi, Skraber Sylvain, Leblanc Laurence, Hoffmann Lucien y Cauchie Henry-Michel. "Comparison of three methods to concentrate Giardia cysts and Cryptosporidium oocysts from surface and drinking waters". Water Science and Technology 62, n.º 1 (1 de julio de 2010): 196–201. http://dx.doi.org/10.2166/wst.2010.311.
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In this study, three methods commercialized by Pall (Envirochek HV), Idexx (FiltaMax) and Whatman (Cryptest) to concentrate Giardia cysts and Cryptosporidium oocysts from surface and drinking waters were compared according to the EPA standard protocol. Twenty litres of surface and 100 litres of drinking waters were inoculated with 103 (oo)cysts before being concentrated by filtration. Our results show that recovery rates of Giardia cysts from surface water was significantly higher using FiltaMax (91 ± 12%) than Cryptest (57 ± 9%) or Envirochek HV (60 ± 4%) while recovery from drinking water was equivalent using FiltaMax (84 ± 7%) or Cryptest (78 ± 7%) but lower using Envirochek HV (34 ± 29%). Recovery of Cryptosporidium oocysts from surface water was significantly higher using Envirochek HV (65 ± 5%) than using FiltaMax (45 ± 7%) or Cryptest (50 ± 7%) while recovery rates from drinking water was equivalent using either FiltaMax (48 ± 8%), Cryptest (57 ± 4%) or Envirochek HV (64 ± 22%). Finally, regardless of the water type, all methods tested allowed recovery rates superior to 24% complying with the EPA standard protocol. Timing, material and practicability associated with each method are discussed.
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Muchiri, John M., Luke Ascolillo, Mutuma Mugambi, Titus Mutwiri, Honorine D. Ward, Elena N. Naumova, Andrey I. Egorov, Seth Cohen, James G. Else y Jeffrey K. Griffiths. "Seasonality of Cryptosporidium oocyst detection in surface waters of Meru, Kenya as determined by two isolation methods followed by PCR". Journal of Water and Health 7, n.º 1 (1 de octubre de 2008): 67–75. http://dx.doi.org/10.2166/wh.2009.109.
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Meru, Kenya has watersheds which are shared by wildlife, humans and domesticated animals. These surface waters can be contaminated by the waterborne pathogen Cryptosporidium. To quantify the seasonality and prevalence of Cryptosporidium in Meru regional surface waters, we used a calcium carbonate flocculation (CCF) and sucrose floatation method, and a filtration and immunomagnetic bead separation method, each of which used PCR for Cryptosporidium detection and genotyping. Monthly water samples were collected from January through June in 2003 and 2004, bracketing two April-May rainy seasons. We detected significant seasonality with 8 of 9 positive samples from May and June (p<0.0014), which followed peak rainy season precipitation and includes some of the subsequent dry season. Six of 9 positive samples revealed C. parvum, and 3 contained C. andersoni. None contained C. hominis. Our results indicate that Meru surface waters are Cryptosporidium-contaminated at the end of rainy seasons, consistent with the timing of human infections reported by others from East Africa and contrasting with the onset of rainy season peak incidence reported from West Africa.
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Mastropasqua, Rodolfo, Vincenzo Fasanella, Luca Agnifili, Claudia Curcio, Marco Ciancaglini y Leonardo Mastropasqua. "Anterior Segment Optical Coherence Tomography Imaging of Conjunctival Filtering Blebs after Glaucoma Surgery". BioMed Research International 2014 (2014): 1–11. http://dx.doi.org/10.1155/2014/610623.
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Time domain (TD) and spectral domain (SD) optical coherence tomography (OCT) are cross-sectional, noncontact, high-resolution diagnostic modalities for posterior and anterior segment (AS) imaging. The AS-OCT provides tomographic imaging of the cornea, iris, lens, and anterior chamber (AC) angle in several ophthalmic diseases. In glaucoma, AS-OCT is utilized to evaluate the morphology of AS structures involved in the pathogenesis of the disease, to obtain morphometric measures of the AC, to evaluate the suitability for laser or surgical approaches, and to assess modifications after treatment. In patients undergoing surgery, AS-OCT is crucial in the evaluation of the filtering bleb functionality, permitting a combined qualitative and quantitative analysis. In this field, AS-OCT may help clinicians in distinguishing between functioning and nonfunctioning blebs by classifying their macroscopic morphology, describing bleb-wall features, bleb cavity, and scleral opening. This information is critical in recognizing signs of filtration failure earlier than the clinical approach and in planning the appropriate timing for management procedures in failing blebs. In this review, we summarize the applications of AS-OCT in the conjunctival bleb assessment.
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Shah, Neel y Ahmed S. Said. "Extracorporeal Support Prognostication—Time to Move the Goal Posts?" Membranes 11, n.º 7 (15 de julio de 2021): 537. http://dx.doi.org/10.3390/membranes11070537.
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Advances in extracorporeal membrane oxygenation (ECMO) technology are associated with expanded indications, increased utilization and improved outcome. There is growing interest in developing ECMO prognostication scores to aid in bedside decision making. To date, the majority of available scores have been limited to mostly registry-based data and with mortality as the main outcome of interest. There continues to be a gap in clinically applicable decision support tools to aid in the timing of ECMO cannulation to improve patients’ long-term outcomes. We present a brief review of the commonly available adult and pediatric ECMO prognostication tools, their limitations, and future directions.
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Preka, Evgenia, Marjolein Bonthuis, Jerome Harambat, Kitty J. Jager, Jaap W. Groothoff, Sergey Baiko, Aysun K. Bayazit et al. "Association between timing of dialysis initiation and clinical outcomes in the paediatric population: an ESPN/ERA-EDTA registry study". Nephrology Dialysis Transplantation 34, n.º 11 (30 de abril de 2019): 1932–40. http://dx.doi.org/10.1093/ndt/gfz069.
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AbstractBackgroundThere is no consensus regarding the timing of dialysis therapy initiation for end-stage kidney disease (ESKD) in children. As studies investigating the association between timing of dialysis initiation and clinical outcomes are lacking, we aimed to study this relationship in a cohort of European children who started maintenance dialysis treatment.MethodsWe used data on 2963 children from 21 different countries included in the European Society of Pediatric Nephrology/European Renal Association–European Dialysis and Transplant Association Registry who started renal replacement therapy before 18 years of age between 2000 and 2014. We compared two groups according to the estimated glomerular filtration rate (eGFR) at start: eGFR ≥8 mL/min/1.73 m2 (early starters) and eGFR <8 mL/min/1.73 m2 (late starters). The primary outcomes were patient survival and access to transplantation. Secondary outcomes were growth and cardiovascular risk factors. Sensitivity analyses were performed to account for selection- and lead time-bias.ResultsThe median eGFR at the start of dialysis was 6.1 for late versus 10.5 mL/min/1.73 m2 for early starters. Early starters were older [median: 11.0, interquartile range (IQR): 5.7–14.5 versus 9.4, IQR: 2.6–14.1 years]. There were no differences observed between the two groups in mortality and access to transplantation at 1, 2 and 5 years of follow-up. One-year evolution of height standard deviation scores was similar among the groups, whereas hypertension was more prevalent among late initiators. Sensitivity analyses resulted in similar findings.ConclusionsWe found no evidence for a clinically relevant benefit of early start of dialysis in children with ESKD. Presence of cardiovascular risk factors, such as high blood pressure, should be taken into account when deciding to initiate or postpone dialysis in children with ESKD, as this affects the survival.
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Ishida, Takuma, Nobuyoshi Akimitsu, Tamami Kashioka, Masakazu Hatano, Toshio Kubota, Yasuyuki Ogata, Kazuhisa Sekimizu y Tsutomu Katayama. "DiaA, a Novel DnaA-binding Protein, Ensures the Timely Initiation ofEscherichia coliChromosome Replication". Journal of Biological Chemistry 279, n.º 44 (23 de agosto de 2004): 45546–55. http://dx.doi.org/10.1074/jbc.m402762200.
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The DnaA protein is the initiator ofEscherichia colichromosomal replication. In this study, we identify a novel DnaA-associating protein, DiaA, that is required for the timely initiation of replication during the cell cycle. DiaA promotes the growth of specific temperature-sensitivednaAmutants and ensures stable minichromosome maintenance, whereas DiaA does not decrease the cellular DnaA content. AdiaA::Tn5mutation suppresses the cold-sensitive growth of an overinitiation typednaAmutant independently of SeqA, a negative modulator of initiation. Flow cytometry analyses revealed that the timing of replication initiation is disrupted in thediaAmutant cells as well as wild-type cells with pBR322 expressing thediaAgene. Gel filtration and chemical cross-linking experiments showed that purified DiaA forms a stable homodimer. Immunoblotting analysis indicated that a single cell contains about 280 DiaA dimers. DiaA stimulates minichromosome replication in anin vitrosystem especially when the level of DnaA included is limited. Moreover, specific and direct binding between DnaA and DiaA was observed, which requires a DnaA N-terminal region. DiaA binds to both ATP- and ADP-bound forms of DnaA with a similar affinity. Thus, we conclude that DiaA is a novel DnaA-associating factor that is crucial to ensure the timely initiation of chromosomal replication.
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Liu, Ying, Luping Wang, Xianfeng Han, Yang Wang, Xuefeng Sun, Hongli Jiang, Wei Shi et al. "The Profile of Timing Dialysis Initiation in Patients with End-stage Renal Disease in China: A Cohort Study". Kidney and Blood Pressure Research 45, n.º 2 (2020): 180–93. http://dx.doi.org/10.1159/000504671.
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Background: Hemodialysis is the main approach for renal replacement therapy in patients with end-stage renal disease (ESRD) in China. The timing of dialysis initiation is one of the key factors influencing patient survival and prognosis. Over the past decade, the relationship between the timing of dialysis initiation and mortality has remained unclear in patients with ESRD in China. Methods: Patients who commenced maintenance hemodialysis from 2009 to 2014 from 24 hemodialysis centers in Mainland China were enrolled in the study (n = 1,674). Patients were divided into 2 groups based on the year they started hemodialysis (patients who started hemodialysis from 2009 to 2011, and patients who started hemodialysis from 2012 to 2014). Analysis of the yearly change in the estimated glomerular filtration rate (eGFR) at the initiation of dialysis was performed for the 2 groups. Meanwhile, the patients were divided into 3 groups based on their eGFR at the initiation of dialysis (<4, 4–8, and >8 mL/min/1.73 m2). For these 3 groups, the relationship between the eGFR at the start of dialysis and mortality were analyzed. Results: The average eGFRs were 5.68 and 5.94 mL/min/1.73 m2 for 2009–2011 and 2012–2014, respectively. Compared with the 2009–2011 group, the proportion of patients with diabetes in 2012–2014 increased from 26.7 to 37.7%. The prognosis of patients with different eGFRs at the start of dialysis was analyzed using Kaplan-Meier survival curves. After adjusting for confounding factors through a Cox regression model, no significant difference was demonstrated among the 3 groups (<4 mL/min/1.73 m2 was used as the reference, in comparison with 4–8 mL/min/1.73 m2 [p = 0.681] and >8 mL/min/1.73 m2 [p = 0.403]). Conclusion: In Mainland China, the eGFR at the start of dialysis did not change significantly over time from 2008 to 2014 and had no association with the mortality of patients with ESRD.
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Zhao, Yuanjun, Yoshihiko Matsui, Yusuke Kinouchi, Takumu Seko, Nobutaka Shirasaki y Taku Matsushita. "Suppressing transmembrane-pressure rise by pulse dosing of submicron super-fine powdered activated carbon: Effects of filtration flux, coagulant types, and coagulant-dose timing during precoating". Journal of Water Process Engineering 49 (octubre de 2022): 103180. http://dx.doi.org/10.1016/j.jwpe.2022.103180.
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Khotko, A. I., D. N. Khotko, V. M. Popkov y A. I. Tarasenk. "Optimizing the lithotripsy timing after drainage of the upper urinary tract in patients with urolithiasis and obstructive uropathy". Vestnik Urologii 9, n.º 3 (5 de octubre de 2021): 62–69. http://dx.doi.org/10.21886/2308-6424-2021-9-3-62-69.
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Introduction. Timely unresolved upper urinary tract (UUT) obstruction in patients with infection can cause severe complications, such as sepsis, pyonephrosis and even death. There are no clear recommendations regarding the methods and timing of drainage. At the same time, this issue is still the subject of discussion in publications of recent years.Purpose of the study. To optimize the timing of lithotripsy after drainage of the UUT in patients with urolithiasis and obstructive uropathy (OU).Materials and methods. At the first stage, 90 patients with OU caused by the stone of the ureteropelvic junction underwent drainage of the UUT using a percutaneous nephrostomy. Subsequently, percutaneous nephrolithotripsy (PNLT) was performed at various times after drainage. The level of inflammatory markers (IL-8) and profibrotic factor (MCP-1) in the urine was determined. The calculated concentrations of urinary biomarkers were normalized by the level of urinary creatinine. Urine sampling for the analysis was carried out during and after the PCN placement (nephrostomy urine) 7 days later, and then once weekly before surgery. The coefficient K was calculated using a patented formula to evaluate the process of kidney remodeling. Urine sampling was performed for culture to determine the bacterial spectrum and antibiotic sensitivity.Results. The values of K ≤ 1.85 were observed in 11 patients of the group with OU (12.2%), K > 1.85 in 79 (87.8%) by day 21. The values of K ≤ 1.85 were achieved in 70 patients (88.6%) by day 28 and 4 patients (80.0%) by day 35. PNLT was performed on 21 days in patients with K ≤ 1.85 (11 patients), no complications were noted in the postoperative period., PNLT was performed in patients with K ≤ 1.85 (70 patients) by day 28, exacerbation of pyelonephritis and the development of chronic kidney disease were not noted. Six patients with values of K ˃ 1.85 underwent PNLT by day 28. In the postoperative period, all patients had an exacerbation of calculous pyelonephritis, 50% had a decrease in glomerular filtration rate within 3 months after surgery. The bacteria in urine were detected in 55 (61.0%) patients. Escherichia coli (63.0%), Proteus mirabilis (18.0%), Enterococcus faecalis (14.5%), Streptococcus haemolyticus (2.5%) were identified most often.Conclusion. The use of the developed remodeling index allows optimizing the surgery timing and minimizing the development of complications during the postoperative period. The presence of bacteria is associated with a long process of renal parenchymal remodeling.
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Khotko, A. I., D. N. Khotko, V. M. Popkov y A. I. Tarasenk. "Optimizing the lithotripsy timing after drainage of the upper urinary tract in patients with urolithiasis and obstructive uropathy". Vestnik Urologii 9, n.º 3 (5 de octubre de 2021): 62–69. http://dx.doi.org/10.21886/2308-6424-2021-9-3-62-69.
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Introduction. Timely unresolved upper urinary tract (UUT) obstruction in patients with infection can cause severe complications, such as sepsis, pyonephrosis and even death. There are no clear recommendations regarding the methods and timing of drainage. At the same time, this issue is still the subject of discussion in publications of recent years.Purpose of the study. To optimize the timing of lithotripsy after drainage of the UUT in patients with urolithiasis and obstructive uropathy (OU).Materials and methods. At the first stage, 90 patients with OU caused by the stone of the ureteropelvic junction underwent drainage of the UUT using a percutaneous nephrostomy. Subsequently, percutaneous nephrolithotripsy (PNLT) was performed at various times after drainage. The level of inflammatory markers (IL-8) and profibrotic factor (MCP-1) in the urine was determined. The calculated concentrations of urinary biomarkers were normalized by the level of urinary creatinine. Urine sampling for the analysis was carried out during and after the PCN placement (nephrostomy urine) 7 days later, and then once weekly before surgery. The coefficient K was calculated using a patented formula to evaluate the process of kidney remodeling. Urine sampling was performed for culture to determine the bacterial spectrum and antibiotic sensitivity.Results. The values of K ≤ 1.85 were observed in 11 patients of the group with OU (12.2%), K > 1.85 in 79 (87.8%) by day 21. The values of K ≤ 1.85 were achieved in 70 patients (88.6%) by day 28 and 4 patients (80.0%) by day 35. PNLT was performed on 21 days in patients with K ≤ 1.85 (11 patients), no complications were noted in the postoperative period., PNLT was performed in patients with K ≤ 1.85 (70 patients) by day 28, exacerbation of pyelonephritis and the development of chronic kidney disease were not noted. Six patients with values of K ˃ 1.85 underwent PNLT by day 28. In the postoperative period, all patients had an exacerbation of calculous pyelonephritis, 50% had a decrease in glomerular filtration rate within 3 months after surgery. The bacteria in urine were detected in 55 (61.0%) patients. Escherichia coli (63.0%), Proteus mirabilis (18.0%), Enterococcus faecalis (14.5%), Streptococcus haemolyticus (2.5%) were identified most often.Conclusion. The use of the developed remodeling index allows optimizing the surgery timing and minimizing the development of complications during the postoperative period. The presence of bacteria is associated with a long process of renal parenchymal remodeling.
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Grebenkina, E. Yu, D. V. Usenko y O. L. Chugunova. "Early diagnosis of kidney failure in children with acute intestinal infections". Infekcionnye bolezni 19, n.º 4 (2021): 29–36. http://dx.doi.org/10.20953/1729-9225-2021-4-29-36.
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In recent years, significant breakthroughs have been made in the study of etiology, pathogenesis, and the development of accessible diagnostic methods, as well as in the treatment of acute intestinal infections, resulting in a significantly lower frequency of their severe course and adverse outcomes and in reducing the frequency and duration of hospitalization. At the same time, the emergence of modern biochemical markers of injury of different organs and systems makes it possible to investigate new pathological conditions that were previously detected in the stage of clinical manifestations. These include the problem of early diagnosis of acute kidney injury in children, the frequency and timing of which have not yet been studied. Objective. Comparative evaluation of the diagnostic value of glomerular filtration rate and serum cystatin C levels for early diagnosis of kidney failure in children with acute intestinal infections (AII). Patients and methods. This study included 80 children with acute intestinal infection who were hospitalized in G.N.Speransky Children’s Clinical Hospital No 9. In all cases the course of disease was moderate-to-severe without developing hemolyticuremic syndrome. To assess kidney function in the acute period of intestinal infection, we studied glomerular filtration rate (GFR) by the “bedside” Schwartz equation, as well as serum cystatin C levels. Results. In the acute period of AII in children under 3 years of age, GFR was 98.56 ± 2.84 mL/min/1.73 m2 according to the “bedside” Schwartz equation of 2009. In the group of children over 3–7 years of age, these values were 108.85 ± 3.84 mL/min/1.73 m2, differences are statistically significant (p < 0.001). High (>950 ng/mL) serum cystatin C levels were found in 22% of patients. In other patients, cystatin C levels remained within or below the normal range. The analysis showed that 10% of children in the age group of 1–3 years and 2.5% of children in the age group of 3–7 years were at risk of developing acute kidney injury in AII, according to the GFR estimation based on the Schwartz “bedside” equation and cystatin C-based equation. When assessing the risk of developing acute kidney injury according to the GFR estimation using the cystatin C-based equation, the proportion of such patients in the age group of 1–3 years was 20% and in the age group of 3–7 years – 22%, and when assessing GFR according to the Schwartz “bedside” equation only, the proportion of children was 7.5% and 7.5%, respectively. Conclusion. Determination of cystatin C levels in children in the early period of acute intestinal infections of moderate severity is an earlier and more accurate marker of acute kidney injury, regardless of age and sex of patients, in comparison with the evaluation of glomerular filtration rate. Inclusion of cystatin C in laboratory test plan allows timely identification of patients who are in the risk group of developing acute kidney injury. Key words: children, kidney failure, acute intestinal infection, acute kidney injury, cystatin C, glomerular filtration rate
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Cooper, Bruce A., Pauline Branley, Liliana Bulfone, John F. Collins, Jonathan C. Craig, Jenny Dempster, Margaret B. Fraenkel et al. "The Initiating Dialysis Early and Late (Ideal) Study: Study Rationale and Design". Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis 24, n.º 2 (marzo de 2004): 176–81. http://dx.doi.org/10.1177/089686080402400209.
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Objectives The primary objective of the IDEAL study is to determine whether the timing of dialysis initiation has an effect on survival in subjects with end-stage renal disease (ESRD). The secondary objectives are to determine the impact of “early start” versus “late start” dialysis on nutritional and cardiac morbidity, quality of life, and economic cost. Design Prospective multicenter randomized controlled trial. Patients are randomized to commence dialysis at a glomerular filtration rate (by Cockcroft–Gault) of either 10 – 14 mL/minute/1.73 m2 (“early start”) or 5 – 7 mL/min/1.73 m2 (“late start”), with stratification for dialysis modality (hemodialysis vs peritoneal dialysis), study center, and the presence or not of diabetes mellitus. Setting Dialysis units throughout Australia and New Zealand. Patients Patients with ESRD commencing chronic dialysis therapy. Outcome Measures Three years from randomization, all-cause mortality, morbidity, and economic impact; structural and functional cardiac status, nutritional state, and quality of life will be assessed. Results To date, 388 patients of a minimum 800 patients have been entered and randomized into the study. Current recruitment rates suggest sufficient patients will be enrolled by December 2004 and follow-up completed by December 2007. Conclusions The IDEAL study will provide evidence for the optimal time to commence dialysis.
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Reitzug, Fabian, Stephen P. Luby, Hemant K. Pullabhotla y Pascal Geldsetzer. "The Effect of Particulate Matter Exposure During Pregnancy on Pregnancy and Child Health Outcomes in South Asia: Protocol for an Instrumental Variable Analysis". JMIR Research Protocols 11, n.º 8 (10 de agosto de 2022): e35249. http://dx.doi.org/10.2196/35249.
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Background Determining the longer-term health effects of air pollution has been difficult owing to the multitude of potential confounding variables in the relationship between air pollution and health. Air pollution in many areas of South Asia is seasonal, with large spikes in particulate matter (PM) concentration occurring in the winter months. This study exploits this seasonal variation in PM concentration through a natural experiment. Objective This project aims to determine the causal effect of PM exposure during pregnancy on pregnancy and child health outcomes. Methods We will use an instrumental variable (IV) design whereby the estimated month of conception is our instrument for exposure to PM with a diameter less than 2.5 μm (PM2.5) during pregnancy. We will assess the plausibility of our assumption that timing of conception is exogenous with regard to our outcomes of interest and will adjust for date of monsoon onset to control for confounding variables related to harvest timing. Our outcomes are 1) birth weight, 2) pregnancy termination resulting in miscarriage, abortion, or still birth, 3) neonatal death, 4) infant death, and 5) child death. We will use data from the Demographic and Health Surveys (DHS) conducted in relevant regions of Bangladesh, India, Nepal, and Pakistan, along with monthly gridded data on PM2.5 concentration (0.1°×0.1° spatial resolution), precipitation data (0.5°×0.5° resolution), temperature data (0.5°×0.5°), and agricultural land use data (0.1°×0.1° resolution). Results Data access to relevant DHSs was granted on June 6, 2021 for India, Nepal, Bangladesh, August 24, 2021 for Pakistan, and June 19 2022 for the latest DHS from India. Conclusions If the assumptions for a causal interpretation of our instrumental variable analysis are met, this analysis will provide important causal evidence on the maternal and child health effects of PM2.5 exposure during pregnancy. This evidence is important to inform personal behavior and interventions, such as the adoption of indoor air filtration during pregnancy as well as environmental and health policy. International Registered Report Identifier (IRRID) DERR1-10.2196/35249
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Ku, Elaine, Charles E. McCulloch y Kirsten L. Johansen. "Starting Renal Replacement Therapy: Is It About Time?" American Journal of Nephrology 50, n.º 2 (2019): 144–51. http://dx.doi.org/10.1159/000501510.
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Background: Studies of the timing of end-stage renal disease (ESRD) have primarily defined “early” versus “late” initiation of dialysis using estimated glomerular filtration rate (eGFR)-based criteria. Our objective was to determine the theoretical time that could be spent in chronic kidney disease (CKD) stage 5 prior to reaching a conservative eGFR threshold of 5 mL/min/1.73 m2 compared to the actual time spent in CKD stage 5 by risk factors of interest. Methods: Eight-hundred and seventy Chronic Renal Insufficiency Cohort participants with CKD stage 5 who started renal replacement therapy (RRT) were included for retrospective study. We used mixed models to estimate the person-specific trajectory of renal function. We then used these individual trajectories to estimate the amount of time that would be spent in CKD stage 5 (between eGFR of 15 and 5 mL/min/1.73 m2) and compared this estimate to the actual time spent in CKD stage 5 prior to ESRD (between eGFR of 15 mL/min/1.73 m2 and ESRD). Results: We found the median observed time between eGFR of 15 mL/min/1.73 m2 to RRT was 9.6 months, but the median predicted time between eGFR of 15 mL/min/1.73 m2 to eGFR of 5 mL/min/1.73 m2 was 17.7 months. Some of the largest differences between the predicted and actual amount of time spent in CKD stage 5 were noted among those with systolic blood pressure <140 mm Hg (9.7 months longer predicted compared to actual), proteinuria <1 g/g (9.1 months), and serum albumin ≥3.5 g/dL (9.0 months). Conclusion: We found marked differences between the actual and predicted time spent in CKD stage 5 based on risk factors of interest. We believe that placing timing of dialysis initiation in the perspective of time is novel and may identify subgroups of patients who may derive particular benefit from a more concerted effort to delay RRT.
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Prescott, L. F., S. Freestone y J. A. N. McAuslane. "Reassessment of the single intravenous injection method with inulin for measurement of the glomerular filtration rate in man". Clinical Science 80, n.º 2 (1 de febrero de 1991): 167–76. http://dx.doi.org/10.1042/cs0800167.
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1. Factors influencing the total body and renal clearances of inulin were investigated in a total of 37 healthy adult volunteers and 10 patients with stable chronic renal failure after the single intravenous injection of a dose of 70 mg/kg given over 5 min. 2. The elimination of inulin was highly concentration-dependent, and in healthy volunteers the renal clearance fell from 103.7 ± 14.4 ml min−1 1.73 m−2 during the first hour after administration to 49.1 ± 20.9 ml min−1 1.73 m−2 over the period 6-8 h. In the patients with renal failure the renal clearance fell correspondingly from 39.7 ± 16.5 to 26.6 ± 8.6 ml min−1 1.73 m−2. There were no changes in the simultaneously measured clearances of creatinine. 3. The values obtained for the total body clearance of inulin after a single injection depend critically on dose, the number and timing of blood samples, the choice of pharmacokinetic model, the number of data points chosen for estimation of the slope of the terminal elimination phase for analysis by the methods of residuals, and the weighting used for curve fitting by non-linear regression analysis. 4. With standardized conditions of sampling from 0 to 2 h and weighted non-linear regression analysis of the plasma concentration-time data, the total body and renal clearances of inulin were almost identical in subjects with normal renal function at 105.2 ± 10.2 and 102.9 ± 13.0 ml min−1 1.73 m−2. In the patients with chronic renal failure sampling was continued for 3 h and the corresponding clearances were 40.4 ± 15.3 and 38.9 ± 15.7 ml min−1 1.73 m−2. 5. The 0-2 h total body and renal clearances of inulin were measured by the single injection method and the renal clearance was measured by the standard constant infusion method on different occasions in 10 healthy volunteers. The respective clearances were similar at 101.4 ± 6.6, 94.9 ± 11.9 and 88.4 ± 12.1 ml min−1 1.73 m−2. 6. The reproducibility of the single injection and constant infusion methods was compared by measuring the inulin clearance with both techniques on three occasions in separate groups of eight and nine healthy volunteers. The mean coefficient of variation for the total body clearance with the single injection method was only 3.9% compared with 9.5% for the renal clearance determined the same way and 12.0% for the renal clearance during constant infusion. 7. Urine collection and fluid loading are not required for the single injection technique, and it is more reproducible and less demanding than the constant infusion method. With simple precautions, the single injection method with inulin is suitable for routine estimation of the glomerular filtration rate.
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Checchi, Vittorio, Marco Montevecchi y Luigi Checchi. "Variation of Efficacy of Filtering Face Pieces Respirators over Time in a Dental Setting: A Pilot Study". Dentistry Journal 9, n.º 4 (24 de marzo de 2021): 36. http://dx.doi.org/10.3390/dj9040036.
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Since aerosol continuously persists in dental settings, where different procedures and patients come in succession, the use of oronasal masks is highly recommended. Among them, respirators known as Filtering Face Pieces (FFP) show a protective superiority compared to surgical masks. Even concerning respirators classified as non-reusable, it is not known how many hours of use are necessary to compromise their filtering capacity. The aim of this study is to investigate the variations of filtering capacity of an FFP2 respirator over time, in order to safely optimize the timing of its use. Five respirators were worn by the same operator during clinical activity for different usage times (8, 16, 24, 32, 40 h), and one respirator was kept unused. All respirators underwent a bacterial filtration efficacy (BFE) test. T-test for paired data with Bootstrap technique and Wilcoxon test for paired data compared BFE values of the five tested FFP2s respectively at each time, and the areas with the corresponding values of the control respirator (FFp2-F). A generalized linear mixed effect model (GLM) was applied considering type of respirator and time as fixed effects and intercept as random effect. No significant statistical differences were present in the BFE of each time. Data obtained by the present study highlight the important ability of FFP2s to maintain their BFE over time, suggesting a long lasting protective function.
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Brunier, Gillian, Joyce A. Hiller, Shirley Drayton, Robyn A. Pugash y Sheldon W. Tobe. "A Change to Radiological Peritoneal Dialysis Catheter Insertion: Three-Month Outcomes". Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis 30, n.º 5 (septiembre de 2010): 528–33. http://dx.doi.org/10.3747/pdi.2009.00114.
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BackgroundBest practices for peritoneal dialysis (PD) catheter insertion call for timely placement of catheters to reduce complications and increase the likelihood of a successful initiation of PD. The purpose of our study was to assess if a change in approach to PD catheter insertion, including a switch to radiological insertion of PD catheters and introduction of a dialysis access nurse to coordinate all patient care, was associated with more outpatient procedures and achievement of guideline-based outcomes, including timelier PD starts.MethodsWe conducted a single-center retrospective chart review of all patients that had their first PD catheter inserted at our center over a 7-year period ending in 2007.ResultsPD catheters were placed in 88 patients by interventional radiology and in 125 patients by surgical insertion during an earlier period. Insertion of PD catheters by interventional radiology was significantly associated with a higher rate of outpatient procedures (70% vs 32%, p < 0.0001) than surgical placement. At PD start, 82% of patients that underwent radiological insertions had an estimated glomerular filtration rate of over 8 mL/minute/1.73 m2and their mean serum albumin level was 38.2 g/L.ConclusionsThe new procedure of radiological insertion of PD catheters, coordinated by a dedicated dialysis access nurse, was associated with more outpatient procedures than the earlier surgical method and allowed patients to receive a PD catheter with timing consistent with clinical practice recommendations.
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Crislip, G. Ryan, Bansari Patel, Riyaz Mohamed, Sarah C. Ray, Qingqing Wei, Jingping Sun, Aaron J. Polichnowski, Jennifer C. Sullivan y Paul M. O’Connor. "Ultrasound measurement of change in kidney volume is a sensitive indicator of severity of renal parenchymal injury". American Journal of Physiology-Renal Physiology 319, n.º 3 (1 de septiembre de 2020): F447—F457. http://dx.doi.org/10.1152/ajprenal.00221.2020.
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Noninvasive determination of the severity of parenchymal injury in acute kidney injury remains challenging. Edema is an early pathological process following injury, which may correlate with changes in kidney volume. The goal of the present study was to test the hypothesis that “increases in kidney volume measured in vivo using ultrasound correlate with the degree of renal parenchymal injury.” Ischemia-reperfusion (IR) of varying length was used to produce graded tissue injury. We first determined 1) whether regional kidney volume in rats varied with the severity (0, 15, 30, and 45 min) of warm bilateral IR and 2) whether this correlated with tubular injury score. We then determined whether these changes could be measured in vivo using three-dimensional ultrasound. Finally, we evaluated cumulative changes in kidney volume up to 14 days post-IR in rats to determine whether changes in renal volume were predictive of latent tubular injury following recovery of filtration. Experiments concluded that noninvasive ultrasound measurements of change in kidney volume over 2 wk are predictive of tubular injury following IR even in animals in which plasma creatinine was not elevated. We conclude that ultrasound measurements of volume are a sensitive, noninvasive marker of tissue injury in rats and that the use of three-dimensional ultrasound measurements may provide useful information regarding the timing, severity, and recovery from renal tissue injury in experimental studies.
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Maluf, Miguel A. "Modified ultrafiltration in surgical correction of congenital heart disease with cardiopulmonary bypass". Perfusion 18, n.º 1_suppl (enero de 2003): 61–68. http://dx.doi.org/10.1191/0267659103pf629oa.
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The surgical correction of congenital heart disease using haemodilution and hypothermia with cardiopulmonary bypass (CPB) may expose patients to tissue ischaemia and initiate a systemic inflammatory response, increasing the total body water and inducing impairment, especially of heart, lung and brain function. It is possible to use ultrafiltration during CPB in the rewarming phase to remove water accumulation in the third space (conventional ultrafiltration). The reduced volume of prime used in children and the ability only to filter the reservoir blood during CPB led the Great Ormond Street Group to modify the method of ultrafiltration with regards to the placement of the filter and the timing of filtration (post-CPB). The main advantage of the modified technique is the ultrafiltration of the patient. A prospective nonrandomized study has been conducted to compare conventional with conventional+modified ultrafiltration. From January 1996 to March 1998, 41 patients underwent correction of congenital heart disease and were submitted to a comparative study (homogeneous groups), using either the conventional or the conventional+modified ultrafiltration techniques. There were no technical complications, no patient required mediastinal re-exploration due to bleeding and it was possible to close all the chests. There were significant differences in the ultrafiltrate volume balance (143.39 /54.3 versus 2279 /71.4 mL; P B /0.001) but there were no significant differences in clinical postoperative evolution between the conventional and the conventional+modified ultrafiltration.
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Johnson, David W., Muh Geot Wong, Bruce A. Cooper, Pauline Branley, Liliana Bulfone, John F. Collins, Jonathan C. Craig et al. "Effect of Timing of Dialysis Commencement on Clinical Outcomes of Patients with Planned Initiation of Peritoneal Dialysis in the Ideal Trial". Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis 32, n.º 6 (noviembre de 2012): 595–604. http://dx.doi.org/10.3747/pdi.2012.00046.
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♦ BackgroundSince the mid-1990s, early dialysis initiation has dramatically increased in many countries. The Initiating Dialysis Early and Late (IDEAL) study demonstrated that, compared with late initiation, planned early initiation of dialysis was associated with comparable clinical outcomes and increased health care costs. Because residual renal function is a key determinant of outcome and is better preserved with peritoneal dialysis (PD), the present pre-specified subgroup analysis of the IDEAL trial examined the effects of early- compared with late-start dialysis on clinical outcomes in patients whose planned therapy at the time of randomization was PD.♦ MethodsAdults with an estimated glomerular filtration rate (eGFR) of 10 – 15 mL/min/1.73 m2who planned to be treated with PD were randomly allocated to commence dialysis at an eGFR of 10 – 14 mL/min/1.73 m2(early start) or 5 – 7 mL/min/1.73 m2(late start). The primary outcome was all-cause mortality.♦ ResultsOf the 828 IDEAL trial participants, 466 (56%) planned to commence PD and were randomized to early start ( n = 233) or late start ( n = 233). The median times from randomization to dialysis initiation were, respectively, 2.03 months [interquartile range (IQR):1.67 – 2.30 months] and 7.83 months (IQR: 5.83 – 8.83 months). Death occurred in 102 early-start patients and 96 late-start patients [hazard ratio: 1.04; 95% confidence interval (CI): 0.79 – 1.37]. No differences in composite cardiovascular events, composite infectious deaths, or dialysis-associated complications were observed between the groups. Peritonitis rates were 0.73 episodes (95% CI: 0.65 – 0.82 episodes) per patient–year in the early-start group and 0.69 episodes (95% CI: 0.61 – 0.78 episodes) per patient–year in the late-start group (incidence rate ratio: 1.19; 95% CI: 0.86 – 1.65; p = 0.29). The proportion of patients planning to commence PD who actually initiated dialysis with PD was higher in the early-start group (80% vs 70%, p = 0.01).♦ ConclusionEarly initiation of dialysis in patients with stage 5 chronic kidney disease who planned to be treated with PD was associated with clinical outcomes comparable to those seen with late dialysis initiation. Compared with early-start patients, late-start patients who had chosen PD as their planned dialysis modality were less likely to commence on PD.
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MOON, SU-JIN, SEUNG-KI KWOK, JI HYEON JU, KYUNG-SU PARK, SUNG-HWAN PARK, CHUL-SOO CHO y HO-YOUN KIM. "Predictors of Chronic Kidney Disease in Korean Patients with Lupus Nephritis". Journal of Rheumatology 38, n.º 12 (1 de octubre de 2011): 2588–97. http://dx.doi.org/10.3899/jrheum.110363.
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Objective.Since chronic kidney disease (CKD) is closely associated with cardiovascular disease and mortality as well as endstage renal disease, prediction of progressive CKD is a clinically important issue. We investigated the independent risk factors for the development of CKD in patients with lupus nephritis (LN).Methods.The cohort included 322 Korean patients diagnosed with LN between 1985 and 2010. We retrospectively analyzed the clinical and laboratory indices, treatment response, the final renal function, and the biopsy findings. The timing and cumulative risk of developing CKD were identified by Kaplan-Meier methods. The independent risk factors for developing CKD were examined by univariate and multivariate Cox proportional hazards regression analyses.Results.The median followup time after the diagnosis of LN was 84 months. CKD occurs in 22% of the patients within 10 years after the diagnosis of LN. The probability of developing CKD was significantly associated with the onset time of LN (delayed-onset LN vs initial-onset LN; HR 2.904, p = 0.003), deteriorated renal function [an estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73 m2 body surface area] at the onset of LN (HR 7.458, p < 0.001), relapse of LN after achieving remission (HR 2.806, p = 0.029), and resistance to induction therapy (HR 8.120, p < 0.001).Conclusion.Our results demonstrate that delayed-onset LN, a decreased eGFR at the time of LN onset, and the failure to achieve a sustained remission are predictors for the development of CKD in Korean patients with LN.
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Fabre, Eric. "Aquatic hyphomycetes in three rivers of southwestern France. II. Spatial and temporal differences between species". Canadian Journal of Botany 76, n.º 1 (1 de enero de 1998): 107–14. http://dx.doi.org/10.1139/b97-156.
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Spatial and temporal changes in conidial concentration of species of aquatic hyphomycetes were studied in three southwestern French rivers (Adour, Nive, and Tech). The survey was conducted from source to mouth for a year by water filtration. Fifty-two species were identified. Alatospora acuminata and Clavariopsis aquatica were the most abundant species in all three rivers. Most other species made small contributions to the total amount of conidia, but species such as Heliscella stellata or Lemonniera aquatica occasionally may be important in a particular river. The timing of seasonal peaks of conidia concentration of some species was studied. Species were classified into three groups according to the similarity or differences among rivers. Peak conidial concentration could appear at the same season on the three rivers (e.g., Alatospora acuminata, Articulospora tetracladia, Heliscella stellata, Lemonniera aquatica, Lunulospora curvula) or in different seasons on the three rivers (e.g., Pyricularia submersa, Tetrachaetum elegans). No peak was found for Clavariopsis aquatica or Clavatospora longibrachiata on any river. Changes in conidial concentration along the three rivers were analysed. Patterns of individual species varied among rivers and seasons. During summer on the Tech River, conidial concentration of Heliscella stellata increased abruptly to the highest values of this study after having remained close to zero in the uppermost 20 km. This coincided with a drastic decrease in community diversity in these reaches. Both altitude and downstream distance influence conidial concentrations in a complex manner. Key words: Ingoldian fungi, conidia concentration, season, elevation.
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Chiu, Li-Chung, Li-Pang Chuang, Shaw-Woei Leu, Yu-Jr Lin, Chee-Jen Chang, Hsin-Hsien Li, Feng-Chun Tsai et al. "Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome: Propensity Score Matching". Membranes 11, n.º 6 (26 de mayo de 2021): 393. http://dx.doi.org/10.3390/membranes11060393.
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The high mortality rate of patients with severe acute respiratory distress syndrome (ARDS) warrants aggressive clinical intervention. Extracorporeal membrane oxygenation (ECMO) is a salvage therapy for life-threatening hypoxemia. Randomized controlled trials of ECMO for severe ARDS comprise a number of ethical and methodological issues. Therefore, indications and optimal timing for implementation of ECMO, and predictive risk factors for outcomes have not been adequately investigated. We performed propensity score matching to match ECMO-supported and non-ECMO-supported patients at 48 h after ARDS onset for comparisons based on clinical outcomes and hospital mortality. A total of 280 severe ARDS patients were included, and propensity score matching of 87 matched pairs revealed that the 90-d hospital mortality rate was 56.3% in the ECMO group and 74.7% in the non-ECMO group (p = 0.028). Subgroup analysis revealed that greater severity of ARDS, higher airway pressure, or a higher Sequential Organ Failure Assessment score tended to benefit from ECMO treatment in terms of survival. Multivariate logistic regression revealed that hospital mortality was significantly lower among patients who received ECMO than among those who did not. Our findings suggested that early initiation of ECMO (within 48 h) may increase the likelihood of survival for patients with severe ARDS.
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Garner, Allen L., Bogdan Neculaes y Dmitry V. Dylov. "Infrared Laser-Based Single Cell Permeabilization by Plasma Membrane Temperature Gradients". Membranes 12, n.º 6 (31 de mayo de 2022): 574. http://dx.doi.org/10.3390/membranes12060574.
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Single cell microinjection provides precise tuning of the volume and timing of delivery into the treated cells; however, it also introduces workflow complexity that requires highly skilled operators and specialized equipment. Laser-based microinjection provides an alternative method for targeting a single cell using a common laser and a workflow that may be readily standardized. This paper presents experiments using a 1550 nm, 100 fs pulse duration laser with a repetition rate of 20 ns for laser-based microinjection and calculations of the hypothesized physical mechanism responsible for the experimentally observed permeabilization. Chinese Hamster Ovarian (CHO) cells exposed to this laser underwent propidium iodide uptake, demonstrating the potential for selective cell permeabilization. The agreement between the experimental conditions and the electropermeabilization threshold based on estimated changes in the transmembrane potential induced by a laser-induced plasma membrane temperature gradient, even without accounting for enhancement due to traditional electroporation, strengthens the hypothesis of this mechanism for the experimental observations. Compared to standard 800 nm lasers, 1550 nm fs lasers may ultimately provide a lower cost microinjection method that readily interfaces with a microscope and is agnostic to operator skill, while inducing fewer deleterious effects (e.g., temperature rise, shockwaves, and cavitation bubbles).
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Rahimalimamaghani, Arash, David Alfredo Pacheco Tanaka, Margot A. Llosa Tanco, Maria Fernanda Neira D’Angelo y Fausto Gallucci. "Ultra-Selective CMSMs Derived from Resorcinol-Formaldehyde Resin for CO2 Separation". Membranes 12, n.º 9 (30 de agosto de 2022): 847. http://dx.doi.org/10.3390/membranes12090847.
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A resorcinol-formaldehyde precursor was synthesized to fabricate the CO2 selective Carbon Molecular Sieve Membranes (CMSMs) developed in this study. The degree of polymerization (DP) was analyzed via Gel Permeation Chromatography (GPC) and its effect on the CO2/N2 perm-selectivity and CO2 permeance was investigated. The membrane that was polymerized at 80 °C (named R80) was selected as the best performing CMSM after a preliminary test. The post treatment with oxidative atmosphere was performed to increase the CO2 permeance and CO2/N2 perm-selectivity on membrane R80. The gas permeation results and Pore Size Distribution (PSD) measurements via perm-porometry resulted in selecting the membrane with an 80 °C polymerization temperature, 100 min of post treatment in 6 bar pressure and 120 °C with an oxygen concentration of 10% (named R80T100) as the optimum for enhancing the performance of CMSMs. The 3D laser confocal microscopy results confirmed the reduction in the surface roughness in post treatment on CMSMs and the optimum timing of 100 min in the treatment. CMSM R80T100 exhibiting CO2/N2 ideal selectivity of 194 at 100 °C with a CO2 permeability of 4718 barrier was performed higher than Robeson’s upper bound limit for polymeric membranes and also the other CMSMs fabricated in this work.
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Tain, You-Lin, Chien-Liang Liu, Hsiao-Ching Kuo y Chien-Ning Hsu. "Kidney Function Trajectory within Six Months after Acute Kidney Injury Inpatient Care and Subsequent Adverse Kidney Outcomes: A Retrospective Cohort Study". Journal of Personalized Medicine 12, n.º 10 (29 de septiembre de 2022): 1606. http://dx.doi.org/10.3390/jpm12101606.
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Timing and extent of kidney function recovery after an acute kidney injury (AKI) episode are associated with chronic kidney disease onset and progression. This study aimed to categorize AKI recovery patterns within 6 months after index hospital discharge and associate them with kidney outcomes. This was a retrospective cohort study of 234,867 patients, hospitalized between 2010 and 2017, and classified as AKI or no AKI. Kidney function recovery from pre-hospitalization baseline within 1.5× serum creatinine (SCr) were evaluated at 3 and 6 months after hospital discharge and categorized as persistent non-recovery (PNR: SCr not recovered at 3 and 6 months), non-recovery (NR: SCr not recovered at 6 months), and recovery (SCr recovered at 6 months). A composite of incident chronic kidney disease, kidney replacement therapy, and estimated glomerular filtration rate reduction >30% from baseline and <15 mL/min/1.73 m2 was evaluated. Of 14,673 AKI surviving patients, 10.18% had PNR and 14.33% showed NR. Compared with no AKI, PNR and NR of AKI were associated with an increased risk of composite adverse outcomes (adjusted subdistribution hazard ratio (SHR) 4.55; 95% CI, 4.05–5.11; SHR, 3.54; 95% CI, 3.18–3.94, respectively). Patients with NR showed a greater risk of adverse outcomes than those with non-rapid recovery at 3 months after hospital discharge. The AKI recovery pattern within 6 months following inpatient care revealed an increasing continuum of risk of long-term adverse kidney outcomes. Risk stratification and a kidney function monitoring plan at discharge are needed to improve post-AKI care.
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Cade, David E., Nicholas Carey, Paolo Domenici, Jean Potvin y Jeremy A. Goldbogen. "Predator-informed looming stimulus experiments reveal how large filter feeding whales capture highly maneuverable forage fish". Proceedings of the National Academy of Sciences 117, n.º 1 (23 de diciembre de 2019): 472–78. http://dx.doi.org/10.1073/pnas.1911099116.
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The unique engulfment filtration strategy of microphagous rorqual whales has evolved relatively recently (<5 Ma) and exploits extreme predator/prey size ratios to overcome the maneuverability advantages of swarms of small prey, such as krill. Forage fish, in contrast, have been engaged in evolutionary arms races with their predators for more than 100 million years and have performance capabilities that suggest they should easily evade whale-sized predators, yet they are regularly hunted by some species of rorqual whales. To explore this phenomenon, we determined, in a laboratory setting, when individual anchovies initiated escape from virtually approaching whales, then used these results along with in situ humpback whale attack data to model how predator speed and engulfment timing affected capture rates. Anchovies were found to respond to approaching visual looming stimuli at expansion rates that give ample chance to escape from a sea lion-sized predator, but humpback whales could capture as much as 30–60% of a school at once because the increase in their apparent (visual) size does not cross their prey’s response threshold until after rapid jaw expansion. Humpback whales are, thus, incentivized to delay engulfment until they are very close to a prey school, even if this results in higher hydrodynamic drag. This potential exaptation of a microphagous filter feeding strategy for fish foraging enables humpback whales to achieve 7× the energetic efficiency (per lunge) of krill foraging, allowing for flexible foraging strategies that may underlie their ecological success in fluctuating oceanic conditions.
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Parker, James C., Troy Stevens, Jason Randall, David S. Weber y Judy A. King. "Hydraulic conductance of pulmonary microvascular and macrovascular endothelial cell monolayers". American Journal of Physiology-Lung Cellular and Molecular Physiology 291, n.º 1 (julio de 2006): L30—L37. http://dx.doi.org/10.1152/ajplung.00317.2005.
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Endothelial cells isolated from pulmonary arteries (RPAEC) and microcirculation (RPMVEC) of rat lungs were grown to confluence on porous filters and mounted on an Ussing-type chamber. Transmembrane pressure (ΔP) was controlled by the reservoir height, and the filtration rate corrected for surface area ( Jv/ A) was measured by timing fluid movement in a calibrated micropipette. These parameters were used to calculate hydraulic conductance (Lp) by using linear regression of Jv/ A on ΔP. Mean Lp values for newly confluent RPAEC monolayers were 22 times higher than those for RPMVEC monolayers (28.6 ± 5.6 vs. 1.30 ± 0.50 × 10−7 cm·s−1·cmH2O−1; P ≤ 0.01). After confluence was reached, electrical resistance and Lp remained stable in RPAEC but continued to change in RPMVEC with days in culture. Both phenotypes exhibited an initial time-dependent sealing response, but Lp also had an inverse relationship to ΔP in RPMVEC monolayers ≥4 days postconfluence that was attributed to cell overgrowth rather than junctional length. In a comparison of the cadherin contents, E-cadherin was predominant in RPMVEC, but VE-cadherin was predominant in RPAEC. At a constant ΔP of 40–45 cmH2O for 2 h, Jv/ A increased 225% in RPAEC monolayers but did not change significantly in RPMVEC monolayers. Significant decreases in Lp were obtained after treatment with 5% albumin, GdCl3, or isoproterenol plus rolipram in both phenotypes. Thus lung microvascular endothelial cells exhibited a significantly lower Lp than conduit vessel endothelium, which would limit alveolar flooding relative to perivascular edema cuff formation during increased pulmonary vascular pressures.
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Shiao, Chih-Chung, Jenq-Wen Huang, Kuo-Liong Chien, Hsueh-Fang Chuang, Yung-Ming Chen y Kwan-Dun Wu. "Early Initiation of Dialysis and Late Implantation of Catheters Adversely Affect Outcomes of Patients on Chronic Peritoneal Dialysis". Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis 28, n.º 1 (enero de 2008): 73–81. http://dx.doi.org/10.1177/089686080802800113.
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Objectives Predialysis nephrology care is thought to affect morbidity and mortality in hemodialysis patients. This study evaluated the impact of different patterns of predialysis care on outcomes of patients undergoing chronic peritoneal dialysis (PD). Design Retrospective cohort. Setting and Participants 275 patients enrolled from January 1997 to March 2005 in a medical center in North Taiwan who recently initiated dialysis were classified according to early or late referral to nephrologists (≥ 6 or <6 months of dialysis), planned or late implantation of Tenckhoff catheters (absence or presence of preceding emergent hemodialysis), and early or late start of dialysis [glomerular filtration rate (GFR) ≥ 5 or <5 mL/minute/1.73 m2]. Main Outcome Measures All-cause mortality and hospitalization. Results During a median follow-up of 2.5 years, 41 deaths, 38 transfers to hemodialysis, and 26 renal transplantations occurred. Late start of dialysis was associated with a significant survival benefit (log rank, p = 0.012) and, along with planned implantation of catheters, exhibited a reduced risk for all-cause hospitalization (log rank, p = 0.025, 0.013). The predictors of overall mortality included baseline GFR [hazard ratio (HR) 1.18, p = 0.023], age (HR 1.07, p < 0.001), and diabetes (HR 3.64, p = 0.001); whereas the risk factors for all-cause hospitalization included age (HR 1.02, p = 0.012), late implantation of catheters (HR 1.78, p = 0.011), and diabetes (HR 1.92, p = 0.005). The timing of nephrology referral did not affect either death or hospitalization. Conclusions Our data do not support earlier initiation of PD, but underscore the importance of planned implantation of catheters before commencement of chronic PD.
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Pan, Heng-Chih, Chiao-Yin Sun, Thomas Tao-Min Huang, Chun-Te Huang, Chun-Hao Tsao, Chien-Heng Lai, Yung-Ming Chen y Vin-Cent Wu. "Distinct Subtyping of Successful Weaning from Acute Kidney Injury Requiring Renal Replacement Therapy by Consensus Clustering in Critically Ill Patients". Biomedicines 10, n.º 7 (7 de julio de 2022): 1628. http://dx.doi.org/10.3390/biomedicines10071628.
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Background: Clinical decisions regarding the appropriate timing of weaning off renal replacement therapy (RRT) in critically ill patients are complex and multifactorial. The aim of the current study was to identify which critical patients with acute kidney injury (AKI) may be more likely to be successfully weaned off RRT using consensus cluster analysis. Methods: In this study, critically ill patients who received RRT at three multicenter referral hospitals at several timepoints from August 2016 to July 2018 were enrolled. An unsupervised consensus clustering algorithm was used to identify distinct phenotypes. The outcomes of interest were the ability to wean off RTT and 90-day mortality. Results: A total of 124 patients with AKI requiring RRT (AKI-RRT) were enrolled. The 90-day mortality rate was 30.7% (38/124), and 49.2% (61/124) of the patients were successfully weaned off RRT for over 90 days. The consensus clustering algorithm identified three clusters from a total of 45 features. The three clusters had distinct features and could be separated according to the combination of urinary neutrophil gelatinase-associated lipocalin to creatinine ratio (uNGAL/Cr), Sequential Organ Failure Assessment (SOFA) score, and estimated glomerular filtration rate at the time of weaning off RRT. uNGAL/Cr (hazard ratio [HR] 2.43, 95% confidence interval [CI]: 1.36–4.33) and clustering phenotype (cluster 1 vs. 3, HR 2.7, 95% CI: 1.11–6.57; cluster 2 vs. 3, HR 44.5, 95% CI: 11.92–166.39) could predict 90-day mortality or re-dialysis. Conclusions: Almost half of the critical patients with AKI-RRT could wean off dialysis for over 90 days. Urinary NGAL/Cr and distinct clustering phenotypes could predict 90-day mortality or re-dialysis.