Mortality predictors in acute kidney injury patients who underwent continuous venovenous hemodiafiltration: A retrospective, single-center study

Continuous renal replacement therapy (CRRT) is an increasingly preferred treatment that is easier to use in patients with hemodynamic impairment and can be applied in critical care settings. There are various subtypes of CRRT, one of which is continuous venovenous hemodiafiltration (CVVHDF). In this study, we examined the general characteristics of intensive care patients who underwent CVVHDF. Methods. The clinical and biochemical data of 123 patients who underwent CVVHDF in the intensive care units of our center between February 2012 and November 2014 were analyzed retrospectively. Patients who died during the course of therapy were compared with those who survived. Results. The study included 123 patients, 73 males (59.3%) and 50 females (40.7%). The mean age was 64.4 years. Eighty-eight patients (71.5%) died during CVVHDF while 35 patients survived (28.5%). Hemodynamic parameters such as systolic and diastolic arterial blood pressure, mean arterial pressure, and pulse pressure were significantly lower in patients who died compared to survivors (p<0.001). Mean lactic acid level was significantly higher in the deceased group than in the surviving group (8.54 mmol/L vs. 3.68 mmol/L, p<0.001, chi-square test). Conclusions. Low bicarbonate level, low systolic arterial blood pressure, and older age were significant independent predictors of mortality in this study. Mortality rates were significantly higher among patients with lactic acidosis and those over 66 years of age. Lactic acid levels can be used to predict mortality in patients undergoing CVVHDF

Sağlıklı donörlerde trombosit aferezi işleminin kanın reolojik özellikleri üzerine etkisinin araştırılması

Günümüzde sıkça uygulanan donör trombosit aferezi esnasında kan dokusu bir tür yapay dolaşıma maruz kalmaktadır. Kan dokusunun akışkanlık özellikleri dokulara yeterli kan akımının sağlanmasında belirleyici bir rol oynar. Sağlıklı kişilerde uygulanan aferezin kanın reolojik özelliklerine etkisini inceleyen çalışma yoktur. Çalışmada donör trombosit aferezinin kanın reolojik özellikleri üzerine etkisinin araştırılması planlanmıştır. Çalışmaya 20 sağlıklı donör alınmıştır. Aferez öncesi ve sonrasında alınan venöz kan örneklerinde hemoreolojik paremetrelerden; eritrosit deformabilitesi bir ektasitometre kullanılarak farklı kayma kuvvetlerinde ölçülmüştür. Aynı cihaz ile otolog ve standart hematokritte (%40) eritrosit agregasyon indeksine bakılmıştır. Digital viskometer kullanılarak otolog ve standart hematokritte (%40) tam kan viskozitesi plazma viskozitesi ölçümleri yapılmıştır. Aferez öncesi ve sonrasında biyokimyasal ve hematolojik paremetreler de değerlendirilmiştir. 8 kişilik alt bir grupta da Nitrik oksit vericisi sodyum nitroprussit'in trombosit aferezi sonrasında azalmış eritrosit deformabilitesi üzerindeki etkisine bakılmıştır. Trombosit aferezi sonrasında eritrosit deformabilitesi belirgin olarak azalmıştır. 8 kişilik alt grupta SNP inkübasyonunun bu deformabilitedeki azalmayı geri çevirdiği saptanmıştır. Hem otolog hem de standart hematokritte (%40) bakılan eritrosit agregasyon indeksinin azaldığı, sadece otolog hematokritte bakılan tam kan viskozitesinin azaldığı ve plazma viskozitesinin değişmediği bulunmuştur. Aferez sonrasında fibrinojen ve total kolestrol düzeyleri azalmış, hematokrit ise artmış bulunmuştur. Bu çalışmanın sonuçları sağlıklı donörlerde trombosit aferez işleminin kanın reolojik özeliklerini belirgin şekilde etkilediğini ve bu etkinin hem olumlu (eritrosit agregasyonu ve tam kan viskozitesinde azalma) hem de olumsuz (eritrosit deformabilitesinde azalma) yönleri olduğunu göstermiştir.During the thrombocyte apheresis that is used frequently today, blood tissue exposed to a kind of artifical circulation. Fludity of blood plays a major role to ensure adequate blood supply to the tissues. There is no study available on the effects of apheresis on blood rheology on healthy donors. The present study was designed the effects of thrombocyte apheresis on the blood rheology. Venous blood samples were obtained before and after the thrombocyte apheresis in twenty healthy donors. As an Hemorheological parameter erythrocyte deformability was determined at various shear stresses by ektacytometry. Erythrocyte aggregation index was calculated with the same device at autolog and standard hematocrit (%40) levels. By using digital viscometer whole blood viscosity at autolog and standard hematocrit (%40) levels, and plasma viscosity were evaluated. Biochemical and haematologicial parameters were analyzed before and after thrombocyte apheresis. The effect of sodium nitroprusside, a nitric oxide donor, on erythrocyte deformability after a thrombocyte apheresis was evaluated in eight donors of a healthy subgroup. Erythrocyte deformability was clearly reduced after thrombocyte apheresis. SNP incubation was able to reverse the reduced erythrocyte deformability by a thrombocyte apheresis. In both autolog and standard hematocrit levels erythrocyte aggregation index reduced, whereas only autolog hematocrit of whole blood viscosity was found to be reduced and no change was observed in plasma viscosity. After thrombocyte apheresis, fibrinogen, total cholesterol concentration reduced, and hematocrit has increased. These results suggested that thrombocyte apheresis clearly effected blood rheology in both favourable (decreased erythrocyte aggregation and whole blood viscosity) and unfavourable (decreased erythrocyte deformability) ways

Mortality predictors in acute kidney injury patients who underwent continuous venovenous hemodiafiltration: A retrospective, single-center study

Continuous renal replacement therapy (CRRT) is an increasingly preferred treatment that is easier to use in patients with hemodynamic impairment and can be applied in critical care settings. There are various subtypes of CRRT, one of which is continuous venovenous hemodiafiltration (CVVHDF). In this study, we examined the general characteristics of intensive care patients who underwent CVVHDF.&#x0D; Methods. The clinical and biochemical data of 123 patients who underwent CVVHDF in the intensive care units of our center between February 2012 and November 2014 were analyzed retrospectively. Patients who died during the course of therapy were compared with those who survived.&#x0D; Results. The study included 123 patients, 73 males (59.3%) and 50 females (40.7%). The mean age was 64.4 years. Eighty-eight patients (71.5%) died during CVVHDF while 35 patients survived (28.5%). Hemodynamic parameters such as systolic and diastolic arterial blood pressure, mean arterial pressure, and pulse pressure were significantly lower in patients who died compared to survivors (p&lt;0.001). Mean lactic acid level was significantly higher in the deceased group than in the surviving group (8.54 mmol/L vs. 3.68 mmol/L, p&lt;0.001, chi-square test).&#x0D; Conclusions. Low bicarbonate level, low systolic arterial blood pressure, and older age were significant independent predictors of mortality in this study. Mortality rates were significantly higher among patients with lactic acidosis and those over 66 years of age. Lactic acid levels can be used to predict mortality in patients undergoing CVVHDF.</jats:p

An unnoticed reason of renal failure: Acute phosphate nephropathy

Acute Phosphate Nephropathy is a clinical and pathological finding characterized by acute and subsequent chronic renal failure following the use of intestinal cleansers containing sodium phosphate. The pathophysiology of Acute Phosphate Nephropathy occurs due to the increase of sodium and water absorption in the proximal tubules due to hypovolemia, and the accumulation of calcium phosphate load in the distal tubules in the collector and distal canals. Renal biopsy findings include acute and chronic tubular damage with tubular and interstitial calcium phosphate deposits. Prevention of Acute Phosphate Nephropathy can be achieved by hydration before and after the use of calcium phosphate in risky patients, minimizing the sodium phosphate dose, and having 12-hour intervals between sodium phosphate applications. In this article, we aimed to present the patients who used sodium phosphate for colonoscopy and developed Acute Phosphate Nephropathy.</jats:p

Предиктори смертності у пацієнтів з гострим пошкодженням нирок, які лікувались безперервною вено-венозною гемодіафільтрацію: ретроспективне одноцентрове дослідження

Continuous renal replacement therapy (CRRT) is an increasingly preferred treatment that is easier to use in patients with hemodynamic impairment and can be applied in critical care settings. There are various subtypes of CRRT, one of which is continuous venovenous hemodiafiltration (CVVHDF). In this study, we examined the general characteristics of intensive care patients who underwent CVVHDF. Methods. The clinical and biochemical data of 123 patients who underwent CVVHDF in the intensive care units of our center between February 2012 and November 2014 were analyzed retrospectively. Patients who died during the course of therapy were compared with those who survived. Results. The study included 123 patients, 73 males (59.3%) and 50 females (40.7%). The mean age was 64.4 years. Eighty-eight patients (71.5%) died during CVVHDF while 35 patients survived (28.5%). Hemodynamic parameters such as systolic and diastolic arterial blood pressure, mean arterial pressure, and pulse pressure were significantly lower in patients who died compared to survivors (p<0.001). Mean lactic acid level was significantly higher in the deceased group than in the surviving group (8.54 mmol/L vs. 3.68 mmol/L, p<0.001, chi-square test). Conclusions. Low bicarbonate level, low systolic arterial blood pressure, and older age were significant independent predictors of mortality in this study. Mortality rates were significantly higher among patients with lactic acidosis and those over 66 years of age. Lactic acid levels can be used to predict mortality in patients undergoing CVVHDF

Evaluación de tinción de Ki-67, CD68 y Bcl-2, diálisis y mortalidad en glomerulonefritis de crescéntica

Immunohistochemical staining of Ki-67, CD68 and Bcl-2 have been studied in glomerulonephritis. We aimed to assess these immunohistochemical staining features, hemodialysis initiation and 60 month mortality rates in crescentic glomerulonephritis.Methods: In this retrospective study, patients, with a previous diagnosis of crescentic glomerulonephritis were divided into two groups: Hemodialysis Initiated and Not Initiated groups. Kidney biopsy specimens’Ki-67, CD68 and Bcl-2 staining scores were defined as below 5% “0”, 5-10% “+1”, 11- 20% “+2”, over 20% “+3”. Patients demographic, laboratory data, status of hemodialysis initiation, and mortality were obtained from medical records and immunohistochemical staining scores were compared between groups. Estimated glomerular filtration rates (eGFR) were assessed at 0, 6, and 12 months, except patients’ ongoing hemodialysis. Results: A total of 56 patients were diagnosed as crescentic glomerulonephritis. Pauci-immune crescentic glomerulonephritis (58.9%) was the most common etiology. Hemodialysis was initiated in 36 patients. Mean age, baseline creatinine, urea, C-reactive protein levels were significantly higher and, hemoglobin and proteinuria levels were significantly lower in the Hemodialysis Initiated group. Immunohistochemical staining scores were not significantly different between groups. In Hemodialysis Initiated group, 8.33% of patients were recovered from hemodialysis Mortality rates were 44,4% and 10% in patients in the group of hemodialysis initiated and not initiated group respectively. When we combine the hemodialysis not initiated patients and patients recovered from hemodialysis; median eGFR at baseline, 6th and 12th month were 32.9, 43.9, and 58.0 mL/ min/1.73m2 , respectively (p=0.016). Conclusion: Hemodialysis initiation was associated with high mortality. Degree of immunohistochemical staining was similar in both groups. Increment in eGFR was documented in first year in patients, other than the ones on still on hemodialysis.Introducción: Se ha estudiado la tinción inmunohistoquímica de Ki-67, CD68 y Bcl-2 en glomerulonefritis. Objetivo: Evaluar estas características de tinción inmunohistoquímica, el inicio de la hemodiálisis y la tasa de mortalidad a los 60 meses en la glomerulonefritis crescéntica. Material y métodos: En este estudio retrospectivo, los pacientes, con diagnóstico previo de glomerulonefritis crescéntica se dividieron en dos grupos: Hemodiálisis iniciada y no iniciada. La puntuación de tinción Ki-67, CD68 y Bcl-2 de las muestras de biopsia de riñón se definió del siguiente modo: por debajo del 5% “0”, 5-10% “+1”, 11-20% “+2”, más del 20% “+3”.Se compararon los siguientes datos en los pacientes: demografía, resultados de laboratorio, de iniciación de la hemodiálisis y la mortalidad obtenida de los registros médicos y las puntuaciones de tinción inmunohistoquímica entre los grupos. La Tasa de filtrado glomerular estimada (TFGe) fue evaluada a los 0, 6 y 12 meses, excepto en los pacientes en hemodiálisis en curso. Resultados: Un total de 56 pacientes fueron diagnosticados con glomerulonefritis crescéntica. La glomerulonefritis crescéntica pauci inmune (58,9%) fue la etiología más común. Se inició hemodiálisis en 36 pacientes. La edad media, los niveles basales de creatinina, urea y proteína C reactiva fueron significativamente más altos, y los niveles de hemoglobina y proteinuria fueron significativamente más bajos en el grupo de Hemodiálisis Iniciada. Las puntuaciones de tinción inmunohistoquímica no fueron significativas entre los grupos. En el grupo de Hemodiálisis Iniciada 8,33% de los pacientes recuperó función renal y salió de diálisis. La tasa de mortalidad en el grupo de Hemodiálisis no Iniciada fue del 10,0% y en el grupo que inicio HD del 44%. Cuando combinamos los pacientes Hemodiálisis no Iniciada y los pacientes recuperados de hemodiálisis la mediana de TGFe en la línea de base, 6º y 12º mes fue 32,9, 43,9 y 58,0 mL/minuto/1,73m2 respectivamente (p<0,016). Conclusión: El inicio de la hemodiálisis se asoció con una alta mortalidad. El grado de tinción inmunohistoquímica fue similar en ambos grupos. El incremento de la TFGe se documentó en el primer año en pacientes distintos de los que aún estaban en hemodiálisis