Renal Replacement Therapy Research Articles

Challenges and potential solutions for cycloserine dosing in patients with sepsis undergoing continuous renal replacement therapy

Continuous kidney replacement therapy (CRRT) is a special form of dialysis, which has more significant advantages than traditional intermittent hemodialysis in treating critically ill patients. The impact of CRRT and disease complexity on drug clearance in critically ill patients has been reported in several studies, nevertheless, the pharmacokinetic changes of cycloserine in patients with sepsis undergoing CRRT have not been reported. Here, we report a case of a 52-year-old man with septic shock and severe multidrug-resistant tuberculosis who underwent anti-TB therapy. The patient's anti-TB regimen included linezolid, clofazimine, cycloserine, and bedaquiline. Following continuous administration for 14 days, the patient was treated with CRRT due to acid-base imbalance and acute renal failure. Blood samples were collected at 0, 2, 4, 6, 10, and 12 hours following cycloserine administration (CRRT was initiated two hours after administration). Changes in plasma concentration of cycloserine before and after the CRRT were measured. The peak concentration of cycloserine was 39.93 mg/L with a trough concentration of 7.90 mg/L, and the AUC0-12h was 294.36 mg•h/L. These findings firstly suggested that the pharmacokinetics of cycloserine may be influenced by sepsis and CRRT therapy, and cycloserine doses may need to be increased during CRRT therapy in patients with sepsis.

Real-Time Dialysis Dose: Ionic Dialysis Versus Classical Urea Kinetic Modeling Indices.

Introduction Worldwide, over 850 million people need renal replacement therapy, and over 80% of them are on hemodialysis. The term "dialysis adequacy" is most often associated with the achievement of minimally acceptable indices - single pool Kt/V (spKt/V) and urea reduction ratio (URR%) and largely does not take into account other clinical indicators in patients. In addition, it should be taken into account that in the conditions of clinical practice, their measurement is carried out according to standards controlled by the regulatory structures and is carried out with a frequency between one and three months, and not during each dialysis procedure. Accordingly, based on the obtained value, we assume that it refers to the urea clearance of the entire dialysis prescription. A new methodology for measuring dialysis adequacy through ionic dialysis allows dose estimation in real time without the need for additional blood testsby recording the difference in sodium ion conductivity at the dialyzer inlet and outlet. The latter corresponds to the dialysis dose delivered and can be measured at each dialysis session, enabling timely therapeutic intervention at minimal cost to the community. The aim of this original article is to present ion dialysis to the community as a reliable and inexpensive alternative to classical urea kinetic modeling (UKM), evaluating the comparability of the two methods and the possible sources of error in the result. Material and methods This was a retrospective study of 32 patients undergoing hemodialysis at the Clinic of Nephrology and Dialysis at the University Hospital St. Marina (Varna, Bulgaria) for the period between January and December 2020.For each of the patients, four measurements (every three months) of the delivered dialysis dose were performed by ion dialysis and classical urea kinetic modeling in order to assess the comparability and reliability of the two methods. Results The analysis of the results proved a high correlation between the validated indicators of dialysis adequacy (spKt/V; URR) and those registered with online monitoring (online clearance monitor) by ionic dialysis - online Kt/V (onKt/V)while at the same time reporting a significant difference in the two methods - primarily based on the anthropometric formulas used to estimate the volume. The established regression models confirmed the high predictive value of ionic dialysis in relation to the actually delivered dose. Discussion Despite the high bond strength, our recorded values ​​for onKt/V are 8% lower compared to results using UKM. Therefore, onKt/V as an assessment metric has the ability to underestimate the dialysis dose received. Various factors as a possible source of error and its cause have been reported by some authors. Several studies have reported differences of 2-5% in instantaneous conductance measurements, which they associate mainly with differences in the diffusion coefficients of urea and sodium, as well as different effects of dialysis membrane charge or inadequate ultrafiltration correction. Conclusions Our study confirms that online clearance monitoring (OCM) is a practical non-invasive tool for daily use that complements the classic performance of OCM by helping to deliver an adequate dialysis dose with increased patient benefit and minimal cost of financial resources.

Sterile water and regional citrate anticoagulation: A simple CRRT strategy for safe correction of severe hyponatraemia.

Hyponatraemia is a prevalent electrolyte disturbance observed in critically ill patients. The rapid correction of low plasma sodium levels by continuous renal replacement therapy (CRRT) carries the risk of developing osmotic demyelination syndrome (ODS), which can be prevented by implementing an individualized CRRT method. This study aims to introduce a CRRT protocol for the safe and gradual correction of severe hyponatraemia. This retrospective case series study was conducted in an intensive care unit (ICU). All four patients with severe hyponatraemia (<125 mmol/L) and renal failure between October 1, 2022, and September 30, 2023, were treated by CRRT with sterile water and regional citrate anticoagulation (RCA). Data on patient demographics, laboratory biochemical parameters, urine outputs and CRRT-related adverse events were collected. Laboratory parameters and urine outputs were compared by paired t-tests before and after CRRT. After CRRT, sodium levels were significantly increased (112.7 ± 6.7 vs. 141.9 ± 2.8 mmol/L, p = .005). Abnormal urine outputs, potassium, creatinine and bicarbonate were corrected (p for all <.05). Safe and gradual correction of hyponatraemia and internal environmental dysregulation was achieved in all patients without any complications related to CRRT, particularly ODS. It is a novel and simple strategy to correct severe hyponatraemia effectively while ensuring the safety of patients that can be easily implemented by experienced nurse staff. The sterile water-based protocol for postfilter dilution is safe to correct severe hyponatraemia with RCA and can be easily performed by experienced critical care nurses according to the precalculated formula. CRRT-trained, experienced ICU nurses are competent to initiate and adjust sterile water infusion discretely to prevent overcorrection of hyponatraemia.

Hypogammaglobulinemia in a child with atypical hemolytic-uremic syndrome

We present a unique clinical case of an atypical hemolytic-uremic syndrome in a child. The mutation in exon 6 of the CD46 gene (chr1:207940532G&gt;C) leads to a homozygous or hemizygous missense substitution. An 8-year-old girl was urgently hospitalized with symptoms of hemorrhagic syndrome and acute kidney injury. The child from the second pregnancy with an aggravated obstetric anamnesis, the first operative labor at the 38th week, who has an aggravated genealogical anamnesis. Initially, the disease developed in the guise of gastroenterological pathology: the girl had dyspeptic disorders, most likely associated with pathology of carbohydrate metabolism, also frequent infectious diseases and a lag in physical development. From the age of 4 years, the girl suffered from persistent hypoalbuminemia, hypoproteinemia and hypogammaglobulinemia, requiring replacement therapy with intravenous immunoglobulins. She was repeatedly examined in gastroenterological departments in Yekaterinburg and Moscow in 2021-2023, but no data concerning protein-losing enteropathies or primary immunodeficiency was obtained. Also, the whole-exome sequencing with result validation hasn’t confirmed an inherited etiology of the presumed congenital immune error. However, a CD46 gene mutation, associated with the development of hemolytic-uremic syndrome in some publications, was identified in the study. The signs of thrombotic microangiopathy were preceded by fever of unspecified etiology: microangiopathic hemolysis, thrombocytopenia, hyperazotemia, C3 consumption, proteinuria, and macrohematuria; hypercholesterolemia, protein metabolism disorder, increased transaminases, ferritin were also noted. According to the ultrasound of the kidneys there were diffuse changes in the parenchyma, decreased velocity indices of blood flow in both renal arteries at all levels. Differential diagnosis was carried out with thrombotic thrombocytopenic purpura, autoimmune hemolytic anemia, antinuclear form of atypical hemolytic-uremic syndrome, viral and bacterial infections, systemic pathology, antiphospholipid syndrome, and hemoblastosis. The girl didn’t need a renal replacement therapy. When complement-blocking therapy with eculizumab was initiated on vital indications, the signs of the disease were gradually eliminated. The prolonged absence of nephropathy in the child may indicate the diversity of the CD46 gene’s functions and different phenotypic manifestation of its mutations. Analysis of literature sources and detection of CD46 “environment” genes (CYBA, LYST, ARPCIB) by full-exome sequencing suggest ambiguity and polymorphism of phenotypic manifestations of complement-mediated mutation.

Obesity hypoventilation syndrome is associated with worse in-hospital outcomes in patients with acute myocardial infarction: A nationwide study

BackgroundObesity hypoventilation syndrome (OHS) is a condition characterized by obesity, daytime hypercapnia, and sleep-disordered breathing. The impact of OHS on outcomes in patients with acute myocardial infarction (AMI) remains poorly understood. MethodsWe conducted a retrospective analysis using data from the National Inpatient Sample (2016–2020) to evaluate the outcomes of patients with OHS admitted for ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI). ResultsAmong STEMI and NSTEMI patients, 0.15 % and 0.37 % had OHS, respectively. After adjusting for confounders, OHS was associated with higher odds of in-hospital mortality, cardiac arrest, acute kidney injury, renal replacement therapy, and respiratory failure requiring intubation in NSTEMI patients. In STEMI patients, OHS was associated with higher odds of cardiac arrest, acute kidney injury, and respiratory failure. ConclusionOHS is associated with worse clinical outcomes in patients admitted with AMI, particularly in those with NSTEMI.

Management of severe ANCA-associated glomerulonephritis: comparison of international recommendations and narrative review

Severe kidney injury in ANCA-associated vasculitis remains a major challenge for healthcare practitioners due to the difficulty in defining the term and the limitations in the evidence base associated with the exclusion of the most severely ill patients from majority of clinical trial protocols. The ACR/VF, EULAR, and KDIGO recommendations intended to answer the questions regarding the management of this patient’s population, but some recommendations on both initial and supportive therapy, provided be the expert panels, differ, which increase the number of treatment options, but also leads to the uncertainty of the expected effect of the treatment. Kidney biopsy plays an important role in identifying patients with a favorable and unfavorable kidney prognosis. Timely histological assessment is necessary not only to confirm the diagnosis, but also to decide whether to intensify therapy if active changes are detected, or, conversely, to discontinue immunosuppressive treatment and switch to renal replacement therapy if chromic changes dominate and the extrarenal manifestations are quiescent. Several scoring systems for assessing kidney damage and risks in the in ANCA-associated vasculitis were proposed during the last decade. Glucocorticoid’s dosing and the choice between cyclophosphamide and rituximab for the initial therapy remains controversial, and the most controversial issue to date remain the indications for the plasma exchange usage. New treatment options for ANCA-associated nephritis, such as the usage of complementblocking therapy are likely to improve the prognosis for the patients with severe renal damage, taking into account the maximum effect on renal function restoration in this particular category.

Comparison of side-hole and step-tip catheters for patients requiring continuous renal replacement therapy in intensive care units: study protocol for a randomised controlled trial

IntroductionIn addition to various techniques involved in catheter insertion, catheter placement location, lumen diameter and operation and management during continuous renal replacement therapy (CRRT), the design of the tip and...

An integrated machine learning model enhances delayed graft function prediction in pediatric renal transplantation from deceased donors

BackgroundKidney transplantation is the optimal renal replacement therapy for children with end-stage renal disease; however, delayed graft function (DGF), a common post-operative complication, may negatively impact the long-term outcomes of both the graft and the pediatric recipient. However, there is limited research on DGF in pediatric kidney transplant recipients. This study aims to develop a predictive model for the risk of DGF occurrence after pediatric kidney transplantation by integrating donor and recipient characteristics and utilizing machine learning algorithms, ultimately providing guidance for clinical decision-making.MethodsThis single-center retrospective cohort study includes all recipients under 18 years of age who underwent single-donor kidney transplantation at our hospital between 2016 and 2023, along with their corresponding donors. Demographic, clinical, and laboratory examination data were collected from both donors and recipients. Univariate logistic regression models and differential analysis were employed to identify features associated with DGF. Subsequently, a risk score for predicting DGF occurrence (DGF-RS) was constructed based on machine learning combinations. Model performance was evaluated using the receiver operating characteristic curves, decision curve analysis (DCA), and other methods.ResultsThe study included a total of 140 pediatric kidney transplant recipients, among whom 37 (26.4%) developed DGF. Univariate analysis revealed that high-density lipoprotein cholesterol (HDLC), donor after circulatory death (DCD), warm ischemia time (WIT), cold ischemia time (CIT), gender match, and donor creatinine were significantly associated with DGF (P < 0.05). Based on these six features, the random forest model (mtry = 5, 75%p) exhibited the best predictive performance among 97 machine learning models, with the area under the curve values reaching 0.983, 1, and 0.905 for the entire cohort, training set, and validation set, respectively. This model significantly outperformed single indicators. The DCA curve confirmed the clinical utility of this model.ConclusionsIn this study, we developed a machine learning-based predictive model for DGF following pediatric kidney transplantation, termed DGF-RS, which integrates both donor and recipient characteristics. The model demonstrated excellent predictive accuracy and provides essential guidance for clinical decision-making. These findings contribute to our understanding of the pathogenesis of DGF.

Divide and Save: A Critical Care Air Transport Team Case With Prolonged Field Care

ABSTRACT Critical care air transport teams (CCATTs) specialize in providing intensive medical and postoperative resuscitative care during air evacuations. In a 2014 mission, a seasoned CCATT was urgently deployed to evacuate 6 American service members with gunshot wounds. Despite only having 2 hours of premission preparation and no further injury or treatment details, CCATT secured additional equipment, medications, and blood supply. Upon arrival to a foreign nonmilitary hospital, they discovered that American ground commanders had lost trust in local medical capabilities. One patient experienced prolonged extremity tourniquet time and surgical delay. This led to acute renal failure, preventing immediate evacuation without continuous renal replacement therapy (CRRT). Deviating from the standard procedure, the CCATT obtained permission to split their team. The CCATT nurse attended 5 stabilized patients during unregulated critical care air transport with plans to swiftly return with CRRT equipment for the critical sixth patient. The physician and respiratory therapist remained at the foreign hospital for 2 days to provide prolonged field care. This case demonstrates the evolving mission scope of CCATT, which may encompass ground triage, prolonged field care, unregulated movement, and atypical CCATT equipment such as CRRT, occasionally necessitating a split team construct. To adapt to these evolving needs, updated policies and training now incorporate these diverse CCATT concepts, emphasizing the importance of flexibility in en route critical care missions.

Impact of renal replacement therapy modality on coagulation and platelet function in critically ill patients: A prospective observational study

Impact of renal replacement therapy modality on coagulation and platelet function in critically ill patients: A prospective observational study

The influence of the region of residence on the tactics of renal replacement therapy

The influence of the region of residence on the tactics of renal replacement therapy

Hemodynamic management of acute kidney injury.

To discuss the role of hemodynamic management in critically ill patients with acute kidney injury. Acute kidney injury (AKI) may be associated with persistent alterations in renal perfusion, even when cardiac output and blood pressure are preserved. The effects of interventions aiming at increasing renal perfusion are best evaluated by renal Doppler or contrast enhance ultrasound. However, limited data have been acquired with these techniques and the essential of the literature is based on surrogates of renal function such as incidence of use of renal replacement therapy. Fluids may increase renal perfusion but their effects are quite unpredictable and can be dissociated from their impact on cardiac output and arterial pressure. Inotropes can also be used in selected conditions. At the de-escalation phase, fluid withdrawal should be considered. Safe fluid withdrawal may be achieved when applied in selected patients with preserved tissue perfusion presenting signs of fluid intolerance. When applied, stopping rules should be set. Dobutamine, milrinone and levosimendan increase renal perfusion in AKI associated with cardiac failure or after cardiac surgery. However, the impact of these agents in sepsis is not well defined. Regarding vasopressors, norepinephrine is the first-line vasopressor agent, but vasopressin derivative may limit the requirement of renal replacement therapy. Angiotensin has promising effects in a limited size post-Hoc analysis of a RCT, but these data need to be confirmed. While correction of severe hypotension is associated with improved renal perfusion and function, the optimal mean arterial pressure (MAP) target level remains undefined, Systematic increase in MAP results in variable changes in renal perfusion. It sounds reasonable to individualize MAP target, paying attention to central venous and intraabdominal pressures, as well as to the response to an increase in MAP. Recent studies have refined the impact of the various hemodynamic interventions on renal perfusion and function in critically ill patients with AKI. Though several of these interventions improve renal perfusion, their impact on renal function is more variable.

The Impact of Point-of-Care Ultrasound-Guided Resuscitation on Clinical Outcomes in Patients With Shock: A Systematic Review and Meta-Analysis.

To determine the impact of point-of-care ultrasound (POCUS)-guided resuscitation on clinical outcomes in adult patients with shock. We searched MEDLINE, Embase, and unpublished sources from inception to December 2023. We included randomized controlled trials (RCTs) that examined the use of POCUS to guide resuscitation in patients with shock. We collected data regarding study and patient characteristics, POCUS protocol, control group interventions, and outcomes. We identified 18 eligible RCTs. POCUS slightly influences physicians' plans for IV fluid (IVF) and vasoactive medication prescription (moderate certainty), but results in little to no changes in the administration of IVF (low to high certainty) or inotropes (high certainty). POCUS may result in no change in the number of CT scans performed (low certainty) but probably reduces the number of diagnostic echocardiograms performed (moderate certainty). POCUS-guided resuscitation probably reduces 28-day mortality (relative risk [RR] 0.88; 95% CI, 0.78-0.99), the duration of vasoactive medication (mean difference -0.73 d; 95% CI, -1.16 to -0.30), and the need for renal replacement therapy (RRT) (RR 0.80; 95% CI, 0.63-1.02) (low to moderate certainty evidence), and lactate clearance (high certainty evidence). POCUS-guided resuscitation may results in little to no difference in ICU or hospital admissions, ICU and hospital length of stay, and the need for mechanical ventilation (MV) (low to moderate certainty evidence). There is an uncertain effect on the risk of acute kidney injury and the duration of MV or RRT (very low certainty evidence). POCUS-guided resuscitation in shock may yield important patient and health system benefits. Due to lack of sufficient evidence, we were unable to explore how the thresholds of operator competency, frequency, and timing of POCUS scans impact patient outcomes.

Haemodynamic effects of intra-aortic balloon pumps stratified by baseline pulmonary artery pulsatility index.

Intra-aortic balloon pump (IABP) devices are commonly used in patients with heart failure related cardiogenic shock (HF-CS), including those with out-of-proportion right ventricular (RV) dysfunction. Pulmonary artery pulsatility index (PAPi) is a haemodynamic surrogate for RV performance. We aimed to assess short-term haemodynamic changes in patients with HF-CS following IABP support stratified by baseline PAPi. This is a single-centre study of 67 consecutive patients with HF-CS who underwent IABP placement between 2020 and 2022. The primary aim was haemodynamic changes of specific variables on pulmonary artery catheter monitoring over 72h following IABP placement. Secondary aims were clinically significant changes in diuretic regimens, changes in inotropes or vasopressors at 72h following IABP, along with clinical outcomes. Prior to IABP placement, 57% of the total cohort (median age 59years [48, 69], 31% female) had Society of Cardiovascular Angiography and Interventions Stage C HF-CS. Thirty-eight (56%) patients had a PAPi <2.0. Following 72h of IABP support, the PAPi <2.0 group had an observed significant decrease in central venous pressure (CVP; 20 to 12mmHg, P<0.001) and mean pulmonary artery pressure (mPAP; 37.5 to 28.5mmHg, P=0.001), and an increase in PAPi (1 to 1.6, P=0.001). No significant change in cardiac index (CI; 2 to 2.1L/min/m2, P=0.31) was observed. The PAPi ≥2.0 group (N=29) had no observed significant change in CVP (10 to 8mmHg, P=0.47), or PAPi (2.6 to 2.8, P=0.92), but there was a significant improvement in CI (1.9 to 2.5L/min/m2, P=0.004) along with reduction in mPA (37 to 29mmHg, P=0.03). The PAPi <2.0 group had a significant increase in diuretic requirement (52.6% vs. 20.7%, P=0.01) and numerically greater addition of inotropes/vasopressors (47.3% vs. 34.4%, P=0.07) compared with the PAPi ≥2.0 group at 72h following IABP placement. Significantly more patients in the PAPi ≥2.0 group underwent left ventricular assist device (55.2% vs. 26.3%, P=0.02), with no overall significant differences observed in escalation to veno-arterial extracorporeal membrane oxygenation, 30-day mortality, renal replacement therapy post-IABP, or rates of heart transplantation. IABP devices in those with HF-CS and low or abnormal PAPi may provide modest short-term haemodynamic benefits without significant improvement in CI, along with greater need for adjustment in medical therapeutics to achieve haemodynamic optimization.

The evolution of public attention in acute kidney injury and continuous renal replacement therapy: trends analysis from 2004 to 2024.

Acute kidney injury (AKI) and the need for Continuous Renal Replacement Therapy (CRRT) are critically important health concerns. This study analyzes global and regional Internet search queries to understand public attention in AKI and CRRT over time. We used Google Trends™ to analyze search queries for AKI and CRRT from January 2004 to March 2024. The study examined global trends and detailed insights from the United States, including state-by-state breakdowns. We identified patterns, peaks of attention, and temporal trends in public attention, comparing regional variations across the US and top-ranking countries worldwide. Global attention in AKI peaked in October 2022, with Portugal, Zambia, and Spain showing the highest regional attention. Within the United States, peak attention was in February 2008. Tennessee, Pennsylvania, and West Virginia were the top states that paid attention to AKI. Attention in CRRT peaked globally in March 2024. South Korea, Saudi Arabia, and Bahrain have led the global attention to CRRT. In the United States, peak attention was in April 2020. West Virginia, Tennessee, and Kentucky showed the highest state-specific attention in CRRT. This study reveals significant temporal and geographical variations in online search patterns for AKI and CRRT, suggesting evolving public attention to these critical health issues. This knowledge can guide the development of targeted public health initiatives, enhance medical education efforts, and help healthcare systems tailor their approach to improving awareness and outcomes in kidney health across diverse populations.

Sepsis-associated acute kidney injury in patients with chronic kidney disease: Patient characteristics, prevalence, timing, trajectory, treatment and associated outcomes.

The features and outcomes of sepsis-associated acute kidney injury (SA-AKI) may be affected by chronic kidney disease (CKD). Accordingly, we aimed to compare SA-AKI in patients with or without CKD. Retrospective cohort study in 12 intensive care units (ICU). We studied the prevalence, patient characteristics, timing, trajectory, treatment and outcomes of SA-AKI with and without CKD. Of 84 240 admissions, 7255 (8.6%) involved patients with CKD. SA-AKI was more common in patients with CKD (21% vs 14%; p < .001). CKD patients were older (70 vs. 60 years; p < .001), had a higher median Charlson co-morbidity index (5 vs. 3; p < .001) and acute physiology and chronic health evaluation (APACHE) III score (78 vs. 60; p < .001) and were more likely to receive renal replacement therapy (RRT) (25% vs. 17%; p < .001). They had less complete return to baseline function at ICU discharge (48% vs. 60%; p < .001), higher major adverse kidney events at day 30 (MAKE-30) (38% vs. 27%; p < .001), and higher hospital and 90-day mortality (21% vs. 13%; p < .001, and 27% vs. 16%; p < .001, respectively). After adjustment for patient characteristics and severity of illness, however, CKD was not an independent risk factor for increased 90-day mortality (OR 0.88; 95% CI 0.76-1.02; p = .08) or MAKE-30 (OR 0.98; 95% CI 0.80-1.09; p = .4). SA-AKI is more common in patients with CKD. Such patients are older, more co-morbid, have higher disease severity, receive different ICU therapies and have different trajectories of renal recovery and greater unadjusted mortality. However, after adjustment day-90 mortality and MAKE-30 risk were not increased by CKD.

Efficient decellularization of human fetal kidneys through optimized SDS exposure

Chronic kidney disease poses a significant threat to public health. Renal replacement therapy is the primary treatment option for end-stage kidney disease. However, there is a promising and relatively new method in regenerative medicine for creating a functional organ known as whole kidney decellularization. This method uses the intrinsic vasculature to perfuse the decellularizing agent into the tissue, effectively penetrating and removing cellular material. The regenerated bioscaffolds could serve as a source of organ donation. This study is focused on evaluating the effectiveness of various SDS exposures in decellularizing human fetal kidneys. The study included human fetal kidneys harvested from fetuses terminated before 14 weeks of gestational age. Kidneys were divided into six treatment groups based on SDS concentration and duration of perfusion. Decellularization, scanning electron microscopy, histopathological staining, immunofluorescent staining, and immunohistochemistry staining were performed to evaluate the adequacy of the process. The statistical analysis revealed that the SDS 0.1% treatment group had the highest collagen deposition after 24 h, significantly greater than the SDS 0.5% treatment group at 24 and 48 h. No significant differences were observed among the other treatment groups. The study concludes that the SDS 0.1% treatment group for 24 h was the most effective in terms of ECM content preservation and effective cell removal. This treatment showed better results than the other treatment groups and can be considered for future whole kidney decellularization studies.

Evaluation of Inflammatory Status in Chronic Kidney Disease Patients and a Comparison Between Hemodialysis and Peritoneal Dialysis Patients.

Introduction Inflammation is a common denominator in patients with chronic kidney disease (CKD), which is not explained by the pre-morbid risk factors and can lead to atherosclerosis and increased cardiovascular mortality. We have compared inflammatory markers like high-sensitive C-reactive protein (hs-CRP) and interleukin-6 (IL-6) in patients with CKD undergoing continuous ambulatory peritoneal dialysis (CAPD) and hemodialysis (HD) in both pre-dialysis phase at baseline and post-dialysis phase at three months to determine which dialysis has a more inflammatory burden on the patient. Materials and methods Fifty CKD patients diagnosed with end-stage renal disease (ESRD) who fulfilled eligibility criteria were recruited in this prospective observational study over two years. We measured levels of IL-6, hs-CRP, serum albumin, and body mass index (BMI) in both pre-dialysis and post-dialysis phases. Our results were obtained by analyzing 50 patients of ESRD who were planned for renal replacement therapy in the form of bridge dialysis, out of which 25 were put on HD and CAPD each. Pre-dialysis assessment was done at baseline and post-dialysis at three months. Each group served as its own control. IL-6 and hs-CRP levels were performed using commercially available kits employing the enzyme-linked immunosorbent assay (ELISA) method. Results Inflammatory markers (hs-CRP, IL-6) were elevated in both the pre-dialysis and post-dialysis phases of CKD, regardless of the dialysis modality. hs-CRP was significantly elevated in the HD group as compared to the CAPD group; however, the difference in IL-6 between the two groups was not significant. Albumin and BMI were significantly low in both groups from baseline, with patients on HD exhibiting lower albumin than the CAPD group, although the result was insignificant. Conclusion Markers of inflammation, like hs-CRP and low albumin, are more pronounced in HD than in CAPD. We conclude that the inflammatory burden is higher in patients undergoing HD.

Evaluation of the Diagnostic Utility of Urine Biomarkers Tissue Inhibitor of Metalloproteinases-2 (TIMP-2) and Insulin-like Growth Factor Binding Protein-7 (IGFBP-7) in Predicting Acute Kidney Injury and Short-term Outcomes among High-risk, Critically Ill Patients in a Tertiary Government Hospital in the Philippines.

Acute kidney injury (AKI) is a common complication of critical illness that often leads to increased mortality and morbidity. Biomarkers detect AKI earlier, providing a window of opportunity for timely intervention. Of the recent biomarkers in literature, the cell cycle arrest biomarkers tissue inhibitor of metalloproteinases-2 (TIMP-2) and insulin-like growth factor binding protein-7 (IGFBP-7) were found to be superior in predicting AKI. Our study aimed to evaluate the diagnostic performance of urine TIMP-2/IGFBP-7 in its ability to predict AKI and major adverse kidney events within 30 days (MAKE30) among high-risk patients for AKI. MAKE30 is a composite outcome comprised of all-cause mortality, use of renal replacement therapy (RRT), or persistent renal dysfunction at hospital discharge truncated at 30 days. We conducted a prospective, cross-sectional study which included 135 adult, non-COVID ICU patients. Baseline urine TIMP-2/IGFBP-7 results were used to dichotomize the population into low risk (<0.3 ng/mL) or high risk (≥0.3 ng/mL) for AKI. Participants were then observed for 30 days and monitored for MAKE30 outcomes. ROC curves were created to calculate the sensitivity, specificity, NPV, PPV, and the AUC of the 0.3 ng/mL cut-off to predict the AKI and MAKE30. Urine TIMP-2/IGFBP-7 cutoff of 0.3 ng/mL predicted AKI with a sensitivity of 82.4%, specificity of 79.2%, PPV of 57.1%, NPV of 93% and AUC of 0.81. MAKE30 was detected with a sensitivity of 62.8%, specificity of 76.1%, PPV of 55.1%, NPV of 81.4% and AUC of 0.69. Elevated levels of urine TIMP-2/IGFBP-7 were found to be associated with AKI (p<0.01), MAKE30 (p<0.01) and all of its subcomponents. Survival or discharge after 30 days were found to be associated with lower urine TIMP-2/IGFBP-7 levels (p<0.01). Urine TIMP-2/IGFBP-7, at its current cut-off at 0.3 ng/mL, can predict the likelihood of developing AKI and major adverse kidney events among high-risk patients for AKI. It can serve as a useful adjunct to existing methods, such as serum creatinine, in the early diagnosis and prognosis of acute kidney injury and expanding the therapeutic window to prevent disease progression and improve outcomes.

Vascular Access for Renal Replacement Therapy in Neonates and Infants: A Single Center Experience

IntroductionNeonatal renal replacement therapy (RRT) is a treatment modality used for severe kidney failure. Historically, its use has been limited in small infants due to circuits with large extra-corporeal volumes that require large double lumen vascular catheters. We sought to review our institution's experience with vascular access and overall survival in infants who receive RRT. MethodsA retrospective chart review of infants less than 5 kg (kg) was performed at our free-standing children's hospital from January 2016 to July 2023. We assessed the number of catheters used per patient, location of catheter placements, size of catheter, duration of treatment, reasons for line removal, and mortality. ResultsA total of 93 neonatal patients were identified who underwent RRT. Thirty-two patients (34.4%) required more than one catheter, with a total of 145 catheters placed for this cohort. The median (IQR) weight at insertion was 3.3 kg (2.7–4.0). The most common location for placement was the right internal jugular vein (n = 114, 78.6%). Patients required catheters for RRT for a median (IQR) of 16 days (7–39). Six patients underwent catheter placement at a weight of less than 2 kg. Nineteen total patients went on to peritoneal dialysis (20.4%). Fifty-three patients died during their admission (57.0%). ConclusionTo our knowledge this is the largest review of catheter use for RRT in infants within an intensive care unit and it reveals the success in treating renal failure in even the smallest infants. Level of EvidenceIV, Treatment Study.