Need For Renal Replacement Therapy Research Articles

Urinary biomarkers to predict acute kidney damage and mortality in COVID-19.

Acute kidney injury (AKI) is a frequent condition in patients hospitalized for COVID-19. There are only a few reports on the use of urinary biomarkers in COVID-19 and no data so far comparing the prognostic use of individual biomarkers in the prediction of adverse outcomes. We performed a prospective mono-centric study on the value of urinary biomarkers in predicting the composite endpoint of a transfer to the intensive care unit, the need for renal replacement therapy, mechanical ventilation, and in-hospital mortality. 41 patients hospitalized for COVID-19 were enrolled in this study. Urine samples were obtained shortly after admission to assess neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), calprotectin, and vascular non-inflammatory molecule-1 (vanin-1). We identified calprotectin as a predictor of a severe course of the disease requiring intensive care treatment (AUC 0.728, p=0.016). Positive and negative predictive values were 78.6% and 76.9%, respectively, using a cut-off concentration of 127.8ng/mL. NGAL tended to predict COVID-19-associated AKI without reaching statistical significance (AUC 0.669, p=0.053). The best parameter in the prediction of in-hospital mortality was NGAL as well (AUC 0.674, p=0.077). KIM-1 and vanin-1 did not reach significance for any of the investigated endpoints. While KIM-1 and vanin-1 did not provide prognostic clinical information in the context of COVID-19, the present study shows that urinary calprotectin is moderately predictive of the need for intensive care unit (ICU) admission, and NGAL may be modestly predictive of AKI in COVID-19. Calprotectin and NGAL show promise as potential helpful adjuncts in the identification of patients at increased risk of poor outcomes or complications in COVID-19.

Acute kidney injury early after left ventricular assist device implantation: incidence, risk factors and clinical consequences.

Renal dysfunction or renal failure is a common complication in patients undergoing a left ventricular assist device (LVAD). Measurement of serum creatinine and estimated glomerular filtration rate (eGFR) is the most commonly used inexpensive and easy method for the evaluation of kidney function. In studies, the development of acute kidney injury (AKI) after LVAD has generally been studied at 1, 3 months and 1 year, but there are almost no studies with 1-week data. We retrospectively analyzed the incidence of AKI, risk factors, length of stay in hospital and intensive care unit (ICU), and postoperative complications of 138 patients who underwent LVAD implantation in our center between 2012 and 2021, according to Kidney Disease Improving Global Outcomes (KDIGO) criteria. We evaluated the preoperative, postoperative 1st day, 2nd day, 1st week, 1st month, 3rd month and 1st year serum creatinine, eGFR and blood urea nitrogen (BUN) values. The mean age of 138 patients who underwent LVAD implantation and evaluated the development of AKI was 50.4 (±10.86) and 119 (86.2%) were males. The incidence of AKI, the need for renal replacement therapy (RRT) and dialysis after LVAD implant were respectively 25.4%, 25.3% and 12.3%. According to the KDIGO criteria, in the AKI (+) patient group, 21 (15.2%) cases were identified as stage 1, 9 (6.5%) as stage 2 and 5 (3.6%) as stage 3. The incidence of AKI was found to be high in cases with diabetes mellitus (DM), age, preoperative creatinine level ≥1.2, and eGFR ≤60 ml/min/m2. There is a statistically significant relationship between having AKI and right ventricular (RV) failure (p=0.0033). Right ventricular failure developed in 10 (28.6%) of 35 patients who developed AKI. If perioperative AKI is recognized early, the development of advanced stages of AKI and mortality can be reduced with nephroprotective measures.

Mean perfusion pressure in cardiopulmonary bypass as a factor of intraoperative acute kidney injury

The OBJECTIVE was to evaluate the role of mean perfusion pressure in the development of acute kidney injury (AKI) in patients operated with CPB.METHODS AND MATERIALS. A retrospective monocenter observational study was conducted among patients CPB (n=97) who underwent planned heart surgery using CPB. Inclusion criteria: age over 18 years, duration of surgery from 90 to 180 minutes, no signs of end-stage renal disease. The group was divided into subgroups according to the level of mean perfusion pressure (MPP): 1st – MPP<60 mmHg, 2nd – MPP equal to and >60 mmHg. Diagnosis of AKI was carried out on the basis of changes in serum creatinine and biomarkers (NGAL, IgG, albumin in urine). The studied parameters were recorded 15 minutes after the start and end of general anesthesia as well as 24 and 48 hours after surgery.RESULTS. In the 1st subgroup, the frequency of AKI was higher: after 24 hours – 48 (78.7 %), in the 2nd subgroup – 10 (27.8 %), and after 48 hours – 21 (34.4 %) and 5 (13.9 %), respectively. In the 1st subgroup, the need for renal replacement therapy was 5 (8.2 %), while in the 2nd subgroup only 1 patient needed renal replacement therapy (2.8 %). Also, in the 1st subgroup, a higher level of lactate was detected at the end of general anesthesia – the median in the 1st subgroup was 4.6 mmol/l (2.5–11.6), in the 2nd – 2.5 mmol/l (1.4–7.2) (p= 0.022). The levels of AKI biomarkers in urine after 24 hours also differed: NGAL in the 1st – 473.1 ng/ml (235.7–749.5) and in the 2nd –111.3 ng/ ml (53.4–152.9) (p=0.003), albumin 174.6 mg/l (151.2–236.9) and 35.8 mg/l (21.3–52.5) respectively (p=0.006), IgG – 61.7 mg/l (24.9–88.5) and 9.7 mg/l (7.1–14.4) (p=0.002).CONCLUSION. Mean perfusion pressure is an important indicator of the adequacy of cardiopulmonary bypass. Lowering it below 60 mmHg leads to hypoperfusion of the kidneys with the risk of acute kidney injury.

Characteristics of need and availability of renal replacement therapy for patients with chronic kidney disease in Azerbaijan

Introduction and Aim: In recent years, there has been an increase in the number of patients with renal pathology in most of the cases without severe symptoms and with significant changes in kidney function, when there is a need for renal replacement therapy (RRT). The objective is to analyze the need and availability of renal replacement therapy in patients with chronic kidney disease. Materials and Methods: Statistical data from the State Statistical Committee of the Republic of Azerbaijan, and Republican Clinical Urological Hospital named after Academician M.J. Javad-Zadeh were used. The dialysis centers and the average load per center in Azerbaijan for the period from 2014-2019 are analyzed. Results: The provision of dialysis machines in Azerbaijan is 7.1%, in economic regions it is on average 7.7%. The highest provision is in the Nakhichevan (10.9%), Ganja-Gazakh (10.1%), and Apsheron (8.9%) economic regions. In the Republican Clinical Urological Hospital named after Academician M. Javad-zade, the need for hemodialysis centers exceeds by 31.6%. Conclusion: With an increase in the number of dialysis machines, there is an increase in the average load per dialysis center. In the economic regions of the republic, the actual number of hemodialysis machines the need meets the standard (>50%).

The Potential Modulatory Effects of Exercise on Skeletal Muscle Redox Status in Chronic Kidney Disease.

Chronic Kidney Disease (CKD) is a global health burden with high mortality and health costs. CKD patients exhibit lower cardiorespiratory and muscular fitness, strongly associated with morbidity/mortality, which is exacerbated when they reach the need for renal replacement therapies (RRT). Muscle wasting in CKD has been associated with an inflammatory/oxidative status affecting the resident cells' microenvironment, decreasing repair capacity and leading to atrophy. Exercise may help counteracting such effects; however, the molecular mechanisms remain uncertain. Thus, trying to pinpoint and understand these mechanisms is of particular interest. This review will start with a general background about myogenesis, followed by an overview of the impact of redox imbalance as a mechanism of muscle wasting in CKD, with focus on the modulatory effect of exercise on the skeletal muscle microenvironment.

Characteristics of Patients with Heart Failure and Advanced Chronic Kidney Disease (Stages 4-5) Not Undergoing Renal Replacement Therapy (ERCA-IC Study).

Despite the frequent coexistence of heart failure (HF) in patients with advanced chronic kidney disease (CKD), it has been understudied, and little is known about its prevalence and prognostic relevance. A retrospective study of 217 patients with advanced CKD (stages 4 and 5) who did not undergo renal replacement therapy (RRT). The patients were followed up for two years. The primary outcome was all-cause death or the need for RRT. Forty percent of patients had a history of HF. The mean age was 78.2 ± 8.8 years and the mean eGFR was 18.4 ± 5.5 mL/min/1.73 m2. The presence of previous HF identified a subgroup of high-risk patients with a high prevalence of cardiovascular comorbidities and was significantly associated with the composite endpoint of all-cause hospitalization or need for RRT (66.7% vs. 53.1%, HR 95% CI 1.62 (1.04-2.52), p = 0.034). No differences were found in the need for RRT (27.6% vs. 32.2%, p = 0.46). Nineteen patients without HF at baseline developed HF during the follow-up and all-cause death was numerically higher (36.8 vs. 19.8%, p = 0.1). Patients with advanced CKD have a high prevalence of HF. The presence of previous HF identified a high-risk population with a worse prognosis that required close follow-up.

Kidney Injury after Cardiac Surgery: Prevention-Associated Cost Reduction.

Cardiac surgery may induce acute kidney injury and the need for renal replacement therapy. It is also associated with higher hospital costs, morbidity and mortality. The aims of this study were to investigate predictors of cardiac surgery associated acute kidney injury in our population and to determine the burden of acute kidney injury in elective cardiac surgery, evaluating the potential cost effectiveness of preventing it through the application of the Kidney Disease: Improving Global Outcomes bundle of care to high-risk patient groups identified by the [TIMP-2]x[IGFBP7] used as a screening test. In a University Hospital single-center retrospective cohort study we analyzed a consecutive sample of adults who underwent elective cardiac surgery between January and March 2015. A total of 276 patients were admitted during the study period. Data from all patients was analyzed until hospital discharge or the patient's death. The economic analysis was performed from the hospital costs' perspective. Cardiac surgery associated acute kidney injury occurred in 86 patients (31%). After adjustment, higher preoperative serum creatinine (mg/L, ORadj = 1.09; 95% CI: 1.01 - 1.17), lower preoperative hemoglobin (g/dL, ORadj = 0.79; 95% CI: 0.67 - 0.94), chronic systemic hypertension (ORadj = 5.00; 95% CI: 1.67 - 15.02), an increase in cardiopulmonary bypass time (min, ORadj = 1.01; 95% CI: 1.00 - 1.01) and perioperative use of sodium nitroprusside (ORadj = 6.33; 95% CI: 1.80 - 22.28) remained significantly associated with cardiac surgery related acute kidney injury. The expected cumulative surplus cost for the hospital linked with cardiac surgery associated acute kidney injury (86 patients) was €120 695.84. Based on a median absolute risk reduction of 16.6%, by dosing kidney damage biomarkers in every patient and using preventive measures in high-risk patients, we would expect a break-even point upon screening 78 patients, which would translate, in our patient cohort, into an overall cost benefit of €7145. Preoperative hemoglobin, serum creatinine, systemic hypertension, cardiopulmonary bypass time and perioperative use of sodium nitroprusside were independent predictors of cardiac surgery associated acute kidney injury. Our cost-effectiveness modelling suggests that the use of kidney structural damage biomarkers combined with an early prevention strategy could be associated with potential cost savings.

Biomarker-guided intervention to prevent acute kidney injury after major surgery (BigpAK-2 trial): study protocol for an international, prospective, randomised controlled multicentre trial

IntroductionPrevious studies demonstrated that the implementation of the Kidney Disease Improving Global Outcomes (KDIGO) guideline-based bundle, consisting of different supportive measures in patients at high risk for acute kidney injury...

ANGIOMYOLIPOMA – VARIED PRESENTATIONS – A CASE SERIES

Renal angiomyolipoma is a benign mesenchymal tumour composed of fat cells, smooth muscle cells, and thick-walled blood vessels. These tumors can occur sporadically or as part of genetic syndromes: most commonly tuberous sclerosis complex. Here we present three cases of Renal angiomyolipoma(AML) in different scenarios - presenting with clinical features like ank pain, abdominal mass or perirenal haematoma with hypovolemic shock. All three cases were evaluated by contrast enhanced CT & diagnosed as renal angiomyolipoma. Nephron sparing surgery - Partial nephrectomy was done in case 1. Case 2 underwent angiography with non- selective angioembolisation preoperatively followed by simple nephrectomy. Case 3, after initial stabilization and evaluation found to be a case of Wunderlich syndrome and simple nephrectomy done. Post intervention period was uneventful for all 3 cases. In the 6-month follow-up, all three patients were doing well with normal renal function and no recurrence in case of partial nephrectomy. Embolisation is the emergency treatment of choice for bleeding angiomyolipoma. Whenever possible, a nephron sparing approach by either transarterial embolisation or partial nephrectomy is to be considered. In cases of angiomyolipoma of both kidneys or in a solitary functioning kidney, renal preservation is mandatory in order to avoid need for renal replacement therapy. Also, recently approved drug Everolimus may be considered for patients not suitable for surgery particularly in tumour seen with tuberous sclerosis

Harnessing Genomic Analysis to Explore the Role of Telomeres in the Pathogenesis and Progression of Diabetic Kidney Disease.

The prevalence of diabetes is increasing globally, and this trend is predicted to continue for future decades. Research is needed to uncover new ways to manage diabetes and its co-morbidities. A significant secondary complication of diabetes is kidney disease, which can ultimately result in the need for renal replacement therapy, via dialysis or transplantation. Diabetic kidney disease presents a substantial burden to patients, their families and global healthcare services. This review highlights studies that have harnessed genomic, epigenomic and functional prediction tools to uncover novel genes and pathways associated with DKD that are useful for the identification of therapeutic targets or novel biomarkers for risk stratification. Telomere length regulation is a specific pathway gaining attention recently because of its association with DKD. Researchers are employing both observational and genetics-based studies to identify telomere-related genes associated with kidney function decline in diabetes. Studies have also uncovered novel functions for telomere-related genes beyond the immediate regulation of telomere length, such as transcriptional regulation and inflammation. This review summarises studies that have revealed the potential to harness therapeutics that modulate telomere length, or the associated epigenetic modifications, for the treatment of DKD, to potentially slow renal function decline and reduce the global burden of this disease.

Selection of appropriate reference creatinine estimate for acute kidney injury diagnosis in patients with severe trauma.

In patients with severe trauma, the diagnosis of acute kidney injury (AKI) is important because it is a predictive factor for poor prognosis and can affect patient care. The diagnosis and staging of AKI are based on change in serum creatinine (SCr) levels from baseline. However, baseline creatinine levels in patients with traumatic injuries are often unknown, making the diagnosis of AKI in trauma patients difficult. This study aimed to enhance the accuracy of AKI diagnosis in trauma patients by presenting an appropriate reference creatinine estimate (RCE). We reviewed adult patients with severe trauma requiring intensive care unit admission between 2015 and 2019 (n=3,228) at a single regional trauma center in South Korea. AKI was diagnosed based on the current guideline published by the Kidney Disease: Improving Global Outcomes organization. AKI was determined using the following RCEs: estimated SCr75-modification of diet in renal disease (MDRD), trauma MDRD (TMDRD), admission creatinine level, and first-day creatinine nadir. We assessed inclusivity, prognostic ability, and incrementality using the different RCEs. The incidence of AKI varied from 15% to 46% according to the RCE used. The receiver operating characteristic curve of TMDRD used to predict mortality and the need for renal replacement therapy (RRT) had the highest value and was statistically significant (0.797, P<0.001; 0.890, P=0.002, respectively). In addition, the use of TMDRD resulted in a mortality prognostic ability and the need for RRT was incremental with AKI stage. In this study, TMDRD was feasible as a RCE, resulting in optimal post-traumatic AKI diagnosis and prognosis.

Development and Validation of a Renal Replacement after Trauma Scoring Tool.

Stress on the healthcare system requires careful allocation of resources such as renal replacement therapy (RRT). The COVID-19 pandemic generated difficulty securing access to RRT for trauma patients. We sought to develop a renal replacement after trauma (RAT) scoring tool to help identify trauma patients who may require RRT during their hospitalization. The 2017 to 2020 TQIP database was divided into a derivation (2017 to 2018 data) and validation (2019 to 2020 data) set. A 3-step methodology was used. Adult trauma patients admitted from the emergency department to the operating room or ICU were included. Patients with chronic kidney disease, transfers from another hospital, and emergency department death were excluded. Multiple logistic regression models were created to determine the risk for RRT in trauma patients. The weighted average and relative impact of each independent predictor was used to derive a RAT score, which was validated using area under receiver operating characteristic curve (AUROC). From 398,873 patients in the derivation and 409,037 patients in the validation set, 11 independent predictors of RRT were included in the RAT score derived with scores ranging from 0 to 11. The AUROC for the derivation set was 0.85. The rate of RRT increased to 1.1%, 3.3%, and 20% at scores of 6, 8, and 10, respectively. The validation set AUROC was 0.83. RAT is a novel and validated scoring tool to help predict the need for RRT in trauma patients. With future improvements including baseline renal function and other variables, the RAT tool may help prepare for the allocation of RRT machines/staff during times of limited resources.

Comparison of Clinical Outcomes Between Culture-Positive and Culture-Negative Sepsis and Septic Shock Patients: A Meta-Analysis.

This meta-analysis has been conducted to compare the clinical outcomes between culture-positive and culture-negative sepsis or septic patients. The present meta-analysis is reported as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Electronic databases, including PubMed and EMBASE, were searched by two authors independently from the inception to January 25, 2023, using the following key terms: "culture positive," "culture negative," "sepsis," and "septic shock." The primary outcome assessed in the present meta-analysis was all-cause mortality. Secondary outcomes included the need for mechanical ventilation, renal replacement therapy, length of ICU stay in days, and length of hospital stay in days. Total 10 studies met the inclusion criteria and were included in the meta-analysis involving 23,973 patients. No statistically significant difference was found between culture-positive and culture-negative patients in terms of all-cause mortality (risk ratio [RR]: 1.09, 95% CI: 0.95-1.24, p-value: 0.23), the need for mechanical ventilation (RR: 0.99, 95% CI: 0.93-1.05, p-value: 0.79), renal replacement therapy requirements (RR: 1.11, 95% CI: 0.95-1.31, p-value: 0.19), and ICU length of stay (mean difference [MD]: 1.70 days, 95% CI: -1.10, 4.49, p-value: 0.23). However, The mean hospital length of stay in days was significantly longer in patients in a culture-positive group compared to the culture-negative group (MD: 3.04, 95% CI: 2.25-3.82, p-value<0.001). In conclusion, the present meta-analysis of 10 studies, including 23,973 patients, found no significant differences in all-cause mortality, need for mechanical ventilation, need for renal replacement therapy, and length of ICU stay between culture-positive and culture-negative sepsis or septic patients. However, a significant difference was found in hospital length of stay, with culture-positive patients having a longer stay.

Long-Term Safety, Clinical and Immunological Outcomes in Primary Membranous Nephropathy with Severe Renal Impairment Treated with Cyclophosphamide and Steroid-Based Regimen

Introduction and Aims: Therapy of primary membranous nephropathy (PMN) with progressive advanced kidney dysfunction is challenging with limited literature and no clear therapeutic strategies. This is due to the scant evidence of effectiveness and uncertainty around the risk-benefit profile of immunosuppression (ImS) when eGFR is less than 30 mL/min. We aimed to determine long-term clinical outcomes in patients with PMN and severe renal impairment treated with combined cyclophosphamide and steroids. Methods: The study is a single-center retrospective longitudinal cohort study. All patients (between 2004 and 2019) with biopsy confirmed PMN who initiated combination therapy with steroids and cyclophosphamide and had an eGFR of ≤30 mL/min/1.73 m² at the time of initiation of therapy were included for analysis. Clinical and laboratory parameters including anti-PLA₂R-Ab were monitored as per standard clinical guidance. Primary outcome was achievement of partial remission. Secondary outcomes included immunological remission, need for renal replacement therapy, and adverse effects. Results: Eighteen patients with median age of 68 (IQR 58–73) years and 5:1 M:F ratio received the combination therapy when eGFR was ≤30 mL/min/1.73 m² (CKD-EPI). At time of ImS, median eGFR and uPCR were 23 (IQR 18–27) mL/min/1.73 m² and 8.4 (IQR 6.9–10.7) g/g, respectively. Median follow-up was for 67 (IQR 27–80) months. 16 patients (89%) achieved partial remission and 7 (39%) achieved complete remission. eGFR increased by 7 mL/min/1.73 m² (27%) after 1 year of starting ImS treatment and 12 mL/min/1.73 m² at end of follow-up. Two patients (11%) developed end-stage renal disease needing renal replacement therapy. 67% achieved both immunological and clinical remission. At the end of the follow-up period, 2 (11%) patients required hospitalization secondary to infections, 4 (22%) patients developed cancer and 4 patients died (22%). Conclusion: Combination therapy with cyclophosphamide and steroids is effective in achieving partial remission and improving renal function in PMN with advanced renal dysfunction. Prospective controlled studies are required to provide further evidence to rationalize treatment and improve outcomes in such patients.

Sex differences in risk factors for end-stage kidney disease and death in type 2 diabetes: A retrospective cohort study.

This study investigated the sex differences in the risk of end-stage kidney disease (ESKD) and mortality, as well as the effect modification of sex on associated factors in patients with type 2 diabetes. This multicenter observational cohort study included 4328 patients with type 2 diabetes. Hazard ratios (HRs) with 95% confidence intervals (CIs) of sex for ESKD and death were estimated using Cox proportional regression with adjustment for baseline covariates. For assessing risk modification, HRs and incidence rates for ESKD and death were compared between sexes across patient characteristics using Cox proportional and Poisson regression models. During a median follow-up of 7 years, 276 patients (70% men) developed ESKD, and 241 patients (68% men) died. Men had higher risks of ESKD (HR 1.34; 95% CI 1.02-1.75; p=.034) and death (HR 1.64; 95% CI 1.24-2.16; p=.001) versus women after adjusting for multiple covariates. Among patients with microalbuminuria, men had a substantially higher risk of ESKD versus women, compared to those with normo- and macroalbuminuria (p for interaction .04). Incidence rates were also increased in men versus women with albuminuria of around 300 mg/g. No differences were detected in the association of sex and death across baseline patient subgroups. In type 2 diabetes, men had an increased risk of ESKD and death versus women. Moderately increased albuminuria was strongly associated with sex difference in developing ESKD.

Diagnosing acute kidney injury ahead of time in critically ill septic patients using kinetic estimated glomerular filtration rate

IntroductionAccurate and actionable diagnosis of Acute Kidney Injury (AKI) ahead of time is important to prevent or mitigate renal insufficiency. The purpose of this study was to evaluate the performance of Kinetic estimated Glomerular Filtration Rate (KeGFR) in timely predicting AKI in critically ill septic patients. MethodsWe conducted a retrospective analysis on septic ICU patients who developed AKI in AmsterdamUMCdb, the first freely available European ICU database. The reference standard for AKI was the Kidney Disease: Improving Global Outcomes (KDIGO) classification based on serum creatinine and urine output (UO). Prediction of AKI was based on stages defined by KeGFR and UO. Classifications were compared by length of ICU stay (LOS), need for renal replacement therapy and 28-day mortality. Predictive performance and time between prediction and diagnosis were calculated. ResultsOf 2492 patients in the cohort, 1560 (62.0%) were diagnosed with AKI by KDIGO and 1706 (68.5%) by KeGFR criteria. Disease stages had agreement of kappa = 0.77, with KeGFR sensitivity 93.2%, specificity 73.0% and accuracy 85.7%. Median time to recognition of AKI Stage 1 was 13.2 h faster for KeGFR, and 7.5 h and 5.0 h for Stages 2 and 3. Outcomes revealed a slight difference in LOS and 28-day mortality for Stage 1. ConclusionsPredictive performance of KeGFR combined with UO criteria for diagnosing AKI is excellent. Compared to KDIGO, deterioration of renal function was identified earlier, most prominently for lower stages of AKI. This may shift the actionable window for preventing and mitigating renal insufficiency.

National Surgical Quality Improvement Project and acute kidney injury: Getting with the times

The American College of Surgeons National Surgical Quality Improvement Project (NSQIP) is the pre-eminent quality improvement database across surgical specialties including orthopedics, general surgery, neurosurgery, urology, otolaryngoloty, plastic and reconstructive surgery, and obstetrics and gynecology. One important perioperative outcome tracked by NSQIP is the incidence of acute kidney injury (AKI). Before 2021, the NSQIP defined AKI as an increase in serum creatinine >2 mg/dL from patients’ baseline or as the acute need for renal replacement therapy.

Case of the Month from the Peter MacCallum Cancer Centre, Melbourne, Australia: combination of stereotactic ablative body radiotherapy and radical nephrectomy for synchronous bilateral primary renal cell carcinoma.

Case of the Month from the Peter MacCallum Cancer Centre, Melbourne, Australia: combination of stereotactic ablative body radiotherapy and radical nephrectomy for synchronous bilateral primary renal cell carcinoma.

Impact of Obesity on Clinical Outcomes of Patients with Intra-Abdominal Hypertension and Abdominal Compartment Syndrome.

Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are associated with high morbidity and mortality. Obesity may result in increased intra-abdominal pressure (IAP) and affect clinical outcomes of patients with IAH and/or ACS. This study aims to establish the impact of obesity on the clinical outcomes of IAH and ACS patients. A systematic search of Medline, Embase, and Scopus was performed in August 2022. Nine studies comprising 9938 patients were included. There were 65.1% males (n = 6250/9596). Patient demographics, comorbidities, and morbidities were analyzed in correlation with obesity and IAP. Obese patients had a higher risk of IAH (OR 8.5, p < 0.001). Obesity was associated with the need for renal replacement therapy, intensive care unit-acquired infections, systemic inflammatory response syndrome, acute respiratory distress syndrome, length of hospital stay, and mortality. This review highlights the lacunae in the existing literature to underpin the direct impact of obesity, independent of obesity-associated comorbidities, on the clinical outcomes of IAH and ACS.

VV-ECMO in severe COVID-19: multidimensional perspectives on the use of a complex treatment

VV-ECMO in severe COVID-19: multidimensional perspectives on the use of a complex treatment