Stopping renin-angiotensin system inhibitors in chronic kidney disease: predictors of response.

Background/aims: Renin-angiotensin system (RAS) inhibitors are considered first-line agents for hypertensive patients with progressive chronic kidney disease (CKD). In a previous study, we showed that stopping RAS inhibitors increased estimated glomerular filtration rate (eGFR) in a significant number of advanced CKD patients. The present study tries to address who would benefit and whether this benefit is predictable.

Cochrane meta-analysis: teicoplanin versus vancomycin for proven or suspected infection.

Objective: To compare efficacy and safety of vancomycin versusteicoplanin in patients with proven or suspected infection.

Data Sources: Cochrane Renal Group's Specialized Register, CENTRAL, MEDLINE, EMBASE, nephrology textbooks and review articles.

Inclusion Criteria: Randomized controlled trials in any language comparing teicoplanin to vancomycin for patients with proven or suspected infection.

Reduced mortality after the implementation of a protocol for the early detection of severe sepsis.

Objective: We evaluate the impact that implementing an in-hospital protocol for the early detection of sepsis risk has on mortality from severe sepsis/septic shock.

Methods: This was a prospective cohort study conducted in 2 phases at 2 general hospitals in Brazil. In phase I, patients with severe sepsis/septic shock were identified and treated in accordance with the Surviving Sepsis Campaign guidelines.

Vasodilation increases pulse pressure variation, mimicking hypovolemic status in rabbits.

Objective: To test the hypothesis that pulse pressure respiratory variation (PPV) amplification, observed in hypovolemia, can also be observed during sodium nitroprusside (SNP)-induced vasodilation.

Introduction: PPV is largely used for early identification of cardiac responsiveness, especially when hypovolemia is suspected. PPV results from respiratory variation in transpulmonary blood flow and reflects the left ventricular preload variations during respiratory cycles.

Pulse oximetry wave variation as a noninvasive tool to assess volume status in cardiac surgery.

Objective: To compare variations of plethysmographic wave amplitude (DeltaPpleth) and to determine the percent difference between inspiratory and expiratory pulse pressure (DeltaPp) cutoff values for volume responsiveness in a homogenous population of postoperative cardiac surgery patients.

Introduction: Intra-thoracic pressure variations interfere with stroke volume variation. Pulse pressure variations through arterial lines during mechanical ventilation have been recommended for the estimation of fluid responsiveness.

Variation in amplitude of central venous pressure curve induced by respiration is a useful tool to reveal fluid responsiveness in postcardiac surgery patients.

We tested the hypothesis that the dynamic evaluation of central venous pressure (CVP) amplitude could be a reliable predictor of fluid responsiveness in patients under mechanical ventilation, similar to the variation of arterial pulse pressure (DeltaPp). Thirty postcardiac surgery patients, under mechanical ventilation, were evaluated. The percentual difference between inspiratory (Ppins) and expiratory pulse pressure (Ppins) was so calculated: DeltaPp (%) = 100 x (Ppins - Ppexp)/[(Ppins + Ppexp)/2].