N-acetylcysteine for patients with prolonged hypotension as prophylaxis for acute renal failure (NEPHRON).

Background: Acute renal failure is a common complication in critically ill patients and carries an increased morbidity and mortality. N-acetylcysteine is an antioxidant and anti-inflammatory agent that may counteract some of the pathophysiologic derangements in shock states.

Objective: To test whether the administration of N-acetylcysteine, compared with placebo, reduces the incidence of acute renal failure in hypotensive patients.

Bone resorption and "relative" immobilization hypercalcemia with prolonged continuous renal replacement therapy and citrate anticoagulation.

Regional citrate anticoagulation is an alternative to heparin in patients with bleeding diatheses who require continuous renal replacement therapy (CRRT). The short-term metabolic consequences that occur with citrate anticoagulation are well described and usually manageable if established protocols are followed vigilantly. Because of its customary short-term nature, the long-term consequences of CRRT with citrate are less often considered and have not been reported.