Association of gender, age, and race on renal outcomes and mortality in patients with severe sepsis and septic shock.

Background: The association of age, gender and race with renal outcomes in patients with severe sepsis and septic shock (SEP) is not completely elucidated. We aimed to shed light on these relationships.

Methods: We performed a retrospective cohort study of hospitalized patients in the USA discharged between January 1st, 2005 and December 31st, 2014 using the National Inpatient Sample.

Importance of Endotoxin Clearance in Endotoxemic Septic Shock: An Analysis From the Evaluating Use of PolymyxinB Hemoperfusion in a Randomized Controlled Trial of Adults Treated for Endotoxemic Septic Shock (EUPHRATES) Trial.

Unlabelled: To investigate the relationship between survival and treatment-related reduction in endotoxin activity for patients in the Evaluating Use of PolymyxinB Hemoperfusion in a Randomized controlled trial of Adults Treated for Endotoxemia and Septic shock trial with baseline endotoxin activity assay greater than or equal to 0.60 to less than 0.90 units.

Renal Replacement Therapy in the ICU.

Objectives: The incidence of acute kidney injury in critically ill patients is increasing steeply. Acute kidney injury in this setting is associated with high morbidity and mortality. There is no doubt that renal replacement therapy for the most severe forms of acute kidney injury can be life saving, but there are a number of uncertainties about the optimal application of renal replacement therapy for patients with acute kidney injury.

Effect of Targeted Polymyxin B Hemoperfusion on 28-Day Mortality in Patients With Septic Shock and Elevated Endotoxin Level: The EUPHRATES Randomized Clinical Trial.

Importance: Polymyxin B hemoperfusion reduces blood endotoxin levels in sepsis. Endotoxin activity can be measured in blood with a rapid assay. Treating patients with septic shock and elevated endotoxin activity using polymyxin B hemoperfusion may improve clinical outcomes.

Plasma oxalate levels in prevalent hemodialysis patients and potential implications for ascorbic acid supplementation.

Objectives: Ascorbic acid (AA) supplementation may increase hemoglobin levels and decrease erythropoiesis-stimulating agent dose requirement in patients with end stage renal disease (ESRD). While plasma AA levels >100μM may be supratherapeutic, levels of at least 30μM may be needed to improve wound healing and levels may need to reach 70μM to optimize erythropoiesis. Of concern, oxalate (Ox), an AA metabolite, can accumulate in ESRD.

Good syndrome and other causes of cytomegalovirus retinitis in HIV-negative patients-case report and comprehensive review of the literature.

We describe a 65-year-old Thai woman who developed cytomegalovirus retinitis (CMVR) in the setting of Good syndrome-a rare, acquired partial immune deficiency caused by thymoma. The patient subsequently developed vitritis with cystoid macular edema (CME) similar to immune recovery uveitis (IRU) despite control of the retinitis with antiviral agents. A comprehensive review of the literature through December, 2014, identified an additional 279 eyes of 208 patients with CMVR in the absence of human immunodeficiency virus (HIV) infection.

Lactic Acidosis in a Patient with Type 2 Diabetes Mellitus.

Lactic acidosis occurs when lactate production exceeds its metabolism. There are many possible causes of lactic acidosis, and in any given patient, several causes may coexist. This Attending Rounds presents a case in point.

Plasma ascorbic acid concentrations in prevalent patients with end-stage renal disease on hemodialysis.

Objective: To determine the prevalence of vitamin C (ascorbic acid [AA]) deficiency in patients with end-stage renal disease, the effect of supplemental AA on plasma AA concentrations, and the extrinsic and intrinsic factors that affect plasma AA concentrations in this patient population.

Design: In study 1, we compared the effect of hemodialysis (HD) on plasma AA concentrations between patients with low and high pre-HD AA concentrations. In study 2, we analyzed kinetic and nonkinetic factors for their association with increased plasma AA concentrations in patients on maintenance HD.

Pseudo-blood leak? A hemodialysis mystery.

Hydroxocobalamin is a treatment for cyanide toxicity with few side effects. We report a case of a hemodialysis patient whose treatment was compromised by hydroxocobalamin interference with the blood leak detector.

A comparison of the infant car seat challenge and the polysomnogram at the time of hospital discharge.

Objective: The American Academy of Pediatrics recommends all infants born at <37 weeks gestation spend a period of observation in a car seat prior to hospital discharge to assess for apnoea, bradycardia or oxygen desaturation. The most recent Cochrane review suggested further studies to determine if the infant car seat challenge (ICSC) accurately predicts the risk of clinically adverse events. We reviewed our experience with the ICSC and the polysomnogram (PSG) to determine if the ICSC accurately predicts the risk of adverse events when compared with the PSG.

The fallacy of the BUN:creatinine ratio in critically ill patients.

Background And Objectives: Acute kidney injury (AKI) is common in critically ill patients and is associated with a high mortality rate. Pre-renal azotemia, suggested by a high blood urea nitrogen to serum creatinine (BUN:Cr) ratio (BCR), has traditionally been associated with a better prognosis than other forms of AKI. Whether this pertains to critically ill patients is unknown.

The patient-centered medical home and the nephrologist.

The patient-centered medical home (PCMH) is a model of practice that has been proposed to address the many ills of our current health care delivery and financing systems. At its heart is a primary care practice that provides comprehensive, coordinated, high-quality, personalized care. Integral to the success of the PCMH model is a "neighborhood" of specialists who subscribe to the principles of the PCMH.

Minerals in dialysis therapy: an introduction.

The 180 l of glomerular filtrate formed each day contain some 1100 g (2.5 pounds) of sodium chloride, of which only 5-10 g are excreted in the urine--95% is reabsorbed by the tubules. Some 425 g (nearly a pound) of sodium bicarbonate and 145 g of glucose are filtered, and more than 99% of both are reabsorbed.

The safety of low-potassium dialysis.

Patients with kidney failure depend on dialysis to maintain neutral potassium balance. The amount of potassium removed during a hemodialysis treatment is inversely proportional to the potassium concentration in the dialysis bath. Nephrologists adjust the dialysis bath potassium to account for individual variation in potassium intake among their patients.

Treatment of lactic acidosis: appropriate confusion.

Background: Lactic acidosis (LA) is common in hospitalized patients and is associated with poor clinical outcomes. There have been major recent advances in our understanding of lactate generation and physiology. However, treatment of LA is an area of controversy and uncertainty, and the use of agents to raise pH is not clearly beneficial.

Idiopathic acute renal vein thrombosis in a young healthy woman with no hypercoagulable state taking oral contraceptives.

Renal veins rarely thrombose. However, when they do, the cause is almost always obvious. The clinical circumstances underlying acute or chronic renal vein thrombosis are well defined.

Management of severe hyperkalemia.

Background And Objectives: Hyperkalemia is one of the few potentially lethal electrolyte disturbances. Prompt recognition and expeditious treatment of severe hyperkalemia are expected to save lives. This review is intended to provide intensivists and other interested clinicians with an understanding of the pathophysiology that underlies hyperkalemia, and a rational approach to its management.