Publications by authors named "Xavier V Parada"
Article Synopsis
- There is a significant lack of data on dialysis decision-making for patients with cirrhosis who are ineligible for transplants, prompting this study to explore RRT initiation processes, predictors, and outcomes.
- The research involved evaluating 372 patients with acute kidney injury due to conditions like hepatorenal syndrome, revealing that those who received RRT had a median survival of 12.5 days, compared to just 2 days for those who didn't.
- The study highlights that most patients receiving RRT had short-term mortality and intensive end-of-life care, and it emphasizes the need for better clinical processes for communication and decision-making regarding RRT in this vulnerable population.
Background & Aims: Acute kidney injury (AKI) in cirrhosis is common and associated with high morbidity, but the incidence rates of different etiologies of AKI are not well described in the US. We compared incidence rates, practice patterns, and outcomes across etiologies of AKI in cirrhosis.
Methods: We performed a retrospective cohort study of 11 hospital networks, including consecutive adult patients admitted with AKI and cirrhosis in 2019.
Hepatorenal syndrome (HRS) is a form of acute kidney injury (AKI) occurring in patients with advanced cirrhosis and is associated with significant morbidity and mortality. The pathophysiology underlying HRS begins with increasing portal pressures leading to the release of vasodilatory substances that result in pooling blood in the splanchnic system and a corresponding reduction in effective circulating volume. Compensatory activation of the sympathetic nervous system and the renin-angiotensin-aldosterone system and release of arginine vasopressin serve to defend mean arterial pressure but at the cost of severe constriction of the renal vasculature, leading to a progressive, often fulminant form of AKI.
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- Acute kidney injury (AKI) is more common in hospitalized COVID-19 patients (23%) compared to those with influenza (13%), indicating a higher risk associated with COVID-19.
- Research involved a study of 2,425 patients, where COVID-19 patients had an increased risk of AKI and higher in-hospital mortality rates compared to influenza patients.
- Despite the higher AKI and mortality rates in COVID-19 patients, long-term kidney recovery outcomes seem similar to those of influenza patients after 90 days, suggesting some resilience in kidney recovery.
Introduction: Urinary neutrophil gelatinase-associated lipocalin (NGAL) has shown promise in differentiating acute tubular necrosis (ATN) from other types of acute kidney injuries (AKIs) in cirrhosis, particularly hepatorenal syndrome (HRS). However, NGAL is not currently available in clinical practice in North America.
Methods: Urinary NGAL was measured in a prospective cohort of 213 US hospitalized patients with decompensated cirrhosis (161 with AKI and 52 reference patients without AKI).
Magnetic resonance imaging (MRI) is a powerful diagnostic tool, but its use is restricted to the scanner suite. Here, we demonstrate that a bedside nuclear magnetic resonance (NMR) sensor can assess fluid status changes in individuals at a fraction of the time and cost compared to MRI. Our study recruited patients with end-stage renal disease (ESRD) who were regularly receiving hemodialysis treatments with intradialytic fluid removal as a model of volume overload and healthy controls as a model of euvolemia.
View Article and Find Full Text PDFBackground And Objectives: Literature on the prognosis of patients with cirrhosis who require RRT for AKI is sparse and is confounded by liver transplant eligibility. An update on outcomes in the nonlisted subgroup is needed. Our objective was to compare outcomes in this group between those diagnosed with hepatorenal syndrome and acute tubular necrosis, stratifying by liver transplant listing status.
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