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Introduction: Anticoagulation is recommended during continuous kidney replacement therapy (CKRT) to prolong the filter lifespan for optimal filter performance. We aimed to evaluate the effect of anticoagulation during CKRT on dialysis dependence and mortality within 90 days of intensive care unit (ICU) admission.
Method: Our retrospective observational study evaluated the first CKRT session in critically ill adults with acute kidney injury (AKI) in Singapore from April to September 2017. The primary outcome was a composite of dialysis dependence or death within 90 days of ICU admission; the main exposure variable was anticoagulation use (regional citrate anticoagulation [RCA] or systemic heparin). Multivariable logistic regression was performed to adjust for possible confounders: age, female sex, Acute Physiology and Chronic Health Evaluation (APACHE II) score, liver dysfunction, coagulopathy (international normalised ratio[INR] >1.5) and platelet counts of less than 100,000/uL).
Results: The study cohort included 276 patients from 14 participating adult ICUs, of whom 176 (63.8%) experienced dialysis dependence or death within 90 days of ICU admission (19 dialysis dependence, 157 death). Anticoagulation significantly reduced the odds of the primary outcome (adjusted odds ratio [AOR] 0.47, 95% confidence interval [CI] 0.27-0.83, P=0.009). Logistic regression analysis using anticoagulation as a 3-level indicator variable demonstrated that RCA was associated with mortality reduction (AOR 0.46, 95% CI 0.25-0.83, P=0.011), with heparin having a consistent trend (AOR 0.51, 95% CI 0.23-1.14, P=0.102).
Conclusion: Among critically ill patients with AKI, anticoagulation use during CKRT was associated with reduced dialysis or death at 90 days post-ICU admission, which was statistically significant for regional citrate anticoagulation and trended in the same direction of benefit for systemic heparin anticoagulation. Anticoagulation during CKRT should be considered whenever possible.
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http://dx.doi.org/10.47102/annals-acadmedsg.202337 | DOI Listing |
Front Med (Lausanne)
December 2024
Metabolismo Óseo, Vascular y Enfermedades Inflamatorias Crónicas, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain.
Introduction: Cardiovascular disease is the major cause of premature death in chronic kidney disease (CKD) and vascular damage is often detected belatedly, usually evaluated by expensive and invasive techniques. CKD involves specific risk factors that lead to vascular calcification and atherosclerosis, where inflammation plays a critical role. However, there are few inflammation-related markers to predict vascular damage in CKD.
View Article and Find Full Text PDFNefrologia (Engl Ed)
December 2024
Department of Medical Doctor Study Program, Faculty of Medicine, Hasanuddin University, Makassar City, South Sulawesi Province, Indonesia.
Background: Chronic kidney disease (CKD) is a major global health problem. Hyperphosphatemia is frequent in CKD and a reason for increased morbidity and mortality as it generates hyperparathyroidism, high fibroblast growth factor 23 (FGF23), and hypocalcemia. Available hyperphosphatemia therapies still have limitations, including risk of metal overload, cardiovascular calcification, and systemic adverse effects (AEs).
View Article and Find Full Text PDFClin Kidney J
December 2024
Department of Health Data Science, Graduate School of Data Science, Yokohama City University, Yokohama, Japan.
Background: Peripheral arterial disease (PAD) occurs frequently in patients undergoing dialysis, but early intervention for PAD may not be fully implemented. We evaluated the effects of financially incentivising dialysis facilities that provided early detection and management of PAD on outcomes of PAD care.
Methods: This retrospective cohort study identified patients aged 18-74 years who received maintenance haemodialysis between April 2016 and March 2021 from the JMDC Claims Database.
BMC Nephrol
December 2024
Department of Intensive Care Unit, Suzhou University Affiliated Changshu Hospital, Changshu, China.
Background And Objective: Critical bedside ultrasound is widely used in clinical practice, and it can monitor renal perfusion. The reduction of renal perfusion and inflammatory injury are two contributing factors to sepsis-associated acute kidney injury (SA-AKI).The aim of this study was to examine whether the oXiris filter was useful in the continuous renal replacement therapy(CRRT) treatment of SA-AKI patients.
View Article and Find Full Text PDFDiabetes Care
December 2024
Division of Nephrology and Hypertension, University of North Carolina School of Medicine, Chapel Hill, NC.
Of the nearly 600,000 people in the U.S. who receive dialysis for chronic kidney failure, >60% have diabetes.
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