Paul M Palevsky

..There does not appear to be a difference in either mortality or recovery of kidney function associated with the various modalities of RRT. Finally, providing higher doses of RRT is not associated with improved clinical outcomes...

..Much as we understand that CKD predisposes to the development of AKI, we must recognize that the relationship is bidirectional and that our patients with AKI are at risk for chronic-on-acute kidney disease...

..Two large multicenter randomized clinical trials addressing this question are currently underway and should provide more definitive data within the next two years...

..Similarly, although data suggest that continuous venovenous hemofiltration (CVVH) should be dosed at no less than 35 ml/kg/hr (postdilution), confirmation of this dosing strategy and validation for other modalities of CRRT are required...

..In this review, we categorize the major complications associated with renal replacement therapy and assess their impact on recovery of renal function...

..Existing data on timing of initiation of renal replacement therapy in acute kidney injury that guide current clinical practice are summarized and issues that need to be addressed in future clinical trials are discussed...

..These data will help inform the study's DSMB and site IRB's of the relationship between the study's treatment arms and concurrent clinical practice...

..Finally, we address the implications of the ATN Study results for clinical practice from the perspective of the study investigators...

..Special issues related to the management of haemodialysis and peritoneal dialysis patients in the perioperative period are also reviewed...

..Definitive resolution of the appropriate indications and timing for initiation of renal replacement therapy in acute renal failure requires prospective evaluation in a randomized clinical trial...

....

..The largest and most recent trials suggest that there is no additional benefit to using effluent flow rates in excess of 20 ml/kg/hour, although earlier studies suggested improved survival with doses of 35 to 45 ml/kg/hour...

..The incidence and outcomes of CIAKI in patients undergoing nonemergent, contrast-enhanced computed tomography in the inpatient and outpatient setting were assessed...

..The factors that affect the implementation of preventive care for contrast-induced acute kidney injury (CIAKI) are unknown...

....

..We sought to characterize renal provider perceptions and practice patterns regarding the treatment of these symptoms...

..This paper discusses the design and key methodological issues that arose during the planning of the study...

..The factors contributing to this remain largely unknown. The aim of this study was to assess the associations of race and ethnicity with anemia care prior to the initiation of renal replacement therapy...

..We sought to characterize the prevalence of and associations of demographic and clinical characteristics with limited health literacy in patients receiving maintenance hemodialysis...

..Pain, erectile dysfunction (ED), and depression are common yet frequently untreated in chronic hemodialysis patients. This study compared two management strategies for these symptoms in this patient population...

..The primary endpoints are changes in scores on pain, erectile dysfunction, and depression surveys. This report describes the rationale and methodology of this clinical trial...

..These findings suggest that cultural background may affect adaptation to chronic hemodialysis therapy...

..The groups considered trial design issues and discussed advantages and disadvantages of several short- and long-term primary endpoints in these patients...

..Companion articles outline the discussions of workgroups for model trials related to prevention or treatment of established AKI in different clinical settings, such as in patients with sepsis...

..We sought to assess provider knowledge of the risk factors and preventive interventions for CIAKI...

..The purpose of this review is to describe the principal risk factors for contrast-induced acute kidney injury and to summarize recent data describing the efficacy of various preventive interventions for this condition...

..The risk of intravascular radiocontrast to residual renal function (RRF) in patients on peritoneal dialysis (PD) remains largely unknown...

..Studies evaluating N-acetylcysteine have been conflicting, with meta-analyses suggesting a small beneficial effect. Studies of other pharmacologic agents have not demonstrated clinical benefit...

..However, these symptoms are prevalent and under-treated, which should spur efforts to assess the impact of improving provider assessment and treatment of these symptoms on patient outcomes, including health-related quality of life...

..We hypothesized that kidney dysfunction would associate with emphysema rather than with airflow obstruction measured by the FEV₁...

..The aim of this study was to assess renal provider recognition of symptoms and their severity in hemodialysis patients...

..The authors of a recent meta-analysis endeavored to provide a definitive assessment of the relative efficacy of these two intravenous fluids...

..The incidence, staging, evaluation, management, and prognosis of acute kidney injury are also examined with special focus given to older adults...

..Unfortunately, no reliable method to predict renal recovery exists. The discovery of biomarkers to aid in clinical risk prediction for recovery after AKI would represent a significant advance over current practice...

....

..This review focuses on the epidemiology and diagnostic approach to ARF in the ICU and summarizes our current understanding of therapeutic approaches including RRT...

..This observation will help guide the post-procedure care of patients who undergo coronary angiography and has important implications for future studies that investigate RCN...

....

..A series of studies have demonstrated that volume expansion, particularly with intravenous fluids, is an effective intervention to reduce the risk for contrast-induced nephropathy...

..Selection of modality of RRT should therefore rely on the resources and expertise available...

..Data on current practices for management of renal replacement therapy (RRT) in acute kidney injury (AKI) are limited, particularly with regard to the dosing of therapy...

....

..The relative roles of arteriovenous (AV) and venovenous (VV) modalities of therapy were also evaluated. The workgroup also addressed the optimal components of a CRRT system from an operational standpoint...

..This article reviews the new criteria for diagnosis and staging of AKI and summarizes the current understanding of the many causes of AKI and the approach to diagnosis and management...

..Immunization rates for each influenza season increased significantly from 62.1% and 61.4% in 1998-1999 to 80.3% and 80.0% in 2000-2001 (Pennsylvania and Delaware respectively)...

..This method is well suited for the rapid analysis of large numbers of samples and is currently being used for in vitro investigations of solute removal by hemodialysis...

..An international, consensus-based, prioritized research agenda was sought to guide clinical and translational research in acute kidney injury...

..We sought to determine whether providers employ these strategies in high-risk patients to limit the development of RCN...

..These developments have set the stage for the first conference and have now driven the spirit of the second. Once again, the final objectives are the development of evidence-based guidelines and directions for future research...

..Accordingly, the second Acute Dialysis Quality Initiative conference in Vicenza, Italy, was organized, and its goals and rationale are presented in this report...

..ClinicalTrials.gov number, NCT00076219.)..

..Design elements of clinical trials can introduce recruitment bias and reduce study efficiency. Trials involving the critically ill may be particularly prone to design-related inefficiencies...

..Institutional or regional quality improvement boards, operating parallel to current IRBs, are suggested as 1 means of ensuring that QIP participants are offered the same protections as those who take part in clinical research...

..Although several observational and interventional studies have addressed these topics, there are no consensus recommendations in this field...