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      Contrast-induced acute kidney injury and renal support for acute kidney injury: a KDIGO summary (Part 2)

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      1 , , 2
      Critical Care
      BioMed Central

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          Abstract

          Acute kidney injury (AKI) is a common and serious problem affecting millions and causing death and disability for many. In 2012, Kidney Disease: Improving Global Outcomes completed the first ever international multidisciplinary clinical practice guideline for AKI. The guideline is based on evidence review and appraisal, and covers AKI definition, risk assessment, evaluation, prevention, and treatment. Two topics, contrast-induced AKI and management of renal replacement therapy, deserve special attention because of the frequency in which they are encountered and the availability of evidence. Recommendations are based on systematic reviews of relevant trials. Appraisal of the quality of the evidence and the strength of recommendations followed the Grading of Recommendations Assessment, Development and Evaluation approach. Limitations of the evidence are discussed and a detailed rationale for each recommendation is provided. This review is an abridged version of the guideline and provides additional rationale and commentary for those recommendation statements that most directly impact the practice of critical care.

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          Most cited references121

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          A simple risk score for prediction of contrast-induced nephropathy after percutaneous coronary intervention: development and initial validation.

          We sought to develop a simple risk score of contrast-induced nephropathy (CIN) after percutaneous coronary intervention (PCI). Although several risk factors for CIN have been identified, the cumulative risk rendered by their combination is unknown. A total of 8,357 patients were randomly assigned to a development and a validation dataset. The baseline clinical and procedural characteristics of the 5,571 patients in the development dataset were considered as candidate univariate predictors of CIN (increase >or=25% and/or >or=0.5 mg/dl in serum creatinine at 48 h after PCI vs. baseline). Multivariate logistic regression was then used to identify independent predictors of CIN with a p value 75 years, anemia, and volume of contrast) were assigned a weighted integer; the sum of the integers was a total risk score for each patient. The overall occurrence of CIN in the development set was 13.1% (range 7.5% to 57.3% for a low [ or=16] risk score, respectively); the rate of CIN increased exponentially with increasing risk score (Cochran Armitage chi-square, p < 0.0001). In the 2,786 patients of the validation dataset, the model demonstrated good discriminative power (c statistic = 0.67); the increasing risk score was again strongly associated with CIN (range 8.4% to 55.9% for a low and high risk score, respectively). The risk of CIN after PCI can be simply assessed using readily available information. This risk score can be used for both clinical and investigational purposes.
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            Contrast-induced acute kidney injury.

            Cardiac angiography and coronary/vascular interventions depend on iodinated contrast media and consequently pose the risk of contrast-induced acute kidney injury (AKI). This is an important complication that accounts for a significant number of cases of hospital-acquired renal failure, with adverse effects on prognosis and health care costs. The epidemiology and pathogenesis of contrast-induced AKI, baseline renal function measurement, risk assessment, identification of high-risk patients, contrast medium use, and preventive strategies are discussed in this report. An advanced algorithm is suggested for the risk stratification and management of contrast-induced AKI as it relates to patients undergoing cardiovascular procedures. Contrast-induced AKI is likely to remain a significant challenge for cardiologists in the future because the patient population is aging and chronic kidney disease and diabetes are becoming more common.
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              Ultrasonic locating devices for central venous cannulation: meta-analysis.

              To assess the evidence for the clinical effectiveness of ultrasound guided central venous cannulation. 15 electronic bibliographic databases, covering biomedical, science, social science, health economics, and grey literature. Systematic review and meta-analysis of randomised controlled trials. Populations Patients scheduled for central venous access. INTERVENTION REVIEWED: Guidance using real time two dimensional ultrasonography or Doppler needles and probes compared with the anatomical landmark method of cannulation. Risk of failed catheter placement (primary outcome), risk of complications from placement, risk of failure on first attempt at placement, number of attempts to successful catheterisation, and time (seconds) to successful catheterisation. 18 trials (1646 participants) were identified. Compared with the landmark method, real time two dimensional ultrasound guidance for cannulating the internal jugular vein in adults was associated with a significantly lower failure rate both overall (relative risk 0.14, 95% confidence interval 0.06 to 0.33) and on the first attempt (0.59, 0.39 to 0.88). Limited evidence favoured two dimensional ultrasound guidance for subclavian vein and femoral vein procedures in adults (0.14, 0.04 to 0.57 and 0.29, 0.07 to 1.21, respectively). Three studies in infants confirmed a higher success rate with two dimensional ultrasonography for internal jugular procedures (0.15, 0.03 to 0.64). Doppler guided cannulation of the internal jugular vein in adults was more successful than the landmark method (0.39, 0.17 to 0.92), but the landmark method was more successful for subclavian vein procedures (1.48, 1.03 to 2.14). No significant difference was found between these techniques for cannulation of the internal jugular vein in infants. An indirect comparison of relative risks suggested that two dimensional ultrasonography would be more successful than Doppler guidance for subclavian vein procedures in adults (0.09, 0.02 to 0.38). Evidence supports the use of two dimensional ultrasonography for central venous cannulation.
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                Author and article information

                Contributors
                Journal
                Crit Care
                Crit Care
                Critical Care
                BioMed Central
                1364-8535
                1466-609X
                2013
                4 February 2013
                4 February 2014
                : 17
                : 1
                : 205
                Affiliations
                [1 ]Ghent University Hospital, De Pintelaan 185, Ghent B9000, Belgium
                [2 ]The CRISMA Center, Department of Critical Care Medicine, 604 Scaife Hall, University of Pittsburgh School of Medicine, Pittsburgh, PA 15261, USA
                [3 ]KDIGO AKI Guideline Work Group: John A Kellum (Work Group Co-Chair), University of Pittsburgh, PA, USA; Norbert Lameire (Work Group Co-Chair), University of Ghent, Belgium; Peter Aspelin, Karolinska Institute, Sweden; Rashad S Barsoum, Cairo University, Egypt; Emmanuel A Burdmann, University of São Paulo, Brazil; Stuart L Goldstein, Cincinnati Children's Hospital Medical Center, OH, USA; Charles A Herzog, Hennepin County Medical Center, MN, USA; Michael Joannidis, Medical University Innsbruck, Austria; Andreas Kribben, University of Duisburg-Essen, Germany; Andrew S Levey, Tufts University, MA, USA; Alison M Macleod, University of Aberdeen, UK; Ravindra L Mehta, University of California, San Diego, CA, USA; Patrick T Murray, University College Dublin, Ireland; Saraladevi Naicker, University of the Witwatersrand, South Africa; Steven M Opal, Brown University, RI, USA; Franz Schaefer, Heidelberg University Hospital, Germany; Miet Schetz, University of Leuven, Belgium; and Shigehiko Uchino, Jikei University School of Medicine, Japan
                Author notes
                for the KDIGO AKI Guideline Work Group
                Article
                cc11455
                10.1186/cc11455
                4056805
                23394215
                11acd221-21e5-4460-a81d-a3b5fdef0648
                Copyright © 2013 BioMed Central Ltd
                Categories
                Review

                Emergency medicine & Trauma
                Emergency medicine & Trauma

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