View clinical trials related to Acute Kidney Injury.
Filter by:Acute kidney injury requiring dialysis (AKI-D) has increased considerably over last 15 years. The national rise in incidence of acute kidney injury has several ramifications in terms of cost to the health services resulting not only from cost of therapy but also from the later consequences of AKI from development of chronic kidney disease and cardiovascular disease. Mortality in patients with AKI-D is very high and remains unchanged in the last decade in England. In recent years it is becoming clearer that even the national incidence and case-fatality of AKI is influenced by regional variation. In last three decades, many studies have reported unwarranted variation in a wide range of procedures, from the performance of cesarean section and coronary angiography to the treatment of early prostate cancer, stroke, and the ailments of the chronically ill. In surgical care there is evidence that the variation may be driven by forces other than patient illness and medical appropriateness such as access to care and other socioeconomic factors, provider capacity of the local system, medical malpractice pressure, and distinctly different local practices. Despite the public health burden of AKI-D in England, it is unclear if regional variation exists in AKI-D. Variation in incidence of AKI-D in different region of a country may be influenced by patient and physician demographics of the regions, physician preferences or the nature of the hospital serving the population. To reduce the incidence and case fatality of AKI-D, it is imperative to understand if variations in incidence and case-fatality in AKI-D exists in different regions of the country. To address this gap in knowledge, the investigators combined national database of hospital admissions and discharge with census data from office of national statistic over a period of fifteen years to determine the trend in change in the regional incidence and case fatality of AKI requiring dialysis in England. The investigators also explored various determinants of the regional variation in the dialysis requiring AKI. Methods Data source The investigators extracted 2000-2015 data from the Hospital Episode Statistics (HES), a data warehouse containing details of all admissions, outpatient appointments, and A&E attendances at National Health Service (NHS) hospitals in England. Definitions The investigators identified all cases of AKI by using validated International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes in any diagnoses codes, in keeping with the objective of the study. Patients with any of the following codes were included: N17.0 for acute renal failure (ARF) with tubular necrosis, N17.1 for ARF with acute cortical necrosis, N17.2 for ARF with medullary necrosis, N17.8 for other ARF and N17.9 for ARF, unspecified. ARF has been replaced by new terminology, AKI, but due to lack of ICD10 codes for AKI, the investigators used the ICD10 codes for ARF and henceforth, will be referred to as AKI in this study. The investigators also extracted all available secondary diagnosis and up to 24 Office of Population Censuses and Surveys Classification of Interventions and Procedures, 4th revision (OPCS-4) codes. To identify patients with AKI-D, the investigators included OPCS code of X40.3 for hemodialysis or X40.4 for hemofiltration in any of the 25 procedures. Patients with chronic kidney disease stage 5 (CKD-5) starting chronic dialysis and end stage renal disease (ESRD) with ICD-10 code of N18.5 and N18.6 respectively were excluded. The investigators also excluded OPCS-4 codes for Arteriovenous fistula (L74.2) or Arteriovenous graft (L74.3) during the inpatient admission. HES data stratifies patient location into 16 different regions. The geographic regions in England were stratified as per the Office of National Statistic (ONS) into nine regions: North East, North West, Yorkshire and Humber, East Midlands, West Midlands, East of England, London, South East and South West. Patients' in geographical locations outside these nine regions were excluded. Patients who were admitted, but were not discharged during the study period will not be included in the study. The investigators also obtained completed hospital discharges from each region to estimate the effect of hospitalization on AKI-D incidence rates, along with number of nephrology consultants in each region from 2000 to 2015 from Health and Social Care Information Centre (HSCIC) in the annual census of medical and dental staff in the NHS. The investigators will also obtain linkage with ONS and UK Renal Registry (UKRR) for long-term patient and renal outcomes. To obtain population incidence of AKI-D for each region, mid-year population of the region in each year from 2000 to 2015 was obtained from the ONS.
Contrast-medium induced nephropathy (CIN) is a frequent and devastating complication of coronary angiography, occurring in 10-50% of cases. As would be expected, the incidence of CIN is much higher in patients with underlying renal dysfunction. Multiple trials have found CIN to be an independent predictor of prolonged hospitalization and both 30 day and 1 year mortality in patients with coronary artery disease. Intravenous contrast dye is felt to cause renal ischemia as the mechanism of injury. Unfortunately, despite the significant morbidity and mortality with CIN, there are few therapeutic interventions to reduce the risk with the exception of hydration and high dose statin therapy. Recently, remote ischemic preconditioning (RIPC), a process of inducing transient arm ischemia by inflating a blood pressure cuff to 200 mmHg for 3 repetitive 5 minute cycles, leads to a systemic cytoprotective response and ultimately reduces ischemic renal injury, myocardial injury, and even cerebral injury following coronary bypass grafting. While there is significant data supporting the role of RIPC in reducing systemic ischemic injury in surgical patients, there is only one small trial studying RIPC in patient's undergoing coronary angiography. The investigators hypothesize that RIPC will reduce the incidence of contrast-induced nephropathy in patients with baseline renal dysfunction undergoing coronary angiography for stable or unstable coronary artery disease.
Hyperkalemia is a common problem in the emergency services and one of the life threatening metabolic emergencies. Calcium, insulin, beta adrenoceptor agonists, bicarbonate, diuretics, sodium polystyrene sulfonate and lastly dialysis are advised in treatment. Especially, avoiding evolution of serious arrythmias and iv calcium using in the treatment of occured electrocardiogram (ECG) abnormalities, there is not sufficient level of survey in the literature. So the aim of this study was to evaluate administration of iv calcium efficiency on vital signs and ECG.
The aim of this study was to prospectively evaluate MECC compared with conventional extracorporeal circulation of diabetic patients undergoing elective coronary revascularization procedures. The investigators focused on the effects of extracorporeal circulation especially the renal function between both groups.
The aim of this study is to evaluate the effect of regional citrate anticoagulation within the scope of continuous renal replacement (CRRT) in critically ill patients with acute kidney injury (AKI) on filter life span and 90-day all cause mortality.
Acute kidney injury (AKI) is a potential complication of cardiac surgery. In animal models, excess exogenous Cl- ion in the bloodstream is associated with AKI. Normal saline IV fluid has higher levels of Cl- ion than the blood usually carries. An alternative IV fluid sold under the name Isolyte has lower Cl- ion levels. There is no literature comparing AKI outcomes in cardiac patients between patients receiving normal saline vs. Isolyte. The investigators propose to recruit and randomize 30 trial-completing cardiac surgery patients (up to 40 enrolled) into 2 study arms and compare renal outcomes.
Prospective, blinded, placebo-controlled trial. Patients: Adult patients (>18 years of age) undergoing de novo Htx, with a preoperative GFR > 30ml/min, not receiving an ABO-incompatible organ with an ischemia time of > 6 hours. A donor age > 70 years is an exclusion criteria. Intervention: Infusion of h-ANP fore five days, starting at the induction of anesthesia. Outcome: Kidney function, evaluated with serum creatinine day 1-7 and kidney clearance, 4-5 Days after Htx plus after 3 and 12 months.
The primary objective of this study is to compare 28 day mortality rates between septic shock patients with acute renal insufficiency treated via L-Carnitine (as an adjunct therapy) versus a similar group of patients not receiving L-Carnitine adjunct therapy.
This proposal will incorporate statistical models developed by the investigators to predict risk for acute kidney injury into our electronic medical record system, enabling an alert to notify providers of the risk status. Pediatric inpatients will be randomly assigned to be in the intervention group, for whom the notification will be implemented, or in the control group, who will receive usual care (no notification). The investigators believe the notification will increase appropriate screening for acute kidney injury and reduce the severity of acute kidney injury in the intervention group.
The purpose of this prospective observational cohort study is to evaluate multimodal monitoring technologies in the perioperative care of cardiac surgical patients. Right ventricular pressure tracings, near infrared spectroscopy (NIRS) and transthoracic ultrasonography will be studied for their ability to detect and predict complications such as right ventricular failure, renal failure and respiratory failure.