3. Dr. Haas invented the first dialysis machine designed for humans and in 1928 he treated 6 patients. All of them died.
4. In 1943, Willem Kolff’s, working in Nazi occupied Netherlands created the second human dialysis machine. In 1943 he dialyzed his first patient, a young man with acute nephritis. In 1945, a 67-year-old woman in uremic coma presented to Dr Kolff. Regained consciousness after 11 hours of hemodialysis. Dr. Haas
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10. Same rise in creatinine. Same diagnosis: acute renal failure. Two completely different diseases. Two women. Same age. Same race.
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16. R isk I njury F ailure L oss of function E nd-Stage Renal disease rifle criteria for stratifying arf
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22. R isk : Inc Cr 50-100% or U.O. < 0.5 mL/kg/hr for > 6 hrs I njury : Inc Cr 100-200% or U.O. < 0.5 mL/kg/hr > 12 hrs F ailure : Inc Cr > 200% or > 4 mg/dL or U.O. < 0.3 mL/kg/hr > 24 hrs or anuria for more than 12 hours L oss of function : Need for dialysis for more than 4 weeks E nd-Stage Renal disease : Need for dialysis for more than 3 months
27. when Hoste looked at markers of severity of illness excluding the renal system: No survival difference between the 4 groups: • Lack of renal failure • Risk • Injury • Failure
28. RIFLE is dependent on creatinine. creatine is a functional marker of organ damage Functional markers: old and busted
44. Hou SH, Bushinsky DA, Wish JB. Am J Med 1983; 74: 243-8. Nash K, Hafeez A, Hou S. Am J Kidney Dis. 2002; 39: 930-6. Kaufman J, Dhakal M, Patel B, Et al. Am J Kidney Dis 1991; 17: 191-8.
45. Hou SH, Bushinsky DA, Wish JB. Am J Med 1983; 74: 243-8. Nash K, Hafeez A, Hou S. Am J Kidney Dis. 2002; 39: 930-6. Kaufman J, Dhakal M, Patel B, Et al. Am J Kidney Dis 1991; 17: 191-8.
46. N=103 N=256 N=389 Pascual J, Liano F. J Am Geriatr Soc 1998, 46: 1-5.
56. Excreted Na = Urine Na x Urine Volume Calculating the Numerator
57. Filtered Na = Serum Na x GFR Calculating the Denominator GFR = Urine Cr x Urine Volume Serum Cr Filtered Na = Serum Na x UrCr x UrVol Serum Cr
58. Urine Na x Urine Volume Serum Na x UrCr x Urine Volume Serum Cr FENa = Excreted Na Filtered Na FENa = Urine Na Serum Na x UrCr Serum Cr FENa = Urine Na x Serum Cr Serum Na x UrCr FENa =
81. odds ratio of death Schiffl, H. et al. N Engl J Med 2002;346:305-310 P=0.002 P=0.005 P=0.007 P=0.02
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83. Ronco 425 CVVH 20/h vs. 35-45 ml/kg/h* Bouman 106 CVVH 20ml/kg/h* vs. 48 ml/kg/h Schiffl 160 Alternate day vs. daily hemodialysis Saudan 206 CVVH 25 ml/kg/h vs. CVVHDF 42 ml/kg/h Total (fixed effects) Total (random effects) 1 10 Odds ratio Study n treatment groups *For purposes of analysis the two high-dose arms in Ronco were combined, as were the two low-dose arms in Bouman. If these groups are removed the odds ratio is unchanged (1.94; P <0.001). Kellum J. Nature Clin Practice Nephrol 2007 3: 128-9.
97. Worse fluid overload severity remained independently associated with mortality (OR, 1.03; 95% CI, 1.01-1.05). The relationship was satisfactorily linear and the OR suggests a 3% increase in mortality for each 1% increase in degree of fluid overload at CRRT initiation.
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99. [in regards to the kidney] these excretory operations are incidental to the major task of keeping our internal environments in the ideal, balanced state . Homer Smith from Fish to Philosopher
Talk about the difficulty of using medline to differentiate the two conditions, imagine the difficulty of studying these patients in a trial for treatment for ARF Nephrology needed a language to describe ARF Similar to CKD where some people used the term CRI to describe a pt with a cr of 1.7 and other described a patient with a cr of 4.5 about to start dialysis
An example of the former is contrast nephropathy where an event is defined by a 0.5 mg/dL or 25% increase in serum creatinine. The use of RRT to define ARF is often used in retrospective cohorts because it is easily gleaned from procedure codes and is unambiguous as well as unanimously perceived as an important end-point.
An example of the former is contrast nephropathy where an event is defined by a 0.5 mg/dL or 25% increase in serum creatinine. The use of RRT to define ARF is often used in retrospective cohorts because it is easily gleaned from procedure codes and is unambiguous as well as unanimously perceived as an important end-point.
An example of the former is contrast nephropathy where an event is defined by a 0.5 mg/dL or 25% increase in serum creatinine. The use of RRT to define ARF is often used in retrospective cohorts because it is easily gleaned from procedure codes and is unambiguous as well as unanimously perceived as an important end-point.
Acute dialysis quality initiative (ADQI) Acute dialysis quality initiative (ADQI) Group of interested intensivists, nephrologists and industry representatives charged with publishing evidence based clinical practice guidelines Created a consensus definition of acute renal failure
Acute dialysis quality initiative (ADQI)
Acute dialysis quality initiative (ADQI)
Acute dialysis quality initiative (ADQI)
Acute dialysis quality initiative (ADQI)
Acute dialysis quality initiative (ADQI)
Acute dialysis quality initiative (ADQI)
Acute dialysis quality initiative (ADQI)
Suggesting the difference in mortality is accounted solely by the increasing severity of renal failure
Paganini at Cleveland clinic retrospectively looked at dose of dialysis during ARF and compared it to survival stratified by Predicted mortality
