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Simple and readily available patient characteristics predicts death and ... - Medical Research News and Interviews on MedicalResearch.com (blog)

MedicalResearch.com Interview with:

Simple and readily available patient characteristics predicts death and ... - Medical Research News and Interviews on MedicalResearch.com (blog)Raghavan Murugan MD, MS, FRCP, FCCP
Associate Professor of Critical Care Medicine and Clinical and Translational Science
Core Faculty, Center for Critical Care Nephrology, CRISMA Center,

Simple and readily available patient characteristics predicts death and ... - Medical Research News and Interviews on MedicalResearch.com (blog)John Kellum, MD
Professor and Vice Chair for Research
Director, Bioengineering and Organ Support Program, CRISMA Center
Director, Center for Assistance in Research using eRecord (CARe)

Department of Critical Care Medicine
University of Pittsburgh Pittsburgh, PA

Medical Research: What is the background for this study? What are the main findings?

Response:In our prior studies, we found that nearly one-half of critically ill patients in the intensive care unit who receive dialysis die by 2 months after acute illness and more than one-third of surviving patients are dialysis dependent. We sought to examine whether simple patient characteristics and inflammatory biomarkers predicted death and non-recovery of kidney function after severe acute kidney injury.

We found that a combination of four simple and readily available patient characteristics including older age, lower mean arterial pressure, need for mechanical ventilation, and higher serum bilirubin levels predicted death and dialysis dependence. Higher plasma concentration of interleukin (IL)-8 in combination with the clinical characteristics also increased risk prediction. To our knowledge, this study is the first large study to examine risk prediction for outcomes after severe acute kidney injury using a panel of biomarkers in a large cohort of critically ill patients receiving dialysis.

Medical Research: What should clinicians and patients take away from your report?

Response:Our findings have important implications for patients and clinicians. First, the four clinical characteristics along with plasma IL-8 could be used to estimate patient prognosis and clinical decision-making by nephrologists and intensivists. For instance, the clinical variables and IL-8 marker levels measured on the day when dialysis initiation is being considered by a clinician could be useful to better inform patients and families about prognosis. Because patients who are older, are mechanically ventilated, and have lower mean arterial pressure, high bilirubin, and IL-8 levels, are likely to have worse outcomes, they may not wish to undergo dialysis and clinicians may treat those patients accordingly. Second, early prediction of renal recovery is likely to be helpful with regard to post-discharge planning by nephrologists after critical illness and monitoring for subsequent progression to chronic kidney disease and end-stage renal disease in patients who are unlikely to have complete renal recovery.

Medical Research: What recommendations do you have for future research as a result of this study?

Response:First, although IL-8 is not yet used in clinical practice to treat patients with acute kidney injury, the assay is easy to perform and could easily be developed into a clinical test. Second, identification of a homogeneous group of patients using biomarker-guided risk assessment allows for examination of new interventions or interventions that have previously failed in clinical trials that included a heterogeneous population of patients with severe acute kidney injury. Third, although we did a cross-validation within our study, our findings require external validation before they can be applied to other patient populations with severe acute kidney injury.

Citation:

Biomarker Enhanced Risk Prediction for Adverse Outcomes in Critically Ill Patients Receiving RRT

Francis Pike, Raghavan Murugan, Christopher Keener, Paul M. Palevsky, Anitha Vijayan, Mark Unruh, Kevin Finkel, Xiaoyan Wen, John A. Kellum, and for the Biological Markers for Recovery of Kidney (BioMaRK) Study Investigators

CJASN CJN.09911014; published ahead of print June 5, 2015, doi:10.2215/CJN.09911014

 

 

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Dialysis helps Budahl redefine life - Daily Republic

Budahl is a retired math teacher from Mitchell High School, a grandfather and a husband, a dialysis patient and a man who doesn't let a diagnosis define his life. Although Budahl receives dialysis three times a week, for three hours each session, he's been able to regain the lifestyle he wants to lead. He travels, visiting family and playing golf—the normal activities of a retired, healthy person, he said.

After 15 years of Type 2 Diabetes led to kidney failure, Budahl said in 2011 he was forced to retire from teaching, as well as from his usual activities.

"You have a lot of pain when your kidneys shut down," Budahl said. "You don't have strength anymore to do your chores, and it even affects you mentally with the decisions you make. Your whole body shuts down."

'Go forward while you can'

At age 57, Budahl said his kidneys were functioning like those of an 85-year-old.

"I would try to mow the lawn and I'd have to sit down seven or eight times in the half hour or 45 minutes it should take me to mow," he said.

Although diabetes runs in his family, he said complications are more dependant on what you put in your body, stating simply: "If you eat bad, you get bad results."

He felt, looking back, he made mistakes and didn't take care of the body he was given.

"But you can't go back and change things. You've got to go forward while you can," he said.

So he goes forward, every Monday, Wednesday and Friday to the DaVita Dialysis Center in Mitchell, (or wherever he's traveling) to receive the treatments he said have added another 15-20 years to his life.

He showed the marks on his arm where the two needles—one for blood to be pumped out and another for the return of his cleaned blood—are inserted into a fistula, a surgically made passageway connecting a vein to an artery, that was built in his forearm. The dialysis machines then do the work of normally functioning kidneys, cleaning and removing the waste products of cells from the blood. He said during his treatment on Monday, 2.8 kilograms, which is just over 6 pounds, of waste fluid was removed by filtering his blood.

Budahl said nine hours of treatments a week might seem like a long time to some, but "it sure beats being dead," so he keeps himself occupied listening to his favorite podcast "Coast to Coast AM" and remains thankful for his treatments.

Fluid intake

Budahl explained that the trick to living on dialysis is regulating your fluid intake, because less weight taken off means less complications, such as cramps, following the removal of excessive waste.

"They try very much to make it (amount of waste removed) consistent, but that's up to you. You can't sit back and drink a gallon of water and expect it to be normal," he said. "It's going to be high, you're going to be heavy. So you get thirsty and you just have a sip. You don't have a bottle, you just have a sip, but that's just part of the game."

Because he's limited to consuming about 30 ounces of liquid a day, including what's in the food he eats, he has to be always cautious and conscious.

With a smile, he said his love for the Forestburg watermelons keeps him on his toes.

Thanks to a dietician who helps him regulate and analyze his meals, Budahl said he knows what foods to eat regularly, such as meat for its protein and calcium, and what foods to avoid, such as kiwi because of its high phosphorus and potassium content that negatively affects his dialysis.

"They do blood work on you about once a month, so you've got about every number you'd want to know about your body coming back at you," he said.

The regulation of weight and fluids is also important, because he said it can take several treatments to get him back to normal after his fluids are too high. When he started dialysis in September, he said the weight they would remove in one setting was astonishing, recalling one particular day where the dialysis machine removed almost 15 pounds of waste in three hours. Because his kidneys had been functioning at only around 20 percent for several years, Budahl said it took roughly five months of dialysis for his body to recover from the poison that was slowing him down.

DaVita

Now, thanks to DaVita, he said, he's back to doing what he loves. He said the nice thing about DaVita is that it's a national chain.

"They are everywhere. It's like the McDonald's of dialysis," he joked.

He feels the center has the upper hand on standard medicine because of the centralized records they keep, making it simple to get his treatments when he visits his daughters in Farmington, Minn., or Lawrence, Kan.

"I just sign over saying I'll be polite and not do anything disastrous, and that I know what the fire and tornado rules are. It's that convenient," he said.

He estimated the cost to be roughly $500 per treatment, noting that the expensive machines, lengthy procedure and the effort of the staff to make sure things are done correctly adds up. Thankfully, Budahl said, Medicare covers his life-saving treatments, and he doesn't take it for granted.

"I seem to make sure that I enjoy what's going on now and don't skimp on things," he said. "I want to enjoy my time with my grandson, with my wife, my kids. I do that a lot more now than I ever did before. And that's a big thing for me, to make sure I don't go without thanking those people that make up my life."

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Trinamool leader Nirmal Maji refers dog to SSKM hospital for hemo-dialysis - India Today

Dialysis for a dog… well almost. But it's not at any veterinary hospital, but at the SSKM Hospital in Kolkata, meant for the homo sapiens and managed by the state government. However, that extraordinary dialysis was not carried out after protestations by a visiting doctor and others at the hospital who red-flagged the idea, citing lack of expertise and also chances of infections.

It all began when Dr Nirmal Maji - an influential Trinamool Congress leader - referred the dog to the SSKM hospital, seeking its dialysis. The dog reportedly belonged to one of Maji's relatives. Maji - who is the president of the state Medical Council and heads the West Bengal chapter of the Indian Medical Association - reportedly sought a hemo-dialysis for the dog. He referred the dog to the nephrology department of SSKM Hospital on June 10. Heeding to Maji's request, nephrology department head Dr Rajendra Pandey forwarded the matter to hospital's director Dr Pradeep Mitra, who had no qualms in honouring Maji's request.

The note that arrived at the table of Mitra reportedly read: "An unidentified dog advised for hemo-dialysis." Mitra was also asked by Maji to expedite the dog's treatment. However, the doctors at the hospital and the visiting consultant Dr Arpita Chowdhury objected to the whole proposal.

Justifying his action Maji said: "The dog is cute. It was suffering for the past three months. So, I sought help from the SSKM authorities."

West Bengal Minister of State for Health Chandrima Bhattacharya told Mail Today: "I will not comment on the incident. I don't know anything about it. You better ask the doctors of the hospital concerned about the issue. They should explain."

When asked whether SSKM Hospital was equipped to treat a dog, the minister said, "I am not a doctor. So I can't really comment on it."

Meanwhile, CPI-M politburo member Suryakanta Mishra, who was the West Bengal health minister during the previous Left Front government, took a jibe at Maji. "So far as I know Nirmal Maji is a doctor for humans. He is not a veterinary expert. But he has forgotten that SSKM Hospital is a state-run hospital where humans are treated, and not the domestic animals of his relatives," Mishra said.

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TMC leader says love us, love our dog: Dr Maji recommends canine for hemo ... - Daily Mail

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Dialysis for a dog… well almost. But it’s not at any veterinary hospital, but at the SSKM Hospital in Kolkata, meant for the homo sapiens and managed by the state government.

However, that extraordinary dialysis was not carried out after protestations by a visiting doctor and others at the hospital who red-flagged the idea, citing lack of expertise and also chances of infections. 

It all began when Dr Nirmal Maji — an influential Trinamool Congress leader — referred the dog to the SSKM hospital, seeking its dialysis. 

TMC leader says love us, love our dog: Dr Maji recommends canine for hemo ... - Daily Mail

Trinamool Congress leader and president of the state medical council Dr Nirmal Maji referred the dog to the SSKM hospital for hemo-dialys

The dog reportedly belonged to one of Maji’s relatives. 

Maji — who is the president of the state Medical Council and heads the West Bengal chapter of the Indian Medical Association — reportedly sought a hemo-dialysis for the dog. 

He referred the dog to the nephrology department of SSKM Hospital on June 10. 

Heeding to Maji’s request, nephrology department head Dr Rajendra Pandey forwarded the matter to hospital’s director Dr Pradeep Mitra, who had no qualms in honouring Maji’s request. 

The note that arrived at the table of Mitra reportedly read: “An unidentified dog advised for hemo-dialysis.” 

Mitra was also asked by Maji to expedite the dog’s treatment. 

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However, the doctors at the hospital and the visiting consultant Dr Arpita Chowdhury objected to the whole proposal.

Justifying his action Maji said: “The dog is cute. It was suffering for the past thremonths. So, I sought help from the SSKM authorities.” 

West Bengal Minister of State for Health Chandrima Bhattacharya told Mail Today: “I will not comment on the incident. 

"I don’t know anything about it. You better ask the doctors of the hospital concerned about the issue. They should explain.” 

When asked whether SSKM Hospital was equipped to treat a dog, the minister said, “I am not a doctor. So I can’t really comment on it.” 

Meanwhile, CPI-M politburo member Suryakanta Mishra, who was the West Bengal health minister during the previous Left Front government, took a jibe at Maji.

“So far as I know Nirmal Maji is a doctor for humans. He is not a veterinary expert. 

"But he has forgotten that SSKM Hospital is a state-run hospital where humans are treated, and not the domestic animals of his relatives,” Mishra said 

 

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SKIMS hosts annual conference of Indian Academy of Nephrology - GreaterKashmir.com

10th Annual Conference of the Indian Academy of Nephrology (IANCON-2015) organized by the Department of Nephrology, SKIMS, was inaugurated here Saturday at SKIMS auditorium.

On the occasion, renowned nephrologists from different parts of country and abroad deliberated on various types of kidney diseases including dialysis, renal transplantation, chronic kidney diseases and latest advances in nephrology.

Dr S C Dash, President Indian Academy of Nephrology stressed on indigenous research and appreciated efforts and interest of nephrologists of SKIMS for organizing the event.

Director SKIMS, Dr Showkat A Zargar highlighted activities of Department of Nephrology and Urology which treat patients with latest procedures for various types of kidney diseases. He said the existing state-of-the-art dialysis unit can cater to 50 patients per day.  He complimented the Department of Nephrology for hosting the conference.

Organizing Secretary & Professor Nephrology Dr Khurshid Banday said the conference is of great significance as various kidney diseases are on rise in Kashmir due to rise in hypertension and diabetes. He hoped that experts participating in the conference will give their overview and share information about the latest advancements in the field of nephrology.

Dean SKIMS Dr Gul Javid and Dr Ghulam Hassan Malik, Convener, organizing committee IANCON 2015 also spoke on the occasion.

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