The Interchangeable Nature of Our Destinies: Health Inequities Born From Social and Structural Determinants of Health and the Advocacy Journey to Overcome Them.

As we explore what constitutes our unique experience as human beings and of disease, we recognize the pivotal role of circumstances and the fortune or misfortune of encountering them. In health, these circumstances-the social and structural determinants of health-can determine a disease phenotype and the extent to which a person can access quality care, acting as drivers for health disparities and social injustice. Unless we want to be bystanders to a status quo that is unjust to our patients and distressing to ourselves, we must engage with this critical aspect of their lives, giving it a place in our consultations and moving us to champion initiatives that can change the health policies that affect entire communities.

Proceedings of the UAB CRRT Academy (2023-2024): Managing De-Escalation of Acute RRT and Optimizing Drug Dosing During RRT Transitions.

In this second installment of the proceedings of the University of Alabama at Birmingham Continuous Renal Replacement Therapy (CRRT) Academy, we focus on the topic of transitions of care in acute RRT. Though we have accumulated data from thousands of critically ill patients with acute kidney injury (AKI) randomized to different strategies for RRT initiation, no trial data exist to guide de-escalation of RRT in the intensive care unit. However, for survivors of severe AKI whose kidney function does not recovery rapidly enough to allow for liberation directly from CRRT, successful de-escalation of care requires the transition from CRRT to intermittent RRT modalities.

An Unusual Case of Anuric Acute Kidney Injury Secondary to the Use of Low-Dose Acetazolamide as Preventive Management for Acute Mountain Sickness.

: Acetazolamide is widely used for acute mountain sickness (AMS) prophylaxis. Whilst generally safe, acute kidney injury (AKI) is a rare but serious adverse event. We present a case of anuric AKI following minimal exposure to acetazolamide, contributing to the limited literature on its nephrotoxicity at prophylactic doses.

Liberation from continuous renal replacement therapy due to renal recovery in adults and children: a literature review and Delphi consensus on clinical practice.

Background: There is no current consensus on the appropriate timing for discontinuing continuous renal replacement therapy (CRRT). We aimed to review the current clinical evidence associated with the successful liberation from CRRT in patients with acute kidney injury and present a literature review with clinical practice points using a modified Delphi process.

Methods: EMBASE, CINAHL, PubMed, and CENTRAL libraries were searched for literature related to CRRT liberation in pediatric and adult AKI patients.

Association of hospital-level continuous kidney replacement therapy use and mortality in critically ill patients with acute kidney injury.

Purpose: In numerous high-risk medical and surgical conditions, an increased volume of patients and procedures is associated with improved processes and survival. This study examined the association of hospital-level continuous kidney replacement therapy (CKRT) utilization rates with all-cause hospital mortality in critically ill patients with acute kidney injury (AKI).

Methods: This multicenter cohort study used data from patients admitted to the intensive care unit (ICU) within the Premier Incorporated AI (PINC-AI) database.

Relationship between magnesium intake and decline in kidney function, incident chronic kidney disease and incident cardiovascular disease.

Background And Hypothesis: Higher magnesium (Mg) intake is associated with a lower risk of stroke, heart failure and mortality, while there are limited data with kidney disease outcomes. We hypothesized that higher dietary Mg intake would be associated with a lower incidence of cardiovascular disease (CVD), chronic kidney disease (CKD) and kidney function decline.

Methods: The Health, Aging, and Body Composition Study is an observational cohort of 3075 community-dwelling older adults.

Acute skeletal muscle wasting in patients with acute kidney injury requiring continuous kidney replacement therapy: A prospective multicenter study.

Purpose: Acute kidney injury (AKI) requiring continuous kidney replacement therapy (CKRT) has been hypothesized to increase the risk of developing intensive care unit-associated weakness (ICU-AW), but prospective data are lacking.

Materials And Methods: This prospective observational study evaluated critically ill adults with AKI requiring CKRT at two U.S.

Increased Plasma Fibroblast Growth Factor 23 and In-hospital Acute Kidney Injury after Cardiac Surgery.

Background: Acute kidney injury (AKI) occurs in 20 to 30% of cardiac surgery patients and is most often classified as mild. A previous study reported that intact fibroblast growth factor 23 (iFGF23) and C-terminal fibroblast growth factor 23 (cFGF23) measured after cardiopulmonary bypass (CPB) were associated with severe AKI after cardiac surgery but did not analyze the association between iFGF23 and all-stage AKI. The primary aim of the study was to determine whether FGF23 biomarker measurements 6 h after CPB were associated with all-stage AKI after cardiac surgery.

Trajectories of fluid management after the initiation of renal replacement therapy in critically ill patients: a secondary analysis of the STARRT-AKI trial.

Background: Fluid management is an essential component of renal replacement therapy (RRT) in critically ill patients. Both a positive cumulative fluid balance (CFB) and a high net ultrafiltration (NUF) rate have been reported to be associated with adverse outcomes in epidemiological studies, although the overall trajectory of fluid balance after RRT initiation is not well-described. We aimed to characterize trajectories of fluid management parameters during RRT and analyse the effect of CFB/NUF on outcomes as a trajectory rather than single or aggregated time points over the first week after initiation of RRT.

Association of vasopressor use during renal replacement therapy and mortality.

Among critically ill patients with acute kidney injury (AKI) requiring renal replacement therapy (RRT) whether vasopressor use is associated with outcomes is unclear. We examined the association of vasopressor use following RRT initiation with in-hospital mortality in critically ill adults with AKI requiring different modalities of RRT. This observational study was conducted using the Premier Inc.

Machine learning models for acute kidney injury prediction and management: a scoping review of externally validated studies.

Despite advancements in medical care, acute kidney injury (AKI) remains a major contributor to adverse patient outcomes and presents a significant challenge due to its associated morbidity, mortality, and financial cost. Machine learning (ML) is increasingly being recognized for its potential to transform AKI care by enabling early prediction, detection, and facilitating an individualized approach to patient management. This scoping review aims to provide a comprehensive analysis of externally validated ML models for the prediction, detection, and management of AKI.

Key performance indicators for acute intermittent kidney replacement therapy in critically ill patients: a protocol for a systematic review.

Introduction: There have been previous initiatives to identify key performance indicators (KPIs) for continuous kidney replacement therapy. However, no formal reviews of the evidence for KPIs of intermittent kidney replacement therapy (IKRT) have been conducted. This systematic review will appraise the evidence for KPIs of IKRT in critically ill patients and is part of the DIALYZING WISELY (NCT05186636) programme which aims to improve the performance of acute renal replacement therapy in intensive care units by aligning local practices with evidence-based best practices.

Achievement of fluid removal targets during intermittent renal replacement therapy in the intensive care unit.

Background: In patients with acute kidney injury (AKI), fluid balance management often relies on the prescription and achievement of fluid removal using intermittent renal replacement therapy (IRRT). This study aimed to describe characteristics associated with the failure to achieve target fluid removal (FATFR).

Methods: This is a retrospective cohort study including IRRT sessions of conventional duration (<5 hours) performed for AKI in the intensive care unit (ICU) from 2017 to 2022 at a tertiary academic center.

Implementation Science in Acute Kidney Injury Care: Challenges and Opportunities.

Implementation science has the potential to bridge the research-to-practice gap in acute kidney injury care. The field of implementation science is multidisciplinary and offers theories, models, and frameworks to establish a roadmap for practical adoption, adaptation, fidelity, and dissemination of evidence-based practices for acute kidney injury care. In this brief narrative article, we describe key methodological aspects of implementation science and provide selected examples of its use in the prevention and management of acute kidney injury.

Postdischarge Care of Acute Kidney Injury Survivors: An Opportunity for Targeted Nurse and Pharmacist Interventions.

The incidence of acute kidney injury (AKI) is increasing, and with it, the population of individuals requiring post-AKI care. Postdischarge follow-up for AKI survivors is recommended within 90 days of an AKI episode to promote kidney recovery and potentially prevent progression of kidney disease. However, timely postdischarge care is often lacking or fragmented and poses a missed opportunity to prevent long-term complications of this condition.

Acute Kidney Injury and Critical Care Nephrology.

Critical care nephrology is an increasingly vital subspecialty within internal medicine that focuses on the comprehensive management of a spectrum of kidney-related complications that arise in critically ill patients. This field plays a crucial role in heterogeneous intensive care unit settings, where the dynamic and complex nature of critical illnesses and acute kidney injury phenotypes often necessitates specialized renal care, including renal replacement therapy. In this manuscript, we present board-style review questions that illustrate distinct clinical scenarios and interventions in critical care nephrology, with an emphasis on key teaching points.

Epidemiology of sepsis-associated acute kidney injury in the ICU with contemporary consensus definitions.

Background: The definition of sepsis-associated acute kidney injury (SA-AKI) was updated in 2023. This study aims to describe the epidemiology of SA-AKI using updated consensus definition and to evaluate clinical outcomes.

Methods: The study was a retrospective cohort analysis conducted at two academic medical centers.

Inter-rater reliability of muscle ultrasonography performed by multidisciplinary novice sonographers in the evaluation of critically ill patients with acute kidney injury requiring continuous kidney replacement therapy.

Early diagnosis of muscle wasting in critically ill patients with acute kidney injury requiring continuous kidney replacement therapy (AKI-CKRT) may improve outcomes timely rehabilitation and nutrition. Muscle ultrasound (MUS) has recently gained traction for assessing muscle atrophy in the intensive care unit (ICU) but requires training to achieve reproducibility. We evaluated the inter-rater reliability of MUS in patients with AKI-CKRT performed by multidisciplinary raters including nephrologists.

Influence of Baseline Kidney Function on Patient and Kidney Outcomes in Patients with COVID-19: A Multi-National Observational Study.

: Acute kidney injury (AKI) is a common complication of coronavirus disease-19 (COVID-19), but the impact of baseline kidney function and care processes on outcomes is not well understood. We hypothesized that baseline kidney health status may influence courses and outcomes of AKI. : This is a multinational, multicenter, retrospective cohort study.