Risk Factors and Management of Acute Renal Injury in Cardiac Surgery
|
|
- Rafe Horn
- 6 years ago
- Views:
Transcription
1 Risk Factors and Management of Acute Renal Injury in Cardiac Surgery Robert S Kramer, MD, FACS Clinical Associate Professor of Surgery Tufts University School of Medicine Maine Medical Center, Portland Maine
2 I have nothing to disclose
3
4
5 Objectives The nephron Definition of AKI Vulnerability of patients to AKI Setting and timing of surgery Pre- and intra-operative factors Intra-operative prevention strategies Treatment of post-op AKI
6 The Nephron
7 Acute Kidney Injury Network (AKIN) Definition of AKI Abrupt reduction (within 48 h) in kidney function defined by an increase in creatinine by 50% or 0.3 mg/dl over baseline
8 AKI duration predictive of increased short and long-term mortality following cardiac surgery Ann Thorac Surg 2010;90:1142 9
9 Development of AKI: Pre-op Intrinsic factors: CKD, renovascular disease Prerenal factors: Recent diuresis, NPO status, impaired LV function ACE Inhibitors and ARB s Nephrotoxins: IV contrast, meds Endotoxemia Inflammation Genetics Rosner and Okusa Clin J Am Soc Nephrol 1: 19 32, 2006
10 Prevention of AKI: Pre-op Strategies Readiness for Surgery (statins, infection, meds, etc) Anemia management Contrast induced nephropathy Maximal Allowable Contrast (MAC) Timing of surgery
11 Readiness for Surgery
12 Pre-op Anemia Management
13 Association between low pre-op Hb and AKI Karkouti Circ 2009:119:
14 Pre-op Cardiac Cath
15 Contrast Induced Nephropathy Calvin et al Nature Reviews Nephrology 6, (Nov 2010)
16 Rate of AKI (%) AKI Rate: Same or Separate Admissions Same admission cath and surg AKI = 50.2% Prior admit cath AKI = 33.7% P-value < Cath Prior Admit Cath Same Admit Kramer et al Ann Thorac Surg 2010;90:
17 Intra-operative Prevention of AKI
18 Intra-op events leading to AKI Ischemic damage to the vulnerable renal medulla Ischemia-reperfusion injury Emboli: Gas and particulate Inflammation: CPB-induced (SIRS) Nephrotoxins: Pigments (free Hb, myoglobin) Rosner and Okusa Clin J Am Soc Nephrol 1: 19 32, 2006 and Kaplan s Cardiac Anesthesia 6 th Edition, Elselvier, N.Y., 2011
19 Key intra-op strategies to prevent AKI Minimize Hemodilution Nadir Hematocrit: The sweet spot Optimize Oxygen Delivery
20 Minimize Hemodilution Small circuits Retrograde autologous priming Low crystalloid volume pre- and during CPB MUF Ultrafiltration
21 The Sweet Spot Loor, Koch et al J Thorac Cardiovasc Surg Sept 2012 p
22 O 2 Delivery During CPB Best predictor for AKI = lowest O 2 delivery Critical value = 272 ml/min/m 2 Ranucci, Ann Thorac Surg 2005;80:
23 Renal Oxygen Delivery From the Anita T.Layton Lab, Duke University
24 O 2 delivery during CPB and creatinine (CABG) Critical value = 272 ml/min/m 2 Peak Serum Creatinine (mg/dl) Oxygen Delivery ml/min/m 2 Ranucci, Ann Thorac Surg 2005;80:
25 O 2 delivery during CPB and ARF (CABG) Critical value = 272 ml/min/m 2 ARF Rate (%) O 2 Delivery ml/min/m 2 Ranucci, Ann Thorac Surg 2005;80:
26 O 2 delivery during CPB and AKI after CABG Hemodilution during CPB = risk factor for postop AKI Detrimental effects may be reduced by adjusting the three variables Ranucci, Ann Thorac Surg 2005;80:
27 Components of formula for O 2 delivery Pump flow Hemoglobin saturation Arterial oxygen content
28 DO2 Formula AKIN Stage II ( % increase in creatinine from baseline) DO 2 cut-off = 262 ml/min/m 2 de Somer et al. Crit Care Aug 10;15(4):R192
29 Goal Directed Perfusion Maintaining DO 2 level above the identified critical value might limit the incidence of postop AKI.
30 Nadir Hematocrit
31 Critical Threshold: Mortality R. H Habib J Thorac Cardiovasc Surg 2003;125: 1438
32 Critical Threshold: Renal and Multi-organ Failure R. H Habib J Thorac Cardiovasc Surg 2003;125: 1438
33 Anemia can be bad Transfusions can be worse Surgenor et al, Circulation. 2006; 114[suppl I]:I-43 I-48
34 CPB Strategies Avoid hyperthermic perfusion: 34% increase in AKI with each 10 min above 37 outlet temperature* Base flow on ideal body weight: Using BSA in obese patients can result in too high CPB flows. ** *Newland. Perfusion January 2013 **Santambrogio et al. J Card Surg 2009;24:
35 CPB Strategies Decreased CPB and X-clamp times are associated with lower incidence of AKI * Intra-op plasma preservation: Plasma vital in preserving endothelial vascular integrity (glycocalyx) ** *Del Duca D, et al Ann Thorac Surg 2007, 84(4): **Unpublished
36 CPB Strategies Minimize peri-op transfusions: Independent variable associated with AKI*. Decrease microemboli: Filters, single clamp technique, epiaortic echo ** BP management: ΔMAP (preop/cpb)*** *Karkouti, Circ 2009:119: **Groom et al Circ Cardiovasc Qual Outcomes 2009 ***Kanji et al. Journal of Cardiothoracic Surgery 2010, 5:71
37 Post-op AKI Management Vasoactive drips to maintain BP Minimize transfusions Diuretics will not reverse AKI Avoid NSAIDS & other nephrotoxins Normovolemia Rapid identification of hemorrhage sources, early decision for return to OR Renal replacement therapy (RRT)
38 Renal Replacement Therapy (RRT) Initiate RRT emergently when lifethreatening changes in fluid, electrolyte, and acid-base balance exist. Consider broader clinical context and trends rather than single BUN and creatinine thresholds alone when making decision to start RRT.
39 Summary Nephron & definition of AKI Vulnerability of patients Setting and timing of surgery Pre- and intra-operative factors Prevention strategies: Minimize hemodilution & maximize DO 2 Management of post-op AKI
40 Thank you
Acute Kidney Injury Subsequent to Cardiac Surgery
The Journal of ExtraCorporeal Technology Review Article Acute Kidney Injury Subsequent to Cardiac Surgery Robert S. Kramer, MD;* Crystal R. Herron, PhD;* Robert C. Groom, CCP, MS;* Jeremiah R. Brown, PhD
More informationTransfusion and Blood Conservation
Transfusion and Blood Conservation Kenneth G. Shann, CCP Assistant Director, Perfusion Services Senior Advisor, Performance Improvement Department of Cardiovascular and Thoracic Surgery Montefiore Medical
More informationAcute Kidney Injury after Cardiac Surgery: Incidence, Risk Factors and Prevention
Acute Kidney Injury after Cardiac Surgery: Incidence, Risk Factors and Prevention Hong Liu, MD Professor of Clinical Anesthesiology Department of Anesthesiology and Pain Medicine University of California
More informationTransfusions in Acute Care Too Little?
Transfusions in Acute Care Too Little? Keyvan Karkouti MD FRCPC MSc Associate Professor Department of Anesthesia; Department of Health Policy, Management, and Evaluation; University of Toronto Scientist
More informationHeinz-Hermann Weitkemper, EBCP. 4th Joint Scandinavian Conference in Cardiothoracic Surgery 2012 Vilnius / Lithuania
Heinz-Hermann Weitkemper, EBCP Everyone who earnestly practices perfusion is acting with the full belief that what they are doing is in the best interest of their patients. Perfusion can never be normal,
More informationConventional vs. Goal Directed Perfusion (GDP) Management: Decision Making & Challenges
Conventional vs. Goal Directed Perfusion (GDP) Management: Decision Making & Challenges GEORGE JUSTISON CCP MANAGER PERFUSION SERVICES UNIVERSITY OF COLORADO HOSPITAL How do you define adequate perfusion?
More informationCardiac surgery and acute kidney injury: retrospective study
Cardiac surgery and acute kidney injury: retrospective study Department of Cardiovascular and Thoracic Surgery University of Liege Hospital (ULg CHU), Belgium MG LAGNY 1, F BLAFFART 1, JO DEFRAIGNE 2,
More informationGoal Directed Perfusion: theory, clinical results, and key rules
Goal Directed Perfusion: theory, clinical results, and key rules M. Ranucci Director of Clinical Research Dept of Cardiothoracic and Vascular Anesthesia and Intensive Care IRCCS Policlinico S.Donato Ranuuci,
More informationAcute Kidney Injury for the General Surgeon
Acute Kidney Injury for the General Surgeon UCSF Postgraduate Course in General Surgery Maui, HI March 20, 2011 Epidemiology & Definition Pathophysiology Clinical Studies Management Summary Hobart W. Harris,
More informationDoes the Use of Ultrafiltration Increase the Risk of Post-Operative Acute Kidney Injury? A Multi-Center Analysis
Does the Use of Ultrafiltration Increase the Risk of Post-Operative Acute Kidney Injury? A Multi-Center Analysis Gordon R. DeFoe, CCP, John Pieroni, CCP, Craig S. Warren, CCP, Charles F. Krumholz, CCP,
More informationLow Oxygen Delivery as a Predictor of Acute Kidney Injury during Cardiopulmonary Bypass
The Journal of ExtraCorporeal Technology Original Articles Low Oxygen Delivery as a Predictor of Acute Kidney Injury during Cardiopulmonary Bypass Richard F. Newland, BSc, CCP; Robert A. Baker, PhD, CCP
More informationNavigating the Dichotomies Between Literature and Your Clinical Practice
Navigating the Dichotomies Between Literature and Your Clinical Practice Robert Groom, CCP, FPP Cardiovascular Institute at Maine Medical Center Disclosures No relevant conflicts related to this presentation
More informationThe Relationship between Intra-Operative Transfusions and Nadir Hematocrit on Post-Operative Outcomes after Cardiac Surgery
The Journal of ExtraCorporeal Technology The Relationship between Intra-Operative Transfusions and Nadir Hematocrit on Post-Operative Outcomes after Cardiac Surgery Joshua B. Goldberg, MD;* Kenneth G.
More informationBlood Management of the Cardiac Patient in the Postoperative Period
Blood Management of the Cardiac Patient in the Postoperative Period Al Stammers, MSA, CCP, Eric Tesdahl, PhD Andy Stasko MS, CCP, RRT, Linda Mongero, BS, CCP, Sam Weinstein, MD, MBA Goal To examine the
More informationDr.Nahid Osman Ahmed 1
1 ILOS By the end of the lecture you should be able to Identify : Functions of the kidney and nephrons Signs and symptoms of AKI Risk factors to AKI Treatment alternatives 2 Acute kidney injury (AKI),
More informationa non-trivial challenge for a perfusionist
DO 2 -guided nephroprotective perfusion - a non-trivial challenge for a perfusionist Dirk Buchwald, Krzysztof Klak xygenium oxygen - Colorless and odorless gas - Most common chemical element on earth atomic
More information12 RANUCCI ET AL Ann Thorac Surg HEMODILUTION DURING CPB AND MORBIDITY RISK 2010;89:11 8 Abbreviations and Acronyms CI confidence interval CPB cardiop
ORIGINAL ARTICLES: CARDIOTHORACIC ANESTHESIOLOGY: The Annals of Thoracic Surgery CME Program is located online at http://cme.ctsnetjournals.org. To take the CME activity related to this article, you must
More informationIs Timing Everything?
The Journal of ExtraCorporeal Technology Is Timing Everything? George Justison, CCP University of Colorado Hospital, Perfusion Services, Aurora, Colorado Presented at Goal Directed Therapy Symposium, 54th
More informationDefining Optimal Perfusion during CPB. Carlo Alberto Tassi Marketing Manager Eurosets Italy
Defining Optimal Perfusion during CPB Carlo Alberto Tassi Marketing Manager Eurosets Italy It is a device able to monitor in a real time vital parameters and able to provide information regarding the transport
More informationOPCAB IS NOT BETTER THAN CONVENTIONAL CABG
OPCAB IS NOT BETTER THAN CONVENTIONAL CABG Harold L. Lazar, M.D. Harold L. Lazar, M.D. Professor of Cardiothoracic Surgery Boston Medical Center and the Boston University School of Medicine Boston, MA
More informationLife After CORAL: What Did CORAL Prove? David Paul Slovut, MD, PhD Co-director TAVR, Dir of Advanced Intervention
Life After CORAL: What Did CORAL Prove? David Paul Slovut, MD, PhD Co-director TAVR, Dir of Advanced Intervention No Relationships to Disclose The Need for Modern Renal Trials Increased rate of RAS diagnosis
More informationAccepted Manuscript. Avoiding Acute Kidney Injury After Cardiac Operations Searching for the Holy Grail Isn t Easy. Victor A. Ferraris, M.D., Ph.D.
Accepted Manuscript Avoiding Acute Kidney Injury After Cardiac Operations Searching for the Holy Grail Isn t Easy Victor A. Ferraris, M.D., Ph.D. PII: S0022-5223(18)33205-7 DOI: https://doi.org/10.1016/j.jtcvs.2018.11.078
More informationECMO vs. CPB for Intraoperative Support: How do you Choose?
ECMO vs. CPB for Intraoperative Support: How do you Choose? Shaf Keshavjee MD MSc FRCSC FACS Director, Toronto Lung Transplant Program Surgeon-in-Chief, University Health Network James Wallace McCutcheon
More informationPreparing for Patients at High Risk of Transfusion
18/10/2017 Preparing for Patients at High Risk of Transfusion Jane Ottens. B.Sc., CCP ( Aust) Ashford Hospital, South Australia Preparing for Patients at High Risk of Transfusion Jane Ottens. B.Sc., CCP
More informationPreoperative Serum Bicarbonate Levels Predict Acute Kidney Iinjry after Cardiac Surgery
International Journal of ChemTech Research CODEN (USA): IJCRGG, ISSN: 0974-4290, ISSN(Online):2455-9555 Vol.11 No.06, pp 203-208, 2018 Preoperative Serum Bicarbonate Levels Predict Acute Kidney Iinjry
More informationAcute Kidney Injury in the ED
+ Acute Kidney Injury in the ED + Dr Eric Clark, MD FRCPC University of Ottawa Canada Canadian Association of Emergency Physicians + Outline 1. Diagnostic challenges 2. ED treatment 3. Contrast induced
More informationNGAL Connect to the kidneys
NGAL Connect to the kidneys Acute kidney injury (AKI) An imposing medical and diagnostic challenge >13 million AKI patients each year ~ 30% with fatal outcome Cardiac surgery > 1 million patients/year
More informationENDPOINTS FOR AKI STUDIES
ENDPOINTS FOR AKI STUDIES Raymond Vanholder, University Hospital, Ghent, Belgium SUMMARY! AKI as an endpoint! Endpoints for studies in AKI 2 AKI AS AN ENDPOINT BEFORE RIFLE THE LIST OF DEFINITIONS WAS
More informationContrast Induced Nephropathy
Contrast Induced Nephropathy O CIAKI refers to an abrupt deterioration in renal function associated with the administration of iodinated contrast media O CIAKI is characterized by an acute (within 48 hours)
More informationOptimal Use of Iodinated Contrast Media In Oncology Patients. Focus on CI-AKI & cancer patient management
Optimal Use of Iodinated Contrast Media In Oncology Patients Focus on CI-AKI & cancer patient management Dr. Saritha Nair Manager-Medical Affairs-India & South Asia GE Healthcare Context Cancer patients
More informationAcute Kidney Injury. I. David Weiner, M.D. Division of Nephrology, Hypertension and Transplantation University of Florida and NF/SGVHS
Acute Kidney Injury I. David Weiner, M.D. Division of Nephrology, Hypertension and Transplantation University of Florida and NF/SGVHS 374-6102 David.Weiner@medicine.ufl.edu www.renallectures.com Concentration
More informationContrast-Induced Nephropathy: Evidenced Based Prevention
Contrast-Induced Nephropathy: Evidenced Based Prevention Michael J Cowley, MD, FSCAI Nothing to disclose Contrast-Induced Nephropathy (CIN) Definitions New onset or worsening of renal function after contrast
More informationSteph ani eph ani Mi M ck i MD Cleveland Clinic
Stephanie Mick MD Stephanie Mick MD Cleveland Clinic Upper hemisternotomy AVR Ascending Aorta MVr Thoracotomy Based Anterior AVR Lateral Thoracotomy Mitral/Tricuspid surgery Robotically assisted surgery
More informationAcute Kidney Injury. Amandeep Khurana, MD Southwest Kidney Institute
Acute Kidney Injury Amandeep Khurana, MD Southwest Kidney Institute 66 yr white male w/ DM, HTN, CAD admitted to an OSH w/ E Coli UTI on 7/24/16, developed E Coli bacteremia and Shock (on vaso + levo)
More informationPeri-Surgical Anemia and the TAVR Patient
Peri-Surgical Anemia and the TAVR Patient Kathrine P Frey, MD Fairview Southdale Hospital Director of Blood and Pre-Operative Anemia Management April, 2015 MIDWEST VALVE SYMPOSIUM, April 2015 Credentials
More informationAdvances in Transfusion and Blood Conservation
Advances in Transfusion and Blood Conservation Arman Kilic, MD Division of Cardiac Surgery, Department of Surgery, Johns Hopkins Hospital, Baltimore, MD No relevant financial relationships to disclose.
More informationTransfusion & Mortality. Philippe Van der Linden MD, PhD
Transfusion & Mortality Philippe Van der Linden MD, PhD Conflict of Interest Disclosure In the past 5 years, I have received honoraria or travel support for consulting or lecturing from the following companies:
More informationThe New Priority: Decreasing Readmissions after Cardiothoracic Surgery: How Do We Get There?
The New Priority: Decreasing Readmissions after Cardiothoracic Surgery: How Do We Get There? Michael Zhen-Yu Tong, MD, MBA Department of Cardiothoracic Surgery Cleveland Clinic No Disclosures Plan Background
More informationEvidence-Based. Management of Severe Sepsis. What is the BP Target?
Evidence-Based Management of Severe Sepsis Michael A. Gropper, MD, PhD Professor and Vice Chair of Anesthesia Director, Critical Care Medicine Chair, Quality Improvment University of California San Francisco
More informationPrevention of Acute Renal Failure Role of vasoactive drugs and diuretic agents
of Acute Renal Failure Role of vasoactive drugs and diuretic agents Armand R.J. Girbes Prof.dr. A.R.J. Girbes Chairman department of Intensive Care VU University Medical Center Netherlands (Failure of)
More informationRecognizing and Treating Patients with the Cardio-Renal Syndrome
Recognizing and Treating Patients with the Cardio-Renal Syndrome Joachim H. Ix, MD, MAS, FASN Professor of Medicine Chief; Division of Nephrology-Hypertension University of California San Diego 1 Conflicts
More informationApplying clinical guidelines treating and managing CKD
Applying clinical guidelines treating and managing CKD Develop patient treatment plan according to level of severity. Source: Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2012
More informationAvailable online at Vol. 10, Issue, 09, pp , September, DOI:
z ISSN: 0975-833X Available online at http://www.journalcra.com International Journal of Current Research Vol. 10, Issue, 09, pp.73768-73781, September, 2018 DOI: https://doi.org/10.24941/ijcr.32236.09.2018
More informationSafety of Same-Day Coronary Angiography in Patients Undergoing Elective Aortic Valve Replacement
Safety of Same-Day Coronary Angiography in Patients Undergoing Elective Aortic Valve Replacement Kevin L. Greason, MD, Lars Englberger, MD, Rakesh M. Suri, MD, PhD, Soon J. Park, MD, Charanjit S. Rihal,
More informationUse of Acute Kidney Injury Biomarkers in Clinical Trials
Use of Acute Kidney Injury Biomarkers in Clinical Trials Design Considerations Amit X. Garg MD, MA (Education), FRCPC, PhD Nephrologist, London Health Sciences Centre Professor, Medicine and Epidemiology
More informationCARDIAC SURGERY is viewed as one of the great medical
Association Between Postoperative Acute Kidney Injury and Duration of Cardiopulmonary Bypass: A Meta-Analysis Avinash B. Kumar, MD, FCCP,* Manish Suneja, MD, Emine O. Bayman, PhD,* Garry D. Weide, DO,*
More informationUse of Acute Kidney Injury Biomarkers in Clinical Trials
Use of Acute Kidney Injury Biomarkers in Clinical Trials Design Considerations Amit X. Garg MD, MA (Education), FRCPC, PhD Nephrologist, London Health Sciences Centre Professor, Medicine and Epidemiology
More informationRenal Protection in the Cardiac Surgery Patient: Peri-Operative Sodium Bicarbonate
SCIENTIFIC ARTICLES Renal Protection in the Cardiac Surgery Patient: Peri-Operative Sodium Bicarbonate Infusion (POSBI) or Not? Hassan H. Amhaz *, Deepak Gupta **, Larry Manders **, George McKelvey ***,
More informationOvercoming the Cardiorenal Syndrome
Overcoming the Cardiorenal Syndrome October 29, 2016 Randall C Starling MD MPH FACC FESC FHFSA FHFA Professor of Medicine Heart & Vascular Institute Cleveland Clinic Lerner College of Medicine Cleveland
More informationUpdate in. Acute Kidney Injury. Mark Devonald Consultant Nephrologist. Nottingham AKI Research Group
Update in Acute Kidney Injury Mark Devonald Consultant Nephrologist If you stay awake you might hear about Why AKI is important Some cases to illustrate some specific points A couple of updates on AKI
More informationAcute kidney injury after neonatal heart surgery, prevention and management
Acute kidney injury after neonatal heart surgery, prevention and management Mirela Bojan, Simone Gioanni, Philippe Pouard, Department of Anaesthesiology and Intensive Care Necker-Enfants Malades, Paris,
More informationWhen and how to start RRT in critically ill patients? Intensive Care Training Program Radboud University Medical Centre Nijmegen
When and how to start RRT in critically ill patients? Intensive Care Training Program Radboud University Medical Centre Nijmegen Case history (1) 64 Hypertension 2004 AVR 2009 Paravalvular leak - dilated
More informationCardiovascular Disease in CKD. Parham Eftekhari, D.O., M.Sc. Assistant Clinical Professor Medicine NSUCOM / Broward General Medical Center
Cardiovascular Disease in CKD Parham Eftekhari, D.O., M.Sc. Assistant Clinical Professor Medicine NSUCOM / Broward General Medical Center Objectives Describe prevalence for cardiovascular disease in CKD
More informationObjectives. Pre-dialysis CKD: The Problem. Pre-dialysis CKD: The Problem. Objectives
The Role of the Primary Physician and the Nephrologist in the Management of Chronic Kidney Disease () By Brian Young, M.D. Assistant Clinical Professor of Medicine David Geffen School of Medicine at UCLA
More informationNothing to disclose 9/25/2017
Jessie O Neal, PharmD, BCCCP Critical Care Clinical Pharmacist University of New Mexico Hospital New Mexico Society of Health-System Pharmacists 2017 Balloon Fiesta Symposium Nothing to disclose 1 Explain
More information9/25/2017. Nothing to disclose
Nothing to disclose Jessie O Neal, PharmD, BCCCP Critical Care Clinical Pharmacist University of New Mexico Hospital New Mexico Society of Health-System Pharmacists 2017 Balloon Fiesta Symposium Explain
More informationAcute Kidney Injury Care in the Chronic Unit
Acute Kidney Injury Care in the Chronic Unit BONNIE B GREENSPAN WITH ASSIST FROM: DENISE MURCEK, JINA BOGLE, MARY SCHIRA, OCTOBER 5, 2017 Objectives At the completion of the session, engaged participants
More informationOn-Pump vs. Off-Pump CABG: The Controversy Continues. Miguel Sousa Uva Immediate Past President European Association for Cardiothoracic Surgery
On-Pump vs. Off-Pump CABG: The Controversy Continues Miguel Sousa Uva Immediate Past President European Association for Cardiothoracic Surgery On-pump vs. Off-Pump CABG: The Controversy Continues Conflict
More informationManaging Patients with Sepsis
Managing Patients with Sepsis Diagnosis; Initial Resuscitation; ARRT Initiation Prof. Achim Jörres, M.D. Dept. of Nephrology and Medical Intensive Care Charité University Hospital Campus Virchow Klinikum
More informationIntraoperative application of Cytosorb in cardiac surgery
Intraoperative application of Cytosorb in cardiac surgery Dr. Carolyn Weber Heart Center of the University of Cologne Dept. of Cardiothoracic Surgery Cologne, Germany SIRS & Cardiopulmonary Bypass (CPB)
More informationRCP : Regional Update in Medicine Acute Kidney Injury : A Renal Problem?
RCP : Regional Update in Medicine Acute Kidney Injury : A Renal Problem? Lui G Forni : Consultant Intensivist & Nephrologist Faculty of Health Sciences : University of Surrey Disclosures Research Funding
More informationMiECC AND THE BRAIN Helena Argiriadou
MiECC AND THE BRAIN Helena Argiriadou Ass. Professor of Anesthesiology Aristotle University of Thessaloniki, Cardiothoracic Department AHEPA University Hospital Thessaloniki, Greece NEUROLOGIC INJURY AND
More informationFluid Resuscitation in Critically Ill Patients with Acute Kidney Injury (AKI)
Fluid Resuscitation in Critically Ill Patients with Acute Kidney Injury (AKI) Robert W. Schrier, MD University of Colorado School of Medicine Denver, Colorado USA Prevalence of acute renal failure in Intensive
More informationManagement of Advanced Systolic Heart Failure. Robert W. Hull MD FACC Associate Professor of Medicine West Virginia University
Management of Advanced Systolic Heart Failure Robert W. Hull MD FACC Associate Professor of Medicine West Virginia University American College of Cardiology Foundation (ACCF) American Heart Association
More informationIntraoperative Fluid Management. David G Hovord BA MB BChir FRCA Clinical Assistant Professor University of Michigan
Intraoperative Fluid Management David G Hovord BA MB BChir FRCA Clinical Assistant Professor University of Michigan Objectives Examine impact of perioperative renal failure, and discuss structure and function
More informationProfessor and Director. Children s Hospital of Richmond
Evaluation of AKI in term and premature infants Timothy E. Bunchman Professor and Director Pediatric Nephrology & Transplantation Children s Hospital of Richmond Virginia Commonwealth Univ. School of Medicine
More informationTread Carefully Because you Tread on my Nephrons. Prescribing Hints in Renal Disease
Tread Carefully Because you Tread on my Nephrons Prescribing Hints in Renal Disease David WP Lappin,, MB PhD FRCPI Clinical Lecturer in Medicine and Consultant Nephrologist and General Physician, Merlin
More informationVariation in Measurement and Reporting of Goal Directed Perfusion Parameters
The Journal of ExtraCorporeal Technology Variation in Measurement and Reporting of Goal Directed Perfusion Parameters Robert A. Baker Cardiac Surgery Research and Perfusion, Flinders Medical Centre and
More informationSAFETY IN THE CATH LAB How to Minimise Contrast Toxicity
SAFETY IN THE CATH LAB How to Minimise Contrast Toxicity Dr. Vijay Kunadian MBBS, MD, MRCP Senior Lecturer and Consultant Interventional Cardiologist Institute of Cellular Medicine, Faculty of Medical
More informationCase Presentation. This presentation is the intellectual property of the author. Contact them for permission to reprint and/or distribute.
Worsening Renal Function in Heart Failure Patients Mark Drazner, MD, MSc Clinical Chief of Cardiology Medical Director, CHF/VAD/Transplant James M. Wooten Chair in Cardiology UT Southwestern Medical Center
More informationManagement of Acute Kidney Injury in the Neonate. Carolyn Abitbol, M.D. University of Miami Miller School of Medicine / Holtz Children s Hospital
Management of Acute Kidney Injury in the Neonate Carolyn Abitbol, M.D. University of Miami Miller School of Medicine / Holtz Children s Hospital Objectives Summarize the dilemmas in diagnosing & recognizing
More informationCoronary Artery Bypass Graft: Monitoring Patients and Detecting Complications
Coronary Artery Bypass Graft: Monitoring Patients and Detecting Complications Madhav Swaminathan, MD, FASE Professor of Anesthesiology Division of Cardiothoracic Anesthesia & Critical Care Duke University
More informationSUPPLEMENTAL MATERIAL
SUPPLEMENTAL MATERIAL Table S1: Number and percentage of patients by age category Distribution of age Age
More informationMeasure Abbreviation: AKI 01 (QCDR Measure ID: ASPIRE19)
Measure Abbreviation: AKI 01 (QCDR Measure ID: ASPIRE19) Data Collection Method: This measure is calculated based on data extracted from the electronic medical record combined with administrative data
More informationDefinition : Stages : ( RIFLE vs. AKIN ) Causes and classification : Pre-renal Renal Post- renal Clinical manifestations and Complication Management
AKI Definition : Stages : ( RIFLE vs. AKIN ) Causes and classification : Pre-renal Renal Post- renal Clinical manifestations and Complication Management and indications for RRT Etiology prerenal causes
More informationPerfusion s Role in Blood Management Guidelines
Perfusion s Role in Blood Management Guidelines Session 4 Standards and Guidelines in Blood Management 9:10-9:20am Jeffrey B. Riley Acknowledge: Mark Lucas and Keith Symolyk No disclosures AmSECT Q&O:
More informationOBJECTVES OF LEARNING
OBJECTVES OF LEARNING ACUTE RENAL FAILURE AND RENAL REPLACEMENT THERAPY DR.TAI CHENG SHENG RECOGNITION OF DEFINITION OF ARF RECOGNITION OF CAUSE OF ARF RECOGNITION OF PATHOGENESIS OF ARF RECOGNITION OF
More informationHeart Failure and Cardio-Renal Syndrome 1: Pathophysiology. Biomarkers of Renal Injury and Dysfunction
CRRT 2011 San Diego, CA 22-25 February 2011 Heart Failure and Cardio-Renal Syndrome 1: Pathophysiology Biomarkers of Renal Injury and Dysfunction Dinna Cruz, M.D., M.P.H. Department of Nephrology San Bortolo
More informationFaculty/Presenter Disclosure
CSI for CKD Unravelling the myths surrounding chronic kidney disease Practical Evidence for Informed Practice Oct 21 2016 Dr. Scott Klarenbach University of Alberta Slide 1: Option B (Presenter with NO
More informationAggressive Resection/Reconstruction of the Aortic Arch in Type A Dissection: Con
Aggressive Resection/Reconstruction of the Aortic Arch in Type A Dissection: Con Thomas G. Gleason, M.D. Ronald V. Pellegrini Professor and Chief Division of Cardiac Surgery University of Pittsburgh Presenter
More informationActualités sur le remplissage peropératoire. Philippe Van der Linden MD, PhD
Actualités sur le remplissage peropératoire Philippe Van der Linden MD, PhD Fees for lectures, advisory board and consultancy: Fresenius Kabi GmbH B Braun Medical SA Perioperative Fluid Volume Administration
More informationPivotal Role of Renal Function in Acute Heart failure
Pivotal Role of Renal Function in Acute Heart failure Doron Aronson MD, FESC Department of Cardiology RAMBAM Health Care Campus Haifa, Israel Classification and definitions of cardiorenal syndromes CRS
More informationVice Dean and Professor of Medicine
Cell based Therapies in Kidney Disease Mark RosenbergM.D. Vice Dean and Professor of Medicine University i of Minnesota Medical Sh School Case Presentation 58 year old diabetic i man admitted dto the
More informationCRRT for the Experience User 1. Claudio Ronco, M.D. David Selewski, M.D. Rolando Claure-Del Granado, M.D. AKI & CRRT Conference March, 2018
CRRT for the Experience User 1 Claudio Ronco, M.D. David Selewski, M.D. Rolando Claure-Del Granado, M.D. AKI & CRRT Conference March, 2018 Disclosures I have no actual or potential conflict of interest
More informationIdentifying and Managing Chronic Kidney Disease: A Practical Approach
Identifying and Managing Chronic Kidney Disease: A Practical Approach S. Neil Finkle, MD, FRCPC Associate Professor Division of Nephrology, Department of Medicine, Dalhousie University Program Director,
More informationDEFINITION, CLASSIFICATION AND DIAGNOSIS OF ACUTE KIDNEY INJURY
DEFINITION, CLASSIFICATION AND DIAGNOSIS OF ACUTE KIDNEY INJURY JOSÉ ANTÓNIO LOPES, MD, PhD Faculty of Medicine, University of Lisbon Department of Nephrology and Renal Transplantation Centro Hospitalar
More informationECMO & Renal Failure Epidemeology Renal failure & effect on out come
ECMO Induced Renal Issues Transient renal dysfunction Improvement in renal function ECMO & Renal Failure Epidemeology Renal failure & effect on out come With or Without RRT Renal replacement Therapy Utilizes
More informationDialyzing challenging patients: Patients with hepato-renal conditions
Dialyzing challenging patients: Patients with hepato-renal conditions Nidyanandh Vadivel MD Medical Director for Living kidney Donor and Pancreas Transplant Programs Swedish Organ Transplant, Seattle Acute
More informationINSPIRETM. Improving Outcomes. Expanding choices. SCIENTIFIC PUBLICATIONS Abstract Book
INSPIRETM Improving Outcomes. Expanding choices. SCIENTIFIC PUBLICATIONS Abstract Book October 2016 INSPIRE TM Abstract Collection Focusing on neurological protection 1 EFFECT OF OXYGENATOR SIZE ON AIR
More informationCardiothoracic Department October 9, Deborah Winters, RN BSN Clinical Excellence
Cardiothoracic Department October 9, 2013 Deborah Winters, RN BSN Clinical Excellence Quarterly Executive Summary CathPCI Registry PCI Performance Measures PCI Process/Outcome Metrics Diagnostic Cath Process/Outcome
More informationCCS/CAIC/CSCS Position Statement on Revascularization Multi-vessel CAD. Teo et al, Canadian Journal of Cardiology 2014;30:
CCS/CAIC/CSCS Position Statement on Revascularization Multi-vessel CAD Teo et al, Canadian Journal of Cardiology 2014;30: 1482-1491 Parallel Paper: Canadian Cardiovascular Society Guidelines for the Diagnosis
More informationWEEK. MPharm Programme. Acute Kidney Injury. Alan M. Green MPHM13: Acute Kidney Injury. Slide 1 of 47
MPharm Programme Acute Kidney Injury Alan M. Green 2017 Slide 1 of 47 Overview Renal Function What is it? Why does it matter? What causes it? Who is at risk? What can we (Pharmacists) do? How do you recognise
More informationMinimizing the Renal Toxicity of Iodinated Contrast
Minimizing the Renal Toxicity of Iodinated Contrast Peter A. McCullough, MD, MPH, FACC, FACP, FAHA, FCCP Chief Academic and Scientific Officer St. John Providence Health System Detroit, MI USA Outline
More informationThe Triple Threat. Cardiac Care in the NT Annual Workshop 2017 is proudly supported by:
The Triple Threat DR KELUM PRIYADARSHANA FRACP CONSULTANT NEPHROLOGIST ROYAL DARWIN HOSPITAL Cardiac Care in the NT Annual Workshop 2017 is proudly supported by: Pathogenesis Diabetes CKD CVD Diabetic
More informationCLINICAL RESEARCH. Zhihuang Qiu Liangwan Chen Hua Cao Guican Zhang Fan Xu Qiang Chen
e-issn 1643-3750 DOI: 10.12659/MSM.892492 Received: 2014.09.15 Accepted: 2014.10.28 Published: 2015.03.04 Analysis of Risk Factors for Acute Kidney Injury after Ascending Aortic Replacement Combined with
More informationIrish Practice Nurses Association Annual Conference Tullamore Court Hotel OCTOBER 6 th 2012
Irish Practice Nurses Association Annual Conference Tullamore Court Hotel OCTOBER 6 th 2012 Susan McKenna Renal Clinical Nurse Specialist Cavan General Hospital Renal patient population ACUTE RENAL FAILURE
More informationHow and why I give IV fluid Disclosures SCA Fluids and public health 4/1/15. Andrew Shaw MB FRCA FCCM FFICM
How and why I give IV fluid Andrew Shaw MB FRCA FCCM FFICM Professor and Chief Cardiothoracic Anesthesiology Vanderbilt University Medical Center 2015 Disclosures Consultant for Grifols manufacturer of
More informationThe Cardiorenal Syndrome in Heart Failure
The Cardiorenal Syndrome in Heart Failure Van N Selby, MD Assistant Professor of Medicine Advanced Heart Failure Program, UCSF October 9, 2015 Disclosures None 1 Cardiorenal Syndrome (CRS) A pathophysiologic
More informationDecision making in acute dialysis
Decision making in acute dialysis Geoffrey Bihl MB.BCh M.MED FCP(SA) Nephrologist and Director Winelands Kidney and Dialysis Centre Somerset West South Africa Important questions in AKI What is the cause?
More informationJMSCR Vol 06 Issue 12 Page December 2018
www.jmscr.igmpublication.org Impact Factor (SJIF): 6.379 Index Copernicus Value: 79.54 ISSN (e)-2347-176x ISSN (p) 2455-0450 DOI: https://dx.doi.org/10.18535/jmscr/v6i12.02 Original Research Article Fractional
More information