Acute kidney injury (AKI) is a complex disorder for which currently there is no accepted definition. Having a uniform standard for diagnosing and classifying AKI would enhance our ability to manage these patients. Future clinical and translational research in AKI will require collaborative networks of investigators drawn from various disciplines, dissemination of information via multidisciplinary joint conferences and publications, and improved translation of knowledge from pre-clinical research. We describe an initiative to develop uniform standards for defining and classifying AKI and to establish a forum for multidisciplinary interaction to improve care for patients with or at risk for AKI. Members representing key societies in critical care and nephrology along with additional experts in adult and pediatric AKI participated in a two day conference in Amsterdam, The Netherlands, in September 2005 and were assigned to one of three workgroups. Each group's discussions formed the basis for draft recommendations that were later refined and improved during discussion with the larger group. Dissenting opinions were also noted. The final draft recommendations were circulated to all participants and subsequently agreed upon as the consensus recommendations for this report. Participating societies endorsed the recommendations and agreed to help disseminate the results. The term AKI is proposed to represent the entire spectrum of acute renal failure. Diagnostic criteria for AKI are proposed based on acute alterations in serum creatinine or urine output. A staging system for AKI which reflects quantitative changes in serum creatinine and urine output has been developed. We describe the formation of a multidisciplinary collaborative network focused on AKI. We have proposed uniform standards for diagnosing and classifying AKI which will need to be validated in future studies. The Acute Kidney Injury Network offers a mechanism for proceeding with efforts to improve patient outcomes.

Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury

https://www.commed.vcu.edu/Chronic_Disease/2012/cochranrvwrschbias.pdf

The Cochrane Collaboration's tool for assessing risk of bias in randomised trials

正しい方法がわかる臨床基本手技 : from the New England journal of medicine

Definition, evaluation, and classification of renal osteodystrophy: A position statement from Kidney Disease: Improving Global Outcomes (KDIGO)

https://www.kidney-international.org/article/S0085-2538(15)52999-2/pdf

A proposed nomenclature and diagnostic criteria for protein–energy wasting in acute and chronic kidney disease

CHRONIC KIDNEY DISEASE MANAGEMENT: Approach to the CKD Patient: Management of Chronic Kidney Disease, Stages 1-4, Shona Pendse and Ajay Singh / Initiation of Dialysis, Shona Pendse, Ajay K. Singh, and Edward T. Zawada, Jr. BLOOD-BASED THERAPIES: Physiologic Principles and Urea Kinetic Modeling, John T. Daugirdas / Hemodialysis Apparatus, Suhail Ahmad, Madhukar Misra, and John T. Daugirdas / Product Water and Hemodialysis Solution Preparation, Richard A. Ward and Todd S. Ing / Venous Catheter Access for Hemodialysis, Michael Allon and Jack Work / Arteriovenous (AV) Access for Hemodialysis, Victoria Kumar, Thomas Depner, Anatole Besarab, and Shubha Ananthakrishnan / Acute Hemodialysis Prescription, John T. Daugirdas, Edward A. Ross, and Allen R. Nissenson / Chronic Hemodialysis Prescription: A Urea Kinetic Approach, John T. Daugirdas / Complications During Hemodialysis, Richard A. Sherman, John T. Daugirdas, and Todd S. Ing / Dialyzer Reuse, Allen M. Kaufman, Robert Levin, Ravi Jayakaran, and Nathan W. Levin / Anticoagulation, Andrew Davenport, Joachim Hertel, Dawn M. Keep, and Ralph J. Caruana / Slow Continuous Therapies, Boon Wee Teo, Jennifer S. Messer, Emil P. Paganini, Miles H. Sigler, Brendan P. Teehan, John T. Daugirdas, and Todd S. Ing / Frequent Daily or Nocturnal Hemodialysis, Gihad E. Nesrallah, Rita S. Suri, Robert M. Lindsay, and Andreas Pierratos / Hemodiafiltration and Hemofiltration, Bernard Canaud and Detlef Krieter / Plasmapheresis, Nuhad Ismail, Dobri D. Kiprov, and Raymond M. Hakim / Use of Dialysis and Hemoperfusion in Treatment of Poisoning, James F. Winchester, Adin Boldur, Chima Oleru, and Chagriya Kitiyakara PERITONEAL DIALYSIS: Physiology of Peritoneal Dialysis, Peter G. Blake and John T. Daugirdas / Apparatus for Peritoneal Dialysis, Olof Heimburger and Peter G. Blake / Peritoneal Access Devices, Stephen R. Ash and John T. Daugirdas / Acute Peritoneal Dialysis Prescription, Stephen M. Korbet and Nouhad O. Kronfol / Adequacy of Peritoneal Dialysis and Chronic Peritoneal Dialysis Prescription, Peter G. Blake / Volume Status and Fluid Overload in Peritoneal Dialysis, Neil Boudville and Peter G. Blake / Peritonitis and Exit-Site Infection, David J. Leehey, Cheuk-Chun Szeto, and Philip K-T Li / Mechanical Complications of Peritoneal Dialysis, Joanne M. Bargman / Metabolic Complications of Peritoneal Dialysis, Sarah S. Prichard CLINICAL PROBLEM AREAS: Psychosocial Issues in End-Stage Renal Disease Patients, Scott D. Cohen, Vicenzio Perkins, and Paul L. Kimmel / Nutrition, Michael V. Rocco and Alp Ikizler / Serum Enzyme Levels, N. D. Vaziri and D. Kayichian / Diabetes, Antonios H. Tzamaloukas and Eli A. Friedman / Hypertension, Carmine Zoccali and Reggio Cal / Hematologic Abnormalities, Steven Fishbane and Emil P. Paganini / Infections, David J. Leehey, Joan P. Cannon, and Joseph R. Lentino / Endocrine Disturbances, Michael J. Flanigan and Victoria S. Lim / Bone Disease, Daniel W. Coyne, Steven C. Cheng, and James A. Delmez / Dialysis in Infants and Children, Susan R. Mendley / Heart and Circulation, Daniel E. Weiner, Anthony J. Nicholls, and Mark J. Sarnak / The Digestive Tract, Susie Q. Lew and Juan P. Bosch / Genitourinary Tract and Male Reproductive Organs, Kar Neng Lai, Anthony J. Schaeffer, and Biff F. Palmer / Obstetrics and Gynecology, Susan Grossman and Susan Hou / Musculoskeletal and Rheumatologic Diseases, Jonathan Kay / Nervous System, Anthony J. Nicholls / Aluminum Toxicity, Patrick C. D'Haese and Marc E. DeBroe Appendix A: Urea Kinetic Modeling: Tables and Figures Appendix B: Molecular Weights and Conversion Tables

Handbook of Dialysis

Although there is a perception that the use of peritoneal dialysis is declining worldwide, compilations of global data are unavailable to test this hypothesis. We assessed longitudinal trends in the use of peritoneal dialysis from 1997 to 2008 in 130 countries. The preferred data sources were renal registries, followed by nephrology societies, health ministries, academic centers, national experts, and industry affiliates. In 2008, there were approximately 196,000 peritoneal dialysis patients worldwide, representing 11% of the dialysis population. In total, 59% were treated in developing countries and 41% in developed countries. Over 12 years, the number of peritoneal dialysis patients increased in developing countries by 24.9 patients per million population and in developed countries by 21.8 per million population. The proportion of all dialysis patients treated with peritoneal dialysis did not change in developing countries but significantly declined in developed countries by 5.3%. The use of automated peritoneal dialysis increased by 14.5% in developing countries and by 30.3% in developed countries. In summary, the number of patients treated with peritoneal dialysis rose worldwide from 1997 to 2008, with a 2.5-fold increase in the prevalence of peritoneal dialysis patients in developing countries. The proportion of all dialysis patients treated with this modality continues to decline in developed countries.

Global trends in rates of peritoneal dialysis.

luid balance management is one of the primaryfunctions of renal replacement therapy. Peritonealdialysis (PD), because of its continuous nature, hasbeen considered an optimal approach to this thera-peutic goal, avoiding fluctuant volume status and af-fording better homeostatic stability (1). This superiorpotential of PD has been illustrated in several studiesshowing, in discreet patient groups, better blood pres-sure control in PD compared to hemodialysis (HD) (2).This therapeutic advantage, however, has not been uni-versally utilized and population surveys still show ashigh a prevalence of hypertension and cardiovascularmortality in PD as in HD populations (3–5). While thelatter may be ascribed in both populations to an in-herited disease burden from the pre end-stage renaldisease (ESRD) phase of renal disease, it is clear thatthe full potential of PD for optimal volume homeosta-sis has remained underutilized (6). Several factors maybe responsible for this underutilization and for the as-sumption prevalent among physicians that HD affordsa more effective means of volume control. By its verynature as a continuous therapy, PD lacks the dramaticillustration of rapid volume removal observed with HD.Similarly, by its very nature as a home therapy, PDlacks the recurrent frequent examination by physi-cians/nurses of volume status afforded by three-timesweekly HD, so the opportunities for triggered inter-ventions are more temporally spaced than in HD. Thesetwo contrasting phenomena (dramatic volume removaland frequent examination) may also explain why theconcept of “dry weight,” a cornerstone clinical operat-ing indicator in HD, is not widely used in the approachto volume management in PD. Patients on PD are rou-tinely instructed to measure their weight on a dailybasis. Guidelines on therapy modifications based onchanges in weight can be safely taught to mostpatients.

Evaluation and management of ultrafiltration problems in peritoneal dialysis

Background. There were 35 265 patients receiving renal replacement therapy in Canada at the end of 2007 with 11.0% of patients on peritoneal dialysis (PD) and 48.9% on hemodialysis (HD) and a remaining 40.1% living with a functioning kidney transplant. There are no contemporary studies examining PD survival relative to HD in Canada. The objective was to compare survival outcomes for incident patients starting on PD as compared to HD in Canada. Methods. Using data from the Canadian Organ Replacement Register, the Cox proportional hazards (PH) model was employed to study survival outcomes for patients initiating PD as compared to HD in Canada from 1991 to 2004 with follow-up to 31 December 2007. Comparisons of outcomes were made between three successive calendar periods: 1991–95, 1996–2000 and 2001–04 with the relative risk of death of incident patients calculated using an intent-to-treat (ITT) analysis with proportional and non-PH models using a piecewise exponential survival model to compare adjusted mortality rates. Results. In the ITT analysis, overall survival for the entire study period favored PD in the first 18 months and HD after 36 months. However, for the 2001–04 cohort, survival favored PD for the first 2 years and thereafter PD and HD were similar. Among female patients >65 years with diabetes, PD had a 27% higher mortality rate. Conclusion. Overall, HD and PD are associated with similar outcomes for end-stage renal disease treatment in Canada.

/pdf/hemodialysis-and-peritoneal-dialysis-are-associated-with-mox3zlpa16.pdf

Hemodialysis and peritoneal dialysis are associated with similar outcomes for end-stage renal disease treatment in Canada

Serum albumin (SA) is a powerful predictor of patient morbidity and mortality in hemodialysis, but data are limited for continuous ambulatory peritoneal dialysis (CAPD). SA was monitored in 76 new CAPD patients over 222 6-month periods and mean SA was correlated with morbidity and mortality during those periods. The influence of initial SA on duration of technique survival was also investigated. To determine which factors best predict SA, correlations with patient demographics and with 6-month measurements of dialytic dose, protein intake, and peritoneal transport were sought. Mean SA overall was 34.1 +/- 3.3 g/L, and mean initial SA was 33.4 +/- 3.1 g/L. Mean SA was lower in diabetics and in those aged 65 or over. Mean SA tended to increase during the first year on CAPD, and this increase was maintained, except in patients aged 65 or over, where it tended to revert to initial values. SA correlated with hospital days (r = -0.20; P

/pdf/serum-albumin-in-patients-on-continuous-ambulatory-2i7qih4v11.pdf

Peter G. Blake

Papers

Handbook of Dialysis

Global trends in rates of peritoneal dialysis.

Evaluation and management of ultrafiltration problems in peritoneal dialysis

Hemodialysis and peritoneal dialysis are associated with similar outcomes for end-stage renal disease treatment in Canada

Serum albumin in patients on continuous ambulatory peritoneal dialysis--predictors and correlations with outcomes.