FIGURE 4 - available via license: Creative Commons Attribution 4.0 International
Content may be subject to copyright.
| Extracorporeal blood purification therapies. (A) Reported the conditions considered to start extracorporeal blood purification therapies. (B) Reported the membranes or modalities used in patients with COVID-19. (C) Reported the likelihood to test interleukin-6 (IL-6) in enrolled centers.
Source publication
Background and Aim
The novel coronavirus disease 2019 remains challenging. A large number of hospitalized patients are at a high risk of developing AKI. For this reason, we conducted a nationwide survey to assess the incidence and management of AKI in critically ill patients affected by the SARS-CoV-2 infection.
Methods
This is a multicenter, obse...
Contexts in source publication
Context 1
... present survey showed that, in the context of the COVID-19 pandemic in Italy, 41.04% of the interviewed clinicians never used EBPTs, while one-third of them (34.33%) used these techniques only in the presence of AKI; by contrast, 24.63% of clinicians resorted to these techniques even in the absence of AKI (Figure 4). In this context, nephrologists used EBPTs, especially in the presence of AKI. ...
Context 2
... systems on direct hemoperfusion or plasma filtration/adsorption that were equally distributed among resuscitators and nephrologists, that is, 18 participants used CytoSorb R (CytoSorbents Corporation, NJ, USA), three used EMIC-2 (Fresenius, Bad Homburg, Germany), three used Toraymixin (Toray Industries, Tokyo, Japan), two used Theranova (Gambro Dialysatoren, Hechingen, Germany, a subsidiary of Baxter International), two used Oxiris (Baxter, Meyzieu, France), two used HA330 (Zhuhai Lizhu Group of Biological Material Co, Ltd., China), and one used HFR Supra (Bellco, Mirandola, Italy), were used by 13.64% of the respondents in <10% of cases, 9.09% in 10-30% of cases, 4.55% in 30-50% of cases, 25% in more than 50% of cases, and never used by 47.73% of the interviewees. Finally, 64.71% of the interviewees stated that they can measure the serum levels of IL-6 in their center (Figure 4). ...
Citations
... The exact underlying pathophysiology of COVID-19 associated AKI is not fully understood but several mechanisms are being discussed to be involved (18). Epidemiological data on the incidence of COVID-19 associated AKI is extremely variable and depending on several factors including geographic and temporal variations during the pandemic (19), but also the lack of use of common diagnostic criteria was associated with an underestimation of AKI rates (20). Accordingly, recommendations for the diagnosis, prevention and management of COVID-19 associated AKI have been published, e.g. by the Acute Disease Quality Initiative (ADQI) Workgroup (15). ...
Introduction
Patients with immune-mediated glomerular diseases are considered at high risk for severe COVID-19 outcomes. However, conclusive evidence for this patient population is scarce.
Methods
We created a global registry and retrospectively collected clinical data of patients with COVID-19 and a previously diagnosed immune-mediated glomerular disease to characterize specific risk factors for severe COVID-19 outcomes.
Results
Fifty-nine patients with a history of immune-mediated glomerular diseases were diagnosed with COVID-19 between 01.03.2020 and 31.08.2021. Over a mean follow-up period of 24.79 ± 18.89 days, ten patients (16.9%) developed acute kidney injury. Overall, 44.1% of patients were managed in an outpatient setting and therefore considered as having “non-severe” COVID-19, while 55.9% of patients had severe COVID-19 requiring hospitalization including worse outcomes. Comparing both groups, patients with severe COVID-19 were significantly older (53.55 ± 17.91 versus 39.77 ± 14.95 years, p = .003), had lower serum albumin levels at presentation (3.00 ± 0.80 g/dL versus 3.99 ± 0.68 g/dL, p = .016) and had a higher risk of developing acute kidney injury (27% versus 4%, p = .018). Male sex (p <.001) and ongoing intake of corticosteroids at presentation (p = .047) were also significantly associated with severe COVID-19 outcomes, while the overall use of ongoing immunosuppressive agents and glomerular disease remission status showed no significant association with the severity of COVID-19 (p = .430 and p = .326, respectively).
Conclusion
Older age, male sex, ongoing intake of corticosteroids and lower serum albumin levels at presentation were identified as risk factors for severe COVID-19 outcomes in patients with a history of various immune-mediated glomerular diseases.
... Sepsis-Associated AKI (SA-AKI) is a life-threatening complication leading to high morbidity and mortality in critically ill patients [2]. Many aspects of SA-AKI are poorly described including clinical definition, epidemiology, pathogenic mechanism, impact of resuscitative and fluid strategies, role of biomarkers for risk stratification, diagnosis, treatment guidance and potential impact on short-and long-term outcomes [3]. Of note, molecules released by different microorganisms (Pathogen Associated Molecular Patterns [PAMPs]) or by injured cells (Damage Associated Molecular Patterns [DAMPs]) into the bloodstream have been shown to be deeply involved in the mechanisms of SA-AKI, thus becoming an attractive therapeutic target. ...
Sepsis-Associated Acute Kidney Injury is a life-threatening condition leading to high morbidity and mortality in critically ill patients admitted to the intensive care unit. Over the past decades, several extracorporeal blood purification therapies have been developed for both sepsis and sepsis-associated acute kidney injury management. Despite the widespread use of extracorporeal blood purification therapies in clinical practice, it is still unclear when to start this kind of treatment and how to define its efficacy. Indeed, several questions on sepsis-associated acute kidney injury and extracorporeal blood purification therapy still remain unresolved, including the indications and timing of renal replacement therapy in patients with septic vs. non-septic acute kidney injury, the optimal dialysis dose for renal replacement therapy modalities in sepsis-associated acute kidney injury patients, and the rationale for using extracorporeal blood purification therapies in septic patients without acute kidney injury. Moreover, the development of novel extracorporeal blood purification therapies, including those based on the use of adsorption devices, raised the attention of the scientific community both on the clearance of specific mediators released by microorganisms and by injured cells and potentially involved in the pathogenic mechanisms of organ dysfunction including sepsis-associated acute kidney injury, and on antibiotic removal. Based on these considerations, the joint commission of the Italian Society of Anesthesiology and Critical Care (SIAARTI) and the Italian Society of Nephrology (SIN) herein addressed some of these issues, proposed some recommendations for clinical practice and developed a common framework for future clinical research in this field.
Graphical abstract
... Then, the predictive capability of different biomarkers varies depending on the etiology of AKI and the group of patients considered. In addition to all these reasons, the main issue concerning the scarce clinical use of biomarkers is the need for more awareness of the importance of early AKI diagnosis and treatment among healthcare team members, as revealed by a recent Italian survey [28,29]. Table 1 summarizes potential markers of persistent vs transient AKI in different settings, some of which are not yet available for clinical use. ...
... AKI awareness programs could help to improve AKI awareness and recognition, and they should include a broader and more appropriate use of early biomarkers of kidney damage [23] and functional tests in critical care settings and the involvement of all healthcare team members, each for their own competence [28]. ...
Acute kidney injury (AKI) affects about half of patients admitted to the intensive care unit (ICU), and worsens their short- and long-term outcomes. Apparently self-limiting AKI episodes initiate a progression toward chronic kidney disease (CKD) through cellular and molecular mechanisms that are yet to be explained. In particular, persistent AKI, defined in 2016 by the Acute Dialysis Quality Initiative as an AKI which lasts more than 48 h from its onset, has been correlated with higher morbidity and mortality, and with a higher progression to acute kidney disease (AKD) and CKD than transient AKI (i.e. AKI with a reversal within 48 h). This classification has been also used in the setting of solid organ transplantation, demonstrating similar outcomes. Due to its incidence and poor prognosis and because prompt interventions seem to change its course, persistent AKI should be recognized early and followed-up also after its recovery. However, while AKI and CKD are well-described syndromes, persistent AKI and AKD are relatively new entities. The purpose of this review is to highlight the key phases of persistent AKI in ICU patients in terms of both clinical and mechanistic features in order to offer to clinicians and researchers an updated basis from which to start improving patients’ care and direct future research.
To explore the research value of structured psychological nursing combined with group health education in patients with blood purification. From May 2020 to March 2022, 96 pure-blood patients in the hospital were selected and divided into research group and control group according to simple random classification, with 48 patients in each group. The control group received routine nursing, and the study group conducted health education combined with structured psychological nursing on the basis of usual care. The disease cognitive ability, negative emotions, blood purification adequacy rate, nutritional status qualification rate and complication rate of the two groups before and after intervention were counted. (1) The number of disease points with unclear status in the study group after intervention was 10.39 ± 1.87, complications were 13.88 ± 2.27, lack of disease information was 12.36 ± 2.16, and unpredictability was 9.58 ± 1.38, which were lower than 13.12 ± 2.53, 17.56 ± 2.53, 15.83 ± 3.0411.67 ± 1.71; (2) After the intervention, the values of SDS of 40.77 ± 3.69 and SAS of 41.52 ± 4.06 were lower than those of 45.82 ± 5.01 and 46.35 ± 4.81 in the control group. (3) The blood adequacy rate of the study group was 91.67%, and the nutritional qualification rate was 93.75%, and the data of both groups were higher than that of 77.08% and 79.17% of the control group. (4) The incidence of complications in the study group was 4.17%, and the control group was 16.67%. Group health education and structured psychological care can effectively alleviate patients' negative emotions and deepen their awareness of diseases, thereby improving blood purification rate and nutrient absorption.
