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Critical Care Updates for the Nephrologist, 2016
Xosé L Pérez1, Kathleen D Liu1
1Intensive Care Medicine, Bellvitge University Hospital, Barcelona, Spain; Division of Nephrology, Department of Medicine, University of California, San Francisco, CA; and Division of Critical Care, Department of Anesthesia, University of California, San Francisco, CA.
Abstract:
With improvements in supportive care, mortality from sepsis and the acute respiratory distress syndrome has declined over the past 20 years. However, mortality associated with these conditions is still high. We will review the latest clinical trial findings in these fields, along with implications for the nephrologist. Very recently, there have been significant changes with regard to the management of anterior ischemic strokes; given the high rate of cerebrovascular disease in patients with CKD or ESRD, we will review those studies here. Finally, we will comment on best care practices in the intensive care unit, which are relevant to the nephrologist.
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Reduced renal clearance and elimination rate are common outcomes of renal impairment. These alterations lead to a prolonged elimination half-life and an altered apparent volume of distribution for drugs. As a result, dosage adjustments are typically necessary to maintain optimal drug levels in the body.
However, dosage adjustments...