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Continuous Renal Replacement Therapy01:30

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Continuous Renal Replacement Therapy, also known as CRRT, is a procedural treatment for acute kidney injury (AKI) that gradually removes uremic toxins and fluids while maintaining acid-base balance and stabilizing electrolytes. It is particularly useful for hemodynamically unstable patients. Unlike intermittent hemodialysis, which is faster, CRRT provides a gentler approach over 24 hours, closely mimicking the function of natural kidneys. However, CRRT is not ideal for patients with...
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Acute Kidney Injury V: Interprofessional Care01:20

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Acute Kidney Injury (AKI) requires a collaborative healthcare approach to restore renal function and prevent complications. Essential management strategies involve monitoring fluid and electrolyte balance, adjusting medications, initiating dialysis when necessary, and providing nutritional support.Fluid and Electrolyte ManagementFluid Monitoring: Regularly monitoring body weight, central venous pressure, and urine output helps detect fluid imbalances early. Patient intake and output are...
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Preoperative ManagementThe primary goals of preoperative management in kidney transplantation are to optimize the patient’s metabolic state and prepare them for surgery through diet adjustments, necessary dialysis, and tailored medical treatment. This phase also involves comprehensive infection screening and patient education about the surgical procedure and postoperative care to improve outcomes and adherence.Medical ManagementA comprehensive evaluation is required for both the living...
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Accurate diagnosis and effective prevention are critical in managing Acute Kidney Injury (AKI), which is linked to high mortality rates ranging from 10% to 80%. Timely recognition of at-risk patients and careful monitoring can significantly reduce the likelihood of kidney damage.Diagnostic Assessments:The diagnostic process starts with a comprehensive medical history to identify prerenal, intrarenal, and postrenal causes.Prerenal causes, such as dehydration, hypotension, or blood loss, should...
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Acute Kidney Injury I: Introduction01:22

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Introduction:Acute Kidney Injury (AKI) describes a swift decrease in kidney function occurring over hours to days, characterized by the kidneys' failure to remove waste products from the bloodstream. This leads to dangerous complications like metabolic acidosis, fluid overload, and electrolyte imbalances, such as hyperkalemia, which can cause life-threatening arrhythmias. AKI is common in both hospital and outpatient settings, often triggered by dehydration, sepsis, or exposure to nephrotoxic...
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Acute Kidney Injury III: Clinical Manifestations01:29

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Acute Kidney Injury (AKI) progresses through distinct clinical phases: the oliguric, diuretic, and recovery phases, each marked by unique manifestations and challenges.Oliguric Phase:The oliguric phase is the initial stage of AKI, typically lasting 10 to 14 days. This phase is marked by a significant reduction in urine output, usually less than 400 mL per day, indicating decreased kidney function. Fluid retention is a prominent feature, leading to symptoms such as edema, hypertension, and...
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Kidney Outcomes Following Utilization of Molecular Adsorbent Recirculating System.

Christopher L Trautman1, Mahnoor Khan1, Lyle W Baker1

  • 1Division of Nephrology and Hypertension, Department of Medicine; Mayo Clinic Jacksonville, Florida, USA.

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Summary

Molecular adsorbent recirculating system (MARS) therapy is used for severe liver failure. Patients needing MARS often require continuous kidney replacement therapy (CKRT), which is linked to significantly higher mortality rates.

Keywords:
acute kidney injurycontinuous kidney replacement therapyliver failuremolecular adsorbent recirculating systemtransplantation

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Area of Science:

  • Nephrology
  • Hepatology
  • Critical Care Medicine

Background:

  • Fulminant hepatic failure often necessitates advanced extracorporeal support like the Molecular Adsorbent Recirculating System (MARS).
  • Acute kidney injury (AKI) is a frequent complication in patients with hepatic failure, often requiring continuous kidney replacement therapy (CKRT).
  • Limited data exists on kidney outcomes for patients undergoing MARS therapy.

Purpose of the Study:

  • To characterize patients receiving MARS therapy.
  • To examine kidney-related events and outcomes in this patient cohort.
  • To assess the impact of concomitant CKRT on mortality and kidney recovery.

Main Methods:

  • Retrospective cohort study of 49 patients who initiated MARS therapy between January 2014 and December 2020.
  • Data collected on treatment indications, liver transplantation, CKRT use, kidney recovery, and mortality.
  • Statistical analysis included relative risk and confidence intervals to compare outcomes between groups.

Main Results:

  • 59% of patients (29/49) required concomitant CKRT.
  • Hepatic encephalopathy was the primary indication for MARS (55%).
  • In-hospital mortality was significantly higher in patients receiving CKRT (41%) compared to those not requiring CKRT (10%). One-year mortality was also substantially higher in the CKRT group (59% vs. 25%).
  • 39% of patients on CKRT recovered kidney function before discharge.

Conclusions:

  • Patients requiring MARS therapy frequently develop AKI necessitating CKRT.
  • Concomitant CKRT in MARS patients is associated with increased in-hospital and one-year mortality.
  • While kidney recovery is possible, the overall prognosis for MARS patients requiring CKRT remains poor.