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Updates in Management and Timing of Dialysis in Acute Kidney Injury
Updates in Management and Timing of Dialysis in Acute Kidney Injury
- Source :
- Journal of Hospital Medicine. 14:232
- Publication Year :
- 2019
- Publisher :
- Wiley, 2019.
-
Abstract
- Acute kidney injury (AKI) is a common complication in hospitalized patients and is associated with mortality, prolonged hospital length of stay, and increased healthcare costs. This paper reviews several areas of controversy in the identification and management of AKI. Serum creatinine and urine output are used to identify and stage AKI by severity. Although standardized definitions of AKI are used in research settings, these definitions do not account for individual patient factors or clinical context which are necessary components in the assessment of AKI. After treatment of reversible causes of AKI, patients with AKI should receive adequate volume resuscitation with crystalloid solutions. Balanced crystalloid solutions generally prevent severe hyperchloremia and could potentially reduce the risk of AKI, but additional studies are needed to demonstrate a clinical benefit. Intravenous albumin may be beneficial in patients with chronic liver disease either to prevent or attenuate the severity of AKI; otherwise, the use of albumin or other colloids (eg, hydroxyethyl starch) is not recommended. Diuretics should be used to treat volume overload, but they do not facilitate AKI recovery or reduce mortality. Nutrition consultation may be helpful to ensure that patients receive adequate, but not excessive, dietary protein intake, as the latter can lead to azotemia and electrolyte disturbances disproportionate to the patient's kidney failure. The optimal timing of dialysis initiation in AKI remains controversial, with conflicting results from two randomized controlled trials.
- Subjects :
- medicine.medical_specialty
Resuscitation
Leadership and Management
medicine.medical_treatment
Context (language use)
Assessment and Diagnosis
urologic and male genital diseases
Chronic liver disease
law.invention
03 medical and health sciences
0302 clinical medicine
Hyperchloremia
Randomized controlled trial
Renal Dialysis
law
Albumins
030225 pediatrics
medicine
Humans
030212 general & internal medicine
Intensive care medicine
Care Planning
Dialysis
urogenital system
business.industry
Health Policy
Acute kidney injury
Health Care Costs
General Medicine
Acute Kidney Injury
Length of Stay
medicine.disease
female genital diseases and pregnancy complications
Creatinine
Fluid Therapy
Fundamentals and skills
Azotemia
business
Subjects
Details
- ISSN :
- 15535606
- Volume :
- 14
- Database :
- OpenAIRE
- Journal :
- Journal of Hospital Medicine
- Accession number :
- edsair.doi.dedup.....17bf070b662c80f54808bd5efe6430af
- Full Text :
- https://doi.org/10.12788/jhm.3105