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  • Derivation and External Validation of Prediction Models for Advanced Chronic Kidney Disease Following Acute Kidney Injury

    Abstract Full Text
    JAMA. 2017; 318(18):1787-1797. doi: 10.1001/jama.2017.16326

    This study uses data from Canadian administrative and clinical ambulatory databases to derive and validate risk prediction models for advanced chronic kidney disease in patients hosptialized with acute kidney injury.

  • Effect of Early Vasopressin vs Norepinephrine on Kidney Failure in Patients With Septic Shock: The VANISH Randomized Clinical Trial

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    JAMA. 2016; 316(5):509-518. doi: 10.1001/jama.2016.10485

    This randomized clinical trial compares the effect of vasopressin vs norepinephrine on kidney failure in patients with septic shock.

  • Intensive vs Standard Blood Pressure Control and Cardiovascular Disease Outcomes in Adults Aged ≥75 Years: A Randomized Clinical Trial

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    JAMA. 2016; 315(24):2673-2682. doi: 10.1001/jama.2016.7050

    This randomized clinical trial evaluates the effects of intensive (<120 mm Hg) systolic blood pressure targets compared with standard (<140 mm Hg) systolic blood pressure targets in patients aged 75 years or older.

  • JAMA June 14, 2016

    Figure: Flowchart of Enrolled Participants and Progress Through the LIPS-A Trial

    Reasons for exclusion were not mutually exclusive and exhaustive because participants could have more than 1 reason for exclusion. Exclusion after randomization (n = 10) resulted in a change from an intention-to-treat analysis to a modified intention-to-treat analysis denoted as the full analysis set in International Conference on Harmonization statistical guidelines (E9 guidelines). The full analysis set was used for all analyses. The ineligibility reasons for the 4 participants withdrawn from the intention-to-treat sample were allergy to aspirin confirmed before first dose but after randomization; non-English speaking and removed per institutional review board determination; participant enrolled into study twice (second enrollment excluded); and patient was determined to have acute kidney injury after consent but prior to first dose. The 6 participants who withdrew consent indicated that previously collected data could not be used in the study.
  • Effect of Early vs Delayed Initiation of Renal Replacement Therapy on Mortality in Critically Ill Patients With Acute Kidney Injury: The ELAIN Randomized Clinical Trial

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    JAMA. 2016; 315(20):2190-2199. doi: 10.1001/jama.2016.5828

    This randomized clinical trial compares the effects of early vs delayed initiation of renal replacement therapy on 90-day all-cause mortality among critically ill patients with AKI.

  • JAMA May 24, 2016

    Figure 1: Flow of Patients Through the ELAIN Trial

    ELAIN indicates Early vs Late Initiation of Renal Replacement Therapy in Critically Ill Patients With Acute Kidney Injury; KDIGO, Kidney Disease: Improving Global Outcomes; RRT, renal replacement therapy; CKD, chronic kidney disease; GFR, glomerular filtration rate; AKI, acute kidney injury; SOFA, sepsis-related organ failure assessment; NGAL, neutrophil gelatinase–associated lipocalin.
  • Early to Dialyze: Healthy and Wise?

    Abstract Full Text
    JAMA. 2016; 315(20):2171-2172. doi: 10.1001/jama.2016.6210
  • JAMA April 12, 2016

    Figure 3: Genome-Wide Transcriptional Analysis of Blood Leukocytes From Patients With Sepsis Who Did or Did Not Acquire an Infection While in the ICU

    A, Genome-wide blood gene expression profiles of 64 patients who developed an intensive care unit (ICU)–acquired infection and 398 patients who did not were each compared to 42 healthy controls. This analysis revealed 97% of the significantly altered gene transcripts in patients with and without acquired infection were common. Log2 fold changes relate to differences in gene expression between patients and healthy controls. Spearman correlation analysis of the resultant log2-transformed fold changes of standard biotin-fluorescence intensities per gene transcript between patients and healthy subjects (intensity genei,patients − intensity genei,health) showed a strongly correlating gene expression response. No differences in blood transcriptional profiles were uncovered when directly comparing patients with and without ICU-acquired infections with samples from patients with no ICU-acquired infection. ρ Indicates Spearman ρ. Each dot represents a specific gene transcript. B and C, Volcano plot representation (integrating log2 fold changes and −log10 Benjamin Hochberg [BH] P values) of genome-wide blood transcriptional profiles of paired ICU admission and event (follow-up) samples from 9 patients with no and 19 patients with ICU-acquired infections. Log2 fold changes relate to the difference in gene expression between (paired) admission and follow-up samples. Each dot represents a specific gene transcript. B, Gene expression profiles of patients without ICU-acquired infections sampled at ICU admission were compared with those sampled at the onset of a noninfectious ICU-acquired complication (2 acute lung injuries, 6 acute kidney injuries; 1 acute myocardial infarction). No differences were identified. C, Gene expression profiles of patients with ICU-acquired infections sampled at ICU admission were compared with samples taken at the onset of an ICU-acquired infectious complication. A total of 128 significantly different genes were identified in the paired samples of patients with ICU-acquired infections. Gray dots denote nonsignificant genes; red dots, significantly overexpressed genes (n=11); blue dots, significantly underexpressed genes (n=117). D, Heat map representation of samples from 19 patients with ICU-acquired infections collected at both ICU admission and at the onset of the infectious complication (paired analysis). Glycolysis-I gene expression values (log2-transformed intensities) were scaled and depicted in color code format, with red denoting overexpression and blue denoting underexpression. GPI indicates glucose-6-phosphate isomerase; TPI1, triosephosphate isomerase 1; GAPDH, glyceraldehyde-3-phosphate dehydrogenase; PGK1, phosphoglycerate kinase 1; PGAM1, phosphoglycerate mutase 1; and ENO1, enolase 1.
  • Postprocedural Blue Toes

    Abstract Full Text
    JAMA. 2016; 315(13):1396-1397. doi: 10.1001/jama.2016.1810

    A man in his 70s with a history of recent CABG surgery presented with blue, tender plantar macules on several toes and red, tender macules on his hands. Laboratory findings included a BUN level of 70 mg/dL, serum creatinine level of 6.1 mg/dL, and peripheral eosinophilia. What would you do next?

  • JAMA March 1, 2016

    Figure 2: Efficacy of Treatment to Prevent Acute Kidney Injury (AKI) in All Patients and Prespecified Subgroups

    Absolute differences are the estimated differences in proportions between the atorvastatin and placebo groups derived from model transformations. Quasi-Poisson log-linear regression was used to calculate the estimates and 95% CIs. The estimates should be interpreted as the relative risk of treatment for the primary end point of AKI. The Pearson χ2 test was used to calculate the P values.
  • JAMA March 1, 2016

    Figure 1: Recruitment, Randomization, and Follow-up for the Statin Acute Kidney Injury Cardiac Surgery RCT

    RCT indicates randomized clinical trial.aThese are approximate data.
  • Perioperative Statins in Cardiac Surgery and Acute Kidney Injury

    Abstract Full Text
    JAMA. 2016; 315(9):873-874. doi: 10.1001/jama.2016.0245
  • High-Dose Perioperative Atorvastatin and Acute Kidney Injury Following Cardiac Surgery: A Randomized Clinical Trial

    Abstract Full Text
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    JAMA. 2016; 315(9):877-888. doi: 10.1001/jama.2016.0548

    This randomized clinical trial compares the effects of short-term high-dose perioperative atorvastatin vs placebo on acute kidney injury following cardiac surgery.

  • Effect of a Buffered Crystalloid Solution vs Saline on Acute Kidney Injury Among Patients in the Intensive Care Unit: The SPLIT Randomized Clinical Trial

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    JAMA. 2015; 314(16):1701-1710. doi: 10.1001/jama.2015.12334

    This randomized trial determines the effect of a buffered crystalloid compared with saline on renal complications among patients in the intensive care unit.

  • Assessing Toxicity of Intravenous Crystalloids in Critically Ill Patients

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    JAMA. 2015; 314(16):1695-1697. doi: 10.1001/jama.2015.12390
  • Effect of Remote Ischemic Preconditioning on Kidney Injury Among High-Risk Patients Undergoing Cardiac Surgery: A Randomized Clinical Trial

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    JAMA. 2015; 313(21):2133-2141. doi: 10.1001/jama.2015.4189

    This randomized trial reports that in high-risk patients undergoing cardiac surgery, remote ischemic preconditioning performed via blood pressure cuff inflation significantly reduced the rate of acute kidney injury and renal replacement therapy.

  • JAMA June 2, 2015

    Figure 2: Analysis of Acute Kidney Injury Biomarkers

    A, Analysis of urine (TIMP-2) × (IGFBP7) before and after remote ischemic preconditioning (RIPC) and cardiopulmonary bypass (CPB) (pre-RIPC, P = .33; post-RIPC, P = <.01; 4 h after CPB, P = .01; 12 h after CPB, P = .01; 24 h after CPB, P = .35) (lower and upper limit of the reference range, 0.03 [2.5 percentile] and 1.93 [97.5 percentile], respectively). B, Analysis of urine neutrophil gelatinase-associated lipocalin (NGAL) concentrations before and after RIPC and CPB (pre-RIPC, P = .79; post-RIPC, P = .72; 4 h after CPB, P = .04; 12 h after CPB, P = .74; 24 h after CPB, P = .28) (reference range, 153 ng/mL; 90% CI, 142 to 182 ng/mL). C, Analysis of HMGB-1 concentrations before and after RIPC (pre-RIPC, P = .23; post-RIPC, P = <.01) (reference range: mean, 0.39 ng/mL; upper limit of the reference range, 1.4 ng/mL [97.5 percentile]). Error bars indicate 95% CI. All P values are for comparison of RIPC vs control. HMGB-1 indicates high-mobility group box 1; (TIMP-2) × (IGFBP7) indicates the product of urine IGFBP7 (insulinlike growth factor–binding protein 7) and TIMP-2 (tissue inhibitor of metalloproteinases 2).
  • Remote Ischemic Preconditioning for Kidney Protection

    Abstract Full Text
    JAMA. 2015; 313(21):2124-2125. doi: 10.1001/jama.2015.5085
  • JAMA March 10, 2015

    Figure: Total and Potentially Preventable 90-Day Readmissions Among Survivors of Severe Sepsis and Matched Hospitalizations for Acute Medical Conditions

    Potentially preventable readmission diagnoses include pneumonia, hypertension, dehydration, asthma, urinary tract infection, chronic obstructive pulmonary disease exacerbation, perforated appendix, diabetes, angina, congestive heart failure, sepsis, acute renal failure, skin or soft tissue infection, and aspiration pneumonitis. The shaded areas indicate 95% confidence intervals.