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Research paper thumbnail of Renal Replacement Therapy in Intensive Care Unit: 10 Commandments

Research paper thumbnail of Implementation of Novel Biomarkers in the Diagnosis, Prognosis, and Management of Acute Kidney Injury: Executive Summary from the Tenth Consensus Conference of the Acute Dialysis Quality Initiative (ADQI)

ADQI Consensus on AKI Biomarkers and Cardiorenal Syndromes, 2013

Detection of acute kidney injury is undergoing a dynamic revolution of biomarker technology allow... more Detection of acute kidney injury is undergoing a dynamic revolution of biomarker technology allowing greater, earlier, and more accurate determination of diagnosis, prognosis, and with powerful implication for management. Biomarkers can be broadly considered as any measurable biologic entity or process that allows differentiation between normal function and injury or disease. The ADQI (Acute Dialysis Quality Initiative) had its Ninth Consensus Conference dedicated to synthesis and formulation of the existing literature on biomarkers for the detection of acute kidney injury in a variety of settings. In the papers that accompany this summary, ADQI workgroups fully develop key concepts from a summary of the literature in the domains of early diagnosis, differential diagnosis, prognosis and management, and concurrent physiologic and imaging measures.

Research paper thumbnail of Renal Replacement Therapy in Intensive Care Unit: 10 Commandments

Academia Letters, 2021

Renal replacement therapy in intensive care units have evolved extensively in last 30 years. The ... more Renal replacement therapy in intensive care units have evolved extensively in last 30 years. The concept of renal replacement and renal support are vital part of organ support in critically ill patients.1 It was 2012 when KDIGO published guideline for acute kidney injury (AKI), it's pathogenesis and management. This helps nephrologists treat critically ill patients in ICUs in a rational way which is supported by authentic data and inferences. Indian data on AKI and dialytic therapies used in AKI is sparse. Whether or not to provide RRT, and when to start, are two of the fundamental questions facing nephrologists and intensive-care practitioners in most cases of severe AKI.2 This is our attempt to simplify the understanding of renal replacement therapy in intensive care units which will help us in managing patients with critical conditions.

Research paper thumbnail of Impact of Preoperative Renal Dysfunction on Outcomes of Off-Pump Coronary Artery Bypass Grafting

The Annals of Thoracic Surgery, 2011

Background. This study assessed whether preoperative renal insufficiency predisposes patients und... more Background. This study assessed whether preoperative renal insufficiency predisposes patients undergoing offpump coronary artery revascularization to postoperative dialysis. Methods. From August 2004 through June 2009, 2,275 patients undergoing off-pump coronary artery bypass were categorized into five groups (stages) by glomerular filtration rate (GFR). Of these, 1,855 patients had renal insufficiency: stage 2: 1,406; stage 3: 428; stage 4: 21, and 414 had normal renal function, stage 1. Excluded were 6 patients with end-stage renal disease (stage 5). Preoperative variables and postoperative outcomes were compared among groups. Results. Preoperative patient characteristics were similar; however, patients with normal renal function were younger (p ‫؍‬ 0.001). Serum creatinine rose significantly above baseline on the first postoperative day in the renal insufficiency groups (p ‫؍‬ 0.001). The GFR groups had similar inotrope use, reexploration rate, duration of postoperative mechanical ventilation, postoperative stroke, wound infection, and mortality rate. Stage 4 patients had a higher incidence of postoperative myocardial infarction (p ‫؍‬ 0.002). Stage 3 and 4 patients had an increased need for postoperative dialysis vs stage 1 patients (p ‫؍‬ 0.002). Conclusions. Nonparametric contingency analysis showed patients with low preoperative GFR (stage 3 and 4, p < 0.0001) and a history of smoking (p ‫؍‬ 0.04) were at increased risk for postoperative dialysis. Patients who required postoperative inotropic support tended toward requiring postoperative dialysis (p ‫؍‬ 0.06). Low preoperative ejection fraction (p ‫؍‬ 0.83), class III or IV angina (p ‫؍‬ 0.069), and postoperative blood transfusions were not associated with the need for postoperative dialysis in patients undergoing off-pump revascularization.

Research paper thumbnail of Implementation of Novel Biomarkers in the Diagnosis, Prognosis, and Management of Acute Kidney Injury: Executive Summary from the Tenth Consensus Conference of the Acute Dialysis Quality Initiative (ADQI)

Contributions to Nephrology, 2013

Detection of acute kidney injury is undergoing a dynamic revolution of biomarker technology allow... more Detection of acute kidney injury is undergoing a dynamic revolution of biomarker technology allowing greater, earlier, and more accurate determination of diagnosis, prognosis, and with powerful implication for management. Biomarkers can be broadly considered as any measurable biologic entity or process that allows differentiation between normal function and injury or disease. The ADQI (Acute Dialysis Quality Initiative) had its Ninth Consensus Conference dedicated to synthesis and formulation of the existing literature on biomarkers for the detection of acute kidney injury in a variety of settings. In the papers that accompany this summary, ADQI workgroups fully develop key concepts from a summary of the literature in the domains of early diagnosis, differential diagnosis, prognosis and management, and concurrent physiologic and imaging measures.

Research paper thumbnail of Renal Replacement Therapy in Intensive Care Unit: 10 Commandments

Research paper thumbnail of Implementation of Novel Biomarkers in the Diagnosis, Prognosis, and Management of Acute Kidney Injury: Executive Summary from the Tenth Consensus Conference of the Acute Dialysis Quality Initiative (ADQI)

ADQI Consensus on AKI Biomarkers and Cardiorenal Syndromes, 2013

Detection of acute kidney injury is undergoing a dynamic revolution of biomarker technology allow... more Detection of acute kidney injury is undergoing a dynamic revolution of biomarker technology allowing greater, earlier, and more accurate determination of diagnosis, prognosis, and with powerful implication for management. Biomarkers can be broadly considered as any measurable biologic entity or process that allows differentiation between normal function and injury or disease. The ADQI (Acute Dialysis Quality Initiative) had its Ninth Consensus Conference dedicated to synthesis and formulation of the existing literature on biomarkers for the detection of acute kidney injury in a variety of settings. In the papers that accompany this summary, ADQI workgroups fully develop key concepts from a summary of the literature in the domains of early diagnosis, differential diagnosis, prognosis and management, and concurrent physiologic and imaging measures.

Research paper thumbnail of Renal Replacement Therapy in Intensive Care Unit: 10 Commandments

Academia Letters, 2021

Renal replacement therapy in intensive care units have evolved extensively in last 30 years. The ... more Renal replacement therapy in intensive care units have evolved extensively in last 30 years. The concept of renal replacement and renal support are vital part of organ support in critically ill patients.1 It was 2012 when KDIGO published guideline for acute kidney injury (AKI), it's pathogenesis and management. This helps nephrologists treat critically ill patients in ICUs in a rational way which is supported by authentic data and inferences. Indian data on AKI and dialytic therapies used in AKI is sparse. Whether or not to provide RRT, and when to start, are two of the fundamental questions facing nephrologists and intensive-care practitioners in most cases of severe AKI.2 This is our attempt to simplify the understanding of renal replacement therapy in intensive care units which will help us in managing patients with critical conditions.

Research paper thumbnail of Impact of Preoperative Renal Dysfunction on Outcomes of Off-Pump Coronary Artery Bypass Grafting

The Annals of Thoracic Surgery, 2011

Background. This study assessed whether preoperative renal insufficiency predisposes patients und... more Background. This study assessed whether preoperative renal insufficiency predisposes patients undergoing offpump coronary artery revascularization to postoperative dialysis. Methods. From August 2004 through June 2009, 2,275 patients undergoing off-pump coronary artery bypass were categorized into five groups (stages) by glomerular filtration rate (GFR). Of these, 1,855 patients had renal insufficiency: stage 2: 1,406; stage 3: 428; stage 4: 21, and 414 had normal renal function, stage 1. Excluded were 6 patients with end-stage renal disease (stage 5). Preoperative variables and postoperative outcomes were compared among groups. Results. Preoperative patient characteristics were similar; however, patients with normal renal function were younger (p ‫؍‬ 0.001). Serum creatinine rose significantly above baseline on the first postoperative day in the renal insufficiency groups (p ‫؍‬ 0.001). The GFR groups had similar inotrope use, reexploration rate, duration of postoperative mechanical ventilation, postoperative stroke, wound infection, and mortality rate. Stage 4 patients had a higher incidence of postoperative myocardial infarction (p ‫؍‬ 0.002). Stage 3 and 4 patients had an increased need for postoperative dialysis vs stage 1 patients (p ‫؍‬ 0.002). Conclusions. Nonparametric contingency analysis showed patients with low preoperative GFR (stage 3 and 4, p < 0.0001) and a history of smoking (p ‫؍‬ 0.04) were at increased risk for postoperative dialysis. Patients who required postoperative inotropic support tended toward requiring postoperative dialysis (p ‫؍‬ 0.06). Low preoperative ejection fraction (p ‫؍‬ 0.83), class III or IV angina (p ‫؍‬ 0.069), and postoperative blood transfusions were not associated with the need for postoperative dialysis in patients undergoing off-pump revascularization.

Research paper thumbnail of Implementation of Novel Biomarkers in the Diagnosis, Prognosis, and Management of Acute Kidney Injury: Executive Summary from the Tenth Consensus Conference of the Acute Dialysis Quality Initiative (ADQI)

Contributions to Nephrology, 2013

Detection of acute kidney injury is undergoing a dynamic revolution of biomarker technology allow... more Detection of acute kidney injury is undergoing a dynamic revolution of biomarker technology allowing greater, earlier, and more accurate determination of diagnosis, prognosis, and with powerful implication for management. Biomarkers can be broadly considered as any measurable biologic entity or process that allows differentiation between normal function and injury or disease. The ADQI (Acute Dialysis Quality Initiative) had its Ninth Consensus Conference dedicated to synthesis and formulation of the existing literature on biomarkers for the detection of acute kidney injury in a variety of settings. In the papers that accompany this summary, ADQI workgroups fully develop key concepts from a summary of the literature in the domains of early diagnosis, differential diagnosis, prognosis and management, and concurrent physiologic and imaging measures.