Major adverse kidney events in pediatric continuous kidney replacement therapy

IMPORTANCE: Continuous kidney replacement therapy (CKRT) is increasingly used in youths with critical illness, but little is known about longer-term outcomes, such as persistent kidney dysfunction, continued need for dialysis, or death. OBJECTIVE: To characterize the incidence and risk factors, including liberation patterns, associated with major adverse kidney events 90 days after CKRT initiation (MAKE-90) in children, adolescents, and young adults. DESIGN, SETTING, AND PARTICIPANTS: This international, multicenter cohort study was conducted among patients aged 0 to 25 years from The Worldwide Exploration of Renal Replacement Outcomes Collaborative in Kidney Disease (WE-ROCK) registry treated with CKRT for acute kidney injury or fluid overload from 2015 to 2021. Exclusion criteria were dialysis dependence, concurrent extracorporeal membrane oxygenation use, or receipt of CKRT for a different indication. Data were analyzed from May 2 to December 14, 2023. EXPOSURE: Patient clinical characteristics and CKRT parameters were assessed. CKRT liberation was classified as successful, reinstituted, or not attempted. Successful liberation was defined as the first attempt at CKRT liberation resulting in 72 hours or more without return to dialysis within 28 days of CKRT initiation. MAIN OUTCOMES AND MEASURES: MAKE-90, including death or persistent kidney dysfunction (dialysis dependence or ≥25% decline in estimated glomerular filtration rate from baseline), were assessed. RESULTS: Among 969 patients treated with CKRT (529 males [54.6%]; median [IQR] age, 8.8 [1.7-15.0] years), 630 patients (65.0%) developed MAKE-90. On multivariable analysis, cardiac comorbidity (adjusted odds ratio [aOR], 1.60; 95% CI, 1.08-2.37), longer duration of intensive care unit admission before CKRT initiation (aOR for 6 days vs 1 day, 1.07; 95% CI, 1.02-1.13), and liberation pattern were associated with MAKE-90. In this analysis, patients who successfully liberated from CKRT within 28 days had lower odds of MAKE-90 compared with patients in whom liberation was attempted and failed (aOR, 0.32; 95% CI, 0.22-0.48) and patients without a liberation attempt (aOR, 0.02; 95% CI, 0.01-0.04). CONCLUSIONS AND RELEVANCE: In this study, MAKE-90 occurred in almost two-thirds of the population and patient-level risk factors associated with MAKE-90 included cardiac comorbidity, time to CKRT initiation, and liberation patterns. These findings highlight the high incidence of adverse outcomes in this population and suggest that future prospective studies are needed to better understand liberation patterns and practices

Consensus-based recommendations on priority activities to address acute kidney injury in children: A modified Delphi consensus statement

Importance: Increasing evidence indicates that acute kidney injury (AKI) occurs frequently in children and young adults and is associated with poor short-term and long-term outcomes. Guidance is required to focus efforts related to expansion of pediatric AKI knowledge. Objective: To develop expert-driven pediatric specific recommendations on needed AKI research, education, practice, and advocacy. Evidence Review: At the 26th Acute Disease Quality Initiative meeting conducted in November 2021 by 47 multiprofessional international experts in general pediatrics, nephrology, and critical care, the panel focused on 6 areas: (1) epidemiology; (2) diagnostics; (3) fluid overload; (4) kidney support therapies; (5) biology, pharmacology, and nutrition; and (6) education and advocacy. An objective scientific review and distillation of literature through September 2021 was performed of (1) epidemiology, (2) risk assessment and diagnosis, (3) fluid assessment, (4) kidney support and extracorporeal therapies, (5) pathobiology, nutrition, and pharmacology, and (6) education and advocacy. Using an established modified Delphi process based on existing data, workgroups derived consensus statements with recommendations. Findings: The meeting developed 12 consensus statements and 29 research recommendations. Principal suggestions were to address gaps of knowledge by including data from varying socioeconomic groups, broadening definition of AKI phenotypes, adjudicating fluid balance by disease severity, integrating biopathology of child growth and development, and partnering with families and communities in AKI advocacy. Conclusions and Relevance: Existing evidence across observational study supports further efforts to increase knowledge related to AKI in childhood. Significant gaps of knowledge may be addressed by focused efforts

Disordered loops in the two-dimensional antiferromagnetic spin-fermion model

The spin-fermion model has long been used to describe the quantum-critical behavior of 2d electron systems near an antiferromagnetic (AFM) instability. Recently, the standard procedure to integrate out the fermions to obtain an effective action for spin waves has been questioned in the clean case. We show that in the presence of disorder, the single fermion loops display two crossover scales: upon lowering the energy, the singularities of the clean fermionic loops are first cut off, but below a second scale new singularities arise that lead again to marginal scaling. In addition, impurity lines between different fermion loops generate new relevant couplings which dominate at low energies. We outline a non-linear sigma model formulation of the single-loop problem, which allows to control the higher singularities and provides an effective model in terms of low-energy diffusive as well as spin modes.Comment: 22 pages, 8 figure

Pulsed extraction of ionization from helium buffer gas

The migration of intense ionization created in helium buffer gas under the influence of applied electric fields is considered. First the chemical evolution of the ionization created by fast heavy-ion beams is described. Straight forward estimates of the lifetimes for charge exchange indicate a clear suppression of charge exchange during ion migration in low pressure helium. Then self-consistent calculations of the migration of the ions in the electric field of a gas-filled cell at the National Superconducting Cyclotron Laboratory (NSCL) using a Particle-In-Cell computer code are presented. The results of the calculations are compared to measurements of the extracted ion current caused by beam pulses injected into the NSCL gas cell.Comment: Accepted for pubilication in Nucl. Instrum. Meth. B, 14 pages, 8 figure

Singular Structure and Enhanced Friedel Oscillations in the Two-Dimensional Electron Gas

We calculate the leading order corrections (in $r_s$) to the static polarization $\Pi^{*}(q,0,)$, with dynamically screened interactions, for the two-dimensional electron gas. The corresponding diagrams all exhibit singular logarithmic behavior in their derivatives at $q=2 k_F$ and provide significant enhancement to the proper polarization particularly at low densities. At a density of $r_s=3$, the contribution from the leading order {\em fluctuational} diagrams exceeds both the zeroth order (Lindhard) response and the self-energy and exchange contributions. We comment on the importance of these diagrams in two-dimensions and make comparisons to an equivalent three-dimensional electron gas; we also consider the impact these finding have on $\Pi^{*}(q,0)$ computed to all orders in perturbation theory

Direct mass measurements beyond the proton drip-line

First on-line mass measurements were performed at the SHIPTRAP Penning trap mass spectrometer. The masses of 18 neutron-deficient isotopes in the terbium-to-thulium region produced in fusion-evaporation reactions were determined with relative uncertainties of about $7\cdot 10^{-8}$, nine of them for the first time. Four nuclides ($^{144, 145}$Ho and $^{147, 148}$Tm) were found to be proton-unbound. The implication of the results on the location of the proton drip-line is discussed by analyzing the one-proton separation energies

Exact integral equation for the renormalized Fermi surface

The true Fermi surface of a fermionic many-body system can be viewed as a fixed point manifold of the renormalization group (RG). Within the framework of the exact functional RG we show that the fixed point condition implies an exact integral equation for the counterterm which is needed for a self-consistent calculation of the Fermi surface. In the simplest approximation, our integral equation reduces to the self-consistent Hartree-Fock equation for the counterterm.Comment: 5 pages, 1 figur

Renormalized perturbation theory for Fermi systems: Fermi surface deformation and superconductivity in the two-dimensional Hubbard model

Divergencies appearing in perturbation expansions of interacting many-body systems can often be removed by expanding around a suitably chosen renormalized (instead of the non-interacting) Hamiltonian. We describe such a renormalized perturbation expansion for interacting Fermi systems, which treats Fermi surface shifts and superconductivity with an arbitrary gap function via additive counterterms. The expansion is formulated explicitly for the Hubbard model to second order in the interaction. Numerical soutions of the self-consistency condition determining the Fermi surface and the gap function are calculated for the two-dimensional case. For the repulsive Hubbard model close to half-filling we find a superconducting state with d-wave symmetry, as expected. For Fermi levels close to the van Hove singularity a Pomeranchuk instability leads to Fermi surfaces with broken square lattice symmetry, whose topology can be closed or open. For the attractive Hubbard model the second order calculation yeilds s-wave superconductivity with a weakly momentum dependent gap, whose size is reduced compared to the mean-field result.Comment: 18 pages incl. 6 figure

Programs and processes for advancing pediatric acute kidney support therapy in hospitalized and critically ill children: A report from the 26th Acute Disease Quality Initiative (ADQI) consensus conference

Pediatric acute kidney support therapy (paKST) programs aim to reliably provide safe, effective, and timely extracorporeal supportive care for acutely and critically ill pediatric patients with acute kidney injury (AKI), fluid and electrolyte derangements, and/or toxin accumulation with a goal of improving both hospital-based and lifelong outcomes. Little is known about optimal ways to configure paKST teams and programs, pediatric-specific aspects of delivering high-quality paKST, strategies for transitioning from acute continuous modes of paKST to facilitate rehabilitation, or providing effective short- and long-term follow-up. As part of the 26th Acute Disease Quality Initiative Conference, the first to focus on a pediatric population, we summarize here the current state of knowledge in paKST programs and technology, identify key knowledge gaps in the field, and propose a framework for current best practices and future research in paKST