Long-term sequelae of severe acute kidney injury in the critically Ill patient without comorbidity: A retrospective cohort study

Background and Objectives: Acute kidney injury (AKI) necessitating renal replacement therapy (RRT) is associated with high mortality and increased risk for end stage renal disease. However, it is unknown if this applies to patients with a preliminary unremarkable medical history. The purpose of this study was to describe overall and renal survival in critically ill patients with AKI necessitating RRT stratified by the presence of comorbidity. Design, Setting, Participants, and Measurements: A retrospective cohort study was performed, between 1994 and 2010, including all adult critically ill patients with AKI necessitating RRT, stratified by the presence of comorbidity. Logistic regression, survival curve and cox proportional hazards analyses were used to evaluate overall and renal survival. Standardized mortality rate (SMR) analysis was performed to compare long-term survival to the predicted survival in the Dutch population. Results: Of the 1067 patients included only 96(9.0%) had no comorbidity. Hospital mortality was 56.6% versus 43.8% in patients with and without comorbidity, respectively. In those who survived hospitalization 10-year survival was 45.0% and 86.0%, respectively. Adjusted for age, sex and year of treatment, absence of comorbidity was not associated with hospital mortality (OR=0.74, 95%-CI=0.47-1.15), while absence of comorbidity was associated with better long-term survival (adjusted HR=0.28, 95%-CI = 0.14-0.58). Compared to the Dutch population, patients without comorbidity had a similar mortality risk (SMR=1.6, 95%-CI=0.7-3.2), while this was increased in patients with comorbidity (SMR=4.8, 95%-CI=4.1-5.5). Regarding chronic dialysis dependency, 10-year renal survival rates were 76.0% and 92.9% in patients with and without comorbidity, respectively. Absence of comorbidity was associated with better renal survival (adjusted HR=0.24, 95%-CI=0.07-0.76). Conclusions: While hospital mortality remains excessively high, the absence of comorbidity in critically ill patients with RRT-requiring AKI is associated with a relative good long-term prognosis in those who survive hospitalization

Predictors of short-term successful discontinuation of continuous renal replacement therapy: results from a prospective multicentre study

Background Prediction of successful discontinuation of continuous renal replacement therapy (CRRT) might reduce complications of over- and under-treatment. The aim of this study was to identify renal and non-renal predictors of short-term successful discontinuation of CRRT in patients in whom CRRT was stopped because renal recovery was expected and who were still in the Intensive Care Unit (ICU) at day 2 after stop CRRT. Methods Prospective multicentre observational study in 92 patients alive after discontinuation of CRRT for acute kidney injury (AKI), still in the ICU and free from renal replacement therapy (RRT) at day 2 after discontinuation. Successful discontinuation was defined as alive and free from RRT at day 7 after stop CRRT. Urinary neutrophil gelatinase-associated lipocalin (NGAL) and clinical variables were collected. Logistic regression and Receiver Operator Characteristic (ROC) curve analysis were performed to determine the best predictive and discriminative variables. Results Discontinuation of CRRT was successful in 61/92 patients (66%). Patients with successful discontinuation of CRRT had higher day 2 urine output, better renal function indicated by higher creatinine clearance (6-h) or lower creatinine ratio (day 2/day 0), less often vasopressors, lower urinary NGAL, shorter duration of CRRT and lower cumulative fluid balance (day 0–2). In multivariate analysis renal function determined by creatinine clearance (Odds Ratio (OR) 1.066, 95% confidence interval (CI) 1.022–1.111, p = 0.003) or by creatinine ratio (day 2/day 0) (OR 0.149, 95% CI 0.037–0.583, p = 0.006) and non-renal sequential organ failure assessment (SOFA) score (OR 0.822, 95% CI 0.678–0.996, p = 0.045) were independently associated with successful discontinuation of CRRT. The area under the curve of creatinine clearance to predict su

Fluid balance-adjusted creatinine at initiation of continuous venovenous hemofiltration and mortality. A post-hoc analysis of a multicenter randomized controlled trial.

Introduction Acute kidney injury (AKI) requiring renal replacement therapy (RRT) is associated with high mortality. The creatinine-based stage of AKI is considered when deciding to start or delay RRT. However, creatinine is not only determined by renal function (excretion), but also by dilution (fluid balance) and creatinine generation (muscle mass). The aim of this study was to explore whether fluid balance-adjusted creatinine at initiation of RRT is rel

Erratum to: 36th International Symposium on Intensive Care and Emergency Medicine

[This corrects the article DOI: 10.1186/s13054-016-1208-6.]

Agricultural R&D in the Phillippines: policy, investments, and institutional profile

This report presents an overview of the Philippine national agricultural R&D system in the context of the country’s wider national science and technology (S&T) policy. The discussion includes institutional developments and recent trends in human and financial resources based on data collected under the Agricultural Science and Technology Indicators (ASTI) initiative. With a total of close to 4,000 full-time equivalent researchers in 2002, the Philippines has one of the largest agricultural research systems in Asia. But in terms of total agricultural research spending, the Philippines ranks behind more economically advanced Asian countries such as Malaysia and South Korea. Nonetheless, agricultural R&D spending in the Philippines has shown significant growth in recent years. In 2002, the country invested $269 million in agricultural R&D (in 2000 international dollars), which is an increase of two-thirds over the level recorded a decade earlier. Public agricultural R&D in the Philippines is heavily reliant on government sources of support. In 2002, the Philippine government provided more than 85 percent of funding to the government agencies. In recent years, however, the share of internally generated resources has gradually increased. Foreign donor support plays only a marginal role in the Philippine agricultural R&D system, distinguishing it from some other countries in the region. The organization of public agricultural R&D in the Philippines is complex. The Philippine Council for Agriculture, Forestry and Natural Resources Research and Development (PCARRD) acts as the central coordinating body providing support to 132 implementing R&D agencies collectively called the National Agriculture and Resources Research and Development Network (NARRDN) as well as 14 region-based consortia. Compared to most countries in the Asia-Pacific region, the private sector plays a relatively important role in conducting agricultural R&D in the Philippines. We estimated that about 18 percent of total (public and private) spending in agricultural R&D was done by the private sector, mostly fruit plantations