Search Results (699)

Background and Aims: Sepsis-associated acute kidney injury (S-AKI) is common and is associated with poor outcomes. This prospective observational study aimed to assess the predictive value of four novel biomarkers—syndecan-1 (SDC1), neutrophil gelatinase-associated lipocalin (NGAL), proenkephalin (PENK), and presepsin (PSPN)—for renal outcomes and mortality in septic ICU patients. Methods: Serum biomarker levels were measured in serum samples collected at the time of sepsis diagnosis on the basis of the Sepsis-3 criteria. Acute kidney injury (AKI) was defined according to the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines, and patients were grouped by the presence of AKI, renal replacement therapy requirement (RRT), and intensive care unit (ICU) survival. Demographic, clinical, laboratory, and severity score data were compared between groups to evaluate the predictive performance of biomarkers and clinical parameters. Results: Of the 140 septic patients included, 55.0% developed AKI, 17.2% required RRT, and the ICU mortality rate was 50.0%. SDC1 was independently associated with both AKI (OR: 1.201; p = 0.024) and RRT initiation (OR: 1.260; p = 0.004). It also demonstrated the highest predictive performance for RRT (AUC: 0.715; p = 0.001) and a significant AUC for AKI evaluation (AUC: 0.659; p = 0.002). NGAL levels were significantly elevated in patients with AKI and higher SOFA scores but were not independently predictive. PENK and PSPN were not significantly associated with any renal outcome or mortality. The combined SOFA–SDC1 model improved discrimination for both AKI (AUC: 0.770) and RRT (AUC: 0.737), surpassing individual predictors. Conclusions: SDC1 emerged as the most reliable biomarker for assessing AKI and predicting the need for RRT, highlighting its potential role in early renal risk stratification among critically ill patients. Full article

Background and Objectives: Severe sepsis complicated by refractory shock is associated with high mortality. Adding continuous hemofiltration to venovenous extracorporeal membrane oxygenation (ECMO) may accelerate clearance of inflammatory mediators and improve haemodynamic stability, but evidence remains limited. We analysed 44 consecutive septic-shock patients treated with combined ECMO-hemofiltration (ECMO group) and compared them with 92 septic-shock patients managed without ECMO or renal replacement therapy (non-ECMO group). Methods: This retrospective single-centre study reviewed adults admitted between January 2018 and March 2025. Demographic, haemodynamic, laboratory and outcome data were extracted from electronic records. Primary outcome was 28-day mortality; secondary outcomes included intensive-care-unit (ICU) length-of-stay, vasopressor-free days, and change in Sequential Organ Failure Assessment (SOFA) score at 72 h. Results: Baseline age (49.2 ± 15.3 vs. 52.6 ± 16.1 years; p = 0.28) and APACHE II (27.8 ± 5.7 vs. 26.9 ± 6.0; p = 0.41) were comparable. At 24 h, mean arterial pressure rose from 52.3 ± 7.4 mmHg to 67.8 ± 9.1 mmHg in the ECMO group (mean change [∆] + 15.5 mmHg, p < 0.001). Controls exhibited a modest 4.9 mmHg rise that did not reach statistical significance (p = 0.07). Inflammatory markers decreased more sharply with ECMO (IL-6 ∆ −778 pg mL⁻¹ vs. −248 pg mL⁻¹, p < 0.001). SOFA fell by 3.6 ± 2.2 points with ECMO versus 1.6 ± 2.4 in controls (p = 0.01). Twenty-eight-day mortality did not differ (40.9% vs. 48.9%, p = 0.43), but ICU stay was longer with ECMO (median 12.5 vs. 9.3 days, p = 0.002). ΔIL-6 correlated with ΔSOFA (ρ = 0.46, p = 0.004). Conclusions: ECMO-assisted hemofiltration improved early haemodynamics and organ-failure scores and accelerated cytokine clearance, although crude mortality remained unchanged. Larger prospective trials are warranted to clarify survival benefit and optimal patient selection. Full article

This study aimed to assess the extent of vitamin B₁ and B₆ vitamer loss during a single peritoneal dialysis (PD) session using a combination of chromatographic techniques and chemometric analysis. Dialysis effluent samples were collected from 41 PD patients (22 on continuous ambulatory peritoneal dialysis (CAPD) and 19 on automated peritoneal dialysis (APD)) during a standardised peritoneal equilibration test. Concentrations of thiamine monophosphate, thiamine diphosphate (ThDP), pyridoxine, pyridoxal (PL), and pyridoxamine were determined using high-performance liquid chromatography with a fluorescence detector. The analytical method was validated in terms of sensitivity, linearity, accuracy, and recovery. Multiple regression analysis was employed to identify potential clinical and demographic predictors of vitamin washout. All vitamers except pyridoxal 5-phosphate (PLP) were detectable in dialysis effluents. ThDP exhibited the greatest loss among the B₁ forms (ca. 0.05–0.57 mg/24 h), while PL exhibited the most significant loss among the B₆ forms (ca. 0.01–0.19 mg/24 h). Vitamin losses varied depending on the dialysis modality (continuous ambulatory peritoneal dialysis, or CAPD, versus automated peritoneal dialysis, or APD) and the peritoneal transport category. Regression analysis identified body weight, haemoglobin, and haematocrit as independent predictors of ThDP washout (R² = 0.58). No statistically robust models were established for the other vitamers. Even short medical procedures (such as single PD) can result in measurable losses of water-soluble vitamins, particularly ThDP and PL. The results emphasise the importance of personalised vitamin supplementation for PD patients and suggest that body composition and haematological parameters significantly influence the loss of thiamine. Full article

Objectives: This systematic literature review aimed to identify studies assessing the clinical efficacy and real-world effectiveness of current and emerging treatments for Fabry disease. Methods: Searches of the MEDLINE, EMBASE, and Cochrane library databases, as well as relevant congress proceedings, were conducted to identify publications reporting on studies in patients of any age, sex, race, or ethnicity who received any approved or experimental treatment for Fabry disease, published before 17 June 2024. Results: Of 1881 publications screened, 234 reported data on renal, cardiac, cerebrovascular, and disease severity outcomes from 225 studies. The majority of reported studies were observational in nature (n = 150; 67%) and involved only adults (n = 172; 74%). Study designs and patient populations were highly heterogeneous, and cross-study conclusions about the effectiveness of different therapies could not be made. Enzyme replacement therapy (ERT) with agalsidase alfa or agalsidase beta stabilized renal function and cardiac structure in patients with Fabry disease. Early initiation of ERT in childhood or young adulthood was associated with better renal and cardiac outcomes than treatment initiation at a later age. The small number of comparator studies of agalsidase alfa and agalsidase beta suggested similar efficacy. Patients treated with migalastat and pegunigalsidase alfa also maintained stable renal function and cardiac structure. Conclusions: Overall, current treatments slow the progression of renal and cardiac decline in patients with Fabry disease. Large cohort studies with long-term follow-up and baseline stratification based on clinical phenotype are needed to address evidence gaps and provide clinicians with robust data to inform treatment decisions. Full article

Background: Melioidosis is a severe infectious disease caused by Burkholderia pseudomallei, with high mortality rates, particularly in severe cases complicated by acute kidney injury (AKI). Objective: The objective of this study was to systematically review and quantitatively synthesize the impact of AKI on mortality and other clinical outcomes—including ICU admission and the need for renal replacement therapy (RRT)—in patients with melioidosis. Methods: A systematic search was conducted in PubMed, Scopus, and Embase up to 16 May 2025. Studies reporting mortality, ICU admission, or RRT use in patients with AKI were included. A random-effects meta-analysis was performed to estimate the odds ratio (OR) for mortality associated with AKI. Results: Twenty-nine studies (380 patients) were included. AKI occurred in 123 patients (32.4%). The pooled analysis revealed that AKI patients had a significantly higher mortality risk than non-AKI patients (OR = 23.37; 95% CI: 13.97–39.10; p = 0.0082), with no significant heterogeneity (I² = 0%). Sensitivity analysis confirmed the robustness of this association. ICU admission and RRT data were frequently reported but were not suitable for meta-analysis due to insufficient data. Conclusions: AKI is a serious complication in melioidosis, significantly increasing the risk of mortality. Early recognition and aggressive management of AKI in melioidosis may be critical to improving clinical outcomes. Full article

Fluid management is a critical component in the treatment of patients suffering with major burns. Clinicians must carefully balance judicious resuscitation with the risks of over- or under-resuscitation. We aimed to identify factors associated with survival in burns patients and determine the importance of resuscitation practices. Patients requiring admission to Burns Services in the United Kingdom between 1 April 2022 and 31 March 2023 were included in the National Burns Audit project on fluid resuscitation practices, to evaluate factors associated with survival and Critical Care Length of Stay (CCLoS). A total of 198 patients were included in the analyses, with median age of 51 years (interquartile range, (IQR) 35–62 years), median Total Burn Surface Area (TBSA%) of 27.5% (IQR 20–40%), and median Baux score 82.5 (IQR 66–105). The following were found to be significant for survival: younger age, smaller TBSA%, lower Baux score and independence from renal replacement therapy. Neither the mechanism of burns nor the fluid resuscitation volumes appeared to influence survival. Although interventions such as tracheostomy or the number of surgical procedures did not appear to affect survival, fluid replacement of more than 6 mL/kg/%TBSA independently predicted longer CCLoS. Volume of fluid resuscitation, within the limits examined in this cohort, did not impact likelihood of survival. Full article

The management of end-stage kidney disease (ESKD) poses a substantial clinical and economic challenge, characterized by a growing patient burden, rising healthcare costs, and persistent unmet needs to enhance survival outcomes and quality of life. Background/Objectives: Conventional high-flux hemodialysis (HD) remains the dominant form of renal replacement therapy for ESKD but is still associated with substantial morbidity and mortality. High-volume post-dilution online hemodiafiltration (HVHDF) offers a promising alternative by enhancing the convective removal of uremic toxins. Methods: We conducted a narrative review of randomized controlled trials, meta-analyses, real-world cohort studies, and registry analyses published between 2010 and 2024. Evidence was categorized into short-term, medium-term, and long-term outcomes, including hemodynamic stability, inflammation, anemia, infection risk, cardiovascular events, cognitive decline, quality of life, and survival. Results: HVHDF improves short-term outcomes by enhancing toxin clearance, stabilizing blood pressure, reducing inflammation and oxidative stress, and improving anemia management. Medium-term benefits include improved nutritional status, reduced hospitalizations related to infections, and improved neurological and immune function. Long-term data from major trials (e.g., ESHOL, CONVINCE) and large real-world studies show consistent reductions in all-cause and cardiovascular mortality, particularly with convection volumes ≥ 23 L/session. A clear dose–response relationship supports the clinical relevance of convection volume targets. HVHDF has also shown benefits in preserving cognitive function and enhancing health-related quality of life. Conclusions: Strong and converging evidence supports HVHDF as a superior dialysis modality. Given its survival benefits, better tolerance, and broader impact on patient outcomes, HVHDF should be considered the new standard of care in dialysis, especially in light of the recent regulatory approval of the machine that provides the ability to perform HDF in the United States. Full article

Background: Infective endocarditis after transcatheter aortic valve replacement (TAVR-IE) is a rare but severe complication associated with high morbidity and mortality. The optimal treatment strategy—surgical explantation versus medical therapy—remains uncertain, particularly given the technical demands of TAVR removal and the advanced age of many affected patients. Methods: We conducted a systematic review and meta-analysis of studies comparing the surgical and medical management of TAVR-IE. Primary outcomes included 30-day mortality and 1-year survival. Secondary analyses explored microbiological profiles, patient demographics, prosthesis type, postoperative complications, and surgical indications. A qualitative synthesis of surgical explantation techniques and reconstructive strategies was also performed based on recent consensus recommendations. Results: Three studies comprising 1557 patients with TAVR-IE were included; 155 (10.0%) underwent surgical treatment. Thirty-day mortality was comparable between groups (surgical: 9.7%; medical: 8.4%), while the pooled odds ratio for one-year survival did not reach statistical significance (OR: 1.91, 95% CI: 0.36–10.22; I² = 88%). However, single-center outcomes demonstrated markedly improved survival with surgery (96% vs. 51%). The most common surgical indications included severe valvular dysfunction (50.3%), aortic root abscess (26.5%), and large vegetations (21.3%), in line with current guideline recommendations. Postoperative complications included acute renal failure (10%) and longer hospitalizations (19.8 vs. 18 days), although these were not statistically different. Contemporary explant strategies—such as the Double Kocher, Tourniquet, and Y-incision aortic enlargement techniques—were highlighted as critical tools for surgical success. Conclusions: While underutilized, surgical intervention for TAVR-IE may offer significant survival benefits in select patients, particularly when guided by established indications and performed at high-volume centers. Outcomes depend heavily on timing, surgical expertise, and appropriate patient selection. As TAVR expands to younger populations, TAVR-IE will become increasingly relevant, necessitating early multidisciplinary involvement and broader familiarity with advanced explant techniques among cardiac surgeons. Full article

Background/Objectives: Data on the prognostic value of frailty in patients undergoing percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) is limited. This study aimed to evaluate the association between frailty and in-hospital complications in patients undergoing CTO-PCI. Methods: We conducted a retrospective cohort study using administrative data from the National Inpatient Sample (2016–2019). Frailty was assessed using the Hospital Frailty Risk Score (HFRS) and categorized into three groups: low risk (<5), intermediate risk (5–15), and high risk (>15). Logistic regression models were applied to estimate odds ratios (ORs) with 95% confidence intervals (CIs) for in-hospital complications. Results: A total of 46,695 patients undergoing CTO-PCI were included. In the adjusted models, patients at high risk of frailty had higher odds of in-hospital mortality (OR 9.51, 95% CI 3.49–26.00), blood transfusion (OR 4.78, 95% CI 1.72–13.20), pericardial complication (OR 16.0, 95% CI 4.85–52.90), and renal replacement therapy (OR 3.83, 95% CI 1.22–12.00) compared to the low-risk group. Intermediate-risk patients also experienced higher odds of most outcomes. Conclusions: Frailty was a significant predictor of in-hospital complications in patients undergoing PCI for CTO. Incorporating frailty assessment into routine clinical practice could enhance risk stratification and enable tailored care strategies for this high-risk population. Full article

Congenital anomalies of the kidney and urinary tract (CAKUT) are the third most common congenital anomaly and a significant public health concern. It is the predominant cause of chronic renal disease in pediatric populations and the principal reason for kidney replacement therapy in individuals under 20, as well as the fourth leading cause in adults. Five candidate genes, including EDA2R, PCDH9, and TRAF7 were identified as potential contributors to CAKUT. These genes had not been previously prioritized in CAKUT research, and our prior studies have demonstrated that the proteins encoded by these candidate genes display dysregulated expression across various CAKUT subgroups. Our research examined the expression patterns of EDA2R, PCDH9, and TRAF7 in yotari (Dab1^−/−) mice at two embryonic stages (E13.5 and E15.5) and two postnatal stages (P4 and P14) to ascertain the potential correlation between Reelin–Dab1 signaling, previously linked to CAKUT phenotypes, and the aforementioned proteins through molecular and morphological analyses. All three observed proteins exhibited the highest area percentage at E13.5, with a trend of decline into postnatal stages, during which specific changes in protein expression were noted between the cortex and medulla of yotari mice compared to wild-type mice. For TRAF7, a statistically significant difference in area percentage at E13.5 was observed, indicating a link with Reelin–Dab1 signaling and a potentially critical role in the pathophysiology of CAKUT, also marked by our prior study. Full article

Pneumocystis pneumonia (PCP) is a serious fungal infection affecting immunocompromised hosts. Decompensated cirrhosis leads to cirrhosis-associated immune dysfunction (CAID), a form of impaired cellular immunity that may predispose patients to opportunistic infections such as PCP. We conducted a retrospective review of 727 patients with proven or probable PCP from 2017 to 2025. Of these, 33 had decompensated cirrhosis. These patients were stratified into two groups: Cirrhosis Only (n = 16) and Cirrhosis with Additional Immunocompromising Conditions (n = 17). Among the patients with cirrhosis, the overall mortality was 48%, with the 90-day mortality reaching 57.6% (95% CI: 39.2–74.5%). Compared with those without cirrhosis, the patients with cirrhosis had a higher risk of mortality (OR: 4.08, 95% CI: 2.01–8.30, p < 0.001), increased intensive care unit (ICU) admission (87% vs. 42%, p < 0.001), and greater need for renal replacement therapy (54.6% vs. 7.5%, p < 0.001). These findings suggest that decompensated cirrhosis alone may represent a sufficient and underrecognized risk factor for PCP, with a high associated mortality. Given the preventable nature of this infection, future studies are needed to assess the incidence, define the risk, and investigate the role of prophylaxis in this vulnerable population. Full article

Chronic kidney disease (CKD) is prevalent throughout the world, and peritoneal dialysis (PD) has been a growing mode of renal replacement therapy (RRT) for over four decades. Peritoneal dialysis has several advantages in cost, patient satisfaction, and quality of life, despite accounting for only one in ten patients on dialysis in the United States. In spite of some contraindications and barriers to effective PD, the vast majority of renal failure patients are candidates, especially when in a high-volume program with surgical expertise readily available. Reliable access via an intraabdominal PD catheter is paramount for managing end-stage renal disease patients. Surgical approaches for PD catheter insertion have evolved substantially alongside innovations in catheter design. Recent data suggests that the advanced laparoscopic catheter placement offers the best results and long-term survival. However, image-guided fluoroscopic insertion can be performed without general anesthesia, is highly effective, and is growing in usage. Being able to start PD urgently is vital in avoiding hemodialysis (HD) and its complications, and this is a growing theme worldwide, despite slightly higher morbidity. Infectious and mechanical complications are relatively common and are frustrating to PD patients and the physicians who care for them. Peritonitis and exit site infections require antibiotic coverage and sometimes, surgical intervention. Catheter dysfunction is a frequent mechanical issue requiring a multidisciplinary approach: medical treatment, nurse-administered flushing and clot dissolvers, interventional radiology evaluation and wire manipulation, and surgical laparoscopy for catheter salvage. Full article

The case-fatality rate of severe leptospirosis can exceed 50%. This retrospective cohort study examined 111 individuals with laboratory-confirmed leptospirosis admitted to Cairns Hospital, a referral hospital in tropical Australia, between January 2015 and June 2024. We examined the patients’ demographic, clinical, laboratory and imaging findings at presentation and then correlated them with the patients’ subsequent clinical course. Severe disease was defined as the presence of pulmonary haemorrhage or a requirement for intensive care unit (ICU) admission. The patients’ median (interquartile range) age was 38 (24–55) years; 85/111 (77%) were transferred from another health facility. Only 13/111 (12%) had any comorbidities. There were 63/111 (57%) with severe disease, including 56/111 (50%) requiring ICU admission. Overall, 56/111 (50%) required vasopressor support, 18/111 (16%) needed renal replacement therapy, 14/111 (13%) required mechanical ventilation and 2/111 (2%) needed extracorporeal membrane oxygenation. Older age—but not comorbidity—was associated with the presence of severe disease. Hypotension, respiratory involvement, renal involvement and myocardial injury—but not liver involvement—frequently heralded a requirement for ICU care. Every patient in the cohort survived to hospital discharge. Leptospirosis can cause multi-organ failure in otherwise well young people in tropical Australia; however, patient outcomes are usually excellent in the country’s well-resourced health system. Full article

Background/Objectives: Continuous renal replacement therapy (CRRT) is an important treatment method that is becoming a commonly-used procedure in neonatal intensive care units (NICUs), especially in critically-ill neonates. Methods: We conducted a retrospective study aimed to evaluate factors influencing the outcomes of CRRT in neonates and preterm infants. The study analyzed data from 41 newborns treated with CRRT at our NICU over a ten-year period. Demographic, clinical, and laboratory parameters were assessed, including gestational age, birth weight, PRISM III score, and laboratory markers like urea, creatinine, and potassium levels, as well as characteristics of CRRT. Results: Our research found that the duration of CRRT, the presence of anuria, and higher potassium levels after initiation of CRRT were significant predictors of a poor outcome. Despite the lack of significant correlation between demographic characteristics, PRISM III score and the outcome, our findings highlight the importance of timely CRRT initiation and efficient management to improve survival. Conclusions: Our study identified several significant prognostic indicators in neonates undergoing renal replacement therapy. While these findings provide valuable insights, further research is needed to establish clear theoretical guidelines and improve clinical decision-making. Full article