ETIENNE MARIA VASCONCELLOS DE MACEDO
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- When Should Renal Replacement Therapy be Initiated for Acute Kidney Injury?(2011) MACEDO, Etienne; MEHTA, Ravindra L.Acute kidney injury (AKI) is now well recognized as an independent risk factor for increased morbidity and mortality particularly when dialysis is needed. Although renal replacement therapy (RRT) has been used in AKI for more than five decades, there is no standard methodology to predict which AKI patients will need dialysis and who will recover renal function without requiring dialysis. The lack of consensus on what parameters should guide the decision to start dialysis has led to a wide variation in dialysis utilization. A contributing factor is the lack of studies in the modern era evaluating the relationship of timing of dialysis initiation and outcomes. Although listed as one of the top priorities in research on AKI, timing of dialysis initiation has not been included as a factor in large, randomized controlled trials in this area. In this review we will discuss the criteria that have been used to define early vs. late initiation in previous studies on dialysis initiation. In addition, we propose a patient-centered approach to define early and late initiation that could serve as framework for managing patients and for future studies in this area.
- RENAL REPLACEMENT THERAPY IN ACUTE KIDNEY INJURY: WHEN, HOW AND HOW MUCH? Introduction(2011) MEHTA, Ravindra; BOUCHARD, Josee; MACEDO, Etienne
- Management options: continuous renal replacement therapy(2011) GRANADO, R. C.-D.; MACEDO, E.; MEHTA, R. L.
- Blood urea nitrogen beyond estimation of renal function(2011) MACEDO, Etienne
- Oliguria is an early predictor of higher mortality in critically ill patients(2011) MACEDO, Etienne; MALHOTRA, Rakesh; BOUCHARD, Josee; WYNN, Susan K.; MEHTA, Ravindra L.Oliguria is a valuable marker of kidney function and a criterion for diagnosing and staging acute kidney injury (AKI). However, the utility of urine output as a specific metric for renal dysfunction is somewhat controversial. To study this issue further we tested whether urine output is a sensitive, specific, and early measure for diagnosing and staging AKI in 317 critically ill patients in a prospective observational study. Urine output was assessed every hour and serum creatinine every 12 to 24h. The sensitivity and specificity of different definitions of oliguria for the diagnosis of AKI were compared with the Acute Kidney Injury Network serum creatinine criterion. The incidence of AKI increased from 24%, based solely on serum creatinine, to 52% by adding the urine output as a diagnostic criterion. Oliguric patients without a change in serum creatinine had an intensive care unit mortality rate (8.8%) significantly higher than patients without AKI (1.3%), and similar to oliguric patients with an increase in serum creatinine (10.4%). The diagnosis of AKI occurred earlier in oliguric than in non-oliguric patients. Oliguria of more than 12h and oliguria of 3 or more episodes were associated with an increased mortality rate. Thus, urine output is a sensitive and early marker for AKI and is associated with adverse outcomes in intensive care unit patients.
- A dangerous entanglement(2011) ELIAS, Rosilene M.; PEDREIRA, Alexandre B.; MACEDO, Etienne; CHAN, Christopher T.Entrapment of guidewires by inferior vena cava filters can occur during the blind insertion of a jugular or a subclavian central venous catheter. Recently, few case reports have been published in the radiology literature. In addition, others have described endovascular techniques aimed at removing entrapped guidewires, avoiding the possibility of vena cava rupture. Given that a temporary hemodialysis venous catheter is frequently used as a first access, the possibility of entrapping the dialysis catheter guidewire should not be neglected.