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Query: UMLS:C0018801 (heart failure)
 72,216 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Acute renal insufficiency after cardiopulmonary bypass can lead to a significant morbidity from fluid overload and electrolyte disturbance, impede pulmonary gas exchange, and postpone weaning from mechanical ventilation. The limitations placed on free water intake result in severe restriction of nutrition while diuretic therapy causes electrolyte imbalance. Artificial renal support either in the form of peritoneal dialysis or hemodialysis may be complicated by sepsis and hemodynamic instability. We reviewed our experience with the use of continuous arteriovenous hemofiltration, an extracorporeal technique for removal of solutes, toxins, and water in critically ill patients with cardiac failure complicated by acute renal insufficiency and hemodynamic instability after cardiopulmonary bypass. Ten infants and children with renal insufficiency caused by low cardiac output had continuous arteriovenous hemofiltration instituted for indications including sepsis, volume overload, oliguria for more than 24 hours nonresponsive to diuretic therapy, and the need for hyperalimentation. All were supported by mechanical ventilation and receiving high-dose inotropic support. Arterial and venous vascular access was successfully obtained by cannulation of the femoral artery and vein in nine patients. Anticoagulation of the circuit was achieved with heparin infusion (6 to 20 micrograms/kg/hr) and monitored by measurement of activated clotting time. The continuous arteriovenous hemofiltration circuit was replaced if there was clot formation, or at 3 days after placement. Dialysis solution (Dianeal) 1.5% or 0.5% was infused as prefilter dilution. With the use of continuous arteriovenous hemofiltration, 20 to 100 m/hr of ultrafiltrate was removed, which allowed correction of hypervolemia, and caloric intake increased from 13.5 kcal/kg/day to 79.5 kcal/kg/day. Continuous arteriovenous hemofiltration was maintained between 5 hours and 8 days and was well tolerated in all patients. Serum urea and creatinine levels declined during continuous arteriovenous hemofiltration. We conclude that continuous arteriovenous hemofiltration is a safe and effective method for fluid and electrolyte homeostasis and that it thus allows hyperalimentation in infants and children after cardiac operations.
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PMID:Continuous arteriovenous hemofiltration after cardiac operations in infants and children. 143 99

Acute renal insufficiency after percutaneous coronary artery intervention (PCI) is a strong predictor of adverse events. However, the effect of chronic renal impairment on the long-term outcomes after PCI has not been well established. The aim of this study was to evaluate the incidence of deteriorated renal function during the chronic phase after PCI and its impact on clinical outcomes. We enrolled 282 consecutive patients who underwent PCI and had serum creatinine measured during the chronic phase (at least 3 months after PCI). We divided the study population into two groups: an advanced group that had an increase in stage of chronic kidney disease during the chronic phase, and a preserved group that included the remainder of the study population. There were 43 patients in the advanced group. We evaluated the incidence of major adverse cardiac events (MACE) that included all-cause death, nonfatal myocardial infarction, and rehospitalization with heart failure or angina pectoris. The rate of rehospitalization for heart failure and angina pectoris was significantly higher in the advanced group than in the preserved group (19.0% vs 6.8%, P < 0.01). In multivariate Cox regression analysis, the advanced group was associated with MACE (hazard ratio 3.50, 95% confidence interval 1.49-8.22, P < 0.01). Deterioration of renal function during long-term follow-up after percutaneous coronary intervention was associated with adverse cardiac events.
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PMID:Association between deteriorated renal function and long-term clinical outcomes after percutaneous coronary intervention. 2182 8