Active clinical trials for "Acute Kidney Injury"

Primary endpoint: To evaluate predictive value of plasmatic levels of Neutrophil Gelatinase Associated Lipocalin (NGAL) to reveal acute kidney failure after cardiac surgery in patients with preoperative chronic kidney failure Secondary endpoint is to obtain threshold values of NGAL.

Acute kidney injury (AKI) is common and costly complication of major surgery. AKI can lead to prolonged hospitalization and a higher likelihood of dialysis, chronic kidney disease and death. However, AKI can be reversed when recognized early, by ensuring that patients receive adequate fluids and medications that worsen kidney function or cause toxicity are avoided or appropriately prescribed. Past research suggests that AKI in surgical settings can be missed early in its onset, leading to delayed intervention and progression to more severe stages. The purpose of this project is to implement clinical decision support for early recognition and management of AKI on surgical units in Alberta hospitals, and to determine whether the initiative leads to improvements in the quality of care for AKI, length of hospital stay for patients, and costs to the healthcare system.

This is prospective cohort study of patients classified by the premedication history of beta-blocker. The investigators aim to evaluate the hemodynamic effect of beta blocker through Swan-Ganz catheter monitoring and arterial pressure waveform analysis during surgery. The investigators also plan to observe the long-term effects of beta blocker on acute renal failure, allograft failure and mortality.

Acute kidney injury (AKI) is a common and major complication of cardiac surgery. The aim of this study is to evaluate the use of a fragment of proencephalin in plasma and other biomarkers as specific markers for early diagnosis of AKI and the need of renal replacement therapy after cardiac surgery.

A Randomized controlled trial aiming to investigate whether ascorbic acid has a role in preventing vancomycin induced nephrotoxicity or not in critically ill patients.

To investigate the influence of preoperative fluid and food intake in cardiac surgery patients on the development of postoperative AKI.

Acute kidney injury (AKI) is a common complication after non-cardiac surgery with adverse short and long term morbidity and mortality. So far there have been no effective therapy for AKI treatment developed, possibly due to the heterogenicity of this syndrome. Therefore, prevention of AKI in high risk patients undergoing non-cardiac surgery, as emphasized by Kidney Disease Improving Global Outcomes (KDIGO), becomes the first priority. However, early prediction of AKI is the first step before taking preventive measures, which really make a great challenge to clinical practitioners because of such a limited time window and complex clinical scenarios. Recently, cumulative evidence have shown that biomarkers and renal ultrasound may play an important role in AKI prediction after non-cardiac surgery. The purpose of this study is to investigate the combination of biomarkers, urine sedimentation and renal resistive index for early prediction of AKI in high risk patients undergoing non-cardiac surgery.

To compare the differences of citrate pharmacokinetics in healthy individuals and critically ill patients as well as the influential factors. To validate a pharmacokinetic model which has been established in a formal paper. To create a safe and effective RCA-CRRT protocol.

Oral phosphate purgative is the preferred bowel regimen on the basis of better tolerability, cost effectiveness, and efficacy. There are also numerous reports of patients with even previously normal renal function developing acute and chronic kidney disease after use of oral phosphate purgative. Several uncontrolled case reports and case series suggest a potential link between oral phosphate and acute kidney injury and/or chronic kidney disease1. Its use is contraindicated in patients with preexisting renal disease because of the risk for developing acute renal failure, so called acute phosphate nephropathy, or electrolyte disturbance. Since most of the outpatients who are going to undergo a colonoscopy are exposed to this agent, it is important to detect or prevent vulnerable patients. We would seek a sensitive and rapid diagnosis method of acute kidney injury following sodium phosphate bowel preparation. Within a few hours, NGAL mRNA is highly upregulated after kidney injury, such as renal ischemia-reperfusion and cisplatin nephropathy, NGAL induction precedes the elevation of classical markers for kidney damage such as serum creatinine. The investigators will investigate the change of NGAL following sodium phosphate bowel preparation.

Acute kidney injury (AKI) is a common heterogeneous disease that complicates several medical and surgical conditions. Recent studies have demonstrated that the occurrence of AKI significantly increase the risk of adverse outcomes. Despite the advanced in modern medicine, the interventions for AKI are not improved. One major reason of the failure to shift therapeutic progress is the clinicians' widespread dependence upon serum creatinine, an unreliable marker during acute changes of renal function, for the diagnosis of AKI. In the past decade, over 20 unique biomarkers of AKI had been explored. Among them, neutrophil gelatinase-associated lipocalin (NGAL), interleukin-18 (IL-18), and kidney injury molecule-1 (KIM-1) have received the most interest. None of them, however, is an idea one. Cysteine-rich protein 61 (Cyr61), a secreted matrix-associated heparin-binding protein, belongs to the "CCN" family. It regulates a broad spectrum of cellular activities, including cell adhesion, migration, proliferation, survival, differentiation, apoptosis, angiogenesis, and extracellular matrix production of multiple cell types. By the kidney ischemic/reperfusion injury animal model, Cyr61 gene was found to be rapidly up-regulated in the renal outer medulla. That portion of the kidney is corresponding to the area of marginally oxygenated under normal condition and most tubular injury following renal ischemic/reperfusion injury.18 Elevation of Cyr61 protein was detected in the kidney and also in urine following injury, making it a potential marker of AKI. Additionally, pulse diagnosis is an integrative part of traditional Chinese medicine. With spectral analysis of the pulse waves, researchers started to observe the pulse wave harmonics. An in vivo study of rats revealed that ligating one or both of the renal arteries significantly reduced the second harmonic component of the pressure pulse at the caudate artery. Ligating the artery toward the spleen prominently reduced the third harmonics component of the pulse. Analysis of the harmonics in the spectrum of the arterial pressure wave revealed that individual organs might have their own natural frequencies. These observations suggested that individual vascular beds exert independent, frequency-specific, effects on the peripheral pressure wave. Among different etiologies, cardiac surgery is an important cause of AKI. It has been shown that AKI after cardiac surgery is relatively highly prevalent and prognostically important. Cardiac surgery is usually performed with the use of extracorporeal cardiopulmonary bypass machine ('on-pump'). Based on the evidence from cell culture study and animal study in the literature, we hypothesize that Cyr61 is rapidly increased in the urine after AKI. We thus design this project to evaluate study the diagnostic role and clinical application of Cyr61 in AKI. We will conduct a prospective cohort study to evaluate the changes of urinary Cyr61 in patients undergoing cardiac surgery. Cyr61 may serve a good biomarker for the early diagnosis of patients with AKI, either singly or in combination with NGAL. By the way, we also try to correlate the changes in those biomarker with a potential new tool：harmonic analysis of arterial pressure pulse waves. We have special interest in following the time course of changes in biomarker and correlate with changes in pulse analysis. Physiological parameters of vascular compliance and regional blood oxygen saturation will be correlated concurrently. It is hoped that early detection of AKI will lead to earlier intervention, thus enhancing our ability to develop beneficial therapies.