Siaki Collection 76725 Porcelain Dinnerware Set, White, 18 Pieces, Polyester

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Payen, D. et al. A positive fluid balance is associated with a worse outcome in patients with acute renal failure. Crit. Care 12(3), R74 (2008).

The SIAKI COLLECTION trademark was assigned an Application Number # 1435835 by the World Intellectual Property Organization (WIPO). Jhee, J. H. et al. Cumulative fluid balance and mortality in elderly patients with acute kidney injury requiring continuous renal-replacement therapy: A multicenter prospective cohort study. Kidney Res Clin Pract 39(4), 414–425 (2020).Medina-Liabres KRP, Jeong JC, Oh HJ, An JN, Lee JP, Kim DK, et al. Mortality predictors in critically ill patients with acute kidney injury requiring continuous renal replacement therapy. Kidney Res Clin Pract. 2021; 40: 401–10. pmid:34233439 Heilmann E, Gregoriano C, Schuetz P. Biomarkers of Infection: Are They Useful in the ICU? Semin Respir Crit Care Med. 2019; 40: 465–75. pmid:31585473

Liu D, Su L, Han G, Yan P, Xie L. Prognostic Value of Procalcitonin in Adult Patients with Sepsis: A Systematic Review and Meta-Analysis. PLoS One. 2015; 10: e0129450. pmid:26076027 Mehta, R. L. et al. Spectrum of acute renal failure in the intensive care unit: the PICARD experience. Kidney Int. 66(4), 1613–1621 (2004).Zaccone V, Falsetti L, Nitti C, Gentili T, Marchetti A, Piersantelli MN, et al. The Prognostic Role of Procalcitonin in Critically Ill Patients Admitted in a Medical Stepdown Unit: A Retrospective Cohort Study. Sci Rep. 2020; 10: 4531. pmid:32161314 One of the strengths of our study is the inclusion of time from AKI diagnosis to CRRT initiation in the multivariable analysis. We found that a 1-day increase in the time between AKI diagnosis and CRRT initiation was associated with an 11% increased risk of the 28-day mortality in our study population. Whether early initiation of CRRT improves mortality in critically ill patients with SIAKI remains controversial, and previous studies have reported inconsistent results. Several retrospective studies have shown that early initiation of CRRT has survival benefits in critically ill patients with SIAKI 35, 36, 37, 38. However, two randomized clinical trials reported that early application of CRRT is deleterious 39 or there was no difference in mortality between early and late RRT initiation in these patients 40. This discrepancy between the results of previous studies might be owing to an unstandardized definition for early and late initiation of CRRT. Furthermore, the optimal timing to initiate CRRT remains undefined in patients with SIAKI. In the present study, we found that the best cutoff value for the time from AKI diagnosis to CRRT initiation for predicting the 28-day mortality was > 1.5 day, with a sensitivity of 71.3% and specificity of 75.6% (AUC, 0.808; P< 0.001). The Kaplan–Meier curve also showed a significant difference in the 28-day mortality between the late CRRT group (> 1.5 days) and early CRRT group (≤ 1.5 days) (Supplementary Fig. S3). Despite the retrospective design of our study, this observation suggests that CRRT initiation within 1.5 days from AKI diagnosis, if possible, should be encouraged to improve the survival of critically ill patients with SIAKI. Despite advances in medical interventions, including CRRT, SIAKI has been reported to be associated with a high mortality rate of 50–60% 3, 32. Until now, most studies on the effect of CRRT on mortality in patients with SIAKI have focused on the timing and dose of CRRT 32 and little research has been conducted on the association between survival and fluid overload in patients with SIAKI receiving CRRT. In this study, we investigated the association between fluid overload and survival in patients receiving CRRT considering the important role of fluid balance in patients with SIAKI. Meyhoff, T. S. et al. Lower vs. higher fluid volumes during initial management of sepsis: A systematic review with meta-analysis and trial sequential analysis. Chest 157(6), 1478–1496 (2020).

Karlsson S, Heikkinen M, Pettila V, Alila S, Vaisanen S, Pulkki K, et al. Predictive value of procalcitonin decrease in patients with severe sepsis: a prospective observational study. Crit Care. 2010; 14: R205. pmid:21078153 Oh, H. J. et al. Can early initiation of continuous renal replacement therapy improve patient survival with septic acute kidney injury when enrolled in early goal-directed therapy?. J. Crit. Care 35, 51–56 (2016).

Renal biopsies from AKI-1 stage patients were compared with biopsies from no AKI patients. Many tubular injury morphologic changes were present in the biopsies of patients, but only the BBL was significantly related to AKI ( Figure 3D). In 45 AKI patients, BBL was present in 39 patients and absent in six patients. BBL was also present in 10 of 95 no AKI patients ( Supplementary Figure 3). Slight increases in Scr and BBL in proximal tubules were important features of early-stage AKI patients. Bone, R. C. et al. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest 101(6), 1644–1655 (1992). Oh, H. J. et al. Early initiation of continuous renal replacement therapy improves patient survival in severe progressive septic acute kidney injury. J. Crit. Care 27(6), 743–749 (2012). Despite its strengths, our study had some limitations. First, owing to its retrospective design, it is not possible to discern whether fluid overload is solely a marker of more severe illness or a causal contributor to mortality in our study subjects. However, as discussed above in the present study, we attempted to adjust for the disease severity indices, such as the SOFA score, APACHE II score, vasopressor use, and ventilator dependency, and found that fluid overload during CRRT was independently associated with the 28-day mortality, suggesting that fluid overload is a potentially modifiable risk factor for mortality in patients with SIAKI receiving CRRT. Second, we included a specific subset of critically ill patients, namely those with SIAKI who received CRRT. Thus, selection bias could not be avoided, and the results of our study might not be generalizable to other populations of critically ill patients with AKI. Third, fluid management using CRRT was implemented through discussion and consultation with the attending nephrologist without a standardized protocol. Thus, variations in fluid management might have affected the effect of fluid overload on survival in the present study. Romagnoli, S., Ricci, Z. & Ronco, C. CRRT for sepsis-induced acute kidney injury. Curr. Opin. Crit. Care 24(6), 483–492 (2018).