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

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Increased expressions of pSTAT3 and ACE2 were associated with BBL SIAKI. (A) Western blot analyses of STAT3, pSTAT3, caspase 3, cleaved-caspase 3 and Bcl-2 levels in renal cortex tissues of CLP AKI mice. (B) Western blot analyses of ACE2 and AGT1R levels in renal cortex tissues of CLP AKI mice. (C) The differences of pSTAT3, Cleaved-caspase 3, Bcl2, AGT1R and ACE2 expressions between No BBL and BBL mice. (D) The difference of AGT1R mRNA expression determined by RT-PCT between No BBL and BBL mice. (E) The difference of ACE2 mRNA expression determined by RT-PCT between No BBL and BBL mice. *, p<0.05; **, p<0.01; ***, p<0.001. Uchino, S. et al. Acute renal failure in critically ill patients: A multinational, multicenter study. JAMA 294(7), 813–818 (2005). One of the major findings is that minimizing fluid overload by CRRT reduced mortality in critically ill patients with SIAKI. In previous studies, the randomized evaluation of normal versus augmented level (RENAL) of replacement therapy study investigators showed that negative fluid balance during CRRT was associated with decreased mortality in patients with AKI (n = 1453) 7. Murugan et al. showed that achieving a high intensity of net ultrafiltration (> 25 mL/kg/day) through CRRT or intermittent RRT was associated with lower 1-year risk-adjusted mortality in patients with AKI (n = 1075), confirming the importance of RRT in fluid management in these patients 8. Recently, Hall et al. demonstrated that a decline in fluid accumulation through CRRT was associated with a lower risk of mortality in critically ill patients with AKI (n = 820) 17. In the present study, the 28-day mortality was the highest in Group 4 (84.7%, %FOpreCRRT > 4.6% and %FOtotal > 9.6%), followed by Group 3 (65.0%, %FOpreCRRT ≤ 4.6% and %FOtotal > 9.6%), Group 2 (43.6%, %FOpreCRRT > 4.6% and %FOtotal ≤ 9.6%), and Group 1 (22%, %FOpreCRRT ≤ 4.6% and %FOtotal ≤ 9.6%). The multivariable analysis also showed that people in Group 4, Group 3, and Group 2 were nearly six times, four times, and two times more likely to die than those in Group 1. These findings showed that minimizing the fluid overload using CRRT is associated with reduced mortality in critically ill patients with SIAKI. One can argue that tolerating fluid removal using CRRT is a sign of less severe illness, such as hemodynamic stability. Thus, our results need to be interpreted cautiously regarding whether the beneficial effect of fluid removal using CRRT on mortality is owing to its direct therapeutic effect or the fact that patients with less severe illness could tolerate fluid removal. However, our multivariable analysis showed that the association between survival and fluid overload remained significant after adjustment for disease severity indices such as SOFA score, APACHE II score, vasopressor use, ventilator dependency, and oliguria, suggesting that disease severity alone may not account for our findings. Finally, in clinical practice, clinicians are inevitably confronted with fluid overload during the management of patients with SIAKI, and the results of our study suggest that efforts are needed to maintain %FOpreCRRT ≤ 4.6% and %FOtotal ≤ 9.6% as much as possible to improve the survival of patients with SIAKI receiving CRRT.

Fig 3. Receiver-operating characteristic curves of % PCT decrease for predicting survival (A) and recovery from dialysis (B) within 28 days after CRRT initiation in patients with SIAKI receiving CRRT. Kellum JA, Lameire N, Group KAGW. Diagnosis, evaluation, and management of acute kidney injury: a KDIGO summary (Part 1). Crit Care. 2013; 17: 204. pmid:23394211 Mat Nor MB, Md Ralib A. Procalcitonin clearance for early prediction of survival in critically ill patients with severe sepsis. Crit Care Res Pract. 2014; 2014: 819034. pmid:24719759 Hoste, E. A. et al. Epidemiology of acute kidney injury in critically ill patients: the multinational AKI-EPI study. Intensive Care Med. 41(8), 1411–1423 (2015). 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).Most previous studies on fluid overload in patients with AKI receiving or not receiving RRT have included a heterogeneous population of patients with AKI, including both SIAKI and non-SIAKI 9, 10, 11, 12, 13, 14, 15, whereas only patients with SIAKI were included in the present study. To the best of our knowledge, the present study is the first to investigate the association between fluid overload and survival in patients with SIAKI receiving CRRT. Previous studies confirming the adverse effects of fluid overload on survival in patients with AKI used various definitions of the degree of fluid overload, including a percentage of fluid accumulation > 10% over the baseline weight 12, 13, 15. However, fluid overload > 10% over the baseline weight was arbitrarily defined without any basis for its definition, and the best cutoff value of the degree of fluid overload for predicting mortality was unknown. In this study, we divided fluid overload into fluid overload from AKI diagnosis to CRRT initiation (%FOpreCRRT) and total fluid overload from AKI diagnosis to ICU discharge (%FOtotal, %FOpreCRRT + %FOpostCRRT) and found that %FOpreCRRT > 4.6% (AUC, 0.826; P < 0.001) and %FOtotal > 9.6% (AUC, 0.834; P < 0.001) were the best cutoff values of the degree of fluid overload for predicting the 28-day mortality. We believe that these cutoff values could help guide fluid management in critically ill patients with SIAKI receiving CRRT and conduct further research on the association between fluid overload and survival in these patients. Continuous variables were expressed as medians with interquartile ranges and were compared using the Mann–Whitney test. Categorical variables were expressed as numbers with percentages and compared using the chi-square test. To determine the independent predictors for survival and recovery from dialysis within 28 days after CRRT initiation, univariable and multivariable Cox proportional hazards analyses were used, and the results were presented as hazard ratios (HR) and 95% confidence intervals (CIs). Significant variables were identified through univariable analysis ( P< 0.1), and clinically important variables were considered in the multivariable analysis. Of the significant variables in the univariable analysis, those included in the SOFA or APACHE II scores i.e., mean arterial pressure, platelet count, pH, and serum creatinine were excluded from the multivariable analysis to avoid a redundant analysis. Instead, the SOFA and APACHE II scores for these variables were considered in the final multivariable analysis. Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, 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. 1992; 101: 1644–55. pmid:1303622

Sutherland, S. M. et al. Fluid overload and mortality in children receiving continuous renal replacement therapy: The prospective pediatric continuous renal replacement therapy registry. Am. J. Kidney Dis. 55(2), 316–325 (2010). Azzini AM, Dorizzi RM, Sette P, Vecchi M, Coledan I, Righi E, et al. A 2020 review on the role of procalcitonin in different clinical settings: an update conducted with the tools of the Evidence Based Laboratory Medicine. Ann Transl Med. 2020; 8: 610. pmid:32566636 Investigators, R. R. T. S. et al. An observational study fluid balance and patient outcomes in the randomized evaluation of normal vs. augmented level of replacement therapy trial. Crit. Care Med. 40(6), 1753–1760 (2012).The SIAKI COLLECTION trademark was assigned an Application Number # 1435835 by the World Intellectual Property Organization (WIPO). Jarvisalo MJ, Hellman T, Uusalo P. Mortality and associated risk factors in patients with blood culture positive sepsis and acute kidney injury requiring continuous renal replacement therapy-A retrospective study. PLoS One. 2021; 16: e0249561. pmid:33819306 Tolwani, A. Continuous renal-replacement therapy for acute kidney injury. N. Engl. J. Med. 367(26), 2505–2514 (2012). 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). Sepsis was defined according to the American College of Chest Physicians/Society of Critical Care Medicine consensus conference criteria 18. If patients had a proven or strongly suspected bacterial infection and had at least two of the systemic inflammatory response syndrome criteria (body temperature > 38 °C or < 36 °C, heart rate > 90 bpm, respiratory rate > 20 breaths/min, PaCO 2< 32 mmHg or use of mechanical ventilation, white cell count > 12,000/mm 3 or < 4000/mm 3, or immature neutrophils > 10%), sepsis was diagnosed. AKI diagnosis was based on the Kidney Disease: Improving Global Outcomes (KDIGO) clinical practice guidelines for AKI (increase in serum creatinine ≥ 0.3 mg/dL within 48 h, increase in serum creatinine ≥ 1.5-times the baseline value, or urine volume < 0.5/kg/h for 6 h) 19. The primary outcome was the best cutoff value of fluid overload in predicting the 28-day mortality after ICU admission in the study population. The secondary outcome was a comparison of the 28-day mortality between the groups determined according to the best cutoff value of fluid overload. Fluid status assessment