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David De Bels, Charalampos Pierrakos, Herbert D. Spapen and Patrick M. Honore

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Patrick M. Honore and Herbert D. Spapen

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Patrick M. Honore, Rita Jacobs, Elisabeth De Waele, Viola Van Gorp and Herbert D. Spapen

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Patrick M. Honoré, Rita Jacobs, Elisabeth De Waele, Jouke De Regt, Thomas Rose and Herbert D. Spapen

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Patrick M. Honore, Rita Jacobs, Olivier Joannes-Boyau, Elisabeth De Waele and Herbert D. Spapen

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Patrick M. Honore, David De Bels, Thierry Preseau, Sebastien Redant and Herbert D. Spapen

Abstract

In most of the case, regional citrate anticoagulation is using diluted citrate around 1% depending on the types used in clinical practice. Diluted citrate is much more safer when compared to highly concentrated citrate around 4% or even more. In clinical practice, trisodium citrate is used in high concentration (around 30%) as a bactericidal agent with anticoagulant properties for locking deep venous catheters used in hemodialysis (HD; close to 25–30% of citrate). In this review article, buffer and anticoagulant potential of citrate are discussed during renal replacement therapy in critically ill patients with particular focus on the practical approach at the bedside.

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Patrick M. Honore, Rita Jacobs, Olivier Joannes-Boyau, Willem Boer, Elisabeth De Waele, Viola Van Gorp and Herbert D. Spapen

Abstract

Sepsis-induced acute kidney injury (SAKI) remains an important challenge for intensive care unit clinicians. We reviewed current available evidence regarding prevention and treatment of SAKI thereby incorporating some major recent advances and developments. Prevention includes early and ample administration of “balanced” crystalloid solutions such as Ringer’s lactate. For monitoring of renal function during resuscitation, lactate clearance rate is preferred above ScvO2 or renal Doppler. Aiming at high central venous pressures seems to be deleterious in light of the novel “kidney afterload” concept. Noradrenaline is the vasopressor of choice for preventing SAKI. Intra-abdominal hypertension, a potent trigger of acute kidney injury in postoperative and trauma patients, should not be neglected in sepsis. Renal replacement therapy (RRT) must be started early in fluid-overloaded patients refractory to diuretics. Continuous RRT (CRRT) is the preferred modality in hemodynamically unstable SAKI but its use in more stable SAKI is increasing. In the absence of hypervolemia, diuretics should be avoided. Antimicrobial dosing during CRRT needs to be thoroughly reconsidered to assure adequate infection control.

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Patrick M. Honore, Rita Jacobs, Olivier Joannes-Boyau, Willem Boer, Elisabeth De Waele, Viola Van Gorp and Herbert D. Spapen

Abstract

Polymyxins are ‘‘old’’ antimicrobials which were abandoned for almost 30 years because of significant renal and neurological toxicity. However, the alarming rise of multi-resistant Gramnegative bacterial infections worldwide has revived interest in these ‘‘forgotten’’ agents. Colistin (polymyxin E) is one of the main antibiotics of this class. It is most often administered as the pro-drug colistimethate sodium. Doses for treatment of systemic infections in adults range between 3 and 9 million IU per day. Colistin is increasingly used for treatment of pneumonia and bacteremia in critically ill patients. During their ICU stay, many of these subjects will need continuous renal replacement therapy (CRRT) because of acute kidney injury or an unstable hemodynamic condition. Based on recent pharmacological data and own experience, we postulate that patients undergoing CRRT may receive substantially higher doses of colistin (i.e., a high loading dose, followed by a maintenance dose up to 4.5 million IU tid). Treatment can be continued for a prolonged time period without increasing toxicity. CRRT counteracts colistin accumulation because the drug is continuously filtered and also significantly adsorbed in the bulk of the dialysis membrane. Implementing such ‘‘CRRT rescue’’ therapy does require the strict use of highly adsorptive dialysis membranes in association with citrate anticoagulation to increase membrane performance.

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An Verdoodt, Patrick M. Honore, Rita Jacobs, Elisabeth De Waele, Viola Van Gorp, Jouke De Regt and Herbert D. Spapen

Abstract

Statins essentially are cholesterol-lowering drugs that are extensively prescribed for primary and secondary prevention of cardiovascular disease. Compelling evidence suggests that the beneficial effects of statins may not only be due to its ability to control cholesterol levels but also due to a pleiotropic cholesterol-independent anti-inflammatory, antioxidant, endothelial-protective and plaque-stabilizing activity. Along this line, statins may also exert acute and long-term effects on renal function. We present a narrative literature review that summarizes arguments in favor of or against the preventive and/or therapeutic use of statins in kidney-related diseases or complications. We also highlight the ongoing controversy regarding statin therapy in chronic and end-stage kidney disease.

Open access

Elisabeth De Waele, Leslie Moerman, Kobe Van Bael, Dimitri Aerden, Erik Debing, Patrick M. Honoré and Pierre Van den Brande

Abstract

Background:Malnutrition has been shown to have an adverse effect on the clinical outcome of surgical patients. A >10% body weight loss in the previous 6 months is a significant preoperative predictor of worse post-operative outcome. There are limited data on malnutrition in vascular surgery patients. The current study was designed to investigate the prevalence of malnutrition in elective vascular surgery patients. Materials and Methods: This is a prospective, observational, auditing study carried out in department of vascular surgery of a tertiary, university and teaching hospital. All patients scheduled to undergo vascular surgery in a 4-month period were screened for malnutrition using the Nutritional Risk Score 2002. Nutritional status was assessed by body weight, body mass index, serum albumin and physical examination by a member of the hospitals’ nutrition team. The body weight was determined daily until 30 days post-operatively. Statistical analysis was performed using SPSS Statistics, Release Version 20.0.0. Results: On admission, 14 of 23 patients (61%) were at risk of malnutrition (Nutritional Risk Score 2002 ≥ 3). Assessment revealed no false-positive results. The mean post-operative body weight declined until Day 9. Afterwards, it rose with a mean weight gain of 1.32 kg. Conclusions: Malnutrition remains a largely unrecognized problem in vascular surgery patients. Given its detrimental effect, screening for malnutrition should be implemented in the pre-operative workup and therapeutic flow charts should be made available. Clear guidelines should also been made available for the bedside clinician.