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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Peripheral Edema, Central Venous Pressure, and Risk of AKI in Critical Illness</title><author><name sortKey="Chen, Kenneth P" sort="Chen, Kenneth P" uniqKey="Chen K" first="Kenneth P." last="Chen">Kenneth P. Chen</name><affiliation><nlm:aff id="aff1">Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts;</nlm:aff></affiliation></author><author><name sortKey="Cavender, Susan" sort="Cavender, Susan" uniqKey="Cavender S" first="Susan" last="Cavender">Susan Cavender</name><affiliation><nlm:aff id="aff2">Division of Health Sciences and Technology, Harvard-Massachusetts Institute of Technology, Cambridge, Massachusetts;</nlm:aff></affiliation></author><author><name sortKey="Lee, Joon" sort="Lee, Joon" uniqKey="Lee J" first="Joon" last="Lee">Joon Lee</name><affiliation><nlm:aff id="aff2">Division of Health Sciences and Technology, Harvard-Massachusetts Institute of Technology, Cambridge, Massachusetts;</nlm:aff></affiliation><affiliation><nlm:aff wicri:cut="; and" id="aff3">School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada</nlm:aff></affiliation></author><author><name sortKey="Feng, Mengling" sort="Feng, Mengling" uniqKey="Feng M" first="Mengling" last="Feng">Mengling Feng</name><affiliation><nlm:aff id="aff2">Division of Health Sciences and Technology, Harvard-Massachusetts Institute of Technology, Cambridge, Massachusetts;</nlm:aff></affiliation><affiliation><nlm:aff id="aff4">Data Analytics Department, Institute for Infocomm Research, Agency for Science, Technology And Research, Singapore</nlm:aff></affiliation></author><author><name sortKey="Mark, Roger G" sort="Mark, Roger G" uniqKey="Mark R" first="Roger G." last="Mark">Roger G. Mark</name><affiliation><nlm:aff id="aff2">Division of Health Sciences and Technology, Harvard-Massachusetts Institute of Technology, Cambridge, Massachusetts;</nlm:aff></affiliation></author><author><name sortKey="Celi, Leo Anthony" sort="Celi, Leo Anthony" uniqKey="Celi L" first="Leo Anthony" last="Celi">Leo Anthony Celi</name><affiliation><nlm:aff id="aff1">Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts;</nlm:aff></affiliation><affiliation><nlm:aff id="aff2">Division of Health Sciences and Technology, Harvard-Massachusetts Institute of Technology, Cambridge, Massachusetts;</nlm:aff></affiliation></author><author><name sortKey="Mukamal, Kenneth J" sort="Mukamal, Kenneth J" uniqKey="Mukamal K" first="Kenneth J." last="Mukamal">Kenneth J. Mukamal</name><affiliation><nlm:aff id="aff1">Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts;</nlm:aff></affiliation></author><author><name sortKey="Danziger, John" sort="Danziger, John" uniqKey="Danziger J" first="John" last="Danziger">John Danziger</name><affiliation><nlm:aff id="aff1">Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts;</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">26787777</idno><idno type="pmc">4822669</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4822669</idno><idno type="RBID">PMC:4822669</idno><idno type="doi">10.2215/CJN.08080715</idno><date when="2016">2016</date><idno type="wicri:Area/Pmc/Corpus">000649</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000649</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Peripheral Edema, Central Venous Pressure, and Risk of AKI in Critical Illness</title><author><name sortKey="Chen, Kenneth P" sort="Chen, Kenneth P" uniqKey="Chen K" first="Kenneth P." last="Chen">Kenneth P. Chen</name><affiliation><nlm:aff id="aff1">Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts;</nlm:aff></affiliation></author><author><name sortKey="Cavender, Susan" sort="Cavender, Susan" uniqKey="Cavender S" first="Susan" last="Cavender">Susan Cavender</name><affiliation><nlm:aff id="aff2">Division of Health Sciences and Technology, Harvard-Massachusetts Institute of Technology, Cambridge, Massachusetts;</nlm:aff></affiliation></author><author><name sortKey="Lee, Joon" sort="Lee, Joon" uniqKey="Lee J" first="Joon" last="Lee">Joon Lee</name><affiliation><nlm:aff id="aff2">Division of Health Sciences and Technology, Harvard-Massachusetts Institute of Technology, Cambridge, Massachusetts;</nlm:aff></affiliation><affiliation><nlm:aff wicri:cut="; and" id="aff3">School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada</nlm:aff></affiliation></author><author><name sortKey="Feng, Mengling" sort="Feng, Mengling" uniqKey="Feng M" first="Mengling" last="Feng">Mengling Feng</name><affiliation><nlm:aff id="aff2">Division of Health Sciences and Technology, Harvard-Massachusetts Institute of Technology, Cambridge, Massachusetts;</nlm:aff></affiliation><affiliation><nlm:aff id="aff4">Data Analytics Department, Institute for Infocomm Research, Agency for Science, Technology And Research, Singapore</nlm:aff></affiliation></author><author><name sortKey="Mark, Roger G" sort="Mark, Roger G" uniqKey="Mark R" first="Roger G." last="Mark">Roger G. Mark</name><affiliation><nlm:aff id="aff2">Division of Health Sciences and Technology, Harvard-Massachusetts Institute of Technology, Cambridge, Massachusetts;</nlm:aff></affiliation></author><author><name sortKey="Celi, Leo Anthony" sort="Celi, Leo Anthony" uniqKey="Celi L" first="Leo Anthony" last="Celi">Leo Anthony Celi</name><affiliation><nlm:aff id="aff1">Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts;</nlm:aff></affiliation><affiliation><nlm:aff id="aff2">Division of Health Sciences and Technology, Harvard-Massachusetts Institute of Technology, Cambridge, Massachusetts;</nlm:aff></affiliation></author><author><name sortKey="Mukamal, Kenneth J" sort="Mukamal, Kenneth J" uniqKey="Mukamal K" first="Kenneth J." last="Mukamal">Kenneth J. Mukamal</name><affiliation><nlm:aff id="aff1">Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts;</nlm:aff></affiliation></author><author><name sortKey="Danziger, John" sort="Danziger, John" uniqKey="Danziger J" first="John" last="Danziger">John Danziger</name><affiliation><nlm:aff id="aff1">Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts;</nlm:aff></affiliation></author></analytic><series><title level="j">Clinical Journal of the American Society of Nephrology : CJASN</title><idno type="ISSN">1555-9041</idno><idno type="eISSN">1555-905X</idno><imprint><date when="2016">2016</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background and objectives</title><p>Although venous congestion has been linked to renal dysfunction in heart failure, its significance in a broader context has not been investigated.</p></sec><sec><title>Design, setting, participants, & measurements</title><p>Using an inception cohort of 12,778 critically ill adult patients admitted to an urban tertiary medical center between 2001 and 2008, we examined whether the presence of peripheral edema on admission physical examination was associated with an increased risk of AKI within the first 7 days of critical illness. In addition, in those with admission central venous pressure (CVP) measurements, we examined the association of CVPs with subsequent AKI. AKI was defined using the Kidney Disease Improving Global Outcomes criteria.</p></sec><sec><title>Results</title><p>Of the 18% (<italic>n</italic>=2338) of patients with peripheral edema on admission, 27% (<italic>n</italic>=631) developed AKI, compared with 16% (<italic>n</italic>=1713) of those without peripheral edema. In a model that included adjustment for comorbidities, severity of illness, and the presence of pulmonary edema, peripheral edema was associated with a 30% higher risk of AKI (95% confidence interval [95% CI], 1.15 to 1.46; <italic>P</italic><0.001), whereas pulmonary edema was not significantly related to risk. Peripheral edema was also associated with a 13% higher adjusted risk of a higher AKI stage (95% CI, 1.07 to 1.20; <italic>P</italic><0.001). Furthermore, levels of trace, 1+, 2+, and 3+ edema were associated with 34% (95% CI, 1.10 to 1.65), 17% (95% CI, 0.96 to 1.14), 47% (95% CI, 1.18 to 1.83), and 57% (95% CI, 1.07 to 2.31) higher adjusted risk of AKI, respectively, compared with edema-free patients. In the 4761 patients with admission CVP measurements, each 1 cm H<sub>2</sub>O higher CVP was associated with a 2% higher adjusted risk of AKI (95% CI, 1.00 to 1.03; <italic>P</italic>=0.02).</p></sec><sec><title>Conclusions</title><p>Venous congestion, as manifested as either peripheral edema or increased CVP, is directly associated with AKI in critically ill patients. Whether treatment of venous congestion with diuretics can modify this risk will require further study.</p></sec></div></front></TEI><pmc article-type="research-article"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Clin J Am Soc Nephrol</journal-id><journal-id journal-id-type="iso-abbrev">Clin J Am Soc Nephrol</journal-id><journal-id journal-id-type="hwp">clinjasn</journal-id><journal-id journal-id-type="pmc">cjn</journal-id><journal-id journal-id-type="publisher-id">CJASN</journal-id><journal-title-group><journal-title>Clinical Journal of the American Society of Nephrology : CJASN</journal-title></journal-title-group><issn pub-type="ppub">1555-9041</issn><issn pub-type="epub">1555-905X</issn><publisher><publisher-name>American Society of Nephrology</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">26787777</article-id><article-id pub-id-type="pmc">4822669</article-id><article-id pub-id-type="publisher-id">08080715</article-id><article-id pub-id-type="doi">10.2215/CJN.08080715</article-id><article-categories><subj-group subj-group-type="heading"><subject>Original Articles</subject><subj-group><subject>Epidemiology and Outcomes</subject></subj-group></subj-group></article-categories><title-group><article-title>Peripheral Edema, Central Venous Pressure, and Risk of AKI in Critical Illness</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Chen</surname><given-names>Kenneth P.</given-names></name><xref ref-type="aff" rid="aff1">*</xref></contrib><contrib contrib-type="author"><name><surname>Cavender</surname><given-names>Susan</given-names></name><xref ref-type="aff" rid="aff2"><sup>†</sup></xref></contrib><contrib contrib-type="author"><name><surname>Lee</surname><given-names>Joon</given-names></name><xref ref-type="aff" rid="aff2"><sup>†</sup></xref><xref ref-type="aff" rid="aff3"><sup>‡</sup></xref></contrib><contrib contrib-type="author"><name><surname>Feng</surname><given-names>Mengling</given-names></name><xref ref-type="aff" rid="aff2"><sup>†</sup></xref><xref ref-type="aff" rid="aff4"><sup>§</sup></xref></contrib><contrib contrib-type="author"><name><surname>Mark</surname><given-names>Roger G.</given-names></name><xref ref-type="aff" rid="aff2"><sup>†</sup></xref></contrib><contrib contrib-type="author"><name><surname>Celi</surname><given-names>Leo Anthony</given-names></name><xref ref-type="aff" rid="aff1">*</xref><xref ref-type="aff" rid="aff2"><sup>†</sup></xref></contrib><contrib contrib-type="author"><name><surname>Mukamal</surname><given-names>Kenneth J.</given-names></name><xref ref-type="aff" rid="aff1">*</xref></contrib><contrib contrib-type="author" corresp="yes"><name><surname>Danziger</surname><given-names>John</given-names></name><xref ref-type="aff" rid="aff1">*</xref></contrib><aff id="aff1"><label>*</label>Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts;</aff><aff id="aff2"><label>†</label>Division of Health Sciences and Technology, Harvard-Massachusetts Institute of Technology, Cambridge, Massachusetts;</aff><aff id="aff3"><label>‡</label>School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada; and</aff><aff id="aff4"><label>§</label>Data Analytics Department, Institute for Infocomm Research, Agency for Science, Technology And Research, Singapore</aff></contrib-group><author-notes><corresp id="cor1"><bold>Correspondence:</bold> Dr. John Danziger, <addr-line>185 Pilgrim Road, Farr 8, Boston, MA 02215</addr-line>. Email: <email>jdanzige@bidmc.harvard.edu</email></corresp></author-notes><pub-date pub-type="ppub"><day>7</day><month>4</month><year>2016</year></pub-date><pub-date pub-type="epub"><day>19</day><month>1</month><year>2016</year></pub-date><volume>11</volume><issue>4</issue><fpage>602</fpage><lpage>608</lpage><history><date date-type="received"><day>28</day><month>7</month><year>2015</year></date><date date-type="accepted"><day>16</day><month>12</month><year>2015</year></date></history><permissions><copyright-statement>Copyright © 2016 by the American Society of Nephrology</copyright-statement><copyright-year>2016</copyright-year></permissions><self-uri xlink:title="pdf" xlink:type="simple" xlink:href="CJN.08080715.pdf"></self-uri><abstract><sec><title>Background and objectives</title><p>Although venous congestion has been linked to renal dysfunction in heart failure, its significance in a broader context has not been investigated.</p></sec><sec><title>Design, setting, participants, & measurements</title><p>Using an inception cohort of 12,778 critically ill adult patients admitted to an urban tertiary medical center between 2001 and 2008, we examined whether the presence of peripheral edema on admission physical examination was associated with an increased risk of AKI within the first 7 days of critical illness. In addition, in those with admission central venous pressure (CVP) measurements, we examined the association of CVPs with subsequent AKI. AKI was defined using the Kidney Disease Improving Global Outcomes criteria.</p></sec><sec><title>Results</title><p>Of the 18% (<italic>n</italic>=2338) of patients with peripheral edema on admission, 27% (<italic>n</italic>=631) developed AKI, compared with 16% (<italic>n</italic>=1713) of those without peripheral edema. In a model that included adjustment for comorbidities, severity of illness, and the presence of pulmonary edema, peripheral edema was associated with a 30% higher risk of AKI (95% confidence interval [95% CI], 1.15 to 1.46; <italic>P</italic><0.001), whereas pulmonary edema was not significantly related to risk. Peripheral edema was also associated with a 13% higher adjusted risk of a higher AKI stage (95% CI, 1.07 to 1.20; <italic>P</italic><0.001). Furthermore, levels of trace, 1+, 2+, and 3+ edema were associated with 34% (95% CI, 1.10 to 1.65), 17% (95% CI, 0.96 to 1.14), 47% (95% CI, 1.18 to 1.83), and 57% (95% CI, 1.07 to 2.31) higher adjusted risk of AKI, respectively, compared with edema-free patients. In the 4761 patients with admission CVP measurements, each 1 cm H<sub>2</sub>O higher CVP was associated with a 2% higher adjusted risk of AKI (95% CI, 1.00 to 1.03; <italic>P</italic>=0.02).</p></sec><sec><title>Conclusions</title><p>Venous congestion, as manifested as either peripheral edema or increased CVP, is directly associated with AKI in critically ill patients. Whether treatment of venous congestion with diuretics can modify this risk will require further study.</p></sec></abstract><kwd-group><kwd>acute renal failure</kwd><kwd>renal function</kwd><kwd>acute kidney injury</kwd><kwd>central venous pressure</kwd><kwd>comorbidity</kwd><kwd>critical illness</kwd><kwd>edema</kwd><kwd>heart failure</kwd><kwd>humans</kwd><kwd>pulmonary edema</kwd></kwd-group><counts><page-count count="7"></page-count></counts><custom-meta-group><custom-meta><meta-name>cover-date</meta-name><meta-value>April 07, 2016</meta-value></custom-meta></custom-meta-group></article-meta></front></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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