Renal

HCO3 bolus effective in reducing contrast nephropathy before emergent catheterization

In this small trial of patients undergoing emergent cardiac catheterization with renal insufficiency (CrCl<60 or Cr>1.1), they were randomized to normal saline or HCO3 bolus; the incidence of CIN was significantly lower in the HCO3 group (3% vs 28%); this can be an effective and efficient way to reduce the incidence of CIN before emergent dye loads (abstract)

Kayexalate dose response in reducing K levels

In this retrospective single center cohort, patients with hyperkalemia (K>5.1) treated with sodium polystyrene (kayexalate) were examined to determine the dose given, and subsequent reduction in serum K. They found a dose response, with K level decreases ranging from 0.8 to 1.4 in those given 15g and 60g respectively. Serum potassium normalized after 1 dose in 94% of patients. Kayexalate dose should be given based on the required reduction in serum K (abstract)

IV diuretic dose and schedule does not affect CHF outcomes

In this randomized trial of hospitalized CHF patients, they were randomized to IV bolus or continuous infusion of furosemide, at either low dose (equivalent to home dose) or high dose (equivalent to 2.5 times the home dose). At 72 hours, there was no significant difference in patient symptoms or serum creatinine between the dosing groups or the schedule groups. The high dose strategy was favorable in diuresis and some secondary outcomes, but at the expense of a transient increase in serum creatinine (abstract). There is no apparent advantage to continuous IV furosemide versus bolus dosing; there may be some advantage to higher diuretic doses (2.5 times equivalent home dose).

Proteinuria predicts acute kidney injury, independent of GFR

In this large cohort of patients with acute kidney injury, proteinuria predicted the risk of injury as well as did GFR. Risk increased with increasing levels of proteinuria, and the highest risk were patients with both proteinuria and low GFR. Currently GFR is used to predict risk of acute kidney injury (and therefore to avoid nephrotoxins such as NSAIDs or IV contrast), but this suggests that proteinuria may need to be evaluated as well (abstract)

Vasopressin antagonists effective in treating hyponatremia

This meta-analysis found vasopressin receptor antagonists are effective at raising serum sodium levels in patients with euvolemic and hypervolemic hyponatremia. Normalization of serum sodium occurred significantly earlier with these agents than without, and were more effective in euvolemic than hypervolemic patients. There was also no increase risk of adverse events or hypernatremia, and no reported demyelination syndromes. Although these agents seem to be still finding their role in clinical medicine, they do appear to be safe and moderately effective based on this meta-analysis (abstract)
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