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Marlies Ostermann – One of the best experts on this subject based on the ideXlab platform.

  • COVID-19-associated Acute kidney injury: consensus report of the 25th Acute Disease Quality Initiative (ADQI) Workgroup.
    Nature reviews. Nephrology, 2020
    Co-Authors: Mitra K. Nadim, Marlies Ostermann, Lui G. Forni, Ravindra L. Mehta, Michael J. Connor, Kathleen D. Liu, Thomas Rimmelé, Alexander Zarbock, Samira Bell, Azra Bihorac
    Abstract:

    Kidney involvement in patients with coronavirus Disease 2019 (COVID-19) is common, and can range from the presence of proteinuria and haematuria to Acute kidney injury (AKI) requiring renal replacement therapy (RRT; also known as kidney replacement therapy). COVID-19-associated AKI (COVID-19 AKI) is associated with high mortality and serves as an independent risk factor for all-cause in-hospital death in patients with COVID-19. The pathophysiology and mechanisms of AKI in patients with COVID-19 have not been fully elucidated and seem to be multifactorial, in keeping with the pathophysiology of AKI in other patients who are critically ill. Little is known about the prevention and management of COVID-19 AKI. The emergence of regional ‘surges’ in COVID-19 cases can limit hospital resources, including dialysis availability and supplies; thus, careful daily assessment of available resources is needed. In this Consensus Statement, the Acute Disease Quality Initiative provides recommendations for the diagnosis, prevention and management of COVID-19 AKI based on current literature. We also make recommendations for areas of future research, which are aimed at improving understanding of the underlying processes and improving outcomes for patients with COVID-19 AKI.

  • Recommendations on Acute Kidney Injury Biomarkers From the Acute Disease Quality Initiative Consensus Conference: A Consensus Statement.
    JAMA network open, 2020
    Co-Authors: Marlies Ostermann, Stuart L Goldstein, Lui G. Forni, Alexander Zarbock, Kianoush Kashani, Etienne Macedo, Raghavan Murugan, Max Bell, Louis M. Guzzi, Michael Joannidis
    Abstract:

    Importance In the last decade, new biomarkers for Acute kidney injury (AKI) have been identified and studied in clinical trials. Guidance is needed regarding how best to incorporate them into clinical practice. Objective To develop recommendations on AKI biomarkers based on existing data and expert consensus for practicing clinicians and researchers. Evidence Review At the 23rd Acute Disease Quality Initiative meeting, a meeting of 23 international experts in critical care, nephrology, and related specialties, the panel focused on 4 broad areas, as follows: (1) AKI risk assessment; (2) AKI prediction and prevention; (3) AKI diagnosis, etiology, and management; and (4) AKI progression and kidney recovery. A literature search revealed more than 65 000 articles published between 1965 and May 2019. In a modified Delphi process, recommendations and consensus statements were developed based on existing data, with 90% agreement among panel members required for final adoption. Recommendations were graded using the Grading of Recommendations, Assessment, Development and Evaluations system. Findings The panel developed 11 consensus statements for biomarker use and 14 research recommendations. The key suggestions were that a combination of damage and functional biomarkers, along with clinical information, be used to identify high-risk patient groups, improve the diagnostic accuracy of AKI, improve processes of care, and assist the management of AKI. Conclusions and Relevance Current evidence from clinical studies supports the use of new biomarkers in prevention and management of AKI. Substantial gaps in knowledge remain, and more research is necessary.

  • Lung–kidney interactions in critically ill patients: consensus report of the Acute Disease Quality Initiative (ADQI) 21 Workgroup
    Intensive care medicine, 2019
    Co-Authors: Michael Joannidis, Sean M Bagshaw, Marlies Ostermann, John R. Prowle, Lui G. Forni, Sebastian J. Klein, Patrick M. Honore, Kianoush Kashani, Vincenzo Cantaluppi, Michael Darmon
    Abstract:

    Multi-organ dysfunction in critical illness is common and frequently involves the lungs and kidneys, often requiring organ support such as invasive mechanical ventilation (IMV), renal replacement therapy (RRT) and/or extracorporeal membrane oxygenation (ECMO). A consensus conference on the spectrum of lung–kidney interactions in critical illness was held under the auspices of the Acute Disease Quality Initiative (ADQI) in Innsbruck, Austria, in June 2018. Through review and critical appraisal of the available evidence, the current state of research, and both clinical and research recommendations were described on the following topics: epidemiology, pathophysiology and strategies to mitigate pulmonary dysfunction among patients with Acute kidney injury and/or kidney dysfunction among patients with Acute respiratory failure/Acute respiratory distress syndrome. Furthermore, emphasis was put on patients receiving organ support (RRT, IMV and/or ECMO) and its impact on lung and kidney function. The ADQI 21 conference found significant knowledge gaps about organ crosstalk between lung and kidney and its relevance for critically ill patients. Lung protective ventilation, conservative fluid management and early recognition and treatment of pulmonary infections were the only clinical recommendations with higher quality of evidence. Recommendations for research were formulated, targeting lung–kidney interactions to improve care processes and outcomes in critical illness.

Francis J. Novembre – One of the best experts on this subject based on the ideXlab platform.

  • Postinoculation PMPA Treatment, but Not Preinoculation Immunomodulatory Therapy, Protects against Development of Acute Disease Induced by the Unique Simian Immunodeficiency Virus SIVsmmPBj
    Journal of virology, 1999
    Co-Authors: Shekema Hodge, Juliette De Rosayro, Amanda A. Glenn, Ifeoma C. Ojukwu, Stephen Dewhurst, Harold M. Mcclure, Norbert Bischofberger, Daniel C. Anderson, Sherry Klumpp, Francis J. Novembre
    Abstract:

    Since it was first isolated in 1985 and 1986 (1, 5, 10, 26), the simian immunodeficiency viruses (SIV) have become an important tool for investigating numerous aspects of lentivirus-host interactions. These viruses have been instrumental in our understanding of the Disease process induced by human immunodeficiency viruvirus type 1 (HIV-1) infection in humans. In addition, the SIV-macaque model has been important for investigating new methods for vaccine and therapy development. The SIV isolates from sooty mangabeys (Cercocebus atys) (SIVsmm) and rhesus macaques (Macaca mulatta) (SIVmac) induce a Disease in Asian macaques that is remarkably similar to HIV-1 infection in humans (20, 24). The usefulness of the SIV-macaque model system is that it recapitulates HIV-1 pathogenesis in a shorter time. However, the pathogenic nature of SIV varies between isolates. Some isolates, such as the SIVmac1A11 isolate (23), have not been shown to cause any Disease. However, most isolates are at least moderately pathogenic and induce AIDS-like Disease within a time frame of 5 to 18 months. We have been investigating a highly pathogenic variant of SIV, termed SIVsmmPBj14 (PBj). This isolate induces an Acutely lethal Disease that is characterized by diarrhea, dehydration, and anorexia, culminating in death in 5 to 14 days postinfection (11). A major focus of replicating virus is found in the lymphoid system of the intestinal tract. This is also where significant pathology occurs, including blunted intestinal villi and hyperproliferative tissue (9, 11). While the Disease appears to be an exaggerated form of Acute retroviral Disease, clinical signs of Disease are similar to those of animals experiencing endotoxic shock. The highly pathogenic nature of this virus suggested that changes in both the genotype and phenotype of SIV contributed to the new Disease syndrome. Initial studies showed that this virus had unique characteristics, including the ability to replicate in unstimulated peripheral blood mononuclear cells (PBMC) and induce PBMC to proliferate (8). The latter characteristic appears to correlate with the observation that animals dying of PBj-induced Acute Disease have hyperproliferative lymphoid tissue in the gut. Contributing to this hyperproliferative state could be the redirection of lymphocytes from the periphery to the intestinal area through induction of specific integrins (12). We have been evaluating the basis for Disease development at the molecular, biological, and pathologic levels. It is now clear that multiple viral genetic elements are required for the Acutely lethal nature of PBj (27, 28), including a single amino acid change in Nef (7, 33). Furthermore, we have demonstrated that the in vitro phenomenon of PBMC proliferation induction by this virus is linked to its ability to induce Acute Disease (27). Inoculation of cells in vitro, or of animals, with PBj has been shown to induce the upregulation of activation markers (CD25 and CD45RO) (33). These results, coupled with the additional finding of significantly increased levels of apoptosis in the hyperplastic gut lymphoid areas, strongly suggest that immune activation is intimately associated with the Acute Disease syndrome (13, 40). To further investigate the roles of immune activation and viral replication in Disease development, we used two methods to try to prevent Disease development: immunosuppression and antiretroviral therapy. The results presented here suggest that while immune activation may play a significant role in the pathogenesis of PBj-induced Disease, viral replication also appears to contribute importantly to Disease development.

Paul Becher – One of the best experts on this subject based on the ideXlab platform.

Azra Bihorac – One of the best experts on this subject based on the ideXlab platform.

  • COVID-19-associated Acute kidney injury: consensus report of the 25th Acute Disease Quality Initiative (ADQI) Workgroup.
    Nature reviews. Nephrology, 2020
    Co-Authors: Mitra K. Nadim, Marlies Ostermann, Lui G. Forni, Ravindra L. Mehta, Michael J. Connor, Kathleen D. Liu, Thomas Rimmelé, Alexander Zarbock, Samira Bell, Azra Bihorac
    Abstract:

    Kidney involvement in patients with coronavirus Disease 2019 (COVID-19) is common, and can range from the presence of proteinuria and haematuria to Acute kidney injury (AKI) requiring renal replacement therapy (RRT; also known as kidney replacement therapy). COVID-19-associated AKI (COVID-19 AKI) is associated with high mortality and serves as an independent risk factor for all-cause in-hospital death in patients with COVID-19. The pathophysiology and mechanisms of AKI in patients with COVID-19 have not been fully elucidated and seem to be multifactorial, in keeping with the pathophysiology of AKI in other patients who are critically ill. Little is known about the prevention and management of COVID-19 AKI. The emergence of regional ‘surges’ in COVID-19 cases can limit hospital resources, including dialysis availability and supplies; thus, careful daily assessment of available resources is needed. In this Consensus Statement, the Acute Disease Quality Initiative provides recommendations for the diagnosis, prevention and management of COVID-19 AKI based on current literature. We also make recommendations for areas of future research, which are aimed at improving understanding of the underlying processes and improving outcomes for patients with COVID-19 AKI.

  • Quality of care after AKI development in the hospital: Consensus from the 22nd Acute Disease Quality Initiative (ADQI) conference
    European journal of internal medicine, 2020
    Co-Authors: Etienne Macedo, Azra Bihorac, Edward D Siew, Ravindra L. Mehta, John A. Kellum, Claudio Ronco, Paul M. Palevsky, Mitchell H. Rosner, Michael Haase, Kianoush Kashani
    Abstract:

    Background Acute kidney injury (AKI) is independently associated with increased morbidity and mortality. Quality improvement has been identified as an important goal in the care of patients with AKI. Different settings can be targeted to improve AKI care, broadly classified these include the inpatient and outpatient environments. In this paper, we will emphasize quality indicators associated with the management and secondary prevention of AKI in hospitalized patients to limit the severity, duration, and complications. Methods During the 22nd Acute Disease Quality Initiative (ADQI) consensus conference, a multidisciplinary group of experts discussed the evidence and used a modified Delphi process to achieve consensus on recommendations for AKI-related quality indicators (QIs) and care processes to improve patient outcomes. The management and secondary prevention of AKI in hospitalized patients were discussed, and recommendations were summarized. Results The first step in optimizing the quality of AKI management is the determination of baseline performance. Data regarding each institution’s/center’s performance can provide a reference point from which to benchmark quality efforts. Quality program initiatives should prioritize achievable goals likely to have the highest impact according to the setting and context. Key AKI quality metrics should include improvement in timely recognition, appropriate diagnostic workup, and implementation of known interventions that limit progression and severity, facilitating recovery, and mitigating AKI-associated complications. We propose the Recognition-Action-Results framework to plan, measure, and report the progress toward improving AKI management quality. Conclusions These recommendations identified and outlined an approach to define and evaluate the quality of AKI management in hospitalized patients.

  • Acute kidney Disease and renal recovery consensus report of the Acute Disease quality initiative adqi 16 workgroup
    Nature Reviews Nephrology, 2017
    Co-Authors: Lakhmir S Chawla, Rinaldo Bellomo, Azra Bihorac, Stuart L Goldstein, Edward D Siew, Sean M Bagshaw, D B Bittleman, Dinna N Cruz, Zoltan H Endre, Robert L Fitzgerald
    Abstract:

    Consensus definitions have been reached for both Acute kidney injury (AKI) and chronic kidney Disease (CKD) and these definitions are now routinely used in research and clinical practice. The KDIGO guideline defines AKI as an abrupt decrease in kidney function occurring over 7 days or less, whereas CKD is defined by the persistence of kidney Disease for a period of >90 days. AKI and CKD are increasingly recognized as related entities and in some instances probably represent a continuum of the Disease process. For patients in whom pathophysiologic processes are ongoing, the term Acute kidney Disease (AKD) has been proposed to define the course of Disease after AKI; however, definitions of AKD and strategies for the management of patients with AKD are not currently available. In this consensus statement, the Acute Disease Quality Initiative (ADQI) proposes definitions, staging criteria for AKD, and strategies for the management of affected patients. We also make recommendations for areas of future research, which aim to improve understanding of the underlying processes and improve outcomes for patients with AKD.

Changsong Wang – One of the best experts on this subject based on the ideXlab platform.

  • Pragmatic Studies for Acute Kidney Injury in China: Renal Replacement Therapy for Acute Kidney Injury and Sepsis Consensus Report of Acute Disease Quality Initiative XIX
    Journal of Translational Critical Care Medicine, 2019
    Co-Authors: John R. Prowle, Changsong Wang, Martin Gallagher
    Abstract:

    In this article, we report consensus of 19th Acute Disease Quality Initiative (ADQI) conference and pragmatic trial proposals on renal replacement therapy (RRT) for Acute kidney injury (AKI)and sepsis. The committee develop a list of key questions for the pragmatic trials. Then a systematic literature search was performed using PubMed and Embase. Finally the group summarized the proposed trials using PICO(Patient, Intervention, Comparator, Outcome). The groups recommended the first step would be a prospective observational study to document the current clinical practice of RRT in ICUs. Then the second stage would be to develop a quality improvement (QI) tools to improve and standardize the RRT practice in ICUs. The committee also proposed the primary outcome and secondary outcomes of the trial. Consensus had been reached for the pragmatic trial of RRT for AKI and sepsis in Chinese ICUs.

  • Pragmatic studies for Acute kidney injury: Consensus report of the Acute Disease Quality Initiative (ADQI) 19 Workgroup.
    Journal of critical care, 2017
    Co-Authors: Zhiyong Peng, Marlies Ostermann, Raymond K. Hsu, Jean Louis Vincent, John R. Prowle, Martin Gallagher, Changsong Wang
    Abstract:

    Purpose: Acute kidney injury (AKI) has become a major medical and financial burden in China along with the rest of the world. There have been considerable advances in the understanding of the epidemiology and pathogenesis of AKI. However, there is no consensus regarding the optimal care for patients. The Acute Disease Quality Initiative (ADQI) 19 meeting focused on identifying and designing relevant and achievable AKI-related studies in China. Materials & methods: he working group developed a list of preliminary questions and objectives and performed analysis of the existing literature. Relevant studies were identified through a literature search using the MEDLINE database and bibliographies of relevant research and review articles. We then used a two-step Delphi process to prioritize a research agenda and proposed specific study designs to address unmet needs. Results: Important gaps in existing knowledge were identified and pragmatic studies were proposed in three distinct areas: care bundles for AKI prevention, renal replacement therapy (RRT) for AKI, and fluid management. In addition, the use of biomarkers to guide clinical trials was discussed. Conclusions: Consensus was reached on a research agenda for AKI with a specific focus on pragmatic trials in China.