SI
Imperial
General Calculators
Addiction Medicine
Anesthesiology
APACHE IIEstimate mortality in the critically illGlasgow Coma Scale (GCS)Document level of consciousness.Sequential Organ Failure Assessment (SOFA)Document clinical severity in the ICU and predict mortalityVascular Quality Initiative (VQI) Cardiac Risk Index (CRI) | Carotid EndarterectomyEstimate risk of post-op myocardial infarction after carotid endarterectomyVQI: Respiratory Adverse Event Risk Post Vascular SurgeryEstimate the risk of pneumonia or respiratory failure after vascular surgery
Airway & Respiratory
BMI
Cardiac Surgery
Intraoperative Monitoring
Obstetrics
Preoperative Assessment
ACC/AHA CV Risk Calculator (2013)Estimate 10-year risk for atherosclerotic cardiovascular diseaseRevised Cardiac Risk Index (Lee Criteria)Rapid pre-op assessment using the Revised Cardiac Risk IndexAsymptomatic ICA (Internal Carotid Artery) Stenosis Surgical Risk StratificationGupta Perioperative Cardiac RiskDetermine peri-operative risk for a wide array of surgeries.Postoperative Respiratory Failure Risk CalculatorEstimate risk of postoperative respiratory failureVSGNE Ruptured Abdominal Aortic Aneurysm (RAAA) Risk ScoreEstimate mortality after open repair of ruptured AAAPre-test probability of CAD (CAD consortium)Determine pre-test probability of coronary artery disease in patients with chest pain.Vascular Quality Initiative (VQI) Cardiac Risk Index (CRI) | EVAREstimate risk of post-op myocardial infarction after EVARVascular Quality Initiative (VQI) Cardiac Risk Index (CRI) | Infra-inguinal BypassEstimate risk of post-op myocardial infarction after infra-inguinal bypassVascular Quality Initiative (VQI) Cardiac Risk Index (CRI) | Open AAA RepairEstimate risk of post-op myocardial infarction after open AAA repairVascular Quality Initiative (VQI) 30-Day Stroke Risk Index for CEAEstimate risk of stroke within 30 days after carotid endarterectomyVascular Quality Initiative (VQI) 1-Year Mortality Risk Index for CEAEstimate probability of death within 1 year after carotid endarterectomyVascular Quality Initiative (VQI) Cardiac Risk Index (CRI) | Suprainguinal BypassEstimate risk of post-op myocardial infarction after suprainguinal bypassGeriatric-Sensitive Perioperative Cardiac Risk Index | GSCRIEstimate risk of perioperative myocardial infarction or cardiac arrest in patients over 65ASA Physical StatusClassification system for assessing the fitness of patients before surgery
Cardiac Surgery
Cardiology
Aortic Disease
Aortic Stenosis/Outflow
Arrhythmia
Atrial Fibrillation
Bleeding Risk
Coronary Artery Disease
ECG
Echocardiography
Heart Failure
Hypertension
Invasive Hemodynamics
Miscellaneous
Mitral Regurgitation
Mitral Stenosis
PCI and Cardiac Surgery
Pre-operative Assessment
Risk Scores
Shunts
Syncope
Treadmill Testing
Critical Care
Cardiac ICU
Cardiac Output - FickCalculate cardiac output, cardiac index, stroke volume and stroke volume indexKillip ClassEstimate mortality in myocardial infarctionTIMI Risk Score (NSTEMI)Guide therapeutic decisions in non-ST elevation MI. Shunt Fraction (Invasive)TIMI Risk Score (STEMI)Systemic Vascular ResistanceGRACEThe GRACE ACS risk calculator estimates risk of death following acute coronary syndrome (ACS)Mean Arterial Pressure (MAP) Calculate MAP
REFERENCE BOOK
KDIGO Clinical Practice Guideline for Acute Kidney Injury
AKI Definition Prevention and Treatment of AKI Contrast-induced AKI Dialysis Interventions for Treatment of AKI
Introduction and Methodology
Introduction
IntroductionGlomerular filtration rate and serum creatinineOliguria and anuriaAcute tubular necrosis (ATN)ARFRIFLE criteriaAKI: acute kidney injury/impairmentValidation studies using RIFLELimitations to current definitions for AKIRationale for a guideline on AKISummary
Methodology
IntroductionGroup member selection and meeting processEvidence selection, appraisal, and presentationOutcome selection judgments, values, and preferencesGrading the quality of evidence and the strength of recommendationsSPONSORSHIPDISCLAIMERSUPPLEMENTARY MATERIAL
AKI Definition
Definition and classification of AKI
IntroductionDefinition of AKIStaging AKI: Recommendations and RationaleResearch RecommendationsSupplementary materialRisk assessmentIntroductionRecommendations and RationaleResearch RecommendationsSupplementary material
Evaluation and general management of patients with and at risk for AKI
IntroductionRecommendations and RationaleResearch recommendationsSupplementary material
Clinical applications
IntroductionExamples of application of AKI definitionsEstimating baseline SCrExamples of application of AKI stagesUrine output vs. SCrTimeframe for diagnosis and stagingClinical judgmentPseudo-AKIAtypical AKISupplementary material
Diagnostic approach to alterations in kidney function and structure
Definitions of AKI, CKD and AKDGFR and SCrGFR/SCr algorithmOliguria as a measure of kidney functionKidney damageSmall kidneys as a marker of kidney damageIntegrated approach to AKI, AKD, and CKDSponsorshipDisclaimerSupplementary material
Prevention and Treatment of AKI
Hemodynamic monitoring and support for prevention and management of AKI
IntroductionFluids: Recommendations and RationaleAlbumin vs. SalineHydroxyethylstarch vs. SalineVasopressors: Recommendations and RationaleProtocolized Hemodynamic Management: Recommendations and RationaleProtocolized hemodynamic management strategies in septic shockGoal-directed therapy for hemodynamic support during the perioperative period in high-risk surgical patientsResearch RecommendationsSupplementary material
General supportive management of patients with AKI, including management of complications
Overview
Glycemic control and nutritional support
Glycemic control in critical illness: Recommendations and RationaleNutritional aspects in the prevention and treatment of critically ill patients with AKITotal Energy Intake: Recommendations and RationaleProtein Intake: Recommendations and RationaleNutrition route: Recommendations and RationalePediatrics ConsiderationsResearch RecommendationsSupplementary material
The use of diuretics in AKI
IntroductionRecommendations and RationaleMannitolResearch Recommendations
Vasodilator therapy: dopamine, fenoldopam, and natriuretic peptides
Dopamine for the prevention or treatment of AKI: Recommendations and RationaleFenoldopam for the prevention or treatment of AKI: Recommendations and RationaleResearch RecommendationsNatriuretic peptides for the prevention or treatment of AKI: Recommendations and RationaleResearch RecommendationsSupplementary Material
Growth factor intervention
Recombinant Human (rh) IGF-1: Recommendations and RationaleErythropoietinResearch RecommendationsSupplementary Material
Adenosine receptor antagonists
IntroductionRecommendations and RationaleResearch Recommendations
Prevention of aminoglycoside- and amphotericin-related AKI
Aminoglycoside nephrotoxicityTreatment of Infections: Recommendations and RationalePatients with Normal Kidney Function in Steady State: Recommendations and RationaleWhen Treatment with Multiple Daily Dosing is Used for More than 24 Hours: Recommendations and RationaleWhen Treatment with Single-Daily Dosing is Used for More than 48 Hours: Recommendations and RationaleTopical or Local Applications of Aminoglycosides: Recommendations and RationaleResearch RecommendationsAmphotericin B nephrotoxicity: Recommendations and RationaleTreatment of Systemic Mycoses or Parasitic Infections: Recommendations and RationaleResearch Recommendations
Other methods of prevention of AKI in the critically ill
On-pump vs. off-pump coronary artery bypass surgery: Recommendations and RationaleResearch RecommendationsN-ACETYLCYSTEINE (NAC): Recommendations and RationaleNAC in critically ill patients: Recommendations and RationaleSponsorshipDisclaimerSupplementary Material
Contrast-induced AKI
Contrast-induced AKI: definition, epidemiology, and prognosis
BackgroundRecommendations and RationaleEpidemiology of CI-AKIPrognosis of CI-AKIResearch RecommendationsSupplementary Material
Assessment of the population at risk for CI-AKI
Recommendations and RationaleRisk-factor questionnaireUrinary protein screeningOther risk factors of CI-AKIRisk models of CI-AKIPatients at Increased Risk for CI-AKI: Recommendations and RationaleNephrotoxicity of Gd chelatesNephrogenic systemic fibrosis (NSF)Supplementary Material
Nonpharmacological prevention strategies of CI-AKI
IntroductionDose/Volume of Contrast-Media Administration: Recommendations and RationaleRoute of administration of contrast mediaResearch RecommendationsSelection of a Contrast Agent: Recommendations and RationaleHigh-osmolar vs. iso-osmolar or low-osmolar contrast mediaLow-osmolar vs. iso-osmolar contrast mediai.a. Iodixanol vs. ioxaglatei.v. AdministrationResearch RecommendationsSupplementary Material
Pharmacological prevention strategies of CI-AKI
Fluid Administration: Recommendations and RationaleUse of oral fluids alone in patients at increased risk of CI-AKI: Recommendations and RationaleRole of nac in the prevention of CI-AKI: Recommendations and RationaleTheophylline: Recommendations and RationaleFenoldopam: Recommendations and RationaleStatins in the prevention of CI-AKISupplementary Material
Effects of hemodialysis or hemofiltration
Recommendations and RationaleSponsorshipDisclaimerSupplementary material
Dialysis Interventions for Treatment of AKI
Timing of renal replacement therapy in AKI
IntroductionRecommendations and RationalePediatric considerations
Research Recommendations
Supplementary material
Criteria for stopping renal replacement therapy in AKI
IntroductionWhen to discontinue RRT: Recommendations and RationaleUse of diuretics: Recommendations and RationalePediatric considerationsResearch Recommendations
Anticoagulation
IntroductionHow to decide to use anticoagulation: Recommendations and RationalePatients without an increased bleeding risk or impaired coagulation and not already receiving effective systemic anticoagulation: Recommendations and RationalePatients with increased bleeding risk who are not receiving anticoagulation: Recommendations and RationaleIn patients with heparin-induced thrombocytopenia: Recommendations and RationalePediatric considerationsResearch RecommendationsSupplementary material
Vascular access for renal replacement therapy in AKI
IntroductionUncuffed nontunneled dialysis catheter vs a tunneled catheter: Recommendations and RationaleWhen choosing a vein for insertion of a dialysis catheter in patients with AKI: Recommendations and RationaleUsing ultrasound guidance for dialysis catheter insertion: Recommendations and RationaleObtaining a chest radiograph promptly after placement and before first use of an internal jugular or subclavian dialysis catheter: Recommendations and RationaleTopical antibiotics: Recommendations and RationaleAntibiotic locks: Recommendations and RationalePediatric considerationsResearch RecommendationsSupplementary material
Dialyzer membranes for renal replacement therapy in AKI
IntroductionRecommendations and RationaleResearch Recommendations
Modality of renal replacement therapy for patients with AKI
IntroductionComplementary therapies in AKI patients: Recommendations and RationaleHemodynamically unstable patients: Recommendations and RationaleAKI patients with acute brain injury or other causes of increased intracranial pressure or generalized brain edema: Recommendations and RationaleProtocols for decreasing hemodynamic instability with intermittent RRTPeritoneal dialysisPediatric considerationsResearch RecommendationsSupplementary material
Buffer solutions for renal replacement therapy in patients with AKI
IntroductionBuffer solution: Recommendations and RationaleDialysis fluids and replacement fluids in patients with AKI: Recommendations and RationaleResearch RecommendationsSupplementary material
Dose of renal replacement therapy in AKI
IntroductionDosing: Recommendations and RationaleKt/V and Effluent Volume Rates: Recommendations and RationaleAdditional considerationsResearch RecommendationsSponsorshipDislcaimerSupplementary material
Organization and Acknowledgements
NoticeWork Group MembershipKDIGO Board MembersReference KeysAbbreviations and AcronymsAbstractForewordBiographic and Disclosure InformationAcknowledgmentsReferences
General Medicine
ICU AKI
APACHE IIEstimate mortality in the critically illContrast Nephropathy Post-PCIEstimate risk of AKI after percutaneous coronary interventionDialysis Risk After Cardiac Surgery (Cleveland Clinic Score by Thakar)Estimate risk of dialysis after cardiac surgery.Dialysis Risk After Cardiac Surgery (Mehta)Estimate the risk of dialysis after cardiac surgery (Mehta model)Fractional Excretion of SodiumDifferentiate pre-renal AKI from ATN.Fractional Excretion of UreaIdentify a pre-renal state in patients using diureticsSequential Organ Failure Assessment (SOFA)Document clinical severity in the ICU and predict mortalityPediatric Renal Angina IndexPredict acute kidney injury in critically ill childrenSTARRT-AKI Enrollment CriteriaDetermine if patients meet criteria for the STARRT-AKI study.Kinetic eGFR (KeGFR)Estimate GFR when creatinine is changing acutely (either rising or falling)PIM2Paediatric Index of Mortality, revised versionSerious Renal Dysfunction Post-PCIAssess risk of dialysis or severe increase in creatinine after PCICRRT Dosing CalculatorCalculate desired dose of dialysate in CRRTKDIGO AKI StagingClassification in acute kidney injury (AKI)
REFERENCE BOOK
KDIGO Clinical Practice Guideline for Acute Kidney Injury
AKI Definition Prevention and Treatment of AKI Contrast-induced AKI Dialysis Interventions for Treatment of AKI
Introduction and Methodology
Introduction
IntroductionGlomerular filtration rate and serum creatinineOliguria and anuriaAcute tubular necrosis (ATN)ARFRIFLE criteriaAKI: acute kidney injury/impairmentValidation studies using RIFLELimitations to current definitions for AKIRationale for a guideline on AKISummary
Methodology
IntroductionGroup member selection and meeting processEvidence selection, appraisal, and presentationOutcome selection judgments, values, and preferencesGrading the quality of evidence and the strength of recommendationsSPONSORSHIPDISCLAIMERSUPPLEMENTARY MATERIAL
AKI Definition
Definition and classification of AKI
IntroductionDefinition of AKIStaging AKI: Recommendations and RationaleResearch RecommendationsSupplementary materialRisk assessmentIntroductionRecommendations and RationaleResearch RecommendationsSupplementary material
Evaluation and general management of patients with and at risk for AKI
IntroductionRecommendations and RationaleResearch recommendationsSupplementary material
Clinical applications
IntroductionExamples of application of AKI definitionsEstimating baseline SCrExamples of application of AKI stagesUrine output vs. SCrTimeframe for diagnosis and stagingClinical judgmentPseudo-AKIAtypical AKISupplementary material
Diagnostic approach to alterations in kidney function and structure
Definitions of AKI, CKD and AKDGFR and SCrGFR/SCr algorithmOliguria as a measure of kidney functionKidney damageSmall kidneys as a marker of kidney damageIntegrated approach to AKI, AKD, and CKDSponsorshipDisclaimerSupplementary material
Prevention and Treatment of AKI
Hemodynamic monitoring and support for prevention and management of AKI
IntroductionFluids: Recommendations and RationaleAlbumin vs. SalineHydroxyethylstarch vs. SalineVasopressors: Recommendations and RationaleProtocolized Hemodynamic Management: Recommendations and RationaleProtocolized hemodynamic management strategies in septic shockGoal-directed therapy for hemodynamic support during the perioperative period in high-risk surgical patientsResearch RecommendationsSupplementary material
General supportive management of patients with AKI, including management of complications
Overview
Glycemic control and nutritional support
Glycemic control in critical illness: Recommendations and RationaleNutritional aspects in the prevention and treatment of critically ill patients with AKITotal Energy Intake: Recommendations and RationaleProtein Intake: Recommendations and RationaleNutrition route: Recommendations and RationalePediatrics ConsiderationsResearch RecommendationsSupplementary material
The use of diuretics in AKI
IntroductionRecommendations and RationaleMannitolResearch Recommendations
Vasodilator therapy: dopamine, fenoldopam, and natriuretic peptides
Dopamine for the prevention or treatment of AKI: Recommendations and RationaleFenoldopam for the prevention or treatment of AKI: Recommendations and RationaleResearch RecommendationsNatriuretic peptides for the prevention or treatment of AKI: Recommendations and RationaleResearch RecommendationsSupplementary Material
Growth factor intervention
Recombinant Human (rh) IGF-1: Recommendations and RationaleErythropoietinResearch RecommendationsSupplementary Material
Adenosine receptor antagonists
IntroductionRecommendations and RationaleResearch Recommendations
Prevention of aminoglycoside- and amphotericin-related AKI
Aminoglycoside nephrotoxicityTreatment of Infections: Recommendations and RationalePatients with Normal Kidney Function in Steady State: Recommendations and RationaleWhen Treatment with Multiple Daily Dosing is Used for More than 24 Hours: Recommendations and RationaleWhen Treatment with Single-Daily Dosing is Used for More than 48 Hours: Recommendations and RationaleTopical or Local Applications of Aminoglycosides: Recommendations and RationaleResearch RecommendationsAmphotericin B nephrotoxicity: Recommendations and RationaleTreatment of Systemic Mycoses or Parasitic Infections: Recommendations and RationaleResearch Recommendations
Other methods of prevention of AKI in the critically ill
On-pump vs. off-pump coronary artery bypass surgery: Recommendations and RationaleResearch RecommendationsN-ACETYLCYSTEINE (NAC): Recommendations and RationaleNAC in critically ill patients: Recommendations and RationaleSponsorshipDisclaimerSupplementary Material
Contrast-induced AKI
Contrast-induced AKI: definition, epidemiology, and prognosis
BackgroundRecommendations and RationaleEpidemiology of CI-AKIPrognosis of CI-AKIResearch RecommendationsSupplementary Material
Assessment of the population at risk for CI-AKI
Recommendations and RationaleRisk-factor questionnaireUrinary protein screeningOther risk factors of CI-AKIRisk models of CI-AKIPatients at Increased Risk for CI-AKI: Recommendations and RationaleNephrotoxicity of Gd chelatesNephrogenic systemic fibrosis (NSF)Supplementary Material
Nonpharmacological prevention strategies of CI-AKI
IntroductionDose/Volume of Contrast-Media Administration: Recommendations and RationaleRoute of administration of contrast mediaResearch RecommendationsSelection of a Contrast Agent: Recommendations and RationaleHigh-osmolar vs. iso-osmolar or low-osmolar contrast mediaLow-osmolar vs. iso-osmolar contrast mediai.a. Iodixanol vs. ioxaglatei.v. AdministrationResearch RecommendationsSupplementary Material
Pharmacological prevention strategies of CI-AKI
Fluid Administration: Recommendations and RationaleUse of oral fluids alone in patients at increased risk of CI-AKI: Recommendations and RationaleRole of nac in the prevention of CI-AKI: Recommendations and RationaleTheophylline: Recommendations and RationaleFenoldopam: Recommendations and RationaleStatins in the prevention of CI-AKISupplementary Material
Effects of hemodialysis or hemofiltration
Recommendations and RationaleSponsorshipDisclaimerSupplementary material
Dialysis Interventions for Treatment of AKI
Timing of renal replacement therapy in AKI
IntroductionRecommendations and RationalePediatric considerations
Research Recommendations
Supplementary material
Criteria for stopping renal replacement therapy in AKI
IntroductionWhen to discontinue RRT: Recommendations and RationaleUse of diuretics: Recommendations and RationalePediatric considerationsResearch Recommendations
Anticoagulation
IntroductionHow to decide to use anticoagulation: Recommendations and RationalePatients without an increased bleeding risk or impaired coagulation and not already receiving effective systemic anticoagulation: Recommendations and RationalePatients with increased bleeding risk who are not receiving anticoagulation: Recommendations and RationaleIn patients with heparin-induced thrombocytopenia: Recommendations and RationalePediatric considerationsResearch RecommendationsSupplementary material
Vascular access for renal replacement therapy in AKI
IntroductionUncuffed nontunneled dialysis catheter vs a tunneled catheter: Recommendations and RationaleWhen choosing a vein for insertion of a dialysis catheter in patients with AKI: Recommendations and RationaleUsing ultrasound guidance for dialysis catheter insertion: Recommendations and RationaleObtaining a chest radiograph promptly after placement and before first use of an internal jugular or subclavian dialysis catheter: Recommendations and RationaleTopical antibiotics: Recommendations and RationaleAntibiotic locks: Recommendations and RationalePediatric considerationsResearch RecommendationsSupplementary material
Dialyzer membranes for renal replacement therapy in AKI
IntroductionRecommendations and RationaleResearch Recommendations
Modality of renal replacement therapy for patients with AKI
IntroductionComplementary therapies in AKI patients: Recommendations and RationaleHemodynamically unstable patients: Recommendations and RationaleAKI patients with acute brain injury or other causes of increased intracranial pressure or generalized brain edema: Recommendations and RationaleProtocols for decreasing hemodynamic instability with intermittent RRTPeritoneal dialysisPediatric considerationsResearch RecommendationsSupplementary material
Buffer solutions for renal replacement therapy in patients with AKI
IntroductionBuffer solution: Recommendations and RationaleDialysis fluids and replacement fluids in patients with AKI: Recommendations and RationaleResearch RecommendationsSupplementary material
Dose of renal replacement therapy in AKI
IntroductionDosing: Recommendations and RationaleKt/V and Effluent Volume Rates: Recommendations and RationaleAdditional considerationsResearch RecommendationsSponsorshipDislcaimerSupplementary material
Organization and Acknowledgements
NoticeWork Group MembershipKDIGO Board MembersReference KeysAbbreviations and AcronymsAbstractForewordBiographic and Disclosure InformationAcknowledgmentsReferences
Illness Severity
Medical ICU
Neurologic ICU
Respiratory ICU
Sepsis
Emergency
Airway
Burns
Chest Pain & Cardiac
General Medicine
ECG: Heart RateA-a GradientUsed to determine cause of hypoxemiaAnion GapCalculate anion gap for use in acid-base disorders.CHADS2 Score for AFAssess risk of stroke in atrial fibrillationCHA2DS2-VASc Score for AFReplacement for CHADS2 for stroke prediction in atrial fibrillationChild Pugh ScoreDetermine severity of cirrhosis.ECG: Corrected QTECG: Cycle LengthFractional Excretion of SodiumDifferentiate pre-renal AKI from ATN.MDRD eGFRCalculate eGFR using the MDRD formulaPrognosis after TIPSS using MELD ScoreOsmolal GapDetect unmeasured osmoles, such as toxic alcoholsPeak Expiratory Flow PredictionPneumonia risk (CURB-65)Estimate prognosis and determine disposition in community-acquired pneumoniaRanson's CriteriaEstimate mortality in patients with pancreatitis. Water Deficit in HypernatremiaDetermine water replacement in hypernatremiaCanadian Syncope Risk Score (CSRS)Estimate prognosis among patients presenting to emergency with syncopeROSIER scaleDetermine which patients are likely to have true stroke vs stroke mimicsModified Early Warning Score (MEWS)Identify patients who are at risk of clinical deterioration and who may require a higher level of care.Mean Arterial Pressure (MAP) Calculate MAPCentor Score (modified) for GAS PharyngitisEstimate likelihood of GAS pharyngitisMaintenance Fluid CalculationsDetermine maintenance IV fluid ratesOttawa chronic obstructive pulmonary disease risk scale (OCRS)Guide admission vs discharge in COPD exacerbationLight's CriteriaDetermine whether a pleural effusion is exudative or transudativeMcMahon Rhabdomyolysis Risk ScorePredict the risk of severe acute kidney injury or mortality in patients with rhabdomyolysisKocher Criteria for Septic ArthritisDetermine risk of septic arthritis in a child with an inflamed hip
Injuries & Trauma
Pediatrics ER
Psychiatry
Sepsis
Surgery
Thrombosis
Endocrinology
Dubbo Osteoporotic Fracture RiskAssess risk of osteoporotic fracture
REFERENCE BOOK
Obesity in Adults | CTFPHC
Diabetes
Electrolytes
Lipids
Thyroid cancer
Gastroenterology
Diarrhea
GI Bleed
Hepatology
Autoimmune Hepatitis DiagnosisClarify the diagnose of autoimmune hepatitisChild Pugh ScoreDetermine severity of cirrhosis.Discriminant Function (Alcoholic Hepatitis)Emory Model (TIPSS)Prognosis after TIPSS using MELD ScorePrognosis in Alcoholic HepatitisEstimates prognosis in alcoholic hepatitis using the MELD scorePELD Score - Age Younger Than 12 yearsPELD (Pediatric End-Stage Liver Disease) is used for liver allocation in the OPTN match systemAlcoholism - Risk of RelapseAlcohol Relapse Risk after Liver TransplantSerum Ascites to Albumin Gradient (SAAG)Determine if ascites due to portal hypertension.FIB-4 for Noninvasive Diagnosis of Hepatic FibrosisNon-invasively identify hepatic fibrosisAPRI (AST to Platelet Ratio Index)Assess likelihood of fibrosis or cirrhosis non-invasively using AST and platelet count.NAFLD Fibrosis ScoreReduce the need for liver biopsy by identifying patients with non-alcoholic fatty liver disease likely or unlikely to have advanced fibrosisMELD Score - Age above 12 yearsScoring system used to rank prioritize candidates for liver transplantation, including MELD-Na used in the OPTN match systemAlcohol Relapse Risk after Liver TransplantMELD Score - Age above 12 yearsScoring system used to rank prioritize candidates for liver transplantation, including MELD-Na used in the OPTN match systemPELD Score - Age Younger Than 12 yearsPELD (Pediatric End-Stage Liver Disease) is used for liver allocation in the OPTN match systemUKELD ScoreThe United Kingdom Model for End-Stage Liver Disease (UKELD) predicts prognosis in chronic liver disease and can be used to prioritize for liver transplantationLille Model for Alcoholic HepatitisEstimate mortality in patients with severe alcoholic hepatitis not responding to corticosteroid therapy BE3A ScoreWhen to treat HCV in decompensated cirrhosis
Inflammatory Bowel Disease
Pancreatitis
Geriatrics
Predicting 3 Year Survival for Incident Elderly ESRD PatientsDetermine appropriateness for transplant referral in elderly patients starting dialysis
Cardiac & Cerebrovascular
Depression
Frailty
General Medicine
Geriatric Psychiatry
Kidney Disease
Neurocognitive Disorder
Hematology
Benign Hematology
Body Surface Area
Malignant Hematology
CMML Prognostic Scoring Systems (from Spain and Dusseldorf)Assess risk of progression to AML and early mortality in CMMLDiffuse Large B-Cell Lymphoma Prognosis (R-IPI)Determine prognosis in diffuse large B-cell lymphomaFollicular Lymphoma prognosisDetermine prognosis in follicular lymphoma (FLIPI)Acute GVHD GradingDetermine severity in acute graft versus host disease.Hodgkin's Disease | PrognosisEstimate prognosis in Hodgkin's disease.Hematopoietic cell transplantation - specific comorbidity index (HCT-CI)MDS Revised - International Prognostic Scoring System (IPSS-R)Assess mortality and progression to acute myeloid leukemia in myelodysplastic syndromeHodgkin's Marrow InvolvementEstimate likelihood of bone marrow involvement in Hodgkin's lymphoma.MDS Intnl Prognostic Scoring Sys (IPSS)Multiple Myeloma Prognosis (ISS)MASCC Febrile Neutropenia RiskAssess risk in febrile neutropenia and appropriateness for outpatient managementMDS Anemia - EPO/GCSF ResponseIdentify those with MDS likely to respond to stem-cell factors.MDS WHO Classification-based Prognostic Scoring System (WPSS)Estimate survival and risk of transformation to AML in myelodysplastic syndrome.MGUS PrognosisDetermine risk of malignant progression to myleoma or lymphoproliferative disorder.MIPI - Mantle Cell Lymphoma PrognosisEstimate prognosis in mantle cell lymphoma.DIPSS Prognosis in MyelofibrosisEstimate prognosis in myelofibrosis.Smoldering Multiple Myeloma PrognosisDetermine risk of progression to symptomatic multiple myeloma.Diffuse Large B-cell Lymphoma Prognosis (IPI24)Determine prognosis in diffuse large B-cell lymphoma.Diffuse Large B-cell Lymphoma Prognosis (NCCN-IPI)Estimate prognosis in diffuse large B-cell lymphomaDIPSS Plus Score for Prognosis in MyelofibrosisEstimate prognosis in myelofibrosis.Multiple Myeloma Prognosis (R-ISS)Revised international staging system for myelomaCLL-IPIThe International Prognostic Index for patients with chronic lymphocytic leukemiaExpected spleen size Provides upper limit of normal for spleen length and volume by ultrasound relative to body height and gender. MDS Revised - International Prognostic Scoring System (IPSS-R) Non-Age AdjustedAssess mortality and progression to acute myeloid leukemia in myelodysplastic syndrome using the non-age adjusted model
Sponsored
CNS International Prognostic Index in Diffuse Large B-Cell Lymphoma (CNS-IPI)Estimate risk of CNS relapse/progression in diffuse large B-cell lymphomaMALT Lymphoma prognosis (MALT-IPI)Estimate prognosis in MALT lymphomaKhorana risk scoreEstimate risk of chemotherapy-associated thrombosisCLL BALL Score for Relapsed/Refractory CLLSokal Score for CMLEstimate survival in CMLEUTOS Score for Chronic Myelogenous Leukemia (CML)Predict outcomes after CML treatment, adjusted for tyrosine kinase treatments
Infectious Disease
MELD Score - Age above 12 yearsScoring system used to rank prioritize candidates for liver transplantation, including MELD-Na used in the OPTN match system
Antibiotic Dosing
Clostridium Difficile
Diagnostic Criteria
Febrile Neutropenia
Fever in Infants
Liver
Respiratory Tract Infection
Sepsis
Tuberculosis
Medical Administration
Medical Imaging
Mental Health
Addictions
Anxiety
Bipolar
Cognition
Depression
Hamilton Depression Rating Scale (HAM-D or HDRS)Determine severity of depressionModified SAD PERSONS ScaleAssess depression with the modified SAD PERSONS ScalePatient Health Questionnaire-9 (PHQ-9)Screening tool to assist in identifying major depressive disorderGeriatric Depression ScaleA questionnaire to screen for depression in geriatric populationsPatient Health Questionnaire-2 (PHQ-2)Ultra-brief screening for depressive disordersAltman Self-Rating Mania Scale (ASRM)5 question scale to screen and stage severity of hypomania/maniaYoung Mania Rating Scale (YMRS)11 question scale to grade the severity of maniaPatient Health Questionnaire-4 (PHQ-4)Ultra-Brief Screening for Anxiety and DepressionCAGE Questionnaire4 question screening for alcohol problemsEdinburgh Postnatal Depression Scale (EPDS)10 question screener for postpartum depressionBipolar Spectrum Diagnostic Scale (BSDS)20 question screener for bipolar spectrum diagnosisWho Five Well Being Index (WHO-5)​5 questions to measure mental well-beingInformant Questionnaire on Cognitive Decline in the Elderly (IQCODE)16 question geriatric cognitive screenerMajor Depression Inventory (MDI)12 question depression severity scalePost Traumatic Stress Disorder (PCL-C)17 question self-report for Post Traumatic Stress DisorderBrief Psychiatric Rating Scale (BPRS)18 clinical questions to assess severity of consolidated symptoms Generalized Anxiety Disorder 2 (GAD-2)Ultra-brief screening for anxiety disorders
REFERENCE BOOK
Screening for Depression | CTFPHC
Eating Disorder
Obsessive Compulsive Disorder
Pediatrics
Post Traumatic Stress
Psychosis
Psychosomatic
Nephrology
Acute Kidney Injury
APACHE IIEstimate mortality in the critically illContrast Nephropathy Post-PCIEstimate risk of AKI after percutaneous coronary interventionDialysis Risk After Cardiac Surgery (Cleveland Clinic Score by Thakar)Estimate risk of dialysis after cardiac surgery.Dialysis Risk After Cardiac Surgery (Mehta)Estimate the risk of dialysis after cardiac surgery (Mehta model)Fractional Excretion of SodiumDifferentiate pre-renal AKI from ATN.Fractional Excretion of UreaIdentify a pre-renal state in patients using diureticsSequential Organ Failure Assessment (SOFA)Document clinical severity in the ICU and predict mortalityPediatric Renal Angina IndexPredict acute kidney injury in critically ill childrenSTARRT-AKI Enrollment CriteriaDetermine if patients meet criteria for the STARRT-AKI study.Kinetic eGFR (KeGFR)Estimate GFR when creatinine is changing acutely (either rising or falling)PIM2Paediatric Index of Mortality, revised versionSerious Renal Dysfunction Post-PCIAssess risk of dialysis or severe increase in creatinine after PCICRRT Dosing CalculatorCalculate desired dose of dialysate in CRRTNCDR AKI and Dialysis Risk after PCIEstimate risk of AKI and dialysis after PCIAdvanced CKD after AKI Risk IndexEstimate risk of advanced chronic kidney disease after acute kidney injuryMayo AKI Risk after Primary Total Hip ArthroplastyEstimate perioperative risk of acute kidney injuryNSAID risk of AKI or hyperkalemiaCalculator to predict risk of AKI or hyperkalemia within 30 days after initiation of prescription NSAIDs in adults 66 years and older.McMahon Rhabdomyolysis Risk ScorePredict the risk of severe acute kidney injury or mortality in patients with rhabdomyolysisKDIGO AKI StagingClassification in acute kidney injury (AKI)
REFERENCE BOOK
KDIGO Clinical Practice Guideline for Acute Kidney Injury
AKI Definition Prevention and Treatment of AKI Contrast-induced AKI Dialysis Interventions for Treatment of AKI
Introduction and Methodology
Introduction
IntroductionGlomerular filtration rate and serum creatinineOliguria and anuriaAcute tubular necrosis (ATN)ARFRIFLE criteriaAKI: acute kidney injury/impairmentValidation studies using RIFLELimitations to current definitions for AKIRationale for a guideline on AKISummary
Methodology
IntroductionGroup member selection and meeting processEvidence selection, appraisal, and presentationOutcome selection judgments, values, and preferencesGrading the quality of evidence and the strength of recommendationsSPONSORSHIPDISCLAIMERSUPPLEMENTARY MATERIAL
AKI Definition
Definition and classification of AKI
IntroductionDefinition of AKIStaging AKI: Recommendations and RationaleResearch RecommendationsSupplementary materialRisk assessmentIntroductionRecommendations and RationaleResearch RecommendationsSupplementary material
Evaluation and general management of patients with and at risk for AKI
IntroductionRecommendations and RationaleResearch recommendationsSupplementary material
Clinical applications
IntroductionExamples of application of AKI definitionsEstimating baseline SCrExamples of application of AKI stagesUrine output vs. SCrTimeframe for diagnosis and stagingClinical judgmentPseudo-AKIAtypical AKISupplementary material
Diagnostic approach to alterations in kidney function and structure
Definitions of AKI, CKD and AKDGFR and SCrGFR/SCr algorithmOliguria as a measure of kidney functionKidney damageSmall kidneys as a marker of kidney damageIntegrated approach to AKI, AKD, and CKDSponsorshipDisclaimerSupplementary material
Prevention and Treatment of AKI
Hemodynamic monitoring and support for prevention and management of AKI
IntroductionFluids: Recommendations and RationaleAlbumin vs. SalineHydroxyethylstarch vs. SalineVasopressors: Recommendations and RationaleProtocolized Hemodynamic Management: Recommendations and RationaleProtocolized hemodynamic management strategies in septic shockGoal-directed therapy for hemodynamic support during the perioperative period in high-risk surgical patientsResearch RecommendationsSupplementary material
General supportive management of patients with AKI, including management of complications
Overview
Glycemic control and nutritional support
Glycemic control in critical illness: Recommendations and RationaleNutritional aspects in the prevention and treatment of critically ill patients with AKITotal Energy Intake: Recommendations and RationaleProtein Intake: Recommendations and RationaleNutrition route: Recommendations and RationalePediatrics ConsiderationsResearch RecommendationsSupplementary material
The use of diuretics in AKI
IntroductionRecommendations and RationaleMannitolResearch Recommendations
Vasodilator therapy: dopamine, fenoldopam, and natriuretic peptides
Dopamine for the prevention or treatment of AKI: Recommendations and RationaleFenoldopam for the prevention or treatment of AKI: Recommendations and RationaleResearch RecommendationsNatriuretic peptides for the prevention or treatment of AKI: Recommendations and RationaleResearch RecommendationsSupplementary Material
Growth factor intervention
Recombinant Human (rh) IGF-1: Recommendations and RationaleErythropoietinResearch RecommendationsSupplementary Material
Adenosine receptor antagonists
IntroductionRecommendations and RationaleResearch Recommendations
Prevention of aminoglycoside- and amphotericin-related AKI
Aminoglycoside nephrotoxicityTreatment of Infections: Recommendations and RationalePatients with Normal Kidney Function in Steady State: Recommendations and RationaleWhen Treatment with Multiple Daily Dosing is Used for More than 24 Hours: Recommendations and RationaleWhen Treatment with Single-Daily Dosing is Used for More than 48 Hours: Recommendations and RationaleTopical or Local Applications of Aminoglycosides: Recommendations and RationaleResearch RecommendationsAmphotericin B nephrotoxicity: Recommendations and RationaleTreatment of Systemic Mycoses or Parasitic Infections: Recommendations and RationaleResearch Recommendations
Other methods of prevention of AKI in the critically ill
On-pump vs. off-pump coronary artery bypass surgery: Recommendations and RationaleResearch RecommendationsN-ACETYLCYSTEINE (NAC): Recommendations and RationaleNAC in critically ill patients: Recommendations and RationaleSponsorshipDisclaimerSupplementary Material
Contrast-induced AKI
Contrast-induced AKI: definition, epidemiology, and prognosis
BackgroundRecommendations and RationaleEpidemiology of CI-AKIPrognosis of CI-AKIResearch RecommendationsSupplementary Material
Assessment of the population at risk for CI-AKI
Recommendations and RationaleRisk-factor questionnaireUrinary protein screeningOther risk factors of CI-AKIRisk models of CI-AKIPatients at Increased Risk for CI-AKI: Recommendations and RationaleNephrotoxicity of Gd chelatesNephrogenic systemic fibrosis (NSF)Supplementary Material
Nonpharmacological prevention strategies of CI-AKI
IntroductionDose/Volume of Contrast-Media Administration: Recommendations and RationaleRoute of administration of contrast mediaResearch RecommendationsSelection of a Contrast Agent: Recommendations and RationaleHigh-osmolar vs. iso-osmolar or low-osmolar contrast mediaLow-osmolar vs. iso-osmolar contrast mediai.a. Iodixanol vs. ioxaglatei.v. AdministrationResearch RecommendationsSupplementary Material
Pharmacological prevention strategies of CI-AKI
Fluid Administration: Recommendations and RationaleUse of oral fluids alone in patients at increased risk of CI-AKI: Recommendations and RationaleRole of nac in the prevention of CI-AKI: Recommendations and RationaleTheophylline: Recommendations and RationaleFenoldopam: Recommendations and RationaleStatins in the prevention of CI-AKISupplementary Material
Effects of hemodialysis or hemofiltration
Recommendations and RationaleSponsorshipDisclaimerSupplementary material
Dialysis Interventions for Treatment of AKI
Timing of renal replacement therapy in AKI
IntroductionRecommendations and RationalePediatric considerations
Research Recommendations
Supplementary material
Criteria for stopping renal replacement therapy in AKI
IntroductionWhen to discontinue RRT: Recommendations and RationaleUse of diuretics: Recommendations and RationalePediatric considerationsResearch Recommendations
Anticoagulation
IntroductionHow to decide to use anticoagulation: Recommendations and RationalePatients without an increased bleeding risk or impaired coagulation and not already receiving effective systemic anticoagulation: Recommendations and RationalePatients with increased bleeding risk who are not receiving anticoagulation: Recommendations and RationaleIn patients with heparin-induced thrombocytopenia: Recommendations and RationalePediatric considerationsResearch RecommendationsSupplementary material
Vascular access for renal replacement therapy in AKI
IntroductionUncuffed nontunneled dialysis catheter vs a tunneled catheter: Recommendations and RationaleWhen choosing a vein for insertion of a dialysis catheter in patients with AKI: Recommendations and RationaleUsing ultrasound guidance for dialysis catheter insertion: Recommendations and RationaleObtaining a chest radiograph promptly after placement and before first use of an internal jugular or subclavian dialysis catheter: Recommendations and RationaleTopical antibiotics: Recommendations and RationaleAntibiotic locks: Recommendations and RationalePediatric considerationsResearch RecommendationsSupplementary material
Dialyzer membranes for renal replacement therapy in AKI
IntroductionRecommendations and RationaleResearch Recommendations
Modality of renal replacement therapy for patients with AKI
IntroductionComplementary therapies in AKI patients: Recommendations and RationaleHemodynamically unstable patients: Recommendations and RationaleAKI patients with acute brain injury or other causes of increased intracranial pressure or generalized brain edema: Recommendations and RationaleProtocols for decreasing hemodynamic instability with intermittent RRTPeritoneal dialysisPediatric considerationsResearch RecommendationsSupplementary material
Buffer solutions for renal replacement therapy in patients with AKI
IntroductionBuffer solution: Recommendations and RationaleDialysis fluids and replacement fluids in patients with AKI: Recommendations and RationaleResearch RecommendationsSupplementary material
Dose of renal replacement therapy in AKI
IntroductionDosing: Recommendations and RationaleKt/V and Effluent Volume Rates: Recommendations and RationaleAdditional considerationsResearch RecommendationsSponsorshipDislcaimerSupplementary material
Organization and Acknowledgements
NoticeWork Group MembershipKDIGO Board MembersReference KeysAbbreviations and AcronymsAbstractForewordBiographic and Disclosure InformationAcknowledgmentsReferences
Chronic Kidney Disease
Fluids & Electrolytes
Glomerulonephritis
Hemodialysis
Hypertension
Nephrolithiasis
PD
PD Candidacy (MATCH-D)Assess candidacy for peritoneal dialysis3-Month Mortality in Incident Elderly ESRD PatientsEstimate the risk of early death (at 3 months) in elderly patients starting dialysis.Predicting 3 Year Survival for Incident Elderly ESRD PatientsDetermine appropriateness for transplant referral in elderly patients starting dialysisPredicting 3 Year Survival for Incident Elderly ESRD PatientsDetermine appropriateness for transplant referral in elderly patients starting dialysis
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Access Care and Complications Management
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OverviewDisclaimer & Use of the Guide
Catheter Insertion and Care
Preoperative Management
IntroductionKey AssessmentsKey ActivitiesPatient EducationOutcomes Evaluation
Perioperative and Intraoperative Management
IntroductionKey AssessmentsKey ActivitiesPatient EducationOutcomes Evaluation
Postoperative Management
IntroductionKey AssessmentsKey ActivitiesPatient EducationOutcomes Evaluation
Chronic Care of Peritoneal Dialysis Catheter
IntroductionKey AssessmentsKey ActivitiesPatient EducationOutcomes EvaluationReferences
Noninfectious Complications
Pericatheter and Subcutaneous Leaks
IntroductionKey AssessmentsKey ActivitiesPatient EducationOutcomes EvaluationManagementReferences
Peritoneal Catheter Obstruction
IntroductionKey AssessmentsKey ActivitiesPatient EducationOutcomes EvaluationReferences
Hernia
IntroductionKey AssessmentsKey ActivitiesPatient EducationOutcomes EvaluationReferences
Abdominal Discomfort During Infusion and Drain
Key AssessmentsKey ActivitiesPatient EducationOutcomes EvaluationReferences
Pneumoperitoneum (Shoulder Pain)
IntroductionKey AssessmentsKey ActivitiesPatient EducationOutcomes EvaluationReferences
Hemoperitoneum
IntroductionKey AssessmentsKey ActivitiesPatient EducationOutcomes EvaluationReferences
Hydrothorax
IntroductionKey AssessmentsKey ActivitiesPatient EducationOutcomes EvaluationReferences
Catheter Adapter Disconnect or Fracture of Peritoneal Catheter
Key AssessmentsKey ActivitiesPatient EducationOutcomes EvaluationReferences
Infectious Complications: Peritonitis Management
Initial Empiric Management of Peritonitis
IntroductionKey AssessmentsKey ActivitiesPatient EducationOutcomes EvaluationInitial Empiric Management of PeritonitisStaphyloccocus aureus PeritonitisEnterococcus PeritonitisStreptococcus PeritonitisPseudomonas aeruginosa PeritonitisGram-negative Bacilli Organism PeritonitisPolymicrobial PeritonitisCulture-negative PeritonitisFungal PeritonitisMycobacterium PeritonitisPeritonitis TerminologyCoagulase-negative StaphylococciRelapsing and Repeat PeritonitisReferencesDisclaimer
Infectious Complications: Management of the Exit-site/Tunnel Infection
Introduction
IntroductionKey AssessmentsKey ActivitiesPatient EducationOutcomes EvaluationDiagnosis and Management of Exit-site/Tunnel InfectionReferencesDisclaimer
Antibiotic Dosing Guidelines
Oral Antibiotics Used in Exit-site and Tunnel InfectionsExit-site Antibiotic ProphylaxisIntraperitoneal Antibiotic Dosing Recommendations for CAPD PatientsIntermittent Dosing of Antibiotics in Automated Peritoneal Dialysis (APD)References
Surgical Salvage Procedures for Infectious Complications
Simultaneous Catheter Replacement for Relapsing Peritonitis
Key AssessmentsKey ActivitiesPatient EducationOutcomes Evaluation
Exit-Site and Tunnel Infections
Key AssessmentsKey ActivitiesPatient EducationOutcomes EvaluationReferences
Appendix
Preoperative and Postoperative PD Catheter Insertion Instructions for PatientsPeritoneal ImagingPrinciples of Accurate Peritoneal Dialysis Effluent Sampling and CulturingPeritoneal Effluent Culture Laboratory ProcessingPeritonitis Rate CalculationsDifferential Diagnosis of Non-infectious Cloudy EffluentProviding for a Safe Environment for Peritoneal DialysisNormal Bacterial Flora of the Human Body
Preoperative Mapping
IntroductionPreoperative Mapping Using a Catheter SampleStencil-Based Preoperative MappingPreoperative Mapping for Upper Abdominal and Presternal CathetersProcedure Day MappingReferencesCalculating Peritonitis Rates: An ExampleAuthor AffiliationsAccess Care and Complications Management   link ⇲
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CSN PD Adequacy Guidelines and Recommendations 2011
Maintenance of RRF
Measurement of RRFUse of Antihypertensive Agents and Diuretis to Preserve RRF
Small-Solute Clearance
Prescription and Targets
Volume Management
Maintenance of Euvolemia and Diagnosis of HypervolemiaTreatment of HypervolemiaAssessment and Management of BP
Management of CV Disease in PD Patients
Dyslipidemia
Nutrition in PD
NutritionNutritional SupplementsCorrection of Impared Anabolism, Acidosis, and Gastroparesis
Management of Hyperglycemia
Glycemic ControlGlucose-Sparing Strategies
Introduction
OverviewMethods and Process for Guideline DevelopmentFigure 1Figure 2Figure 3
Maintenance of RRF
Measurement of RRF
Overview
Use of Antihypertensive Agents and Diuretics to Preserve RRF
OverviewBackground
Research
Overview
Small-Solute Clearance
Prescriptions and Targets
OverviewBackground
Volume Management
Maintenance of Euvolemia and Diagnosis of Hypervolemia
OverviewBackground
Treatment of Hypervolemia
OverviewBackground
Assessment and Management of BP
OverviewBackground
Management of CV Disease in PD Patients
Dyslipidemia
OverviewBackground
Coronary Artery Disease/Chronic Heart Failure
Overview
Research
Overview
Nutrition in PD
Nutrition
OverviewBackground
Nutritional Supplements
OverviewBackground
Correction of Impaired Anabolism, Acidosis, and Gastroparesis
OverviewBackground
Research
Overview
Management of Hyperglycemia
Glycemic Control
OverviewBackground
Glucose-Sparing Strategies
OverviewBackgroundDisclosuresReferences
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PD Prescription Quick Reference Guide
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PD Prescription Management Guide
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CNS International Prognostic Index in Diffuse Large B-Cell Lymphoma (CNS-IPI)Estimate risk of CNS relapse/progression in diffuse large B-cell lymphomaMALT Lymphoma prognosis (MALT-IPI)Estimate prognosis in MALT lymphomaKhorana risk scoreEstimate risk of chemotherapy-associated thrombosisCLL BALL Score for Relapsed/Refractory CLLSokal Score for CMLEstimate survival in CMLEUTOS Score for Chronic Myelogenous Leukemia (CML)Predict outcomes after CML treatment, adjusted for tyrosine kinase treatments
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Carboplatin AUC Dosing (Calvert)Prognosis in Renal Cell Carcinoma (UISS)Estimate survival in renal cell carcinomaBrain Metastases Prognostic IndexEstimate prognosis in patients with brain metastases using the graded prognostic assessmentSerious Illness Conversation GuideSteps to elicit important information from your patients about their goals and valuesKhorana risk scoreEstimate risk of chemotherapy-associated thrombosisTNM Staging for Lung Cancer (AJCC 2017)Classify lung cancer using the TNM staging system
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Screening for Breast Cancer | CTFPHC
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Screening for Colorectal Cancer | CTFPHC
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Screening for Lung Cancer | CTFPHC
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Screening for Prostate Cancer | CTFPHC
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Screening for Cervical Cancer | CTFPHC
Orthopedics
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APGARNewborn assessmentSNAP-IV 26 - Teacher & Parent Rating ScaleAssess children for attention deficit hyperactivity disorder (ADHD)Pediatric Endotracheal Tube SizePediatric Glasgow Coma ScalePediatric Strep ScorePELD Score - Age Younger Than 12 yearsPELD (Pediatric End-Stage Liver Disease) is used for liver allocation in the OPTN match systemWestley Croup ScoreAssess croup severityPIM2Paediatric Index of Mortality, revised versionPCDAIPediatric Crohn's Disease Activity IndexPELD Score - Age Younger Than 12 yearsPELD (Pediatric End-Stage Liver Disease) is used for liver allocation in the OPTN match systemCentor Score (modified) for GAS PharyngitisEstimate likelihood of GAS pharyngitisPhiladelphia Criteria in Febrile Infants Identify febrile infants aged 29 – 56 days old who are lower risk for serious bacterial infection Boston Criteria for Febrile InfantsIdentify febrile infants aged 28 – 89 days old who are lower risk for serious bacterial infection Rochester Criteria for Febrile InfantsIdentify febrile infants aged ≤ 60 days old who are low-risk for serious bacterial infectionPECARN Rule for Pediatric Head Injury < 2 years oldAssess the need for neuroimaging in pediatric head trauma PECARN Rule for Pediatric Head Injury ≥ 2 years oldAssess the need for neuroimaging in pediatric head trauma PRAM Score for Pediatric Asthma Exacerbation SeverityAssess asthma severity in pediatric patientsKocher Criteria for Septic ArthritisDetermine risk of septic arthritis in a child with an inflamed hipAlberta Croup Severity
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Tobacco Smoking in Children and Adolescents | CTFPHC
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Screening for Developmental Delay | CTFPHCReview Canadian Task Force on Preventive Health Care guideline on screening for developmental delay
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Obesity in Children | CTFPHC
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Diagnosis and Management of Congenital Diaphragmatic Hernia (CDH): A Clinical Practice Guideline
Physical Medicine and Rehabilitation
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ACC/AHA CV Risk Calculator (2013)Estimate 10-year risk for atherosclerotic cardiovascular disease
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Screening for Type 2 Diabetes | CTFPHC
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Tobacco Smoking in Children and Adolescents | CTFPHC
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Screening for Colorectal Cancer | CTFPHC
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Screening for Cognitive Impairment | CTFPHC
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Screening for Depression | CTFPHC
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Screening for Developmental Delay | CTFPHCReview Canadian Task Force on Preventive Health Care guideline on screening for developmental delay
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Screening for Lung Cancer | CTFPHC
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Obesity in Adults | CTFPHC
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Obesity in Children | CTFPHC
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Pelvic Exam | CTFPHC
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Screening for Prostate Cancer | CTFPHC
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Screening for Hepatitis C | CTFPHCReview Canadian Task Force on Preventive Health Care guideline on Hepatitis C screening
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Screening for Abdominal Aortic Aneurysm | CTFPHC
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Impaired Vision | CTFPHC
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Screening for Asymptomatic Bacteriuria in Pregnancy | CTFPHC
Respirology
Asthma & COPD
DVT/PE
General Respirology
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Renal Graft Failure at 5-Years, Predicted 1 Year Post TransplantEstimate the risk of kidney transplant graft failure at 5 yearsRenal Graft Failure at 5-Years, Predicted 7 Days Post TransplantEstimate the risk of kidney transplant graft failure at 5 yearsRenal Graft Failure at 5-Years, Predicted at Time of TransplantEstimate the risk of kidney transplant graft failure at 5 yearsPELD Score - Age Younger Than 12 yearsPELD (Pediatric End-Stage Liver Disease) is used for liver allocation in the OPTN match systemAlcohol Relapse Risk after Liver TransplantGupta Perioperative Cardiac RiskDetermine peri-operative risk for a wide array of surgeries.Postoperative Respiratory Failure Risk CalculatorEstimate risk of postoperative respiratory failurePredicting 3 Year Survival for Incident Elderly ESRD PatientsDetermine appropriateness for transplant referral in elderly patients starting dialysisMELD Score - Age above 12 yearsScoring system used to rank prioritize candidates for liver transplantation, including MELD-Na used in the OPTN match systemAlcohol Relapse Risk after Liver TransplantMELD Score - Age above 12 yearsScoring system used to rank prioritize candidates for liver transplantation, including MELD-Na used in the OPTN match systemPELD Score - Age Younger Than 12 yearsPELD (Pediatric End-Stage Liver Disease) is used for liver allocation in the OPTN match systemPredicting 3 Year Survival for Incident Elderly ESRD PatientsDetermine appropriateness for transplant referral in elderly patients starting dialysisRenal Graft Failure at 5-Years, Predicted 1 Year Post TransplantEstimate the risk of kidney transplant graft failure at 5 yearsRenal Graft Failure at 5-Years, Predicted 7 Days Post TransplantEstimate the risk of kidney transplant graft failure at 5 yearsRenal Graft Failure at 5-Years, Predicted at Time of TransplantEstimate the risk of kidney transplant graft failure at 5 yearsUKELD ScoreThe United Kingdom Model for End-Stage Liver Disease (UKELD) predicts prognosis in chronic liver disease and can be used to prioritize for liver transplantation
Urology
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Preoperative Assessment
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WHO Surgical Safety Checklist
Vascular Surgery
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WHO Surgical Safety Checklist
REFERENCE BOOK

KDIGO Clinical Practice Guideline for Acute Kidney Injury
Natriuretic peptides for the prevention or treatment of AKI: Recommendations and Rationale

Natriuretic peptides for the prevention or treatment of AKI

Several natriuretic peptides are in clinical use or in development for treatment of congestive heart failure (CHF) or renal dysfunction, and could potentially be useful to prevent or treat AKI.

Atrial natriuretic peptide (ANP) is a 28-amino-acid peptide with diuretic, natriuretic, and vasodilatory activity.224 ANP is mainly produced in atrial myocytes, and the rate of release from the atrium increases in response to atrial stretch.225 Early animal studies showed that ANP decreases preglomerular vascular resistance and increases postglomerular vascular resistance, leading to increased GFR.226 It also inhibits renal tubular sodium reabsorption. Increases in GFR and diuresis have also been confirmed in clinical studies.227 It could thus be expected that ANP might be useful for treatment of AKI, and several RCTs have been conducted to test this hypothesis.


  • 3.5.3: We suggest not using atrial natriuretic peptide(ANP) to prevent (2C) or treat (2B) AKI.
Rationale

There have been several negative studies of prophylactic ANP therapy; for example, ANP failed in two studies to prevent primary renal transplant dysfunction228,229 and ANP prophylaxis also failed to prevent CI-AKI.230 Based on the positive results of small clinical studies using ANP to treat AKI, a randomized placebo-controlled trial in 504 critically ill patients with AKI was conducted.231 Patients received 24-hour i.v. infusion of either ANP (0.2 µg/kg/min) or placebo. The primary outcome was dialysis-free survival for 21 days after treatment. Despite the large size of the trial, ANP administration had no effect on 21-day dialysis-free survival, mortality, or change in plasma creatinine concentration. Of note, the mean SCr at enrollment (anaritide group: 4.4 mg/dl [389 µmol/l]; placebo group: 5.0 mg/dl [442 µmol/l]) in this study confirms that intervention in this trial was extremely late in the course of AKI. In subgroup analysis, dialysis-free survival was higher in the treatment group for patients with oliguria ( < 400 ml/d; ANP 27%, placebo 7%, P = 0.008). A subsequent trial in 222 patients with oliguric renal failure, however, failed to demonstrate any benefit of ANP.232 The dose and duration of ANP treatment and primary outcome were the same as the previous study. The dose of ANP might have been too high (0.2 µg/kg/min) in both studies: hypotension (systolic blood pressure < 90mm Hg) occurred more frequently in the ANP groups of both trials (in the first study, 46% vs. 18%, P < 0.001; and in the second study, 97% vs. 58%, P < 0.001), and this may have negated any potential benefit of renal vasodilation in these patients. In addition to an excessive dose, the failure of these large studies has also been attributed in subsequent analyses to the late initiation of the drug to patients with severe AKI and an inadequate duration of infusion (only 24 hours).

A promising, but underpowered, study of ANP to treat AKI immediately following cardiac surgery showed a decreased rate of postoperative RRT compared to placebotreated patients.233 In this study, Sward et al. randomized 61 patients with AKI following cardiac surgery (defined as a SCr increase ≥ 50% from a baseline < 1.8 mg/dl [< 159 µmol/l]) to receive infusion of ANP or placebo until the SCr decreased below the baseline value at enrollment, the patient died, or one of four prespecified dialysis criteria was reached. Of note, all patients received infusions of furosemide (20–40 mg/h) and oliguria, defined as a urine output ≤ 0.5 ml/kg/h for 3 hours, was an exclusion criterion and an automatic dialysis indication. The primary end-point was the rate of dialysis within 21 days of enrollment. CrCl was significantly higher on the third study day in ANP-treated subjects (P = 0.04). Using prespecified dialysis criteria, 21% of patients in the ANP group and 47% in the placebo group were dialyzed within 21 days (hazard ratio [HR] 0.28; 95% CI 0.10–0.73; P = 0.009). The combined secondary end-point of death-ordialysis was similarly improved in the ANP group (28%) compared to placebo (57%; HR 0.35; 95% CI 0.14–0.82; P = 0.017). The incidence of hypotension during the first 24 hours was 59% in the ANP group and 52% in controls (P = NS).

It is intriguing to speculate on the potential reasons for the positive outcome of this trial, compared to larger prior studies of ANP for AKI prevention and therapy. Apart from the possibility that this is a false-positive, underpowered study, possible explanations include the use of ANP earlier in the course of AKI (the mean SCr in the prior ANP studies was much higher), and at lower doses (50 ng/kg/min vs. 200 ng/kg/min) that avoided the significant rate of hypotension observed in prior trials. The use of prespecified dialysis criteria was another strength of this trial. More recently, Sward et al.,234 compared the renal hemodynamic effects of ANP and furosemide in 19 mechanically ventilated post–cardiac surgery patients with normal renal function, measuring renal blood flow, GFR, and renal oxygen extraction. ANP infusion (25–50 ng/kg/min) increased GFR, filtration fraction, fractional excretion of sodium, and urine output, accompanied by a 9% increase in tubular sodium absorption and a 26% increase in renal oxygen consumption. Furosemide infusion (0.5 mg/kg/h) increased urine output 10-fold and fractional excretion of sodium 15-fold, while decreasing tubular sodium absorption by 28% and lowering renal oxygen consumption by 23%. Furosemide also lowered GFR by 12% and filtration fraction by 7%. Thus, although the balance of renal hemodynamic and tubular effects of the two drugs appears to favor furosemide for improving renal oxygen delivery-consumption balance, ANP is more likely to acutely improve GFR. One might speculate that the use of furosemide infusion in all of the subjects in the successful ANP trial may have provided an important protection against renal ischemia by reducing tubular sodium absorption and associated oxygen consumption, despite an increase in GFR in the ANP group. A larger prospective trial of ANP to improve dialysis-free survival in this setting is required, perhaps with and without furosemide infusion.

Pooled analysis of 11 studies involving 818 participants in the prevention cohort showed a trend toward reduction in the need for RRT in the ANP group (OR 0.45; 95% CI 0.21–0.99; P = 0.05). Restricting the analysis to studies that used low-dose ANP preparations did not change the overall effect for this outcome. There was no significant difference noted between the ANP and control groups for mortality in the prevention category (OR 0.67; 95% CI 0.19–2.35; P = 0.53), and this effect was unchanged by restricting the analysis to studies that used low-dose ANP preparations. However, these studies were generally of poor quality, several without reported baseline SCr values or clear definitions of AKI or RRT indications (Suppl Tables 10 and 11), and only one was of adequate quality.

Nigwekar et al., recently conducted a systematic review and meta-analysis of ANP for management of AKI.235 They found 19 relevant studies, among which 11 studies were for prevention and eight were for treatment of AKI. Pooled analysis of the eight treatment studies, involving 1043 participants, did not show significant difference for RRT requirement between the ANP and control groups (OR 0.59; 95% CI 0.32–1.08; P = 0.12). There was also no significant difference for mortality (OR 1.01; 95% CI 0.72–1.43; P = 0.89). However, low-dose ANP preparations were associated with significant reduction in RRT requirement (OR 0.34; 95% CI 0.12–0.96; P = 0.04). The incidence of hypotension was not different between the ANP and control groups for low-dose studies (OR 1.55; 95% CI 0.84–2.87), whereas it was significantly higher in the ANP group in the high-dose ANP studies (OR 4.13; 95% CI 1.38–12.41). Finally, a pooled analysis of studies that examined oliguric AKI did not show any significant benefit from ANP for RRT requirement (OR 0.46; 95% CI 0.19–1.12; P = 0.09) or mortality (OR 0.94; 95% CI 0.62–1.43; P = 0.79). Only two of the treatment studies included in the Nigwekar analysis 231,232 were of adequate size and quality to meet the criteria for our systematic review (Suppl Tables 12 and 13), which found no significant inconsistencies in the findings of both trials that (combined) included 720 subjects (351 treated with ANP) (Suppl Table 12). Thus, although subset analyses separating low-dose from high-dose ANP trials suggest potential benefits, the preponderance of the literature suggests no benefit of ANP therapy for AKI. Therefore, the Work Group suggests that these agents not be used to prevent or treat AKI. This conclusion is based on placing a high value on avoiding potential hypotension and harm associated with the use of a vasodilator in high-risk perioperative and ICU patients, and a low value on potential benefit which is supported by relatively low-quality evidence from retrospective subset analyses from negative multicenter trials.

Urodilatin is another natriuretic peptide that is produced by renal tubular cells, and was found to have the same renal hemodynamic effect as ANP without systemic hypotensive effects.236 Limited data suggest that urodilatin improves the course of established postoperative AKI.237 Fifty-one patients who received orthotopic heart transplants received urodilatin (6–20 ng/kg/min) up to 96 hours postoperatively. AKI occurred in 6% of these patients, compared to 20% in a historical control group that did not receive urodilatin.237 However, in another small, placebo-controlled study of 24 patients who underwent orthotopic heart transplants, the incidence of AKI was unchanged,238 although duration of hemofiltration (HF) was significantly shorter and the frequency of intermittent hemodialysis (IHD) less in those who received urodilatin. Taken together, these data suggest that natriuretic peptides may have a role in the therapy of early AKI following cardiac surgery, but further prospective trials are needed to confirm this potential indication.

Nesiritide (brain natriuretic peptide) is the latest natriuretic peptide introduced for clinical use, and is approved by the Food and Drug Administration (FDA) only for the therapy of acute, decompensated CHF. Meta-analysis of outcome data from these and some other nesiritide CHF trials has generated some controversy.239-241 Sackner-Bernstein et al.,239 analyzed mortality data from 12 randomized trials; in three trials that provided 30-day mortality data, they found a trend towards an increased risk of death in nesiritidetreated subjects. In another meta-analysis of five randomized trials that included 1269 subjects,240 the same investigators also found that there was a relationship between nesiritide use and worsening renal function, defined as a SCr increase > 0.5 mg/dl ( > 44.2 µmol/l). Nesiritide doses ≤ 0.03 µg/kg/min significantly increased the risk of renal dysfunction compared to non–inotrope-based controls or compared to all control groups (including inotropes). Even at doses ≤ 0.015 µg/kg/min, nesiritide was associated with increased renal dysfunction compared to controls. There was no difference in dialysis rates between the groups. Another retrospective study determined independent risk factors for 60-day mortality by multivariate analysis in a cohort of 682 elderly heart-failure patients treated with nesiritide vs. those who were not.242 When patients were stratified according to nesiritide usage, AKI emerged as an independent risk factor for mortality only among patients who received the drug. Strikingly, among these heart-failure patients who developed AKI, nesiritide usage emerged as the only independent predictor of mortality.

The manufacturers of nesiritide convened an expert panel, which concluded that further trial data are needed to discern the effects of nesiritide therapy on renal function and survival in patients with decompensated CHF. The panel also reemphasized that the indication for nesiritide therapy is acute decompensated CHF, not chronic intermittent therapy or other uses, and in particular noted that the drug should not be used to improve renal function or in place of diuretic therapy in CHF patients, as there is no proof of the utility of the drug for these purposes. A 7000-patient multicenter RCT in acute decompensated heart failure is currently in progress to determine the clinical effectiveness of nesiritide therapy for acute decompensated heart failure (the Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart Failure; Clinicaltrials.gov identifier NCT00475852). Meanwhile, nesiritide is approved for treatment of symptomatic acute decompensated heart failure.

Uncontrolled studies using nesiritide for cardiovascular support of patients with CHF undergoing cardiac surgery have suggested beneficial effects on renal function. Mentzer et al.,243 conducted a 303-patient, multicenter, randomized, double-blind trial of a 24- to 96-hour infusion of 0.01 µg/kg/ min of nesiritide vs. placebo in patients with chronic left ventricular dysfunction (ejection fraction ≤ 40%) undergoing cardiac surgery using cardiopulmonary bypass. The Nesiritide Administered Peri-Anesthesia in Patients Undergoing Cardiac Surgery trial was an exploratory, safetyoriented study with five primary end-points, including three renal end-points and two hemodynamic end-points. There were no significant differences between the groups in baseline patient characteristics; SCr values were ~1.1 mg/dl (97.2 µmol/l), with eGFR ~80 ml/min per 1.73 m2. The mean duration of study drug infusion was ~40 hours in both groups. Perioperative renal function quantified by the three renal primary end-points was better in the nesiritide group (peak SCr increase of 0.15 mg/dl [13.3 µmol/l] vs. placebo group 0.34 mg/dl [30.1 µmol/l]; P < 0.001; eGFR decrease of -10.2 ml/min per 1.73 m2 vs. placebo -17.8 ml/ min per 1.73 m2, P = 0.001; initial 24-hour urinary output 2.9 ± 1.2 l vs. placebo 2.3 ± 1 l; P < 0.001). The RR of AKI in the nesiritide group compared to placebo was 0.58 (0.27–1.21); the 180-day mortality was also reduced in the nesiritide group (RR 0.48 [0.22–1.05]; P = 0.046) (Suppl Table 9). These trends were more pronounced in the small, 62-patient subset with preoperative SCr values > 1.2 mg/dl ( > 106 µmol/l). Although SCr increased postoperatively in both groups, it returned to baseline within 12 hours in the nesiritide group, and remained elevated throughout hospitalization in the placebo group. Use of vasoactive drugs and hemodynamic parameters did not differ significantly between the groups. Adverse events also were similar between the groups, as was 30-day and 180-day mortality (although capture of mortality data was incomplete). Thus, it appears that administration of nesiritide infusion during and after cardiac surgery with cardiopulmonary bypass in patients with preoperative left ventricular dysfunction has favorable short-term effects on renal function, with short-term adverse effects comparable to placebo infusion; however, as mentioned earlier, this is not an FDA-approved indication for this drug. It is interesting to speculate that, based upon these results, any renoprotective effect of this vasoactive drug during and after cardiopulmonary bypass is not mediated by effects on systemic perfusion (similar in both groups), but rather suggesting an effect on regional perfusion or a pleiotropic phenomenon. Unfortunately, these promising pilot study findings have not been followed up with a confirmatory prospective clinical trial.

A prospective, randomized clinical trial (the Nesiritide Study), found no benefit of nesiritide for 21-day dialysis and/ or death in patients undergoing high-risk cardiovascular surgery.244 However, the study did demonstrate that the prophylactic use of nesiritide was associated with reduced incidence of AKI, the latter defined by the AKIN Group, in the immediate postoperative period (nesiritide 6.6% vs. placebo 28.5%, P = 0.004). Recently, Lingegowda et al.245 investigated whether the observed renal benefits of nesiritide had any long-term impact on cumulative patient survival and renal outcomes. Data on all 94 patients from the Nesiritide Study were obtained with a mean follow-up period of 20.8 ± 10.4 months. No differences in cumulative survival between the groups were noted, but patients with in-hospital incidence of AKI had a higher rate of mortality than those with no AKI (41.4% vs. 10.7%; P = 0.002). It seemed, thus, that the possible renoprotection provided by nesiritide in the immediate postoperative period was not associated with improved long-term survival in patients undergoing highrisk cardiovascular surgery.

In summary, although evidence from a variety of small studies suggests the potential for therapy with natriuretic peptides to be useful for the prevention or treatment of AKI in a variety of settings, there are no definitive trials to support the use of ANP, BNP, or nesiritide for these purposes. Thus, the Work Group suggests that these agents not be used for prevention or treatment of AKI.

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