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 CMML CPSS-MolEstimate risk of progression to AML in those with CMML using molecular genetics data
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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Pathology
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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 CMML CPSS-MolEstimate risk of progression to AML in those with CMML using molecular genetics data
Solid Tumor
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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ACC/AHA CV Risk Calculator (2013)Estimate 10-year risk for atherosclerotic cardiovascular disease
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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 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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Impaired Vision | CTFPHC
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Screening for Asymptomatic Bacteriuria in Pregnancy | CTFPHC
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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WHO Surgical Safety Checklist
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REFERENCE BOOK

KDIGO Clinical Practice Guideline for Acute Kidney Injury
Fluid Administration: Recommendations and Rationale

Chapter 4.4: Pharmacological prevention strategies of CI-AKI

Fluid administration

Extracellular volume expansion at the time of radiocontrastmedia administration may serve to counteract both the intrarenal hemodynamic alterations and the direct tubulotoxic effects that play a role in the pathophysiology of CIAKI. Neurohumoral effects of volume expansion that may attenuate radiocontrast-induced medullary hypoxia include suppression of vasopressin as well as inhibition of the reninangiotensin axis; but an increased synthesis of vasodilatory renal prostaglandins may also play a role.464

Volume expansion may also directly reduce cellular damage by dilution of the contrast medium, particularly in the medullary tubular segments. Likewise, an effect of radiocontrast media to increase tubular fluid viscosity may be diminished by intravascular volume expansion.465 It is important to note that these potentially attenuating effects of volume expansion are speculative, and the precise mechanisms by which volume expansion protects against CI-AKI remain unknown.


  • 4.4.1: We recommend i.v. volume expansion with either isotonic sodium chloride or sodium bicarbonate solutions, rather than no i.v. volume expansion, in patients at increased risk for CI-AKI. (1A)
Rationale

Despite the recognition of volume depletion as an important risk factor for AKI, there are no RCTs that have directly evaluated the role of fluids vs. placebo in the prevention of AKI. However, RCTs have compared different fluids and have combined fluids with other interventions.191 Furthermore, comparisons between outcomes seen in these trials191 and historical untreated control subjects466 suggest a large benefit from fluids. In particular, volume expansion and treatment of dehydration are well-established interventions in the prevention of CI-AKI. A recent propensity analysis, however, noted that strategies to prevent CI-AKI are implemented rather nonuniformly.467 Pre– and post–contrast-media administration i.v. fluids were given to only 264 of 660 study patients (40.0%), more commonly with coronary angiography than with CT (91.2% vs. 16.6%). Other preventive measures, such as administration of NAC or discontinuation of NSAIDs, were equally rarely applied. Only 39.2% of patients received NAC, while only 6.8% of patients were instructed to discontinue NSAIDs. In a propensity analysis, the use of i.v. fluids was associated with a reduced rate of CI-AKI. The incidence of CI-AKI was lowest following CT (range, 0.0–10.9%) and was highest following noncoronary angiography (range, 1.9–34.0%).

The fluids that have been tested in the prevention of CI-AKI are hypotonic saline (0.45%), isotonic saline (0.9%) and isotonic sodium bicarbonate. The interpretation of all these studies is hampered by the fact that not all other risk factors (susceptibilities) for CI-AKI were excluded or considered in every study (i.e., age of the patient, presence of CKD and/or diabetes prior to contrast-media administration, type and dose of contrast agent, associated therapy with NAC, and other risk factors [see Chapter 2.2]).

There is no clear evidence from the literature to guide the choice of the optimal rate and duration of fluid infusion in CI-AKI prevention, but most studies suggest that the fluids should be started at least 1 h before and continued for 3–6 hours after contrast-media administration. A ‘‘good’’ urine output ( > 150 ml/h) in the 6 hours after the radiological procedure has been associated with reduced rates of AKI in one study.468 Since not all of i.v. administered isotonic crystalloid remains in the vascular space, in order to achieve a urine flow rate of at least 150 ml/h, ≥ 1.0–1.5 ml/kg/h of i.v. fluid has to be administered for 3–12 hours before and 6–12 hours after contrast-media exposure.

Mueller et al.469 found that i.v. 0.9% saline solution, compared to 0.45% saline solution in dextrose, in 1620 patients undergoing coronary angiography significantly reduced CI-AKI. The sustained administration of isotonic saline before and after radiocontrast injection seems, thus, to be more protective than equivalent volumes of hypotonic saline.464 Although the mechanism by which sodium bicarbonate, beyond its volume-expanding effects, might further reduce CI-AKI remains poorly defined, it has been postulated that sodium bicarbonate infusion may decrease generation of free radicals mediated by the Haber-Weiss reaction by increasing tubular pH. The Haber-Weiss reaction is most active at lower pH levels.470 Sodium bicarbonate infusion may also scavenge the potent oxidant peroxynitrate, produced via a nitric oxide–mediated pathway.471 Reactive oxygen species activate cytokine-induced inflammatory mediators, resulting in damage to proximal tubular cells,472 and it is likely that the activation of these mediators is influenced by tissue hypoxia and intracellular medullary acidosis.473

It is worth noting that, compared to i.v. bicarbonate, the combination of oral azetazolamide inducing an alkaline urine, plus i.v. saline, was more effective for the prevention of

Figure 15 | Bicarbonate vs. saline and risk of CI-AKI. Reprinted from Zoungas S, Ninomiya T, Huxley R et al. Systematic review: sodium bicarbonate treatment regimens for the prevention of contrast-induced nephropathy. Ann Intern Med 2009; 151: 631–638 with permission from American College of Physicians481; accessed http://www.annals.org/content/151/9/631.full

CI-AKI than saline alone, in a relatively small study in children with stable chronic renal failure (CRF).474 It could also be hypothesized that sodium bicarbonate has a stronger impact in lowering the intratubular viscosity caused by the contrast medium, compared to isotonic saline, because it causes less tubular sodium reabsorption than saline.

Sodium bicarbonate solutions have been tested in the prevention of CI-AKI in comparison with isotonic saline, either with or without NAC. A number of systematic reviews on the role of sodium bicarbonate compared to isotonic saline in the prevention of CI-AKI are available.475–481

The most recent and probably the most complete systematic review481 analyzed MEDLINE, PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials from 1950 to December 2008; conference proceedings; and ClinicalTrials.gov, without language restriction (Figure 15). This systematic review included RCTs of i.v. sodium bicarbonate that prespecified the outcome of CI-AKI as a 25% increase in baseline SCr concentration or an absolute increase of 0.5 mg/dl (44.2 µmol/l) after contrast-media administration. Twenty-three published and unpublished trials with information on 3563 patients and 396 CI-AKI events were included. The pooled RR was 0.62 (95% CI 0.45–0.86), with evidence of significant heterogeneity across studies. Some heterogeneity was due to the difference in the estimates between published and unpublished studies: RR 0.43 (95% CI 0.25–0.75) vs. 0.78 (95% CI 0.52–1.17), respectively. Meta-regression showed that small, poor-quality studies that assessed outcomes soon after contrast-media administration were more likely to suggest the benefit of bicarbonate (P < 0.05 for all). No clear effects of treatment on the risk for dialysis, heart failure, and total mortality were identified.

Suppl Tables 22 and 23 summarize the evidence from RCTs where isotonic bicarbonate was compared to isotonic saline alone, without concomitant other ‘‘preventive’’ interventions. In all studies, a minimum of 50 patients in both arms and publication as full paper were required for inclusion in the tables. Only three studies directly compared isotonic bicarbonate to isotonic saline.470,482,483 In a fourth study by Brar et al.,484 NAC was included in 47% and 46% of the patients in both arms of the study (bicarbonate vs. saline), respectively. The first study was a small single-center RCT470 enrolling 119 patients with stable SCr of at least 1.1 mg/dl (97.2 µmol/l), randomized to either infusion of isotonic saline or isotonic sodium bicarbonate before and after contrast-media administration. CI-AKI (defined as an increase of 25% in SCr from baseline within 48 hours) developed in 1.7% in the bicarbonate group, compared to 13.6% in the saline solution group.

Ozcan et al.483 included three prophylactic regimens: infusion of sodium bicarbonate, sodium chloride, and sodium chloride plus oral NAC (600mg b.i.d.). The incidence of CI-AKI, defined as an increase in SCr level > 25% or 0.5mg/dl (44.2 µmol/l) after 48 hours was significantly lower in the sodium bicarbonate group (4.5%) compared to sodium chloride alone (13.6%, P = 0.036). After adjusting for the Mehran nephropathy risk score, the risk of CI-AKI significantly reduced with sodium bicarbonate compared to sodium chloride alone (adjusted risk ratio 0.29; P = 0.043).

By contrast, Adolph et al.482 did not find differences in CIAKI between the two fluid regimens on day 1 after angiography; even on day 2, most parameters were similar in both groups. In none of the above-mentioned studies was there need for RRT.

Finally, a recent but retrospective study485 defined CI-AKI as an increase in SCr ≥ 25% within 48 hours of receiving contrast media, and compared sodium bicarbonate to normal saline in patients exposed to cardiac angiography. One group of patients (n = 89) received prophylactic bicarbonate; a second group, normal saline (n = 98). The patients in the bicarbonate group had more severe renal disease with higher baseline SCr (1.58 ± 0.5 mg/dl; 140 ± 44.2 µmol/l) vs. (1.28 ± 0.3 mg/dl; 113 ± 26.5 µmol/l), P = 0.001 and a lower eGFR, compared to the normal saline group. After contrast-media exposure, there was significant drop in eGFR (6.4%) and increase in SCr (11.3%) in the normal saline group and no significant change in the bicarbonate group. Three patients (3.4%) in the bicarbonate group, as opposed to 14 patients (14.3%) in the normal saline group, developed CI-AKI (P = 0.011). Two patients in the normal saline group and none in the bicarbonate group needed dialysis. This study suggests that the use of i.v. sodium bicarbonate is more effective than normal saline in preventing CI-AKI.

Three studies compared bicarbonate and saline solutions associated with the administration of NAC in both study arms.486-488 Recio-Mayoral et al.488 conducted a prospective single-center RCT in 111 consecutive patients with acute coronary syndrome undergoing emergency angioplasty. One group of patients received an infusion of sodium bicarbonate plus NAC started just before contrast-media injection and continued for 12 hours after angioplasty. The second (control) group received the standard fluid protocol consisting of i.v. isotonic saline for 12 hours after angioplasty. In both groups, two doses of oral NAC were administered the next day. A SCr concentration > 0.5 mg/dl ( > 44.2 µmol/l) from baseline after emergency angioplasty was observed in 1.8% in the bicarbonate group and in 21.8% of the saline group. Mortality and need for RRT were not significantly different between both groups. Briguori et al.486 randomized 326 CKD patients (SCr ≥ 2 mg/dl [ ≥ 177 µmol/l] and/or eGFR < 40 ml/min per 1.73 m2), and referred for coronary and/or peripheral procedures to three different protocols: prophylactic administration of 0.9% saline infusion plus NAC (n = 111), sodium bicarbonate infusion plus NAC (n = 108), and 0.9% saline plus ascorbic acid plus NAC (n = 107). CI-AKI was defined as an increase of ≥ 25% in the SCr concentration 48 hours after the procedure. CI-AKI occurred in 9.9% of the saline plus NAC group, in 1.9% of the bicarbonate/NAC group (P = 0.019 vs. saline plus NAC group), and in 10.3% of the saline plus ascorbic acid plus NAC group (P = 1.00 vs. saline plus NAC group). There was no difference in mortality nor in need for RRT among the different groups. While these two studies suggest that isotonic bicarbonate may provide greater benefit than isotonic saline, either in association with NAC or not, neither study can be considered conclusive.

Maioli et al.487 prospectively compared the efficacy of sodium bicarbonate vs. isotonic saline in addition to NAC in a larger population of 502 patients with an estimated CrCl < 60 ml/min, and undergoing coronary angiography or intervention. CI-AKI was defined as an absolute increase of SCr ≥ 0.5 mg/dl ( ≥ 44.2 µmol/l) measured within 5 days. CIAKI occurred in 10.8%; 10% were treated with sodium bicarbonate and 11.5% with saline. In patients with CI-AKI, the mean increase in creatinine was not significantly different in the two study groups. Based on this last prospective study, bicarbonate does not seem to be more efficient than saline. Furthermore, a retrospective cohort study at the Mayo Clinic assessed the risk of CI-AKI associated with the use of sodium bicarbonate, NAC, or the combination. Surprisingly, i.v. sodium bicarbonate was associated with an increased incidence of CI-AKI.489

While one might take the position that, if in doubt, one should choose the regimen that is potentially superior, the Work Group also considered the potential harm. In addition, isotonic bicarbonate solutions are usually composed by adding 154 ml of 8.4% sodium bicarbonate (i.e., 1 mmol/ ml) to 846 ml of 5% glucose solution, resulting in a final sodium and bicarbonate concentration of 154 mmol/l each. Since this mixing of the solution is often done at the bedside or in the hospital pharmacy, there is the possibility for errors leading to the infusion of a hypertonic bicarbonate solution. The potential for harm from dosing errors, and the added burden from preparation of the bicarbonate solution, has to be taken into account in clinical practice when making a choice between using bicarbonate rather than standard isotonic saline solutions. Taken together, the Work Group concluded that there is a possible but inconsistent benefit of bicarbonate solutions based on overall moderate-quality evidence (Suppl Table 22). As discussed above, the potential of harm and the additional burden for preparing the bicarbonate solutions led the Work Group not to express a preference for or against one solution (isotonic saline or isotonic bicarbonate). Thus, either can be used for the prevention of CI-AKI.

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