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Pediatrics Nov 2021In this state-of-the-art review, we highlight the major advances over the last 5 years in neonatal acute kidney injury (AKI). Large multicenter studies reveal that... (Review)
Review
In this state-of-the-art review, we highlight the major advances over the last 5 years in neonatal acute kidney injury (AKI). Large multicenter studies reveal that neonatal AKI is common and independently associated with increased morbidity and mortality. The natural course of neonatal AKI, along with the risk factors, mitigation strategies, and the role of AKI on short- and long-term outcomes, is becoming clearer. Specific progress has been made in identifying potential preventive strategies for AKI, such as the use of caffeine in premature neonates, theophylline in neonates with hypoxic-ischemic encephalopathy, and nephrotoxic medication monitoring programs. New evidence highlights the importance of the kidney in "crosstalk" between other organs and how AKI likely plays a critical role in other organ development and injury, such as intraventricular hemorrhage and lung disease. New technology has resulted in advancement in prevention and improvements in the current management in neonates with severe AKI. With specific continuous renal replacement therapy machines designed for neonates, this therapy is now available and is being used with increasing frequency in NICUs. Moving forward, biomarkers, such as urinary neutrophil gelatinase-associated lipocalin, and other new technologies, such as monitoring of renal tissue oxygenation and nephron counting, will likely play an increased role in identification of AKI and those most vulnerable for chronic kidney disease. Future research needs to be focused on determining the optimal follow-up strategy for neonates with a history of AKI to detect chronic kidney disease.
Topics: Acute Kidney Injury; Biomarkers; Caffeine; Humans; Hypoxia-Ischemia, Brain; Infant, Newborn; Infant, Premature; Kidney; Lipocalin-2; Multicenter Studies as Topic; Oxygen Consumption; Renal Replacement Therapy; Research; Risk Factors; Theophylline; Water-Electrolyte Balance
PubMed: 34599008
DOI: 10.1542/peds.2021-051220 -
International Journal of Sport... Sep 2021Beer is used to socialize postexercise, celebrate sport victory, and commiserate postdefeat. Rich in polyphenols, beer has antioxidant effects when consumed in...
Beer is used to socialize postexercise, celebrate sport victory, and commiserate postdefeat. Rich in polyphenols, beer has antioxidant effects when consumed in moderation, but its alcohol content may confer some negative effects. Despite beer's popularity, no review has explored its effects on exercise performance, recovery, and adaptation. Thus, a systematic literature search of three databases (PubMed, SPORTDiscus, and Web of Science) was conducted by two reviewers. The search resulted in 16 studies that were appraised and reviewed. The mean PEDro score was 5.1. When individuals are looking to rehydrate postexercise, a low-alcohol beer (<4%) may be more effective. If choosing a beer higher in alcoholic content (>4%), it is advised to pair this with a nonalcoholic option to limit diuresis, particularly when relatively large volumes of fluid (>700 ml) are consumed. Adding Na+ to alcoholic beer may improve rehydration by decreasing fluid losses, but palatability may decrease. These conclusions are largely based on studies that standardized beverage volume, and the results may not apply equally to situations where people ingest fluids and food ad libitum. Ingesting nonalcoholic, polyphenol-rich beer could be an effective strategy for preventing respiratory infections during heavy training. If consumed in moderation, body composition and strength qualities seem largely unaffected by beer. Mixed results that limit sweeping conclusions are owed to variations in study design (i.e., hydration and exercise protocols). Future research should incorporate exercise protocols with higher ecological validity, recruit more women, prioritize chronic study designs, and use ad libitum fluid replacement protocols for more robust conclusions.
Topics: Alcohol Drinking; Beer; Dehydration; Exercise; Female; Fluid Therapy; Humans; Water-Electrolyte Balance
PubMed: 34284350
DOI: 10.1123/ijsnem.2021-0064 -
Archives of Disease in Childhood. Fetal... Sep 2021Total body water (TBW) is one component of fat-free mass and changes in TBW are influenced by fluid shifts (especially during transition to postnatal life), electrolyte... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Total body water (TBW) is one component of fat-free mass and changes in TBW are influenced by fluid shifts (especially during transition to postnatal life), electrolyte balance and nutritional status. Normal values for term-born neonates and preterm infants at birth have not been defined in large cohorts, limiting investigation into its monitoring and use in clinical practice.
OBJECTIVE
To systematically review the evidence base for percentage of TBW in term-born infants, quantify the effect of prematurity on TBW at birth, and describe normal progression of TBW over time in preterm infants.
METHODS
Systematic review of Medline, Web of Science Core Collection and EBSCO-CINAHL (January 1946 to January 2020). Included articles used dilutional methods to assess TBW.
RESULTS
Searches identified 2349 articles of which 22 included data suitable for analysis. Mean TBW in term-born newborns was 73.8% (95% CI 72.47% to 75.06%, 15 studies, 433 infants). Meta-regression showed that TBW was higher in preterm infants (up to 90% at 26 weeks gestation, dropping to 75% at 36 weeks corrected gestation) and was negatively correlated with gestation at birth, falling 1.44% per week (95% CI 0.63% to 2.24%, 9 studies, 179 infants). Analysis of TBW over time during the ex utero growth of preterm infants was not possible due to paucity of data.
CONCLUSION
This review defines the normal TBW percentage in term-born infants and confirms and quantifies previous findings that preterm infants have a higher TBW percentage.
Topics: Body Composition; Body Water; Gestational Age; Humans; Infant, Newborn; Infant, Premature; Reference Values; Water-Electrolyte Balance
PubMed: 33789970
DOI: 10.1136/archdischild-2020-321112 -
Ultrasound in Medicine & Biology May 2021Lung ultrasonography is accurate in detecting pulmonary edema and overcomes most limitations of traditional diagnostic modalities. Whether use of lung...
Lung ultrasonography is accurate in detecting pulmonary edema and overcomes most limitations of traditional diagnostic modalities. Whether use of lung ultrasonography-guided management has an effect on cumulative fluid balances and other clinical outcomes remains unclear. In this systematic review, we included 12 studies using ultrasonography guided-management with a total of 2290 patients. Four in-patient studies found a reduced cumulative fluid balance (ranging from -0.3 L to -2.4 L), whereas three out-patient studies found reduction in dialysis dry weight (ranging from -2.6 kg to -0.2 kg) compared with conventionally managed patients. None of the studies found adverse effects related to hypoperfusion. The use of lung ultrasonography-guided management was not associated with other clinical outcomes. This systematic review shows that lung ultrasonography-guided management, exclusively or in concert with other diagnostic modalities, is associated with a reduced cumulative fluid balance. Studies thus far have not shown a consistent effect on clinical outcomes.
Topics: Humans; Lung; Pulmonary Edema; Renal Dialysis; Treatment Outcome; Ultrasonography; Water-Electrolyte Balance
PubMed: 33637390
DOI: 10.1016/j.ultrasmedbio.2021.01.024 -
Cerebrovascular Diseases (Basel,... 2020Hyponatremia is a common electrolyte disorder in patients with stroke, which leads to various fatal complications. We performed a systematic review and meta-analysis to... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Hyponatremia is a common electrolyte disorder in patients with stroke, which leads to various fatal complications. We performed a systematic review and meta-analysis to investigate the outcomes of acute stroke patients with hyponatremia.
METHODS
We searched MEDLINE, EMBASE, and the Cochrane Library databases for relevant literature in English published up to March 2020. Two review authors independently screened and selected the studies by assessing the eligibility and validity based on the inclusion criteria. Mortality at 90 days was set as the primary end point, and in-hospital mortality and length of hospital stay were set as the secondary end points. We conducted the data synthesis and analyzed the outcomes by calculating the odds ratio (OR) and mean difference.
RESULTS
Of 835 studies, 15 studies met the inclusion criteria (n = 10,745). The prevalence rate of stroke patients with hyponatremia was 7.0-59.2%. They had significantly higher 90-day mortality (OR, 1.73; 95% confidence interval (CI), 1.24-2.42) and longer length of hospital stay (mean difference, 10.68 days; 95% CI, 7.14-14.22) than patients without hyponatremia. Patients with hyponatremia had a higher tendency of in-hospital mortality than those without hyponatremia (OR, 1.61; 95% CI, 0.97-2.69).
CONCLUSIONS
The development of hyponatremia in the clinical course of stroke is associated with higher short-term mortality and a longer hospital stay. Although the causal relationship is unclear, hyponatremia could be a significant predictor of poor outcomes after stroke.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Biomarkers; Female; Hospital Mortality; Humans; Hyponatremia; Length of Stay; Male; Middle Aged; Risk Assessment; Risk Factors; Sodium; Stroke; Time Factors; Treatment Outcome; Water-Electrolyte Balance; Young Adult
PubMed: 33017822
DOI: 10.1159/000510751 -
The National Medical Journal of India 2019Administration of intravenous fluids is the most common therapy given to patients admitted to a hospital. Evidence suggests that the use of normal saline (NS) in large... (Meta-Analysis)
Meta-Analysis
Administration of intravenous fluids is the most common therapy given to patients admitted to a hospital. Evidence suggests that the use of normal saline (NS) in large quantities is not without adverse effects. Balanced salt solutions (BSS) contain bicarbonate or one of its precursors that act as a buffer, and the electrolyte composition resembles that of plasma. We reviewed studies across different setups such as intensive care units (ICUs), major surgeries, renal transplants and emergency departments to identify the effect(s) of NS and to find evidence favouring the use of BSS over NS. The use of NS is strongly associated with hyperchloraemic acidosis in almost all the studies. In the largest and latest trial in ICUs, it was found that higher chloride levels were associated with renal injury. No significant difference was found in mortality in any of the trials. In surgical patients, studies found only transient hyperchloraemia and increase in the base deficit in patients receiving NS. Systematic reviews and meta-analyses did not find any significant differences in adverse outcomes such as the need for renal replacement therapy or mortality with the use of saline; however, blood chloride levels were consistently higher with saline compared to BSS. There is a need for larger trials with better methodology to determine if the physiological benefits of BSS translate into better clinical outcomes.
Topics: Acute Disease; Adult; Child; Child, Preschool; Critical Care; Crystalloid Solutions; Humans; Infant; Water-Electrolyte Balance
PubMed: 32769243
DOI: 10.4103/0970-258X.291297 -
Worldviews on Evidence-based Nursing Dec 2019The charting of daily fluid balances and measurement of body weight changes are two noninvasive methods commonly used in the intensive care unit for estimating body...
BACKGROUND
The charting of daily fluid balances and measurement of body weight changes are two noninvasive methods commonly used in the intensive care unit for estimating body fluid status. The determination of body fluid status plays an important role in the management of critically ill patients where aggressive fluid resuscitation is often required. This can adversely affect patient outcomes if changes in fluid distribution are not detected early in patients who are susceptible to fluid overload.
AIM
To synthesize the best available evidence on the accuracy of daily fluid balance charting compared with the measurement of body weight for the estimation of body fluid status in critically ill adult patients.
METHODS
The review considered studies that investigated the accuracy of charting daily fluid balances or changes in body weight measurements or used both noninvasive methods in the estimation of body fluid status. The search sought to identify published, English language studies from 1980 until February 2018. Databases searched included MEDLINE, CINAHL, EMBASE, TRIP, Scopus, TROVE, ProQuest Dissertations, Australian and New Zealand Trials Registry, and Cochrane Central Register of Clinical Trials. Three reviewers independently assessed retrieved studies that matched inclusion criteria using standardized critical appraisal instruments.
RESULTS
The review included 13 cohort studies. Effectiveness of daily fluid balance charting was affected by inaccuracies observed in seven studies. Inability to obtain consecutive daily body weight measurements reduced the accuracy of monitoring changes in five studies. Seven studies found measurement of daily fluid balance inconsistent with changes in body weight.
LINKING EVIDENCE TO ACTION
The accuracy of charting fluid balance is suspect. Measurement of body weight is hard to accomplish. A combination of the two commonly used methods is more likely to be effective in estimating body fluid status than reliance on one single approach.
Topics: Adult; Body Weight; Critical Illness; Humans; Intensive Care Units; Statistics as Topic; Water-Electrolyte Balance
PubMed: 31811748
DOI: 10.1111/wvn.12394 -
International Journal of Molecular... Nov 2019Several environmental factors, such as drought, salinity, and extreme temperatures, negatively affect plant growth and development, which leads to yield losses. The... (Comparative Study)
Comparative Study Meta-Analysis
Several environmental factors, such as drought, salinity, and extreme temperatures, negatively affect plant growth and development, which leads to yield losses. The tolerance or sensitivity to abiotic stressors are the expression of a complex machinery involving molecular, biochemical, and physiological mechanisms. Here, a meta-analysis on previously published RNA-Seq data was performed to identify the genes conferring tolerance to chilling, osmotic, and salt stresses, by comparing the transcriptomic changes between tolerant and susceptible rice genotypes. Several genes encoding transcription factors (TFs) were identified, suggesting that abiotic stress tolerance involves upstream regulatory pathways. A gene co-expression network defined the metabolic and signalling pathways with a prominent role in the differentiation between tolerance and susceptibility: (i) the regulation of endogenous abscisic acid (ABA) levels, through the modulation of genes that are related to its biosynthesis/catabolism, (ii) the signalling pathways mediated by ABA and jasmonic acid, (iii) the activity of the "Drought and Salt Tolerance" TF, involved in the negative regulation of stomatal closure, and (iv) the regulation of flavonoid biosynthesis by specific MYB TFs. The identified genes represent putative key players for conferring tolerance to a broad range of abiotic stresses in rice; a fine-tuning of their expression seems to be crucial for rice plants to cope with environmental cues.
Topics: Dehydration; Disease Resistance; Gene Expression Profiling; Gene Expression Regulation, Plant; Oryza; Osmoregulation; Plant Proteins; Salt Tolerance; Transcription Factors
PubMed: 31726733
DOI: 10.3390/ijms20225662 -
Physiology & Behavior May 2019Hypohydration is generally considered to have a negative effect on cognitive function, despite several studies reporting comparable findings between hydration states.... (Meta-Analysis)
Meta-Analysis
Hypohydration is generally considered to have a negative effect on cognitive function, despite several studies reporting comparable findings between hydration states. Recommendations to avoid moderate dehydration (≥ 2% loss in body mass) are commonly made to athletes, on the provision that this deficit may impair optimal cognitive performance. To determine whether cognitive function is impaired by hypohydration, and investigate the existence of the proposed critical water deficit of ≥2% loss in body mass purported to diminish cognitive performance, we conducted a systematic search of the literature and examined appropriate studies by meta-analysis. Overall, cognitive performance was not found to be impaired by hypohydration (g = -0.177; 95% CI = -0.532-0.179; P = .331). Nor were the underlying cognitive domains (complex attention, executive function, learning and memory) impaired (all P > .236), independent of the incurred fluid loss (less than or >2% loss in body mass), although results were not always homogenous (I ranging between 0% and 93%). Collectively, these results suggest that hypohydration may not compromise cognitive function, nor any of the investigated subdomains to a greater extent than if euhydration had been maintained. Furthermore, recommendations to avoid moderate hypohydration on the basis of maintaining optimal cognitive function are not substantiated by this meta-analysis.
Topics: Athletes; Attention; Cognition; Dehydration; Executive Function; Humans; Water-Electrolyte Balance
PubMed: 30876770
DOI: 10.1016/j.physbeh.2019.03.008 -
European Journal of Nutrition Mar 2019Athletes in Olympic combat sports experience body water fluctuations resulting from training and intentional dehydration when making weight. Despite the popularity of... (Meta-Analysis)
Meta-Analysis
PURPOSE
Athletes in Olympic combat sports experience body water fluctuations resulting from training and intentional dehydration when making weight. Despite the popularity of urine specific gravity (U) and urine osmolality (U) measurement in characterizing fluid fluctuations, their utility remains questioned. This systematic review/meta-analysis examined the utility of urinary hydration indices in laboratory and field settings in Olympic combat sport athletes.
METHODS
27 articles met the inclusion criteria for systematic review, 15 studies were included in the meta-analysis; with U and U the main outcome variables. Meta-regression analyses evaluated the interrelationship among body mass (B), fluid intake, and urine measures.
RESULTS
Significant U alterations were observed following different sampling time frames: dehydration (ES 0.59; 95% CI 0.46-0.72; p = 0.001), follow-up period (ES 0.31; 95% CI 0.11-0.50; p = 0.002) and rehydration (ES - 0.34; 95% CI - 0.56 to - 0.12; p = 0.003). Direct comparison of laboratory (ES 0.20; 95% CI - 0.19 to 0.59; p = 0.324) and field (ES 0.35; 95% CI 0.14-0.56; p = 0.001) sampling showed marginally trivial and small effects. Small effects on U were observed following dehydration (ES 0.31; 95% CI 0.12-0.74, p = 0.15), follow-up period (ES 0.39; 95% CI 0.08-0.70, p = 0.015) and rehydration (ES - 0.45; 95% CI - 0.60 to 0.30, p = 0.001). Meta-regression analysis suggests only fluid intake predicts U alterations (p = 0.044) during rehydration protocols.
CONCLUSIONS
There were likely small changes in both U and U readings across all experimental conditions, with moderate-to-large heterogeneity in all studies, except for U readings during dehydration protocols. The meta-regression failed to provide conclusive evidence concerning the interrelationship among urine measures, B fluctuations, and fluid intake.
Topics: Adult; Athletes; Dehydration; Drinking; Female; Humans; Male; Osmolar Concentration; Sports; Urinalysis; Water-Electrolyte Balance; Young Adult
PubMed: 30820653
DOI: 10.1007/s00394-019-01937-2