***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The incidence and consequences of fluid overload in the surgical ICU ( SICU ) have not been well defined , but may influence length of stay , days requiring mechanical ventilation , and mortality .  Forty-eight consecutive patients admitted to our SICU were prospect ively monitored for acute changes in weight and its impact on clinical management and outcome . When defined as a gain greater than 10 % from their preoperative or premorbid weight ( or an approximately 20 % increase in total body water ) , 40 % of patients had fluid overload . Patients were divided into three groups : those who had gained less than or equal to 10 % , those with a weight gain between 11 % and 20 % , and those with greater than 20 % increase in weight . Significant differences were found with respect to vasopressor dependence , colloid administration , and mortality . When indexed by initial Acute Physiology and Chronic Health Evaluation ( APACHE II ) mortality prediction scores , all groups had similar degrees of illness . On average , presumably due to volume limitations , patients were inadequately nourished during 85 % of their SICU stay . Our results suggest that the morbidity of fluid overload can be significant , and warrants a fresh look at the methods of intraoperative fluid resuscitation Background Continuous renal replacement therapy ( CRRT ) is essential in the management of critically ill patients with acute kidney injury ( AKI ) . However , the optimal timing for initiating CRRT remains controversial , especially in elderly patients . Therefore , we investigated the outcomes of early CRRT initiation in elderly patients with AKI . Methods A total of 607 patients ≥65 years of age who started CRRT due to AKI between August 2009 and December 2013 were prospect ively enrolled . They were divided into two groups based on the median 6-hour urine output immediately before CRRT initiation . Propensity score matching was used to compare the overall survival rate , CRRT duration , and hospitalization duration . Results The median age of both groups was 73.0 years , and 60 % of the patients were male . The most common cause of AKI was sepsis . In the early CRRT group , the mean arterial pressure was higher , but the prothrombin time and total bilirubin , aspartate aminotransferase , and alanine aminotransferase levels were lower . The overall cumulative survival rate was higher in the early CRRT group ( log-rank P < 0.01 ) . Late CRRT initiation was associated with a higher mortality rate than early initiation after adjusting for age , sex , the Charlson comorbidity index , systolic arterial pressure , prothrombin time , the total bilirubin , aspartate aminotransferase , and alanine aminotransferase levels , cumulative fluid balance and diuretic use ( hazard ratio , 1.35 ; 95 % confidence interval 1.06 , 1.71 , P = 0.02 ) . Following propensity score matching , patient survival was significantly better in the early CRRT group than in the late CRRT group ( P < 0.01 ) . The total duration of hospitalization from the start of CRRT was shorter among the survivors when CRRT was started earlier ( 26.7 versus 39.1 days , P = 0.04 ) . Conclusion A better prognosis can be expected if CRRT is applied early in the course of AKI in critically ill , elderly patients Whether earlier initiation of RRT in critically ill patients with AKI can improve outcomes remains debated . We examined follow-up data from a large clinical trial to prospect ively investigate the long-term outcomes associated with the timing of RRT initiation in such patients . We extended the follow-up of patients in the Early Versus Delayed Initiation of RRT in Critically Ill Patients with AKI ( ELAIN ) Trial from 90 days to 1 year after r and omization for 230 ( 99.6 % ) patients . The primary outcome was a composite of major adverse kidney events ( persistent renal dysfunction , dialysis dependence , and mortality ) at 1 year . Secondary outcomes included inflammatory markers . Overall , 72 of 111 ( 64.9 % ) and 106 of 119 ( 89.1 % ) patients met the primary outcome in the early ( stage 2 AKI ) and delayed ( stage 3 AKI ) initiation groups , respectively ( odds ratio [ OR ] with early initiation , 0.23 ; 95 % confidence interval [ 95 % CI ] , 0.11 to 0.45 ; P < 0.001 ) . The early initiation group had a 1-year all-cause mortality rate ( 56 of 111 [ 50.2 % ] ) significantly lower than that of the delayed initiation group ( 83 of 119 [ 69.8 % ] ; absolute difference , -19.6 % ; 95 % CI , -32.0 % to -7.2 % ; P<0.01 ) . After 1 year , 16 of 55 ( 29.1 % ) and 23 of 36 ( 63.9 % ) surviving patients in the early and delayed groups , respectively , failed to recover renal function ( absolute difference , -34.8 % ; 95 % CI , -54.6 % to -15.0 % ; P=0.001 ) . In conclusion , early initiation of RRT in these critically ill patients with AKI  significantly reduced the occurrence of major adverse kidney events , reduced mortality , and enhanced renal recovery at 1 year Background The timing of initiation of renal replacement therapy ( RRT ) in severe acute kidney injury ( AKI ) remains controversial , with early initiation result ing in unnecessary therapy for some patients while expectant therapy may delay RRT for other patients . The furosemide stress test ( FST ) has been shown to predict the need for RRT and therefore could be used to exclude low-risk patients from enrollment in trials of RRT timing . We conducted this multicenter pilot study to determine whether FST could be used to screen patients at high risk for RRT and to determine the feasibility of incorporating FST into a trial of early initiation of RRT . Methods FST was performed using intravenous furosemide ( 1 mg/kg in furosemide-naive patients or 1.5 mg/kg in previous  furosemide  users ) . FST-nonresponsive patients ( urine output less than 200 mL in 2 h ) were then r and omized to early ( initiation within 6 h ) or st and ard ( initiation by urgent indication ) RRT . Results FST was completed in all patients ( 100 % ) . Only 6/44 ( 13.6 % ) FST-responsive patients ultimately received RRT while 47/60 ( 78.3 % ) nonresponders r and omized to st and ard RRT either received RRT or died ( P < 0.001 ) . Among 118 FST-nonresponsive patients , 98.3 % in the early RRT arm and 75 % in the st and ard RRT arm received RRT . The adherence to the protocol was 94.8 % and 100 % in the early and st and ard RRT group , respectively . We observed no differences in 28-day mortality ( 62.1 versus 58.3 % , P = 0.68 ) , 7-day fluid balance , or RRT dependence at day 28 . However , hypophosphatemia occurred more frequently in the early RRT arm ( P = 0.002 ) . Conclusion The furosemide stress test appears to be feasible and effective in identifying patients for r and omization to different RRT initiation times . Our findings should guide implementation of large-scale r and omized controlled trials for the timing of RRT initiation . Trial registration clinical trials.gov , NCT02730117 . Registered 6 April 2016 In patients with severe acute kidney injury ( AKI ) but no urgent indication for renal replacement therapy ( RRT ) , the optimal time to initiate RRT remains controversial . While starting RRT preemptively may have benefits , this may expose patients to unnecessary RRT . To study this , we conducted a 12-center open-label pilot trial of critically ill adults with volume replete severe AKI . Patients were r and omized to accelerated ( 12 h or less from eligibility ) or st and ard RRT initiation .  Outcomes were adherence to protocol -defined time windows for RRT initiation ( primary ) , proportion of eligible patients enrolled , follow-up to 90 days , and safety in 101 fully eligible patients ( 57 with sepsis ) with a mean age of 63 years . Median serum creatinine and urine output  at enrollment were 268 micromoles/l and 356 ml per 24 h , respectively . In the accelerated arm , all patients commenced RRT and 45/48 did so within 12 h from eligibility ( median 7.4 h ) . In the st and ard arm , 33 patients started RRT at a median of 31.6 h from eligibility , of which 19 did not receive RRT ( 6 died and 13 recovered kidney function ) . Clinical outcomes were available for all patients at 90 days following enrollment , with mortality 38 % in the accelerated and 37 % in the st and ard arm . Two surviving patients , both r and omized to st and ard RRT initiation , were still RRT dependent at day 90 . No safety signal was evident in either arm . Our findings can inform the design of a large-scale effectiveness r and omized control trial Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Abstract Acute kidney injury ( AKI ) is associated with increased morbidity and mortality and is frequently encountered in coronary care units ( CCUs ) . Its clinical presentation differs considerably from that of prerenal or intrinsic AKI . We used the biomarkers calprotectin and neutrophil gelatinase-associated lipocalin ( NGAL ) and compared their utility in predicting and differentiating intrinsic AKI.This was a prospect i ve observational study conducted in a CCU of a tertiary care university hospital . Patients who exhibited any comorbidity and a kidney stressor were enrolled . Urinary sample s of the enrolled patients collected between September 2012 and August 2013 were tested for calprotectin and NGAL . The definition of AKI was based on Kidney Disease Improving Global Outcomes classification . All prospect i ve demographic , clinical , and laboratory data were evaluated as predictors of AKI.A total of 147 adult patients with a mean age of 67 years were investigated . AKI was diagnosed in 71 ( 50.3 % ) patients , whereas intrinsic AKI was diagnosed in 43 ( 60.5 % ) of them . Multivariate logistic regression analysis revealed urinary calprotectin and serum albumin as independent risk factors for intrinsic AKI . For predicting intrinsic AKI , both urinary NGAL and calprotectin displayed excellent areas under the receiver operating characteristic curve ( AUROC ) ( 0.918 and 0.946 , respectively ) . A combination of these markers revealed an AUROC of 0.946.Our result revealed that calprotectin and NGAL had considerable discriminative powers for predicting intrinsic AKI in CCU patients . Accordingly , careful inspection for medication , choice of therapy , and early intervention in patients exhibiting increased biomarker levels might improve the outcomes of kidney injury Introduction Abdominal surgery is probably associated with more likelihood to cause acute kidney injury ( AKI ) . The aim of this study was to evaluate whether early or late start of renal replacement therapy ( RRT ) defined by simplified RIFLE ( sRIFLE ) classification in AKI patients after major abdominal surgery  will affect outcome . Methods A multicenter prospect i ve observational study based on the NSARF ( N ational Taiwan University S urgical ICU A ssociated R enal F ailure ) Study Group data base . 98 patients ( 41 female , mean age 66.4 ± 13.9 years ) who underwent acute RRT according to local indications for post-major abdominal surgery AKI between 1 January , 2002 and 31 December , 2005 were enrolled The demographic data , comorbid diseases , types of surgery and RRT , as well as the indications for RRT were documented . The patients were divided into early dialysis ( sRIFLE-0 or Risk ) and late dialysis ( LD , sRIFLE -Injury or Failure ) groups . Then we measured and recorded patients ' outcome including in-hospital mortality and RRT wean-off until 30 June , 2006 . Results The in-hospital mortality was compared as endpoint . Fifty-seven patients ( 58.2 % ) died during hospitalization . LD ( hazard ratio ( HR ) 1.846 ; P = 0.027 ) , old age ( HR 2.090 ; P = 0.010 ) , cardiac failure ( HR 4.620 ; P < 0.001 ) , pre-RRT SOFA score ( HR 1.152 ; P < 0.001 ) were independent indicators for in-hospital mortality . Conclusions The findings of this study support earlier initiation of acute RRT , and also underscore the importance of predicting prognoses of major abdominal surgical patients with AKI by using RIFLE classification Objective : The impact of continuous venovenous hemofiltration on  sepsis-induced multiple organ failure  severity is controversial . We sought to assess the effect of early application of hemofiltration on the degree of organ dysfunction and plasma cytokine levels in 
    Output:
    
Overall , early RRT initiation did not provide a survival benefit , but a possible benefit of fewer MV days was detected .
Early RRT might also provide the benefit of shorter MV or RRT support in the surgical population and in AKI patients with high plasma NGAL .
Depending on the conventional indication for RRT initiation , the watchful waiting strategy is safe on the basis of all primary and secondary outcomes