11 results on '"Basu, Rajit K."'
Search Results
2. Extracorporeal Liver Support Therapies for Children
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Schaefer, Betti, Schmitt, Claus Peter, Basu, Rajit K., Warady, Bradley A., editor, Alexander, Steven R., editor, and Schaefer, Franz, editor
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- 2021
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3. Consensus acute kidney injury criteria integration identifies children at risk for long-term kidney dysfunction after multiple organ dysfunction syndrome
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Gorga, Stephen M., Carlton, Erin F., Kohne, Joseph G., Barbaro, Ryan P., and Basu, Rajit K.
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- 2021
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4. Renal replacement therapy in the management of intoxications in children: recommendations from the Pediatric Continuous Renal Replacement Therapy (PCRRT) workgroup
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Raina, Rupesh, Grewal, Manpreet K, Blackford, Martha, Symons, Jordan M., Somers, Michael J. G., Licht, Christoph, Basu, Rajit K, Sethi, Sidharth Kumar, Chand, Deepa, Kapur, Gaurav, McCulloch, Mignon, Bagga, Arvind, Krishnappa, Vinod, Yap, Hui-Kim, de Sousa Tavares, Marcelo, Bunchman, Timothy E, Bestic, Michelle, Warady, Bradley A, and de Ferris, Maria Díaz-González
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- 2019
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5. Pediatric AKI in the real world: changing outcomes through education and advocacy—a report from the 26th Acute Disease Quality Initiative (ADQI) consensus conference.
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Mottes, Theresa, Menon, Shina, Conroy, Andrea, Jetton, Jennifer, Dolan, Kristin, Arikan, Ayse Akcan, Basu, Rajit K., Goldstein, Stuart L., Symons, Jordan M., Alobaidi, Rashid, Askenazi, David J., Bagshaw, Sean M., Barhight, Matthew, Barreto, Erin, Bayrakci, Benan, Ray II, O. N. Bignall, Bjornstad, Erica, Brophy, Patrick, Charlton, Jennifer, and Chanchlani, Rahul
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HEALTH education ,EVALUATION of medical care ,OCCUPATIONAL roles ,CONSENSUS (Social sciences) ,PATIENT advocacy ,TEACHING methods ,PEDIATRICS ,CONFERENCES & conventions ,QUALITY assurance ,CHILDREN'S health ,HEALTH care teams ,INTERPROFESSIONAL relations ,QUALITY of life ,PATIENT care ,MEDICAL practice ,ACUTE kidney failure ,DELPHI method ,DIFFUSION of innovations ,CHILDREN - Abstract
Background: Acute kidney injury (AKI) is independently associated with increased morbidity and mortality across the life course, yet care for AKI remains mostly supportive. Raising awareness of this life-threatening clinical syndrome through education and advocacy efforts is the key to improving patient outcomes. Here, we describe the unique roles education and advocacy play in the care of children with AKI, discuss the importance of customizing educational outreach efforts to individual groups and contexts, and highlight the opportunities created through innovations and partnerships to optimize lifelong health outcomes. Methods: During the 26th Acute Disease Quality Initiative (ADQI) consensus conference, a multidisciplinary group of experts discussed the evidence and used a modified Delphi process to achieve consensus on recommendations on AKI research, education, practice, and advocacy in children. Results: The consensus statements developed in response to three critical questions about the role of education and advocacy in pediatric AKI care are presented here along with a summary of available evidence and recommendations for both clinical care and research. Conclusions: These consensus statements emphasize that high-quality care for patients with AKI begins in the community with education and awareness campaigns to identify those at risk for AKI. Education is the key across all healthcare and non-healthcare settings to enhance early diagnosis and develop mitigation strategies, thereby improving outcomes for children with AKI. Strong advocacy efforts are essential for implementing these programs and building critical collaborations across all stakeholders and settings. [ABSTRACT FROM AUTHOR]
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- 2024
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6. Synergistic association of fluid overload and acute kidney injury on outcomes in pediatric cardiac ECMO: a retrospective analysis of the KIDMO database.
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Pettit, Kevin A., Selewski, David T., Askenazi, David J., Basu, Rajit K., Bridges, Brian C., Cooper, David S., Fleming, Geoffrey M., Gien, Jason, Gorga, Stephen M., Jetton, Jennifer G., King, Eileen C., Steflik, Heidi J., Paden, Matthew L., Sahay, Rashmi D., Zappitelli, Michael, and Gist, Katja M.
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CARDIOVASCULAR disease related mortality ,RELATIVE medical risk ,THERAPEUTICS ,HYPERVOLEMIA ,CONFIDENCE intervals ,CARDIOVASCULAR diseases ,EXTRACORPOREAL membrane oxygenation ,RENAL replacement therapy ,DESCRIPTIVE statistics ,ACUTE kidney failure ,SECONDARY analysis ,CREATININE ,COMPUTER operating systems ,DISEASE complications ,CHILDREN - Abstract
Background: Acute kidney injury (AKI) and fluid overload (FO) are associated with poor outcomes in children receiving extracorporeal membrane oxygenation (ECMO). Our objective is to evaluate the impact of AKI and FO on pediatric patients receiving ECMO for cardiac pathology. Methods: We performed a secondary analysis of the six-center Kidney Interventions During Extracorporeal Membrane Oxygenation (KIDMO) database, including only children who underwent ECMO for cardiac pathology. AKI was defined using Kidney Disease: Improving Global Outcomes (KDIGO) creatinine criteria. FO was defined as < 10% (FO–) vs. ≥ 10% (FO +) and was evaluated at ECMO initiation, peak during ECMO, and ECMO discontinuation. Primary outcomes were mortality and length of stay (LOS). Results: Data from 191 patients were included. Non-survivors (56%) were more likely to be FO + than survivors at peak ECMO fluid status and ECMO discontinuation. There was a significant interaction between AKI and FO. In the presence of AKI, the adjusted odds of mortality for FO + was 4.79 times greater than FO– (95% CI: 1.52–15.12, p = 0.01). In the presence of FO + , the adjusted odds of mortality for AKI + was 2.7 times higher than AKI– [95%CI: 1.10–6.60; p = 0.03]. Peak FO + was associated with a 55% adjusted relative increase in LOS [95%CI: 1.07–2.26, p = 0.02]. Conclusions: The association of peak FO + with mortality is present only in the presence of AKI +. Similarly, AKI + is associated with mortality only in the presence of peak FO +. FO + was associated with LOS. Studies targeting fluid management have the potential to improve LOS and mortality outcomes. A higher resolution version of the Graphical abstract is available as Supplementary information. [ABSTRACT FROM AUTHOR]
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- 2023
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7. Early Sequential Risk Stratification Assessment to Optimize Fluid Dosing, CRRT Initiation and Discontinuation in Critically Ill Children with Acute Kidney Injury: Taking Focus 2 Process Article
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Roy, Jean-Philippe, Krallman, Kelli A., Basu, Rajit K., Chima, Ranjit S., Fei, Lin, Wilder, Sarah, Schmerge, Alexandra, Gerhardt, Bradley, Fox, Kaylee, Kirby, Cassie, and Goldstein, Stuart L.
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Furosemide Stress Test (FST) ,Renal Angina Index (RAI) ,NGAL ,urologic and male genital diseases ,Children ,female genital diseases and pregnancy complications ,Article ,Acute Kidney Injury (AKI) - Abstract
Background: Acute Kidney Injury (AKI) is common in critically ill children and is associated with increased morbidity and mortality. Recognition and management of AKI is often delayed, predisposing patients to risk of clinically significant fluid accumulation (Fluid Overload (FO)). Early recognition and intervention in high risk patients could decrease fluid associated morbidity. We aim to assess an AKI Clinical Decision Algorithm (CDA) using a sequential risk stratification strategy integrating the Renal Angina Index (RAI), urine Neutrophil Gelatinase-Associated Lipocalin (NGAL) and the Furosemide Stress Test (FST) to optimize AKI and FO prediction and management in critically ill children. Methods/Design: This single center prospective observational cohort study evaluates the AKI CDA in a Pediatric Intensive Care Unit (PICU). Every patient ≥ 3 months old has the risk score RAI calculated automatically at 12 hours of admission. Patients with a RAI ≥ 8 (fulfilling renal angina) have risk further stratified with a urine NGAL and, if positive (NGAL ≥ 150ng/mL), subsequently by their response to a standardized dose of furosemide (namely FST). RAI negative or NGAL negative patients are treated per usual care. FST-responders are managed conservatively, while non-responders receive fluid restrictive strategy and/or continuous renal replacement therapy (CRRT) at 10%-15% of FO. 2100 patients over 3 years will be evaluated to capture 210 patients with severe AKI (KDIGO Stage 2 or 3 AKI), 100 patients with >10% FO, and 50 requiring CRRT. Primary analyses: Standardizing a pediatric FST and assessing prediction accuracy of CDA for severe AKI, FO>10% and CRRT requirement in children. Secondary analyses in patients with AKI: Renal function return to baseline, RRT and mortality within 28 days. Discussion: This will be the first prospective evaluation of feasibility of AKI CDA, integrating individual prediction tools in one cohesive and comprehensive approach, and its prediction of FO>10% and AKI, as well as the first to standardize the FST in the pediatric population. This will increase knowledge on current AKI prediction tools and provide actionable insight for early interventions in critically ill children based on their level of risk.
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- 2021
8. Renal Dysfunction Criteria in Critically Ill Children: The PODIUM Consensus Conference.
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Fitzgerald, Julie C., Basu, Rajit K., Fuhrman, Dana Y., Gorga, Stephen M., Hassinger, Amanda B., Sanchez-Pinto, L. Nelson, Selewski, David T., Sutherland, Scott M., and Akcan-Arikan, Ayse
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CONSENSUS (Social sciences) , *ONLINE information services , *MEDICAL information storage & retrieval systems , *CRITICALLY ill , *SYSTEMATIC reviews , *PATIENTS , *KIDNEY diseases , *TREATMENT effectiveness , *MEDLINE , *HOSPITAL care of children , *DISEASE complications , *CHILDREN - Abstract
CONTEXT: Renal dysfunction is associated with poor outcomes in critically ill children. OBJECTIVE: To evaluate the current evidence for criteria defining renal dysfunction in critically ill children and association with adverse outcomes. To develop contemporary consensus criteria for renal dysfunction in critically ill children. DATA SOURCES: PubMed and Embase were searched from January 1992 to January 2020. STUDY SELECTION: Included studies evaluated critically ill childrenwith renal dysfunction, performance characteristics of assessment tools for renal dysfunction, and outcomes related to mortality, functional status, or organ-specific or other patient-centered outcomes. Studieswith adults or premature infants (≤36 weeks' gestational age), animal studies, reviews, case series, and studies not published in Englishwith inability to determine eligibility criteriawere excluded. DATA EXTRACTION: Data were extracted from included studies into a standard data extraction form by task force members. RESULTS: The systematic reviewsupported the following criteria for renal dysfunction: (1) urine output < 0.5mL/kg per hour for ≥ 6 hours and serumcreatinine increase of 1.5 to 1.9 times baseline or ≥0.3mg/dL, or (2) urine output < 0.5mL/kg per hour for ≥12 hours, or (3) serum creatinine increase ≥2 times baseline, or (4) estimated glomerular filtration rate <35 mL/minute/1.73m², or (5) initiation of renal replacement therapy, or (6) fluid overload ≥20%. Data also support criteria for persistent renal dysfunction and for high risk of renal dysfunction. LIMITATIONS: All included studies were observational and many were retrospective. CONCLUSIONS: We present consensus criteria for renal dysfunction in critically ill children. [ABSTRACT FROM AUTHOR]
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- 2022
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9. Acute Renal Replacement Therapy in Pediatrics.
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Basu, Rajit K., Wheeler, Derek S., Goldstein, Stuart, and Doughty, Lesley
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ACUTE kidney failure , *CATHETERS , *HEMODIALYSIS , *KIDNEY diseases , *LONGITUDINAL method , *HEALTH outcome assessment , *PERITONEAL dialysis , *THERAPEUTICS , *TREATMENT effectiveness , *CHILDREN ,TREATMENT of acute kidney failure - Abstract
Acute kidney injury (AKI) independently increases morbidity and mortality in children admitted to the hospital. Renal replacement therapy (RRT) is an essential therapy in the setting of AKI and fluid overload. The decision to initiate RRT is complex and often complicated by concerns related to patient hemodynamic and thermodynamic instability. The choice of which RRT modality to use depends on numerous criteria that are both patient and treatment center specific. Surprisingly, despite decades of use, no randomized, controlled trial study involving RRT in pediatrics has been performed. Because of these factors, clear-cut consensus is lacking regarding key questions surrounding RRT delivery. In this paper, we will summarize existing data concerning RRT use in children. We discuss the major modalities and the data-driven specifics of each, followed by controversies in RRT. As no standard of care is in widespread use for RRT in AKI or in multiorgan disease, we conclude in this paper that prospective studies of RRT are needed to identify best practice guidelines. [ABSTRACT FROM AUTHOR]
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- 2011
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10. Weight as a Risk Factor for Mortality in Critically Ill Patients.
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Ayalon, Itay, Woo, Jessica G., Basu, Rajit K., Kaddourah, Ahmad, Goldstein, Stuart L., and Kaplan, Jennifer M.
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ARTIFICIAL respiration , *BODY weight , *CRITICALLY ill , *LENGTH of stay in hospitals , *MORTALITY , *CHILDHOOD obesity , *PATIENTS , *RISK assessment , *SEPSIS , *WATER-electrolyte imbalances , *SECONDARY analysis , *CHILDREN - Abstract
OBJECTIVES: To explore the hypothesis that obesity is associated with increased mortality and worse outcomes in children who are critically ill. METHODS: Secondary analysis of the Assessment of Worldwide Acute Kidney Injury, Renal Angina, and Epidemiology study, a prospective, multinational observational study. Patients between 3 months and 25 years across Asia, Australia, Europe, and North America were recruited for 3 consecutive months. Patients were divided into 4 groups (underweight, normal weight, overweight, and obese) on the basis of their BMI percentile for age and sex. RESULTS: A total of 3719 patients were evaluated, of whom 542 (14%) had a primary diagnosis of sepsis. One thousand fifty-nine patients (29%) were underweight, 1649 (44%) were normal weight, 423 (11%) were overweight, and 588 (16%) were obese. The 28-day mortality rate was 3.6% for the overall cohort and 9.1% for the sepsis subcohort and differed significantly by weight status (5.8%, 3.1%, 2.2%, and 1.8% for subjects with underweight, normal weight, overweight, and obesity, respectively, in the overall cohort [P < .001] and 15.4%, 6.6%, 3.6%, and 4.7% in the sepsis subcohort, respectively [P = .003]). In a fully adjusted model, 28-day mortality risk was 1.8-fold higher in the underweight group versus the normal weight group in the overall cohort and 2.9-fold higher in the sepsis subcohort. Patients who were overweight and obese did not demonstrate increased risk in their respective cohorts. Patients who were underweight had a longer ICU length of stay, increased need for mechanical ventilation support, and a higher frequency of fluid overload. CONCLUSIONS: Patients who are underweight make up a significant proportion of all patients in the PICU, have a higher short-term mortality rate, and have a more complicated ICU course. [ABSTRACT FROM AUTHOR]
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- 2020
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11. Quantitative SARS-CoV-2 Serology in Children With Multisystem Inflammatory Syndrome (MIS-C).
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Rostad, Christina A., Chahroudi, Ann, Mantus, Grace, Lapp, Stacey A., Teherani, Mehgan, Macoy, Lisa, Tarquinio, Keiko M., Basu, Rajit K., Kao, Carol, Linam, W. Matthew, Zimmerman, Matthew G., Pei-Yong Shi, Menachery, Vineet D., Oster, Matthew E., Edupuganti, Srilatha, Anderson, Evan J., Suthar, Mehul S., Wrammert, Jens, and Jaggi, Preeti
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BLOOD sedimentation , *HOSPITAL care of children , *CONFIDENCE intervals , *ENZYME-linked immunosorbent assay , *LENGTH of stay in hospitals , *IMMUNOGLOBULINS , *LONGITUDINAL method , *MUCOCUTANEOUS lymph node syndrome , *PROTEINS , *REGRESSION analysis , *SEROLOGY , *VIRAL pneumonia , *SYSTEMIC inflammatory response syndrome , *COVID-19 , *SARS-CoV-2 , *CHILDREN - Abstract
OBJECTIVES: We aimed to measure severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) serological responses in children hospitalized with multisystem inflammatory syndrome in children (MIS-C) compared with those with coronavirus disease 2019 (COVID-19), those with Kawasaki disease (KD), and hospitalized pediatric controls. METHODS: From March 17, 2020, to May 26, 2020, we prospectively identified hospitalized children with MIS-C (n = 10), symptomatic COVID-19 (n = 10), and KD (n = 5) and hospitalized controls (n = 4) at Children's Healthcare of Atlanta. With institutional review board approval, we obtained prospective and residual blood samples from these children and measured SARS-CoV-2 spike receptor-binding domain (RBD) immunoglobulin M and immunoglobulin G (IgG), full-length spike IgG, and nucleocapsid protein antibodies using quantitative enzyme-linked immunosorbent assays and SARS-CoV-2 neutralizing antibodies using live-virus focus-reduction neutralization assays. We statistically compared the logtransformed antibody titers among groups and performed linear regression analyses. RESULTS: All children with MIS-C had high titers of SARS-CoV-2 RBD IgG antibodies, which correlated with full-length spike IgG antibodies (R² = 0.956; P, .001), nucleocapsid protein antibodies (R² = 0.846; P < .001), and neutralizing antibodies (R² = 0.667; P < .001). Children with MIS-C had significantly higher SARS-CoV-2 RBD IgG antibody titers (geometric mean titer 6800; 95% confidence interval 3495-13 231) than children with COVID-19 (geometric mean titer 626; 95% confidence interval 251-1563; P < .001), children with KD (geometric mean titer 124; 95% confidence interval 91-170; P, .001), and hospitalized controls (geometric mean titer 85; P < .001). All children with MIS-C also had detectable RBD immunoglobulin M antibodies, indicating recent SARS-CoV-2 infection. RBD IgG titers correlated with the erythrocyte sedimentation rate (R² = 0.512; P < .046) and with hospital (R² = 0.548; P = .014) and ICU lengths of stay (R² = 0.590; P = .010). CONCLUSIONS: Quantitative SARS-CoV-2 serology may have a role in establishing the diagnosis of MIS-C, distinguishing it from similar clinical entities, and stratifying risk for adverse outcomes. [ABSTRACT FROM AUTHOR]
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- 2020
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