11 results on '"Sethi, Sidharth Kumar"'
Search Results
2. Dialysis disequilibrium syndrome (DDS) in pediatric patients on dialysis: systematic review and clinical practice recommendations
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Raina, Rupesh, Davenport, Andrew, Warady, Bradley, Vasistha, Prabhav, Sethi, Sidharth Kumar, Chakraborty, Ronith, Khooblall, Prajit, Agarwal, Nirav, Vij, Manan, Schaefer, Franz, Malhotra, Kunal, and Misra, Madhukar
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- 2022
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3. Prevention of dialysis disequilibrium syndrome in children with advanced uremia with a structured hemodialysis protocol: A quality improvement initiative study.
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Sethi, Sidharth Kumar, Luyckx, Valerie, Bunchman, Timothy, Nair, Aishwarya, Bansal, Shyam Bihari, Pember, Bryce, Soni, Kritika, Savita, Yadav, Dinesh Kumar, Sharma, Vivek, Alhasan, Khalid, and Raina, Rupesh
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SYNDROMES in children , *DIALYSIS (Chemistry) , *HEMODIALYSIS , *UREMIA , *CHILD patients - Abstract
Background: Dialysis disequilibrium syndrome (DDS) is a rare but significant concern in adult and pediatric patients undergoing dialysis initiation with advanced uremia or if done after an interval. It is imperative to gain insights into the epidemiological patterns, pathophysiological mechanisms, and preventive strategies aimed at averting the onset of this ailment. Design: Prospective observational quality improvement initiative cohort study. Setting and Participants: A prospective single‐center study involving 50 pediatric patients under 18 years recently diagnosed with chronic kidney disease stage V with blood urea ≥200 mg/dL, admitted to our tertiary care center for dialysis initiation from January 2017 to October 2023. Quality Improvement Plan: A standardized protocol was developed and followed for hemodialysis in pediatric patients with advanced uremia. This protocol included measures such as lower urea reduction ratios (targeted at 20%–30%) with shorter dialysis sessions and linear dialysate sodium profiling. Prophylactic administration of mannitol and 25% dextrose was also done to prevent the incidence of dialysis disequilibrium syndrome. Measures: Incidence of dialysis disequilibrium syndrome and severe dialysis disequilibrium syndrome, mortality, urea reduction ratios (URRs), neurological outcome at discharge, and development of complications such as infection and hypotension. Long‐term outcomes were assessed at the 1‐year follow‐up including adherence to dialysis, renal transplantation, death, and loss to follow‐up. Results: The median serum creatinine and urea levels at presentation were 7.93 and 224 mg/dL, respectively. A total of 20% of patients had neurological symptoms attributable to advanced uremia at the time of presentation. The incidence of dialysis disequilibrium syndrome was 4% (n = 2) with severe dialysis disequilibrium syndrome only 2% (n = 1). Overall mortality was 8% (n = 4) but none of the deaths were attributed to dialysis disequilibrium syndrome. The mean urea reduction ratios for the first, second, and third dialysis sessions were 23.45%, 34.56%, and 33.50%, respectively. The patients with dialysis disequilibrium syndrome were discharged with normal neurological status. Long‐term outcomes showed 88% adherence to dialysis and 38% renal transplantation. Limitations: This study is characterized by a single‐center design, nonrandomized approach, and limited sample size. Conclusions: Our structured protocol served as a framework for standardizing procedures contributing to low incidence rates of dialysis disequilibrium syndrome. [ABSTRACT FROM AUTHOR]
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- 2024
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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. Challenges of long‐term vascular access in pediatric hemodialysis: Recommendations for practitioners.
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Raina, Rupesh, Joshi, Hirva, Chakraborty, Ronith, and Sethi, Sidharth Kumar
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SURGICAL arteriovenous shunts ,HOME hemodialysis ,CENTRAL venous catheters ,CHRONIC kidney failure ,HEMODIALYSIS ,ARTERIOVENOUS fistula - Abstract
Kidney transplantation is the preferred treatment of end‐stage renal disease in children. However, time to transplant varies, making a well‐functioning long‐term vascular access essential for performing hemodialysis efficiently and without disruption until a kidney becomes available. However, establishing long‐term vascular access in pediatric patients can present distinct challenges due to this population's unique characteristics, such as smaller body size and lower‐diameter blood vessels. There are three main pediatric long‐term vascular access options, which include central venous catheters (CVC), arteriovenous fistula (AVF), and arteriovenous graft (AVG). CVC are currently the most widely used modality, although various studies and guidelines recommend AVF or AVG as the preferred option. Although AVF should be used whenever possible, it is crucial that clinicians consider factors such as patient size, physical exam findings, comorbidities, predicted duration of treatment to decide on the most optimal long‐term vascular access modality. This article reviews the three long‐term vascular access methods in children and the benefits and complications of each. [ABSTRACT FROM AUTHOR]
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- 2021
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6. Pediatric intradialytic hypotension: recommendations from the Pediatric Continuous Renal Replacement Therapy (PCRRT) Workgroup.
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Raina, Rupesh, Lam, Stephanie, Raheja, Hershita, Krishnappa, Vinod, Hothi, Daljit, Davenport, Andrew, Chand, Deepa, Kapur, Gaurav, Schaefer, Franz, Sethi, Sidharth Kumar, McCulloch, Mignon, Bagga, Arvind, Bunchman, Timothy, and Warady, Bradley A.
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MANNITOL ,MIDODRINE ,BARORECEPTORS ,BLOOD volume ,DRUGS ,HEMODIALYSIS ,MEDICAL information storage & retrieval systems ,HYPOTENSION ,KIDNEY diseases ,MEDLINE ,ONLINE information services ,SODIUM ,THERAPEUTICS ,ULTRAFILTRATION ,SYSTEMATIC reviews ,CHILDREN ,DIAGNOSIS ,PREVENTION - Abstract
Intradialytic hypotension (IDH) is a common adverse event resulting in premature interruption of hemodialysis, and consequently, inadequate fluid and solute removal. IDH occurs in response to the reduction in blood volume during ultrafiltration and subsequent poor compensatory mechanisms due to abnormal cardiac function or autonomic or baroreceptor failure. Pediatric patients are inherently at risk for IDH due to the added difficulty of determining and attaining an accurate dry weight. While frequent blood pressure monitoring, dialysate sodium profiling, ultrafiltration-guided blood volume monitoring, dialysate cooling, hemodiafiltration, and intradialytic mannitol and midodrine have been used to prevent IDH, they have not been extensively studied in pediatric population. Lack of large-scale studies on IDH in children makes it difficult to develop evidence-based management guidelines. Here, we aim to review IDH preventative strategies in the pediatric population and outlay recommendations from the Pediatric Continuous Renal Replacement Therapy (PCRRT) Workgroup. Without strong evidence in the literature, our recommendations from the expert panel reflect expert opinion and serve as a valuable guide. [ABSTRACT FROM AUTHOR]
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- 2019
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7. Prolonged intermittent renal replacement therapy in children.
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Sinha, Rajiv, Sethi, Sidharth Kumar, Bunchman, Timothy, Lobo, Valentine, and Raina, Rupesh
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BLOOD filtration , *HEMODIALYSIS , *HEMODYNAMICS , *INTENSIVE care units , *KIDNEY diseases , *PEDIATRICS , *PERITONEAL dialysis , *THERAPEUTICS , *TREATMENT duration ,TREATMENT of acute kidney failure - Abstract
Wide ranges of age and weight in pediatric patients makes renal replacement therapy (RRT) in acute kidney injury (AKI) challenging, particularly in the pediatric intensive care unit (PICU), wherein children are often hemodynamically unstable. Standard hemodialysis (HD) is difficult in this group of children and continuous veno-venous hemofiltration/dialysis (CVVH/D) has been the accepted modality in the developed world. Unfortunately, due to cost constraints, CVVH/D is often not available and peritoneal dialysis (PD) remains the common mode of RRT in resource-poor facilities. Acute PD has its drawbacks, and intermittent HD (IHD) done slowly over a prolonged period has been explored as an alternative. Various modes of slow sustained IHD have been described in the literature with the recently introduced term prolonged intermittent RRT (PIRRT) serving as an umbrella terminology for all of these modes. PIRRT has been widely accepted in adults with studies showing it to be as effective as CVVH/D but with an added advantage of being more cost-effective. Pediatric data, though scanty, has been promising. In this current review, we elaborate on the practical aspects of undertaking PIRRT in children as well as summarize its current status. [ABSTRACT FROM AUTHOR]
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- 2018
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8. Hemodialysis in neonates and infants: A systematic review.
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Raina, Rupesh, Vijayaraghavan, Prashanth, Kapur, Gaurav, Sethi, Sidharth Kumar, Krishnappa, Vinod, Kumar, Deepak, Bunchman, Timothy E., Bolen, Shari D., and Chand, Deepa
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HEMODIALYSIS ,BLOOD flow ,NEWBORN infants ,NEONATAL mortality ,HEALTH outcome assessment ,TREATMENT of acute kidney failure ,TREATMENT of chronic kidney failure ,ACUTE kidney failure ,AGE distribution ,CHRONIC kidney failure ,META-analysis ,NEONATAL intensive care ,PROGNOSIS ,RISK assessment ,NEONATAL intensive care units ,TREATMENT effectiveness - Abstract
Hemodialysis (HD) in neonates and infants poses unique challenges due to high risks of mortality attributable to obligatory small blood flow volumes. Although HD is often necessary in neonates, its effectiveness and feasibility are poorly understood. The aim of this review is to describe in detail the few studies reporting on HD in neonates and infants (<12 months old) and then dissertate more broadly on the subject with an emphasis on recent innovations with potential to overcome traditional barriers for effective HD in this population. We detail the clinical characteristics, outcomes, technical considerations, maintenance and complications associated with HD, and provide guidance for addressing challenges associated with HD in this population. [ABSTRACT FROM AUTHOR]
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- 2018
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9. Heparin free dialysis in critically sick children using sustained low efficiency dialysis (SLEDD-f): A new hybrid therapy for dialysis in developing world.
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Sethi, Sidharth Kumar, Bansal, Shyam B., Khare, Anshika, Dhaliwal, Maninder, Raghunathan, Veena, Wadhwani, Nikita, Nandwani, Ashish, Yadav, Dinesh Kumar, Mahapatra, Amit Kumar, and Raina, Rupesh
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HEPARIN , *HEMODIALYSIS , *CHILD patients , *HEMODYNAMICS , *ACQUISITION of data - Abstract
Background: In critically sick adults, sustained low efficiency dialysis [SLED] appears to be better tolerated hemodynamically and outcomes seem to be comparable to CRRT. However, there is paucity of data in critically sick children. In children, two recent studies from Taiwan (n = 11) and India (n = 68) showed benefits of SLED in critically sick children. Aims and objectives: The objective of the study was to look at the feasibility and tolerability of sustained low efficiency daily dialysis-filtration [SLEDD-f] in critically sick pediatric patients. Material and methods: Design: Retrospective study Inclusion criteria: All pediatric patients who had undergone heparin free SLEDD-f from January 2012 to October 2017. Measurements: Data collected included demographic details, vital signs, PRISM III at admission, ventilator parameters (where applicable), number of inotropes, blood gas and electrolytes before, during, and on conclusion of SLED therapy. Technical information was gathered regarding SLEDD-f prescription and complications. Results: Between 2012–2017, a total of 242 sessions of SLEDD-f were performed on 70 patients, out of which 40 children survived. The median age of patients in years was 12 (range 0.8–17 years), and the median weight was 39 kg (range 8.5–66 kg). The mean PRISM score at admission was 8.77±7.22. SLEDD-f sessions were well tolerated, with marked improvement in fluid status and acidosis. Premature terminations had to be done in 23 (9.5%) of the sessions. There were 21 sessions (8.6%) terminated due to hypotension and 2 sessions (0.8%) terminated due to circuit clotting. Post- SLEDD-f hypocalcemia occurred in 15 sessions (6.2%), post- SLEDD-f hypophosphatemia occurred in 1 session (0.4%), and post- SLEDD-f hypokalemia occurred in 17 sessions (7.0%). Conclusions: This study is the largest compiled data on pediatric SLEDD-f use in critically ill patients. Our study confirms the feasibility of heparin free SLEDD-f in a larger pediatric population, and even in children weighing <20 kg on inotropic support. [ABSTRACT FROM AUTHOR]
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- 2018
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10. Treatment of AKI in developing and developed countries: An international survey of pediatric dialysis modalities.
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Raina, Rupesh, Chauvin, Abigail M., Bunchman, Timothy, Askenazi, David, Deep, Akash, Ensley, Michael J., Krishnappa, Vinod, and Sethi, Sidharth Kumar
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TREATMENT of acute kidney failure ,HEMODIALYSIS ,PEDIATRICS ,HEALTH surveys ,CAUSES of death ,DISEASE incidence ,DEVELOPED countries - Abstract
Hypothesis: Acute kidney injury (AKI) is a common cause of morbidity and mortality worldwide, with a pediatric incidence ranging from 19.3% to 24.1%. Treatment of pediatric AKI is a source of debate in varying geographical regions. Currently CRRT is the treatment for pediatric AKI, but limitations due to cost and accessibility force use of adult equipment and other therapeutic options such as peritoneal dialysis (PD) and hemodialysis (HD). It was hypothesized that more cost-effective measures would likely be used in developing countries due to lesser resource availability. Methods: A 26-question internet-based survey was distributed to 650 pediatric Nephrologists. There was a response rate of 34.3% (223 responses). The survey was distributed via pedneph and pcrrt email servers, inquiring about demographics, technology, resources, pediatric-specific supplies, and preference in renal replacement therapy (RRT) in pediatric AKI. The main method of analysis was to compare responses about treatments between nephrologists in developed countries and nephrologists in developing countries using difference-of-proportions tests. Results: PD was available in all centers surveyed, while HD was available in 85.1% and 54.1% (p = 0.00), CRRT was available in 60% and 33.3% (p = 0.001), and SLED was available in 20% and 25% (p = 0.45) centers of developed and developing world respectively. In developing countries, 68.5% (p = 0.000) of physicians preferred PD to costlier therapies, while in developed countries it was found that physicians favored HD (72%, p = 0.00) or CRRT (24%, p = 0.041) in infants. Conclusions: Lack of availability of resources, trained physicians and funds often preclude standards of care in developing countries, and there is much development needed in terms of meeting higher global standards for treating pediatric AKI patients. PD remains the main modality of choice for treatment of AKI in infants in developing world. [ABSTRACT FROM AUTHOR]
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- 2017
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11. A young child with fever and unexplained acute kidney injury: Questions.
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Sethi, Sidharth Kumar, Nautiyal, Arushi, Rana, Alka, Duggal, Rajan, Nandwani, Ashish, Yadav, Dinesh, Mahapatra, Amit, Dhaliwal, Maninder, Raghunathan, Veena, and Bansal, Shyam Bihari
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ACUTE kidney failure , *ANEMIA diagnosis , *SPLEEN diseases , *THROMBOCYTOPENIA , *NECROSIS , *HYPERKALEMIA , *HYPERTENSION , *AMINOTRANSFERASES , *ASCITES , *BIOPSY , *BLOOD diseases , *CEREBRAL cortex , *DIAGNOSTIC errors , *FEVER , *HEMODIALYSIS , *INTENSIVE care units , *PEDIATRICS , *PLEURAL effusions , *URINALYSIS , *DEXAMETHASONE , *MEDICALLY unexplained symptoms , *SYMPTOMS , *CHILDREN , *DIAGNOSIS ,TREATMENT of acute kidney failure ,BONE marrow examination - Abstract
A quiz is presented concerning a young child with fever and unexplained acute kidney injury.
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- 2018
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