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Expanded use and steady improvements in continuous renal replacement techniques (CRRT) have enhanced the safety of the application of kidney replacement therapy (KRT) to hemodynamically unstable intensive care unit (ICU) patients. The longer duration of therapy and the personalized prescription provided by continuous therapies are associated with greater hemodynamic stability and a modestly higher likelihood of kidney recovery than standard intermittent hemodialysis (IHD). Studies designed to evaluate the effect on mortality over intermittent therapies lack evidence of benefit. A lack of standardization and considerable variation in how CRRT is performed leads to wide variation in how the technique is prescribed, delivered, and optimized. Technology has progressed in critical care nephrology, and more progress is coming. New CRRT machines are equipped with a friendly user interface that allows easy performance and monitoring, permitting outcome measurements and improved patient quality control. This review discusses the key concepts necessary to guide nephrologists to prescribe and deliver KRT to critically ill ICU patients.

Critically ill patients who develop severe acute kidney injury in the intensive care unit often require treatment with renal replacement therapies (RRTs). This complication is associated with severe morbidity and mortality and high costs, both during hospitalization and postdischarge. This article discusses the operational requirements to develop and conduct a RRT program, as well as the financial implications of this complex form of patient care. The management of these programs must occur in a context where a clear organizational and educational framework and a multidisciplinary team ensures safety, effectiveness, cost-control, and a clear quality control framework.

The magnetic properties of $${\text{SrFe}}_{12}{\text{O}}_{19}$$ SrFe 12 O 19 , a paradigmatic hexaferrite for permanent magnet applications, have been addressed in detail combining density functional theory including spin–orbit coupling and a Hubbard U term with Monte Carlo simulations. This multiscale approach allows to estimate the Néel temperature of the material from ab initio exchange constants, and to determine the influence of different computational conditions on the magnetic properties by direct comparison versus available experimental data. It is found that the dominant influence arises from the choice of the Hubbard U term, with a value in the 2–3 eV range as the most adequate to quantitatively reproduce the two most relevant magnetic properties of this material, namely: its large perpendicular magnetocrystalline anisotropy and its elevated Néel temperature.

The synthesis of a novel expanded π-conjugated system, namely benzotri(7-azaindole), BTAI, is reported. Its C 3h symmetry along with the integration of six complementary donor and acceptor N-H···N hydrogen bonds in the conjugated structure promote the 2D self-assembly on Au(111) over extended areas. Besides, a perfect commensurability with the gold lattice endows the physisorbed molecular film with a remarkable stability. The structural features of BTAI result in two levels of surface chirality: Firstly, the molecules become chiral upon adsorption on the surface. Then, due to the favorable N-H···N hydrogen bond-directed self-assembly, along with the relative molecular rotation with respect to the substrate, supramolecular chirality manifests in two mirror enantiomorphous domains. Thus, the system undergoes spontaneous chiral resolution. LEED and STM assisted by theoretical simulations have been employed to characterize in detail these novel 2D conglomerates with relevant chiral properties for systems with C 3h symmetry.

Spin-orbit coupling (SOC) is generally understood as a highly localized interaction within each atom, whereby core electrons holding large J splittings transfer the SOC to the valence electrons of the same atom, while their direct impact on neighbor valence orbitals is usually small. Seivane and Ferrer [Phys. Rev. Lett. 99, 183401 (2007)PRLTAO0031-900710.1103/PhysRevLett.99.183401] proposed an approach within a tight-binding type ab initio framework assuming that the transfer of SOC from core to valence orbitals only takes place when both are on the same atom, leading to the so-called on-site approximation, which then has been successfully applied to a variety of systems. In this work we thoroughly test its general validity by confronting SOC related properties such as spin splittings, spin textures, or magnetic anisotropies calculated under the on-site approximation versus the more general approach where all the contributions to the SOC, including three-center integrals, are explicitly included. After considering a variety of systems with different dimensionalities, all presenting a strong SOC, we conclude that although the on-site approximation often provides accurate results, it breaks down in some systems where 5d electrons are close to the Fermi level due to their strong SOC and moderately large spatial extension. Furthermore, there are a few examples where subtle inaccuracies lead to qualitatively wrong conclusions, the most clear case being the doping of the topological surface state in Bi2Se3(0001). Finally, magnetic anisotropy energies calculated under this approximation tend to be underestimated., This work was financially supported by the Spanish MINECO, MICIU, AEI, and EU FEDER (Grants No. MAT2015-66888-C3-1R, No. RTI2018-097895-B-C41, No. PGC2018-094783, No. PGC2018-096955-C43, and No. PGC2018-096955-C44), Generalitat de Catalunya (Grant No. 2017SGR1506), and the EU MaX Center of Excellence (EU-H2020 Grant No. 824143). ICN2 is supported by the Severo Ochoa program from Spanish MINECO (Grant No. SEV-2017-0706) and the CERCA Program of Generalitat de Catalunya. ICMAB is supported by the Spanish MICINN through the Severo Ochoa Centers of Excellence Program (Grant No. CEX2019-000917-S). R.C. acknowledges the funding from the European Union’s Horizon 2020 research and innovation program under the Marie Skłodoswka-Curie Grant Agreement No. 665919., With funding from the Spanish government through the ‘Severo Ochoa Centre of Excellence’ accreditation (CEX2019-000917-S).

AKI is a common complication in hospitalized and critically ill patients. Its incidence has steadily increased over the past decade. Whether transient or prolonged, AKI is an independent risk factor associated with poor short- and long-term outcomes, even if patients do not require KRT. Most patients with early AKI improve with conservative management; however, some will require dialysis for a few days, a few weeks, or even months. Approximately 10%-30% of AKI survivors may still need dialysis after hospital discharge. These patients have a higher associated risk of death, rehospitalization, recurrent AKI, and CKD, and a lower quality of life. Survivors of critical illness may also suffer from cognitive dysfunction, muscle weakness, prolonged ventilator dependence, malnutrition, infections, chronic pain, and poor wound healing. Collaboration and communication among nephrologists, primary care physicians, rehabilitation providers, physical therapists, nutritionists, nurses, pharmacists, and other members of the health care team are essential to create a holistic and patient-centric care plan for overall recovery. Integration of the patient and family members in health care decisions, and ongoing education throughout the process, are vital to improve patient well-being. From the nephrologist standpoint, assessing and promoting recovery of kidney function, and providing appropriate short- and long-term follow-up, are crucial to prevent rehospitalizations and to reduce complications. Return to baseline functional status is the ultimate goal for most patients, and dialysis independence is an important part of that goal. In this review, we seek to highlight the varying aspects and stages of recovery from AKI complicating critical illness, and propose viable strategies to promote recovery of kidney function and dialysis independence. We also emphasize the need for ongoing research and multidisciplinary collaboration to improve outcomes in this vulnerable population.

Nanometer-thick epitaxial Co films intercalated between graphene (Gr) and a heavy metal (HM) substrate are promising systems for the development of spin–orbitronic devices due to their large perpendicular magnetic anisotropy (PMA). A combination of theoretical modeling and experiments reveals the origin of the PMA and explains its behavior as a function of the Co thickness. High quality epitaxial Gr/Con/HM(111) (HM = Pt,Ir) heterostructures are grown by intercalation below graphene, which acts as a surfactant that kinetically stabilizes the pseudomorphic growth of highly perfect Co face-centered tetragonal (fct) films, with a reduced number of stacking faults as the only structural defect observable by high-resolution scanning transmission electron microscopy (STEM). Magneto-optic Kerr effect (MOKE) measurements show that such heterostructures present PMA up to large Co critical thicknesses of about 4 nm (20 ML) and 2 nm (10 ML) for Pt and Ir substrates, respectively. X-ray magnetic circular dichroism (XMCD) measurements show an inverse power law of the anisotropy of the orbital moment with Co thickness, reflecting its interfacial nature, that changes sign at about the same critical values. First principles calculations show that, regardless of the presence of graphene, ideal Co fct films on HM buffers do not sustain PMAs beyond around 6 mLs due to the in-plane contribution of the inner bulk-like Co layers. The large experimental critical thicknesses sustaining PMA can only be retrieved by the inclusion of structural defects that promote a local hcp stacking such as twin boundaries or stacking faults. Remarkably, a layer resolved analysis of the orbital momentum anisotropy reproduces its interfacial nature, and reveals that the Gr/Co interface contribution is comparable to that of the Co/Pt(Ir)., Financial support from MINECO (Grant Nos. RTI2018-097895-B-C41, RTI2018-097895-B-C42 and RTI2018-097895-B-C43 (FUN-SOC), PID2019-103910GB-I00, FIS2016-78591-C3-1-R and FIS2016-78591-C3-2-R (SKYTRON), PGC2018-098613-B-C21 (SpOrQuMat), PCI2019-111908-2 and PCI2019-111867-2 (FLAGERA 3 grant SOgraphMEM)], from Regional Government of Madrid (grant number P2018/NMT-4321 (NANOMAGCOST-CM)) and from Gobierno Vasco-UPV/EHU (grant numbers GIU18/138 and IT-1246-19). We acknowledge experiments at ALBA BL29 via proposal no. 2019023333. IMDEA-Nanociencia acknowledges support from the “Severo Ochoa” Program for Centres of Excellence in R&D (MINECO, Grant SEV-2016-0686).

Acute kidney injury (AKI) is a common complication of acute illness and carries a significant risk of mortality and morbidity, resulting in high health-care-associated costs. The incidence of AKI appears to be rising, making it ever more important to understand its acute and chronic consequences. In this review, we explore the evolving epidemiology of AKI, describe the impact of AKI on other organs, and discuss the short- and long-term effects of AKI on mortality and morbidity and its economic burden.

This article is part of the JCP Special Topic on Electronic Structure Software., A review of the present status, recent enhancements, and applicability of the SIESTA program is presented. Since its debut in the mid-1990s, SIESTA’s flexibility, efficiency, and free distribution have given advanced materials simulation capabilities to many groups worldwide. The core methodological scheme of SIESTA combines finite-support pseudo-atomic orbitals as basis sets, norm-conserving pseudopotentials, and a realspace grid for the representation of charge density and potentials and the computation of their associated matrix elements. Here, we describe the more recent implementations on top of that core scheme, which include full spin–orbit interaction, non-repeated and multiple-contact ballistic electron transport, density functional theory (DFT)+U and hybrid functionals, time-dependent DFT, novel reduced-scaling solvers, density-functional perturbation theory, efficient van der Waals non-local density functionals, and enhanced molecular-dynamics options. In addition, a substantial effort has been made in enhancing interoperability and interfacing with other codes and utilities, such as WANNIER90 and the second-principles modeling it can be used for, an AiiDA plugin for workflow automatization, interface to Lua for steering SIESTA runs, and various post-processing utilities. SIESTA has also been engaged in the Electronic Structure Library effort from its inception, which has allowed the sharing of various low-level libraries, as well as data standards and support for them, particularly the PSeudopotential Markup Language definition and library for transferable pseudopotentials, and the interface to the ELectronic Structure Infrastructure library of solvers. Code sharing is made easier by the new open-source licensing model of the program. This review also presents examples of application of the capabilities of the code, as well as a view of on-going and future developments., Siesta development was historically supported by different Spanish National Plan projects (Project Nos. MEC-DGES-PB95-0202, MCyT-BFM2000-1312, MEC-BFM2003-03372, FIS2006-12117, FIS2009-12721, FIS2012-37549, FIS2015-64886-P, and RTC-2016-5681-7), the latter one together with Simune Atomistics Ltd. We are thankful for financial support from the Spanish Ministry of Science, Innovation and Universities through Grant No. PGC2018-096955-B. We acknowledge the Severo Ochoa Center of Excellence Program [Grant Nos. SEV-2015-0496 (ICMAB) and SEV-2017-0706 (ICN2)], the GenCat (Grant No. 2017SGR1506), and the European Union MaX Center of Excellence (EU-H2020 Grant No. 824143). P.G.-F. acknowledges support from Ramón y Cajal (Grant No. RyC-2013-12515). J.I.C. acknowledges Grant No. RTI2018-097895-B-C41. R.C. acknowledges the European Union’s Horizon 2020 Research and Innovation Program under Marie Skłodoswka-Curie Grant Agreement No. 665919. D.S.P, P.K., and P.B. acknowledge Grant No. MAT2016-78293-C6, FET-Open No. 863098, and UPV-EHU Grant No. IT1246-19. V. W. Yu was supported by a MolSSI Fellowship (U.S. NSF Award No. 1547580), and V.B. and V.W.Y. were supported by the ELSI Development by the NSF (Award No. 1450280).

Background Acute kidney injury (AKI) is increasingly encountered in community settings and contributes to morbidity, mortality, and increased resource utilization worldwide. In low-resource settings, lack of awareness of and limited access to diagnostic and therapeutic interventions likely influence patient management. We evaluated the feasibility of the use of point-of-care (POC) serum creatinine and urine dipstick testing with an education and training program to optimize the identification and management of AKI in the community in 3 low-resource countries. Methods and findings Patients presenting to healthcare centers (HCCs) from 1 October 2016 to 29 September 2017 in the cities Cochabamba, Bolivia; Dharan, Nepal; and Blantyre, Malawi, were assessed utilizing a symptom-based risk score to identify patients at moderate to high AKI risk. POC testing for serum creatinine and urine dipstick at enrollment were utilized to classify these patients as having chronic kidney disease (CKD), acute kidney disease (AKD), or no kidney disease (NKD). Patients were followed for a maximum of 6 months with repeat POC testing. AKI development was assessed at 7 days, kidney recovery at 1 month, and progression to CKD and mortality at 3 and 6 months. Following an observation phase to establish baseline data, care providers and physicians in the HCCs were trained with a standardized protocol utilizing POC tests to evaluate and manage patients, guided by physicians in referral hospitals connected via mobile digital technology. We evaluated 3,577 patients, and 2,101 were enrolled: 978 in the observation phase and 1,123 in the intervention phase. Due to the high number of patients attending the centers daily, it was not feasible to screen all patients to assess the actual incidence of AKI. Of enrolled patients, 1,825/2,101 (87%) were adults, 1,117/2,101 (53%) were females, 399/2,101 (19%) were from Bolivia, 813/2,101 (39%) were from Malawi, and 889/2,101 (42%) were from Nepal. The age of enrolled patients ranged from 1 month to 96 years, with a mean of 43 years (SD 21) and a median of 43 years (IQR 27–62). Hypertension was the most common comorbidity (418/2,101; 20%). At enrollment, 197/2,101 (9.4%) had CKD, and 1,199/2,101 (57%) had AKD. AKI developed in 30% within 7 days. By 1 month, 268/978 (27%) patients in the observation phase and 203/1,123 (18%) in the intervention phase were lost to follow-up. In the intervention phase, more patients received fluids (observation 714/978 [73%] versus intervention 874/1,123 [78%]; 95% CI 0.63, 0.94; p = 0.012), hospitalization was reduced (observation 578/978 [59%] versus intervention 548/1,123 [49%]; 95% CI 0.55, 0.79; p < 0.001), and admitted patients with severe AKI did not show a significantly lower mortality during follow-up (observation 27/135 [20%] versus intervention 21/178 [11.8%]; 95% CI 0.98, 3.52; p = 0.057). Of 504 patients with kidney function assessed during the 6-month follow-up, de novo CKD arose in 79/484 (16.3%), with no difference between the observation and intervention phase (95% CI 0.91, 2.47; p = 0.101). Overall mortality was 273/2,101 (13%) and was highest in those who had CKD (24/106; 23%), followed by those with AKD (128/760; 17%), AKI (85/628; 14%), and NKD (36/607; 6%). The main limitation of our study was the inability to determine the actual incidence of kidney dysfunction in the health centers as it was not feasible to screen all the patients due to the high numbers seen daily. Conclusions This multicenter, non-randomized feasibility study in low-resource settings demonstrates that it is feasible to implement a comprehensive program utilizing POC testing and protocol-based management to improve the recognition and management of AKI and AKD in high-risk patients in primary care., Etienne Macedo and colleagues report on a point-of-care testing program for acute kidney injury and disease in high-risk primary care patients., Author summary Why was this study done? The study was designed to assess the feasibility of implementing interventions to optimize care of acute kidney injury (AKI). We used a comprehensive 5R approach—risk, recognition, response, renal support, and rehabilitation—to test the intervention in resource-constrained regions in Africa, Asia, and Latin America. What did the researchers do and find? Patients seen in community healthcare centers were screened and assigned a risk level for AKI based on their presenting signs and symptoms. Patients with moderate to high risk were approached for consent and enrolled in the study, underwent kidney function assessment, and were followed for their disposition and outcomes. Kidney function was assessed using point-of-care (POC) tests that included a test strip for measuring creatinine level in the blood using a portable device and a urine dipstick test to evaluate for proteinuria. What do these findings mean? The ISN 0by25 trial successfully demonstrated the utility of a symptom-based health assessment risk score coupled with a POC creatinine and urine dipstick test in early recognition of kidney disease and appropriate triaging and management of patients presenting to primary healthcare centers in low-income countries. Kidney dysfunction was associated with an increased risk of mortality, which was higher in patients with a moderate severity of AKI. Recognition and management of patients was facilitated by the combination of the POC test and guidance through teleconsultation.

The American Society of Nephrology has established a new initiative, AKI!Now, with the goal of promoting excellence in the prevention and treatment of AKI by building a foundational program that transforms education and delivery of AKI care, aiming to reduce morbidity and associated mortality and to improve long-term outcomes. In this article, we describe our current efforts to improve early recognition and management involving inclusive interdisciplinary collaboration between providers, patients, and their families; discuss the ongoing need to change some of our current AKI paradigms and diagnostic methods; and provide specific recommendations to improve AKI recognition and care. In the hospital and the community, AKI is a common and increasingly frequent condition that generates risks of adverse events and high costs. Unfortunately, patients with AKI may frequently have received less than optimal quality of care. New classifications have facilitated understanding of AKI incidence and its impact on outcomes, but they are not always well aligned with AKI pathophysiology. Despite ongoing research efforts, treatments to promote or hasten kidney recovery remain ineffective. To avoid progression, the current approach to AKI emphasizes the promotion of early recognition and timely response. However, a lack of awareness of the importance of early recognition and treatment among health care team members and the heterogeneity of approaches within the health care teams assessing the patient remains a major challenge. Early identification is further complicated by differences in settings where AKI occurs (the community or the hospital), and by differences in patient populations and cultures between the intensive care unit and ward environments. To address these obstacles, we discuss the need to improve education at all levels of care and to generate specific guidance on AKI evaluation and management, including the development of a widely applicable education and an AKI management toolkit, engaging hospital administrators to incorporate AKI as a quality initiative, and raising awareness of AKI as a complication of other disease processes.

Our group has revealed an unprecedented one-dimensional (1D) Si atomic arrangement solely comprising highly perfect alternating pentagons residing in the missing row troughs of the reconstructed surface Ag(1 1 0). It is the first pure pentagonal phase ever found for silicon low-dimensional structures, initially theoretically supported by density functional theory (DFT) calculations compared to scanning tunneling microscopy observations, further rapidly confirmed by surface X-ray diffraction measurements. In fact, until now such a structure has only been obtained synthetically as 1D nanoribbons (1D-NRs) grown on a silver (1 1 0) substrate. These NRs adopt a highly ordered chiral arrangement in single- and/or double-strands. We thus simultaneously demonstrate the existence of penta-silicene, a recently conjectured novel pentagonal silicon allotrope, which remained unveiled for more than one decade, and which materializes a paradigmatic shift from normal hexagonal silicene. The discovery of 1D-penta-silicene NRs increases the chances of the future isolation of this new low-dimensional Si allotrope, provided these epitaxial NRs can be detached from the silver surface.

We propose a realistic topological p−n junction (TPNJ) by matching two BiSe (0001) slabs with opposite arrangements of planar twin boundary defects. The atomistic modeling of such a device leads to dislocation defects in the hexagonal lattice in several quintuple layers. Nevertheless, total energy calculations reveal that the interface relaxes, yielding a smooth geometrical transition that preserves the nearest-neighbors fcc-type geometry throughout these defect layers. The electronic, magnetic, and transport properties of the junction have then been calculated at the ab initio level under open boundary conditions, i.e., employing a thin-film geometry that is infinite along the electron transport direction. Indeed, a p−n junction is obtained with a built-in potential as large as 350 meV. The calculations further reveal the spin texture across the interface with unprecedented detail. As the main result, we obtain non-negligible transmission probabilities around the Γ point, which involve an electron spin-flip process while crossing the interface., This work has been supported by the Spanish Ministry of Economy and Competitiveness through Grant No. MAT2015-66888-C3-1R, MINECO/FEDER.

As advances in Critical Care Medicine continue, critically ill patients are surviving despite the severity of their illness. The incidence of acute kidney injury (AKI) has increased, and its impact on clinical outcomes as well as medical expenditures has been established. The role, indications and technological advancements of renal replacement therapy (RRT) have evolved, allowing more effective therapies with less complications. With these changes, Critical Care Nephrology has become an established specialty, and ongoing collaborations between critical care physicians and nephrologist have improved education of multi-disciplinary team members and patient care in the ICU. Multidisciplinary programs to support these changes have been stablished in some hospitals to maximize the delivery of care, while other programs have continue to struggle in their ability to acquire the necessary resources to maximize outcomes, educate their staff, and develop quality initiatives to evaluate and drive improvements. Clearly, the role of the nephrologist in the ICU has evolved, and varies widely among institutions. This special article will provide insights that will hopefully optimize the role of the nephrologist as the leader of the acute care nephrology program, as clinician for critically ill patients, and as teacher for all members of the health care team.

A second-order perturbation (2PT) approach to the spin-orbit interaction (SOI) is implemented within a density-functional theory framework. Its performance is examined by applying it to the calculation of the magnetocrystalline anisotropy energies (MAE) of benchmark systems, and its efficiency and accuracy are compared with the popular force theorem method. The case studies are tetragonal FeMe alloys (Me=Co, Cu, Pd, Pt, Au), as well as FeMe (Me=Co, Pt) bilayers with (111) and (100) symmetry, which cover a wide range of SOI strength and electronic band structures. The 2PT approach is found to provide a very accurate description for 3d and 4d metals and, moreover, this methodology is robust enough to predict easy axis switching under doping conditions. In all cases, the details of the bandstructure, including states far from the Fermi level, are responsible for the finally observed MAE value, sometimes overruling the effect of the SOI strength. From a technical point of view, it is confirmed that accuracy in the MAE calculations is subject to the accuracy of the Fermi level determination., Discussions with G Teobaldi and M dos Santos Dias are acknowledged. MB-R and AA thank financial support from MINECO (grant number FIS2016-75862-P), the University of the Basque Country (UPV/EHU) and the Basque Government (IT-756-13). JIC thanks MINECO for grant MAT2015-66888-C3-1R. Computational resources were provided by the DIPC computing centre.

This chapter reports the conclusions of an expert consensus conference on the basic principles and nomenclature of renal replacement therapy, currently used to manage acute kidney injury. Common definitions, transport mechanisms, and modalities used to deliver continuous extracorporeal therapies are discussed. A description of performance characteristics of membranes, filters, transmembrane transport of solutes and fluid, flows, and methods of measurement of delivered treatment are provided, focusing on continuous renal replacement therapies, which are used in the management of critically ill patients with acute kidney injury. Devices and operations are classified and defined in detail to provide guidelines for use of terminology in papers and research.

Introduction Nephrotoxicity from drugs accounts for 18% to 27% of cases of acute kidney injury. Determining a genetic predisposition may potentially be important in minimizing risk. The aims of this study are as follows: to determine whether a genetic predisposition exists for the development of drug-induced kidney disease (DIKD), using genome-wide association and whole-genome sequencing studies; to describe the frequency, course, risk factors, resolution and outcomes of DIKD cases; to investigate the role of ethnic/racial variability in the genetics of DIKD; and to explore the use of different tools establishing causality of DIKD. Methods A total of 800 patients will be enrolled worldwide and blood samples for DNA collected. Data on the patient risk factors, vital signs, laboratory parameters, drug exposure, and DIKD course will be recorded. A panel of nephrologists will adjudicate all cases. Genome-wide association studies will be conducted using population controls matched on biogeographic ancestry to determine whether there is a genetic predisposition to DIKD. The primary endpoint is the identification of specific drug-related polymorphisms associated with DIKD. Secondary endpoints include the following: frequency of DIKD by causal drug and drug combinations; DIKD genetic variability; exploration of causality assessment tools; risk factor identification; description of the course of DIKD, including mortality and dialysis dependency at hospital discharge and 28 and 90 days post-event. Results Data are currently being analyzed. Results are pending. Discussion The Genetic Contribution to Drug Induced Renal Injury (DIRECT) study will be the first observational cohort study to investigate the genetic determinants of DIKD. If the trial is positive, its findings will potentially translate into safer patient outcomes, by genotypic individualization of therapy and minimization of harm.

Epidemiological data for acute kidney injury are scarce, especially in low-income countries (LICs) and lower-middle-income countries (LMICs). We aimed to assess regional differences in acute kidney injury recognition, management, and outcomes.In this multinational cross-sectional study, 322 physicians from 289 centres in 72 countries collected prospective data for paediatric and adult patients with confirmed acute kidney injury in hospital and non-hospital settings who met criteria for acute kidney injury. Signs and symptoms at presentation, comorbidities, risk factors for acute kidney injury, and process-of-care data were obtained at the start of acute kidney injury, and need for dialysis, renal recovery, and mortality recorded at 7 days, and at hospital discharge or death, whichever came earlier. We classified countries into high-income countries (HICs), upper-middle-income countries (UMICs), and combined LICs and LMICs (LLMICs) according to their 2014 gross national income per person.Between Sept 29 and Dec 7, 2014, data were collected from 4018 patients. 2337 (58%) patients developed community-acquired acute kidney injury, with 889 (80%) of 1118 patients in LLMICs, 815 (51%) of 1594 in UMICs, and 663 (51%) of 1241 in HICs (for HICs vs UMICs p=0.33; p0.0001 for all other comparisons). Hypotension (1615 [40%] patients) and dehydration (1536 [38%] patients) were the most common causes of acute kidney injury. Dehydration was the most frequent cause of acute kidney injury in LLMICs (526 [46%] of 1153 vs 518 [32%] of 1605 in UMICs vs 492 [39%] of 1260 in HICs) and hypotension in HICs (564 [45%] of 1260 vs 611 [38%%] of 1605 in UMICs vs 440 [38%] of 1153 LLMICs). Mortality at 7 days was 423 (11%) of 3855, and was higher in LLMICs (129 [12%] of 1076) than in HICs (125 [10%] of 1230) and UMICs (169 [11%] of 1549).We identified common aetiological factors across all countries, which might be amenable to a standardised approach for early recognition and treatment of acute kidney injury. Study limitations include a small number of patients from outpatient settings and LICs, potentially under-representing the true burden of acute kidney injury in these areas. Additional strategies are needed to raise awareness of acute kidney injury in community health-care settings, especially in LICs.International Society of Nephrology.

Controlling the spin of electrons in nanoscale electronic devices is one of the most promising topics aiming at developing devices with rapid and high density information storage capabilities. The interface magnetism or spinterface resulting from the interaction between a magnetic molecule and a metal surface, or vice versa, has become a key ingredient in creating nanoscale molecular devices with novel functionalities. Here, we present a single-molecule wire that displays large (>10000%) conductance switching by controlling the spin-dependent transport under ambient conditions (room temperature in a liquid cell). The molecular wire is built by trapping individual spin crossover Fe-II complexes between one Au electrode and one ferromagnetic Ni electrode in an organic liquid medium. Large changes in the single-molecule conductance (>100-fold) are measured when the electrons flow from the Au electrode to either an alpha-up or a beta-down spin-polarized Ni electrode. Our calculations show that the current flowing through such an interface appears to be strongly spin-polarized, thus resulting in the observed switching of the single-molecule wire conductance. The observation of such a high spin-dependent conductance switching in a single-molecule wire opens up a new door for the design and control of spin-polarized transport in nanoscale molecular devices at room temperature.

Despite extensive research, no therapeutic interventions have been shown to prevent AKI, accelerate recovery of AKI, or reduce progression of AKI to CKD in patients. This failure in translation has led investigators to speculate that the animal models being used do not predict therapeutic responses in humans. Although this issue continues to be debated, an important concern that has not been addressed is whether improvements in preclinical study design can be identified that might also increase the likelihood of translating basic AKI research into clinical practice using the current models. In this review, we have taken an evidence-based approach to identify common weaknesses in study design and reporting in preclinical AKI research that may contribute to the poor translatability of the findings. We focused on use of N-acetylcysteine or sodium bicarbonate for the prevention of contrast-induced AKI and use of erythropoietin for the prevention of AKI, two therapeutic approaches that have been extensively studied in clinical trials. On the basis of our findings, we identified five areas for improvement in preclinical study design and reporting. These suggested and preliminary guidelines may help improve the quality of preclinical research for AKI drug development.

Previous randomized controlled trials evaluating the efficacy of mycophenolate mofetil (MMF) in patients with immunoglobulin A nephropathy (IgAN) have produced varying results.Double-blind placebo-controlled randomized controlled trial.52 children, adolescents, and adults with biopsy-proven IgAN in 30 centers in the United States and Canada. Entry criteria: age older than 7 to younger than 70 years; urine protein-creatinine ratio (UPCR), ≥0.6g/g (males) or ≥0.8g/g (females); and estimated glomerular filtration rate ≥ 50mL/min/1.73m(2) (≥40mL/min/1.73m(2) if receiving angiotensin-converting enzyme inhibitor). Mean age, 32±12 (SD) years; 62% men; and 73% white.Lisinopril (or losartan) plus a highly purified omega-3 fatty acid (Omacor [Pronova Biocare]) was given to 94 patients for 3 months; 52 of the patients with persistent UPCR≥0.6g/g (males) and ≥0.8g/g (females) were randomly assigned to MMF or placebo (target dose, 25-36mg/kg/d) in addition to lisinopril/losartan plus Omacor.Change in UPCR after 6 and 12 months treatment with MMF/placebo and 12 months after the end of treatment.UPCR measured on 24-hour urine samples. Glomerular filtration rate estimated with the Schwartz (age 18 years) or Cockcroft-Gault (age ≥ 18 years) formula.44 patients completed 6 months of treatment with MMF (n=22) or placebo (n=22). The trial was terminated early at the recommendation of the Data Monitoring Committee because of the lack of benefit. No patient achieved a complete remission (UPCR0.2g/g). Mean UPCRs at randomization and after 6 months were 1.45 (95% CI, 1.16-1.75) and 1.40 (95% CI, 1.09-1.70) for MMF and 1.41 (95% CI, 1.17-1.65) and 1.58 (95% CI, 1.13-2.04) for placebo, respectively. The mean difference in UPCR change between these groups (MMF minus placebo) was -0.22 (95% CI, -0.75 to 0.31; P=0.4). Adverse events were rare apart from nausea (MMF, 8.7%; placebo, 3.7%); one of these MMF patients withdrew.Low patient enrollment and short follow-up.MMF did not reduce proteinuria significantly in patients with IgAN who had persistent proteinuria after lisinopril/losartan plus Omacor.

Acute kidney injury (AKI) is a commonly encountered syndrome associated with various aetiologies and pathophysiological processes leading to decreased kidney function. In addition to retention of waste products, impaired electrolyte homeostasis and altered drug concentrations, AKI induces a generalized inflammatory response that affects distant organs. Full recovery of kidney function is uncommon, which leaves these patients at risk of long-term morbidity and death. Estimates of AKI prevalence range from

espanolLa terapia de reemplazo renal continuo (CRRT, por sus siglas en ingles) se utiliza en pacientes criticamente enfermos con lesion renal aguda (LRA). Este tratamiento tiene una historia cargada de tintes pasionales y ambiciosos que han revolucionado el tratamiento en las Unidades de terapia intensiva. Avances tecnologicos permiten remover toxinas y ajustar liquidos y moleculas de manera paulatina y segura, lo que que plausiblemente mejora el pronostico clinico. Las terapias continuas requieren una estrecha colaboracion del equipo multidisciplinario. Aunque los datos no demuestran ventaja entre las distintas modalidades de tratamiento de sustitucion renal, creemos que avanzamos hacia una estandarizacion del tratamiento con base en la evidencia, que ha de promover una continua mejoria en el tratamiento de pacientes criticos con LRA. En el presente articulo se comenta la evolucion tecnologica, los componentes del circuito extracorporeo, los pasos iniciales en el uso de las maquinas, los principios en mecanismos de transporte y, finalmente, las modalidades de mayor uso en CRRT. EnglishContinuous renal replacement therapy (CRRT) is used in critically ill patients with acute kidney injury. This modality of treatment, loaded with a history full of passion and ambition, has revolutionized treatment in intensive care units. Technological advances allow the removal of toxins and management of fluids and molecules in a gradual and safe way that plausibly improves the clinical prognosis. This technique requires close collaboration of the multidisciplinary team. Although data do not demonstrate an advantage among the different modalities of renal replacement therapy, we firmly believe that we are moving towards an evidence-based standardization of treatment, which should promote a continuous improvement in the management of critically ill patients with acute renal injury. The present study accomplishes the evolution of technology, the components of the extracorporeal circuit, the initial steps while using these dedicated machines, the principles of mechanisms of solute and water transport, and finally the most frequently prescribed modalities in CRRT.

The integration of modern information communication technology and technologically advanced equipment to routine clinical practice are important technological stepping stones in the management of patients with acute kidney injury (AKI). These tools improve practice and patient outcomes by supporting and individualizing all phases of AKI management. This narrative review describes the most recent bedside technological advances in AKI diagnosis, renal replacement therapy education, prescription, monitoring, delivery, and measurement of outcomes with an emphasis on providing highly personalized patient care.

Acute kidney injury (AKI) is one of the most common complications in acutely ill patients. The epidemiology, clinical presentation, and outcome vary between patients and countries.Patients with AKI often exhibit multiple organ dysfunction that is caused, in part, by marked cross-talk between the kidney and other organs and tissues. These deleterious interactions arise, at least in part, from systemic inflammatory changes, an increased cytokine load, increases in leukocyte trafficking and activation of neurohormonal processes. Typical short-term complications of AKI include acute lung injury, liver dysfunction, cardio-renal syndrome, brain dysfunction, systemic inflammation, and increased mortality. Survivors of AKI are at risk of chronic kidney disease, cardiovascular morbidity, strokes, infections, bone fractures and increased mortality. AKI is associated with high healthcare costs as a result of a longer stay in hospital, increased costs for investigations and interventions and the development of long-term complications including dialysis dependence, chronic comorbidities and re-hospitalisations. The outcomes and financial implications are worse in low-income countries compared to high-income countries. Key Message: AKI is common among hospitalised patients and associated with serious short- and long-term complications, increased mortality, and high health care costs. There are important differences in epidemiology and outcomes between low- and high-income countries.

This chapter focuses on the definitions and impact of prescription and delivery of the right dose of treatment in patients on continuous renal replacement therapy (CRRT). We define "dose" and the concepts of efficiency, intensity, and efficacy; differentiate their multiple components; and describe the practical application of those concepts to direct patient care. In the article, we emphasize the effects of delivered dose variation on solute control, and list the main factors affecting CRRT dose delivery. Finally, we summarize the main indicators of dose monitoring and emphasize the importance of an excellent quality control system to ensure appropriate delivery of care to critically ill patients with acute kidney injury.

Background: Acute kidney injury (AKI) is one of the most common complications in acutely ill patients. The epidemiology, clinical presentation, and outcome vary b

The integration of modern information communication technology and technologically advanced equipment to routine clinical practice are important technological stepping stones in the management of patients with acute kidney injury (AKI). These tools improve practice and patient outcomes by supporting and individualizing all phases of AKI management. This narrative review describes the most recent bedside technological advances in AKI diagnosis, renal replacement therapy education, prescription, monitoring, delivery, and measurement of outcomes with an emphasis on providing highly personalized patient care.

A combined scanning tunneling microscopy, angle- and spin-resolved photoemission spectroscopy and density functional theory study of graphene on Ir(1 1 1) intercalated with a well-ordered, full Pb monolayer is presented. Lead intercalation between graphene and Ir(111) reduces the coupling to the metallic substrate in such a way that its corrugation becomes negligible and distortions of the linear dispersion largely disappear, while graphene's sublattice symmetry is maintained and it turns out to be n-doped. Remarkably, the spin–orbit splittings induced by the proximity of the Ir(1 1 1) surface are preserved after Pb intercalation in a wide energy range. We further show that the Pb/Ir(1 1 1) surface induces a complex spin texture with both in-plane and out-of-plane components. Our calculations reveal the origin of the out-of-plane spin components in graphene to trace back to the out-of-plane spin-polarized surface and resonance states of Ir(1 1 1), while the Pb interlayer on its own does not induce any vertical spin polarization in the carbon sheet. However, the Brillouin zone folding imposed by the rectangular symmetry of the intercalated Pb layer plays an instrumental role in the spin–orbit coupling (SOC) transfer to graphene, as well as in the linearization of its bands. Finally, since no sizeable gap is observed at the Dirac point, we suggest that an intrinsic (Kane and Mele type) SOC does not exceed the extrinsic (Rashba) SOC for graphene on Pb/Ir(111)., We acknowledge the support by the Basque Departamento de Educacion, UPV/EHU (Grant No. IT-756-13), Spanish Ministerio de Economia y Competitividad (MINECO Grants No. FIS2016- 75862-P, MAT2015-66888-C3-1R and FIS2015-67367-C2-1-P), Comunidad de Madrid (MAD2DCM and Nanofrontmag) and Tomsk State University competitiveness improvement programme (project No. 8.1.01.2017). The support by the Saint Petersburg State University (Grant No. 15.61.202.2015) and Russian Foundation for Basic Research (Grant No. 18-32-00145) are also acknowledged. The part of photoemission measurements had been supported by Russian Science Foundation Grant No. 18-12-00062. IMDEA Nanociencia acknowledges support from the ‘Severo Ochoa’ Programme for Centres of Excellence in R&D (MINECO, Grant SEV-2016-0686).

Background In low and middle-income countries, reliable data on the epidemiology of childhood acute kidney injury (AKI) is lacking. The Global Snapshot, conducted by the ISN “0by25” AKI initiative, was a world-wide cross-sectional, observational study to evaluate AKI in hospitalized patients. Here we report the pediatric results of this study. Patients and methods We prospectively collected data on children who met the Kidney Disease Improving Global Outcomes AKI criteria during a 10-week window in late 2014. AKI risk factors, etiological factors, management and outcomes were recorded using standardized forms and protocols. Countries were classified according to their 2014 gross national income (GNI) per person into high-income countries (HIC), upper-middle income countries (UMIC) and low and low-middle income countries (LLMIC). Need for renal replacement therapy, mortality, and renal recovery were assessed 7 days after AKI diagnosis or at hospital discharge, whichever came first. Results 92 centers from 41 countries collected data on 354 pediatric AKI patients; 53% of the children developed AKI while hospitalized and 47% in the community. The most common etiological factors for AKI differed across GNI categories as well as between patients with community-acquired vs. hospital-acquired AKI. Children from HIC were younger, and larger proportion of AKI in this group were due to post-surgical complications vs. other etiologies when compared to other income categories. In patients with hypotension as the cause of AKI, the adjusted risk of death was almost 10-fold higher compared to patients without hypotension as an etiological factor for AKI development. Mortality was similar within AKI stages in HIC and UMIC. In LLMIC, patients with the highest AKI level of severity had higher mortality than patients in higher income categories. Patients from LLMIC and UMIC had a 57-fold and 11 fold higher adjusted risk of death, respectively, compared to patients from HIC. Conclusion In resource-limited countries, pediatric AKI-associated mortality is disproportionately higher when compared to high-resource areas, especially among patients with more severe AKI.

Acute kidney injury (AKI) is increasingly common around the world. Because of the low availability of effective therapies and resource limitations, early preventive and therapeutic measures are essential to decrease morbidity, mortality, and cost. Timely recognition and diagnosis of AKI requires a heightened degree of suspicion in the appropriate clinical and environmental context. In low- and middle-income countries (LMICs), early detection is impaired by limited resources and low awareness. In this article, we report the consensus recommendations of the 18th Acute Dialysis Quality Initiative meeting in Hyderabad, India, on how to improve recognition of AKI. We expect these recommendations will lead to an earlier and more accurate diagnosis of AKI, and improved research to promote a better understanding of the epidemiology, etiology, and histopathology of AKI in LMICs.

AKI is frequent and is associated with poor outcomes. There is limited information on the epidemiology of AKI worldwide. This study compared patients with AKI in emerging and developed countries to determine the association of clinical factors and processes of care with outcomes.This prospective observational study was conducted among intensive care unit patients from nine centers in developed countries and five centers in emerging countries. AKI was defined as an increase in creatinine of ≥0.3 mg/dl within 48 hours.Between 2008 and 2012, 6647 patients were screened, of whom 1275 (19.2%) developed AKI. A total of 745 (58% of those with AKI) agreed to participate and had complete data. Patients in developed countries had more sepsis (52.1% versus 38.0%) and higher Acute Physiology and Chronic Health Evaluation (APACHE) scores (mean±SD, 61.1±27.5 versus 51.1±25.2); those from emerging countries had more CKD (54.3% versus 38.3%), GN (6.3% versus 0.9%), and interstitial nephritis (7.0% versus 0.6%) (all P0.05). Patients from developed countries were less often treated with dialysis (15.5% versus 30.2%; P0.001) and started dialysis later after AKI diagnosis (2.0 [interquartile range, 0.75-5.0] days versus 0 [interquartile range, 0-5.0] days; P=0.02). Hospital mortality was 22.0%, and 13.3% of survivors were dialysis dependent at discharge. Independent risk factors associated with hospital mortality included older age, residence in an emerging country, use of vasopressors (emerging countries only), dialysis and mechanical ventilation, and higher APACHE score and cumulative fluid balance (developed countries only). A lower probability of renal recovery was associated with residence in an emerging country, higher APACHE score (emerging countries only) and dialysis, while mechanical ventilation was associated with renal recovery (developed countries only).This study contrasts the clinical features and management of AKI and demonstrates worse outcomes in emerging than in developed countries. Differences in variations in care may explain these findings and should be considered in future trials.

A combined scanning tunneling microscopy, x-ray photoelectron spectroscopy, angle-resolved photoemission spectroscopy, and density functional theory study of graphene on a Fe-Ir(111) alloy with variable Ir concentration is presented. Starting from an intercalated Fe layer between the graphene and Ir(111) surface we find that graphene-substrate interaction can be fine-tuned by Fe-Ir alloying at the interface. When a critical Ir-concentration close to 0.25 is reached in the Fe layer, the Dirac cone of graphene is largely restored and can thereafter be tuned across the Fermi level by further increasing the Ir content. Indeed, our study reveals an abrupt transition between a chemisorbed phase at small Ir concentrations and a physisorbed phase above the critical concentration. The latter phase is highly reminiscent of the graphene on the clean Ir(111) surface. Furthermore, the transition is accompanied by an inversion of the graphene's induced magnetization due to the coupling with the Fe atoms from antiferromagnetic when chemisorbed to weakly ferromagnetic in the physisorption regime, with spin polarizations whose magnitude may be tuned with the amount of Fe content., This work has been funded by the Spanish MINECO under contract Nos. FIS2013-48286-C2-1-P, MAT2013-47878-C2-R, MAT2015-66888-C3-1R, and MAT2013-46593-C6-4-P as well as the Basque Government Grants IT621-13 and IT756-13.

Acute kidney injury (AKI) is common in critically ill patients and associated with grim short- and long-term outcome. Although in the vast majority of cases AKI is multifactorial, with sepsis, shock and nephrotoxicity accounting for most episodes, specific causes of AKI are not uncommon. Despite remaining uncertainties regarding their prevalence in the ICU, prompt recognition of specific aetiologies of AKI is likely to ensure timely management, limit worsening of renal dysfunction, and ultimately limit renal and systemic consequences of AKI. The ability to recognize conditions that may be associated with specific aetiologies and the appropriate use of clinical imaging, biological and immunological tests, along with optimal assessment of the need for renal biopsies, should be part of routine ICU care. In this review, we summarize uncertainties, current knowledge and recent advances regarding specific types of AKI. We describe the most common specific causes as well as rare aetiologies requiring urgent management, and outline available tools that may be used during the diagnostic work-up along with their limitations.

We use large-scale DFT calculations to investigate with unprecedented detail the so-called spin-orbit (SO) proximity effect in graphene adsorbed on the Pt(111) and Ni(111)/Au semi-infinite surfaces, previously studied via spin and angle resolved photoemission (SP-ARPES) experiments. The key finding is that, due to the hybridization with the metal's bands, the Dirac cones manifest an unexpectedly rich spin texture including out-of-plane and even radial in-plane spin components at (anti)crossings where local gap openings and deviations from linearity take place. Both the continuum character of the metallic bands and the back folding associated to the moir\'e patterns enhance the spin texture and induce sizable splittings which, nevertheless, only become giant (~100 meV) at anticrossing regions; that is, where electronic transport is suppressed. At the quasilinear regions the splitted bands typically disperse with different broadenings and tend to cross with their magnetization continuously changing in order to match that at the edges of the upper and lower gaps. As a result, both the splittings and spin direction become strongly k dependent. The SO manifests in an analogous way for the spin-polarized G/Au/Ni(111) system, although here the magnetic exchange interactions dominate inducing small splittings (~10 meV) in the $\pi$ bands while the SO mainly introduces a small Rashba splitting in the Dirac cones as their magnetization acquires a helical component. While revealing such complex spin texture seems challenging from the experimental side, our results provide an important reference for future SP-ARPES measurements of similar graphene based systems extensively investigated for applications in spintronics., Comment: 16 pages, 12 figures