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How new biomarkers aid the anesthetist to detect and prevent perioperative acute kidney injury.

Khaschayar Saadat-Gilani, Alexander Zarbock,

<h4>Purpose of review</h4>Acute kidney injury (AKI) is underestimated but common in the perioperative setting. Although the association of this syndrome with an increased morbidity and mortality has been well established, little progress has been made in the diagnosis or prevention of AKI in recent years. This is partly due to ... Read more >>

Curr Opin Anaesthesiol (Current opinion in anaesthesiology)
[2021, 34(3):364-372]

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Kinetic Changes of Plasma Renin Concentrations Predict Acute Kidney Injury in Cardiac Surgery Patients.

Mira Küllmar, Khaschayar Saadat-Gilani, Raphael Weiss, Christina Massoth, Anas Lagan, Manuel Núñez Cortés, Joachim Gerss, Lakhmir S Chawla, Danilo Fliser, Melanie Meersch, Alexander Zarbock,

<b>Rationale:</b> The renin-angiotensin-aldosterone system is a major pathway in regulating blood pressure, glomerular filtration, and fluid homeostasis. During inflammatory diseases, generation of angiotensin II might be disturbed, leading to increased renin concentrations. Cardiac surgery and the use of cardiopulmonary bypass both induce inflammatory response and cardiovascular instability, which can contribute ... Read more >>

Am J Respir Crit Care Med (American journal of respiratory and critical care medicine)
[2021, 203(9):1119-1126]

Cited: 1 time

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Restrictive fluid management versus usual care in acute kidney injury (REVERSE-AKI): a pilot randomized controlled feasibility trial.

Suvi T Vaara, Marlies Ostermann, Laurent Bitker, Antoine Schneider, Elettra Poli, Eric Hoste, Jan Fierens, Michael Joannidis, Alexander Zarbock, Frank van Haren, John Prowle, Tuomas Selander, Minna Bäcklund, Ville Pettilä, Rinaldo Bellomo, ,

<h4>Purpose</h4>We compared a restrictive fluid management strategy to usual care among critically ill patients with acute kidney injury (AKI) who had received initial fluid resuscitation.<h4>Methods</h4>This multicenter feasibility trial randomized 100 AKI patients 1:1 in seven ICUs in Europe and Australia. Restrictive fluid management included targeting negative or neutral daily fluid ... Read more >>

Intensive Care Med (Intensive care medicine)
[2021, :]

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In Response.

Alexander Zarbock, Khaschayar Saadat-Gilani, Melanie Meersch,

Anesth Analg (Anesthesia and analgesia)
[2021, 132(5):e83-e84]

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[Impact of handover of anesthesia care on adverse postoperative outcomes-The HandiCAP trial].

Christina Massoth, Khaschayar Saadat-Gilani, Melanie Meersch, ,

Anaesthesist (Der Anaesthesist)
[2021, 70(4):320-323]

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Prevention of Cardiac Surgery-Associated Acute Kidney Injury by Implementing the KDIGO Guidelines in High-Risk Patients Identified by Biomarkers: The PrevAKI-Multicenter Randomized Controlled Trial.

Alexander Zarbock, Mira Küllmar, Marlies Ostermann, Gianluca Lucchese, Kamran Baig, Armando Cennamo, Ronak Rajani, Stuart McCorkell, Christian Arndt, Hinnerk Wulf, Marc Irqsusi, Fabrizio Monaco, Ambra Licia Di Prima, Mercedes García Alvarez, Stefano Italiano, Jordi Miralles Bagan, Gudrun Kunst, Shrijit Nair, Camilla L'Acqua, Eric Hoste, Wim Vandenberghe, Patrick M Honore, John A Kellum, Lui G Forni, Philippe Grieshaber, Christina Massoth, Raphael Weiss, Joachim Gerss, Carola Wempe, Melanie Meersch,

<h4>Background</h4>Prospective, single-center trials have shown that the implementation of the Kidney Disease: Improving Global Outcomes (KDIGO) recommendations in high-risk patients significantly reduced the development of acute kidney injury (AKI) after surgery. We sought to evaluate the feasibility of implementing a bundle of supportive measures based on the KDIGO guideline in ... Read more >>

Anesth Analg (Anesthesia and analgesia)
[2021, :]

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Comparison of C-C motif chemokine ligand 14 with other biomarkers for adverse kidney events after cardiac surgery.

Christina Massoth, Mira Küllmar, Dominic Enders, John A Kellum, Lui G Forni, Melanie Meersch, Alexander Zarbock, ,

<h4>Objective</h4>Outcomes after acute kidney injury are affected by both the severity and the duration of the insult. Patients with persistent acute kidney injury have higher major adverse kidney events, including 90-day mortality, renal replacement therapy, and persistent kidney dysfunction. Methods to identify these patients are urgently needed to improve outcomes. ... Read more >>

J Thorac Cardiovasc Surg (The Journal of thoracic and cardiovascular surgery)
[2021, :]

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Sarilumab in patients admitted to hospital with severe or critical COVID-19: a randomised, double-blind, placebo-controlled, phase 3 trial.

François-Xavier Lescure, Hitoshi Honda, Robert A Fowler, Jennifer Sloane Lazar, Genming Shi, Peter Wung, Naimish Patel, Owen Hagino, ,

<h4>Background</h4>Elevated proinflammatory cytokines are associated with greater COVID-19 severity. We aimed to assess safety and efficacy of sarilumab, an interleukin-6 receptor inhibitor, in patients with severe (requiring supplemental oxygen by nasal cannula or face mask) or critical (requiring greater supplemental oxygen, mechanical ventilation, or extracorporeal support) COVID-19.<h4>Methods</h4>We did a 60-day, ... Read more >>

Lancet Respir Med (The Lancet. Respiratory medicine)
[2021, 9(5):522-532]

Cited: 2 times

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Potential Renoprotective Strategies in Adult Cardiac Surgery: A Survey of Society of Cardiovascular Anesthesiologists Members to Explore the Rationale and Beliefs Driving Current Clinical Decision-Making.

David R McIlroy, Bennett Roman, Frederic T Billings, Bruce A Bollen, Amanda Fox, Mariya Geube, Hong Liu, Linda Shore-Lesserson, Alexander Zarbock, Andrew D Shaw,

<h4>Objectives</h4>The authors sought to (1) characterize the rationale underpinning anesthesiologists' use of various perioperative strategies hypothesized to affect renal function in adult patients undergoing cardiac surgery, (2) characterize existing belief about the quality of evidence addressing the renal impact of these strategies, and (3) identify potentially renoprotective strategies for which ... Read more >>

J Cardiothorac Vasc Anesth (Journal of cardiothoracic and vascular anesthesia)
[2021, :]

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Acute Kidney Injury in Cardiac Surgery.

Christina Massoth, Alexander Zarbock, Melanie Meersch,

Acute kidney injury (AKI) occurs frequently after cardiac surgery and is associated with high morbidity and mortality. Although the number of cardiac surgical procedures is constantly growing worldwide, incidence of cardiac surgery-associated AKI is still around 40% and has a significant impact on global health care costs. Numerous trials attempted ... Read more >>

Crit Care Clin (Critical care clinics)
[2021, 37(2):267-278]

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Treatment of spinal anaesthesia-induced hypotension with cafedrine/theodrenaline versus ephedrine during caesarean section: Results from HYPOTENS, a national, multicentre, prospective, noninterventional study.

Peter Kranke, Götz Geldner, Peter Kienbaum, Hans Jürgen Gerbershagen, Daniel Chappell, Jan Wallenborn, Susanne Huljic, Tilo Koch, Thomas Keller, Stephan Weber, Oliver Kunitz, Ulf Linstedt, Leopold H J Eberhart, ,

<h4>Background</h4>In Germany, hypotension induced by spinal anaesthesia is commonly treated with a combination of cafedrine hydrochloride (C, 200 mg) and theodrenaline hydrochloride (T, 10 mg) in 2 ml. We compared the effectiveness of C/T with ephedrine.<h4>Objectives</h4>The primary objectives were to assess the speed of onset and the ability to restore blood pressure without ... Read more >>

Eur J Anaesthesiol (European journal of anaesthesiology)
[2021, :]

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Perioperative Organ Failure: A Preventable Complication?

Alexander Zarbock, Markus W Hollmann,

Anesth Analg (Anesthesia and analgesia)
[2020, 131(6):1663-1665]

Cited: 0 times

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Kindlin-3: at the right place at the right time.

Andreas Margraf, Alexander Zarbock,

Blood (Blood)
[2021, 137(1):1-2]

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MCAM/CD146 Signaling via PLCγ1 Leads to Activation of β1-Integrins in Memory T-Cells Resulting in Increased Brain Infiltration.

Lisa Zondler, Sebastian Herich, Petra Kotte, Katharina Körner, Tilman Schneider-Hohendorf, Heinz Wiendl, Nicholas Schwab, Alexander Zarbock,

Multiple sclerosis is a chronic auto-inflammatory disease of the central nervous system affecting patients worldwide. Neuroinflammation in multiple sclerosis is mainly driven by peripheral immune cells which invade the central nervous system and cause neurodegenerative inflammation. To enter the target tissue, immune cells have to overcome the endothelium and transmigrate ... Read more >>

Front Immunol (Frontiers in immunology)
[2020, 11:599936]

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Randomized controlled multicentre study of albumin replacement therapy in septic shock (ARISS): protocol for a randomized controlled trial.

Yasser Sakr, Michael Bauer, Axel Nierhaus, Stefan Kluge, Ulricke Schumacher, Christian Putensen, Falk Fichtner, Sirak Petros, Christian Scheer, Ulrich Jaschinski, Ivan Tanev, David Jacob, Norbert Weiler, P Christian Schulze, Fritz Fiedler, Barbara Kapfer, Frank Brunkhorst, Ingmar Lautenschlaeger, Katja Wartenberg, Stefan Utzolino, Josef Briegel, Onnen Moerer, Petra Bischoff, Alexander Zarbock, Michael Quintel, Luciano Gattinoni, ,

<h4>Background</h4>Albumin is a key regulator of fluid distribution within the extracellular space and has several properties beyond its oncotic activity. The accumulating evidence suggests that supplementation of albumin may provide survival advantages only when the insult is severe as in patients with septic shock.<h4>Methods/design</h4>The randomized controlled multicentre study of albumin ... Read more >>

Trials (Trials)
[2020, 21(1):1002]

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Systemic Inflammatory Response Syndrome After Surgery: Mechanisms and Protection.

Andreas Margraf, Nadine Ludwig, Alexander Zarbock, Jan Rossaint,

The immune system is an evolutionary hallmark of higher organisms that defends the host against invading pathogens and exogenous infections. This defense includes the recruitment of immune cells to the site of infection and the initiation of an inflammatory response to contain and eliminate pathogens. However, an inflammatory response may ... Read more >>

Anesth Analg (Anesthesia and analgesia)
[2020, 131(6):1693-1707]

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One out of three bystanders of out-of-hospital cardiac arrests suffers pathological psychological processing a few weeks after the incident- results from a systematic telephone interview

Peter Brinkrolf, Bibiana Metelmann, Camilla Metelmann, Mina Baumgarten, Carolin Scharte, Alexander Zarbock, Klaus Hahnenkamp, Andreas Bohn,

<h4>Background: </h4> Witnessing an out-of-hospital cardiac arrest (OHCA) is a traumatic experience. It is known, that some bystanders struggle with coping of these events. The impact of (part-) performing CPR vs. passive observing OHCA and of being a stranger as bystander vs. family and friends of the patient is still ... Read more >>

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Perioperative Renoprotection: Clinical Implications.

Khaschayar Saadat-Gilani, Alexander Zarbock, Melanie Meersch,

Acute kidney injury (AKI) remains a common complication in the perioperative setting affecting patients' short- and long-term outcome. Because therapeutic options are restricted to the use of renal replacement therapy, preventive strategies have become increasingly important. Several substances have been investigated for preventing AKI with limited to no effects. The ... Read more >>

Anesth Analg (Anesthesia and analgesia)
[2020, 131(6):1667-1678]

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Publisher Correction: COVID-19-associated acute kidney injury: consensus report of the 25th Acute Disease Quality Initiative (ADQI) Workgroup.

Mitra K Nadim, Lui G Forni, Ravindra L Mehta, Michael J Connor, Kathleen D Liu, Marlies Ostermann, Thomas Rimmelé, Alexander Zarbock, Samira Bell, Azra Bihorac, Vincenzo Cantaluppi, Eric Hoste, Faeq Husain-Syed, Michael J Germain, Stuart L Goldstein, Shruti Gupta, Michael Joannidis, Kianoush Kashani, Jay L Koyner, Matthieu Legrand, Nuttha Lumlertgul, Sumit Mohan, Neesh Pannu, Zhiyong Peng, Xose L Perez-Fernandez, Peter Pickkers, John Prowle, Thiago Reis, Nattachai Srisawat, Ashita Tolwani, Anitha Vijayan, Gianluca Villa, Li Yang, Claudio Ronco, John A Kellum,

An amendment to this paper has been published and can be accessed via a link at the top of the paper. ... Read more >>

Nat Rev Nephrol (Nature reviews. Nephrology)
[2020, 16(12):765]

Cited: 3 times

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Treatment of intraoperative hypotension with cafedrine/theodrenaline versus ephedrine : A prospective, national, multicenter, non-interventional study-the HYPOTENS trial.

L Eberhart, G Geldner, A Kowark, T-P Zucker, S Kreuer, M Przemeck, S Huljic, T Koch, T Keller, S Weber, P Kranke, ,

<h4>Background</h4>Sympathomimetic drugs are a therapeutic cornerstone for the management of hypotensive states like intraoperative hypotension (IOH). While cafedrine/theodrenaline (C/T) is widely used in Germany to restore blood pressure in patients with IOH, more research is required to compare its effectiveness with alternatives such as ephedrine (E) that are more commonly available internationally.<h4>Methods</h4>HYPOTENS ... Read more >>

Anaesthesist (Der Anaesthesist)
[2021, 70(4):298-307]

Cited: 0 times

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Effect of Regional Citrate Anticoagulation vs Systemic Heparin Anticoagulation During Continuous Kidney Replacement Therapy on Dialysis Filter Life Span and Mortality Among Critically Ill Patients With Acute Kidney Injury: A Randomized Clinical Trial.

Alexander Zarbock, Mira Küllmar, Detlef Kindgen-Milles, Carola Wempe, Joachim Gerss, Timo Brandenburger, Thomas Dimski, Bartosz Tyczynski, Michael Jahn, Nils Mülling, Martin Mehrländer, Peter Rosenberger, Gernot Marx, Tim Philipp Simon, Ulrich Jaschinski, Philipp Deetjen, Christian Putensen, Jens-Christian Schewe, Stefan Kluge, Dominik Jarczak, Torsten Slowinski, Marc Bodenstein, Patrick Meybohm, Stefan Wirtz, Onnen Moerer, Andreas Kortgen, Philipp Simon, Sean M Bagshaw, John A Kellum, Melanie Meersch, ,

<h4>Importance</h4>Although current guidelines suggest the use of regional citrate anticoagulation (which involves the addition of a citrate solution to the blood before the filter of the extracorporeal dialysis circuit) as first-line treatment for continuous kidney replacement therapy in critically ill patients, the evidence for this recommendation is based on few ... Read more >>

JAMA (JAMA)
[2020, 324(16):1629-1639]

Cited: 2 times

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The integrin-linked kinase is required for chemokine-triggered high-affinity conformation of the neutrophil β2-integrin LFA-1.

Andreas Margraf, Giulia Germena, Hannes C A Drexler, Jan Rossaint, Nadine Ludwig, Barbara Prystaj, Sina Mersmann, Katharina Thomas, Helena Block, Wiebke Gottschlich, Chang Liu, Peter W Krenn, Hermann Haller, Barbara Heitplatz, Marika Meyer Zu Brickwedde, Markus Moser, Dietmar Vestweber, Alexander Zarbock,

Neutrophil adhesion and extravasation into tissue at sites of injury or infection depend on binding of the integrin lymphocyte function-associated antigen 1 (LFA-1) to ICAM-1 expressed on activated endothelial cells. The activation-dependent conformational change of LFA-1 to the high-affinity conformation (H+) requires kindlin-3 binding to the β2-integrin cytoplasmic domain. Here ... Read more >>

Blood (Blood)
[2020, 136(19):2200-2205]

Cited: 3 times

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[Quality improvement measures in the care of critically ill intensive care patients with renal replacement therapy for acute kidney injury : Position paper of the Kidney Section of DIVI in collaboration with DGAI and DGIIN].

Detlef Kindgen-Milles, Peter Heering, Melanie Meersch-Dini, Michael Schmitz, Michael Oppert, Stefan John, Achim Jörres, Alexander Zarbock, Carsten Willam,

Renal replacement therapy is after mechanical ventilation one of the most important and frequently used organ replacement therapies in daily routine intensive care practice. In contrast to mechanical ventilation, quality standards for renal replacement therapy are less well known and defined. In this position paper of the German Interdisciplinary Association ... Read more >>

Med Klin Intensivmed Notfmed (Medizinische Klinik, Intensivmedizin und Notfallmedizin)
[2020, 115(7):566-570]

Cited: 0 times

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The Macrophage Migration Inhibitory Factor (MIF) Promoter Polymorphisms (rs3063368, rs755622) Predict Acute Kidney Injury and Death after Cardiac Surgery.

Luisa Averdunk, Jürgen Bernhagen, Karl Fehnle, Harald Surowy, Hermann-Josef Lüdecke, Sören Mucha, Patrick Meybohm, Dagmar Wieczorek, Lin Leng, Gernot Marx, David E Leaf, Alexander Zarbock, Kai Zacharowski, On Behalf Of The RIPHeart Study Collaborators, Richard Bucala, Christian Stoppe,

<h4>Background</h4>Macrophage Migration Inhibitory Factor (MIF) is highly elevated after cardiac surgery and impacts the postoperative inflammation. The aim of this study was to analyze whether the polymorphisms CATT<sub>5-7</sub> (rs5844572/rs3063368,"-794") and G>C single-nucleotide polymorphism (rs755622,-173) in the <i>MIF</i> gene promoter are related to postoperative outcome.<h4>Methods</h4>In 1116 patients undergoing cardiac surgery, the ... Read more >>

J Clin Med (Journal of clinical medicine)
[2020, 9(9):]

Cited: 1 time

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Recommendations on Acute Kidney Injury Biomarkers From the Acute Disease Quality Initiative Consensus Conference: A Consensus Statement.

Marlies Ostermann, Alexander Zarbock, Stuart Goldstein, Kianoush Kashani, Etienne Macedo, Raghavan Murugan, Max Bell, Lui Forni, Louis Guzzi, Michael Joannidis, Sandra L Kane-Gill, Mathieu Legrand, Ravindra Mehta, Patrick T Murray, Peter Pickkers, Mario Plebani, John Prowle, Zaccaria Ricci, Thomas Rimmelé, Mitchell Rosner, Andrew D Shaw, John A Kellum, Claudio Ronco,

<h4>Importance</h4>In the last decade, new biomarkers for acute kidney injury (AKI) have been identified and studied in clinical trials. Guidance is needed regarding how best to incorporate them into clinical practice.<h4>Objective</h4>To develop recommendations on AKI biomarkers based on existing data and expert consensus for practicing clinicians and researchers.<h4>Evidence review</h4>At the ... Read more >>

JAMA Netw Open (JAMA network open)
[2020, 3(10):e2019209]

Cited: 5 times

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