Consensus recommendations on fasting during Ramadan for patients with kidney disease: review of available evidence and a call for action (RaK Initiative).

Ramadan fasting (RF) involves abstaining from food and drink during daylight hours; it is obligatory for all healthy Muslims from the age of puberty. Although sick individuals are exempt from fasting, many will fast anyway. This article explores the impact of RF on individuals with kidney diseases through a comprehensive review of existing literature and consensus recommendations. This study was conducted by a multidisciplinary panel of experts.The recommendations aim to provide a structured approach to assess and manage fasting during Ramadan for patients with kidney diseases, empowering both healthcare providers and patients to make informed decisions while considering their unique circumstances.

Serum Interleukin-18, Kidney Injury Molecule-1, and the Renal Resistive Index for Predicating Acute Kidney Injury in Critically Ill Patients with Sepsis.

Interleukin-18 (IL-18) is a pro-inflammatory cytokine that rises approximately 24-48 h before a diagnosis of acute kidney injury (AKI). Kidney injury molecule-1 (KIM-1) is one of the most promising early biomarkers. It participates in the process of both kidney injury and healing, although the precise mechanism of the restoration of tubular integrity after injury still remains unclear. The renal resistive index (RRI) is used for evaluating changes in intrarenal perfusion occurring in renal parenchyma diseases. The study included 80 critically ill patients with sepsis, divided into 40 patients who developed AKI and 40 patients without AKI. All patients were evaluated through their history, clinical examination, laboratory investigations of serum IL-18 and KIM-1, and the RRI. Serum IL 18, serum KIM-1, and the RRI were significantly higher in critically ill patients with sepsis and AKI. Receiver operating characteristic analysis for detecting AKI 1 day after admission showed that the area under the curve (AUC) for serum IL-18 was 86.1%, the AUC for serum KIM-1 was 86%, and the AUC for the RRI was 88%, demonstrating statistical significance for the diagnosis of AKI within the next 24 h. Serum IL-18, KIM-1, and the RRI represent early predictors of AKI in critically ill septic patients.

Preventing acute kidney injury and improving outcome in critically ill patients utilizing risk prediction score (PRAIOC-RISKS) study. A prospective controlled trial of AKI prevention.

BACKGROUND: Acute kidney injury (AKI) has significant impact on mortality and morbidity in critically ill patients. METHODS: A prospective controlled interventional pilot study composed of observation and intervention arms was run at two different Intensive care unit (ICU) sites. A recently validated risk prediction score was used to predict the AKI in critically ill patients at high risk of developing AKI. All patients with established AKI at the time of recruitment were excluded from the study. A package of early preventive measures, including an early nephrology review was applied to high risk patients in the intervention arm to prevent AKI development. RESULTS: We have recruited 108 patients at the intervention site and 98 patients at the observation site. The primary outcome measure was the AKI incidence. AKI incidence was significantly lower in the intervention arm than its incidence in the observation arm (11% vs 26%, p = 0.002). The median Time till recovery of AKI episodes was significantly lower in the intervention arm (3(1) vs. 5(2) days, p = 0.014) 0.30 day mortality was lower in the intervention arm, however, not statistically significant. CONCLUSION: Our pilot study showed that it was feasible to apply a simple risk score to implement early preventive measures to high risk patients, consequently, mitigating the risk of AKI development and reducing the time till recovery of AKI episodes. Multicentre studies are needed to confirm this favourable effect.