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Anticoagulation in dialysis

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https://www.readbyqxmd.com/read/28910806/warfarin-use-and-increased-mortality-in-end-stage-renal-disease
#1
Mark C Lin, Elani Streja, Melissa Soohoo, Medhat Hanna, Javad Savoj, Kamyar Kalantar-Zadeh, Wei Ling Lau
BACKGROUND: Controversy exists regarding the benefits and risks of warfarin therapy in chronic kidney disease (CKD) and end-stage renal disease (ESRD) patients. In this study, we assessed mortality and cardiovascular outcomes associated with warfarin treatment in patients with stages 3-5 CKD and ESRD admitted to the University of California-Irvine Medical Center. METHODS: In a retrospective matched cohort study, we identified 59 adult patients with stages 3-6 CKD initiated on warfarin during the period 2011-2013, and 144 patients with stages 3-6 CKD who had indications for anticoagulation therapy but were not initiated on warfarin...
September 15, 2017: American Journal of Nephrology
https://www.readbyqxmd.com/read/28894790/aortic-dissection-and-severe-renal-failure-6-years-after-kidney-transplantation
#2
Amaury Dujardin, Awena Le Fur, Diego Cantarovich
We report the case of a patient with long-term history of hypertension, presenting with transient neurological disorders and severe graft failure several years after kidney transplantation. Cause of end-stage renal disease was hypertensive nephrosclerosis. Chronic hemodialysis lasted for 1 year. After transplantation and throughout follow-up, serum creatinine ranged from 200 to 230 μmol/L and maintenance immunosuppression included sirolimus and low-dose steroids. Six years after transplantation, the patient presented with right hip pain radiating to the lower back, transient aphasia, confusion, and hemiparesis...
September 2017: Transplantation Direct
https://www.readbyqxmd.com/read/28893450/emergency-medicine-evaluation-and-management-of-the-end-stage-renal-disease-patient
#3
REVIEW
Brit Long, Alex Koyfman, Courtney M Lee
BACKGROUND: End stage renal disease (ESRD) is increasing in the U.S., and these patients demonstrate greater all-cause mortality, cardiovascular events, and hospitalization rates when compared to those with normal renal function. These patients may experience significant complications associated with loss of renal function and dialysis. OBJECTIVE: This review evaluates complications of ESRD including cardiopulmonary, neurologic, infectious disease, vascular, and access site complications, as well as medication use in this population...
September 5, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28884390/patients-treated-for-acute-vte-during-periods-of-treatment-related-thrombocytopenia-have-high-rates-of-recurrent-thrombosis-and-transfusion-related-adverse-outcomes
#4
B T Samuelson Bannow, R B Walter, T B Gernsheimer, D A Garcia
Venous thromboembolism (VTE) is a common complication of hematologic malignancies. Prolonged periods of thrombocytopenia are experienced universally by patients undergoing treatment for these diseases, yet data to guide management of anticoagulation in this setting are lacking. To obtain data on the management and outcomes of VTE in patients with thrombocytopenia related to the treatment of hematologic malignancies. This was an observational cohort study of patients experiencing VTE during periods of treatment-related thrombocytopenia over a 5-year period at the Fred Hutchinson Cancer Research Center...
September 7, 2017: Journal of Thrombosis and Thrombolysis
https://www.readbyqxmd.com/read/28871391/hemofiltration-induces-generation-of-leukocyte-derived-cd31-cd41-microvesicles-in-sepsis
#5
Georg Franz Lehner, Ulrich Harler, Clemens Feistritzer, Viktoria Maria Haller, Julia Hasslacher, Romuald Bellmann, Michael Joannidis
BACKGROUND: Microvesicles (MV) are extracellular vesicles known to be associated with cellular activation and inflammation. Hemofiltration is an effective blood purification technique for patients with renal failure and possibly also eliminates inflammatory mediators in the setting of sepsis. On the other hand, proinflammatory stimuli are induced by blood contacting the artificial membrane during extracorporeal blood purification. In chronic dialysis patients a systemic increase in MV has been described...
September 4, 2017: Annals of Intensive Care
https://www.readbyqxmd.com/read/28867226/structural-analysis-of-a-sulfated-galactan-from-the-tunic-of-the-ascidian-microcosmus-exasperatus-and-its-inhibitory-effect-of-the-intrinsic-coagulation-pathway
#6
Diana C Restrepo-Espinosa, Yony Román, Jhonny Colorado-Ríos, Arquimedes Paixão de Santana-Filho, Guilherme Lanzi Sassaki, Thales R Cipriani, Alejandro Martínez, Marcello Iacomini, Mauro S G Pavão
Several bioactive sulfated galactans have been isolated from the tunic of different species of ascidians. The biological activity of this kind of polysaccharides has been related with the presence and position of sulfate groups, and by the chemical composition of this kind of polysaccharides. A sulfated galactan (1000RS) was isolated from the tunic of the Brazilian ascidia Microcosmus exasperatus through proteolytic digestion, ethanol precipitation, dialysis and freeze-thaw cycles. Homogeneity and molecular weight were estimated by using size exclusion chromatography...
August 31, 2017: International Journal of Biological Macromolecules
https://www.readbyqxmd.com/read/28857854/heparin-free-prolonged-intermittent-hemodialysis-using-calcium-free-citrate-dialysate-in-critically-ill-patients
#7
Stanislas Faguer, Morgane Saint-Cricq, Marie-Béatrice Nogier, Isabelle Labadens, Laurence Lavayssiere, Nassim Kamar, Olivier Cointault
OBJECTIVES: Critically ill patients who have a high risk of bleeding but require prolonged intermittent dialysis need a heparin-free easy-to-use alternative type of anticoagulation within the dialysis circuit. We assessed the safety and efficiency of heparin-free regional citrate anticoagulation of the dialysis circuit using a calcium-free citrate-containing dialysate, with calcium reinjected according to ionic dialysance. DESIGN: Prospective cohort study. SETTING: Critical care units...
August 28, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28856671/direct-oral-anticoagulant-medications-in-calciphylaxis
#8
Brian J King, Rokea A El-Azhary, Marian T McEvoy, Raymond C Shields, Robert D McBane, James T McCarthy, Mark D P Davis
BACKGROUND: Recent studies suggest that calciphylaxis is a thrombotic condition in which arteriolar thrombosis leads to painful skin infarcts and consequent morbidity and mortality. Paradoxically, warfarin is implicated as a risk factor for calciphylaxis. Our objective is to report the use of oral direct thrombin and factor Xa inhibitors (termed direct oral anticoagulants [DOACs]) in patients with calciphylaxis. METHODS: We retrospectively reviewed records of 16 patients with calciphylaxis who received concomitant administration of novel anticoagulants...
August 30, 2017: International Journal of Dermatology
https://www.readbyqxmd.com/read/28836163/blood-glutamate-reducing-effect-of-hemofiltration-in-critically-ill-patients
#9
Evgeni Brotfain, Ruslan Kutz, Julia Grinshpun, Benjamin F Gruenbaum, Shaun E Gruenbaum, Amit Frenkel, Agzam Zhumadilov, Vladimir Zeldetz, Yoav Bichovsky, Matthew Boyko, Moti Klein, Alexander Zlotnik
Glutamate toxicity plays a well-established role in secondary brain damage following acute and chronic brain insults. Previous studies have demonstrated the efficacy of hemodialysis and peritoneal dialysis in reducing blood glutamate levels. However, these methods are not viable options for hemodynamically unstable patients. Given more favorable hemodynamics, longer treatment, and less needed anticoagulation, we investigated whether hemofiltration could be effective in lowering blood glutamate levels. Blood samples were taken from 10 critically ill patients immediately before initiation of hemofiltration and after 1, 2, 4, 6, and 12 h, for a total of 6 blood samples...
August 23, 2017: Neurotoxicity Research
https://www.readbyqxmd.com/read/28831705/predictors-of-first-ischemic-lower-limb-ulcer-in-dialysis-patients-an-observational-cohort-study
#10
Simeone Andrulli, Chiara Chiavenna, Maria Carla Bigi, Monica Crepaldi, Cesare Dell'Oro, Flavia Tentori, Celestina Manzoni, Giuseppe Bacchini, Mauro Maria Corti, Giuseppe Pontoriero
BACKGROUND: Lower limb ischemia affects the quality of life, physical activity and life expectancy of dialysis patients. The aim of this study was to investigate the risk factors associated with ischemic foot ulcers considering clinical, laboratory and therapeutic domains. METHODS: This observational cohort study was based on data from the Nephrology and Dialysis Department database of Alessandro Manzoni Hospital, Lecco (Italy). All of the incident patients who started dialysis between 1 January 1999 and 29 February 2012 were enrolled, excluding temporary guests, patients with acute renal failure and patients with previous limb ischemia or amputation...
August 22, 2017: Journal of Nephrology
https://www.readbyqxmd.com/read/28817831/practical-value-of-anti-xa-activity-in-the-evaluation-of-extracorporeal-circuit-anticoagulation-during-haemodialysis-results-of-a-cross-sectional-single-centre-study
#11
Karlien L M Coene, Marijke J E Dekker, Marieke C H M Kerskes, Maaike Hengst, Marc J M Schonck, Constantijn J A M Konings, Volkher Scharnhorst
BACKGROUND/AIMS: Anticoagulation of the extracorporeal circuit is essential for adequate haemodialysis (HD). Low molecular weight heparins (LMWHs) are safe and sufficient towards achieving this goal. In the Netherlands, dosage is based on bodyweight and adjusted based on clinical events. LMWH levels during dialysis can be quantified through measurement of the anti-Xa activity and a target range of 0.5-1.0 IU/mL has been proposed. We aimed to evaluate the practical value of the anti-Xa activity to guide LMWH dosage in HD patients...
August 18, 2017: Nephron
https://www.readbyqxmd.com/read/28792509/regional-citrate-anticoagulation-for-continuous-renal-replacement-therapy-in-pediatric-patients-with-liver-failure
#12
Keila Rodriguez, Poyyapakkam R Srivaths, Leyat Tal, Mary N Watson, Alyssa A Riley, Ryan W Himes, Moreshwar S Desai, Michael C Braun, Ayse Akcan Arikan
Pediatric liver failure patients frequently develop multiple organ failure and require continuous renal replacement therapy (CRRT) as part of supportive therapy in the pediatric intensive care unit. While many centers employ no anticoagulation for fear of bleeding complications, balanced coagulation disturbance predisposes these patients to clotting as well as bleeding, making maintenance of longer circuit life to deliver adequate dialysis clearance challenging. Regional citrate anticoagulation (RCA) is an attractive option as it avoids systemic anticoagulation, but since citrate metabolism is impaired in liver failure, concerns about toxicity has limited its use...
2017: PloS One
https://www.readbyqxmd.com/read/28762633/platelet-activation-and-clotting-cascade-activation-by-dialyzers-designed-for-high-volume-online-hemodiafiltration
#13
Kamonwan Tangvoraphonkchai, Anne Riddell, Andrew Davenport
INTRODUCTION: Hemodialysis patients are pro-thrombotic. Higher volume online postdilutional hemodiafiltration (OL-HDF), with increasing hematocrit increases the risk of clotting in the extracorporeal circuit (ECC). We wished to determine whether OL-HDF increased platelet activation and ECC clotting. METHODS: Coagulation parameters, platelet, white cell, and endothelial activation markers were measured at the start and end of dialysis sessions in 10 patients and also pre- and post-dialyzer after 15 minutes using two different dialyzers designed for high volume OL-HDF; cellulose triacetate (TAGP) and polysulphone (PS), and polyvinylpyrrolidone (PVP)...
August 1, 2017: Hemodialysis International
https://www.readbyqxmd.com/read/28757750/dialysis-catheter-related-pulmonary-embolism-in-a-patient-with-paraquat-intoxication
#14
Li-Keng Chao, Te-Chao Fang
A 30-year-old woman was sent to the emergency room after alcohol and paraquat ingestion. After three sessions of hemoperfusion via the indwelling double-lumen catheter, the patient could tolerate ambient air and her urine output was good. However, on the 10(th) day of hospitalization, she had a sudden onset of dyspnea and hypoxia. Pulmonary embolism was diagnosed by a computed tomography pulmonary angiogram. The patient recovered after anticoagulation therapy. We could find no reports of dyspnea caused by pulmonary embolism in patients with paraquat intoxication...
October 2016: Ci Ji Yi Xue za Zhi, Tzu-chi Medical Journal
https://www.readbyqxmd.com/read/28729905/an69st-membranes-adsorb-nafamostat-mesylate-and-affect-the-management-of-anticoagulant-therapy-a-retrospective-study
#15
Takahiro Hirayama, Nobuyuki Nosaka, Yasumasa Okawa, Soichiro Ushio, Yoshihisa Kitamura, Toshiaki Sendo, Toyomu Ugawa, Atsunori Nakao
BACKGROUND: In Japan, nafamostat mesylate (NM) is frequently used as an anticoagulant during continuous renal replacement therapy (CRRT). The dialyzer membrane AN69ST has been reported to adsorb NM and affect the management of anticoagulant therapy. However, the adsorbed amount has not yet been quantitatively assessed. Therefore, in this study, we evaluated the pre- and post-hemofilter prolongation of the activated clotting time (ACT) in patients with AN69ST and PS membranes. We also measured the adsorption of NM in three types of CRRT membranes using an experimental model...
2017: Journal of Intensive Care
https://www.readbyqxmd.com/read/28699181/predicting-in-a-predicament-stroke-and-hemorrhage-risk-prediction-in-dialysis-patients-with-atrial-fibrillation
#16
REVIEW
Amber O Molnar, Manish M Sood
Whether to anticoagulate dialysis patients with atrial fibrillation is a common clinical dilemma with limited high-quality data to inform decision-making. While the efficacy and safety of anticoagulation for stroke prevention in dialysis patients with atrial fibrillation has long been debated and remains unclear, the more upstream issue of stroke risk assessment from atrial fibrillation has received relatively little attention. In the general population, a handful of risk scores to help predict stroke and hemorrhage risk in the setting of atrial fibrillation are widely validated and applied in clinical practice...
July 11, 2017: Seminars in Dialysis
https://www.readbyqxmd.com/read/28692694/renal-replacement-therapy-practices-for-patients-with-acute-kidney-injury-in-china
#17
William R Clark, Xiaoqiang Ding, Haibo Qiu, Zhaohui Ni, Ping Chang, Ping Fu, Jiarui Xu, MinMin Wang, Li Yang, Jing Wang, Claudio Ronco
Recent data indicate AKI is very common among hospitalized Chinese patients and continuous renal replacement therapy (CRRT) is increasingly offered for treatment. However, only anecdotal information regarding CRRT's use in relation to other modalities and the specific manner in which it is prescribed exists currently. This report summarizes the results of a comprehensive physician survey designed to characterize contemporary dialytic management of AKI patients in China, especially with respect to the utilization of CRRT...
2017: PloS One
https://www.readbyqxmd.com/read/28683729/crrtnet-a-prospective-multi-national-observational-study-of-continuous-renal-replacement-therapy-practices
#18
Michael Heung, Sean M Bagshaw, Andrew A House, Luis A Juncos, Robin Piazza, Stuart L Goldstein
BACKGROUND: Continuous renal replacement therapy (CRRT) is the recommended modality of dialysis for critically ill patients with hemodynamic instability. Yet there remains significant variability in how CRRT is prescribed and delivered, and limited evidence-basis to guide practice. METHODS: This is a prospective, multi-center observational study of patients undergoing CRRT. Initial enrollment phase will occur at 4 academic medical centers in North America over 5 years, with a target enrollment of 2000 patients...
July 6, 2017: BMC Nephrology
https://www.readbyqxmd.com/read/28682569/-nephrologist-and-icu-the-need-of-new-expertise
#19
Filippo Mariano, Marco Pozzato
Episodes of dialytic Acute Kidney Injury (AKI stage III KDIGO) can lead to chronic kidney disease (CKD), even after a long time. Prelimary data indicate that the relationship between AKI and CKD is affected by dialysis technical modalities and factors in part modifiable, such as an early dialysis timing, dose adeguacy, continuous treatment, use of biocompatible membranes and regional citrate anticoagulation. However, in most ICUs involvement of nephrologist consultant is marginal. Of more, nephrological follow-up after discharge, which allows to slow down the progression rate of CKD even just by a correct pharmacological and dietetic approach (sartans, ACEis), is an uncommon practice...
April 2017: Giornale Italiano di Nefrologia: Organo Ufficiale Della Società Italiana di Nefrologia
https://www.readbyqxmd.com/read/28682563/-non-vitamin-k-dependent-oral-anticoagulants-noacs-in-chronic-kidney-disease-patients-with-non-valvular-atrial-fibrillation
#20
Luca Di Lullo, Vincenzo Barbera, Antonio Bellasi, Mario Cozzolino, Domenico Russo, Giovanni Otranto, Francesca Santoboni, Claudio Ronco
Atrial fibrillation (AF) represents the most common arrhythmia in patients with chronic kidney disease (CKD). As in the general population, AF is associated with an increased risk of thromboembolism and stroke, according to progressive decline of glomerular filtration rate (GFR). However, CKD patients, especially those on renal replacement therapy (RRT), also exhibit an increased risk of bleeding, especially from the gastrointestinal tract. Oral anticoagulation is the most effective form of thromboprophylaxis in patients with AF presenting increased risk of stroke...
April 2017: Giornale Italiano di Nefrologia: Organo Ufficiale Della Società Italiana di Nefrologia
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