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Anticoagulation in dialysis

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https://www.readbyqxmd.com/read/27901553/a-prediction-and-simulation-model-for-target-oriented-regional-citrate-calcium-anticoagulation-in-extracorporeal-blood-purification
#1
Martin Brandl, Karlheinz Kellner
AIMS: Regional citrate-calcium anticoagulation is becoming more and more attractive for extracorporeal treatments in the clinical routine. METHODS: A prediction and simulation tool for the safe application of RCA during extracorporeal treatments was introduced. The model predicts the course of the ionized calcium level in the patient and the current anticoagulation status in the extracorporeal circuit based on the actual settings of the dialysis machine. RESULTS: The simulation tool delivers areas in which the blood and dialysate flow can be adjusted to reach the desired target values for RCA and predicts the time course of several parameters during treatment...
November 29, 2016: International Journal of Artificial Organs
https://www.readbyqxmd.com/read/27892885/vitamin-k-antagonists-for-stroke-prevention-in-hemodialysis-patients-with-atrial-fibrillation-a-systematic-review-and-meta-analysis
#2
Hans Van Der Meersch, Dirk De Bacquer, An S De Vriese
BACKGROUND: The use of vitamin K antagonists (VKAs) in hemodialysis patients with atrial fibrillation (AF) is controversial. No randomized trials are available and observational studies have yielded conflicting results, engendering a large clinical practice variability and physician uncertainty. An unresolved but highly relevant question is whether AF poses a true risk of ischemic stroke in hemodialysis and whether any form of oral anticoagulation is therefore warranted. METHODS: We conducted a systematic review of studies that compared the incidence of ischemic stroke and bleeding in hemodialysis patients with AF taking VKA and those not taking VKA...
October 4, 2016: American Heart Journal
https://www.readbyqxmd.com/read/27876356/-low-flux-dialysate-daily-home-hemodialysis-a-result-for-the-62%C3%A2-first-french-and-belgian-patients
#3
Anaïs Benabed, Patrick Henri, Thierry Lobbedez, Eric Goffin, Simona Baluta, Abdelkader Benziane, Ahmed Rachi, Johan W van der Pijl, Clémence Bechade, Maxence Ficheux
Since 2011, a new device is available for low flux dialysate quotidian home hemodialysis in France and Belgium. This study aims to evaluate the characteristics and dialysis prescriptions for Nx Stage System One™ users. We retrospectively included patients trained between 2011 and 2013 in France and Belgium. We collected data concerning their clinical features, their dialysis prescriptions, their laboratory parameters until 6 months of dialysis and, reason for dropping in case of cessation. Sixty-two patients from 31 centers, aged 48±18 years old, with a sex ratio 46/16 (M/F) are included with a median Charlson comorbidity index of 1 [0-3]...
November 18, 2016: Néphrologie & Thérapeutique
https://www.readbyqxmd.com/read/27860413/development-of-a-wearable-bioartificial-kidney-using-the-bioartificial-renal-epithelial-cell-system-brecs
#4
Kimberly A Johnston, Angela J Westover, Alvaro Rojas-Pena, Deborah A Buffington, Christopher J Pino, Peter L Smith, H David Humes
Cell therapy for the treatment of renal failure in the acute setting has proved successful, with therapeutic impact, yet development of a sustainable, portable bioartificial kidney for treatment of chronic renal failure has yet to be realized. Challenges in maintaining an anticoagulated blood circuit, the typical platform for solute clearance and support of the biological components, have posed a major hurdle in advancement of this technology. This group has developed a Bioartificial Renal Epithelial Cell System (BRECS) capable of differentiated renal cell function while sustained by body fluids other than blood...
November 18, 2016: Journal of Tissue Engineering and Regenerative Medicine
https://www.readbyqxmd.com/read/27859427/citrate-buffered-dialysis-solution-citrasate-allows-avoidance-of-anticoagulation-during-intermittent-hemodiafiltration-at-the-cost-of-decreased-performance-and-systemic-biocompatibility
#5
Pavlina Richtrova, Jan Mares, Lukas Kielberger, Ladislav Trefil, Jaromir Eiselt, Tomas Reischig
Reportedly, citrate-based dialysis solution enables heparin dose tapering or even complete exclusion, particularly in postdilution hemodiafiltration (HDF). The aim of the study was to verify this strategy in predilution setting and to assess its short-term safety, efficacy, and biocompatibility. Ten regular hemodialysis patients were assigned to predilution HDF on acetate- and citrate-based dialysis solutions (0.8 mmol/l trisodium citrate) at random order. Acetate HDF was performed using routine dose of heparin while citrate HDF was heparin free...
November 10, 2016: Artificial Organs
https://www.readbyqxmd.com/read/27852694/warfarin-utilisation-and-anticoagulation-control-in-patients-with-atrial-fibrillation-and-chronic-kidney-disease
#6
Felix Yang, Jessica A Hellyer, Claire Than, Aditya J Ullal, Daniel W Kaiser, Paul A Heidenreich, Donald D Hoang, Wolfgang C Winkelmayer, Susan Schmitt, Susan M Frayne, Ciaran S Phibbs, Mintu P Turakhia
OBJECTIVE: To evaluate warfarin prescription, quality of international normalised ratio (INR) monitoring and of INR control in patients with atrial fibrillation (AF) and chronic kidney disease (CKD). METHODS: We performed a retrospective cohort study of patients with newly diagnosed AF in the Veterans Administration (VA) healthcare system. We evaluated anticoagulation prescription, INR monitoring intensity and time in and outside INR therapeutic range (TTR) stratified by CKD...
November 15, 2016: Heart: Official Journal of the British Cardiac Society
https://www.readbyqxmd.com/read/27796019/-renal-failure-management-of-uremic-condition-and-replacement-therapy
#7
Riccardo Magistroni, Giovanna Capolongo, Giovanni Piscopo
Replacement therapy implemented by renal transplantation is preferable to dialysis treatment and also in uremic population with ADPKD. In preparation for the transplant nephrectomy is a procedure associated with morbidity and mortality in patient with ADPKD, it should be performed on the basis of stringent clinical indications. When the kidney transplant is not possible, peritoneal dialysis in appropriate patients is not contraindicated with comparable results to the extracorporeal dialytic treatment. The therapeutic targets in substitution treatment with respect to pressure levels, lipids, hemoglobin, anticoagulation regime are comparable to the non ADPKD uremic population...
September 2016: Giornale Italiano di Nefrologia: Organo Ufficiale Della Società Italiana di Nefrologia
https://www.readbyqxmd.com/read/27769175/warfarin-use-and-stroke-bleeding-and-mortality-risk-in-patients-with-end-stage-renal-disease-and-atrial-fibrillation-a-systematic-review-and-meta-analysis
#8
Jingwen Tan, Shuiqing Liu, Jodi B Segal, G Caleb Alexander, Mara McAdams-DeMarco
BACKGROUND: Patients with end stage renal disease (ESRD), including stage 5 chronic kidney disease (CKD), hemodialysis (HD) and peritoneal dialysis (PD), are at high risk for stroke-related morbidity, mortality and bleeding. The overall risk/benefit balance of warfarin treatment among patients with ESRD and AF remains unclear. METHODS: We systematically reviewed the associations of warfarin use and stroke outcome, bleeding outcome or mortality in patients with ESRD and AF...
October 21, 2016: BMC Nephrology
https://www.readbyqxmd.com/read/27742825/atrial-fibrillation-and-chronic-kidney-disease-struggling-through-thick-and-thin
#9
Simardeep Gill, Min Jun, Pietro Ravani
The prevalence of atrial fibrillation and the risk of stroke display an age-related increase in the chronic kidney disease (CKD) population. Evidence from large randomized controlled trials conducted in the general population supports the use of anticoagulation to reduce the risk of stroke in the setting of non-valvular atrial fibrillation. However, data in the non-dialysis-dependent and dialysis-dependent CKD populations are limited largely to observational studies, which demonstrate conflicting results regarding the risk-benefit profile of anticoagulation...
October 14, 2016: Nephrology, Dialysis, Transplantation
https://www.readbyqxmd.com/read/27734602/recurrent-heparin-induced-thrombocytopenia-due-to-heparin-rinsing-before-priming-the-machine-in-a-hemodialysis-patient-a-case-report
#10
Jin Han Lim, Kyung Pyo Kang, Sik Lee, Sung Kwang Park, Won Kim
Heparin has remained the most commonly used anticoagulant for patients undergoing hemodialysis. It is usually safe to use but can have severe adverse effects in some cases. Heparin-induced thrombocytopenia (HIT) is a life-threatening complication of exposure to heparin. It results from an autoantibody directed against endogenous platelet factor 4 (PF4) in complex with heparin, which activates platelets and can cause catastrophic arterial and venous thromboses. Here, we present the case of an 80-year-old woman with a recent diagnosis of chronic renal failure who developed acute HIT (platelet count nadir, 15 × 10(9) /L) on day 7 of hemodialysis performed with routine heparin anticoagulation, who despite subsequent heparin-free hemodialysis (with argatroban and warfarin) developed recurrent HIT (complicated by acute cerebral infarction) on day 11 that we attributed to "rinsing" of the circuit with heparin-containing saline (3,000 units of unfractionated heparin, with subsequent saline washing) performed pre-dialysis as per routine...
October 13, 2016: Hemodialysis International
https://www.readbyqxmd.com/read/27720627/-challenges-in-renal-transplantation
#11
R Thuret, F Kleinclauss, N Terrier, G Karam, M O Timsit
OBJECTIVES: To describe kidney transplantation surgical techniques and to propose strategies in high-risk recipients. MATERIAL AND METHODS: Relevant publications were identified through Medline (http://www.ncbi.nlm.nih.gov/) and Embase (http://www.embase.com/) database using the following keywords, alone or in association, "renal transplantation; peripheral arterial disease; obesity; third and fourth transplantation; robotic-assisted kidney transplant; anticoagulant therapy; dual kidney transplant"...
October 6, 2016: Progrès en Urologie
https://www.readbyqxmd.com/read/27682213/the-management-of-neonatal-acute-and-chronic-renal-failure-a-review
#12
Malcolm G Coulthard
Most babies with chronic renal failure are identified antenatally, and over half that are treated with peritoneal dialysis receive kidney transplants before school age. Most infants that develop acute renal failure have hypotension following cardiac surgery, or multiple organ failure. Sometimes the falls in glomerular filtration and urine output are physiological and reversible, and sometimes due to kidney injury, but (illogically) it is now common to define them all as having 'acute kidney injury'. Contrary to widespread opinion, careful interpretation of the plasma creatinine concentrations can provide sensitive evidence of early acute renal failure...
September 25, 2016: Early Human Development
https://www.readbyqxmd.com/read/27668230/mitral-valve-replacement-in-a-dialysis-dependent-patient
#13
Ansheng Mo, Zhihu Tao, Zhiqiang Feng, Xiaoping Yang, Jun Wu
Patients with end-stage renal disease have a higher risk of morbidity and mortality than those without end-stage renal disease in cardiovascular surgery. Poor outcomes are especially found in patients who undergo valve surgery. We report successful mitral valve replacement (MVR) in a dialysis-dependent patient. The patient recovered well at postoperation and had the complication of anticoagulation at follow-up. Based on this successful case, we believe that myocardial protection, prevention of infection, nutritional support, and close monitoring of blood coagulation function are important in dialysis-dependent patients undergoing valve replacement...
August 2016: Annals of Translational Medicine
https://www.readbyqxmd.com/read/27668164/cardiac-arrest-caused-by-nafamostat-mesilate
#14
Hyo Shik Kim, Kyung Eun Lee, Ji Hyun Oh, Chan Sung Jung, Dughyun Choi, Yunsuek Kim, Jin Seok Jeon, Dong Cheol Han, Hyunjin Noh
A 65-year-old man was transferred from the Department of Vascular Surgery to Nephrology because of cardiac arrest during hemodialysis. He underwent incision and drainage for treatment of a buttock abscess. Nafamostat mesilate was used as an anticoagulant for hemodialysis to address bleeding from the incision and drainage site. Sudden cardiac arrest occurred after 15 minutes of dialysis. The patient was treated in the intensive care unit for 5 days. Continuous veno-venous hemodiafiltration was started without any anticoagulant in the intensive care unit...
September 2016: Kidney Research and Clinical Practice
https://www.readbyqxmd.com/read/27664921/polyphenolic-polysaccharide-conjugates-of-sanguisorba-officinalis-l-with-anticoagulant-activity-mediated-mainly-by-heparin-cofactor-ii
#15
Izabela Pawlaczyk-Graja, Sebastian Balicki, Rafał Ziewiecki, Mária Matulová, Peter Capek, Roman Gancarz
A macromolecular complex has been isolated from the dried flowering parts of medicinal plant Sanguisorba officinalis L. (So) by multi-step extraction procedure, including that with extraction by organic solvents to degrease the plant material, then with hot alkali, followed by neutralization, partitioning with organic solvents and dialysis. The complex was purified by size-exclusion chromatography into five fractions labeled as So1-So5. Individual fractions differed in the chemical composition and molecular weight distribution patterns...
September 21, 2016: International Journal of Biological Macromolecules
https://www.readbyqxmd.com/read/27659468/atrial-fibrillation-and-thromboembolism-in%C3%A2-patients-with-chronic-kidney-disease
#16
REVIEW
Yee C Lau, Marco Proietti, Elisa Guiducci, Andrew D Blann, Gregory Y H Lip
A bidirectional relationship exists between atrial fibrillation (AF) and chronic renal disease. Patients with AF have a higher incidence of renal dysfunction, and the latter predisposes to incident AF. The coexistence of both conditions results in a higher risk for thromboembolic-related adverse events but a paradoxical increased hemorrhagic risk. Oral anticoagulants (both vitamin K antagonists [VKAs] and non-VKA oral anticoagulants [NOACs]) have been demonstrated to be effective in mild to moderate renal dysfunction...
September 27, 2016: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/27648311/ultrasound-assisted-catheter-directed-thrombolysis-in-the-management-of-a-right-atrial-thrombus-a-new-weapon-in-the-armamentarium
#17
Mohamed Shokr, Ramanjit Kaur, Kevin Belgrave, Arshad Javed, Mahir Elder, Shaun Cardozo, Luis Afonso, Amir Kaki
Catheter related thrombosis (CRT) is a commonly encountered entity fraught with substantial risk for mortality secondary to various complications including pulmonary embolism (PE), tricuspid regurgitation, endocarditis, right sided heart failure, and cardiogenic and septic shock. CRT carries a mortality rate of 18% in hemodialysis patients and more than 40% in nonhemodialysis patients. Management strategies include systemic anticoagulation, systemic thrombolysis, surgical evacuation, and percutaneous retrieval with no established guidelines...
2016: Case Reports in Cardiology
https://www.readbyqxmd.com/read/27623980/relevance-of-non-nutritional-calories-in-mechanically-ventilated-critically-ill-patients
#18
E Bousie, D van Blokland, H J W Lammers, A R H van Zanten
BACKGROUND/OBJECTIVES: Overfeeding in critically ill patients is associated with many complications. Propofol, dextrose infusion and citrate dialysis provide non-nutritional calories (NNCs), potentially causing overfeeding. The relevance of NNCs for total caloric intake has not been systematically studied. SUBJECTS/METHODS: We retrospectively studied adult mechanically ventilated intensive care unit (ICU) patients receiving enteral nutrition with or without supplemental parenteral nutrition...
September 14, 2016: European Journal of Clinical Nutrition
https://www.readbyqxmd.com/read/27598317/patients-characteristics-affect-the-survival-benefit-of-warfarin-treatment-for-hemodialysis-patients-with-atrial-fibrillation-a-historical-cohort-study
#19
Diego Brancaccio, Luca Neri, Francesco Bellocchio, Carlo Barbieri, Claudia Amato, Flavio Mari, Bernard Canaud, Stefano Stuard
BACKGROUND: Stroke prevention in dialysis-dependent patients with atrial fibrillation (AF) is an unresolved clinical dilemma. Indeed, no randomized controlled trial evaluating the efficacy and safety of oral anticoagulants in this population, has been conducted so far. Observational research on the use of warfarin in patients on dialysis has shown conflicting results. This uncertainty is mirrored by the wide variations in warfarin prescription patterns across centers. We sought to evaluate the association between the use of vitamin K antagonists (VKAs) and mortality among hemodialysis patient with AF and to assess potential factors affecting the risk-benefit profile of warfarin in this population...
2016: American Journal of Nephrology
https://www.readbyqxmd.com/read/27584039/phosphatidylserine-and-phosphatidylethanolamine-bind-to-protein-z-cooperatively-and-with-equal-affinity
#20
Tanusree Sengupta, Narayanan Manoj
Protein Z (PZ) is an anticoagulant that binds with high affinity to Protein Z-dependent protease inhibitor (ZPI) and accelerates the rate of ZPI-mediated inhibition of factor Xa (fXa) by more than 1000-fold in the presence of Ca2+ and phospholipids. PZ promotion of the ZPI-fXa interaction results from the anchoring of the Gla domain of PZ onto phospholipid surfaces and positioning the bound ZPI in close proximity to the Gla-anchored fXa, forming a ternary complex of PZ/ZPI/fXa. Although interaction of PZ with phospholipid membrane appears to be absolutely crucial for its cofactor activity, little is known about the binding of different phospholipids to PZ...
2016: PloS One
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