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Anticoagulation in dialysis

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https://www.readbyqxmd.com/read/28616216/warfarin-related-nephropathy-induced-by-three-different-vitamin-k-antagonists-analysis-of-13-biopsy-proven-cases
#1
Léonard Golbin, Cécile Vigneau, Guy Touchard, Eric Thervet, Jean-Michel Halimi, Théophile Sawadogo, Nathan Lagoutte, Pascale Siohan, Elie Zagdoun, Alexandre Hertig, Nathalie Rioux-Leclercq, Thierry Frouget
Background: Acute kidney injury (AKI) with renal tubular obstruction by red blood cell casts (RBCC) has been described in patients treated with warfarin and is known as warfarin-related nephropathy (WRN). Methods: To determine whether other vitamin K antagonists (VKA) cause WRN, we retrospectively collected and analyzed the clinical and histological data of 13 patients treated with different VKA (seven with fluindione, four with warfarin and two with acenocoumarol) in seven French hospitals. Results: They all developed gross hematuria following overanticoagulation complicated by severe AKI (median serum creatinine concentration = 693 μmol/L)...
June 2017: Clinical Kidney Journal
https://www.readbyqxmd.com/read/28608569/membrane-based-therapeutic-plasma-exchange-mtpe-technical-and-clinical-experience
#2
Casey N Gashti, Daniel C Andreoli, Dipal Patel
Therapeutic plasma exchange (TPE) has long been utilized to manage a variety of immune-mediated diseases. The basic principle relies on removal of circulating pathogenic substances from the bloodstream. Methods of plasma separation include centrifuge (cTPE) and membrane (mTPE). Although mTPE has existed for a few decades, recent advances in developing highly permeable filters that are compatible with currently existing dialysis machines has opened a new frontier. Published data in the area of technical and clinical experience with mTPE is lacking...
June 13, 2017: Journal of Clinical Apheresis
https://www.readbyqxmd.com/read/28583916/balancing-anticoagulation-decisions-in-patients-on-dialysis-with-atrial-fibrillation
#3
EDITORIAL
Eli N Deal, Jerrica E Shuster
No abstract text is available yet for this article.
June 5, 2017: Journal of the American Society of Nephrology: JASN
https://www.readbyqxmd.com/read/28569990/prospective-randomized-multicenter-controlled-trial-triathron-1-on-a-new-antithrombogenic-hydrophilic-dialysis-membrane
#4
Claudio Ronco, Alessandra Brendolan, Federico Nalesso, Monica Zanella, Massimo De Cal, Valentina Corradi, Grazia M Virzì, Fiorenza Ferrari, Francesco Garzotto, Anna Lorenzin, Aakash N Karopadi, Marco Sartori, Silvia De Rosa, Sara Samoni, Faeq Husain-Syed, Alessandra Spinelli, Mauro Neri, Gianluca Villa, Alberta Alghisi
INTRODUCTION: Hemodialysis treatment requires anticoagulation to prevent thrombosis of the dialyzer. The Hydrolink® (NV series; Toray) has been designed to reduce thrombotic complications by increasing membrane hydrophilic properties. Previous studies have confirmed reduced platelet activation, improved removal of β2-microglobulin and excellent small-solute removal. METHODS: We designed a prospective, multi-centered, randomized clinical study to compare the antithrombogenic effects (platelet count) of NV dialyzers versus conventional treatment...
May 29, 2017: International Journal of Artificial Organs
https://www.readbyqxmd.com/read/28554992/dialysis-procedures-alter-metabolic-conditions
#5
REVIEW
Bernd Stegmayr
A progressive chronic kidney disease results in retention of various substances that more or less contribute to dysfunction of various metabolic systems. The accumulated substances are denominated uremic toxins. Although many toxins remain undetected, numerous newly defined toxins participate in the disturbance of food breakdown. In addition, toxic effects may downregulate other pathways, resulting in a reduced ability of free fatty acid breakdown by lipoprotein lipase (LPL) and hepatic lipase (HL). Dialysis may even worsen metabolic functions...
May 27, 2017: Nutrients
https://www.readbyqxmd.com/read/28553032/stroke-in-patients-with-chronic-kidney-disease%C3%A2-how-do-we-approach-and-manage-it
#6
REVIEW
S Nayak-Rao, M P Shenoy
Renal failure is a potent risk factor for stroke, which is a leading cause of morbidity and mortality worldwide. The risk of stroke is 5-30 times higher in patients with chronic kidney disease (CKD), especially on dialysis. Case fatality rates are also higher reaching almost 90%. It is therefore important to understand the factors that predispose to stroke in this vulnerable population to better apply preventive strategies. The heightened risk of stroke in CKD represents the interplay of the vascular co-morbidities that occur with renal impairment and factors specific to renal failure such as malnutrition-inflammation-atherosclerosis complex, the effect of uremic toxins, dialysis techniques, vascular access, and the use of anticoagulants to maintain flow in the extracorporeal circuit...
May 2017: Indian Journal of Nephrology
https://www.readbyqxmd.com/read/28545622/warfarin-and-the-risk-of-stroke-and-bleeding-in-patients-with-atrial-fibrillation-receiving-dialysis-a-systematic-review-and-meta-analysis
#7
REVIEW
Ziv Harel, Glenn M Chertow, Prakesh S Shah, Shai Harel, Paul Dorian, Andrew T Yan, Gustavo Saposnik, Manish M Sood, Amber O Molnar, Jeffrey Perl, Rachel M Wald, Sam Silver, Ron Wald
BACKGROUND: Patients with atrial fibrillation who receive dialysis are at a high risk of ischemic stroke. The role of warfarin in mitigating this risk in patients with atrial fibrillation who receive dialysis is uncertain. Our objective was to examine the safety and efficacy of warfarin in patients who have atrial fibrillation and receive dialysis. METHODS: We used MedLine, Embase, and the Cochrane Library to conduct a systematic review and meta-analysis of published and unpublished observational and interventional studies related to the use of warfarin in patients with atrial fibrillation who receive dialysis, and provided data on the risk of stroke and/or bleeding outcomes relative to placebo or no anticoagulation therapy...
June 2017: Canadian Journal of Cardiology
https://www.readbyqxmd.com/read/28544274/antithrombotic-therapy-in-end-stage-renal-disease
#8
REVIEW
Svetha Chunduri, Jon E Folstad, Tushar J Vachharajani
The delicate balance of risk vs. benefit of using antiplatelet and antithrombotic agents in the general population is well established. The decision to use these agents in the end stage renal disease (ESRD) population remains complex and difficult. The concomitant association of a prothombotic state with high risk of bleeding in the ESRD population requires individualization and careful clinical judgment before implementing such therapy. There remains a paucity of clinical trials and lack of substantial evidence in literature for safe and effective use of antithrombotic drugs in patients with advanced chronic kidney disease...
May 23, 2017: Hemodialysis International
https://www.readbyqxmd.com/read/28535516/citrate-anticoagulation-during-continuous-renal-replacement-therapy
#9
Davide Ricci, Laura Panicali, Maria Grazia Facchini, Elena Mancini
During extracorporeal dialysis, some anticoagulation strategy is necessary to prevent the coagulation of blood. Heparin has historically been used as an anticoagulant because of its efficacy combined with low cost. However, a variable incidence of hemorrhagic complications (5-30%) has been documented in patients undergoing continuous renal replacement therapy (CRRT) with heparin as an anticoagulant. Citrate has anticoagulation properties secondary to its ability to chelate calcium, which is necessary for the coagulation cascade...
2017: Contributions to Nephrology
https://www.readbyqxmd.com/read/28502818/renal-function-considerations-for-stroke-prevention-in-atrial-fibrillation
#10
REVIEW
John Fanikos, Allison E Burnett, Charles E Mahan, Paul P Dobesh
Renal impairment increases risk of stroke and systemic embolic events and bleeding in patients with atrial fibrillation. Direct oral anticoagulants have varied dependence on renal elimination, magnifying the importance of appropriate patient selection, dosing, and periodic kidney function monitoring. In randomized controlled trials of nonvalvular atrial fibrillation, direct oral anticoagulants were at least as effective and associated with less bleeding compared with warfarin. Each direct oral anticoagulant was associated with reduced risk of stroke and systemic embolic events and major bleeding compared with warfarin in nonvalvular atrial fibrillation patients with mild or moderate renal impairment...
May 11, 2017: American Journal of Medicine
https://www.readbyqxmd.com/read/28498661/mesoporous-silica-nanoparticles-encapsulated-agarose-and-heparin-as-anticoagulant-and-resisting-bacterial-adhesion-coating-for-biomedical-silicone
#11
Fan Wu, Tingting Xu, Guangyao Zhao, Shuangshuang Meng, Mimi Wan, Bo Chi, Chun Mao, Jian Shen
Silicone catheter has been widely used in peritoneal dialysis. The research missions of improving blood compatibility and the ability of resisting bacterial adhesion of silicone catheter have been implemented for the biomedical requirements. However, most of modification methods of surface modification were only able to develop the blood-contacting biomaterials with good hemocompatibility. It is difficult for the biomaterials to resist bacterial adhesion. Here, agarose was selected to resist bacterial adhesion, and heparin was chosen to improve hemocompatibility of materials...
May 17, 2017: Langmuir: the ACS Journal of Surfaces and Colloids
https://www.readbyqxmd.com/read/28482261/nonvitamin-k-dependent-oral-anticoagulants-noacs-in-chronic-kidney-disease-patients-with-atrial-fibrillation
#12
REVIEW
L Di Lullo, C Ronco, M Cozzolino, D Russo, L Russo, B Di Iorio, A De Pascalis, V Barbera, M Galliani, E Vitaliano, C Campana, F Santoboni, A Bellasi
Atrial fibrillation (AF) represents the most common arrhythmia in patients with chronic kidney disease (CKD). As in the general population, in CKD patients AF is associated with an increased risk of thromboembolism and stroke. 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...
May 4, 2017: Thrombosis Research
https://www.readbyqxmd.com/read/28480998/evaluation-of-osmocells-a-new-semi-automatic-device-for-osmotic-fragility-assessment
#13
D Gérard, A-J Fattet, C Brakta, A Phulpin, D Steschenko, J-F Lesesve, J Perrin
INTRODUCTION: The osmotic fragility (OF) test was a central test for the diagnosis of hereditary red blood cell (RBC) disorders (mostly hereditary spherocytosis (HS), but thalassaemia as well). Nowadays although the traditional multitubes method has lost a prominent place, many laboratories still perform such a laboured test, despite the lack of standardization. In fact, the evaluation of OF may offer an inexpensive screening for RBC disorders. We present a new semi-automatic device, allowing the continuous recording of OF, by an updated dialysis method...
May 8, 2017: International Journal of Laboratory Hematology
https://www.readbyqxmd.com/read/28479423/treating-peripheral-artery-disease-in-the-wake-of-rising-costs-and-protracted-length-of-stay
#14
Grace J Wang, Benjamin M Jackson, Paul J Foley, Scott M Damrauer, Venkat Kalapatapu, Michael A Golden, Ronald M Fairman
OBJECTIVE: There has been growing scrutiny in the treatment of patients with peripheral artery disease (PAD) due to the utilization of resources to manage this complex patient population. The purpose of this study was to determine the factors associated with prolonged length of stay (LOS>7 days) following lower extremity bypass using data from the Vascular Quality Initiative (VQI) as well as to define the additional costs incurred due to prolonged LOS in our health system. METHODS: Summary statistics were performed of patients undergoing lower extremity bypass from 2010-2015...
May 4, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/28431568/a-case-report-of-severe-calciphylaxis-suggested-approach-for-diagnosis-and-treatment
#15
Margret Patecki, Gabriele Lehmann, Jan Hinrich Bräsen, Jessica Schmitz, Anna Bertram, Lars Daniel Berthold, Hermann Haller, Wilfried Gwinner
BACKGROUND: Calciphylaxis is a serious complication in patients with chronic kidney disease associated mineral and bone disorder. It can occur in conditions with low and high bone turnover. So far, there are no definite diagnostic and therapeutic guidelines which may prevent the devastating outcome in many calciphylaxis patients. We report a case which clearly illustrates that knowledge of the underlying bone disorder is essential for a directed treatment. Based on this experience we discuss a systematic diagnostic and therapeutic approach in patients with calciphylaxis...
April 21, 2017: BMC Nephrology
https://www.readbyqxmd.com/read/28428030/complement-inhibition-with-eculizumab-for-thrombotic-microangiopathy-rescues-a-living-donor-kidney-transplant-in-a-patient-with-antiphospholipid-antibody-syndrome
#16
Praveen Ramakrishnan Geethakumari, Patrick Mille, Rakesh Gulati, Srikanth Nagalla
Antiphospholipid antibody syndrome (APS) is an enigmatic heterogeneous disorder despite several revelations in its pathobiology. Renal transplantation in patients with APS has been notoriously difficult due to the high risk of development of thrombotic microangiopathy (TMA), which is often refractory to conventional treatment modalities such as aggressive anticoagulation and plasmapheresis. We describe a case of a 58-year-old male with secondary APS undergoing living unrelated renal transplantation for end-stage renal disease from lupus nephritis...
March 10, 2017: Transfusion and Apheresis Science
https://www.readbyqxmd.com/read/28425077/unexpected-and-striking-effect-of-heparin-free-dialysis-on-cytokine-release
#17
Alicja Rydzewska-Rosolowska, Joanna Gozdzikiewicz-Lapinska, Jacek Borawski, Ewa Koc-Zorawska, Michal Mysliwiec, Beata Naumnik
Heparin (both unfractionated and low molecular weight) is not only a potent anticoagulant but also has many pleiotropic effects, some of which are mediated by cytokine release. We compared the effect of hemodialysis (HD) with enoxaparin as an anticoagulant and without systemic anticoagulation (heparin-grafted membrane-Evodial) on the release of monocyte chemoattractant protein 1 (MCP-1), endostatin (ES) and activin A (Act-A). Nineteen stable HD patients were dialyzed with or without heparin, and plasma levels of MCP-1, ES and Act-A were measured after such a dialysis...
April 19, 2017: International Urology and Nephrology
https://www.readbyqxmd.com/read/28407129/a-noninferiority-trial-comparing-a-heparin-grafted-membrane-plus-citrate-containing-dialysate-versus-regional-citrate-anticoagulation-results-of-the-cited-study
#18
RANDOMIZED CONTROLLED TRIAL
Björn Meijers, Christoph Metalidis, Thomas Vanhove, Ruben Poesen, Dirk Kuypers, Pieter Evenepoel
Background.: Anticoagulation is a prerequisite for successful haemodialysis. Heparin and low-molecular weight heparins are routinely used despite increased bleeding risk. Regional citrate anticoagulation (RCA) is efficacious, but is laborious and may induce metabolic disturbances. Heparin-grafted membranes are less efficacious. It is not known whether combining citrate-containing dialysate and a heparin-grafted membrane is a valid anticoagulation strategy. Methods.: We performed a randomized crossover noninferiority trial, with a prespecified noninferiority threshold of 10% in maintenance dialysis patients ( n  = 25)...
April 1, 2017: Nephrology, Dialysis, Transplantation
https://www.readbyqxmd.com/read/28396914/-anticoagulation-in-patients-with-chronic-kidney-disease-recommendations-from-the-working-group-heart-kidney-of-the-german-cardiac-society-and-the-german-society-of-nephrology
#19
G Schlieper, V Schwenger, A Remppis, T Keller, R Dechend, S Massberg, S Baldus, T Weinreich, G Hetzel, J Floege, F Mahfoud, D Fliser
Indications for anticoagulation are thromboembolic events, prosthetic heart valves, and atrial fibrillation with a corresponding risk score. Clinical trials have excluded patients with advanced chronic kidney disease and these data cannot be always generalized to patients with chronic kidney disease. Non-vitamin K antagonist oral anticoagulants (NOACs) are mostly not recommended or are contraindicated in advanced stages of chronic kidney disease. Observational studies have shown that dialysis patients with atrial fibrillation do not profit from coumarin anticoagulants; prospective studies are lacking...
April 10, 2017: Der Internist
https://www.readbyqxmd.com/read/28375903/bleeding-risk-of-antithrombotic-treatment-in-patients-on-hemodialysis
#20
Eduardo Vázquez, Carmen Sánchez-Perales, Sonia Ortega, Teresa Vázquez-Sánchez, Enrique Quesada, Daniel Salas, Juan Carlos Fernández-Guerrero
BACKGROUND: The risk-benefit of antithrombotic treatment (ATT) has not been established in patients on dialysis. Our objective was to determine the influence of ATT on the risk of hemorrhage in patients on hemodialysis. METHODS: We included patients who began dialysis between 2003 and 2007. We determined the rates of fatal bleeding or bleeding leading to hospitalization or transfusion. RESULTS: Two hundred twenty-one patients were included...
April 2017: Journal of Cardiovascular Pharmacology
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