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Anticoagulation in dialysis

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https://www.readbyqxmd.com/read/28431568/a-case-report-of-severe-calciphylaxis-suggested-approach-for-diagnosis-and-treatment
#1
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
#2
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
#3
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
#4
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
#5
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
#6
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
https://www.readbyqxmd.com/read/28355402/budd-chiari-syndrome-secondary-to-catheter-associated-inferior-vena-cava-thrombosis
#7
Gustavo N Araujo, Luciane M Restelatto, Carlos A Prompt, Cristina Karohl
INTRODUCTION: Patients with chronic kidney disease (CKD) are at increased risk for thrombotic complications. The use of central venous catheters as dialysis vascular access additionally increases this risk. We describe the first case of Budd-Chiari syndrome (BCS) secondary to central venous catheter misplacement in a patient with CKD. CASE REPORT: A 30-year-old female patient with HIV/AIDS and CKD on hemodialysis was admitted to the emergency room for complaints of fever, prostration, and headache in the last six days...
March 2017: Jornal Brasileiro de Nefrologia: ʹorgão Oficial de Sociedades Brasileira e Latino-Americana de Nefrologia
https://www.readbyqxmd.com/read/28339843/availability-and-cost-of-extracorporeal-treatments-for-poisonings-and-other-emergency-indications-a-worldwide-survey
#8
Josée Bouchard, Valery Lavergne, Darren M Roberts, Monique Cormier, Genevieve Morissette, Marc Ghannoum
Background: Extracorporeal treatments (ECTRs) are used for different conditions, including replacement of organ function and poisoning. Current recommendations for ECTRs in various poisonings suggest that intermittent haemodialysis (IHD) is the most efficient technique. However, the practicality of these recommendations is poorly defined in view of limited information on availability and cost worldwide. Methods: A survey invitation to an Internet-based questionnaire was emailed between January 2014 and March 2015 to members of international societies to determine the availability, time to initiation and cost of ECTRs (including filters, dialysate, catheter, anticoagulant and nursing/physician salary)...
April 1, 2017: Nephrology, Dialysis, Transplantation
https://www.readbyqxmd.com/read/28337775/effectiveness-and-safety-assessment-of-citrate-anticoagulation-during-albumin-dialysis-in-comparison-to-other-methods-of-anticoagulation
#9
Agnieszka Dyla, Wojciech Mielnicki, Joanna Bartczak, Tomasz Zawada, Piotr Garba
Liver failure is a serious and often deadly disease often requiring MARS (Molecular Adsorbent Recirculating System) therapy. Choosing the safe and effective method of anticoagulation during artificial liver support systems seems to be very difficult and extremely important. The aim of this study was to assess effectiveness and safety of regional anticoagulation with citrate in liver failure patients during MARS. We used a single center observational study. We analyzed 158 MARS sessions performed in 65 patients: 105 (66...
March 23, 2017: Artificial Organs
https://www.readbyqxmd.com/read/28303632/the-comparative-safety-and-effectiveness-of-bivalirudin-versus-heparin-monotherapy-in-patients-on-dialysis-undergoing-percutaneous-coronary-intervention-insights-from-the-blue-cross-blue-shield-of-michigan-cardiovascular-consortium
#10
Devraj Sukul, Milan Seth, Theodore Schreiber, Akshay Khandelwal, Louis A Cannon, Thomas A LaLonde, Hitinder S Gurm
BACKGROUND: Dialysis patients are at a higher risk of bleeding after percutaneous coronary intervention (PCI); however, due to their exclusion from randomized clinical trials, the optimal antithrombotic regimen for this population remains unknown. We sought to evaluate the comparative safety and effectiveness of bivalirudin monotherapy versus unfractionated heparin (UFH) monotherapy in dialysis patients undergoing PCI. METHODS: We included dialysis patients who underwent PCI in a multicenter registry between January 2010 and September 2015 at 47 Michigan hospitals...
March 17, 2017: Catheterization and Cardiovascular Interventions
https://www.readbyqxmd.com/read/28302754/apixaban-pharmacokinetics-at-steady-state-in-hemodialysis-patients
#11
Thomas A Mavrakanas, Caroline F Samer, Sharon J Nessim, Gershon Frisch, Mark L Lipman
It is unclear whether warfarin is protective or harmful in patients with ESRD and atrial fibrillation. This state of equipoise raises the question of whether alternative anticoagulants may have a therapeutic role. We aimed to determine apixaban pharmacokinetics at steady state in patients on hemodialysis. Seven patients received apixaban 2.5 mg twice daily for 8 days. Blood samples were collected before and after apixaban administration on days 1 and 8 (nondialysis days). Significant accumulation of the drug was observed between days 1 and 8 with the 2...
March 16, 2017: Journal of the American Society of Nephrology: JASN
https://www.readbyqxmd.com/read/28297047/patient-related-factors-influencing-patency-of-autogenous-brachiocephalic-haemodialysis-fistulas
#12
Alexander Lamprou, Cor de Bruin, Arie van Roon, Jan Loonstra, Maarten van der Laan, Ignace Tielliu, Clark Zeebregts
OBJECTIVE: The objective of this study was to analyse the outcome of autogenous brachiocephalic fistula for dialysis purposes and to determine modifiable and non-modifiable patient-related factors of influence on the patency of a newly created fistula. DESIGN OF STUDY: A single-centre retrospective cohort study with the aim of determining patient-related factors of influence on primary failure, primary, primary assisted and secondary patency of autogenous brachiocephalic fistulas...
March 6, 2017: Journal of Vascular Access
https://www.readbyqxmd.com/read/28284300/renal-replacement-therapy-in-acute-kidney-injury-controversies-and-consensus
#13
REVIEW
Michael Heung, Lenar Yessayan
Acute kidney injury (AKI) is a common complication among critically ill patents, and 5% of intensive care unit (ICU) patients require initiation of renal replacement therapy (RRT). In recent years, clinical trials have provided evidence-based guidance for some important aspects of RRT management in patients with AKI, such as dialysis dosing and approaches to anticoagulation in patients undergoing continuous RRT. However, there remain many areas of uncertainty, and delivery of RRT in the ICU requires clinical judgment, flexibility, and an understanding of dialysis principles...
April 2017: Critical Care Clinics
https://www.readbyqxmd.com/read/28276631/antithrombotic-medications-in-dialysis-patients-a-double-edged-sword
#14
Georgios Vlachopanos, Farid Girgis Ghalli
In the clinical context of end-stage renal disease (ESRD), thrombosis and bleeding risks are simultaneously increased and may have devastating consequences. While anticoagulant and antiplatelet drugs are indispensable for the prevention of thromboembolic events, the significantly higher bleeding risk makes their handling extremely complicated. In ESRD, they are frequently administered for a wide array of conditions. For example, atrial fibrillation is quite common in ESRD and warrants the use of anticoagulants like warfarin...
February 2017: Journal of Evidence-based Medicine
https://www.readbyqxmd.com/read/28253497/comparison-of-the-an69st-membrane-versus-citrate-enriched-dialysate-on-clotting-events-during-hemodialysis-without-systemic-anticoagulation
#15
Vanessa Nseir, Antoine Rachas, Michelle Elias, Hélène Francois, Erika Nnang Obada, Hans Kristian Lorenzo, Bernard Charpentier, Antoine Durrbach, Séverine Beaudreuil
BACKGROUND: The optimal management of anticoagulation in hemodialyzed patients with a high risk of bleeding is controversial. METHODS: We compared premature termination of dialysis caused by clotting events between AN69ST membranes (G1) and 0.8 mmol/L citrate-enriched dialysate (G2). The number of sessions that had increased venous pressure (VP) and variations in urea-reduction ratio (URR) were analyzed. RESULTS: Six hundred and two sessions were analyzed in 259 patients: 22...
2017: Blood Purification
https://www.readbyqxmd.com/read/28249361/heparin-induced-amyloid-fibrillation-of-%C3%AE-2-microglobulin-explained-by-solubility-and-a-supersaturation-dependent-conformational-phase-diagram
#16
Masatomo So, Yasuko Hata, Hironobu Naiki, Yuji Goto
Amyloid fibrils are fibrillar deposits of denatured proteins associated with amyloidosis and are formed by a nucleation and growth mechanism. We revisited an alternative and classical view of amyloid fibrillation: amyloid fibrils are crystal-like precipitates of denatured proteins formed above solubility upon breaking supersaturation. Various additives accelerate and then inhibit amyloid fibrillation in a concentration-dependent manner, suggesting that the combined effects of stabilizing and destabilizing forces affect fibrillation...
March 1, 2017: Protein Science: a Publication of the Protein Society
https://www.readbyqxmd.com/read/28223192/anticoagulation-for-atrial-fibrillation-in-dialysis-patients-what-is-known-and-what-does-the-future-hold
#17
EDITORIAL
Timothy M Markman, Saman Nazarian
No abstract text is available yet for this article.
May 2017: Heart Rhythm: the Official Journal of the Heart Rhythm Society
https://www.readbyqxmd.com/read/28202161/complication-profile-failure-to-rescue-and-mortality-following-elective-endovascular-aortic-aneurysm-repair
#18
David S Kauvar, Eric D Martin, Todd E Simon, Matthew D Givens
INTRODUCTION: Understanding the relationship between patient risk factors, postoperative complications, and morbidity and mortality is important when considering elective endovascular aortic aneurysm repair (E-EVAR) performed to prevent aneurysm rupture mortality. We aimed to stratify complications in E-EVAR and explore their relationship with postoperative death. METHODS: E-EVAR cases from 2012 NSQIP were identified. 30-day complications were categorized as major (MAJCX) or minor (MINCX) using the Clavien-Dindo classification...
February 8, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/28164512/critical-deviations-of-ionized-calcium-measurements-when-using-blood-gas-analyzers-to-monitor-citrate-dialysis
#19
Thorsten Feldkamp, Norbert Weiler, Michael Marx, Peter B Luppa, Ralf Junker
BACKGROUND: During the course of acute kidney injury (AKI) patients may require renal replacement therapy (RRT). The preferred therapeutic measure for such patients is continuous RRT (CRRT). Anticoagulation is required to prevent clotting of the extracorporeal circuit. The actual KDIGO guidelines recommend citrate as the first line anticoagulant. METHODS: Citrate dose infused into the extracorporeal circuit should achieve an extracorporeal calcium concentration of 0...
October 1, 2016: Clinical Laboratory
https://www.readbyqxmd.com/read/28133243/-a-case-of-thyroid-carcinoma-in-consideration-for-perioperative-management
#20
Katsuhisa Enomoto, Kenichi Sakurai
When patients are on long-term dialysis, various kinds of medication are given. We report our experience with a 75-yearold woman with thyroid carcinoma incidentally discovered during dialysis. Ultrasonography of the thyroid showed a tumor of about 3 cm in the right lobe center. The dialysis performed surgery on the day when we were not dialyzed. Heparinization for anticoagulation was not administered. Adhesion with the circumferential organ was strong, and in the perioperative findings, the thyroid gland showed difficulty in sublation...
November 2016: Gan to Kagaku Ryoho. Cancer & Chemotherapy
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