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Atrial fibrillation (AF) is the most common arrhythmia in patients with chronic kidney disease (CKD). In this population, AF is associated with an increased risk of thromboembolism and stroke as a result of a progressive decline in the glomerular filtration rate. However, CKD patients, in particular those on renal replacement therapy, also have an increased risk of bleeding, especially from the gastrointestinal tract. Oral anticoagulation is the most effective form of thromboprophylaxis in patients with AF presenting an increased risk of stroke. Limited evidence of its efficacy, the increased risk of bleeding as well as some concern regarding the use of warfarin in CKD have often resulted in the underuse of anticoagulation in CKD patients. A large body of evidence suggests that non-vitamin-K-dependent oral anticoagulants (NOACs) significantly reduce the risk of stroke, intracranial hemorrhage and mortality. Hence, they are currently recommended for patients with AF at risk of stroke. However, the metabolism of NOACs is largely dependent on the kidneys for elimination and little is known about their use in patients with creatinine clearance <25 mL/min, who have been excluded from all pivotal phase III NOAC trials. This review focuses on the current pharmacokinetic, observational and prospective data on NOACs in patients affected by moderate to advanced CKD (creatinine clearance 15-49 mL/min) and in those on dialysis. [ABSTRACT FROM AUTHOR]

Galectin-3 is a 32- to 35-kDa member of the galectin family of b-galactoside-binding lectins, which is characterized by a carbohydrate recognition domain. Through its carbohydrate-binding function, it regulates cell growth, differentiation, and inflammation. It also plays a complex, context-dependent role in the kidneys. During the development, it promotes nephrogenesis and is strongly expressed in the ureteric bud and its derivatives. An increase in the concentration of galectin-3 has been reported to be associated with fibrosis of the kidneys. Elevated levels of plasma galectin-3 are also associated with increased risks of rapid renal function decline, incident chronic kidney disease, and progressive renal impairment, and also with cardiovascular endpoints, infection, and all-cause mortality in patients with renal function impairment. This review discusses a general survey on galectin-3 expressions in nephrogenesis, kidney injury in animal models, clinical renal diseases, and renal transplantation and the potential role of galectin-3 for treatment in kidney disease. [ABSTRACT FROM AUTHOR]

Sonography in peritoneal dialysis patents Traditionally computed tomography (CT) and more recently magnetic resonance (MR) are the imaging modalities of choice for the evaluation of peritoneum and peritoneal cavity in primary and secondary pathologic conditions. Nevertheless, ultrasound (US) also may be a valuable, accurate, safe, relatively inexpensive and readily accessible diagnostic tool to investigate the diseases that can affect the peritoneal membrane. US is able to provide quantitative information demonstrating much smaller quantities of free intraperitoneal fluid (ascites) being more sensitive than CT in this regard. Sonographic characteristics of ascites allow to detect the presence of blood, pus or neoplastic cells in echogenic fluid. Sonography is very helpful when planning and performing interventional procedures on abdominal wall such as: fine-needle aspiration, core biopsy and drainage: with modern devices lesions of less than 4 mm may be easily targeted. Ultrasonography is used in the assessment of several procedures and complications in peritoneal dialysis (PD) patents. Some of them are well documented whereas other indications are less clear. Peritoneal ultrasound fields of applications include some of the following: correct patents' enrollement, ultrasound-guided catheter's placement, potential diagnosis of exit site and tunnel infections and/or peritonitis (both infectious and/or sclerosing) and leakage amount's assessment. The purpose of this review is to describe an US technique for optimal detection and localization of the main complications commonly encountered in patents affected by chronic kidney disease undergoing peritoneal dialysis. [ABSTRACT FROM AUTHOR]

Vitamin D represents the precursor of calcitriol, crucial for bone and mineral metabolism. The high prevalence of vitamin D deficiency and the detection of vitamin D receptor (VDR) both in the heart and vessels have focused the interest on potential cardiovascular effects of vitamin D. Although several experimental data showed the protective role of vitamin D, on the other hand vitamin D "overdose"can contribute to heart and vascular calcification. Meta-analyses of randomized-controlled trials (RCTs) underlined the association of vitamin D deficiency and increased cardiovascular morbidity and mortality but no significant improvements on cardiovascular outcomes are provided by the supplementation of vitamin D. The following review provides an update on pathophysiology of vitamin D and vitamin D receptor (VDR) discussing on the association with cardiovascular risk factors and disease and on the role of vitamin D supplementation in preventing cardiovascular disease in chronic kidney disease (CKD) patients. [ABSTRACT FROM AUTHOR]