19 results on '"End stage renal disease"'
Search Results
2. [Atrial fibrillation, oral anticoagulation and nephroprotection: caution or bravery?]
- Author
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Di Lullo L, Magnocavallo M, Vetta G, Lavalle C, Barbera V, Ronco C, Paoletti E, Ravera M, Fusaro M, Russo D, De Pascalis A, and Bellasi A
- Subjects
- Administration, Oral, Anticoagulants adverse effects, Female, Humans, Male, Atrial Fibrillation complications, Atrial Fibrillation drug therapy, Courage, Kidney Failure, Chronic chemically induced, Renal Insufficiency, Chronic drug therapy, Stroke etiology, Stroke prevention & control
- Abstract
Atrial fibrillation (AF) and chronic kidney disease (CKD) are strictly related and share several risk factors (i.e. hypertension, diabetes mellitus, congestive heart failure). As consequence, AF is very common among CKD patients, especially in those with end stage renal disease (ESRD). Moreover, patients with AF and advanced kidney disease have a higher mortality rate than patients with preserved renal function due to an increased incidence of stroke and an unpredicted elevated hemorrhagic risk. The adequate long-term oral anticoagulation in this subgroup of patients represents a major challenging issue faced by physicians in clinical practice. Direct oral anticoagulants (DOACs) are currently contraindicated in patients with ESRD while vitamin K antagonists (VKAs) are characterized by a narrow therapeutic window, increased tissue calcification and an unfavorable risk/benefit ratio with low stroke prevention effect and augmented risk of major bleeding. The purpose of this review is to shed light on the applications of DOAC therapy in CKD patients, especially in ESRD patients., (Copyright by Società Italiana di Nefrologia SIN, Rome, Italy.)
- Published
- 2022
3. Safety and Efficacy of Apixaban, Rivaroxaban, and Warfarin in End-Stage Renal Disease With Atrial Fibrillation: A Systematic Review and Meta-Analysis.
- Author
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Abdullah HM, Ullah W, Jafar MS, van Zyl M, Saeed R, Alam M, Alraies MC, and Fischman DL
- Subjects
- Administration, Oral, Humans, Pyrazoles adverse effects, Pyridones adverse effects, Rivaroxaban adverse effects, Stroke diagnosis, Stroke etiology, Stroke prevention & control, Warfarin adverse effects, Anticoagulants adverse effects, Atrial Fibrillation complications, Atrial Fibrillation diagnosis, Atrial Fibrillation drug therapy, Kidney Failure, Chronic complications, Kidney Failure, Chronic diagnosis, Kidney Failure, Chronic drug therapy
- Abstract
Background: The use of warfarin in patients with atrial fibrillation (AF) and end-stage renal disease (ESRD) has been implicated with efficacy and safety concerns. Evidence on the role of direct oral anticoagulants (DOACs) in this population is limited., Methods: Electronic databases were searched and articles comparing the safety and efficacy of warfarin with apixaban or rivaroxaban were identified. Pooled hazard ratios (HR) were computed using a random-effects model., Results: A total of eight articles consisting of 30,806 patients; (rivaroxaban 2196, apixaban 2745 and warfarin 25,865) were identified. The pooled HR for major bleeding events favored apixaban over warfarin (0.53, 95% confidence interval (CI) 0.33-0.84, p = 0.008). Apixaban was similar to warfarin in terms of clinically relevant non-major bleeding (HR 1.08, 95% CI 0.64-1.84, p = 0.77) and stroke events (HR 1.09, 95% CI 0.85, 1.39, p = 0.99). There was no significant difference in the risk of major bleeding events (HR 0.95, 95% CI 0.50-1.81, p = 0.88) and stroke between rivaroxaban (HR 1.39, 95% CI, 0.59-3.29, p = 0.09) and warfarin. The combined results of major bleeding in the apixaban group were not affected by the sensitivity analysis., Conclusions: Apixaban may have a lower risk of major bleeding and comparable risk of stroke when compared with warfarin in AF patients with ESRD., (Copyright © 2020 Elsevier Inc. All rights reserved.)
- Published
- 2021
- Full Text
- View/download PDF
4. Comparison of CHA2DS2-VASc and C2HEST scores for predicting the incidence of atrial fibrillation among patients with end-stage renal disease.
- Author
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Hu WS and Lin CL
- Subjects
- Aged, Atrial Fibrillation physiopathology, Female, Humans, Incidence, Kidney Failure, Chronic pathology, Male, Middle Aged, Risk Assessment, Risk Factors, Atrial Fibrillation diagnosis, Kidney Failure, Chronic complications
- Abstract
Purpose: The authors have studied assessment of CHA2DS2-VASc score versus C2HEST score in atrial fibrillation risk prediction in end-stage renal disease patients., Methods: The authors conducted this study by Longitudinal Health Insurance Database 2000. The authors totally enrolled 4,601 end-stage renal disease patients. The predictive capability of atrial fibrillation by using CHA2DS2-VASc and C2HEST score was estimated by area under the receiver operating characteristic curve (AUROC)., Results: The AUROC for CHA2DS2-VASc score in predicting atrial fibrillation events was 0.5786, and AUROC for C2HEST score for atrial fibrillation prediction was 0.5983., Conclusion: Both scores yield almost identical AUROC values implying no difference in predictive power. Further work is warranted to verify the prognostic value of the current scores.
- Published
- 2020
- Full Text
- View/download PDF
5. Prevalence and associated factors of undiagnosed atrial fibrillation among end-stage renal disease patients on maintenance haemodialysis: a cross-sectional study.
- Author
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AlAwwa I, Al-Hindi R, Alfraihat N, Obeid A, Ibrahim S, Jallad S, Al-Awwa A, and Saleh A
- Subjects
- Adult, Aged, Aged, 80 and over, Atrial Fibrillation diagnosis, Cross-Sectional Studies, Female, Humans, Jordan epidemiology, Kidney Failure, Chronic diagnosis, Kidney Failure, Chronic epidemiology, Male, Middle Aged, Prevalence, Risk Assessment, Risk Factors, Young Adult, Atrial Fibrillation epidemiology, Kidney Failure, Chronic therapy, Renal Dialysis
- Abstract
Background: Atrial fibrillation (AF) is the most prevalent sustained arrhythmia worldwide and it aggravates cardiovascular morbidity and mortality; however, this is largely under-diagnosed. Moreover, among end-stage renal disease patients on haemodialysis, AF is substantially more common and serious. The researchers conducted this study to assess the prevalence of, and the factors correlated with AF in Jordanian haemodialysis patients., Methods: In a cross-sectional analysis conducted from October 2018 to February 2019 in four tertiary hospitals, the researchers enrolled all consenting patients aged 18 years or older who were on haemodialysis for at least three months prior to the study. We screened for AF clinically by pulse palpation, precordial auscultation, by an automated blood pressure monitor and an electrocardiogram. The researchers reported qualitative variables as counts and frequencies, while continuous variables were summarised using the mean or median where necessary. We used multiple logistic regression with backward selection to identify independent risk factors of AF., Results: A total of 231 patients were enrolled; mean age was 54.8 ± 15.6 years (from 20 to 86), and 44.3% of them were women. The prevalence of AF was found to be 7.8% (95% CI, 4.8-12.2), with no gender disparity. Age (adjusted odds ratio [AOR] = 1.05; 95% CI, 1.01-1.10; p = 0.031), history of ischaemic heart disease (AOR = 3.74; 95% CI, 1.09-12.34; p = 0.033), history of smoking (AOR = 0.15; 95% CI, 0.02-0.60; p = 0.019), and low interdialytic weight gain (AOR = 0.50: 95% CI, 0.25-0.91; p = 0.031) were independently correlated to AF., Conclusions: The prevalence of AF among patients on maintenance haemodialysis is high, but largely undiagnosed. AF is generally associated with advancing age, history of ischaemic heart disease, lower interdialytic weight gain, and history of smoking. We suggest routine check-up of AF in this high-risk group of patients as anticoagulant therapy if indicated may prevent serious complications. However, there is a need for large-scale cohort studies and for the creation of regional chronic kidney disease and dialysis registries in the Middle East region.
- Published
- 2020
- Full Text
- View/download PDF
6. Oral Anticoagulation for Atrial Fibrillation Thromboembolism Prophylaxis in the Chronic Kidney Disease Population: the State of the Art in 2019.
- Author
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Zhang L, Steckman DA, Adelstein EC, Schulman-Marcus J, Loka A, Mathew RO, Venditti FJ, and Sidhu MS
- Subjects
- Administration, Oral, Hemorrhage, Humans, Warfarin adverse effects, Anticoagulants therapeutic use, Atrial Fibrillation drug therapy, Renal Insufficiency, Chronic drug therapy
- Abstract
Atrial fibrillation (AF) is the most common cardiac rhythm disturbance and is associated with increased risk of thromboembolism. Oral anticoagulants are effective at reducing rates of thromboembolism in patients with AF in the general population. Patients with AF and concurrent chronic kidney disease (CKD) have higher risk of thromboembolism and bleeding compared with patients with normal renal function. Among moderate CKD and end-stage renal disease (ESRD) patients on chronic dialysis, the use of oral anticoagulants is controversial. Use of warfarin, while beneficial in non-CKD patients, raises a number of concerns such as increased bleeding risk, labile anticoagulant effect, and calciphylaxis, especially in the ESRD population. The newer direct oral anticoagulant (DOAC) agents have demonstrated comparable efficacy and improved safety profiles compared with coumadin but are not as well studied in the CKD population. This review highlights the efficacy and safety of coumadin and the DOACs for thromboembolism prophylaxis in non-valvular AF patients with CKD.
- Published
- 2019
- Full Text
- View/download PDF
7. [Atrial fibrillation in severe and end stage renal disease: from oral anticoagulation therapy to percutaneous left atrial appendage occlusion].
- Author
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Merella P, Casu G, Mazzone P, Lorenzoni G, D'Angelo G, and Genovesi S
- Subjects
- Administration, Oral, Anticoagulants administration & dosage, Antithrombins administration & dosage, Atrial Fibrillation surgery, Hemorrhage etiology, Hemorrhage prevention & control, Humans, Kidney Failure, Chronic therapy, Renal Replacement Therapy, Stroke etiology, Thromboembolism etiology, Anticoagulants adverse effects, Atrial Appendage surgery, Atrial Fibrillation complications, Contraindications, Drug, Kidney Failure, Chronic complications, Stroke prevention & control, Thromboembolism prevention & control
- Abstract
Non-valvular atrial fibrillation (AF) is the most frequent arrhythmia in the general population and its prevalence increases with age. The prevalence and incidence of AF is high in patients with chronic kidney failure (CKD). The most important complication associated with AF, both in the general population and in that with CKD, is thromboembolic stroke. For this reason, in patients with AF, the Guidelines indicate oral anticoagulant therapy (OAT) with vitamin K antagonists (VKAs) or direct oral anticoagulants (DOACs) for thromboembolic risk prevention. Patients with severe CKD and, in particular, with end stage renal disease (ESRD) undergoing renal replacement therapy, often have both a high thromboembolic and hemorrhagic risk and therefore present both an indication and a contraindication to OAT. In addition, patients with severe or ESRD were excluded from trials that showed the efficacy of different antithrombotic drugs in patients with AF. Thus there is no evidence of the effectiveness of OAT in this population. This review deals with the issues related to OAT in patients with severe or end stage CKD and the possible use of percutaneous closure of the left auricula (LAAO), recently proposed as an alternative in patients with an absolute contraindication of OAT in this population., (Copyright by Società Italiana di Nefrologia SIN, Rome, Italy.)
- Published
- 2019
8. Warfarin use and the risk of stroke, bleeding, and mortality in older adults on dialysis with incident atrial fibrillation.
- Author
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Tan J, Bae S, Segal JB, Zhu J, Alexander GC, Segev DL, and McAdams-DeMarco M
- Subjects
- Age Factors, Aged, Aged, 80 and over, Atrial Fibrillation diagnosis, Atrial Fibrillation mortality, Female, Hemorrhage mortality, Humans, Incidence, Kidney Failure, Chronic diagnosis, Kidney Failure, Chronic mortality, Male, Risk Assessment, Risk Factors, Sex Factors, Stroke diagnosis, Stroke mortality, Time Factors, Treatment Outcome, United States, Anticoagulants adverse effects, Atrial Fibrillation drug therapy, Hemorrhage chemically induced, Kidney Failure, Chronic therapy, Renal Dialysis adverse effects, Renal Dialysis mortality, Stroke prevention & control, Warfarin adverse effects
- Abstract
Aim: There is conflicting evidence regarding the safety and effectiveness of warfarin for atrial fibrillation (AF) treatment among older end-stage renal disease (ESRD) patients, and differences among subgroups are unclear., Methods: Older dialysis patients who were newly diagnosed with AF (7/2007-12/2011) were identified in the United States Renal Data System. The adjusted hazard ratios (HR) of the outcomes (any stroke, ischaemic stroke, major bleeding, severe gastrointestinal bleeding, and death) by time-varying warfarin use were estimated using Cox regression accounting for the inverse probability of treatment weight., Results: Among 5765 older dialysis patients with incident AF, warfarin was associated with significantly increased risk of major bleeding (HR = 1.50, 95% CI 1.33-1.68), but was not statistically associated with any stroke (HR = 0.92, 95% CI 0.75-1.12), ischaemic stroke (HR = 0.88, 95%CI 0.70-1.11) or gastrointestinal bleeding (HR = 1.03, 95% CI 0.80-1.32). Warfarin use was associated with a reduced risk of mortality (HR = 0.72, 95%CI 0.65-0.80). The association between warfarin and major bleeding differed by sex (male: HR = 1.29; 95%CI 1.08-1.55; female: HR = 1.67; 95%CI 1.44-1.93; P-value for interaction = 0.03)., Conclusion: Older ESRD patients with AF who were treated with warfarin had a no difference in stroke risk, lower mortality risk, but increased major bleeding risk. The bleeding risk associated with warfarin was greater among women than men. The risk/benefit ratio of warfarin may be less favourable among older women., (© 2017 Asian Pacific Society of Nephrology.)
- Published
- 2019
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9. Treatment of atrial fibrillation with warfarin among older adults with end stage renal disease.
- Author
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Tan J, Bae S, Segal JB, Zhu J, Segev DL, Alexander GC, and McAdams-DeMarco M
- Subjects
- Aged, Aged, 80 and over, Cohort Studies, Female, Hemorrhage chemically induced, Humans, Male, Anticoagulants adverse effects, Atrial Fibrillation drug therapy, Kidney Failure, Chronic complications, Warfarin adverse effects
- Abstract
Background: There is increasing evidence questioning the use of warfarin for atrial fibrillation (AF) among older adults with end stage renal disease (ESRD). We assessed the patterns and determinants of warfarin utilization among these patients in the US., Methods: We assembled a cohort of older adults (age ≥65) undergoing dialysis with incident AF from July 2007 to November 2011 from the US Renal Data System (USRDS). We used descriptive statistics to characterize warfarin utilization within 30 days of AF discharge, and logistic regression to quantify patient characteristics associated with warfarin initiation., Results: Among 5730 older adults undergoing dialysis with incident AF, 15.5% initiated warfarin. Among 2906 patients with high risk of bleeding, 12.7% initiated warfarin; whereas 14.9% initiated warfarin among 4824 patients with high risk of stroke. After adjustment for patient characteristics, warfarin initiation was lower among patients who were older [odds ratio (OR) = 0.74 per 10-year increase, 95% confidence interval (CI) 0.66-0.83] and those with a history of diabetes (OR = 0.75, 95% CI 0.63-0.90), myocardial infarction (OR = 0.64, 95% CI 0.50-0.80), or bleeding (OR = 0.63, 95% CI 0.50-0.80). There was no association between sex, race, or dialysis modality and warfarin initiation. Among patients who initiated warfarin, 46.8% discontinued warfarin use after a median treatment length of 8.6 months., Conclusion: Despite the unclear benefit and increased bleeding risk of warfarin treatment in patients with ESRD, 1 in 8 older adults undergoing dialysis with incident AF in the US who had high risk of bleeding used warfarin. Changes to warfarin therapy due to discontinuation were common after initiation.
- Published
- 2017
- Full Text
- View/download PDF
10. Warfarin use and stroke, bleeding and mortality risk in patients with end stage renal disease and atrial fibrillation: a systematic review and meta-analysis.
- Author
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Tan J, Liu S, Segal JB, Alexander GC, and McAdams-DeMarco M
- Subjects
- Atrial Fibrillation mortality, Humans, Kidney Failure, Chronic mortality, Kidney Failure, Chronic therapy, Renal Dialysis, Anticoagulants adverse effects, Atrial Fibrillation complications, Hemorrhage epidemiology, Kidney Failure, Chronic complications, Stroke epidemiology, Warfarin adverse effects
- Abstract
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. We conducted a comprehensive literature search in Feb 2016 using key words related to ESRD, AF and warfarin in PubMed, Embase and Cochrane Library without language restriction. We searched for randomized trials and observational studies that compared the use of warfarin with no treatment, aspirin or direct oral anticoagulants (DOACs), and reported quantitative risk estimates on these outcomes. Paired reviewers screened articles, collected data and performed qualitative assessment using the Cochrane Risk of Bias Assessment Tool for Non-randomized Studies of Interventions. We conducted meta-analyses using the random-effects model with the DerSimonian - Laird estimator and the Knapp-Hartung methods as appropriate., Results: We identified 2709 references and included 20 observational cohort studies that examined stroke outcome, bleeding outcome and mortality associated with warfarin use in 56,146 patients with ESRD and AF. The pooled estimates from meta-analysis for the stroke outcome suggested that warfarin use was not associated with all-cause stroke (HR = 0.92, 95 % CI 0.74-1.16) or any stroke (HR = 1.01, 95 % CI 0.81-1.26), or ischemic stroke (HR = 0.80, 95 % CI 0.58-1.11) among patients with ESRD and AF. In contrast, warfarin use was associated with significantly increased risk of all-cause bleeding (HR = 1.21, 95 % CI 1.01-1.44), but not associated with major bleeding (HR = 1.18, 95 % CI 0.82-1.69) or gastrointestinal bleeding (HR = 1.19, 95 % CI 0.81-1.76) or any bleeding (HR = 1.21, 95 % CI 0.99-1.48). There was insufficient evidence to evaluate the association between warfarin use and mortality in this population (pooled risk estimate not calculated due to high heterogeneity). Results on DOACs were inconclusive due to limited relevant studies., Conclusions: Given the absence of efficacy and an increased bleeding risk, these findings call into question the use of warfarin for AF treatment among patients with ESRD.
- Published
- 2016
- Full Text
- View/download PDF
11. Atrial fibrillation in end stage renal disease patients: influence of hemodialysis on P wave duration and atrial dimension.
- Author
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Genovesi S, Fabbrini P, Pieruzzi F, Galbiati E, Sironi E, Pogliani D, Bonforte G, Viganò MR, and Stella A
- Subjects
- Aged, Atrial Fibrillation diagnostic imaging, Atrial Fibrillation physiopathology, Echocardiography, Female, Heart Atria physiopathology, Heart Conduction System physiopathology, Humans, Kidney Failure, Chronic complications, Male, Middle Aged, Organ Size, Atrial Fibrillation etiology, Electrocardiography, Heart Atria diagnostic imaging, Kidney Failure, Chronic therapy, Renal Dialysis adverse effects
- Abstract
Background: Prevalence and incidence of atrial fibrillation (AF) are high in hemodialysis (HD) patients. Intra-atrial conduction velocity slowing plays an important role in AF onset. The aim of our study was to measure P wave duration (Pwd), expression of intra-atrial conduction velocity, in HD patients with and without a history of AF., Methods: The study was performed in 47 end stage renal disease (ESRD) patients, subdivided into four groups: 19 patients within the first 6 months from starting HD therapy (HD1); the same patients studied 18 ± 3 months later (HD2); patients with no history of AF and long dialytic age (HD3, n = 13); and patients with sinus rhythm but history of AF (HDAF, n = 15); and 18 healthy controls. In all patients P wave high resolution recording and electrolyte plasma values were obtained before and after a HD session, and atrial diameter was assessed by echocardiography., Results: Patients with the shortest dialysis vintage showed the shortest Pwd [131.2 ± 11.0 (HD1) vs. 139.8 ± 11.7 (HD2), 142.1 ± 7.2 (HD3), 152.3 ± 15.0 (HDAF) ms; p < 0.05], while Pwd was prolonged in patients with AF history when compared to all other groups (p < 0.03). At multivariate analysis atrial dimension was independently related to Pwd (R = 0.40, p < 0.02). HD session induced a significant increase of Pwd (141 ± 14.0-152 ± 17.0 ms, p < 0.001), that was correlated to modifications of K(+) concentration (R = 0.8, p < 0.0001)., Conclusions: HD therapy prolongs Pwd. HD patients with a history of AF have prolonged Pwd compared to patients without, suggesting that increased Pwd is a marker of AF risk in patients with ESRD. HD session acutely increases Pwd, creating conditions favoring AF onset.
- Published
- 2015
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12. Safety and pharmacokinetic profile of apixaban in end‐stage renal disease: A real‐world analysis
- Author
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Chen I. Tseng, Alistair J. Roddick, Matthew J. Bottomley, Susan Shapiro, and Udaya Udayaraj
- Subjects
anticoagulation ,apixaban ,atrial fibrillation ,dialysis ,end stage renal disease ,pharmacokinetics ,Diseases of the blood and blood-forming organs ,RC633-647.5 - Published
- 2023
- Full Text
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13. Prevalence and associated factors of undiagnosed atrial fibrillation among end-stage renal disease patients on maintenance haemodialysis: a cross-sectional study
- Author
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Izzat AlAwwa, Reham Al-Hindi, Nadeen Alfraihat, Ahmad Obeid, Sarah Ibrahim, Shatha Jallad, Ahmad Al-Awwa, and Akram Saleh
- Subjects
Atrial fibrillation ,Nonvalvular ,Arrhythmia ,End stage renal disease ,Haemodialysis ,Stroke ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Abstract Background Atrial fibrillation (AF) is the most prevalent sustained arrhythmia worldwide and it aggravates cardiovascular morbidity and mortality; however, this is largely under-diagnosed. Moreover, among end-stage renal disease patients on haemodialysis, AF is substantially more common and serious. The researchers conducted this study to assess the prevalence of, and the factors correlated with AF in Jordanian haemodialysis patients. Methods In a cross-sectional analysis conducted from October 2018 to February 2019 in four tertiary hospitals, the researchers enrolled all consenting patients aged 18 years or older who were on haemodialysis for at least three months prior to the study. We screened for AF clinically by pulse palpation, precordial auscultation, by an automated blood pressure monitor and an electrocardiogram. The researchers reported qualitative variables as counts and frequencies, while continuous variables were summarised using the mean or median where necessary. We used multiple logistic regression with backward selection to identify independent risk factors of AF. Results A total of 231 patients were enrolled; mean age was 54.8 ± 15.6 years (from 20 to 86), and 44.3% of them were women. The prevalence of AF was found to be 7.8% (95% CI, 4.8–12.2), with no gender disparity. Age (adjusted odds ratio [AOR] = 1.05; 95% CI, 1.01–1.10; p = 0.031), history of ischaemic heart disease (AOR = 3.74; 95% CI, 1.09–12.34; p = 0.033), history of smoking (AOR = 0.15; 95% CI, 0.02–0.60; p = 0.019), and low interdialytic weight gain (AOR = 0.50: 95% CI, 0.25–0.91; p = 0.031) were independently correlated to AF. Conclusions The prevalence of AF among patients on maintenance haemodialysis is high, but largely undiagnosed. AF is generally associated with advancing age, history of ischaemic heart disease, lower interdialytic weight gain, and history of smoking. We suggest routine check-up of AF in this high-risk group of patients as anticoagulant therapy if indicated may prevent serious complications. However, there is a need for large-scale cohort studies and for the creation of regional chronic kidney disease and dialysis registries in the Middle East region.
- Published
- 2020
- Full Text
- View/download PDF
14. Anticoagulation in Patients with End-Stage Renal Disease and Non-Valvular Atrial Fibrillation – Review Article
- Author
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Mahmoud Khalifa, Yara Adel Altahan, and Paavana Varanasi
- Subjects
end stage renal disease ,esrd ,atrial fibrillation ,anticoagulation ,non valvular ,dialysis ,novel oral anticoagulants ,noacs ,direct oral anticoagulants ,doacs ,coumadin ,warfarin ,vitamin k antagonist ,Medicine (General) ,R5-920 - Abstract
Over the years, the number of patients with end-stage renal disease (ESRD) have been steadily increasing. Cardiovascular causes account for 55.2% of all deaths among ESRD patients. In particular, there is an increased risk of atrial fibrillation (AF) & venous thromboembolism (VTE). AF is more prevalent in hemodialysis (HD) (21.3%) than in peritoneal dialysis (PD) (15.5%) or in patients with kidney transplant (13.7%). In addition to AF, the risk of stroke (event rate of 5.61 per 100 person years) in ESRD patients is greatly increased compared to those without renal impairment (event rate of 3.61 per 100 person years), which is very concerning due to the already increased cardiovascular mortality among these patients. ESRD is a complex condition in which usual interventions do not often provide the desired outcome seen in other comorbidities. The inherent paradox of hypercoagulability and increased risk of bleeding along with the lack of risk tratification models further complicate the selection of anticoagulants in patients with ESRD and AF. Due to the lack of controlled trials and the contradictory results and outcomes, it is not possible to argue for or against the use of any particular therapeutic agent. Data regarding risks and benefits of antiplatelet agents use among ESRD patients with AF has been conflicting and there is no consensus or guideline regarding their routine use.
- Published
- 2021
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15. Thromboembolic and Bleeding Risk in Atrial Fibrillation Patients with Chronic Kidney Disease: Role of Anticoagulation Therapy
- Author
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Michele Magnocavallo, Antonio Bellasi, Marco Valerio Mariani, Maria Fusaro, Maura Ravera, Ernesto Paoletti, Biagio Di Iorio, Vincenzo Barbera, Domenico Giovanni Della Rocca, Roberto Palumbo, Paolo Severino, Carlo Lavalle, and Luca Di Lullo
- Subjects
atrial fibrillation ,chronic kidney disease ,warfarin ,direct oral anticoagulants ,end stage renal disease ,left atrial appendage occlusion ,Medicine - Abstract
Atrial fibrillation (AF) and chronic kidney disease (CKD) are strictly related; several independent risk factors of AF are often frequent in CKD patients. AF prevalence is very common among these patients, ranging between 15% and 20% in advanced stages of CKD. Moreover, the results of several studies showed that AF patients with end stage renal disease (ESRD) have a higher mortality rate than patients with preserved renal function due to an increased incidence of stroke and an unpredicted elevated hemorrhagic risk. Direct oral anticoagulants (DOACs) are currently contraindicated in patients with ESRD and vitamin K antagonists (VKAs), remaining the only drugs allowed, although they show numerous critical issues such as a narrow therapeutic window, increased tissue calcification and an unfavorable risk/benefit ratio with low stroke prevention effect and augmented risk of major bleeding. The purpose of this review is to shed light on the applications of DOAC therapy in CKD patients, especially in ESRD patients.
- Published
- 2020
- Full Text
- View/download PDF
16. Warfarin use and stroke, bleeding and mortality risk in patients with end stage renal disease and atrial fibrillation: a systematic review and meta-analysis.
- Author
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Jingwen Tan, Shuiqing Liu, Segal, Jodi B., Alexander, G. Caleb, and McAdams-DeMarco, Mara
- Subjects
WARFARIN ,DRUG therapy ,KIDNEY disease treatments ,ATRIAL fibrillation treatment ,HEMODIALYSIS ,STROKE-related mortality ,HEMORRHAGE risk factors - Abstract
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. We conducted a comprehensive literature search in Feb 2016 using key words related to ESRD, AF and warfarin in PubMed, Embase and Cochrane Library without language restriction. We searched for randomized trials and observational studies that compared the use of warfarin with no treatment, aspirin or direct oral anticoagulants (DOACs), and reported quantitative risk estimates on these outcomes. Paired reviewers screened articles, collected data and performed qualitative assessment using the Cochrane Risk of Bias Assessment Tool for Non-randomized Studies of Interventions. We conducted meta-analyses using the random-effects model with the DerSimonian - Laird estimator and the Knapp-Hartung methods as appropriate. Results: We identified 2709 references and included 20 observational cohort studies that examined stroke outcome, bleeding outcome and mortality associated with warfarin use in 56,146 patients with ESRD and AF. The pooled estimates from meta-analysis for the stroke outcome suggested that warfarin use was not associated with all-cause stroke (HR = 0.92, 95% CI 0.74-1.16) or any stroke (HR = 1.01, 95% CI 0.81-1.26), or ischemic stroke (HR = 0.80, 95% CI 0.58-1.11) among patients with ESRD and AF. In contrast, warfarin use was associated with significantly increased risk of all-cause bleeding (HR = 1.21, 95% CI 1.01-1.44), but not associated with major bleeding (HR = 1.18, 95% CI 0.82-1.69) or gastrointestinal bleeding (HR = 1.19, 95% CI 0.81-1.76) or any bleeding (HR = 1.21, 95% CI 0.99-1.48). There was insufficient evidence to evaluate the association between warfarin use and mortality in this population (pooled risk estimate not calculated due to high heterogeneity). Results on DOACs were inconclusive due to limited relevant studies. Conclusions: Given the absence of efficacy and an increased bleeding risk, these findings call into question the use of warfarin for AF treatment among patients with ESRD. [ABSTRACT FROM AUTHOR]
- Published
- 2016
- Full Text
- View/download PDF
17. Risk of Cerebral Infarction in Japanese Hemodialysis Patients: Miyazaki Dialysis Cohort Study (MID study).
- Author
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Toida, Tatsunori, Sato, Yuji, Nakagawa, Hideto, Komatsu, Hiroyuki, Uezono, Shigehiro, Yamada, Kazuhiro, Ishihara, Tabito, Hisanaga, Shuichi, Kitamura, Kazuo, and Fujimoto, Shouichi
- Subjects
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ANTICOAGULANTS , *HEMODIALYSIS patients , *JAPANESE people , *CEREBRAL infarction , *ATRIAL fibrillation , *PLATELET aggregation inhibitors , *DISEASES - Abstract
Background/Aims: Predictors including the preventive effects of antiplatelet and anticoagulant drugs on cerebral infarction (CI) events have not yet been clarified in dialysis patients. The aim of the present study was to examine the risk of CI and preventive effects of these drugs in Japanese hemodialysis patients. Methods: Patients receiving maintenance hemodialysis (n=1,551, median age (interquartile range), 69.0 (59.0-78.0) years; 41.5% female) were enrolled in the Miyazaki Dialysis Cohort Study and prospectively followed-up for 3 years. Kaplan-Meier and Cox's regression analyses were used to clarify the risk of CI. Results: Eightyfour patients developed CI at an incidence of 21.5/1000 patients per year. The presence of a previous history of CI, atrial fibrillation (AF), and diabetes mellitus in addition to age were also identified as predictive factors for new CI, whereas no relationship was observed between antiplatelet and/or anticoagulant usage and CI. Furthermore, no significant difference was noted in the frequency of CI events between patients with AF who received warfarin and those who did not. Conclusions: The incidence of CI was higher in dialysis patients with a previous history of CI and AF; however, the preventive effects of antiplatelet/anticoagulant drugs on the development of CI were not evident. [ABSTRACT FROM AUTHOR]
- Published
- 2016
- Full Text
- View/download PDF
18. Thromboembolic and Bleeding Risk in Atrial Fibrillation Patients with Chronic Kidney Disease: Role of Anticoagulation Therapy.
- Author
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Magnocavallo, Michele, Bellasi, Antonio, Mariani, Marco Valerio, Fusaro, Maria, Ravera, Maura, Paoletti, Ernesto, Di Iorio, Biagio, Barbera, Vincenzo, Della Rocca, Domenico Giovanni, Palumbo, Roberto, Severino, Paolo, Lavalle, Carlo, and Di Lullo, Luca
- Subjects
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CHRONIC kidney failure , *ATRIAL fibrillation , *CHRONICALLY ill , *ANTICOAGULANTS , *THROMBOEMBOLISM - Abstract
Atrial fibrillation (AF) and chronic kidney disease (CKD) are strictly related; several independent risk factors of AF are often frequent in CKD patients. AF prevalence is very common among these patients, ranging between 15% and 20% in advanced stages of CKD. Moreover, the results of several studies showed that AF patients with end stage renal disease (ESRD) have a higher mortality rate than patients with preserved renal function due to an increased incidence of stroke and an unpredicted elevated hemorrhagic risk. Direct oral anticoagulants (DOACs) are currently contraindicated in patients with ESRD and vitamin K antagonists (VKAs), remaining the only drugs allowed, although they show numerous critical issues such as a narrow therapeutic window, increased tissue calcification and an unfavorable risk/benefit ratio with low stroke prevention effect and augmented risk of major bleeding. The purpose of this review is to shed light on the applications of DOAC therapy in CKD patients, especially in ESRD patients. [ABSTRACT FROM AUTHOR]
- Published
- 2021
- Full Text
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19. Guidelines on myocardial revascularization
- Published
- 2010
- Full Text
- View/download PDF
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