Case Series of 5 Patients with End-Stage Renal Disease with Reversible Dyspnea, Heart Failure, and Pulmonary Hypertension Related to Arteriovenous Dialysis Access

No single-tablet antiretroviral (ARV) regimens (STRs) are approved for patients with human immunodeficiency virus (HIV) and end-stage renal disease (ESRD) on hemodialysis (HD). Based on known pharmacokinetic (PK) properties, abacavir (ABC)/lamivudine (3TC)/dolutegravir (DTG) STR may represent a promising option. This case series presents the safety and efficacy of ABC/3TC/DTG STR in patients with HIV and ESRD on HD. Patients were included if they were HIV-positive, maintained on intermittent HD for ESRD, switched to an ARV regimen containing ABC/3TC/DTG, and had at least one set of virologic data before and after the switch. Average age (±standard deviation) was 59 (±8) years. The majority of patients were cis-gender male and non-Hispanic Black. Only one demonstrated clinically significant resistance at baseline. All were on multiple-tablet regimens prior to the switch. Five patients (83%) achieved undetectable HIV-RNA after the switch while only four patients (46%) were undetectable immediately prior. No decline in immune function was noted. ABC/3TC/DTG STR was well tolerated. Only one patient self-reported an adverse event (nausea), which resolved without drug discontinuation. Based on these data, it appears that ABC/3TC/DTG may be a safe and effective ARV-STR option for patients with HIV and ESRD on HD. A larger trial including a PK analysis is needed to confirm these findings.

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Abstract 17623: A Case of Biopsy-proven Immunoglobulin G4-Related Disease Associated With Multiple Giant Coronary Artery Aneurysms, Peripheral Arterial Aneurysms, End Stage Renal Disease, and Heart Failure

Circulation ◽

10.1161/circ.132.suppl_3.17623 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Mark D Benson ◽

Cathryn Byrne-Dugan ◽

Dale Adler ◽

Mark Feinberg ◽

Deepak Bhatt

Keyword(s):

Heart Failure ◽

Coronary Artery ◽

Renal Disease ◽

End Stage Renal Disease ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Coronary Arterial Disease ◽

Related Disease ◽

Stage Renal Disease ◽

End Stage

A 54-year-old man with remote large cell non-Hodgkin’s lymphoma in remission following R-CHOP and severe atopic dermatitis was transferred from another hospital with a non-ST elevation myocardial infarction. Over the preceding year, the patient had suffered recurrent admissions for acutely decompensated heart failure with a newly depressed left ventricular ejection fraction (LVEF) of 20% by echocardiography and rapidly progressive end-stage renal disease of unclear etiology requiring the initiation of hemodialysis. Prior workup had demonstrated an infrarenal abdominal aortic aneurysm and bilateral common iliac artery aneurysms with subsequent computed tomography (CT) additionally demonstrating a superior mesenteric artery aneurysm. The patient was taken for immediate coronary arteriography, which demonstrated giant aneurysms in the left main and right coronary arteries, as well as multivessel severe stenoses. CT coronary angiogram demonstrated significant circumferential wall thickening throughout the coronary vasculature. Given concern for IgG4-related disease (IgG4-RD), a renal biopsy was pursued that confirmed the diagnosis. 18F-fluorodeoxyglucose positron emission tomography-CT identified only mild aortic inflammation. The patient was treated with high-dose steroids and rituximab. The serological inflammatory markers improved, and he underwent coronary artery bypass grafting. Pericardial, aortic adventitial, left internal mammary artery, and saphenous vein biopsies showed cardiovascular involvement of IgG4-RD. The patient has been maintained on rituximab with normalization of his LVEF and no recurrence of chest pain over the past eighteen months. IgG4-RD is a fibroinflammatory systemic disease newly described in 2003 and only recently found to involve the cardiovascular system with several reports of peripheral aneurysmal disease. To our knowledge, the current case represents the first report of a patient successfully treated for biopsy-proven IgG4-RD associated with coronary artery disease and left ventricular systolic dysfunction. IgG4-RD may represent a novel mechanism underlying some forms of peripheral and coronary arterial disease and may offer new insights into vascular biology.

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The Frequency of Pulmonary Hypertension among End Stage Renal Disease Patients on Hemodialysis

Journal of Saidu Medical College, Swat ◽

10.52206/jsmc.2020.10.1.272 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Irfan Mirza ◽

Ahmad Zeb Khan ◽

Mufti Baleegh ◽

Amirullah . ◽

Tahir Rashid ◽

...

Keyword(s):

Pulmonary Hypertension ◽

Renal Disease ◽

End Stage Renal Disease ◽

Public Health Problem ◽

Sampling Technique ◽

Global Public Health ◽

Endstage Renal Disease ◽

Mortality And Morbidity ◽

Stage Renal Disease ◽

End Stage

Background: Chronic kidney disease is one of the global public health problem. It is a major cause of mortality and morbidity. Endstage renal disease patients will have either option of renal transplant or dialysis. Although dialysis is an effective form of renalreplacement therapy but it also have long term side effects. Pulmonary hypertension is one of them.Objective: To find frequency of pulmonary hypertension among end stage renal disease patients on hemodialysis in our populationMaterial and Methods: In this study a total of 163 patients were included, using 18.8% prevalence of pulmonary hypertension inend stage renal disease patients on hemodialysis, with 95% confidence interval and 6% margin of error, using WHO software. Moreover non-probability consecutive sampling technique was used for sample collection.Results: Our study shows that mean age was 52 years with SD ± 8.21. Fifty five percent patients were male and 73(45%) patientswere female. Forty eight percent patients had pulmonary hypertension.Conclusion: Our study concludes that the incidence of pulmonary hypertension was found to be one of the major contributingfactor among end stage renal disease patients on hemodialysis in our population.

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Clinical Considerations in Hemodialysis Access Intervention

Interventional Radiology ◽

10.1093/med/9780190276249.003.0045 ◽

2018 ◽

pp. 594-614

Author(s):

Eric K. Hoffer

Keyword(s):

Renal Disease ◽

Arteriovenous Fistula ◽

End Stage Renal Disease ◽

Morbidity And Mortality ◽

Dialysis Access ◽

Hemodialysis Access ◽

National Kidney Foundation ◽

Clinical Considerations ◽

Stage Renal Disease ◽

End Stage

Interventional radiologists developed and refined the endovascular approaches to maintenance of the permanent arteriovenous vascular accesses that are integral to the provision of hemodialysis for patients with end stage renal disease. As methods of percutaneous arteriovenous fistula creation expand the scope of IR, this chapter reviews the clinical indications and preferences pertinent to dialysis access creation with respect to National Kidney Foundation Recommendations. Accesses remain imperfect, plagued by the development of flow-limiting intimal hyperplastic stenoses, and require monitoring and maintenance to minimize complications, morbidity and mortality. The measures of dialysis access function used in the surveillance of vascular accesses that indicate potential stenosis, and the utility of pre-occlusion recanalization of these stenoses are discussed. Complications specific to dialysis access interventions are also addressed.

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