scholarly journals Efficacy and Safety of Non-Vitamin K Antagonist Oral Anticoagulants in Patients With Atrial Fibrillation and Chronic Kidney Disease Stage G4: A Single-Center Experience: Erratum

2021 ◽  
Vol 78 (2) ◽  
pp. 330-330
Keyword(s):  
Atrial Fibrillation ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Oral Anticoagulants ◽  
Chronic Kidney Disease Stage ◽  
Vitamin K Antagonist ◽  
Disease Stage ◽  
Efficacy And Safety ◽  
Single Center ◽  
Single Center Experience

scholarly journals Non-vitamin K antagonist oral anticoagulants vs. vitamin-K antagonists in patients with atrial fibrillation and chronic kidney disease: a nationwide cohort study

2019 ◽  
Vol 17 (1) ◽  
Author(s):  
Emma Kirstine Laugesen ◽  
Laila Staerk ◽  
Nicholas Carlson ◽  
Anne-Lise Kamper ◽  
Jonas Bjerring Olesen ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Vitamin K ◽  
Major Bleeding ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Vitamin K Antagonist ◽  
All Cause Mortality ◽  
Comparable Population

Abstract Background We aimed to compare effectiveness and safety of non-vitamin K antagonist oral anticoagulants (NOACs) versus vitamin-K antagonists (VKA) in atrial fibrillation (AF) patients with chronic kidney disease (CKD) not receiving dialysis. Methods By using personal identification numbers, we cross-linked individual-level data from Danish administrative registries. We identified every citizen with a prior diagnosis of AF and CKD who initiated NOAC or VKA (2011–2017). An external analysis of 727 AF patients with CKD (no dialysis) was performed to demonstrate level of kidney function in a comparable population. Study outcomes included incidents of stroke/thromboembolisms (TEs), major bleedings, myocardial infarctions (MIs), and all-cause mortality. We used Cox proportional hazards models to determine associations between oral anticoagulant treatment and outcomes. Results Of 1560 patients included, 1008 (64.6%) initiated VKA and 552 (35.4%) initiated NOAC. In a comparable population we found that 95.3% of the patients had an estimated glomerular filtration rate (eGFR) < 59 mL/min. Patients treated with NOAC had a significantly decreased risk of major bleeding (hazard ratio (HR): 0.47, 95% confidence interval (CI): 0.26–0.84) compared to VKA. There was not found a significant association between type of anticoagulant and risk of stroke/TE (HR: 0.83, 95% CI: 0.39–1.78), MI (HR: 0.45, 95% CI: 0.18–1.11), or all-cause mortality (HR: 0.99, 95% CI: 0.77–1.26). Conclusion NOAC was associated with a lower risk of major bleeding in patients with AF and CKD compared to VKA. No difference was found in risk of stroke/TE, MI, and all-cause mortality.

scholarly journals A Rare Case of Adult Nesidioblastosis Causing Persistent Hypoglycemia in Patient With Atrial Fibrillation and Chronic Kidney Disease

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A987-A988
Author(s):  
Paria Zarghamravanbakhsh ◽  
Swetha Murthi ◽  
Emilia Pauline Liao
Keyword(s):  
Atrial Fibrillation ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Chronic Kidney Disease Stage ◽  
Gastrointestinal Surgery ◽  
Uncinate Process ◽  
Disease Stage ◽  
Hyperinsulinemic Hypoglycemia ◽  
Oral Contrast ◽  
Loop Recorder

Abstract Nesidioblastosis is a very rare adult disorder in the absence of gastrointestinal surgery. Nesidioblastosis is a disorder of the endocrine pancreas causing hyperinsulinemic hypoglycemia. We describe a case of 83 year-old Caucasian male, with a 3-year history of severe refractory hypoglycemia with glucose level below 2.1 mmol/L. Confusion and sleepiness were reported as his neuroglycopenic symptoms. According to his family, his symptoms improved within 30 minutes of drinking orange juice. Hypoglycemia episodes mostly occurred while fasting and post exercise (after playing golf). His work up included low venous plasma glucose levels, high insulin and C-peptide levels that were consistent with an insulinoma. His history is remarkable for chronic kidney disease stage 3, penicillin allergy and atrial fibrillation with loop recorder for cardiac rhythm monitoring, which precluded him from undergoing CT with IV contrast or MRI studies. Abdominal computed tomography with oral contrast did not reveal any lesion. In an attempt to localize the suspected Insulinoma, he had celiac angiogram and portal vein sampling, which were inconclusive. He had a PET scan with dotatate that showed increased amount activity in the uncinate process of the pancreas. He was diagnosed with insulinoma and placed on monthly lanreotide injections, however continued to have severe hypoglycemia episodes. Due to persistent refractory hypoglycemia, patient underwent distal pancreatectomy and splenectomy and the histological findings were consistent with nesidioblastosis. Patient developed hyperglycemia in the post-operative course which was controlled with a carb consistent diet. This case demonstrates that differentiation between insulinoma and nesidioblastosis is very challenging, and in most cases, the diagnosis is made post operatively based on histologic findings.

Warfarin Dosing and Outcomes in Chronic Kidney Disease: A Closer Look at Warfarin Disposition

2019 ◽  
Vol 20 (8) ◽  
pp. 633-645
Author(s):  
Osama Y. Alshogran
Keyword(s):  
Atrial Fibrillation ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Warfarin Therapy ◽  
Oral Anticoagulants ◽  
Cardiovascular Complications ◽  
Efficacy And Safety ◽  
Review Of Literature ◽  
Growing Body ◽  
Warfarin Dosing

Background: Chronic Kidney Disease (CKD) is a prevalent worldwide health problem. Patients with CKD are more prone to developing cardiovascular complications such as atrial fibrillation and stroke. This warrants the use of oral anticoagulants, such as warfarin, in this population. While the efficacy and safety of warfarin in this setting remain controversial, a growing body of evidence emphasizes that warfarin use in CKD can be problematic. This review discusses 1) warfarin use, dosing and outcomes in CKD patients; and 2) possible pharmacokinetic mechanisms for altered warfarin dosing and response in CKD. Methods: Structured search and review of literature articles evaluating warfarin dosing and outcomes in CKD. Data and information about warfarin metabolism, transport, and pharmacokinetics in CKD were also analyzed and summarized. Results: The literature data suggest that changes in warfarin pharmacokinetics such as protein binding, nonrenal clearance, the disposition of warfarin metabolites may partially contribute to altered warfarin dosing and response in CKD. Conclusion: Although the evidence to support warfarin use in advanced CKD is still unclear, this synthesis of previous findings may help in improving optimized warfarin therapy in CKD settings.

544-P: Efficacy and Safety of Insulin Degludec in Adults with T2D Macroalbuminuria and Chronic Kidney Disease Stage 2 and 3B

Diabetes ◽  
2019 ◽  
Vol 68 (Supplement 1) ◽  
pp. 544-P
Author(s):  
MARIA DOLORES GARCIA DE LUCAS ◽  
BEATRIZ AVILES BUENO ◽  
JULIAN OLALLA ◽  
JUDITH LOPEZ-FERNANDEZ
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Chronic Kidney Disease Stage ◽  
Insulin Degludec ◽  
Disease Stage ◽  
Efficacy And Safety

Atrial fibrillation and chronic kidney disease

ESC CardioMed ◽  
2018 ◽  
pp. 2237-2240
Author(s):  
Ken Okumura ◽  
Hirofumi Tomita
Keyword(s):  
Atrial Fibrillation ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Vitamin K ◽  
Oral Anticoagulants ◽  
Cardiovascular Complications ◽  
Vitamin K Antagonist ◽  
Bleeding Complications ◽  
The Common

Atrial fibrillation (AF) is one of the common cardiovascular complications in patients with chronic kidney disease (CKD), and enhances synergistically the risks of stroke, systemic thromboembolism, and bleeding complications, resulting in increased mortality. One major concern in the treatment strategy for patients with AF and CKD has been a lack of robust evidence that improves quality of life and prognosis. Although a paradigm shift from warfarin to non-vitamin K antagonist oral anticoagulants has occurred in stroke prevention in AF, the role and indication of non-vitamin K antagonist oral anticoagulants remain to be established in patients with advanced CKD. Considering the fact that the prevalence of CKD in the general population increases with age, elderly people suffering from both CKD and AF will be increasingly frequent in the highly aged societies.

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