scholarly journals Periprocedural Risk of Stroke Is Elevated in Patients with End-Stage Renal Disease on Hemodialysis

2015 ◽  
Vol 5 (3) ◽  
pp. 91-94 ◽  
Author(s):  
Laurel Cherian ◽  
James Conners ◽  
Shawna Cutting ◽  
Vivien H. Lee ◽  
Sarah Song
Keyword(s):  
Renal Disease ◽  
Symptom Onset ◽  
End Stage Renal Disease ◽  
Case Series ◽  
Elevated Risk ◽  
Diffusion Weighted Mri ◽  
Clinical Factors ◽  
Stroke Service ◽  
Stage Renal Disease ◽  
End Stage

Objective: To describe the most common clinical factors and stroke etiologies in a case series of patients with end-stage renal disease on hemodialysis (ESRD/HD) with transient ischemic attack (TIA) or ischemic stroke (IS). Background: Prior studies have shown that patients on HD are at an elevated risk of stroke, but these studies have focused on the overall stroke risk. This case series sought to determine the percentage of acute ischemic events that occur during or immediately after HD. Methods: ICD-9 codes were used to identify IS and TIA patients with ESRD/HD admitted to the stroke service from August 22, 2011, to June 21, 2014. Charts were reviewed to determine the age, sex, and race/ethnicity of the cohort. TIA/IS diagnosis was confirmed by a vascular neurologist. Clinical factors were assessed, including: onset during or shortly after HD, defined as occurring within 12 h of HD; the presence of a lesion on diffusion-weighted MRI; hypotension, hyponatremia, or hypoglycemia at symptom onset; the stroke etiology; the presence of focal neurologic deficits; whether the patient was in the window period for intravenous tissue plasminogen activator (IVtPA) upon presentation, and whether the patient received IVtPA. Results: We identified 34 ESRD/HD patients with a diagnosis of TIA/stroke in the specified time period. A majority of patients (70.6%) were African American. Patient age ranged from 32 to 84 years, with a median age of 67 years. Twenty-seven patients (79.4%) had confirmed ischemic infarcts on diffusion-weighted MRI. Seven patients (20.6%) were diagnosed with TIA. In 13 patients (38.2%), symptom onset occurred during or shortly after HD. Of these 13 patients, 8 (61.5%) had symptom onset during HD. Three patients (8.8%) had documented hypotension near the time of symptom onset, and 2 (5.9%) were hyponatremic on presentation to the emergency department. The distribution of stroke etiologies was as follows: 4 (11.8%) watershed distribution, 1 (2.9%) large artery atherosclerosis, 2 (20.6%) small vessel disease, 10 (29.4%) cardioembolic, and 9 (26.5%) cryptogenic. In 28 patients (82.4%), focal neurologic deficits were observed on presentation. Nine patients (26.5%) arrived within the window period for IVtPA, and 4 (11.8%) were eligible and received IVtPA. Conclusions: Of all patients with ESRD on HD admitted to the stroke service over the study period, over one third (38.3%) had the onset of their ischemic event during or shortly after HD, and nearly one quarter (23.5%) had the onset during HD. While clinicians may be tempted to attribute neurologic changes after HD to metabolic etiologies, they should also be aware that HD represents a period of elevated risk for acute ischemia.

Abacavir/lamivudine/dolutegravir single tablet regimen in patients with human immunodeficiency virus and end-stage renal disease on hemodialysis

2018 ◽  
Vol 30 (2) ◽  
pp. 181-187 ◽  
Author(s):  
Sarah M Michienzi ◽  
Christopher A Schriever ◽  
Melissa E Badowski
Keyword(s):  
Human Immunodeficiency Virus ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Case Series ◽  
Drug Discontinuation ◽  
Immunodeficiency Virus ◽  
Before And After ◽  
Clinically Significant ◽  
Stage Renal Disease ◽  
End Stage

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.

scholarly journals Elevated risk of stroke among patients with end-stage renal disease

2003 ◽  
Vol 64 (2) ◽  
pp. 603-609 ◽  
Author(s):  
Stephen L. Seliger ◽  
Daniel L. Gillen ◽  
W.T. Longstreth ◽  
Bryan Kestenbaum ◽  
Catherine O. Stehman-Breen
Keyword(s):  
Renal Disease ◽  
End Stage Renal Disease ◽  
Elevated Risk ◽  
Stage Renal Disease ◽  
End Stage

scholarly journals Executive function in end-stage renal disease: Acute effects of hemodialysis and associations with clinical factors

PLoS ONE ◽  
2018 ◽  
Vol 13 (9) ◽  
pp. e0203424 ◽  
Author(s):  
María del Mar Sánchez-Fernández ◽  
Gustavo A. Reyes del Paso ◽  
José Manuel Gil-Cunquero ◽  
María José Fernández-Serrano
Keyword(s):  
Executive Function ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Acute Effects ◽  
Clinical Factors ◽  
Stage Renal Disease ◽  
End Stage

Tolerability of Dose Escalation of Ibandronate in Patients with Multiple Myeloma and End-Stage Renal Disease: A Case Series

Onkologie ◽  
2009 ◽  
Vol 32 (8-9) ◽  
pp. 482-486 ◽  
Author(s):  
Dirk M. Henrich ◽  
Martin Hoffmann ◽  
Michael Uppenkamp ◽  
Raoul Bergner
Keyword(s):  
Multiple Myeloma ◽  
Renal Disease ◽  
Dose Escalation ◽  
End Stage Renal Disease ◽  
Case Series ◽  
Stage Renal Disease ◽  
End Stage

scholarly journals Histopathologic Review of Calcemic Uremic Arteriolopathy: A Case Series

2019 ◽  
Vol 53 (2) ◽  
Author(s):  
Jay-V James G. Barit ◽  
Eileen Liesl A. Cubillan
Keyword(s):  
Renal Disease ◽  
Vascular Calcification ◽  
End Stage Renal Disease ◽  
Subcutaneous Fat ◽  
Case Series ◽  
Chronic Dialysis ◽  
Fat Necrosis ◽  
Proper Diagnosis ◽  
Stage Renal Disease ◽  
End Stage

Calcemic uremic arteriolopathy or calciphylaxis is an uncommon disorder presenting clinically as skin ischemia and necrosis, and histologically as vascular calcification and thrombosis of dermal and subdermal vasculature. This study described two Filipino females with end-stage renal disease on chronic dialysis with non-healing ulcers on the lower extremities as a result of calcification in the vessels of the dermis and subcutaneous fat with associated fat necrosis. Current understanding of its various histologic features was reviewed for proper diagnosis.

scholarly journals The scope of homoeopathy in improving the quality of life in patients with end-stage renal disease: A case series

2021 ◽  
Vol 4 ◽  
pp. 4-11 ◽  
Author(s):  
Mehvish Haris Dandoti ◽  
Anand Ramchandra Kapse
Keyword(s):  
Quality Of Life ◽  
Renal Failure ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Short Form ◽  
Case Series ◽  
Well Being ◽  
Stage Renal Disease ◽  
End Stage

Objectives: Lifestyle disorders such as diabetes mellitus, hypertension and cardiovascular diseases eventually affect the kidneys, often causing renal failure. The current gold standard methods for managing renal failure are renal replacement therapy and haemodialysis. Unfortunately, dialysis deteriorates the patient’s quality of life (QOL). Homoeopaths rarely treat cases with such advanced irreversible pathology; the scope of homoeopathy in such cases is, therefore, unclear. We observed the effect of homoeopathy as an adjuvant on the QOL in patients with end-stage renal disease (ESRD). The QOL was assessed using the Marathi version of the Kidney Disease QOL Short Form 1.3 (KDQOL SF version 1.3). Materials and Methods: Three Indian patients with ESRD (two men and one woman, individualized ages 38, 50 and 54 years) consented to have their data published. The cases were managed with constitutional homoeopathic remedies in the 50 millesimal (LM) potency as an adjuvant to their current allopathic medications and were observed for 6 months. They were assessed with the Marathi version of the KDQOL SF 1.3 before and after homoeopathic management along with regular haemodialysis. Results: The patients showed significant improvements in the QOL, especially in the areas of sleep, pain, symptoms and problems, cognitive functioning, emotional well-being and social functioning, as assessed based on the increase in scores in their respective domains. Conclusion: The results of the observations are promising and in concurrence with homoeopathic philosophy; the benefits of constitutional medicines were seen. All three patients showed an improvement in their QOL. However, studies with larger sample size and randomised controlled trial study design are suggested. Homoeopathic constitutional treatment has a significant impact on the QOL in patients with ESRD.

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