Elective Surgery in Patients with End Stage Renal Disease: What's the Risk?

2009 ◽  
Vol 75 (9) ◽  
pp. 790-793 ◽  
Author(s):  
Christopher R. Schneider ◽  
William Cobb ◽  
Shivani Patel ◽  
David Cull ◽  
Cass Anna ◽  
...  
Keyword(s):  
Renal Function ◽  
Renal Disease ◽  
Surgical Procedures ◽  
General Surgery ◽  
Normal Renal Function ◽  
End Stage Renal Disease ◽  
Elective Surgical Procedures ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Little research has been performed in regards to the morbidity and outcomes associated with elective general surgery performed on patients with end stage renal disease (ESRD). With minimal data about the severity of disease in these patients, we sought to quantify the differences in the ESRD patient undergoing elective surgical procedures compared with matched controls. A review of all ESRD patients undergoing elective surgical procedures at a University Medical Center between 2001 and 2005 was performed. Outcomes included length of hospital stay, 1 year morbidity, and mortality. These patients were then compared with a control group with normal renal function matched 2:1. Fifty-two consecutive ESRD patients undergoing elective general surgery procedures were compared with 104 matched controls. The ESRD group experienced more complications (25 vs 16, P = 0.05) and had a larger number of overall complications compared with the controls (33 vs 19, P < 0.05). Length of stay was significantly longer in the ESRD group as well (8 vs 2.65 days, P < 0.0001). Incidence of death (4%) in the ESRD group was increased as well. Patients with ESRD require longer hospital stays and have an increased overall incidence and frequency of complications than patients with normal renal function undergoing elective general surgery procedures. The significantly increased morbidity should be considered when evaluating expected outcomes.

scholarly journals Efficacy and Safety of Sugammadex for the Reversal of Rocuronium-Induced Neuromuscular Blockade in Patients with End-Stage Renal Disease: A Systematic Review and Meta-Analysis

Medicina ◽  
2021 ◽  
Vol 57 (11) ◽  
pp. 1259
Author(s):  
Young-Sung Kim ◽  
Byung-Gun Lim ◽  
Young-Ju Won ◽  
Seok-Kyeong Oh ◽  
Jung-Suk Oh ◽  
...  
Keyword(s):  
Systematic Review ◽  
Renal Function ◽  
Renal Disease ◽  
General Anesthesia ◽  
Neuromuscular Blockade ◽  
Normal Renal Function ◽  
End Stage Renal Disease ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Background and Objectives: Sugammadex is widely used in anesthesia to reverse rocuronium-induced neuromuscular blockade (NMB). In patients with compromised kidney function, most drugs show alteration of their pharmacokinetic profile with reduced clearance. The purpose of this article is to examine the efficacy, pharmacokinetics, and safety of sugammadex in end-stage renal disease (ESRD) patients receiving general anesthesia, using a systematic review. Materials and Methods: The databases of PubMed, EMBASE, the Cochrane Library, Web of Science, Scopus, KoreaMed, and ClinicalTrials.gov were searched for studies comparing the efficacy or safety outcomes of sugammadex administration for the reversal of rocuronium-induced NMB, in ESRD patients (group R) or in those with normal renal function (group N) undergoing surgery under general anesthesia. Results: We identified nine studies with 655 patients—six prospective, case-control studies with 179 patients (89 and 90 in groups R and N) and three retrospective observational studies with 476 ESRD patients. In the six prospective studies, the times taken to reach a train-of-four ratio ≥0.9, 0.8, and 0.7 were significantly longer in group R than in group N (weighted mean difference [95% confidence interval] [min]: 1.14 [0.29 to 2.00], 0.9 [0.24 to 1.57], 0.89 [0.20 to 1.57], respectively). The total plasma clearance of sugammadex was significantly lower in group R than in group N. There was no significant difference in the incidence of NMB recurrence and prolonged time to recovery between the groups. In the three retrospective studies, the possibility of sugammadex-related adverse events appears to be insignificant. Conclusions: Sugammadex may effectively and safely reverse rocuronium-induced NMB in patients with ESRD, although the recovery to a TOF ratio of 0.9 may be prolonged compared to patients with normal renal function. Further studies are needed, considering the small number of studies included and the high heterogeneity of some of the results.

scholarly journals Segmental Abnormalities of White Matter Microstructure in End-Stage Renal Disease Patients: An Automated Fiber Quantification Tractography Study

2021 ◽  
Vol 15 ◽  
Author(s):  
Yuhan Jiang ◽  
Yangyingqiu Liu ◽  
Bingbing Gao ◽  
Yiwei Che ◽  
Liangjie Lin ◽  
...  
Keyword(s):  
Renal Function ◽  
White Matter ◽  
Renal Disease ◽  
Left Hemisphere ◽  
End Stage Renal Disease ◽  
Fiber Tracts ◽  
White Matter Microstructure ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Background and Purpose: End-stage renal disease (ESRD) results in extensive white matter abnormalities, but the specific damage segment cannot be identified. This study aimed to determine the segmental abnormalities of white matter microstructure in ESRD and its relationship with cognitive and renal function indicators.Methods: Eighteen ESRD patients and 19 healthy controls (HCs) were prospectively recruited. All participants underwent DTI and clinical assessments. Automatic fiber quantification (AFQ) was applied to generate bundle profiles along 16 main white matter tracts. We compared the DTI parameters between groups. Besides, we used partial correlation and multiple linear regression analyses to explore the associations between white matter integrity and cognitive performance as well as renal function indicators.Results: In the global tract level, compared to HCs, ESRD patients had greater MD, AD, and RD values and lower FA value in several fibers (P &lt; 0.05, FDR correction). In the point-wise level, extensive damage existed in specific locations of different fiber tracts, particularly in the left hemisphere (P &lt; 0.05, FDR correction). Among these tracts, the mean AD values of the left cingulum cingulate correlated negatively with MoCA score. Urea and UA level were independent predictors of the AD value of superior component of the left corticospinal. Besides, urea level was the independent predictors of mean MD value of left anterior thalamic radiation (ATR).Conclusion: White matter fiber tract damage in ESRD patients may be characterized by abnormalities in its specific location, especially in the left hemisphere. Aberrational specific located fibers were related to cognitive impairment and renal dysfunction.

Evaluation of Induction Doses of Propofol: Comparison between Endstage Renal Disease and Normal Renal Function Patients

2002 ◽  
Vol 30 (5) ◽  
pp. 584-587 ◽  
Author(s):  
P. Goyal ◽  
G. D. Puri ◽  
C. K. Pandey ◽  
S. Srivastva
Keyword(s):  
Renal Failure ◽  
Renal Function ◽  
Renal Disease ◽  
Normal Renal Function ◽  
End Stage Renal Disease ◽  
Objective Assessment ◽  
Haemoglobin Concentration ◽  
End Point ◽  
Stage Renal Disease ◽  
End Stage

Anaemia, hypoproteinaemia and acidic pH in renal failure patients can alter the pharmacokinetics and pharmaco-dynamics of anaesthetic agents, resulting in altered dose requirements. We evaluated the induction dose of propofol in adult patients with end-stage renal disease by titrating the hypnotic effect by means of a clinical parameter as well as using a more objective assessment of hypnosis, the Bispectral Index (BIS) monitor. The dose was compared with that for patients with normal renal function. Propofol doses that provided the clinical end-point of hypnosis (syringe drop method), as well as the end-point of a mean (SD) BIS value of 50 (5), were evaluated in 27 end-stage renal disease and 27 normal renal function patients. Propofol was administered at 0.2mg/kg every 15 seconds until these end-points were achieved. End-stage renal disease patients required significantly higher propofol doses to achieve the clinical end-point of hypnosis (1.42 (0.24) mg/kg versus 0.89 (0.2) mg/kg in normal renal function patients, P<0.05 unpaired “t” test). Propofol dose required to achieve a BIS of 50 (5) was also higher in end-stage renal disease patients (2.03 (0.4) mg/kg versus 1.39 (0.43) mg/kg in normal renal function patients, P<0.05). There was a significant negative correlation of propofol dose with preoperative haemoglobin concentration. A hyperdynamic circulation in renal failure patients with anaemia may be responsible for the higher propofol dose requirement in this group.

Pharmacokinetic Comparison of Flurbiprofen in End-Stage Renal Disease Subjects and Subjects with Normal Renal Function

1991 ◽  
Vol 31 (9) ◽  
pp. 808-814 ◽  
Author(s):  
Eugenio A. Cefali ◽  
Wesley J. Poynor ◽  
Domenic Sica ◽  
Steven Cox
Keyword(s):  
Renal Function ◽  
Renal Disease ◽  
Normal Renal Function ◽  
End Stage Renal Disease ◽  
Stage Renal Disease ◽  
End Stage

scholarly journals High Detection Rate and Risk Factors of Melanosis Coli in End-Stage Renal Disease Patients Awaiting Kidney Transplantation: A Single-Center Retrospective Study in China

2020 ◽  
Author(s):  
Wu-Xing Zhang ◽  
Wei Zhou ◽  
Yang Li ◽  
Yang Wang ◽  
Wei Huang
Keyword(s):  
Renal Function ◽  
Normal Renal Function ◽  
End Stage Renal Disease ◽  
Detection Rate ◽  
Univariate Analysis ◽  
Multivariate Logistic Regression ◽  
Melanosis Coli ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Abstract Background. Rhubarb-containing Traditional Chinese Medicine (TCM) is widely used to manage chronic renal failure in China. Studies show that anthranoids contained in rhubarb are related to the occurrence of melanosis coli (MC). However, no study on the detection rate of MC in end-stage renal disease (ESRD) patients in China has been reported.Methods. We conducted a retrospective study on 99 ESRD patients who received a colonoscopy as part of pre-transplant work-up between Jan 1, 2017 and July 1, 2020 in a single center in Beijing, China. 200 age- and gender-matched subjects with normal renal function and received a colonoscopy for health screening in the same period were randomly selected as control group. The detection rate of MC in ESRD patients and control subjects was calculated and compared. Univariate analysis and multivariate logistic regression were performed in succession to determine the association between ESRD and MC, and also probe the independent MC risk factors in ESRD patients.Results. Among the 99 ESRD patients, MC was detected in 19, with a detection rate of 19.2% (95% confidence interval [CI]: 11.3%, 27.1%). In contrast, among 200 control subjects with normal renal function, MC was only detected in 1 subject, with an detection rate of 0.5% (95%CI: 0.5%, 1.5%) (ESRD vs. control: odds ratio [OR] = 47.263, 95% CI: 6.222, 358.981; p = 0.000). After adjustment of age, body mass index(BMI), albumin, hemoglobin and Charlson comorbidity index, being ESRD was still associated with the presence of MC (Odds ratio[95%CI]: 36.251[3.435, 382.559], p = 0.003). In ESRD patients, both univariate analysis (OR = 4.358, 95% CI: 1.329, 14.286; p = 0.012) and multivariate logistic regression (OR = 4.916, 95% CI: 1.462, 16.525, p = 0.010) found that past use of Rhubarb-containing TCM was the only independent risk factor of MC.Conclusion. The prevalence of MC in this cohort of ESRD patients was 19.2%, which was significantly higher than that of control with normal renal function. Past use of Rhubarb-containing traditional Chinese herbs was the only independent risk factor for the detection of MC in these ESRD patients. Our work highlights firstly that when prescribing Rhubarb-containing TCM to ESRD patients, the risk of MC development should be alerted, and also there is a need for arranging high quality, well-designed studies to examine the prevalence, etiology, impact, management and prognosis of MC in ESRD patients, especially those awaiting kidney transplantation.

Clinical Presentation of Chronic Hepatitis C in Patients with End-Stage Renal Disease and on Hemodialysis Versus Those with Normal Renal Function

2005 ◽  
Vol 100 (9) ◽  
pp. 2010-2018 ◽  
Author(s):  
Ke-Qin Hu ◽  
Steve M Lee ◽  
Shirley X. Hu ◽  
Victor W. Xia ◽  
Donald J. Hillebrand ◽  
...  
Keyword(s):  
Renal Function ◽  
Chronic Hepatitis ◽  
Hepatitis C ◽  
Renal Disease ◽  
Chronic Hepatitis C ◽  
Normal Renal Function ◽  
End Stage Renal Disease ◽  
Clinical Presentation ◽  
Stage Renal Disease ◽  
End Stage

scholarly journals A CLINICO-PATHOLOGICAL INVESTIGATION OF UPPER URINARY TRACT TUMORS IN PATIENTS WITH NORMAL RENAL FUNCTION AND IN PATIENTS WITH END STAGE RENAL DISEASE

2006 ◽  
Vol 97 (1) ◽  
pp. 27-32
Author(s):  
Shoji Kitajima ◽  
Tsunenori Kondo ◽  
Fumio Ito ◽  
Junpei Iizuka ◽  
Masayuki Nanri ◽  
...  
Keyword(s):  
Renal Function ◽  
Urinary Tract ◽  
Renal Disease ◽  
Normal Renal Function ◽  
End Stage Renal Disease ◽  
Upper Urinary Tract ◽  
Stage Renal Disease ◽  
End Stage

scholarly journals Generation, clearance, toxicity, and monitoring possibilities of unaccounted uremic toxins for improved dialysis prescriptions

2018 ◽  
Vol 315 (4) ◽  
pp. F890-F902 ◽  
Author(s):  
James G. Atherton ◽  
David S. Hains ◽  
John Bissler ◽  
Bradford D. Pendley ◽  
Ernő Lindner
Keyword(s):  
Renal Function ◽  
Renal Disease ◽  
Normal Renal Function ◽  
End Stage Renal Disease ◽  
Blood Purification ◽  
Uremic Toxins ◽  
Indoxyl Sulfate ◽  
Stage Renal Disease ◽  
End Stage ◽  
Cellular Secretion

Current dialysis-dosing calculations provide an incomplete assessment of blood purification. They exclude clearances of protein-bound uremic toxins (PB-UTs), such as polyamines, p-cresol sulfate, and indoxyl sulfate, relying solely on the clearance of urea as a surrogate for all molecules accumulating in patients with end-stage renal disease (ESRD). PB-UTs clear differently in dialysis but also during normal renal function. The kidney clears PB toxins via the process of secretion, whereas it clears urea through filtration. Herein, we review the clearance, accumulation, and toxicity of various UTs. We also suggest possible methods for their monitoring toward the ultimate goal of a more comprehensive dialysis prescription. A more inclusive dialysis prescription would retain the kidney-filtration surrogate, urea, and consider at least one PB toxin as a surrogate for UTs cleared through cellular secretion. A more comprehensive assessment of UTs that includes both secretion and filtration is expected to result in a better understanding of ESRD toxicity and consequently, to reduce ESRD mortality.

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