Fibrinokinetic Deficit in Chronic Kidney Disease and End Stage Renal Disease Patients Contributes to the Hemostatic Abnormalities

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 4078-4078
Author(s):  
Cafer Adiguzel ◽  
Vinod Bansal ◽  
Josephine Cunanan ◽  
Evangelos Litinas ◽  
Debra Hoppensteadt ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
End Stage Renal Disease ◽  
Clot Lysis ◽  
Maintenance Hemodialysis ◽  
Normal Male ◽  
Male And Female ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Abstract An increase in bleeding is observed in patients with chronic kidney disease (CKD) and end stage renal disease (ESRD) despite the normal coagulation profile and fibrinogen level. The hemostatic deficit in these patients may due to the defects in fibrin formation. The fibrinokinetic profile of CKD (n=50) and ESRD patients on hemodialysis prior to and after dialysis was measured. Citrated plasma from each patient was supplemented with 25 μl of 5 U thrombin and 25 μl of 0.05 M CaCl. The rate of fibrin formation was measured by monitoring the optical density (OD) at 405 nM. After reaching steady state, 50 μl of urokinase (30,000 U/ml) was added to measure the fibrinolytic profile. Forty normal male and female individuals were also analyzed. In addition PT, aPTT and fibrinogen levels were also measured. The normal male and female fibrinokinetic profile showed a strong clot formation with the clot reaching an average OD of 1.2±0.3 (range 0.7–1.4). In the CKD patients a much weaker clot was formed with an average OD of 0.21±0.13 (range 0.05–0.41). In the ESRD patients on maintenance hemodialysis, the pre-dialysis sample showed a weaker fibrinokinetic profile reaching near normal levels with a clot density of 1.3±0.4 (range 0.8–1.6). In the urokinase induced fibrinolysis assay, the CKD patients plasma exhibited a much stronger fibrinolytic index in comparison to the normal population (80% clot lysis vs. 20%). In the ESRD patients the clot lysis profile was relatively weaker in comparison to the CKD patients, suggesting that hemodialysis may contribute to impaired clot formation. These results are contrary to the reported observations that dense clot resistant to fibrinolysis are formed in CKD and ESRD patients. Furthermore the clot sobserved in these patients were highly susceptible to lysis. The maintenance hemodialysis results in improving the fibrinokinetic and fibrinolytic profile in the ESRD patients. Therefore maintenance hemodialysis contributes to improved hemostasis in ESRD patients.

scholarly journals Frequency of Ischemic Heart Disease in Patients of End Stage Renal Disease

2021 ◽  
Vol 15 (7) ◽  
pp. 2059-2061
Author(s):  
Muhammad Farhan Akhtar ◽  
Hafiz Muhammad Waqas Siddque ◽  
Talha Nazir ◽  
Ubaid Khan
Keyword(s):  
Chronic Kidney Disease ◽  
Heart Disease ◽  
Kidney Disease ◽  
Renal Disease ◽  
Ischemic Heart Disease ◽  
End Stage Renal Disease ◽  
Ischemic Heart ◽  
Maintenance Hemodialysis ◽  
Stage Renal Disease ◽  
End Stage

Introduction: The disease burden of Chronic Kidney Disease (CKD) is increasing every day and adding the burden on our healthcare system. Many patients are being treated by hemodialysis due to a very limited recourses available. Cardiovascular complications such as ischemic heart disease (IHD) are very common in patients who are being treated by hemodialysis and one of the leading causes of death in these patients. Objective: Frequency of IHD in the patients of ESRD. Methodology: Cross-sectional type of study was piloted for duration of three months from April 2019 to June 2019 in Nephrology Department Mayo Hospital Lahore. Eighty one patients were recruited who fulfilled the inclusion criteria i.e. patients suffering end stage renal disease on maintenance hemodialysis through non-probability, convenient sampling. A standard questionnaire was used to collect the data. All the data was analyzed by using SPSS (software package for statistical analysis) version 20. Results: The study was carried out among 81 patients with diagnosis of Chronic Kidney Disease on the maintenance hemodialysis. Most patients in study were falling in the range of 21-60 years. The study included 46 (56.8%) males and 35(43.2%) females. The frequency of Ischemic Heart Diseases in these patients was found to be 56.8% (46/81 cases). Conclusion: Both genders are equally affected. The frequency of IHD in patients of end stage renal disease who are on hemodialysis is observed to be high, but not as much high as observed in previous studies. Both genders are affected almost equally. Key Words: Ischemic Heart Disease, End stage renal disease, chronic kidney disease, Hemodialysis

Nutrition in Kidney Failure

2020 ◽  
Author(s):  
Serpil Muge Deger ◽  
T. Alp Ikizler
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Maintenance Hemodialysis ◽  
Protein Energy Wasting ◽  
Risk Of Death ◽  
Protein Energy ◽  
Stage Renal Disease ◽  
End Stage

Among the many factors that affect outcome in patients with chronic kidney disease (CKD), a state of metabolic and nutritional derangements, more aptly called protein-energy wasting (PEW) CKD, plays a major role.1 Multiple studies now indicate that PEW is highly prevalent and is closely associated with important clinical outcomes, such as hospitalizations and risk of death in this patient population. The focus of this review is to provide an overview of nutrition and metabolism in all stages of CKD, including end-stage renal disease (ESRD). This review contains 3 figures, 5 tables, and 105 references.  Key words: chronic-kidney disease (CKD), dialysis, end stage renal disease (ESRD), inflammation, maintenance hemodialysis (MHD), protein-energy wasting (PEW),uremia  

The Continuum of Chronic Kidney Disease and End-Stage Renal Disease: Challenges and Opportunities for Chronic Peritoneal Dialysis in the United States

2007 ◽  
Vol 27 (2) ◽  
pp. 125-130 ◽  
Author(s):  
Rajnish Mehrotra
Keyword(s):  
Chronic Kidney Disease ◽  
Peritoneal Dialysis ◽  
Kidney Disease ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Chronic Peritoneal Dialysis ◽  
The Usa ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

End-stage renal disease (ESRD) patients undergoing renal replacement therapy have a high mortality rate and suffer from considerable morbidity. Degree of nutritional decline, disordered mineral metabolism, and vascular calcification are some of the abnormalities that predict an adverse outcome for ESRD patients. All these abnormalities begin early during the course of chronic kidney disease (CKD), long before the need for maintenance dialysis. Thus, CKD represents a continuum of metabolic and vascular abnormalities. Treatment of these abnormalities early during the course of CKD and a timely initiation of dialysis have the potential of improving patient outcomes. However, the thesis that successful management of these abnormalities will favorably modify the outcomes of dialysis patients remains untested. The proportion of incident USA ESRD patients starting chronic peritoneal dialysis (CPD) has historically been low. Limited physician training and inadequate predialysis patient education appear to underlie the low CPD take-on in the USA. Furthermore, two key changes have occurred in the USA: steep decline in CPD take-on and progressive increase in the use of automated peritoneal dialysis. The decline in CPD take-on has afflicted virtually every subgroup examined and has occurred, paradoxically, when the CPD outcomes in the country have improved. Understanding the reasons for historically low CPD take-on and recent steep declines in utilization may allow the development of plans to reverse these trends.

scholarly journals Apolipoproteins A and B and PCSK9: Nontraditional Cardiovascular Risk Factors in Chronic Kidney Disease and in End-Stage Renal Disease

2019 ◽  
Vol 2019 ◽  
pp. 1-17 ◽  
Author(s):  
Cristiana-Elena Vlad ◽  
Liliana Foia ◽  
Roxana Popescu ◽  
Iuliu Ivanov ◽  
Mihaela Catalina Luca ◽  
...  
Keyword(s):  
Risk Factors ◽  
Chronic Kidney Disease ◽  
Cardiovascular Risk ◽  
Kidney Disease ◽  
Cardiovascular Mortality ◽  
End Stage Renal Disease ◽  
Cardiovascular Events ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Purpose. Nontraditional cardiovascular risk factors as apolipoprotein A (ApoA), apolipoprotein B (ApoB), and the proprotein convertase subtilisin/kexin type 9 (PCSK9) increase the prevalence of cardiovascular mortality in chronic kidney disease (CKD) or in end-stage renal disease (ESRD) through quantitative alterations. This review is aimed at establishing the biomarker (ApoA, ApoB, and PCSK9) level variations in uremic patients, to identify the studies showing the association between these biomarkers and the development of cardiovascular events and to depict the therapeutic options to reduce cardiovascular risk in CKD and ESRD patients. Methods. We searched the electronic database of PubMed, Scopus, EBSCO, and Cochrane CENTRAL for studies evaluating apolipoproteins and PCSK9 in CKD and ESRD. Randomized controlled trials, observational studies (including case-control, prospective or retrospective cohort), and reviews/meta-analysis were included if reference was made to those keys and cardiovascular outcomes in CKD/ESRD. Results. 18 studies met inclusion criteria. Serum ApoA-I has been significantly associated with the development of new cardiovascular event and with cardiovascular mortality in ESRD patients. ApoA-IV level was independently associated with maximum carotid intima-media thickness (cIMT) and was a predictor for sudden cardiac death. The ApoB/ApoA-I ratio represents a strong predictor for coronary artery calcifications, cardiovascular mortality, and myocardial infarction in CKD/ESRD. Plasma levels of PCSK9 were not associated with cardiovascular events in CKD patients. Conclusions. Although the “dyslipidemic status” in CKD/ESRD is not clearly depicted, due to different research findings, ApoA-I, ApoA-IV, and ApoB/ApoA-I ratio could be predictors of cardiovascular risk. Serum PCSK9 levels were not associated with the cardiovascular events in patients with CKD/ESRD. Probably in the future, the treatment of dyslipidemia in CKD/ESRD will be aimed at discovering new effective therapies on the action of these biomarkers.

scholarly journals Neurophysiological and Neuroradiological Changes in children with chronic kidney disease

2020 ◽  
Author(s):  
Sameh Abd El Naby ◽  
Ali El-Shafie ◽  
Wael Bahbah ◽  
Asmaa Mahmoud
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Pediatric Nephrology ◽  
Neurological Complications ◽  
Maintenance Hemodialysis ◽  
Axonal Polyneuropathy ◽  
Stage Renal Disease ◽  
End Stage

Abstract Background: Patients with chronic kidney disease on hemodialysis are frequently afflicted with neurological complications. These complications can potentially affect both the central and peripheral nervous systems. Common neurological complications in CKD include stroke, cognitive dysfunction, and encephalopathy, peripheral and autonomic neuropathies.Aim: to detect the neurological manifestations and complications in children with chronic kidney disease through neurophysiological and neuro-radiological findings.Methods: The study included 50 patients with CKD admitted to pediatric nephrology unit. Their history, complete physical and neurological examination finding had been recorded. All of them underwent nerve conduction, electromyography (EMG), electroencephalography (EEG) and magnetic resonance imaging (MRI).Results: Included children were 23 males and 27 females with mean age of (12.8±3.44 year). 11 (22%) patients of end stage renal disease developed polyneuropathy mostly of axonal polyneuropathy pattern while 78% of them showed normal electrophysiological studies. No myopathy was detected. Abnormal electroencephalography findings were detected in 18% of patients in the form of generalized and focal (temporal, occipital and frontal) epileptogenic activity had been found. Abnormal MRI findings were detected in 16% of patients mostly of encephalomalachia. Conclusion: Neurological status in patients with end stage renal disease on maintenance hemodialysis therapy was impaired. Uremic neuropathy is highly prevalent in these patients. They developed polyneuropathy mostly of axonal polyneuropathy pattern. EEG is a useful tool for detection of subclinical or latent uremic encephalopathy and/or epileptogenic activity. Early detection and management of these neurological conditions may estimate a window to reduce physical disability in children with CKD.

scholarly journals Social support and self-management among end-stage renal disease patients undergoing hemodialysis in Indonesia

2021 ◽  
Author(s):  
Chorina Mega Noviana ◽  
Anggri Noorana Zahra
Keyword(s):  
Social Support ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
End Stage Renal Disease ◽  
Health Behavior Change ◽  
Self Management ◽  
Functional Social Support ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Background: Self-management is the latest multidisciplinary intervention that empowers end-stage renal disease (ESRD) patients to be active in maintaining their health status. The implementation of self-management among ESRD patients undergoing hemodialysis in Indonesia remains relatively low, contributing to the high prevalence of complications and morbidity. The social cognitive theory proposes that social support is one of the environmental factors affecting health behavior change. Therefore, this study aimed to investigate the association between social support and self-management among ESRD patients undergoing hemodialysis in Indonesia.Design and Methods: A cross-sectional study was conducted among 107 ESRD patients selected by consecutive sampling. Data were collected online from four chronic kidney disease communities in Indonesia in June 2020. Medical Outcome Study Social Support Survey and Hemodialysis Self-Management Instrument were used to measure patients’ functional social support and self-management levels. Statistical analysis using the Chi-square test was applied to evaluate the association between social support and self-management.Results: More than half of the patients had high social support (51%) and good self-management (53%). There was a significant relationship between social support and self-management (p = 0.027; α = 0.05; odds ratio 95% CI = 2.386). Conclusions: Social support is a potential environmental factor that can be modified to enhance health behavior change among ESRD patients in Indonesia, with the specific behavior being self-management. This study recommends functional social support as an integral part of self-management intervention provided through cooperation between health workers, chronic kidney disease community, and patient companions.

scholarly journals Investigation of the Impact of Endodontic Therapy on Survival among Dialysis Patients in Taiwan: A Nationwide Population-Based Cohort Study

2021 ◽  
Vol 18 (1) ◽  
pp. 326
Author(s):  
Chih-Chien Chiu ◽  
Ya-Chieh Chang ◽  
Ren-Yeong Huang ◽  
Jenq-Shyong Chan ◽  
Chi-Hsiang Chung ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Root Canal ◽  
Dialysis Patients ◽  
Root Canal Therapy ◽  
Risk Of Death ◽  
Stage Renal Disease ◽  
End Stage

Objectives Dental problems occur widely in patients with chronic kidney disease (CKD) and may increase comorbidities. Root canal therapy (RCT) is a common procedure for advanced decayed caries with pulp inflammation and root canals. However, end-stage renal disease (ESRD) patients are considered to have a higher risk of potentially life-threatening infections after treatment and might fail to receive satisfactory dental care such as RCT. We investigated whether appropriate intervention for dental problems had a potential impact among dialysis patients. Design Men and women who began maintenance dialysis (hemodialysis or peritoneal dialysis) between January 1, 2000, and December 31, 2015, in Taiwan (total 12,454 patients) were enrolled in this study. Participants were followed up from the first reported dialysis date to the date of death or end of dialysis by December 31, 2015. Setting Data collection was conducted in Taiwan. Results A total of 2633 and 9821 patients were classified into the RCT and non-RCT groups, respectively. From the data of Taiwan’s National Health Insurance, a total of 5,092,734 teeth received RCT from 2000 to 2015. Then, a total of 12,454 patients were followed within the 16 years, and 4030 patients passed away. The results showed that members of the non-RCT group (34.93%) had a higher mortality rate than those of the RCT group (22.79%; p = 0.001). The multivariate-adjusted hazard ratio for the risk of death was 0.69 (RCT vs. non-RCT; p = 0.001). Conclusions This study suggested that patients who had received RCT had a relatively lower risk of death among dialysis patients. Infectious diseases had a significant role in mortality among dialysis patients with non-RCT. Appropriate interventions for dental problems may increase survival among dialysis patients. Abbreviations: CKD = chronic kidney disease, ESRD = end-stage renal disease, RCT = root canal therapy.

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