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.

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 Prevalence and Associated Factors of Frailty and Mortality in Patients with End-Stage Renal Disease Undergoing Hemodialysis: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 18 (7) ◽  
pp. 3471
Author(s):  
Hyeon-Ju Lee ◽  
Youn-Jung Son
Keyword(s):  
Systematic Review ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Associated Factors ◽  
Meta Analysis ◽  
Screening Tools ◽  
Cochrane Library ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Hemodialysis is the most common type of treatment for end-stage renal disease (ESRD). Frailty is associated with poor outcomes such as higher mortality. ESRD patients have a higher prevalence of frailty. This systematic review and meta-analysis aimed to identify the prevalence and associated factors of frailty and examine whether it is a predictor of mortality among ESRD patients undergoing hemodialysis. Five electronic databases including PubMed, Embase, CINAHL, Web of Science, and Cochrane Library were searched for relevant studies up to 30 November 2020. A total of 752 articles were found, and seven studies with 2604 participants in total were included in the final analysis. The pooled prevalence of frailty in patients with ESRD undergoing hemodialysis was 46% (95% Confidence interval (CI) 34.2−58.3%). Advanced age, female sex, and the presence of diabetes mellitus increased the risk of frailty in ESRD patients undergoing hemodialysis. Our main finding showed that patients with frailty had a greater risk of all-cause mortality compared with those without (hazard ratio (HR): 2.02, 95% CI: 1.65−2.48). To improve ESRD patient outcomes, healthcare professionals need to assess the frailty of older ESRD patients, particularly by considering gender and comorbidities. Comprehensive frailty screening tools for ESRD patients on hemodialysis need to be developed.

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.

scholarly journals Covid-19 in end-stage renal disease patients with renal replacement therapies: A systematic review and meta-analysis

2021 ◽  
Vol 15 (6) ◽  
pp. e0009156
Author(s):  
Tanawin Nopsopon ◽  
Jathurong Kittrakulrat ◽  
Kullaya Takkavatakarn ◽  
Thanee Eiamsitrakoon ◽  
Talerngsak Kanjanabuch ◽  
...  
Keyword(s):  
Systematic Review ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Meta Analysis ◽  
Case Fatality ◽  
Global Average ◽  
Specific Protocol ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Background The novel coronavirus (COVID-19), caused by SARS-CoV-2, showed various prevalence and case-fatality rates (CFR) among patients with different pre-existing chronic conditions. End-stage renal disease (ESRD) patients with renal replacement therapy (RRT) might have a higher prevalence and CFR due to reduced immune function from uremia and kidney tropism of SARS-CoV-2, but there was a lack of systematic study on the infection and mortality of the SARS-CoV-2 infection in ESRD patients with various RRT. Methodology/Principal findings We searched five electronic databases and performed a systematic review and meta-analysis up to June 30, 2020, to evaluate the prevalence and case fatality rate (CFR) of the COVID-19 infection among ESRD patients with RRT. The global COVID-19 data were retrieved from the international database on June 30, 2020, for estimating the prevalence and CFR of the general population as referencing points. Of 3,272 potential studies, 34 were eligible studies consisted of 1,944 COVID-19 confirmed cases in 21,873 ESRD patients with RRT from 12 countries in four WHO regions. The overall pooled prevalence in ESRD patients with RRT was 3.10% [95% confidence interval (CI) 1.25–5.72] which was higher than referencing 0.14% global average prevalence. The overall estimated CFR of COVID-19 in ESRD patients with RRT was 18.06% (95% CI 14.09–22.32) which was higher than the global average at 4.98%. Conclusions This meta-analysis suggested high COVID-19 prevalence and CFR in ESRD patients with RRT. ESRD patients with RRT should have their specific protocol of COVID-19 prevention and treatment to mitigate excess cases and deaths.

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.

scholarly journals Depressive symptoms and dietary non-adherence among end stage renal disease patients undergoing hemodialysis therapy: systematic review

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Mignote Hailu Gebrie ◽  
Jodi Ford
Keyword(s):  
Systematic Review ◽  
Depressive Symptoms ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Longitudinal Design ◽  
Future Research ◽  
Stage Renal Disease ◽  
End Stage ◽  
The Relationship ◽  
Esrd Patients

Abstract Background Research suggests that patients with end stage renal disease undergoing hemodialysis have a higher rate of depression and dietary non adherence leading to hospitalization and mortality. The purpose of this review was to synthesize the quantitative evidence on the relationship between depressive symptoms and dietary non adherence among end stage renal disease (ESRD) patients receiving hemodialysis. Methods A systematic review was undertaken. Three electronic databases were searched including PubMed, CINHAL and Web of Science. Only quantitative studies published between 2001 and 2016 were included in the review. Result A total of 141 publications were reviewed during the search process and 28 articles that fulfilled the inclusion criteria were included in the review. Eleven studies (39.3%) reported on the prevalence of depressive symptoms or depression and its effect on patient outcomes. Ten studies (35.7%) focused on dietary adherence/non adherence in patients with ESRD and the remaining seven (25%) articles were descriptive studies on the relationship between depressive symptoms and dietary non adherence in patients with ESRD receiving hemodialysis. The prevalence of depressive symptoms and dietary non adherence ranged as 6–83.49% and from 41.1–98.3% respectively. Decreased quality of life & increased morbidity and mortality were positively associated with depressive symptoms. Other factors including urea, hemoglobin, creatinine and serum albumin had also association with depressive symptoms. Regarding dietary non adherence, age, social support, educational status, behavioral control and positive attitudes are important factors in ESRD patients receiving hemodialysis. Having depressive symptoms is more likely to increase dietary non adherence. Conclusion Depressive symptoms and dietary non adherence were highly prevalent in patients with end stage renal disease receiving hemodialysis therapy. Nearly all of the articles that examined the relationship between depressive symptoms and dietary non adherence found a significant association. Future research using experimental or longitudinal design and gold standard measures with established cut-points is needed to further explain the relationship.

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.

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