scholarly journals End-stage renal disease is associated with increased post endoscopic retrograde cholangiopancreatography adverse events in hospitalized patients

2018 ◽  
Vol 24 (41) ◽  
pp. 4691-4697 ◽  
Author(s):  
Tarek Sawas ◽  
Fateh Bazerbachi ◽  
Samir Haffar ◽  
Won K Cho ◽  
Michael J Levy ◽  
...  
Keyword(s):  
Adverse Events ◽  
Renal Disease ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
End Stage Renal Disease ◽  
Hospitalized Patients ◽  
Endoscopic Retrograde ◽  
Stage Renal Disease ◽  
End Stage

scholarly journals Safety and Efficacy of Immune Checkpoint Inhibitors for Patients With Metastatic Urothelial Carcinoma and End-Stage Renal Disease: Experiences From Real-World Practice

2020 ◽  
Vol 10 ◽  
Author(s):  
Ming-Chun Kuo ◽  
Po-Jung Su ◽  
Chun-Chieh Huang ◽  
Hao-Lun Luo ◽  
Tai-Jan Chiu ◽  
...  
Keyword(s):  
Adverse Events ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Immune Checkpoint Inhibitors ◽  
Checkpoint Inhibitors ◽  
Hematologic Toxicity ◽  
Safety And Efficacy ◽  
Metastatic Urothelial Carcinoma ◽  
Stage Renal Disease ◽  
End Stage

BackgroundImmune checkpoint inhibitors (ICIs) are used widely for treating metastatic urothelial carcinoma (mUC). In practical settings, evidence is lacking on the efficacy of ICIs in some difficult-to-treat patients, such as those with end-stage renal disease (ESRD). Herein, we evaluate the safety and efficacy of ICIs for patients with mUC and ESRD.MethodsFor this retrospective study, patients with mUC who were given ICIs at Kaohsiung Chang Gang Memorial Hospital and Linkou Chang Gung Memorial Hospital between April 2016 and November 2019 were consecutively enrolled. All clinicopathologic data, treatment responses, and adverse events were recorded. The immune-related adverse events (AEs), objective response rate (ORR), progression-free survival (PFS), and overall survival (OS) were compared between ESRD and non-ESRD groups.ResultsIn total, 129 patients with mUC were enrolled, with 11 patients categorized as the ESRD group. Among these patients with ESRD receiving ICIs, 7 of 11 (63.6%) had high-grade (grade ≥3) AEs, chiefly hematologic toxicity. Some rarely encountered AEs were noted, including toxic epidermal necrolysis, tuberculosis reactivation, ascites, and cytokine release syndrome. Patients in the ESRD group had numerically higher ORR (54.5% vs. 28.8%, p = 0.09), PFS (7.1 vs. 3.5 months, p = 0.42), and OS (not reached vs. 15.4 months) than the non-ESRD group. A multivariate Cox regression model demonstrated that leukocytosis (hazard ratio [HR]: 2.63; 95% confidence interval [CI]: 1.23–5.63; p = 0.01) and neutrophil-to-lymphocyte ratio (HR 2.91; 95% CI: 1.30–6.53; p = 0.01) were independent prognostic factors.ConclusionAdministration of ICIs in patients with mUC and ESRD demonstrated a modest antitumor activity, and should be used with caution for increasing risk of hematologic toxicity.

A Multicenter Analysis of Factors Associated With Apixaban-Related Bleeding in Hospitalized Patients With End-Stage Renal Disease on Hemodialysis

2017 ◽  
Vol 51 (11) ◽  
pp. 954-960 ◽  
Author(s):  
Taylor D. Steuber ◽  
Dane L. Shiltz ◽  
Alex C. Cairns ◽  
Qian Ding ◽  
Katie J. Binger ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Odds Ratio ◽  
The United States ◽  
Hospitalized Patients ◽  
Bleeding Events ◽  
Factors Associated ◽  
Stage Renal Disease ◽  
End Stage

Background: In 2014, the United States Food and Drug Administration approved a labeling change for apixaban to include recommendations for patients with severe renal impairment and patients with end-stage renal disease (ESRD) on hemodialysis (HD), though these recommendations are largely based on pharmacokinetic and pharmacodynamic data. Objective: Identify variables associated with bleeding events in hospitalized patients with ESRD on HD receiving apixaban. Methods: This retrospective, multicenter cohort study evaluated hospitalized patients with ESRD on HD receiving apixaban from January 1, 2013, through March 31, 2016. Correlational analysis and logistic regression were completed to identify factors associated with bleeding. Results: A total of 114 adults were included in the analysis. The median length of stay (LOS) was 6.2 (interquartile range = 3.8-11.9) days and bleeding events occurred in a total of 17 patients (15%). A weak correlation was identified for higher cumulative apixaban exposure, increased number of HD sessions while receiving apixaban, and increased hospital LOS ( P < 0.05; correlation coefficient < 0.40). When controlling for confounders, logistic regression revealed that composite bleeding events were independently increased by continuation of outpatient apixaban (odds ratio = 13.07; 95% CI = 1.54-110.54; P = 0.018), increased total daily dose of apixaban (odds ratio = 1.72; 95% CI = 1.20 to 2.48; P = 0.003), and total HD sessions while receiving apixaban (odds ratio = 2.04; 95% CI = 1.06-3.92; P = 0.033). Conclusion: The association between these factors and increased bleeding should prompt concern for long-term anticoagulation with apixaban in patients with ESRD receiving chronic HD.

scholarly journals Comparative efficacy and acceptability of treatments for restless legs syndrome in end-stage renal disease: a systematic review and network meta-analysis

2019 ◽  
Vol 35 (9) ◽  
pp. 1609-1618 ◽  
Author(s):  
Chien-Wei Huang ◽  
Min-Jing Lee ◽  
Liang-Jen Wang ◽  
Po-Tsang Lee ◽  
Yu-Kang Tu ◽  
...  
Keyword(s):  
Systematic Review ◽  
Side Effects ◽  
Combination Therapy ◽  
Adverse Events ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Meta Analysis ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Abstract Background Restless legs syndrome (RLS) is common in end-stage renal disease (ESRD) patients and impairs health and quality of life significantly. However, the optimal treatment of RLS in ESRD patients is uncertain and less studied compared with idiopathic RLS patients. Methods We conducted a systematic review and network meta-analysis to compare the efficacy and acceptability of treatments for RLS in ESRD patients. Randomized controlled trials (RCTs) by February 2019 in the PubMed, Cochrane Library, Embase and ClinicalTrials.gov were reviewed. RLS severity reduction was treated as treatment efficacy, and adverse events were treated as acceptable. Both outcomes were appraised using a random effects model expressed as standardized mean differences and odds ratios with 95% confidence intervals (CIs), respectively, and were ranked using surface under the cumulative ranking curve (SUCRA) probabilities to obtain a hierarchy of interventions. Results A total of 12 RCTs were included, comprising 9 interventions and 498 participants. All the interventions significantly improved RLS severity without critical side effects compared with placebo. Gabapentin achieved the greatest decrease of RLS severity [standardized mean difference (SMD) = 1.95, 95% CI 0.81–3.09 (SUCRA: 79.3%)], despite its frequent adverse events [SMD = 0.18, 95% CI 0.02–1.50 (19.9%)]. The combination therapy of exercise plus dopamine agonist had better efficacy [SMD = 1.60, 95% CI 0.08–3.12 (59.8%)] and acceptability [SMD = 1.41, 95% CI 0.01–142.53 (63.9%)] compared with that of vitamin C plus vitamin E [SMD = 1.50, 95% CI 0.47–2.54 (56.6%); SMD = 0.32, 95% CI 0.04–2.86 (32.5%)]. Conclusions This network meta-analysis supports that gabapentin is the most effective treatment for RLS in ESRD patients. Exercise plus dopamine agonist is a favorable combination therapy concerning side effects. Future large RCTs with long-term treatment outcomes are necessary.

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