scholarly journals Lower Gastrointestinal Bleeding in Chronic Hemodialysis Patients

2011 ◽  
Vol 2011 ◽  
pp. 1-8 ◽  
Author(s):  
Fahad Saeed ◽  
Nikhil Agrawal ◽  
Eugene Greenberg ◽  
Jean L. Holley
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Gastrointestinal Bleeding ◽  
Chronic Hemodialysis ◽  
Lower Gastrointestinal Bleeding ◽  
Gi Bleeding ◽  
Common Causes ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Gastrointestinal (GI) bleeding is more common in patients with chronic kidney disease and is associated with higher mortality than in the general population. Blood losses in this patient population can be quite severe at times and it is important to differentiate anemia of chronic diseases from anemia due to GI bleeding. We review the literature on common causes of lower gastrointestinal bleeding (LGI) in chronic kidney disease (CKD) and end-stage renal disease (ESRD) patients. We suggest an approach to diagnosis and management of this problem.

scholarly journals Asymmetric (ADMA) and Symmetric (SDMA) Dimethylarginines in Chronic Kidney Disease: A Clinical Approach

2019 ◽  
Vol 20 (15) ◽  
pp. 3668 ◽  
Author(s):  
Elena Oliva-Damaso ◽  
Nestor Oliva-Damaso ◽  
Francisco Rodriguez-Esparragon ◽  
Juan Payan ◽  
Eduardo Baamonde-Laborda ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Clinical Approach ◽  
Risk Markers ◽  
Naturally Occurring ◽  
Stage Renal Disease ◽  
End Stage ◽  
Oxide Synthase ◽  
Esrd Patients

Asymmetric dimethylarginine (ADMA) and its enantiomer, Symmetric dimethylarginine (SDMA), are naturally occurring amino acids that were first isolated and characterized in human urine in 1970. ADMA is the most potent endogenous inhibitor of nitric oxide synthase (NOS), with higher levels in patients with end-stage renal disease (ESRD). ADMA has shown to be a significant predictor of cardiovascular outcome and mortality among dialysis patients. On the other hand, although initially SDMA was thought to be an innocuous molecule, we now know that it is an outstanding marker of renal function both in human and in animal models, with ESRD patients on dialysis showing the highest SDMA levels. Today, we know that ADMA and SDMA are not only uremic toxins but also independent risk markers for mortality and cardiovascular disease (CVD). In this review, we summarize the role of both ADMA and SDMA in chronic kidney disease along with other cardiovascular risk factors.

Efficacy of Tai Chi on Patients With Chronic Kidney Disease

2021 ◽  
pp. 109980042110479
Author(s):  
Mei Ha ◽  
Yuhui Yang ◽  
Yu Shi ◽  
Ya Lu ◽  
Kun Chen ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Tai Chi ◽  
Gene Profile ◽  
Positive Effects ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Previous systematic reviews elucidate the efficacy of Tai Chi on the rehabilitation and treatment for various chronic diseases. Yet, no consensus has been reached on its efficacy and safety from those with chronic kidney disease (CKD). Therefore, we conducted a systematic review to critically summarize what is already known about the prevailing benefits of Tai Chi for CKD patients. There was no evidence that Tai Chi had adverse effects on CKD patients. Long-term Tai Chi exercises could improve quality of life, cardiorespiratory fitness, and physical motor function for the end-stage renal disease (ERSD) patients undergoing dialysis. Regular Tai Chi exercises might exert modest influences in delaying CKD progression for mild–moderate CKD patients. However, there is insufficient evidence to demonstrate positive effects of Tai Chi exercises on bone health of the ESRD patients. Accordingly, rigorously designed, longer-term studies of Tai Chi are warranted to identify its efficacy on CKD patients across different stages, especially targeting potential mechanisms in terms of Tai Chi altering biological gene profile expressions.

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.

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 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.

Treatment with Cinacalcet in Hemodialysis Patients with Severe Secondary Hyperparathyroidism, Influences Bone Mineral Metabolism and Anemia Parameters

2020 ◽  
Vol 15 (3) ◽  
pp. 249-263
Author(s):  
Maria Aktsiali ◽  
Theodora Papachrysanthou ◽  
Ioannis Griveas ◽  
Christos Andriopoulos ◽  
Panagiotis Sitaras ◽  
...  
Keyword(s):  
Bone Mineral ◽  
Mineral Metabolism ◽  
Treatment Options ◽  
Dry Weight ◽  
Chronic Hemodialysis ◽  
Protective Agent ◽  
Positive Correlation ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Background: Due to the premium rate of Chronic Kidney Disease, we have increased our knowledge with respect to diagnosis and treatment of Bone Mineral Disease (BMD) in End- Stage Renal Disease (ESRD). Currently, various treatment options are available. The medication used for Secondary Hyper-Parathyroidism gives promising results in the regulation of Ca, P and Parathormone levels, improving the quality of life. The aim of the present study was to investigate the relation of cinacalcet administration to not only parathormone, Ca and P but also to anemia parameters such as hematocrit and hemoglobin. Materials and Methods: retrospective observational study was conducted in a Chronic Hemodialysis Unit. One-hundred ESRD patients were recruited for twenty-four months and were evaluated on a monthly rate. Biochemical parameters were related to medication prescribed and the prognostic value was estimated. Cinacalcet was administered to 43 out of 100 patients in a dose of 30-120 mg. Results: Significant differences were observed in PTH, Ca and P levels with respect to Cinacalcet administration. Ca levels appeared to be higher at 30mg as compared to 60mg cinacalcet. Furthermore, a decreasing age-dependent pattern was observed with respect to cinacalcet dosage. A positive correlation was observed between Dry Weight (DW) and cinacalcet dose. Finally, a positive correlation between Hematocrit and Hemoglobin and cinacalcet was manifested. Conclusions: Cinacalcet, is a potential cardiovascular and bone protective agent, which is approved for use in ESRD patients to assist SHPT. A novel information was obtained from this study, regarding the improvement of the control of anemia.

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