scholarly journals Anticoagulation in Patients with End-Stage Renal Disease and Atrial Fibrillation: Confusion, Concerns and Consequences

2020 ◽  
Vol 22 (3) ◽  
pp. 306-316
Author(s):  
Narender Goel ◽  
Deepika Jain ◽  
Danny B. Haddad ◽  
Divya Shanbhogue
Keyword(s):  
Atrial Fibrillation ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Clinical Decision Making ◽  
Controlled Trial ◽  
Oral Anticoagulants ◽  
Increased Risk ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

End-stage renal disease (ESRD) patients have a higher prevalence of diabetes mellitus, hypertension, congestive heart failure and advanced age, along with an increased incidence of non-valvular atrial fibrillation (AF), thereby increasing the risk for cerebrovascular accidents. Systemic anticoagulation is therefore recommended in patients with ESRD with AF to reduce the risk and complications from thromboembolism. Paradoxically, these patients are at an increased risk of bleeding due to great degree of platelet dysfunction and impaired interaction between platelet and endothelium. Currently, CHA2DS2-VASc and Hypertension, Abnormal liver/kidney function, Stroke, Bleeding, Labile INR, Elderly, Drugs or alcohol (HAS-BLED) are the recommended models for stroke risk stratification and bleeding risk assessment in patients with AF. There is conflicting data regarding benefits and risks of medications such as antiplatelet agents, warfarin and direct oral anticoagulants in ESRD patients with AF. Moreover, there is no randomized controlled trial data to guide the clinical decision making. Hence, a multi-disciplinary approach with annual re-evaluation of treatment goals and risk-benefit assessment has been recommended. In this article, we review the current recommendations with risks and benefits of anticoagulation in patients with ESRD with AF.

Oral Anticoagulants in Patients With Atrial Fibrillation and End-Stage Renal Disease

2019 ◽  
Vol 24 (6) ◽  
pp. 499-508
Author(s):  
Junaid A. B. Zaman ◽  
Anil K. Bhandari
Keyword(s):  
Atrial Fibrillation ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Oral Anticoagulants ◽  
Bleeding Risk ◽  
Additional Risk ◽  
Increased Risk ◽  
Stage Renal Disease ◽  
End Stage

The role of oral anticoagulants (OAC) in atrial fibrillation (AF) is well established. However, none of the randomized controlled trials included patients with end-stage renal disease (ESRD) leaving a lack of evidence in this large, challenging and unique patient group. Patients on hemodialysis (HD) with AF have additional risk factors for stroke due to vascular comorbidities, HD treatment, age, and diabetes. Conversely, they are also at increased risk of major bleeding due to uremic platelet impairment. Anticoagulants increase bleeding risk in patients with ESRD and HD up to 10-fold compared with non chronic kidney disease (CKD) patients on warfarin. There are conflicting data and recommendations regarding use of OACs in ESRD which will be reviewed in this article. We conclude by proposing a modified strategy for OAC use in ESRD based on the latest evidence.

scholarly journals Apoprotein(A) Isoforms Risk Factors for Atherogenesis in Esrd Patients on Haemodialysis

2014 ◽  
Vol 68 (1) ◽  
pp. 16-20
Author(s):  
Danica Labudovic ◽  
Katerina Tosheska-Trajkovska ◽  
Sonja Alabakovska
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Renal Disease ◽  
Vascular Disease ◽  
End Stage Renal Disease ◽  
Relative Risks ◽  
Increased Risk ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Abstract Introduction. End-stage renal disease (ESRD) patients undergoing hemodialysis are at an increased risk of arteriosclerotic vascular disease (ASVD). The increased risk is commonly attributed to the traditional risk factors related to ESRD. However, interest for more recent risk factors for ASVD, such as the level of lipoprotein(a) and its specific apoprotein(a) has been promoted. The aim of this paper is to determine whether apo(a) phenotype is a risk factor for arteriosclerotic vascular disease in ESRD patients who are on hemodialysis. Methods. Apo(a) phenotypisation was performed by using the Western Blot Technique of blood samples from 96 end-stage renal disease patients who were undergoing hemodialysis, and from 100 healthy individuals. Results. Frequency distribution of the basic apo(a) isoforms calculated by means of the χ2-test has shown that there was no significant statistical difference in distribution among patients on hemodialysis, and healthy carriers (χ2-0.36, p<0.548-for carriers of single apo(a) isoforms, (χ2-0.10, p<0.7545-for carriers of double apo(a) isoforms). The calculated relative risks have demonstrated that apo(a) phenotype was not a risk factor for ASVD in HD patients. Conclusion. Based on the results obtained, it can be concluded that the apo(a) phenotype is not a risk factor for arteriosclerotic vascular disease in patients undergoing hemodialysis.

scholarly journals Non‐Vitamin K Antagonist Oral Anticoagulants Provide Less Adverse Renal Outcomes Than Warfarin In Non‐Valvular Atrial Fibrillation: A Systematic Review and MetaAnalysis

2021 ◽  
Author(s):  
Patita Sitticharoenchai ◽  
Kullaya Takkavatakarn ◽  
Smonporn Boonyaratavej ◽  
Kearkiat Praditpornsilpa ◽  
Somchai Eiam‐Ong ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Acute Kidney Injury ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Oral Anticoagulants ◽  
Kidney Injury ◽  
Incidence Rates ◽  
Renal Outcomes ◽  
Stage Renal Disease ◽  
End Stage

Background Non‐vitamin K antagonist oral anticoagulants (NOACs) have better pharmacologic properties than warfarin and are recommended in preference to warfarin in most patients with non‐valvular atrial fibrillation. Besides lower bleeding complications, other advantages of NOACs over warfarin particularly renal outcomes remain inconclusive. Methods and Results Electronic searches were conducted through Medline, Scopus, Cochrane Library databases, and ClinicalTrial.gov. Randomized controlled trials and observational cohort studies reporting incidence rates and hazard ratio (HR) of renal outcomes (including acute kidney injury, worsening renal function, doubling serum creatinine, and end‐stage renal disease) were selected. The random‐effects model was used to calculate pooled incidence and HR with 95% CI. Eighteen studies were included. A total of 285 201 patients were enrolled, 118 863 patients with warfarin and 166 338 patients with NOACs. The NOACs group yielded lower incidence rates of all renal outcomes when compared with the warfarin group. Patients treated with NOACs showed significantly lower HR of risk of acute kidney injury (HR, 0.70, 95% CI, 0.64–0.76; P <0.001), worsening renal function (HR, 0.83; 95% CI, 0.73–0.95; P =0.006), doubling serum creatinine (HR, 0.58; 95% CI, 0.41–0.82; P =0.002), and end‐stage renal disease (HR, 0.82; 95% CI, 0.78–0.86; P <0.001). Conclusions In non‐valvular atrial fibrillation, patients treated with NOACs have a lower risk of both acute kidney injury and end‐stage renal disease when compared with warfarin.

Abstract 17741: Atrial Fibrillation and Incident End-Stage Renal Disease: the REasons for Geographic and Racial Differences in Stroke (REGARDS) Study

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Wesley T O’Neal ◽  
Rikki Tanner ◽  
Jimmy T Efird ◽  
Usman Baber ◽  
Alvaro Alonso ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
General Population ◽  
Renal Disease ◽  
Racial Differences ◽  
End Stage Renal Disease ◽  
Increased Risk ◽  
Regards Study ◽  
Stage Renal Disease ◽  
End Stage ◽  
Study Participants

Background: Recently, it has been shown that atrial fibrillation (AF) is an independent risk factor for end-stage renal disease (ESRD) among persons with chronic kidney disease (CKD). However, the association between AF and incident ESRD has not been examined in the general population. Methods: A total of 25,315 study participants (mean age 65 ± 9.0 years; 54% women; 40% blacks) from the REasons for Geographic and Racial Differences in Stroke (REGARDS) study were included in this analysis. AF was identified in study participants at baseline (2003- 2007) by the study electrocardiogram and self-reported history of a physician diagnosis. Incident cases of ESRD were identified through linkage of REGARDS participants with the United States Renal Data System. Cox proportional-hazards regression was used to generate hazard ratios (HR) and 95% confidence intervals (95%CI) for the association between ESRD and AF. Results: A total of 2,190 (8.7%) participants had AF at baseline. Over a median follow-up of 7.7 years, 295 (1.2%) participants developed ESRD. In multivariable adjusted models, AF was associated with an increased risk of incident ESRD (Table 1). However, the association between AF and ESRD became non-significant after adjustment for baseline markers of CKD. Similar results were obtained when albumin-to-creatinine ratio was included in the model as a continuous variable (log-transformed). An interaction between AF and CKD was not detected. Conclusion: AF is associated with an increased risk of ESRD in the general population. However, this association potentially is explained by underlying CKD.

scholarly journals The risk factors associated with COVID-19-Related death among patients with end‐stage renal disease

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Hadith Rastad ◽  
Hanieh-Sadat Ejtahed ◽  
Gita Shafiee ◽  
Anis Safari ◽  
Ehsan Shahrestanaki ◽  
...  
Keyword(s):  
Renal Disease ◽  
Hospital Mortality ◽  
Medical History ◽  
End Stage Renal Disease ◽  
Demographic Factors ◽  
Increased Risk ◽  
Significant Difference ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Abstract Background The extent to which patients with End-stage renal disease (ESRD) are at a higher risk of COVID-19-related death is still unclear. Therefore, the aim of this study was to identify the ESRD patients at increased risk of COVID-19 -related death and its associated factors. Methods This retrospective cohort study was conducted on 74 patients with ESRD and 446 patients without ESRD hospitalized for COVID-19 in Alborz province, Iran, from Feb 20 2020 to Apr 26 2020. Data on demographic factors, medical history, Covid-19- related symptoms, and blood tests were obtained from the medical records of patients with confirmed COVID-19. We fitted univariable and multivariable Cox regression models to assess the association of underlying condition ESRD with the COVID-19 in-hospital mortality. Results were presented as crude and adjusted Hazard Ratios (HRs) and 95% confidence intervals (CIs). In the ESRD subgroup, demographic factors, medical history, symptoms, and blood parameters on the admission of survivors were compared with non-survivors to identify factors that might predict a high risk of mortality. Results COVID-19 patients with ESRD had in-hospital mortality of 37.8% compared to 11.9% for those without ESRD (P value < 0.001). After adjusting for confounding factors, age, sex, and comorbidities, ESRD patients were more likely to experience in-hospital mortality compared to non-ESRD patients (Adjusted HR (95% CI): 2.59 (1.55–4.32)). The Log-rank test revealed that there was a significant difference between the ESRD and non-ESRD groups in terms of the survival distribution (χ2 (1) = 21.18, P-value < 0.001). In the ESRD subgroup, compared to survivors, non-survivors were older, and more likely to present with lack of consciousness or O2 saturation less than 93%; they also had lower lymphocyte but higher neutrophil counts and AST concentration at the presentation (all p –values < 0.05). Conclusions Our findings suggested that the presence of ESRD would be regarded as an important risk factor for mortality in COVID-19 patients, especially in those who are older than age 65 years and presented with a lack of consciousness or O2 saturation less than 93%.

scholarly journals Increased risk of atrial fibrillation in end-stage renal disease patients on dialysis

Medicine ◽  
2016 ◽  
Vol 95 (25) ◽  
pp. e3933 ◽  
Author(s):  
Cheng-Huang Shen ◽  
Cai-Mei Zheng ◽  
Kee-Thai Kiu ◽  
Hsin-An Chen ◽  
Chia-Chang Wu ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Increased Risk ◽  
Stage Renal Disease ◽  
End Stage

scholarly journals Stroke Prophylaxis in Patients with Atrial Fibrillation and End-Stage Renal Disease

2020 ◽  
Vol 9 (1) ◽  
pp. 123 ◽  
Author(s):  
Martin van Zyl ◽  
Hafez M. Abdullah ◽  
Peter A. Noseworthy ◽  
Konstantinos C. Siontis
Keyword(s):  
Atrial Fibrillation ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Oral Anticoagulants ◽  
Current Evidence ◽  
Care Utilization ◽  
High Risk Population ◽  
Unique Challenge ◽  
Stage Renal Disease ◽  
End Stage

Atrial fibrillation (AF) is an important comorbidity in patients with end-stage renal disease (ESRD) undergoing dialysis that portends increased health care utilization, morbidity, and mortality in this already high-risk population. Patients with ESRD have a particularly high stroke risk, which is further compounded by AF. However, the role of anticoagulation for stroke prophylaxis in ESRD and AF is debated. The ESRD population presents a unique challenge because of the combination of elevated stroke and bleeding risks. Warfarin has been traditionally used in this population, but it is associated with significant risks of minor and major bleeding, particularly intracranial, thus leading many clinicians to forgo anticoagulation altogether. When anticoagulation is prescribed, rates of adherence and persistence are poor, leaving many patients untreated. The direct oral anticoagulants (DOACs) may offer an alternative to warfarin in ESRD patients, but these agents have not been extensively studied in this population and uncertainties regarding comparative effectiveness (versus warfarin, each other, and no treatment) remain. In this review, we discuss the current evidence on the risk and benefits of anticoagulants in this challenging population and comparisons between warfarin and DOACs, and review future directions including options for non-pharmacologic stroke prevention.

scholarly journals Effect of α-Lipoic Acid on Oxidative Stress in End-Stage Renal Disease Patients Receiving Intravenous Iron

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Arif Showkat ◽  
William R. Bastnagel ◽  
Joanna Q. Hudson
Keyword(s):  
Oxidative Stress ◽  
Renal Disease ◽  
Lipoic Acid ◽  
End Stage Renal Disease ◽  
Transferrin Saturation ◽  
Lipid Hydroperoxide ◽  
Increased Risk ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Oxidative stress is associated with increased risk of cardiovascular disease in end-stage renal disease (ESRD) patients. Intravenous (IV) iron has been shown to increase oxidative stress. The aim of the study was to evaluate changes in oxidative stress markers following administration of IV sodium ferric gluconate (SFG) to ESRD patients with and without administration of the antioxidant, α-lipoic acid. This is an open-label, crossover study. 125 mg of IV SFG was administered during control (C) and intervention (I) visits. During the I visit, 600 mg of α-lipoic acid was given orally prior to IV SFG. Blood samples were collected at defined time periods for F2-isoprostane (FIP), lipid hydroperoxide (LHP), malondialdehyde (MDA), and iron indices. We recruited ten African-American ESRD subjects: 50% male; mean age 45±9 years; mean hemoglobin 13±1 g/dL; ferritin 449±145 ng/mL; transferrin saturation 27±4%. There were no significant differences in iron indices between the two visits after IV SFG. MDA, FIP, and LHP increased significantly for both C and I visits with a greater increase in the I group. Administration of IV SFG results in an acute rise in oxidative stress in ESRD patients. In contrast to previous studies, administration of α-lipoic acid was associated with a greater increase in oxidative stress.

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