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Kaewlai R, Chomchalerm G, Tongsai S, Chatpuwaphat J, Chatkaewpaisal A, Khamman P, Thamtorawat S, Praditsuktavorn B, Maitriwong W, Matsumoto J. Predictors and pathways of in-hospital mortality in active vascular contrast extravasation detected on abdominopelvic CT. Insights Imaging 2024; 15:174. [PMID: 38992307 PMCID: PMC11239638 DOI: 10.1186/s13244-024-01748-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 06/17/2024] [Indexed: 07/13/2024] Open
Abstract
OBJECTIVES This study aimed to identify factors influencing in-hospital mortality in adult patients with active vascular contrast extravasation (AVCE) on abdominopelvic computed tomography (CT). METHODS All consecutive patients with AVCE detected on CT between January 2019 and May 2022 were retrospectively included. Their data were compared through uni- and multivariable analyses between patients with and without in-hospital mortality. Path analysis was utilized to clarify the relationships among factors affecting mortality. RESULTS There were 272 patients (60.2 ± 19.4 years, 150 men) included, of whom 70 experienced in-hospital mortality. Multivariable analysis revealed nonsurgery, chronic kidney disease (CKD) stage 4-5 or dialysis, prolonged partial thromboplastin time (PTT), minimum AVCE length > 8 mm, and a lower rate of packed red cell (PRC) transfusion were identified as independent predictors of in-hospital mortality (p = 0.005-0.048). Path analysis demonstrated direct influences of CKD4-5 or dialysis, prolonged PTT, and minimum AVCE length on mortality (coefficients 0.525-0.616; p = 0.009 to < 0.001). PRC transfusion impacted mortality through nonsurgery (coefficient 0.798, p = 0.003) and intensive care unit (ICU) admission (coefficients 0.025, p = 0.016), leading to subsequent death. Three AVCE spaces (free, loose, and tight) defined on CT were not directly associated with in-hospital mortality. CONCLUSION In adults with AVCE on CT, AVCE size had a direct independent influence on mortality, highlighting the critical role of radiologists in detecting and characterizing this finding. Additionally, CKD4-5 or dialysis and prolonged PTT also directly influenced mortality, while the lower rate of PRC transfusion impacted mortality through nonsurgery and ICU admission. CLINICAL RELEVANCE STATEMENT In patients with active vascular contrast extravasation (AVCE) on abdominopelvic CT, larger AVCE directly increased in-hospital mortality. Radiologists' detection and characterization of this finding is crucial, along with recognizing factors like CKD4-5, dialysis, and prolonged PTT to improve patient outcomes. KEY POINTS Several factors independently predicted in-hospital mortality in patients with abdominopelvic AVCE. Extravasation length > 8 mm was the only imaging marker predictive of in-hospital mortality. Non-imaging factors correlated with in-hospital mortality, and PRC transfusion impacted mortality through nonsurgery and ICU admission pathways.
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Affiliation(s)
- Rathachai Kaewlai
- Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Rd, Bangkok Noi, Bangkok, 10700, Thailand.
| | - Gun Chomchalerm
- Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Rd, Bangkok Noi, Bangkok, 10700, Thailand
| | - Sasima Tongsai
- Department of Research, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Rd, Bangkok Noi, Bangkok, 10700, Thailand
| | - Jitti Chatpuwaphat
- Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Rd, Bangkok Noi, Bangkok, 10700, Thailand
| | - Anchisa Chatkaewpaisal
- Department of Anatomy, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Rd, Bangkok Noi, Bangkok, 10700, Thailand
| | - Pramuk Khamman
- Department of Anatomy, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Rd, Bangkok Noi, Bangkok, 10700, Thailand
| | - Somrach Thamtorawat
- Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Rd, Bangkok Noi, Bangkok, 10700, Thailand
| | - Banjerd Praditsuktavorn
- Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Rd, Bangkok Noi, Bangkok, 10700, Thailand
| | - Worapat Maitriwong
- Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Rd, Bangkok Noi, Bangkok, 10700, Thailand
| | - Junichi Matsumoto
- Department of Emergency and Critical Care Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
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Zanetto A, Campello E, Senzolo M, Simioni P. The evolving knowledge on primary hemostasis in patients with cirrhosis: A comprehensive review. Hepatology 2024; 79:460-481. [PMID: 36825598 DOI: 10.1097/hep.0000000000000349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 02/13/2023] [Indexed: 02/25/2023]
Abstract
Patients with cirrhosis develop complex alterations in primary hemostasis that include both hypocoagulable and hypercoagulable features. This includes thrombocytopenia, multiple alterations of platelet function, and increased plasma levels of von Willebrand factor. Contrary to the historical view that platelet dysfunction in cirrhosis might be responsible for an increased bleeding tendency, the current theory posits a rebalanced hemostasis in patients with cirrhosis. Severe thrombocytopenia is not indicative of the bleeding risk in patients undergoing invasive procedures and does not dictate per se the need for pre-procedural prophylaxis. A more comprehensive and individualized risk assessment should combine hemostatic impairment, the severity of decompensation and systemic inflammation, and the presence of additional factors that may impair platelet function, such as acute kidney injury and bacterial infections. Although there are multiple, complex alterations of platelet function in cirrhosis, their net effect is not yet fully understood. More investigations evaluating the association between alterations of platelet function and bleeding/thrombosis may improve risk stratification in patients with decompensated cirrhosis. Besides hemostasis, the assessment of von Willebrand factor Ag and ADP-induced, whole-blood platelet aggregation normalized by platelet count (VITRO score and PLT ratio) are promising biomarkers to predict the risk of hepatic decompensation and survival in both compensated and decompensated patients. Further investigations into the in vivo interplay between platelets, circulating blood elements, and endothelial cells may help advance our understanding of cirrhotic coagulopathy. Here, we review the complex changes in platelets and primary hemostasis in cirrhosis and their potential clinical implications.
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Affiliation(s)
- Alberto Zanetto
- Gastroenterology and Multivisceral Transplant Unit, Azienda Ospedale-Università Padova, Padova, Italy
- Department of Surgery, Oncology, and Gastroenterology, University of Padova, Padova, Italy
| | - Elena Campello
- Department of Medicine, General Internal Medicine and Thrombotic and Hemorrhagic Diseases Unit, Padova University Hospital, Padova, Italy
| | - Marco Senzolo
- Gastroenterology and Multivisceral Transplant Unit, Azienda Ospedale-Università Padova, Padova, Italy
- Department of Surgery, Oncology, and Gastroenterology, University of Padova, Padova, Italy
| | - Paolo Simioni
- Department of Medicine, General Internal Medicine and Thrombotic and Hemorrhagic Diseases Unit, Padova University Hospital, Padova, Italy
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Kukreja N, Rodriguez IE, Moore HB, LaRiviere W, Crouch C, Stewart E, Nydam TL, Kennealey P, Hendrickse AD, Pomfret EA, Fernandez-Bustamante A. The in-vitro influence of urea concentration on thromboelastrography in patients with and without end stage renal disease. Am J Surg 2023; 226:817-822. [PMID: 37407391 PMCID: PMC10733546 DOI: 10.1016/j.amjsurg.2023.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/25/2023] [Accepted: 06/20/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND End stage renal disease (ESRD) is associated with platelet dysfunction but also thromboembolic complications. The specific role of increased blood urea nitrogen (BUN) on coagulation is unclear. We aimed to characterize thromboelastography (TEG) parameters from males and females with ESRD and normal kidney function and evaluate if exogenous urea in vitro reproduced those TEG differences. METHODS We collected blood samples from 20 living kidney donors and 20 kidney recipients. TEG was performed without and with two increasing urea concentrations in vitro. TEG parameters were compared between recipients and donors. RESULTS Blood from kidney recipients showed baseline increased maximum amplitude (MA) and shortened time to maximum amplitude (TMA) compared to donors. These differences were not confirmed in females. In all patients, BUN was inversely correlated with TMA (r = -0.342; p = 0.031). In males, BUN and creatinine concentrations showed a direct correlation with MA (0.583; p = 0.007) and an inverse correlation with TMA (r = -0.520; p = 0.019). Urea in vitro decreased R-time (p = 0.005) and increased LY30 (p = 0.009) in donors but not recipients. CONCLUSIONS ESRD is associated with increased MA and decreased TMA on TEG. No change in MA was observed with increasing urea concentrations in vitro. Gender-specific variability in TEG parameters were observed.
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Affiliation(s)
- Naveen Kukreja
- Department of Anesthesiology, University of Colorado School of Medicine, Aurora, CO, USA.
| | - Ivan E Rodriguez
- Colorado Center for Transplantation Care, Research, and Education (CCTCARE). Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Hunter B Moore
- Colorado Center for Transplantation Care, Research, and Education (CCTCARE). Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | | | - Cara Crouch
- Department of Anesthesiology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Erin Stewart
- Department of Anesthesiology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Trevor L Nydam
- Colorado Center for Transplantation Care, Research, and Education (CCTCARE). Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Peter Kennealey
- Colorado Center for Transplantation Care, Research, and Education (CCTCARE). Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Adrian D Hendrickse
- Department of Anesthesiology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Elizabeth A Pomfret
- Colorado Center for Transplantation Care, Research, and Education (CCTCARE). Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
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Qiu Z, Pang X, Xiang Q, Cui Y. The Crosstalk between Nephropathy and Coagulation Disorder: Pathogenesis, Treatment, and Dilemmas. J Am Soc Nephrol 2023; 34:1793-1811. [PMID: 37487015 PMCID: PMC10631605 DOI: 10.1681/asn.0000000000000199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 07/10/2023] [Indexed: 07/26/2023] Open
Abstract
ABSTRACT The interaction between the kidney and the coagulation system greatly affects each other because of the abundant vessel distribution and blood perfusion in the kidney. Clinically, the risks of complicated thrombosis and bleeding have become important concerns in the treatment of nephropathies, especially nephrotic syndrome, CKD, ESKD, and patients with nephropathy undergoing RRTs. Adverse effects of anticoagulant or procoagulant therapies in patients with nephropathy, especially anticoagulation-related nephropathy, heparin-induced thrombocytopenia, and bleeding, seriously worsen the prognosis of patients, which have become challenges for clinicians. Over the decades, the interaction between the kidney and the coagulation system has been widely studied. However, the effects of the kidney on the coagulation system have not been systematically investigated. Although some coagulation-related proteins and signaling pathways have been shown to improve coagulation abnormalities while avoiding additional kidney damage in certain kidney diseases, their potential as anticoagulation targets in nephropathy requires further investigation. Here, we review the progression of research on the crosstalk between the coagulation system and kidney diseases and systematically analyze the significance and shortcomings of previous studies to provide new sight into future research. In addition, we highlight the status of clinical treatment for coagulation disorder and nephropathy caused by each other, indicating guidance for the formulation of therapeutic strategies or drug development.
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Affiliation(s)
- Zhiwei Qiu
- Department of Pharmacy, Peking University First Hospital, Beijing, China
- Institute of Clinical Pharmacology, Peking University First Hospital, Beijing, China
| | - Xiaocong Pang
- Department of Pharmacy, Peking University First Hospital, Beijing, China
- Institute of Clinical Pharmacology, Peking University First Hospital, Beijing, China
| | - Qian Xiang
- Department of Pharmacy, Peking University First Hospital, Beijing, China
- Institute of Clinical Pharmacology, Peking University First Hospital, Beijing, China
| | - Yimin Cui
- Department of Pharmacy, Peking University First Hospital, Beijing, China
- Institute of Clinical Pharmacology, Peking University First Hospital, Beijing, China
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Kim TS, Min BH, Baek SY, Kim K, Min YW, Lee H, Rhee PL, Kim JJ, Lee JH. Effect of renal insufficiency on the short- and long-term outcomes of endoscopic submucosal dissection for early gastric cancer: Propensity score-matched analysis. Dig Endosc 2023; 35:869-878. [PMID: 36997298 DOI: 10.1111/den.14560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 03/27/2023] [Indexed: 04/01/2023]
Abstract
OBJECTIVES It is unclear whether renal insufficiency (RI) itself is a risk factor for adverse outcomes after gastric endoscopic submucosal dissection (ESD). We aimed to evaluate the safety and efficacy of gastric ESD in patients with and without RI using propensity score-matching analysis. METHODS In all, 4775 patients with 4775 early gastric cancer lesions undergoing ESD were analyzed. 1:1 propensity score-matching was performed between patients with and without RI using 12 variables. After matching, logistic regression and survival analyses were performed for short- and long-term outcomes of ESD, respectively. RESULTS The matching yielded 188 pairs of patients with and without RI. In both univariable and multivariable analyses, the presence of RI was not significantly associated with postprocedural bleeding (unadjusted odds ratio 1.81, 95% confidence interval 0.74-4.42; adjusted odds ratio 1.86, 95% confidence interval 0.74-4.65, respectively). When RI patients were subclassified into patients with estimated glomerular filtration rate (eGFR) 30-59 mL/min/1.73 m2 and eGFR <30 mL/min/1.73 m2 , no significant differences in bleeding rates were found compared to their matched controls in both groups. Perforation, en bloc resection, en bloc and R0 resection, and curative resection rates of RI patients were 2.1%, 98.4%, 91.0%, and 78.2%, respectively, which were comparable to those of non-RI patients. During a median follow-up of 119 months, there was no difference in gastric cancer-specific survival between patients with and without RI (P = 0.143). CONCLUSION The outcomes of ESD were comparable in patients with and without RI. Decreased renal function itself may not be a reason to keep patients with RI from receiving gastric ESD.
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Affiliation(s)
- Tae-Se Kim
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Byung-Hoon Min
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sun-Young Baek
- Biomedical Statistics Center, Data Science Research Institute, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Korea
| | - Kyunga Kim
- Biomedical Statistics Center, Data Science Research Institute, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Korea
- Department of Digital Health, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Korea
| | - Yang Won Min
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyuk Lee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Poong-Lyul Rhee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae J Kim
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jun Haeng Lee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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6
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Alothman S, Cornejo J, Adrales G, Li C, Sebastian R. Comparative outcomes of bariatric surgery in patients with ESRD on dialysis in the modern era of renal transplantation: analysis using the 2015-2020 MBSAQIP database. Surg Endosc 2023; 37:7106-7113. [PMID: 37400685 DOI: 10.1007/s00464-023-10200-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 06/11/2023] [Indexed: 07/05/2023]
Abstract
BACKGROUND Severe obesity is a relative contraindication for renal transplantation, therefore bariatric surgery is an important option as a pre-kidney transplant weight loss strategy. However, comparative data regarding postoperative outcomes of laparoscopic sleeve gastrectomy (LSG) or laparoscopic Roux-en-Y gastric bypass (LRYGB) in patients with or without ESRD on dialysis are scarce. METHODS Patients between 18- and 80-year-old who underwent LSG and RYGB were included. To determine the outcomes of patient who underwent bariatric surgery with ESRD on dialysis, a 1:4 PSM was performed between the patients with ESRD on dialysis and those without renal disease. The PSM analyses in both groups were performed using 20 preoperative characteristics. Then 30-day postoperative outcomes were assessed. RESULTS The operative time and postoperative-LOS were significantly longer in ESRD patients on dialysis compared to those with no renal disease either for LSG (82.37 ± 40.42 vs. 73.62 ± 38.65; P < 0.001, 2.22 ± 3.01 vs. 1.67 ± 1.90; P < 0.001) or for LRYGB (129.13 ± 63.20 vs. 118.72 ± 54.16; P = 0.002, 2.53 ± 1.74 vs. 2.00 ± 1.68; P < 0.001). In the LSG cohort (2137 vs. 8495 matched cases), patients with ESRD on dialysis showed significant increase in mortality (0.7% vs 0.3%; P = 0.019), unplanned ICU admission (3.1% vs 1.3%; P < 0.001), blood transfusions (2.3% vs 0.8%; P 0.001), readmissions (9.1% vs. 4.0%; P < 0.001), reoperations (3.4% vs. 1.2%; P < 0.001), interventions (2.3% vs. 1.0%; P = 0.006). In the LRYGB group (443 vs. 1769 matched cases), patients with ESRD on dialysis showed a significantly higher need for unplanned ICU admission (3.8% vs. 1.4%; P = 0.027), readmissions (12.4% vs. 6.6%; P = 0.011), and interventions (5.2% vs. 2.0%; P = 0.050). CONCLUSION Bariatric surgery is a safe procedure for patients with ESRD on dialysis to help them get a kidney transplant. Even though this group experienced a higher incidence of postoperative complications compared to those without kidney disease, the absolute complication rates are low and not associated with bariatric-specific complications. Therefore, ESRD should not be perceived as contraindications to bariatric surgery.
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Affiliation(s)
- Sara Alothman
- Department of Surgery, Northwest Hospital, Randallstown, MD, USA.
| | - Jorge Cornejo
- Department of Surgery, Northwest Hospital, Randallstown, MD, USA
| | - Gina Adrales
- Department of Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Christina Li
- Department of Surgery, Northwest Hospital, Randallstown, MD, USA
| | - Raul Sebastian
- Department of Surgery, Northwest Hospital, Randallstown, MD, USA
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Diltz ZR, West EJ, Colatruglio MR, Kirwan MJ, Konrade EN, Thompson KM. Perioperative Management of Comorbidities in Spine Surgery. Orthop Clin North Am 2023; 54:349-358. [PMID: 37271563 DOI: 10.1016/j.ocl.2023.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The number of spinal operations performed in the United States has significantly increased in recent years. Along with these rising numbers, there has been a corresponding increase in the number of patient comorbidities. The focus of this article is to review comorbidities in Spine surgery patients and outline strategies to optimize patients and avoid complications.
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Affiliation(s)
- Zachary R Diltz
- Department of Orthopedic Surgery, Campbell Clinic, University of Tennessee Health Science Center, 1211 Union Avenue, Memphis, TN 38104, USA; Campbell Clinic Orthopedics, 1400 South Germantown Road, Germantown, TN 38138, USA
| | - Eric J West
- Department of Orthopedic Surgery, Campbell Clinic, University of Tennessee Health Science Center, 1211 Union Avenue, Memphis, TN 38104, USA; Campbell Clinic Orthopedics, 1400 South Germantown Road, Germantown, TN 38138, USA
| | - Matthew R Colatruglio
- Department of Orthopedic Surgery, Campbell Clinic, University of Tennessee Health Science Center, 1211 Union Avenue, Memphis, TN 38104, USA; Campbell Clinic Orthopedics, 1400 South Germantown Road, Germantown, TN 38138, USA
| | - Mateo J Kirwan
- Department of Orthopedic Surgery, Campbell Clinic, University of Tennessee Health Science Center, 1211 Union Avenue, Memphis, TN 38104, USA; Campbell Clinic Orthopedics, 1400 South Germantown Road, Germantown, TN 38138, USA
| | - Elliot N Konrade
- Department of Orthopedic Surgery, Campbell Clinic, University of Tennessee Health Science Center, 1211 Union Avenue, Memphis, TN 38104, USA; Campbell Clinic Orthopedics, 1400 South Germantown Road, Germantown, TN 38138, USA
| | - Kirk M Thompson
- Department of Orthopedic Surgery, Campbell Clinic, University of Tennessee Health Science Center, 1211 Union Avenue, Memphis, TN 38104, USA; Campbell Clinic Orthopedics, 1400 South Germantown Road, Germantown, TN 38138, USA.
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Shi SS, Yang XZ, Zhang XY, Huang L, Guo HD, Li SF, Zhang W, Zhang YQ. Mallory-Weiss syndrome in four hemodialysis patients: a case study. BMC Nephrol 2023; 24:188. [PMID: 37365498 DOI: 10.1186/s12882-023-03250-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 06/20/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND Hemodialysis patients are prone to gastrointestinal bleeding, and Mallory-Weiss syndrome (MWS) is one of the causes. Mallory-Weiss syndrome is often induced by severe vomiting, manifests as upper gastrointestinal bleeding, and is self-limited with a good prognosis. However, mild vomiting in hemodialysis patients can lead to the occurrence of MWS, and the mild early symptoms are easy to misdiagnose, leading to the aggravation of the disease. CASE PRESENTATION In this paper, we report four hemodialysis patients with MWS. All patients displayed symptoms of upper gastrointestinal bleeding. The diagnosis of MWS was confirmed by gastroscopy. One patient had a history of severe vomiting; however, the other three reported histories of mild vomiting. Three patients received the conservative hemostasis treatment, and the gastrointestinal bleeding stopped. One patient underwent the gastroscopic and interventional hemostasis treatments. The conditions of three of the patients improved. Unfortunately, one of the patients died due to the cardia insufficiency. CONCLUSIONS We think that the mild symptoms of MWS are easily covered up by other symptoms. This may lead to delays in diagnosis and treatment. For patients with severe symptoms, gastroscopic hemostasis is still the first choice, and interventional hemostasis can also be considered. For patients with mild symptoms, drug hemostasis is the first consideration.
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Affiliation(s)
- Shuai-Shuai Shi
- Department of Nephrology, Heji Hospital of Changzhi Medical College, Changzhi, 046011, Shanxi, China
| | - Xian-Zhu Yang
- Graduate School of Changzhi Medical College Changzhi, Shanxi, 046000, China
| | - Xiao-Ye Zhang
- Graduate School of Changzhi Medical College Changzhi, Shanxi, 046000, China
| | - Lei Huang
- Department of Endoscopy, Heji Hospital of Changzhi Medical College, Changzhi, 046011, Shanxi, China
| | - Hui-Dan Guo
- Department of Nephrology, Heji Hospital of Changzhi Medical College, Changzhi, 046011, Shanxi, China
| | - Shuang-Fang Li
- Department of Radiology, Heji Hospital of Changzhi Medical College, Changzhi, 046011, Shanxi, China
| | - Wei Zhang
- Department of Nephrology, Heji Hospital of Changzhi Medical College, Changzhi, 046011, Shanxi, China
| | - Yi-Qiang Zhang
- Department of Biochemistry, Changzhi Medical College, 161 JieFang East Street, Changzhi, Shanxi, 046000, P.R. China.
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Jamal Y, Camacho Y, Hanft S, Chiarolanzio P, Goldberg MD, Mullally JA. A Case of Pituitary Apoplexy and Cavernous Sinus Syndrome during Hemodialysis. Case Rep Endocrinol 2023; 2023:3183088. [PMID: 37152694 PMCID: PMC10154637 DOI: 10.1155/2023/3183088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 01/27/2023] [Accepted: 03/18/2023] [Indexed: 05/09/2023] Open
Abstract
Background Pituitary apoplexy (PA) is a clinical syndrome of pituitary hemorrhage or infarction and can result in hypopituitarism as well as compression of adjacent brain structures. Visual loss occurs frequently, as a result of tumor expansion and compression of the optic chiasm and optic nerves. Additionally, with pituitary tumor invasion into the fixed space of the cavernous sinus, compression of multiple cranial nerves can result in cavernous sinus syndrome (CSS). We describe a case of an undiagnosed pituitary tumor manifesting as abrupt PA with CSS during hemodialysis (HD). Clinical Case. A 77-year-old male with end-stage renal disease (ESRD) presented with acute onset of severe headache, decreased vision, ophthalmoplegia of the left eye, and hypotension during HD. MRI of the brain revealed a 2.5 cm pituitary adenoma with acute hemorrhage, compression of the left prechiasmatic optic nerve, and invasion into the left cavernous sinus (CS). The hormonal profile was consistent with multiple pituitary hormone deficiencies. The patient was treated with glucocorticoids and underwent transsphenoidal resection of the tumor. He had an uneventful postoperative hospital course, and his left visual acuity stabilized, although there was no immediate improvement in his other ocular symptoms. Conclusion Our case highlights a rare constellation of a pituitary adenoma with CS invasion complicated by PA and CSS during HD. The pathophysiology of PA is not well understood, and there are very limited data regarding PA in patients with end-stage renal disease (ESRD) on HD. Prompt recognition of PA in a patient presenting with CSS, particularly in the HD setting, is essential to ensure appropriate care is provided for this medical emergency.
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Affiliation(s)
- Yusra Jamal
- Division of Endocrinology, Department of Medicine, Westchester Medical Center, New York, USA
| | - Yudi Camacho
- Division of Endocrinology, Department of Medicine, Westchester Medical Center, New York, USA
| | - Simon Hanft
- Department of Neurosurgical Oncology, Westchester Medical Center, New York, USA
| | | | - Michael D. Goldberg
- Division of Endocrinology, Department of Medicine, Westchester Medical Center, New York, USA
| | - Jamie A. Mullally
- Division of Endocrinology, Department of Medicine, Westchester Medical Center, New York, USA
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Chen Y, Liu K, Song K, Fang C, Zhu L, Wu G, Zha J, Zha J. Spontaneous hepatic haemorrhage after caesarean section in a patient with uraemia and superimposed preeclampsia: a case report. J Int Med Res 2023; 51:3000605231166510. [PMID: 37032603 PMCID: PMC10107969 DOI: 10.1177/03000605231166510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2023] Open
Abstract
Perinatal spontaneous hepatic haemorrhage is a very rare disease affecting pregnant women, particularly those on long-term dialysis, that has a high maternal and infant mortality rate. Most patients experience preeclampsia with haemolysis, elevated liver enzymes and low platelets syndrome. Here, the case of a 35-year-old multigravida patient with known chronic kidney disease and chronic hypertension with uraemia, who developed spontaneous hepatic haemorrhage after caesarean section, is described. The patient experienced sudden massive circulatory failure, but hemodynamics were temporarily stabilized after emergency surgery. Following transfer to the intensive care unit for continued treatment, her blood pressure and haemoglobin level continued to drop. Selective hepatic artery embolization was performed on day 2 after delivery, and her vital signs gradually stabilized. On day 30 after delivery, the patient was discharged in a stable condition. The newborn recovered after therapy in neonatal intensive care for 2 months. The present case suggests that, for perinatal spontaneous hepatic haemorrhage, timely and accurate diagnosis, multidisciplinary management and determining the therapeutic approach according to clinical symptoms are essential.
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Affiliation(s)
- Yuanyuan Chen
- Department of Critical Care Medicine, Anqing Municipal Hospital, Anqing City, Anhui Province, China
| | - Kai Liu
- Cardiovascular Department, Anqing Municipal Hospital, Anqing City, Anhui Province, China
| | - Kangjie Song
- Department of Hepatobiliary Surgery, Anqing Municipal Hospital, Anqing City, Anhui Province, China
| | - Changtai Fang
- Department of Critical Care Medicine, Anqing Municipal Hospital, Anqing City, Anhui Province, China
| | - Lianghua Zhu
- Department of Critical Care Medicine, Anqing Municipal Hospital, Anqing City, Anhui Province, China
| | - Gaofei Wu
- Department of Critical Care Medicine, Anqing Municipal Hospital, Anqing City, Anhui Province, China
| | - Junjing Zha
- Department of Critical Care Medicine, Anqing Municipal Hospital, Anqing City, Anhui Province, China
| | - Jiaan Zha
- Department of Critical Care Medicine, Anqing Municipal Hospital, Anqing City, Anhui Province, China
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11
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Wallisch WJ, Kidd B, Shen L, Hammer R, Siscel J. Coagulopathy and Emergent Reversal of Anticoagulation. Anesthesiol Clin 2023; 41:249-261. [PMID: 36872002 DOI: 10.1016/j.anclin.2022.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
More patients than ever are presenting for urgent or emergent procedures while therapeutically anticoagulated for various medical indications. Medications including warfarin, antiplatelet agents such as clopidogrel, direct oral anticoagulants such as apixaban, and even heparin or heparinoids may be present. Each of these medication classes presents its own challenges when coagulopathy needs to be quickly corrected. This review article presents evidence-based discussions of monitoring and reversal of these medication-induced coagulopathies. In addition, there will be a brief discussion of other potential coagulopathies that may be encountered in providing acute care anesthesia.
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Affiliation(s)
- William John Wallisch
- Department of Anesthesiology, University of Kansas Medical Center, 3901 Rainbow Boulevard, Mail Stop 1034, Kansas City, KS 66160, USA.
| | - Brent Kidd
- Department of Anesthesiology, University of Kansas Medical Center, 3901 Rainbow Boulevard, Mail Stop 1034, Kansas City, KS 66160, USA
| | - Liang Shen
- Department of Anesthesiology, Weill Cornell Medical College, 525 East 68th Street, M324, New York, NY 10065, USA
| | - Rachel Hammer
- Department of Anesthesiology, Emory University, 1364 Clifton Road Northeast, Atlanta, GA 30322, USA
| | - Jordan Siscel
- Department of Anesthesiology, University of Kansas Medical Center, 3901 Rainbow Boulevard, Mail Stop 1034, Kansas City, KS 66160, USA
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12
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Diaz C, Quintero JA, Zarama V, Bustamante-Cristancho LA. Bleeding Complications in Uremic Patients After Ultrasound-Guided Central Venous Catheter Placement. Open Access Emerg Med 2023; 15:21-28. [PMID: 36660271 PMCID: PMC9843503 DOI: 10.2147/oaem.s384081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 12/09/2022] [Indexed: 01/13/2023] Open
Abstract
Introduction Bleeding associated with elevated blood urea nitrogen (BUN) is a known complication. Patients with uremia require a central venous catheter insertion by dialysis. The relation between BUN and bleeding complications during central venous catheter insertion is not yet clear. Objective We described the frequency of complications associated with central venous catheter implantation in uremic patients and evaluated the statistical relationship between bleeding complications and catheter type, number of punctures, and catheter insertion site. Also, we determined if any value of BUN is associated with bleeding complications. Methods We included patients with a serum value of BUN >70 mg/dl that required insertion of a central venous catheter. The quantitative variables were expressed through the measure of central tendency. A bivariate analysis and a ROC curve were performed. Results A total of 273 catheters were included in this study. Bleeding complications were detected in 69 cases (25.3%), and local bleeding was the most frequent complication in 51/69 cases. Statistically significant association was not established. We did not find a specific cut-off value directly related to BUN levels and the rate of complications. Conclusion Bleeding complications associated with the insertion of central venous catheter and the suspected disorder of hemostasis given by BUN levels >70 mg/dl are common. It was not possible to determine a BUN cut-off value to predict complications. The association analysis was not conclusive. High BUN levels should not be considered a high-risk condition for central venous cannulation under ultrasound guidance performed by trained personnel.
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Affiliation(s)
- Carime Diaz
- Critical Medicine, Emergency Department, Fundación Valle del Lili, Cali, 760032, Colombia
| | - Jaime A Quintero
- Critical Medicine, Emergency Department, Fundación Valle del Lili, Cali, 760032, Colombia,Centro de Investigaciones Clínicas (CIC), Fundación Valle del Lili, Cali, 760032, Colombia,Correspondence: Jaime A Quintero, Critical Medicine, Emergency Department, Centro de Investigaciones Clínicas, Fundación Valle del Lili, Carrera 98 No. 18-49, Cali, 760032, Colombia, Tel +57 3184257759, Email
| | - Virginia Zarama
- Critical Medicine, Emergency Department, Fundación Valle del Lili, Cali, 760032, Colombia
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13
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Binder V, Chruścicka-Smaga B, Bergum B, Jaisson S, Gillery P, Sivertsen J, Hervig T, Kaminska M, Tilvawala R, Nemmara VV, Thompson PR, Potempa J, Marti HP, Mydel P. Carbamylation of Integrin α IIb β 3: The Mechanistic Link to Platelet Dysfunction in ESKD. J Am Soc Nephrol 2022; 33:1841-1856. [PMID: 36038265 PMCID: PMC9528322 DOI: 10.1681/asn.2022010013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 06/05/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Bleeding diatheses, common among patients with ESKD, can lead to serious complications, particularly during invasive procedures. Chronic urea overload significantly increases cyanate concentrations in patients with ESKD, leading to carbamylation, an irreversible modification of proteins and peptides. METHODS To investigate carbamylation as a potential mechanistic link between uremia and platelet dysfunction in ESKD, we used liquid chromatography-tandem mass spectrometry (HPLC-MS/MS) to quantify total homocitrulline, and biotin-conjugated phenylglyoxal labeling and Western blot to detect carbamylated integrin α IIb β 3 (a receptor required for platelet aggregation). Flow cytometry was used to study activation of isolated platelets and platelet-rich plasma. In a transient transfection system, we tested activity and fibrinogen binding of different mutated forms of the receptor. We assessed platelet adhesion and aggregation in microplate assays. RESULTS Carbamylation inhibited platelet activation, adhesion, and aggregation. Patients on hemodialysis exhibited significantly reduced activation of α IIb β 3 compared with healthy controls. We found significant carbamylation of both subunits of α IIb β 3 on platelets from patients receiving hemodialysis versus only minor modification in controls. In the transient transfection system, modification of lysine 185 in the β 3 subunit was associated with loss of receptor activity and fibrinogen binding. Supplementation of free amino acids, which was shown to protect plasma proteins from carbamylation-induced damage in patients on hemodialysis, prevented loss of α IIb β 3 activity in vitro. CONCLUSIONS Carbamylation of α IIb β 3-specifically modification of the K185 residue-might represent a mechanistic link between uremia and dysfunctional primary hemostasis in patients on hemodialysis. The observation that free amino acids prevented the carbamylation-induced loss of α IIb β 3 activity suggests amino acid administration during dialysis may help to normalize platelet function.
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Affiliation(s)
- Veronika Binder
- Broegelmann Research Laboratory, University of Bergen, Bergen, Norway
| | | | - Brith Bergum
- Broegelmann Research Laboratory, University of Bergen, Bergen, Norway
| | - Stéphane Jaisson
- Laboratory of Biochemistry and Molecular Biology, Unité Mixte de Recherche (UMR) Centre National de la Recherche Scientifique (CNRS) 7369, University of Reims Champagne-Ardenne, Reims, France
| | - Philippe Gillery
- Laboratory of Biochemistry and Molecular Biology, Unité Mixte de Recherche (UMR) Centre National de la Recherche Scientifique (CNRS) 7369, University of Reims Champagne-Ardenne, Reims, France
| | - Joar Sivertsen
- Department of Immunology and Transfusion Medicine, Haukeland University Hospital, Bergen, Norway
| | - Tor Hervig
- Broegelmann Research Laboratory, University of Bergen, Bergen, Norway
- Department of Immunology and Transfusion Medicine, Haukeland University Hospital, Bergen, Norway
| | - Marta Kaminska
- Broegelmann Research Laboratory, University of Bergen, Bergen, Norway
| | - Ronak Tilvawala
- Department of Biochemistry and Pharmacology, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Venkatesh V. Nemmara
- Department of Biochemistry and Pharmacology, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Paul R. Thompson
- Department of Biochemistry and Pharmacology, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Jan Potempa
- Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University, Krakow, Poland
- Department of Oral Immunology and Infectious Diseases, University of Louisville School of Dentistry, Louisville, Kentucky
| | - Hans-Peter Marti
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Piotr Mydel
- Broegelmann Research Laboratory, University of Bergen, Bergen, Norway
- Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University, Krakow, Poland
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14
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Liu CH, Kao JH. Noninvasive Diagnosis of Hepatic Fibrosis in Hemodialysis Patients with Hepatitis C Virus Infection. Diagnostics (Basel) 2022; 12:2282. [PMID: 36291971 PMCID: PMC9600350 DOI: 10.3390/diagnostics12102282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/18/2022] [Accepted: 09/19/2022] [Indexed: 08/29/2023] Open
Abstract
Hepatitis C virus (HCV) is a major health problem in hemodialysis patients, which leads to significant morbidity and mortality through progressive hepatic fibrosis or cirrhosis. Percutaneous liver biopsy is the gold standard to stage hepatic fibrosis. However, it is an invasive procedure with postbiopsy complications. Because uremia may significantly increase the risk of fatal and nonfatal bleeding events, the use of noninvasive means to assess the severity of hepatic fibrosis is particularly appealing to hemodialysis patients. To date, researchers have evaluated the performance of various biochemical, serological, and radiological indices for hepatic fibrosis in hemodialysis patients with HCV infection. In this review, we will summarize the progress of noninvasive indices for assessing hepatic fibrosis and propose a pragmatic recommendation to diagnose the stage of hepatic fibrosis with a noninvasive index, in hemodialysis patients with HCV infection.
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Affiliation(s)
- Chen-Hua Liu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei 100225, Taiwan
- Hepatitis Research Center, National Taiwan University Hospital, Taipei 100225, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, Yun-Lin Branch, Douliou 640203, Taiwan
| | - Jia-Horng Kao
- Department of Internal Medicine, National Taiwan University Hospital, Taipei 100225, Taiwan
- Hepatitis Research Center, National Taiwan University Hospital, Taipei 100225, Taiwan
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei 100233, Taiwan
- Department of Medical Research, National Taiwan University Hospital, Taipei 100225, Taiwan
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15
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Cofer LB, Soomro QH, Xia Y, Luttrell-Williams E, Myndzar K, Charytan DM, Berger JS. Platelet Activity and Cardiovascular Risk in CKD and Peripheral Artery Disease. Kidney Int Rep 2022; 7:2242-2250. [PMID: 36217517 PMCID: PMC9546761 DOI: 10.1016/j.ekir.2022.07.169] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 07/17/2022] [Accepted: 07/21/2022] [Indexed: 01/25/2023] Open
Abstract
Introduction Platelet dysfunction and cardiovascular risk are well-recognized features of chronic kidney disease (CKD). Platelets drive the development and progression of cardiovascular disease (CVD). The relationships between kidney function, platelet activity, and cardiovascular risk are poorly defined. Methods We compared platelet activity and incident cardiovascular events by CKD status (estimated glomerular filtration rate [eGFR] < 60 ml/min per 1.73 m2) using data from the Platelet Activity and Cardiovascular Events study, a prospective cohort study that enrolled adults with peripheral artery disease (PAD) undergoing lower extremity revascularization. Platelet activity was measured using light transmission aggregometry (LTA) in response to submaximal dose agonist stimulation, and the subjects were followed for incident adverse cardiovascular events for a median of 18 months. Results Overall, 113 of 285 (40%) subjects had CKD. Subjects with, versus without, CKD had higher platelet aggregation in response to stimulation with adenosine diphosphate (ADP), serotonin, epinephrine, and arachidonic acid (AA) + ex vivo aspirin (P < 0.05 for each). Following multivariable adjustment, subjects with CKD had elevated risk for myocardial infarction (MI) (adjusted hazard ratio 2.2, 95% confidence interval [1.02–4.9]) and major adverse cardiovascular events (MACE) (1.9 [1.2–3.3]) compared to those without CKD. Platelet aggregation in response to submaximal dose agonist stimulation mediated 7% to 26% of the excess risk for cardiovascular events associated with CKD. Conclusion Among subjects with PAD undergoing lower extremity revascularization, CKD is associated with increased platelet activity that mediates, in part, elevated cardiovascular risk.
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16
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The American Association of Endocrine Surgeons Guidelines for the Definitive Surgical Management of Secondary and Tertiary Renal Hyperparathyroidism. Ann Surg 2022; 276:e141-e176. [PMID: 35848728 DOI: 10.1097/sla.0000000000005522] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To develop evidence-based recommendations for safe, effective, and appropriate treatment of secondary (SHPT) and tertiary (THPT) renal hyperparathyroidism. BACKGROUND Hyperparathyroidism is common among patients with chronic kidney disease, end-stage kidney disease, and kidney transplant. The surgical management of SHPT and THPT is nuanced and requires a multidisciplinary approach. There are currently no clinical practice guidelines that address the surgical treatment of SHPT and THPT. METHODS Medical literature was reviewed from January 1, 1985 to present January 1, 2021 by a panel of 10 experts in SHPT and THPT. Recommendations using the best available evidence was constructed. The American College of Physicians grading system was used to determine levels of evidence. Recommendations were discussed to consensus. The American Association of Endocrine Surgeons membership reviewed and commented on preliminary drafts of the content. RESULTS These clinical guidelines present the epidemiology and pathophysiology of SHPT and THPT and provide recommendations for work-up and management of SHPT and THPT for all involved clinicians. It outlines the preoperative, intraoperative, and postoperative management of SHPT and THPT, as well as related definitions, operative techniques, morbidity, and outcomes. Specific topics include Pathogenesis and Epidemiology, Initial Evaluation, Imaging, Preoperative and Perioperative Care, Surgical Planning and Parathyroidectomy, Adjuncts and Approaches, Outcomes, and Reoperation. CONCLUSIONS Evidence-based guidelines were created to assist clinicians in the optimal management of secondary and tertiary renal hyperparathyroidism.
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17
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EASL Clinical Practice Guidelines on prevention and management of bleeding and thrombosis in patients with cirrhosis. J Hepatol 2022; 76:1151-1184. [PMID: 35300861 DOI: 10.1016/j.jhep.2021.09.003] [Citation(s) in RCA: 122] [Impact Index Per Article: 61.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 09/13/2021] [Indexed: 12/11/2022]
Abstract
The prevention and management of bleeding and thrombosis in patients with cirrhosis poses several difficult clinical questions. These Clinical Practice Guidelines have been developed to provide practical guidance on debated topics, including current views on haemostasis in liver disease, controversy regarding the need to correct thrombocytopenia and abnormalities in the coagulation system in patients undergoing invasive procedures, and the need for thromboprophylaxis in hospitalised patients with haemostatic abnormalities. Multiple recommendations in this document are based on interventions that the panel feels are not useful, even though widely applied in clinical practice.
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18
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Kidney Disease: Improving Global Outcomes Classification of Chronic Kidney Disease and Short-Term Outcomes of Patients Undergoing Liver Resection. J Am Coll Surg 2022; 234:827-839. [DOI: 10.1097/xcs.0000000000000112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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19
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Wang IK, Yen TH, Chen CH, Hsu SP, Sun Y, Lien LM, Chang WL, Lai TC, Chen PL, Chen CC, Huang PH, Lin CH, Su YC, Lin MC, Li CY, Sung FC, Hsu CY. Intravenous tissue plasminogen activator for acute ischemic stroke in patients with renal dysfunction. QJM 2022; 114:848-856. [PMID: 32770252 DOI: 10.1093/qjmed/hcaa237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/06/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE This study used the Taiwan Stroke Registry data to evaluate the efficacy and safety of intravenous tissue plasminogen activator (tPA) in treating acute ischemic stroke in patients with renal dysfunction. DESIGN We identified 3525 ischemic stroke patients and classified them into two groups according to the estimated glomerular filtration rate (eGFR) at the emergency department: ≥60, and <60 ml/min/1.73 m2 or on dialysis and by the propensity score from August 2006 to May 2015. The odds ratio of poor functional outcome (modified Rankin Scale ≥2) was calculated for patients with tPA treatment (N = 705), compared to those without tPA treatment (N = 2820), by eGFR levels, at 1, 3 and 6 months after ischemic stroke. We also evaluated the risks of intracerebral hemorrhage, upper gastrointestinal bleeding, mortality, between the two groups by eGFR levels. RESULTS Among patients with eGFR levels of <60 ml/min/1.73 m2, tPA therapy reduced the odds ratio of poor functional outcome to 0.60 (95% confidence interval = 0.42-0.87) at 6 months after ischemic stroke. The tPA therapy was not associated with increased overall risk of upper gastrointestinal bleeding, but with increased risk of intracerebral hemorrhage. The low eGFR was not a significant risk factor of intracerebral hemorrhage among ischemic stroke patients receiving tPA treatment. CONCLUSIONS tPA for acute ischemic stroke could improve functional outcomes without increasing the risks of upper gastrointestinal bleeding for patients with or without renal dysfunction. The low eGFR was not a significant risk factor for intracerebral hemorrhage among patients receiving tPA treatment.
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Affiliation(s)
- I-K Wang
- From the Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan
- Department of Internal Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Division of Nephrology, China Medical University Hospital, Taichung, Taiwan
| | - T-H Yen
- Division of Nephrology, Chang Gung Memorial Hospital, Taipei, Taiwan
- Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - C-H Chen
- Department of Neurology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Stroke Center, National Cheng Kung University Hospital, Tainan, Taiwan
| | - S-P Hsu
- Department of Neurology, E-Da Hospital, I-Shou University, Kaohsiung City, Taiwan
| | - Y Sun
- Neurology, En Chu Kong Hospital, New Taipei City, Taiwan
| | - L-M Lien
- Department of Neurology, Shin Kong Wu-Ho-Su Memorial Hospital, Taipei, Taiwan
- Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - W-L Chang
- Department of Neurology, Show Chwan Memorial Hospital, Changhua County, Taiwan
| | - T-C Lai
- Division of Neurology Department of Internal Medicine, Cheng Hsin General Hospital, Taipei, Taiwan
| | - P-L Chen
- Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Neurology, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - C-C Chen
- Department of Neurology, St Martin De Porres Hospital, Chiayi City, Taiwan
| | - P-H Huang
- Department of Neurology, Cathay General Hospital, Taipei, Taiwan
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
| | - C-H Lin
- Section of Neurology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Y-C Su
- Management Office for Health Data
| | - M-C Lin
- Management Office for Health Data
| | - C-Y Li
- From the Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan
- Department of Anesthesiology, China Medical University Hospital, Taichung, Taiwan
| | - F-C Sung
- Department of Health Services Administration, China Medical University College of Public Health, Taichung 404, Taiwan
- Department of Food Nutrition and Health Biotechnology, Asia University, Lioufeng Road, Wufeng, Taichung, Taiwan
| | - C Y Hsu
- From the Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan
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20
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Abstract
Platelets are commonly transfused either therapeutically or prophylactically to maintain hemostasis. Most platelet transfusions are used to manage patients with hematologic malignancies. Although platelet transfusion guidelines have been published, platelet transfusion practices are still heterogeneous. Platelet transfusion guidelines partly lack recommendations or differ in the platelet threshold recommendations in some clinical situations. This article reviews platelet transfusions focusing on transfusion guidelines and platelet thresholds in different clinical settings.
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Affiliation(s)
- Shan Yuan
- Division of Transfusion Medicine, Department of Pathology, City of Hope National Medical Center, Duarte, CA 91010-3000, USA
| | - Zaher K Otrock
- Division of Transfusion Medicine, Department of Pathology and Laboratory Medicine, Henry Ford Hospital, K6, 2799 West Grand Boulevard, Detroit, MI 48202, USA; Department of Pathology, Wayne State University School of Medicine, Detroit, MI, USA.
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21
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Barrios RHS, Burguera Vion V, Álvarez Nadal M, Cintra Cabrera M, Elías Triviño S, Villa Hurtado D, Ortego S, Fernández Lucas M, Rivera-Gorrin M. Safety of renal biopsy bleeding prophylaxis with desmopressin. J Int Med Res 2021; 49:3000605211040764. [PMID: 34590925 PMCID: PMC8489756 DOI: 10.1177/03000605211040764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Percutaneous renal biopsy (PRB) is invasive, and bleeding-related complications are a concern. Desmopressin (DDAVP) is a selective type 2 vasopressin receptor-agonist also used for haemostasis. AIM To evaluate the side effects of intravenous (IV) weight-adjusted desmopressin preceding PRB. METHODS This was a retrospective study of renal biopsies performed by nephrologists from 2013 to 2017 in patients who received single-dose DDAVP pre-PRB. RESULTS Of 482 PRBs, 65 (13.5%) received DDAVP (0.3 µg/kg); 55.4% of the PRBs were native kidneys. Desmopressin indications were altered platelet function analyser (PFA)-100 results (75.3% of the patients), urea >24.9 mmol/L (15.5%), antiplatelet drugs (6.1%) and thrombocytopaenia (3%). Of the 65 patients, 30.7% had minor asymptomatic complications, and 3 patients had major complications. Pre-PRB haemoglobin (Hb) <100 g/L was a risk factor for Hb decrease >10 g/L, and altered collagen-epinephrine (Col-Epi) time was a significant risk factor for overall complications. Mean sodium decrease was 0.6 ± 3 mmol/L. Hyponatraemia without neurological symptoms was diagnosed in two patients; no cardiovascular events occurred. CONCLUSION Hyponatraemia after single-dose DDAVP is rare. A single IV dose of desmopressin adjusted to the patient's weight is safe as pre-PRB bleeding prophylaxis.
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Affiliation(s)
- R Haridian Sosa Barrios
- Nephrology Department, Hospital Universitario Ramón y Cajal, IRYCIS Madrid, Spain.,Spanish Group of Diagnostic and Interventional Nephrology, Spanish Society of Nephrology (GNDI), Spain
| | - Víctor Burguera Vion
- Nephrology Department, Hospital Universitario Ramón y Cajal, IRYCIS Madrid, Spain.,Spanish Group of Diagnostic and Interventional Nephrology, Spanish Society of Nephrology (GNDI), Spain
| | - Marta Álvarez Nadal
- Nephrology Department, Hospital Universitario Ramón y Cajal, IRYCIS Madrid, Spain
| | - Melissa Cintra Cabrera
- Spanish Group of Diagnostic and Interventional Nephrology, Spanish Society of Nephrology (GNDI), Spain.,Nephrology Department, Hospital Universitario Virgen de la Macarena, Sevilla, Spain
| | - Sandra Elías Triviño
- Nephrology Department, Hospital Universitario Ramón y Cajal, IRYCIS Madrid, Spain
| | - Daniel Villa Hurtado
- Nephrology Department, Hospital Universitario Ramón y Cajal, IRYCIS Madrid, Spain
| | - Sofía Ortego
- Nephrology Department, Hospital Universitario Ramón y Cajal, IRYCIS Madrid, Spain
| | - Milagros Fernández Lucas
- Nephrology Department, Hospital Universitario Ramón y Cajal, IRYCIS Madrid, Spain.,Spanish Group of Diagnostic and Interventional Nephrology, Spanish Society of Nephrology (GNDI), Spain.,Associate Professor, Alcala University, Madrid, Spain.,Red de investigación renal (REDinREN), ISCIII (ERC 10 RD12/0021/0020) Nephrology, Spain
| | - Maite Rivera-Gorrin
- Nephrology Department, Hospital Universitario Ramón y Cajal, IRYCIS Madrid, Spain.,Spanish Group of Diagnostic and Interventional Nephrology, Spanish Society of Nephrology (GNDI), Spain.,Associate Professor, Alcala University, Madrid, Spain.,Red de investigación renal (REDinREN), ISCIII (ERC 10 RD12/0021/0020) Nephrology, Spain
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22
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Jun KW, Cho J, Kim MH, Hwang JK, Park SC, Moon IS, Kim JI. Changes in hemostatic factors after kidney transplantation: A retrospective cohort study. Medicine (Baltimore) 2021; 100:e27179. [PMID: 34516516 PMCID: PMC8428698 DOI: 10.1097/md.0000000000027179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 08/21/2021] [Indexed: 01/05/2023] Open
Abstract
Chronic kidney disease affects hemostasis in complex ways, producing both thrombotic and hemorrhagic diatheses. These changes may impact patient morbidity and mortality pre-transplantation, as well as allograft survival after kidney transplantation (KT). This study was conducted to analyze changes in hemostatic factors in the early post-KT period.We retrospectively analyzed 676 recipients of kidney allografts from December 2009 to December 2014. Patients receiving plasmapheresis pre- or post-KT, experiencing early allograft failure, or receiving anticoagulants or antiplatelet agents pre- or post-KT were excluded.Of the 367 included patients, acute (≤1 month) rejection occurred in 4.1% and delayed graft function occurred in 3.3%. Postoperative bleeding complications occurred in 7.9% of patients and thrombotic complications in 3.3%. Pre-transplantation, recipients had below normal hemoglobin, above normal d-dimer and homocysteine levels, and elevated rates of antiphospholipid antibodies. Hemoglobin increased to almost normal by postoperative day (POD) 28 (P < .001). d-dimer increased on POD7, 14, and 28, although the values were not significantly different from pre-KT. The pattern of d-dimer changes suggested that they were a nonspecific consequence of major surgery. Homocysteine decreased to normal by POD7 (P < .001). The percentage of patients with ≥1 prothrombotic factor was 82.0% pre-KT and only 14.2% on POD28 (P < .001).The most of patients exhibited prothrombotic tendencies, including increased d-dimer and homocysteine, and increased prevalence of antiphospholipid antibodies before transplantation. They also had pre-transplantation anemia, suggesting a concomitant bleeding diathesis. However, most of these abnormal hemostatic factors improved or resolved after KT.
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Affiliation(s)
- Kang Woong Jun
- Department of Surgery, Bucheon St, Mary's Hospital, College of Medicine, The Catholic University of Korea, Gyeonggi-do
| | - Jinbeom Cho
- Department of Surgery, Bucheon St, Mary's Hospital, College of Medicine, The Catholic University of Korea, Gyeonggi-do
| | - Mi Hyeong Kim
- Department of Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Eunpyeong-gu
| | - Jeong Kye Hwang
- Department of Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Eunpyeong-gu
| | - Sun Cheol Park
- Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seocho-gu
| | - In Sung Moon
- Department of Surgery, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Yeongdeungpo-gu, Seoul
| | - Ji Il Kim
- Department of Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu-si, Gyeonggi-do, Republic of Korea
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Kang BS, Kim YI, Hong SY, Ban SS, Han WS, Kim BG. Decline in platelet function following administration of a snake venom-derived hemocoagulase in a patient with end-stage renal disease. Kidney Res Clin Pract 2020; 39:501-503. [PMID: 33214344 PMCID: PMC7770999 DOI: 10.23876/j.krcp.20.116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 07/15/2020] [Accepted: 07/18/2020] [Indexed: 11/04/2022] Open
Affiliation(s)
- Byung Soo Kang
- Department of Internal Medicine, Bagae General Hospital, Pyeongtaek, Republic of Korea
| | - Young Il Kim
- Department of Internal Medicine, Bagae General Hospital, Pyeongtaek, Republic of Korea
| | - Sae-Yong Hong
- Department of Internal Medicine, Bagae General Hospital, Pyeongtaek, Republic of Korea
| | - Seong Su Ban
- Department of Neurosurgery, Bagae General Hospital, Pyeongtaek, Republic of Korea
| | - Won Seon Han
- Department of Clinical Pathology, Bagae General Hospital, Pyeongtaek, Republic of Korea
| | - Byung Geun Kim
- Department of Orthopedics, Bagae General Hospital, Pyeongtaek, Republic of Korea
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24
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Borghese O, Pisani A, Di Centa I. Puncture Site Necrosis Over Hemodialysis Native and Prosthetic Vascular Accesses. Ann Vasc Surg 2020; 73:178-184. [PMID: 33383140 DOI: 10.1016/j.avsg.2020.11.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 11/10/2020] [Accepted: 11/11/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND The aim of this study was to detail our experience in the management of skin necrosis/ulceration over hemodialysis vascular accesses. METHODS We collected demographics and operative data about patients undergoing surgery for skin necrosis over native or prosthetic vascular accesses. The different procedural techniques used and outcomes achieved were analyzed. RESULTS Over a six-year period (2013-2019), 593 hemodialysis accesses were created and 16 patients (50%, 8 male; median age 63.6 years, range 42-87; 12 native and 4 prosthetic accesses) were emergently/urgently treated for skin necrosis with danger of rupture (n 9), minor active bleeding (n 4) or life-threatening hemorrhage (n 3). Underlying causes were local infection, aneurysm/pseudo-aneurysm formation and venous stenosis. Most accesses were preserved. Rescue procedures consisted in excision of skin necrosis in association with aneurysmorrhaphy (n 1, 6.3%), simple closure of the venous breach (n 2, 12.5%) or resection and direct re-anastomosis (n 7, 43.8%). Concomitant endoluminal dilatation of venous outflow was needed in 7 (43.8%) cases. No intraoperative complications were observed. At a median of 13 months (range 1-39), 90% of rescued accesses were still functional. CONCLUSIONS Skin necrosis/ulceration over vascular access requires prompt surgical intervention ahead the risk of life-threatening hemorrhage. The rescue of a functional access is possible in most patients and provides an efficient dialysis in postoperative period.
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Affiliation(s)
- Ottavia Borghese
- Department of Vascular and Endovascular Surgery, Foch Hospital, Suresnes, France; Sapienza University, Rome, Italy.
| | - Angelo Pisani
- Department of Cardiovascular Surgery Bichat-Claude Bernard Hospital, Paris, France
| | - Isabelle Di Centa
- Department of Vascular and Endovascular Surgery, Foch Hospital, Suresnes, France
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25
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Chionh CY, Soh DY, Tan CH, Khaw JY, Wong YC, Foong S. A device for surveillance of vascular access sites for bleeding: results from a clinical evaluation trial. Sci Rep 2020; 10:18153. [PMID: 33097747 PMCID: PMC7585412 DOI: 10.1038/s41598-020-74571-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 10/05/2020] [Indexed: 11/09/2022] Open
Abstract
Post-procedural wound haemorrhage is a potentially life-threatening complication. For haemodialysis patients, bleeding is often encountered after vascular access procedures and fatal episodes have been reported. Visual monitoring for bleeding is manpower intensive and bleeding episodes may still be missed between inspections. A device, Blood WArning Technology with Continuous Haemoglobin sensor (BWATCH), was developed to detect bleeding from wounds. This a prospective, observational clinical trial on patients who have had a dialysis catheter inserted or removed. The battery-powered, disc-shaped device (43 mm diameter, 12 mm height) was placed over the dressing for at least six hours. The device detects reflected light with characteristics specific for haemoglobin and an alarm would be triggered if bleeding occurs. There were 250 participants (177 post-insertion, 73 post-removal) and 36 episodes of bleeding occurred. The device alarm was triggered in all instances but there were also 9 false alarms. Specificity was 95.8%, false positive rate was 4.2% and positive predictive value was 80.0%. Sensitivity and negative predictive value were 100% but detection failure may still occur due to improper application or device maintenance. The use of technological aids for monitoring improves patient safety and may reduce demand on manpower.
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Affiliation(s)
- Chang Yin Chionh
- Department of Renal Medicine, Changi General Hospital, Singapore, Singapore. .,Engineering Product Development Pillar, Singapore University of Technology & Design, Singapore, Singapore.
| | - Desilyn Yuqing Soh
- Clinical Trials and Research Unit, Changi General Hospital, Singapore, Singapore
| | - Chee How Tan
- Engineering Product Development Pillar, Singapore University of Technology & Design, Singapore, Singapore
| | - Jien-Yi Khaw
- Engineering Product Development Pillar, Singapore University of Technology & Design, Singapore, Singapore
| | - Ying Ching Wong
- Engineering Product Development Pillar, Singapore University of Technology & Design, Singapore, Singapore
| | | | - Shaohui Foong
- Engineering Product Development Pillar, Singapore University of Technology & Design, Singapore, Singapore
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26
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Bahrainwala JZ, Gelfand SL, Shah A, Abramovitz B, Hoffman B, Leonberg-Yoo AK. Preoperative Risk Assessment and Management in Adults Receiving Maintenance Dialysis and Those With Earlier Stages of CKD. Am J Kidney Dis 2020; 75:245-255. [DOI: 10.1053/j.ajkd.2019.07.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 07/01/2019] [Indexed: 11/11/2022]
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27
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Shamsuddin N, Karuppannan M, Hafiz Wan Md Adnan WA, Farooqui M, Gnanasan S. Pattern of complementary and alternative medicine (CAM) use among patients with chronic kidney disease. Complement Ther Clin Pract 2019; 37:86-92. [PMID: 31539806 DOI: 10.1016/j.ctcp.2019.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Revised: 09/12/2019] [Accepted: 09/12/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Noorasyikin Shamsuddin
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, University of Malaya, Kuala Lumpur, Malaysia.
| | - Mahmathi Karuppannan
- Department of Pharmacy Practice, Faculty of Pharmacy, Universiti Teknologi MARA Cawangan Selangor, Puncak Alam, Malaysia
| | | | - Maryam Farooqui
- Department of Pharmacy Practice, Unaizah College of Pharmacy, Qassim University, Unaizah, Qassim, Saudi Arabia
| | - Shubashini Gnanasan
- Department of Pharmacy Practice, Faculty of Pharmacy, Universiti Teknologi MARA Cawangan Selangor, Puncak Alam, Malaysia
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28
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Hopley CW, Kavanagh S, Patel MR, Ostrom C, Baumgartner I, Berger JS, Blomster JI, Fowkes FGR, Jones WS, Katona BG, Mahaffey KW, Norgren L, Rockhold FW, Hiatt WR. Chronic kidney disease and risk for cardiovascular and limb outcomes in patients with symptomatic peripheral artery disease: The EUCLID trial. Vasc Med 2019; 24:422-430. [DOI: 10.1177/1358863x19864172] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In patients with symptomatic peripheral artery disease (PAD), the impact of chronic kidney disease (CKD) on major adverse cardiovascular events has not been fully evaluated. The Examining Use of Ticagrelor In PAD (EUCLID) trial randomized 13,885 patients with PAD to ticagrelor 90 mg twice daily or clopidogrel 75 mg daily. This post hoc analysis compared the incidence of the primary composite endpoint (cardiovascular death, myocardial infarction (MI), or ischemic stroke) in patients with CKD (eGFR < 60 mL/min/1.73 m2) with those without CKD (eGFR ⩾ 60 mL/min/1.73 m2). The primary safety endpoint was thrombolysis in MI (TIMI) major bleeding. A total of 13,483 patients were included; 3332 (25%) had CKD, of whom 237 had stage 4/5 disease. Median follow-up was approximately 30 months. After statistical adjustment, patients with CKD had a higher rate of the primary endpoint compared with those without CKD (6.75 vs 3.72 events/100 patient-years; adjusted hazard ratio (HR) 1.45, 95% CI 1.30–1.63). CKD was not associated with increased risk of hospitalization for acute limb ischemia (ALI) (adjusted HR 0.96, 95% CI 0.69–1.34) or major amputation (adjusted HR 0.92, 95% CI 0.66–1.28). CKD was not associated with a significantly increased risk of major bleeding (adjusted HR 1.21, 95% CI 0.89–1.64), but minor bleeding was significantly increased (adjusted HR 1.51, 95% CI 1.07–2.15). In conclusion, patients with PAD and CKD had higher rates of cardiovascular death, MI, and ischemic stroke, but similar rates of ALI, major amputation, and TIMI major bleeding when compared with patients without CKD. ClinicalTrials.gov Identifier: NCT01732822
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Affiliation(s)
- Charles W Hopley
- Department of Medicine, Section of Nephrology and Hypertension, Geisel School of Medicine at Dartmouth, Dartmouth Hitchcock Medical Center, Hanover, NH, USA
- CPC Clinical Research, Aurora, CO, USA
| | | | - Manesh R Patel
- Duke Clinical Research Institute, Durham, NC, USA
- Department of Medicine, Division of Cardiology, Duke University School of Medicine, Durham, NC, USA
| | | | - Iris Baumgartner
- Swiss Cardiovascular Centre, Inselspital, Division of Angiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jeffrey S Berger
- Departments of Medicine and Surgery, New York University School of Medicine, New York, NY, USA
| | | | - F Gerry R Fowkes
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - W Schuyler Jones
- Duke Clinical Research Institute, Durham, NC, USA
- Department of Medicine, Division of Cardiology, Duke University School of Medicine, Durham, NC, USA
| | | | - Kenneth W Mahaffey
- Stanford Center for Clinical Research, Stanford University School of Medicine, Stanford, CA, USA
| | - Lars Norgren
- Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | | | - William R Hiatt
- CPC Clinical Research, Aurora, CO, USA
- Department of Medicine, Division of Cardiology, University of Colorado School of Medicine, Aurora, CO, USA
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29
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Jegatheswaran J, Hundemer GL, Massicotte-Azarniouch D, Sood MM. Anticoagulation in Patients With Advanced Chronic Kidney Disease: Walking the Fine Line Between Benefit and Harm. Can J Cardiol 2019; 35:1241-1255. [PMID: 31472820 DOI: 10.1016/j.cjca.2019.07.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 07/03/2019] [Accepted: 07/04/2019] [Indexed: 12/23/2022] Open
Abstract
Chronic kidney disease affects more than 3 million Canadians and is highly associated with cardiovascular diseases that require anticoagulation, such as atrial fibrillation and venous thromboembolism. Patients with chronic kidney disease are at a problematic crossroads; they are at high risk of thrombotic conditions requiring anticoagulation and bleeding complications due to anticoagulation. The limited high-quality clinical evidence to guide decision-making in this area further compounds the dilemma. In this review, we discuss the physiology and epidemiology of bleeding and thrombosis in patients with kidney disease. We specifically focus on patients with advanced kidney disease (estimated glomerular filtration rate ≤ 30 mL/min) or who are receiving dialysis and focus on the nephrologist perspective regarding these issues. We summarize the existing evidence for anticoagulation use in the prevention of stroke with atrial fibrillation and provide practical clinical recommendations for considering anticoagulation use in this population. Last, we examine specific scenarios such as the use of a glomerular filtration rate estimating equation and dosing, the use of existing prediction tools for stroke and hemorrhage risk, current patterns of anticoagulation use (including during the dialysis procedure), and vascular calcification with vitamin K antagonist use in patients with chronic kidney disease.
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Affiliation(s)
| | - Gregory L Hundemer
- Division of Nephrology, University of Ottawa, Ottawa, Ontario, Canada; The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | | | - Manish M Sood
- Division of Nephrology, University of Ottawa, Ottawa, Ontario, Canada; The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; The Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
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Abstract
Poorly controlled diabetes with comorbid manifestations negatively affects outcomes in lower extremity trauma, increasing the risk of short-term and long-term complications. Management strategies of patients with diabetes that experience lower extremity trauma should also include perioperative management of hyperglycemia to reduce adverse and serious adverse events.
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Affiliation(s)
- George T Liu
- Orthopaedic Surgery, University of Texas Southwestern Medical Center, 1801 Inwood Road, Dallas, TX 75390-8883, USA; Foot and Ankle Service, Orthopaedic Surgery, Parkland Memorial Hospital, Level 1 Trauma Center, 5200 Harry Hines Boulevard, Dallas, TX 75235, USA.
| | - Drew T Sanders
- Orthopaedic Surgery, University of Texas Southwestern Medical Center, 1801 Inwood Road, Dallas, TX 75390-8883, USA; Orthopaedic Trauma Service, Parkland Memorial Hospital, Level 1 Trauma Center, 5200 Harry Hines Boulevard, Dallas, TX 75235, USA
| | - Katherine M Raspovic
- Orthopaedic Surgery, University of Texas Southwestern Medical Center, 1801 Inwood Road, Dallas, TX 75390-8883, USA; Foot and Ankle Service, Orthopaedic Surgery, Parkland Memorial Hospital, Level 1 Trauma Center, 5200 Harry Hines Boulevard, Dallas, TX 75235, USA
| | - Dane K Wukich
- Orthopaedic Surgery, University of Texas Southwestern Medical Center, 1801 Inwood Road, Dallas, TX 75390-8883, USA; Foot and Ankle Service, Orthopaedic Surgery, Parkland Memorial Hospital, Level 1 Trauma Center, 5200 Harry Hines Boulevard, Dallas, TX 75235, USA
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31
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Borisov AS, Malov AA, Kolesnikov SV, Lomivorotov VV. Renal Replacement Therapy in Adult Patients After Cardiac Surgery. J Cardiothorac Vasc Anesth 2019; 33:2273-2286. [PMID: 30871949 DOI: 10.1053/j.jvca.2019.02.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 02/04/2019] [Accepted: 02/08/2019] [Indexed: 01/28/2023]
Affiliation(s)
- Alexander S Borisov
- Department of Anaesthesiology and Intensive Care, E. Meshalkin National Medical Research Center, Novosibirsk, Russia
| | - Andrey A Malov
- Department of Anaesthesiology and Intensive Care, E. Meshalkin National Medical Research Center, Novosibirsk, Russia
| | - Sergey V Kolesnikov
- Department of Anaesthesiology and Intensive Care, E. Meshalkin National Medical Research Center, Novosibirsk, Russia
| | - Vladimir V Lomivorotov
- Department of Anaesthesiology and Intensive Care, E. Meshalkin National Medical Research Center, Novosibirsk, Russia; Novosibirsk State University, Novosibirsk, Russia.
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32
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Choi YK, Ahn JY, Na HK, Jung KW, Kim DH, Lee JH, Choi KD, Song HJ, Lee GH, Jung HY. Outcomes of endoscopic submucosal dissection for gastric epithelial neoplasm in chronic kidney disease patients: propensity score-matched case-control analysis. Gastric Cancer 2019; 22:164-171. [PMID: 29948388 DOI: 10.1007/s10120-018-0848-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 06/06/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Little is known about the outcomes of gastric endoscopic submucosal dissection (ESD) in patients with chronic kidney disease (CKD). We compared the efficacy and safety of ESD between CKD and non-CKD patients. METHODS From January 2005 to December 2014, 102 CKD patients underwent ESD for gastric neoplasms at a tertiary medical institution were reviewed retrospectively. A propensity score-matched control group (102 patients) was selected from non-CKD patients to compare clinical outcomes between CKD and non-CKD patients. RESULTS En bloc resection (96.1%) and curative resection (88.2%) rates in the CKD group did not significantly differ from those in the non-CKD group. Median procedure times (25.0 vs. 21.5 min, p = 0.734) and perforation risk (p = 0.480) were similar between groups. The CKD group showed a tendency towards more bleeding events (p = 0.052) and had a significantly longer hospital stay (p = 0.001). In a subgroup analysis, stage 3 CKD patients exhibited a bleeding risk comparable to that exhibited by non-CKD patients (HR 1.35; 95% CI 0.36-5.06; p = 0.654), whereas stage 4 (HR 5.79; 95% CI 1.52-22.0; p = 0.010) and stage 5 (HR 4.80; 95% CI 1.58-14.6; p = 0.006) patients showed higher bleeding risks than non-CKD patients. In a multivariate analysis, stage 4/5 CKD was a significant predictor for bleeding risk (HR 4.99; 95% CI 1.32-18.8; p = 0.018). CONCLUSIONS ESD for gastric epithelial neoplasms can be performed in stage 3 CKD patients with comparable efficacy and safety to that performed in non-CKD patients. Stage 4 and 5 CKD patients should be closely monitored for bleeding events after ESD.
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Affiliation(s)
- Young Kwon Choi
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Ji Yong Ahn
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea.
| | - Hee Kyong Na
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Kee Wook Jung
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Do Hoon Kim
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Jeong Hoon Lee
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Kee Don Choi
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Ho June Song
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Gin Hyug Lee
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Hwoon-Yong Jung
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
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Smeda JS, Watson D, Stuckless J, Negandhi A. Post-stroke losartan and captopril treatments arrest hemorrhagic expansion in SHRsp without lowering blood pressure. Vascul Pharmacol 2018; 111:26-35. [DOI: 10.1016/j.vph.2018.08.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 02/27/2018] [Accepted: 08/11/2018] [Indexed: 12/28/2022]
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Mochizuki Y, Harada H, Yokokawa M, Kinoshita N, Kubota K, Okado T, Fukayama H. Oral and maxillofacial surgery in patients undergoing dialysis for advanced renal disease: report of five cases. BMC Oral Health 2018; 18:166. [PMID: 30340570 PMCID: PMC6194553 DOI: 10.1186/s12903-018-0634-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 10/08/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Perioperativemanagement of hemodialysis patients involves many difficulties. High mortality rate and circulatory or respiratory complications in these patients were reported. However, in such reports, there is no concrete information of perioperative management in hemodialysis patients to prevent surgical complications and successful outcomes. CASE PRESENTATION We retrospectively reviewed the cases of 5 hemodialysis patients who underwent oral surgery under general anesthesia between January 2005 and December 2017. Primary disease was oral squamous cell carcinoma (SCC) in 4 patients and mandibular ameloblastoma in 1 patient. Partial resection was performed in 2 cases, neck dissection in 1 case. Two cases underwent surgery including vascularized reconstruction. The patients were dialyzed the day before and after surgery for the control of fluid and electrolyte status. Patients received intraoperative and postoperative intravenous infusion of potassium-free solution at 20-40 mL/h. Erythropoiesis-stimulating agents (ESAs) were used on the day of hemodialysis during hospitalization. Nafamostat mesilate as an anticoagulant during hemodialysis were used from postoperative day (POD)1 to 7. From POD 1 to 10, cephalosporin as prophylactic antibiotics is adjusted to quarter from half the initial dose. The resuming time of oral intake was similar to that of other oral surgery patients without kidney disease. The daily intake limits of protein, salt and liquid were managed during hospitalization and no cases suffered from malnutrition. No cardiorespiratory complications occurred during the perioperative period. In a case of vascularized osteocutaneous scapular flap reconstruction, grafted scapular bone survived and scapular cutaneous flap necrotized. Necrotic tissue was debrided and split thickness skin was successfully used to cover the grafted scapular bone. CONCLUSIONS Postoperative better result could be achieved if adequate perioperative management specific to hemodialysis patients is carried out. Vascularized flap reconstruction at oral and maxillofacial region in hemodialysis patients is beneficial treatment. Even if the first flap has wound complication secondary flap reconstruction is success and aesthetically better results could be achieved by the strict wound management and debridement.
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Affiliation(s)
- Yumi Mochizuki
- Department of Oral and Maxillofacial Surgery, Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8549, Japan.
| | - Hiroyuki Harada
- Department of Oral and Maxillofacial Surgery, Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8549, Japan
| | - Misaki Yokokawa
- Department of Oral and Maxillofacial Surgery, Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8549, Japan
| | - Naoya Kinoshita
- Department of Oral and Maxillofacial Surgery, Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8549, Japan
| | - Kazumasa Kubota
- Department of Gerontology and Gerodontology, Gerodontology and Oral Rehabilitation, Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8549, Japan
| | - Tomokazu Okado
- Department of Nephrology, Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Haruhisa Fukayama
- Department of Anesthesiology and Clinical Physiology, Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8549, Japan
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35
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Malkin AD, Ye SH, Lee EJ, Yang X, Zhu Y, Gamble LJ, Federspiel WJ, Wagner WR. Development of zwitterionic sulfobetaine block copolymer conjugation strategies for reduced platelet deposition in respiratory assist devices. J Biomed Mater Res B Appl Biomater 2018; 106:2681-2692. [PMID: 29424964 PMCID: PMC6085169 DOI: 10.1002/jbm.b.34085] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 01/04/2018] [Accepted: 01/19/2018] [Indexed: 01/22/2023]
Abstract
Respiratory assist devices, that utilize ∼2 m2 of hollow fiber membranes (HFMs) to achieve desired gas transfer rates, have been limited in their adoption due to such blood biocompatibility limitations. This study reports two techniques for the functionalization and subsequent conjugation of zwitterionic sulfobetaine (SB) block copolymers to polymethylpentene (PMP) HFM surfaces with the intention of reducing thrombus formation in respiratory assist devices. Amine or hydroxyl functionalization of PMP HFMs (PMP-A or PMP-H) was accomplished using plasma-enhanced chemical vapor deposition. The generated functional groups were conjugated to low molecular weight SB block copolymers with N-hydroxysuccinimide ester or siloxane groups (SBNHS or SBNHSi) that were synthesized using reversible addition fragmentation chain transfer polymerization. The modified HFMs (PMP-A-SBNHS or PMP-H-SBNHSi) showed 80-95% reduction in platelet deposition from whole ovine blood, stability under the fluid shear of anticipated operating conditions, and uninhibited gas exchange performance relative to non-modified HFMs (PMP-C). Additionally, the functionalization and SBNHSi conjugation technique was shown to reduce platelet deposition on polycarbonate and poly(vinyl chloride), two other materials commonly found in extracorporeal circuits. The observed thromboresistance and stability of the SB modified surfaces, without degradation of HFM gas transfer performance, indicate that this approach is promising for longer term pre-clinical testing in respiratory assist devices and may ultimately allow for the reduction of anticoagulation levels in patients being supported for extended periods. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 2681-2692, 2018.
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Affiliation(s)
- Alexander D. Malkin
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania 15219, United States
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania 15219, United States
| | - Sang-Ho Ye
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania 15219, United States
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania 15219, United States
| | - Evan J. Lee
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania 15219, United States
| | - Xiguang Yang
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania 15219, United States
| | - Yang Zhu
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania 15219, United States
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania 15219, United States
| | - Lara J. Gamble
- Department of Bioengineering and NESAC/BIO, University of Washington, Seattle, Washington 98195, United States
| | - William J. Federspiel
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania 15219, United States
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania 15219, United States
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania 15219, United States
- Chemical and Petroleum Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania 15219, United States
| | - William R. Wagner
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania 15219, United States
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania 15219, United States
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania 15219, United States
- Chemical and Petroleum Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania 15219, United States
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Long B, Koyfman A, Lee CM. Emergency medicine evaluation and management of the end stage renal disease patient. Am J Emerg Med 2017; 35:1946-1955. [PMID: 28893450 DOI: 10.1016/j.ajem.2017.09.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Revised: 09/02/2017] [Accepted: 09/03/2017] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND End stage renal disease (ESRD) is increasing in the U.S., and these patients demonstrate greater all-cause mortality, cardiovascular events, and hospitalization rates when compared to those with normal renal function. These patients may experience significant complications associated with loss of renal function and dialysis. OBJECTIVE This review evaluates complications of ESRD including cardiopulmonary, neurologic, infectious disease, vascular, and access site complications, as well as medication use in this population. DISCUSSION ESRD incidence is rapidly increasing, and patients commonly require renal replacement therapy including hemodialysis (HDS) or peritoneal dialysis (PD), each type with specific features. These patients possess greater risk of neurologic complications, cardiopulmonary pathology, infection, and access site complications. Focused history and physical examination are essential. Neurologic issues include uremic encephalopathy, cerebrovascular pathology, and several others. Cardiopulmonary complications include pericarditis, pericardial effusion/tamponade, acute coronary syndrome, sudden cardiac death, electrolyte abnormalities, pulmonary edema, and air embolism. Infections are common, with patients more commonly presenting in atypical fashion. Access site infections and metastatic infections must be treated aggressively. Access site complications include bleeding, aneurysm/pseudoaneurysm, thrombosis/stenosis, and arterial steal syndrome. Specific medication considerations are required for analgesics, sedatives, neuromuscular blocking agents, antimicrobials, and anticoagulants. CONCLUSIONS Consideration of renal physiology with complications in ESRD can assist emergency providers in the evaluation and management of these patients. ESRD affects many organ systems, and specific pharmacologic considerations are required.
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Affiliation(s)
- Brit Long
- San Antonio Military Medical Center, Department of Emergency Medicine, 3841 Roger Brooke Dr, Fort Sam Houston, TX 78234, United States.
| | - Alex Koyfman
- The University of Texas Southwestern Medical Center, Department of Emergency Medicine, 5323 Harry Hines Boulevard, Dallas, TX 75390, United States
| | - Courtney M Lee
- Joint Base Elmendorf Richardson Medical Center, Department of Emergency Medicine, 5955 Zeamer Ave, JBER, AK, 99506, United States
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Ito K, Ookawara S, Ueda Y, Miyazawa H, Kofuji M, Hayasaka H, Uchida T, Yanai K, Ishii H, Shindo M, Kitano T, Hirai K, Kaku Y, Hoshino T, Tabei K, Morishita Y. Changes in Cerebral Oxygenation Associated with Intradialytic Blood Transfusion in Patients with Severe Anemia Undergoing Hemodialysis. NEPHRON EXTRA 2017; 7:42-51. [PMID: 28559914 PMCID: PMC5436034 DOI: 10.1159/000471812] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 03/16/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Hemodialysis (HD) patients frequently suffer from severe anemia caused by various hemorrhagic disorders in addition to renal anemia. Intradialytic blood transfusion is sometimes performed; however, the cerebral oxygenation changes associated with this procedure remain unclear. METHODS Sixteen HD patients with severe anemia who required intradialytic blood transfusion were included (12 men and 4 women; mean age, 64.8 ± 9.8 years). Cerebral regional oxygen saturation (rSO2) was monitored using near-infrared spectroscopy, and cerebral fractional oxygen extraction (FOE) was calculated before and after HD. Twenty-five HD patients with well-maintained hemoglobin (Hb) levels were included as a control group. RESULTS Cerebral rSO2 values were significantly lower in HD patients with severe anemia than in the control group (42.4 ± 9.9 vs. 52.5 ± 8.5%, p = 0.001). Following intradialytic blood transfusion (385 ± 140 mL of concentrated red blood cells), Hb levels significantly increased (from 7.2 ± 0.9 to 9.1 ± 1.1 g/dL, p < 0.001), and cerebral rSO2 values significantly improved after HD (from 42.4 ± 9.9 to 46.3 ± 9.0%, p < 0.001). Cerebral FOE values before HD in patients with severe anemia were significantly higher than those in the control group (severe anemia, 0.56 ± 0.10; controls, 0.45 ± 0.08; p < 0.001). After HD with intradialytic blood transfusion, these values significantly decreased (0.52 ± 0.09 after HD versus 0.56 ± 0.10 before HD, p = 0.002). CONCLUSION HD patients with severe anemia represented cerebral oxygen metabolism deterioration, which could be significantly improved by intradialytic blood transfusion.
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Affiliation(s)
- Kiyonori Ito
- aDivision of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Susumu Ookawara
- aDivision of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Yuichiro Ueda
- aDivision of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Haruhisa Miyazawa
- aDivision of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Masaya Kofuji
- bDepartment of Clinical Engineering, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Hideyuki Hayasaka
- bDepartment of Clinical Engineering, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Takayuki Uchida
- bDepartment of Clinical Engineering, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Katsunori Yanai
- aDivision of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Hiroki Ishii
- aDivision of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Mitsutoshi Shindo
- aDivision of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Taisuke Kitano
- aDivision of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Keiji Hirai
- aDivision of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Yoshio Kaku
- aDivision of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Taro Hoshino
- aDivision of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Kaoru Tabei
- cMinami-Uonuma City Hospital, Niigata, Japan
| | - Yoshiyuki Morishita
- aDivision of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
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Ma TKW, Chow KM, Kwan BCH, Leung CB, Szeto CC, Li PKT. Manifestation of tranexamic acid toxicity in chronic kidney disease and kidney transplant patients: A report of four cases and review of literature. Nephrology (Carlton) 2017; 22:316-321. [DOI: 10.1111/nep.12762] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 03/03/2016] [Accepted: 03/06/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Terry King-Wing Ma
- Carol and Richard Yu Peritoneal Dialysis Research Centre; Department of Medicine & Therapeutics, Prince of Wales Hospital; The Chinese University of Hong Kong; Shatin Hong Kong
| | - Kai Ming Chow
- Carol and Richard Yu Peritoneal Dialysis Research Centre; Department of Medicine & Therapeutics, Prince of Wales Hospital; The Chinese University of Hong Kong; Shatin Hong Kong
| | - Bonnie Ching-Ha Kwan
- Carol and Richard Yu Peritoneal Dialysis Research Centre; Department of Medicine & Therapeutics, Prince of Wales Hospital; The Chinese University of Hong Kong; Shatin Hong Kong
| | - Chi Bon Leung
- Carol and Richard Yu Peritoneal Dialysis Research Centre; Department of Medicine & Therapeutics, Prince of Wales Hospital; The Chinese University of Hong Kong; Shatin Hong Kong
| | - Cheuk Chun Szeto
- Carol and Richard Yu Peritoneal Dialysis Research Centre; Department of Medicine & Therapeutics, Prince of Wales Hospital; The Chinese University of Hong Kong; Shatin Hong Kong
| | - Philip Kam-Tao Li
- Carol and Richard Yu Peritoneal Dialysis Research Centre; Department of Medicine & Therapeutics, Prince of Wales Hospital; The Chinese University of Hong Kong; Shatin Hong Kong
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Contaifer D, Carl DE, Warncke UO, Martin EJ, Mohammed BM, Van Tassell B, Brophy DF, Chalfant CE, Wijesinghe DS. Unsupervised analysis of combined lipid and coagulation data reveals coagulopathy subtypes among dialysis patients. J Lipid Res 2016; 58:586-599. [PMID: 27993949 DOI: 10.1194/jlr.p068833] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 12/01/2016] [Indexed: 01/22/2023] Open
Abstract
Hemodialysis (HD) and peritoneal dialysis (PD) are the primary means of managing end stage renal disease (ESRD). However, these treatment modalities are associated with the onset of coagulation abnormalities. Effective management of coagulation risk among these patients requires the identification of surrogate markers that provide an early indication of the coagulation abnormalities. The role of sphingolipids in the manifestation and prediction of coagulation abnormalities among dialysis patients have never been investigated. Herein, we report the first instance of an in depth investigation into the sphingolipid changes among ESRD patients undergoing HD and PD. The results reveal distinct differences in terms of perturbations to specific sphingolipid biosynthetic pathways that are highly dependent on the treatment modality. Our studies also demonstrated strong correlation between specific sphingolipids and coagulation parameters, such as HexCer(d18:1/26:0) and maximal amplitude (MA), SM(d18:1/24:1) and tissue factor pathway inhibitor, and sphingosine 1-phosphate d18:1 and FX (Spearman ρ of 0.93, 0.89, and -0.89, respectively). Furthermore, our study revealed the potential for using HexCer(d18:1/22:0), HexCer(d18:1/24:0), and HexCer(d18:1/26:0) (r2 = 0.71, 0.82, and 0.63, respectively) and coagulation parameter MA (r2 = 0.7) for successful diagnosis of differential coagulopathies among ESRD patients undergoing HD, providing an opportunity toward personalized disease management.
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Affiliation(s)
- Daniel Contaifer
- Department of Pharmacotherapy and Outcomes Science, School of Pharmacy, Virginia Commonwealth University (VCU), Richmond, VA
| | - Daniel E Carl
- Departments of Internal Medicine, Virginia Commonwealth University (VCU), Richmond, VA
| | - Urszula Osinska Warncke
- Department of Pharmacotherapy and Outcomes Science, School of Pharmacy, Virginia Commonwealth University (VCU), Richmond, VA
| | - Erika J Martin
- Department of Pharmacotherapy and Outcomes Science, School of Pharmacy, Virginia Commonwealth University (VCU), Richmond, VA
| | - Bassem M Mohammed
- Department of Pharmacotherapy and Outcomes Science, School of Pharmacy, Virginia Commonwealth University (VCU), Richmond, VA
| | - Benjamin Van Tassell
- Department of Pharmacotherapy and Outcomes Science, School of Pharmacy, Virginia Commonwealth University (VCU), Richmond, VA
| | - Donald F Brophy
- Department of Pharmacotherapy and Outcomes Science, School of Pharmacy, Virginia Commonwealth University (VCU), Richmond, VA
| | - Charles E Chalfant
- Biochemistry and Molecular Biology, Virginia Commonwealth University (VCU), Richmond, VA .,Hunter Holmes McGuire Veterans Administration Medical Center, VCU Johnson Center for Critical Care Research, VCU Massey Cancer Center, and VCU Institute of Molecular Medicine, Richmond, VA
| | - Dayanjan S Wijesinghe
- Department of Pharmacotherapy and Outcomes Science, School of Pharmacy, Virginia Commonwealth University (VCU), Richmond, VA .,Surgery, Virginia Commonwealth University (VCU), Richmond, VA
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Jung SC, Kim CH, Ahn JH, Cho YD, Kang HS, Cho WS, Kim JE, Ahn C, Han MH. Endovascular Treatment of Intracranial Aneurysms in Patients With Autosomal Dominant Polycystic Kidney Disease. Neurosurgery 2016; 78:429-35; discussion 435. [PMID: 26492429 DOI: 10.1227/neu.0000000000001068] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Little is known about the outcome of endovascular treatment for intracranial aneurysms in patients with autosomal dominant polycystic kidney disease (ADPKD). OBJECTIVE To present clinical outcomes in terms of safety, effectiveness, and renal functions to assess contrast-induced nephropathy in endovascular coil embolization for intracranial aneurysms in ADPKD patients. METHODS Nineteen ADPKD patients (female:male, 15:4; mean age, 49.8 years; range, 20-67 years) had 26 aneurysms (mean size, 5.86 mm; range, 2.5-11.6 mm) and underwent 22 endovascular treatment sessions from 2001 to 2013. Four patients presented with ruptured aneurysms. Periprocedural complications, clinical outcomes with modified Rankin Scale scores, laboratory findings, and chronic kidney disease (CKD) stage before and after treatment were documented. Acute renal impairment was defined as serum creatinine (Cr) elevation by ≥ 0.5 mg/dL or 25% relative to baseline. RESULTS Symptomatic periprocedural complications developed after 1 endovascular procedure (1 of 22, 4.5%), and good clinical outcomes (modified Rankin Scale scores, 0-1) were achieved in 90% of patients (17 of 19). Overall, acute renal impairment occurred in 9.1% of treatment sessions (2 of 22). Acute renal impairment developed in 25% of high-risk patients (baseline Cr > 2.0 mg/dL) and 33.3% of baseline CKD stage 5 sessions but in none of the low-risk patients (baseline Cr ≤ 2.0 mg/dL) and in no CKD stage 1 to 4 sessions. CONCLUSION With appropriate management, coil embolization may be safe and effective for intracranial aneurysms in ADPKD. There is a concern about contrast-induced nephropathy in patients with CKD stage 5 or high serum Cr level (>2.0 mg/dL).
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Affiliation(s)
- Seung Chai Jung
- *Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea; ‡Department of Neurology, Myongji Hospital, Goyang, Republic of Korea; §Department of Neurosurgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea; ¶Departments of Radiology, ‖Neurosurgery, and #Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
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Seminars in Dialysis: The 100 Most Highly Cited Papers. Semin Dial 2016; 29:518-520. [PMID: 27774673 DOI: 10.1111/sdi.12536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Ishigami J, Grams ME, Naik RP, Coresh J, Matsushita K. Chronic Kidney Disease and Risk for Gastrointestinal Bleeding in the Community: The Atherosclerosis Risk in Communities (ARIC) Study. Clin J Am Soc Nephrol 2016; 11:1735-1743. [PMID: 27515592 PMCID: PMC5053788 DOI: 10.2215/cjn.02170216] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 07/06/2016] [Indexed: 01/10/2023]
Abstract
BACKGROUND AND OBJECTIVES Patients on dialysis are known to have higher risk for gastrointestinal (GI) bleeding. However, data on mild to moderate CKD, particularly elevated albuminuria, are limited. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Among 11,088 participants in the Atherosclerosis Risk in Communities (ARIC) Study, we investigated the association of eGFR and urinary albumin-to-creatinine ratio (ACR) with risk for hospitalization with GI bleeding. Kidney measures were assessed at visit four (1996-1998), and follow-up was continued through 2011. RESULTS During a median follow-up of 13.9 years, 686 first incident hospitalizations with GI bleeding were observed (incidence rate, 4.9 per 1000 person-years [95% confidence interval (95% CI), 4.5 to 5.3]). Multivariable Cox proportional hazards models revealed that both lower eGFR and higher ACR were associated with higher risk for GI bleeding. With eGFR≥90 ml/min per 1.73 m2 as a reference, risk for GI bleeding was significant in moderately decreased eGFR of 30-59 ml/min per 1.73 m2 (hazard ratio [HR], 1.51; 95% CI, 1.13 to 2.02), and was highest in severely decreased eGFR<30 ml/min per 1.73 m2 (HR, 7.06; 95% CI, 3.91 to 12.76). Compared with ACR<10 mg/g, risk for GI bleeding became significantly higher in mild albuminuria with ACR 10-29 mg/g (HR, 1.36; 95% CI, 1.08 to 1.69), and was nearly double in moderate and severe albuminuria (HR, 2.13; 95% CI, 1.66 to 2.71 for ACR 30-299 mg/g, and HR, 2.07; 95% CI, 1.33 to 3.22 for ACR≥300 mg/g). These results were largely consistent in demographic and clinical subgroups and independent of incident cardiovascular events or dialysis during follow-up. CONCLUSIONS Individuals with even mild to moderate CKD warrant clinical attention regarding the risk of hospitalization with GI bleeding.
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Affiliation(s)
| | | | - Rakhi P. Naik
- Hematology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
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Sridhar ARM, Yarlagadda V, Kanmanthareddy A, Parasa S, Maybrook R, Dawn B, Reddy YM, Lakkireddy D. Incidence, predictors and outcomes of hematoma after ICD implantation: An analysis of a nationwide database of 85,276 patients. Indian Pacing Electrophysiol J 2016; 16:159-164. [PMID: 27979375 PMCID: PMC5153424 DOI: 10.1016/j.ipej.2016.10.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 10/21/2016] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Pocket hematoma is one of the most common complications following cardiac device implantation. This study examined the impact of this complication on in-hospital outcomes following Implantable Cardioverter Defibrillator (ICD) implantation. METHODS Data from Nationwide Inpatient Sample (NIS) 2010 was queried to identify all primary implantations of ICDs and Cardiac Resynchronization Therapy Defibrillators (CRT-D) during the year 2010 using ICD-9 codes. We then identified the patients who experienced a procedure related hematoma during the hospital stay. We compared the outcomes of the patients with and without a hematoma complication. All analyses were performed using SPSS 20 complex samples using appropriate weights to adjust for the complex sampling design of the national database. RESULTS Out of a total of 85,276 primary ICD implantations in the year 2010, 2233 (2.6% of the implantations) were complicated by a hematoma. Increased age (p < 0.001), and comorbidities such as congestive heart failure (odds ratio (OR) - 1.86, p < 0.001), coagulopathy (OR - 2.3, p < 0.001) and renal failure (OR - 1.52, p < 0.001) were associated with an increased risk of pocket hematoma formation. Patients who developed a hematoma had a longer hospitalization (9.1 days versus 5.5 days, p < 0.001) and higher in-hospital costs ($56,545 versus $47,015, p < 0.001) compared to patients who did not have a hematoma. Overall mortality associated with ICD implantation was low (0.6%), and hematoma formation did not adversely affect mortality (0.6% versus 0.4%, p = 0.63). CONCLUSION Hematoma occurs infrequently after ICD implantation, however, it adversely impacts the cost of procedure and length of stay.
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Affiliation(s)
| | - Vivek Yarlagadda
- Division of Cardiovascular Diseases, Cardiovascular Research Institute, The University of Kansas Hospital & Medical Center, 3901 Rainbow Boulevard MS 4023, Kansas City, KS 66160-7200, USA
| | - Arun Kanmanthareddy
- Division of Cardiovascular Diseases, Cardiovascular Research Institute, The University of Kansas Hospital & Medical Center, 3901 Rainbow Boulevard MS 4023, Kansas City, KS 66160-7200, USA
| | - Sravanthi Parasa
- The University of Kanas Medical Center, 3901 Rainbow Boulevard MS 4023, Kansas City, KS 66160-7200, USA
| | - Ryan Maybrook
- Division of Cardiovascular Diseases, Cardiovascular Research Institute, The University of Kansas Hospital & Medical Center, 3901 Rainbow Boulevard MS 4023, Kansas City, KS 66160-7200, USA
| | - Buddhadeb Dawn
- Division of Cardiovascular Diseases, Cardiovascular Research Institute, The University of Kansas Hospital & Medical Center, 3901 Rainbow Boulevard MS 4023, Kansas City, KS 66160-7200, USA
| | - Yeruva Madhu Reddy
- Division of Cardiovascular Diseases, Cardiovascular Research Institute, The University of Kansas Hospital & Medical Center, 3901 Rainbow Boulevard MS 4023, Kansas City, KS 66160-7200, USA
| | - Dhanunjaya Lakkireddy
- Division of Cardiovascular Diseases, Cardiovascular Research Institute, The University of Kansas Hospital & Medical Center, 3901 Rainbow Boulevard MS 4023, Kansas City, KS 66160-7200, USA.
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Abstract
Acute kidney injury (AKI) is associated with significant short-term morbidity and mortality, which cannot solely be explained by loss of organ function. Renal replacement therapy allows rapid correction of most acute changes associated with AKI, indicating that additional pathogenetic factors play a major role in AKI. Evidence suggests that reduced renal cytokine clearance as well as increased cytokine production by the acutely injured kidney contribute to a systemic inflammation state, which results in significant effects on other organs. AKI seems to compromise the function of the innate immune system. AKI is an acute systemic disease with serious distant organ effects.
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Affiliation(s)
- Kai Singbartl
- Department of Anesthesiology, Penn State College of Medicine, Milton S. Hershey Medical Center, P.O. Box 850, H187 Hershey, PA 17033, USA
| | - Michael Joannidis
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Anichstr. 35, Innsbruck A-6020, Austria.
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Risk factors for bleeding evaluated using the Forrest classification in Japanese patients after endoscopic submucosal dissection for early gastric neoplasm. Eur J Gastroenterol Hepatol 2015; 27:1022-9. [PMID: 26075810 DOI: 10.1097/meg.0000000000000419] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND/AIMS Bleeding remains a serious complication after endoscopic submucosal dissection (ESD). Second-look endoscopy for hemostasis helps prevent post-ESD bleeding. We investigated the relationships between patient characteristics, tumor characteristics, and the Forrest classification for exposed vessels on artificial ulcers after ESD and evaluated whether hemostasis during second-look endoscopy was useful for preventing post-ESD bleeding. PATIENTS AND METHODS We analyzed 250 patients (265 lesions) who underwent ESD for gastric neoplasms. Vessels classified by Forrest classifications during scheduled second-look endoscopy were analyzed for associations with patient characteristics, tumor characteristics, and recurrent bleeding. RESULTS Two of 250 patients (0.8%) underwent emergency hemostatic endoscopy before scheduled second-look endoscopy. The remaining 248 patients (99.2%) underwent scheduled second-look endoscopy on the day after ESD. Patients with Forrest classification Ia, Ib, or IIa vessels had a significantly higher risk for recurrent bleeding after scheduled second-look endoscopy compared with patients with IIb or III vessels according to univariate analysis (P<0.05) and multivariate logistic regression analysis (odds ratio: 3.45; 95% confidence interval: 1.04-11.41; P=0.042). Univariate analysis indicated that hemodialysis correlated significantly with the presence of Ia, Ib, or IIa vessels compared with that of IIb or III vessels found during second-look endoscopy (P<0.05). Multivariate analysis indicated a significant relationship between hemodialysis and recurrent bleeding after second-look endoscopy (odds ratio: 10.05; 95% confidence interval: 1.97-51.26; P=0.006). CONCLUSION Hemodialysis is a risk factor for post-ESD bleeding. Proper classification of exposed vessels within post-ESD ulcers according to the Forrest classification using second-look endoscopy might help predict or prevent recurrent bleeding.
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Bellringer SF, Guthrie LCH, Talbot B, Ricketts DM, Rogers BA. Renal replacement therapy: implications for the surgeon. Br J Hosp Med (Lond) 2015; 76:464-7. [PMID: 26255916 DOI: 10.12968/hmed.2015.76.8.464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Renal replacement therapy comprises peritoneal dialysis, haemodialysis and renal transplantation. Patients undergoing renal replacement therapy often require surgery for a number of different reasons. This review summarizes likely surgical procedures for these patients and some of the common complications.
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Affiliation(s)
- S F Bellringer
- Senior House Officer in the Department of Trauma and Orthopaedics, Brighton and Sussex University Hospital NHS Trust, Brighton BN2 5BE
| | - Lt Col Hc Guthrie
- Consultant in the Department of Trauma and Orthopaedics, St George's Hospital, St George's University Hospitals NHS Trust, London
| | - Bem Talbot
- Registrar in Renal Medicine in the Department of Renal Medicine
| | | | - B A Rogers
- Consultant in the Department of Trauma and Orthopaedics, Brighton and Sussex University Hospital NHS Trust, Brighton
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47
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Lessne ML, Holly B, Huang SY, Kim CY. Diagnosis and management of hemorrhagic complications of interventional radiology procedures. Semin Intervent Radiol 2015; 32:89-97. [PMID: 26038617 DOI: 10.1055/s-0035-1549373] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Image-guided interventions have allowed for minimally invasive treatment of many common diseases, obviating the need for open surgery. While percutaneous interventions usually represent a safer approach than traditional surgical alternatives, complications do arise nonetheless. Inadvertent injury to blood vessels represents one of the most common types of complications, and its affect can range from inconsequential to catastrophic. The interventional radiologist must be prepared to manage hemorrhagic risks from percutaneous interventions. This manuscript discusses this type of iatrogenic injury, as well as preventative measures and treatments for postintervention bleeding.
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Affiliation(s)
- Mark L Lessne
- Vascular and Interventional Specialists of Charlotte Radiology, Charlotte, North Carolina
| | - Brian Holly
- Department of Radiology, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Steven Y Huang
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Charles Y Kim
- Division of Vascular and Interventional Radiology, Duke University Medical Center, Durham, North Carolina
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Abstract
There has been extraordinary progress over the last half-century in the field of medical transplantation in which tissue, organs, or body parts from one human are placed into another. Solid organ transplants have allowed thousands of children with otherwise devastating inherited or acquired disorders to survive. Depending upon the clinical situation, there are many specific peri-transplant issues that must be carefully addressed to optimize outcomes. Although surgical, immunologic, and infectious concerns are usually in the forefront, important aspects regarding hemostasis frequently arise. The number of solid organs that can be successfully transplanted in children has expanded over the last decades and includes kidney, liver, heart, lung, intestine, pancreas, and thymus. Bleeding complications may occur in the setting of organ failure prior to transplantation, during the surgical procedure, or in the post-transplant setting, and can results in significant morbidity. This report will focus on preventing and managing non-surgical-related bleeding complications in children undergoing liver, heart, kidney transplantation, in whom there are often unique aspects of coagulation to be considered.
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Affiliation(s)
- L Raffini
- Division of Hematology, Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - C Witmer
- Division of Hematology, Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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Ravi S, Chacko B, Sawada H, Kramer PA, Johnson MS, Benavides GA, O’Donnell V, Marques MB, Darley-Usmar VM. Metabolic plasticity in resting and thrombin activated platelets. PLoS One 2015; 10:e0123597. [PMID: 25875958 PMCID: PMC4395425 DOI: 10.1371/journal.pone.0123597] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 02/24/2015] [Indexed: 12/24/2022] Open
Abstract
Platelet thrombus formation includes several integrated processes involving aggregation, secretion of granules, release of arachidonic acid and clot retraction, but it is not clear which metabolic fuels are required to support these events. We hypothesized that there is flexibility in the fuels that can be utilized to serve the energetic and metabolic needs for resting and thrombin-dependent platelet aggregation. Using platelets from healthy human donors, we found that there was a rapid thrombin-dependent increase in oxidative phosphorylation which required both glutamine and fatty acids but not glucose. Inhibition of fatty acid oxidation or glutamine utilization could be compensated for by increased glycolytic flux. No evidence for significant mitochondrial dysfunction was found, and ATP/ADP ratios were maintained following the addition of thrombin, indicating the presence of functional and active mitochondrial oxidative phosphorylation during the early stages of aggregation. Interestingly, inhibition of fatty acid oxidation and glutaminolysis alone or in combination is not sufficient to prevent platelet aggregation, due to compensation from glycolysis, whereas inhibitors of glycolysis inhibited aggregation approximately 50%. The combined effects of inhibitors of glycolysis and oxidative phosphorylation were synergistic in the inhibition of platelet aggregation. In summary, both glycolysis and oxidative phosphorylation contribute to platelet metabolism in the resting and activated state, with fatty acid oxidation and to a smaller extent glutaminolysis contributing to the increased energy demand.
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Affiliation(s)
- Saranya Ravi
- Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- UAB Mitochondrial Medicine Laboratory, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- Center for Free Radical Biology, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Balu Chacko
- Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- UAB Mitochondrial Medicine Laboratory, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- Center for Free Radical Biology, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Hirotaka Sawada
- Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- UAB Mitochondrial Medicine Laboratory, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- Center for Free Radical Biology, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Philip A. Kramer
- Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- UAB Mitochondrial Medicine Laboratory, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- Center for Free Radical Biology, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Michelle S. Johnson
- Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- UAB Mitochondrial Medicine Laboratory, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- Center for Free Radical Biology, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Gloria A. Benavides
- Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- UAB Mitochondrial Medicine Laboratory, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- Center for Free Radical Biology, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Valerie O’Donnell
- Department of Medical Biochemistry, Cardiff University, Cardiff, United Kingdom
| | - Marisa B. Marques
- Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Victor M. Darley-Usmar
- Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- UAB Mitochondrial Medicine Laboratory, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- Center for Free Radical Biology, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- * E-mail:
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Affiliation(s)
- Pablo Aguilera
- Emergency Medicine Program, P. Universidad Católica de Chile, Santiago, Región Metropolitana, Chile.
| | - Paul Jhun
- Department of Emergency Medicine, University of California, San Francisco, CA
| | - Aaron Bright
- Department of Emergency Medicine, University of Southern California, Los Angeles, CA
| | - Mel Herbert
- Department of Emergency Medicine, University of Southern California, Los Angeles, CA
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