Does timing of dialysis in patients with ESRD and acute myocardial infarcts affect morbidity or mortality?

Diagnosis and treatment of myocardial infarction in patient with end - stage renal disease on chronic hemodialysis

This review represents different aspects of myocardial infarction in patient with end - stage renal disease on chronic hemodialysis. We discuss difficulties in diagnosis, optimal method of coronary revascularization, timing of hemodialysis session, medical therapy, as well as epidemiology and prognosis. There are no unambiguous answers to these problems because patients with end - stage renal disease were excluded from most of the studies.

Practical issues in clinical scenarios involving CKD patients requiring antithrombotic therapy in light of the 2017 ESC guideline recommendations

BACKGROUND

The choice of the most appropriate antithrombotic regimen that balances ischemic and bleeding risks was addressed by the August 2017 European Society of Cardiologists (ESC)/European Association for Cardio-Thoracic Surgery Focused Update recommendations, which propose new evaluation scores and protocols for patients requiring a coronary stent or patients with an acute coronary syndrome, atrial fibrillation, or a high bleeding risk and indication for oral anticoagulation therapy.

DISCUSSION

Numerous questions remain regarding antithrombotic regimens and risk management algorithms for both ischemic and hemorrhagic events in patients with chronic kidney disease (CKD) in various clinical scenarios. Limitations of current studies include a general ack of advanced CKD patients in major randomized controlled trials, of evidence on algorithm implementation, and of robust assessment tools for hemorrhagic risk. Herein, we aim to analyze the ESC Update recommendations and the newly implemented risk scores (DAPT, PRECISE-DAPT, PARIS) from the point of view of CKD, providing suggestions on drug choice (which combination has the best evidence), dosage, and duration (the same or different as for non-CKD population) of antithrombotics, as well as to identify current shortcomings and to envision directions of future research.

CONCLUSION

We provide an evidence-based perspective on the new proposed bleeding management protocol, with focus on the CKD population. Despite previous important steps on antithrombotic therapy of renal patients, there remain many unsolved questions for which our suggestions could fundament new randomized controlled trials and specific protocols.

Sustained Low-Efficiency Daily Dialysis as Renal Replacement Therapy for the Critically Ill

Understanding proper management of acute kidney injury (AKI) is important given that studies consistently demonstrate an increasing incidence rate of AKI in the critically ill. AKI carries a significant risk for mortality, which only increases if dialysis becomes a necessary treatment. It is not clear whether modalities other than conventional intermittent hemodialysis improve outcomes in AKI. Sustained low-efficiency daily dialysis (SLEDD) is a more recent extracorporeal treatment whose distinguishing characteristic is its hybrid integration of both continuous and intermittent hemodialysis modalities. Besides providing comparable hemodynamic stability through its decreased blood flow rate and extended hours of use, SLEDD is less complicated, is less expensive, and is convenient for staff and patient. As a result, its use in critical care is on the rise.