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Predicting in a predicament: Stroke and hemorrhage risk prediction in dialysis patients with atrial fibrillation
Abstract Whether to anticoagulate dialysis patients with atrial fibrillation is a common clinical dilemma with limited high‐quality data to inform decision‐making. While the efficacy and safety of anticoagulation for stroke prevention in dialysis patients with atrial fibrillation has long been debated and remains unclear, the more upstream issue of stroke risk assessment from atrial fibrillation has received relatively little attention. In the general population, a handful of risk scores to help predict stroke and hemorrhage risk in the setting of atrial fibrillation are widely validated and applied in clinical practic...
Source: Seminars In Dialysis - July 1, 2017 Category: Hematology Authors: Amber O. Molnar, Manish M. Sood Tags: REVIEW ARTICLE Source Type: research

Evidence for the Prevention and Treatment of Stroke in Dialysis Patients
Abstract The risks of both ischemic and hemorrhagic stroke are particularly high in dialysis patients of any age and outcomes are poor. It is therefore important to identify strategies that safely minimize stroke risk in this population. Observational studies have been unable to clarify the relative importance of traditional stroke risk factors such as blood pressure and cholesterol in those on dialysis, and are affected by biases that usually make them an inappropriate source of data on which to base therapeutic decisions. Well‐conducted randomized trials are not susceptible to such biases and can reliably investigate t...
Source: Seminars In Dialysis - May 1, 2014 Category: Hematology Authors: William Herrington, Richard Haynes, Natalie Staplin, Jonathan Emberson, Colin Baigent, Martin Landray Tags: Review Source Type: research

Blood Pressure Recordings During Hemodialysis Access Interventions: Implications for Acute Management
Abstract A retrospective study evaluating the pattern of blood pressure and its related complications before, during, and after percutaneous hemodialysis interventions was performed in patients presenting with asymptomatic hypertension. Hemodialysis patients undergoing percutaneous interventions including tunneled hemodialysis catheter insertion, percutaneous balloon angioplasty and thrombectomy procedure, and stage II hypertension (systolic blood pressure ≥160 mmHg) were included in this analysis. Blood pressure medications were not used while midazolam and fentanyl were routinely administered. Patients were followed f...
Source: Seminars In Dialysis - March 28, 2013 Category: Hematology Authors: Arif Asif, Hector Castro, Ahmed Ameen Waheed, Vishesh Kumar, Syed S Haqqie, Gary Siskin, Roy O Mathew, Darius Mason, Tushar Vachharajani, Ali Nayer, Donna Merrill, Muhammad UT Akmal, Loay Salman Tags: Investigation Source Type: research

Vitamin K Antagonists: Beyond Bleeding
Abstract Warfarin is the most widely used oral anticoagulant in clinical use today. Indications range from prosthetic valve replacement to recurrent thromboembolic events due to antiphospholipid syndrome. In hemodialysis (HD) patients, warfarin use is even more frequent than in the nonrenal population due to increased cardiovascular comorbidities. The use of warfarin in dialysis patients with atrial fibrillation requires particular caution because side effects may outweigh the assumed benefit of reduced stroke rates. Besides increased bleeding risk, coumarins exert side effects which are not in the focus of clinical routin...
Source: Seminars In Dialysis - January 9, 2014 Category: Hematology Authors: Thilo Krüger, Jürgen Floege Tags: Review Source Type: research

Clopidogrel Use in End‐Stage Kidney Disease
In conclusion, current evidence suggests that ESKD patients may not derive the same benefits from clopidogrel therapy as the general population and this therapy may be associated with harm. Properly designed observational studies and randomized controlled trials are needed to establish the role of clopidogrel in patients with ESKD, the use of platelet assays to tailor therapy, and the role of other antiplatelet agents such as prasugrel or ticagrelor in patients who exhibit high on‐treatment residual platelet reactivity.
Source: Seminars In Dialysis - November 1, 2014 Category: Hematology Authors: Bassem Y. Tanios, Houssam S. Itani, Deborah L. Zimmerman Tags: Review Source Type: research

The physical deterioration of dialysis patients —Ignored, ill‐reported, and ill‐treated
Abstract The progressive physical deterioration of dialysis patients is apparent to all who are involved in their care. Exercise can help stem this decline, yet exercise uptake in chronic and end‐stage kidney disease is low. The involvement of exercise professionals has been shown to significantly increase patients’ physical function and improve their quality of life. However, exercise professionals are scarce in renal programs, far less than dietetic and social work services. A review of 10 years of renal exercise publications in the physical therapy and rehabilitation literature found that only 0.4% (7 out of a total...
Source: Seminars In Dialysis - June 5, 2017 Category: Hematology Authors: Paul N. Bennett, Nicole Capdarest ‐Arest, Kristen Parker Tags: EDITORIAL Source Type: research

A brief review of intradialytic hypotension with a focus on survival
Abstract Intradialytic hypotension (IDH), a common complication of ultrafiltration during hemodialysis therapy, is associated with high mortality and morbidity. IDH, defined as a nadir systolic blood pressure of less than 90 mm Hg on more than 30% of treatments, is a relevant definition and is correlated with mortality. Risk factors for IDH include patient demographics, anti‐hypertensive medication use, larger interdialytic weight gain, and dialysis prescription features as dialysate sodium, high ultrafiltration rate, and dialysate temperature. A high frequency of IDH events carries a substantial death risk. An ultrafilt...
Source: Seminars In Dialysis - May 1, 2017 Category: Hematology Authors: Jason A. Chou, Kamyar Kalantar ‐Zadeh, Anna T. Mathew Tags: INTRADIALYTIC HYPOTENSION: PERSPECTIVES IN CONTEMPORARY PRACTICE Source Type: research