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Efficacy and safety of direct oral anticoagulants vs vitamin K antagonists in patients with atrial fibrillation and end-stage renal disease on hemodialysis: A systematic review and meta-analysis
CONCLUSIONS: Among AF patients with ESRD on chronic hemodialysis, the risk of ischemic stroke, ischemic stroke or systemic embolism, minor bleeding, major bleeding, and all-cause mortality is similar in patients treated with DOACs compared to VKAs. Given that the meta-analysis of RCTs on gastrointestinal bleeding did not confirm the results of the meta-analysis of the observational studies, it cannot be concluded that gastrointestinal bleeding is lower among DOAC-treated patients.PROTOCOL REGISTRATION: PROSPERO CRD42023391966.PMID:37648582 | DOI:10.1016/j.ejim.2023.08.020
Source: European Journal of Internal Medicine - August 30, 2023 Category: Internal Medicine Authors: Ioannis Kyriakoulis Anastasia Adamou Iliana Stamatiou David Dimitris Chlorogiannis Ioannis Kardoutsos Despoina Koukousaki George Ntaios Source Type: research

Long-term Clinical Outcomes of Elective Carotid Artery Stenting in Patients Undergoing Maintenance Hemodialysis.
Conclusion CAS in maintenance hemodialysis patients may be feasible and effective for the prevention of stroke with proper case selection, appropriate technique and strict perioperative management. The most common causes of death during the follow-up of maintenance hemodialysis patients were diseases other than stroke. PMID: 32062623 [PubMed - in process]
Source: Internal Medicine - February 19, 2020 Category: Internal Medicine Tags: Intern Med Source Type: research

The Association between Earlobe Creases and Cardiovascular Events in Japanese Hemodialysis Patients: A Prospective Cohort Study.
Conclusion Earlobe creases were not independently associated with cardiovascular events among Japanese hemodialysis patients, suggesting that these marks are simply indicative of advanced age. PMID: 31839659 [PubMed - as supplied by publisher]
Source: Internal Medicine - December 18, 2019 Category: Internal Medicine Tags: Intern Med Source Type: research

Use of proton pump inhibitors is associated with an increase in adverse cardiovascular events in patients with hemodialysis: Insight from the kids registry.
CONCLUSIONS: These results indicate that the use of PPIs in patients with maintenance hemodialysis might increase mortality and cardiovascular events without decreasing the risk of bleeding. Therefore, it should always be analyzed if a patient truly needs PPIs. PMID: 31735546 [PubMed - as supplied by publisher]
Source: European Journal of Internal Medicine - November 13, 2019 Category: Internal Medicine Authors: Kosedo I, Tokushige A, Takumi T, Yoshikawa A, Teraguchi K, Takenouchi K, Shiraishi K, Ikeda D, Imamura M, Sonoda T, Kanda D, Ikeda Y, Ido A, Ohishi M Tags: Eur J Intern Med Source Type: research

Lithium intoxication presenting as altered consciousness and arrhythmia with cardiogenic shock: A case report
Rationale: Lithium has been used to treat bipolar disorder. Lithium has a narrow therapeutic index, with a therapeutic level between 0.6 and 1.5 mEq/L. The possible complications of lithium overdose include altered mental status, hand tremor, muscle weakness, nausea, vomiting, diarrhea, seizure, syncope, and arrhythmia. Lithium intoxication can be fatal and is difficult to diagnose in patients without a history of lithium intake. The occurrence of serious cardiac arrhythmias is rare in lithium intoxication. Patient concerns: An 81-year-old man was brought to the emergency department because of consciousness disturba...
Source: Medicine - November 1, 2018 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

Association of early loss of primary functional patency of arteriovenous access with mortality in incident hemodialysis patients: A nationwide population-based observational study
The long-term survival and life quality of hemodialysis (HD) patients depend on adequacy of dialysis via a well-functioning vascular access. Loss of primary functional patency (PFP) of an arteriovenous access (AVA) eventually happens in HD patients. The association between time to loss of PFP of AVAs and mortality in HD patients remains unclear. The retrospective nationwide population-based cohort study compared the hazards of mortality with time to loss of PFP. We enrolled 1618 adult incident HD patients who received HD via AVAs for at least 90 days between January 1, 2001 and December 31, 2013. They were divided into ear...
Source: Medicine - August 1, 2018 Category: Internal Medicine Tags: Research Article: Observational Study Source Type: research

Atrial Fibrillation had Less Impact on the Risk of Ischemic Stroke in Non-anticoagulated Patients Undergoing Hemodialysis: Insight from the RAKUEN study.
Conclusion A great impact on death, but not ischemic stroke, was observed in non-anticoagulated hemodialysis patients with AF in comparison to those without AF from the analysis of the RAKUEN study. PMID: 29607945 [PubMed - as supplied by publisher]
Source: Internal Medicine - April 4, 2018 Category: Internal Medicine Tags: Intern Med Source Type: research

Risk analysis of dialysis-dependent patients who underwent coronary artery bypass grafting: Effects of dialysis modes on outcomes
This study aimed to stratify the risk factors and effects of dialysis modes in relation to coronary artery bypass grafting (CABG) surgery among dialysis-dependent patients. This retrospective study enrolled dialysis-dependent patients who underwent CABG from October 2005 to January 2015. All data of demographics, medical history, surgical details, postoperative complications, and in-hospital mortality were analyzed, and patients were categorized as those with or without in-hospital mortality and those with preoperative hemodialysis (HD) or peritoneal dialysis (PD). Of 134 enrolled patients, 25 (18.7%) had in-hospital mor...
Source: Medicine - September 1, 2017 Category: Internal Medicine Tags: Research Article: Observational Study Source Type: research

The effectiveness and safety of angiotensin-converting enzyme inhibition or receptor blockade in vascular diseases in patients with hemodialysis
Abstract: Patients with end-stage renal disease (ESRD) who are on hemodialysis have high risk of vascular diseases. Our study sought to examine whether angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin type 1 receptor blockers (ARBs) could reduce the frequencies of cardiovascular and cerebrovascular events in patients receiving hemodialysis using the medication possession ratio (MPR) method of analysis. This retrospective cohort study identified cases of ESRD with dialysis from the National Health Insurance Research Database between 1999 and 2006, and used Cox-regression methods to evaluate risk of poor outc...
Source: Medicine - March 1, 2017 Category: Internal Medicine Tags: Research Article: Observational Study Source Type: research

Posterior Reversible Encephalopathy Syndrome with Extensive Deep White Matter Lesions Including the Temporal Pole.
We report the case of a 55-year-old man with atypical PRES, who had malignant hypertension and renal dysfunction. Magnetic resonance imaging of the brain revealed extensive vasogenic edema in the deep white matter including the temporal pole, as well as in the brainstem and cerebellum. Antihypertensive therapy and hemodialysis contributed to both clinical and radiological improvement. Involvement of the deep white matter including the temporal pole, which is rarely affected in an ischemic stroke, should be recognized as a potential sign of PRES. PMID: 27904123 [PubMed - in process]
Source: Internal Medicine - December 3, 2016 Category: Internal Medicine Tags: Intern Med Source Type: research

Warfarin Use and Risk of Stroke in Patients With Atrial Fibrillation Undergoing Hemodialysis: A Meta-Analysis
Abstract: In spite of the substantial burden of atrial fibrillation and associated elevated ischemic stroke risk in patients undergoing hemodialysis, the role of warfarin in these high-risk patients remains uncertain. Our objective was to clarify the association between warfarin use and risk of stroke for patients with atrial fibrillation undergoing dialysis. PubMed and Embase from January 1966 to January 2015 were searched to identify relevant studies. Inclusion criteria were cohort studies, patients with atrial fibrillation undergoing hemodialysis, and reported quantitative estimates of the multivariate adjusted relativ...
Source: Medicine - February 1, 2016 Category: Internal Medicine Tags: Research Article: Meta-Analysis of Observ Studies in Epidemiology Source Type: research

Dialysis
More than 400 000 persons in the United States are currently receiving maintenance dialysis as life-sustaining treatment for end-stage renal disease (ESRD), with more than 90% receiving in-center hemodialysis. Mortality rates in the ESRD population in the United States remain extremely high (18%-20% per year) despite a slight downward trend during the past 2 to 3 years. Most deaths among patients with ESRD are due to cardiovascular disease, with exceptionally high rates, particularly on an age-adjusted basis, of heart failure, stroke, and sudden death. In fact, sudden death accounts for roughly 1 in 4 deaths among patien...
Source: JAMA Internal Medicine - April 27, 2015 Category: Internal Medicine Source Type: research