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Risk of Stroke in Long-term Dialysis Patients Compared With the General Population
Conclusions: Patients undergoing dialysis are at elevated risk of stroke. Patients undergoing PD appear to be less likely to develop hemorrhagic stroke than those undergoing HD. Comprehensive control of hypertension and diabetes is necessary when delivering dialysis treatment.
Source: American Journal of Kidney Diseases - December 2, 2013 Category: Urology & Nephrology Authors: Hsi-Hao Wang, Shih-Yuan Hung, Junne-Ming Sung, Kuan-Yu Hung, Jung-Der Wang Tags: Dialysis Source Type: research

ESRD After Heart Failure, Myocardial Infarction, or Stroke in Type  2 Diabetic Patients With CKD
Conclusions Most ESRD cases occurred in individuals without intercurrent CV events who had lower eGFRs than individuals with intercurrent CV events, but similar post-ESRD mortality. Nevertheless, intercurrent CV events, particularly heart failure, are strongly associated with risk for ESRD. These findings underscore the need for kidney-specific therapies in addition to treatment of CV risk factors to lower ESRD incidence in diabetes.
Source: American Journal of Kidney Diseases - June 7, 2017 Category: Urology & Nephrology Source Type: research

Treatment of Anemia With Darbepoetin Prior to Dialysis Initiation and Clinical Outcomes: Analyses From the Trial to Reduce Cardiovascular Events With Aranesp Therapy (TREAT)
ConclusionsDespite initiating dialysis therapy with a higher hemoglobin level, prior treatment with darbepoetin was not associated with a reduction in mortality, myocardial infarction, or heart failure in the first 180 days, but a higher frequency of stroke was observed. In the absence of more definitive data, this may inform decisions regarding the use of erythropoiesis-stimulating agents to treat mild to moderate anemia in patients with type 2 diabetes and chronic kidney disease nearing dialysis therapy initiation.
Source: American Journal of Kidney Diseases - December 19, 2018 Category: Urology & Nephrology Source Type: research

Anatomic Brain Disease in Hemodialysis Patients: A Cross-sectional Study
Background: Although dialysis patients are at high risk of stroke and have a high burden of cognitive impairment, there are few reports of anatomic brain findings in the hemodialysis population. Using magnetic resonance imaging of the brain, we compared the prevalence of brain abnormalities in hemodialysis patients with that in a control population without known kidney disease. Study Design: Cross-sectional cohort. Setting & Participants: 45 maintenance hemodialysis patients and 67 controls without reported kidney disease, both without history of known stroke. Predictor: The primary predictor was dialysis status. Co...
Source: American Journal of Kidney Diseases - October 5, 2012 Category: Urology & Nephrology Authors: David A. Drew, Rafeeque Bhadelia, Hocine Tighiouart, Vera Novak, Tammy M. Scott, Kristina V. Lou, Kamran Shaffi, Daniel E. Weiner, Mark J. Sarnak Tags: Dialysis Source Type: research

Atrial Fibrillation in CKD: Balancing the Risks and Benefits of Anticoagulation
Chronic kidney disease (CKD) and atrial fibrillation are common conditions that often coexist and are associated with increased risk of stroke. Despite the wealth of evidence for optimal management of atrial fibrillation in the general population, the role of anticoagulation with warfarin in individuals with CKD with atrial fibrillation is far less well defined. Current recommendations for anticoagulation in patients treated with dialysis and those with an earlier stage of CKD are based on clinical trials in the general atrial fibrillation population that have largely excluded individuals with CKD. Observational studies of...
Source: American Journal of Kidney Diseases - June 7, 2013 Category: Urology & Nephrology Authors: Khai P. Ng, Nicola C. Edwards, Gregory Y.H. Lip, Jonathan N. Townend, Charles J. Ferro Tags: In Practice Source Type: research

Longer-term Outcomes of Darbepoetin Alfa Versus Epoetin Alfa in Patients With ESRD Initiating Hemodialysis: A Quasi-experimental Cohort Study
Conclusions In incident hemodialysis patients, mortality and cardiovascular event rates did not differ between patients treated at facilities predominantly using DPO versus EPO.
Source: American Journal of Kidney Diseases - May 2, 2015 Category: Urology & Nephrology Source Type: research

Effect of Early Initiation of Dialysis on Cardiac Structure and Function: Results From the Echo Substudy of the IDEAL Trial
Conclusions: Advanced cardiac disease in these patients with stage 5 chronic kidney disease did not progress during the 12-month study period and planned early initiation of dialysis therapy did not result in differences in any echocardiographic variables of cardiac structure and function.
Source: American Journal of Kidney Diseases - November 16, 2012 Category: Urology & Nephrology Authors: Gillian A. Whalley, Tom H. Marwick, Robert N. Doughty, Bruce A. Cooper, David W. Johnson, Andrew Pilmore, David C.H. Harris, Carol A. Pollock, John F. Collins, IDEAL Echo Substudy Investigators Tags: Dialysis Source Type: research

Serum n-3 and n-6 Polyunsaturated Fatty Acid Profile as an Independent Predictor of Cardiovascular Events in Hemodialysis Patients
Conclusions: In hemodialysis patients, serum PUFA profile is unfavorably altered, and the low n-3-PUFA:AA ratios are independent predictors of CVD.
Source: American Journal of Kidney Diseases - April 19, 2013 Category: Urology & Nephrology Authors: Tetsuo Shoji, Ryusuke Kakiya, Tomoshige Hayashi, Yoshihiro Tsujimoto, Mika Sonoda, Hideaki Shima, Katsuhito Mori, Shinya Fukumoto, Hideki Tahara, Atushi Shioi, Tsutomu Tabata, Masanori Emoto, Yoshiki Nishizawa, Masaaki Inaba Tags: Dialysis Source Type: research

Association of Serum Bicarbonate With Risk of Renal and Cardiovascular Outcomes in CKD: A Report From the Chronic Renal Insufficiency Cohort (CRIC) Study
Conclusions: In a cohort of participants with CKD, low serum bicarbonate level was an independent risk factor for kidney disease progression, particularly for participants with preserved kidney function. The risk of heart failure was higher at the upper extreme of serum bicarbonate levels. There was no association between serum bicarbonate level and all-cause mortality or atherosclerotic events.
Source: American Journal of Kidney Diseases - March 13, 2013 Category: Urology & Nephrology Authors: Mirela Dobre, Wei Yang, Jing Chen, Paul Drawz, L. Lee Hamm, Edward Horwitz, Thomas Hostetter, Bernard Jaar, Claudia M. Lora, Lisa Nessel, Akinlolu Ojo, Julia Scialla, Susan Steigerwalt, Valerie Teal, Myles Wolf, Mahboob Rahman, CRIC Investigators Tags: Pathogenesis and Treatment of Kidney Disease Source Type: research

Ischemic and Hemorrhagic Stroke: High Incidence in Hemodialysis and Peritoneal Dialysis Patients
Related Article, p. 604
Source: American Journal of Kidney Diseases - March 27, 2014 Category: Urology & Nephrology Authors: David A. Drew, Mark J. Sarnak Tags: Editorials Source Type: research

Home Blood Pressure Monitoring in CKD
Hypertension is common in patients with chronic kidney disease (CKD) and the prevalence increases with declining kidney function. Hypertension management is particularly important due to the increased risk of cardiovascular disease and stroke in the CKD population. Most clinical decisions for blood pressure (BP) management are based on BP readings in the office or dialysis unit. These BP readings often are inaccurate. Home BP monitoring provides more data than conventional clinic or dialysis-unit BP measurements and is relatively easy to accomplish, is cost-effective, and has been shown to have an increasing role in the ma...
Source: American Journal of Kidney Diseases - February 14, 2014 Category: Urology & Nephrology Authors: Debbie L. Cohen, Yonghong Huan, Raymond R. Townsend Tags: In Practice Source Type: research

Assessment of Achieved Clinic and Ambulatory Blood Pressure Recordings and Outcomes During Treatment in Hypertensive Patients With CKD: A Multicenter Prospective Cohort Study
Conclusions In patients with treated CKD, clinic BP above goal and ambulatory BP at goal identify a low-risk condition, whereas clinic BP at goal and ambulatory BP above goal are associated with higher cardiorenal risk, similar to that observed in patients with both clinic and ambulatory BPs above goal.
Source: American Journal of Kidney Diseases - October 29, 2014 Category: Urology & Nephrology Source Type: research

Dose-Finding Study of Rivaroxaban in Hemodialysis Patients
Conclusions A 10-mg dose of rivaroxaban in hemodialysis patients without residual kidney function results in drug exposure similar as published for 20mg in healthy volunteers. Rivaroxaban is not eliminated by dialysis. There is no accumulation after multiple daily dosing. The efficacy and safety of rivaroxaban in hemodialysis patients should be the subject of a large randomized trial.
Source: American Journal of Kidney Diseases - June 22, 2015 Category: Urology & Nephrology Source Type: research

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