A Scoping Review of Alternative Anticoagulation Strategies for Hemodialysis Patients with a Mechanical Heart Valve.

Introduction: Patients with end-stage renal disease (ESRD) have high rates of cardiac valvulopathy but can develop contraindications for vitamin K antagonist (VKA) therapy. We explored the evidence for alternative anticoagulation strategies in patients with ESRD with a contraindication for VKA therapy.

Methods: A scoping review was completed, searching MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Web of Science, and Conference abstracts from inception to March 30, 2021.

Mycobacterium tuberculosis peritonitis in peritoneal dialysis patients: A scoping review.

Background: The clinical syndrome of Mycobacterium tuberculosis (M. tuberculosis) peritoneal dialysis (PD) peritonitis is poorly understood. Whether local tuberculosis (TB) patterns modify the clinical syndrome, and what factors associate with poor outcomes is also unknown.

Untargeted metabolomics reveals N, N, N-trimethyl-L-alanyl-L-proline betaine (TMAP) as a novel biomarker of kidney function.

The diagnosis and prognosis of chronic kidney disease (CKD) currently relies on very few circulating small molecules, which can vary by factors unrelated to kidney function. In end-stage renal disease (ESRD), these same small molecules are used to determine dialysis dose and dialytic clearance. Therefore, we aimed to identify novel plasma biomarkers to estimate kidney function in CKD and dialytic clearance in ESRD.

The choice of dialysate sodium is influenced by hemodialysis frequency and duration: what should it be and for what modality?

Cardiovascular disease is the leading cause of mortality in hemodialysis patients. A chronic state of volume and pressure overload contributes, and central to this is the net sodium balance over the course of a hemodialysis. Of recent interest is the contribution of the dialysate sodium concentration (Dial-Na+) to clinical outcomes.

Effect of CKD and dialysis modality on exposure to drugs cleared by nonrenal mechanisms.

Background: Patients with kidney disease frequently experience adverse effects from medication exposure, even when drugs are cleared by nonrenal pathways. Although many studies suggest that nonrenal drug clearance is decreased in chronic kidney disease (CKD), there remains a paucity of in vivo studies in patients with varying degrees of decreased kidney function and those comparing the impact of dialysis modality (eg, hemodialysis [HD] and peritoneal dialysis [PD]).

Study Design: We performed in vivo clinical pharmacokinetic studies of midazolam, a nonrenally cleared specific probe for CYP3A4, and fexofenadine, a nonspecific probe for hepatic and intestinal transporters.

What is single needle cannulation hemodialysis: is it adequate?

Background: It is important to know the relative clearances obtained when using single-needle versus double-needle cannulation techniques.

Method: Twelve hemodialysis treatments were conducted using a machine that is capable of single-needle as well as double-needle cannulation. Single-needle and double-needle blood flow rates, as well as urea clearance, were compared.

Nocturnal home hemodialysis associates with improvement of electrocardiographic features linked to sudden cardiac death.

Sudden cardiac death (SCD) remains the leading cause of death in hemodialysis patients. We performed a retrospective electrocardiograph (ECG) and chart review to determine whether hemodialysis modality, frequency, or duration could predict change in ECG parameters associated with SCD. Frequent nocturnal hemodialysis was associated with an improvement in Tpeak to Tend within 365 days (83.

Warfarin use in hemodialysis patients with atrial fibrillation: decisions based on uncertainty.

Background: Warfarin prescribing patterns for hemodialysis patients with atrial fibrillation vary widely amongst nephrologists. This may be due to a paucity of guiding evidence, but also due to concerns of increased risks of warfarin use in this population. The literature lacks clarity on the balance of warfarin therapy between prevention of thrombotic strokes and the increased risks of bleeding in hemodialysis patients with atrial fibrillation.

Plasma sodium setpoint: is it constant or changed by hemodialysis prescription?

Stability of predialysis sodium "setpoint" has not been validated in quotidian dialysis patients. We performed a retrospective review of our home hemodialysis program, to determine the effect of transitioning from conventional thrice weekly to home hemodialysis modalities differing in dialysis duration and frequency (n = 87). Mean sodium setpoint remained constant in patients who went home on intermittent hemodialysis, but decreased by 100 days in frequent nocturnal home hemodialysis (FNHD) (140.

Frequent nocturnal hemodialysis associates with improvement of prolonged QTc intervals.

Background/aims: Sudden cardiac death remains the leading cause of death in hemodialysis (HD) patients. Prolongation of QTc intervals (as measured by the tangent method) increases sudden cardiac death risk in populations without kidney disease.

Methods: We performed a retrospective electrocardiograph (ECG) and chart review of HD patients.

Pre to post-dialysis plasma sodium change better predicts clinical outcomes than dialysate to plasma sodium gradient in quotidian hemodialysis.

Sodium balance across a hemodialysis treatment influences interdialytic weight gain (IDWG), pre-dialysis blood pressure, and the occurrence of intradialytic hypotension, which associate with patient morbidity and mortality. In thrice weekly conventional hemodialysis patients, the dialysate sodium minus pre-dialysis plasma sodium concentration (δDPNa+) and the post-dialysis minus pre-dialysis plasma sodium (δPNa+) are surrogates of sodium balance, and are associated with both cardiovascular and all-cause mortality. However, whether δDPNa+ or δPNa+ better predicts clinical outcomes in quotidian dialysis is unknown.

Should patients with advanced chronic kidney disease and atrial fibrillation receive chronic anticoagulation?

Atrial fibrillation is prevalent in dialysis patients. Both ischaemic and haemorrhagic stroke are common in patients on dialysis with atrial fibrillation. In the general population, warfarin is highly effective for prophylaxis of ischaemic stroke, and though warfarin use likely increases the risk of intracranial haemorrhage, the absolute increase in risk is small.

Evaluation of an electronic warfarin nomogram for anticoagulation of hemodialysis patients.

Background: Warfarin nomograms to guide dosing have been shown to improve control of the international normalized ratio (INR) in the general outpatient setting. However, the effectiveness of these nomograms in hemodialysis patients is unknown. We evaluated the effectiveness of anticoagulation using an electronic warfarin nomogram administered by nurses in outpatient hemodialysis patients, compared to physician directed therapy.