Genovesi S.,University of Milan Bicocca |
Expert Opinion on Drug Safety | Year: 2013
The prevalence of atrial fibrillation (AF) in patients with chronic renal failure (CRF) and end-stage renal disease (ESRD) is very high and also in this population AF is associated with an increased risk of stroke. Warfarin is the treatment of choice for AF to prevent thromboembolic events, but it has been reported that its use in CRF and hemodialysis (HD) patients is associated with an increased risk of bleeding compared with patients with normal renal function. Moreover, historical studies suggest that warfarin increases the incidence of both ischemic and hemorrhagic strokes in HD patients. However, a clear benefit:risk ratio against warfarin in patients with CRF or ESRD and AF has not been demonstrated. New oral anticoagulants, thrombin or factor Xa inhibitors, are now available. Patients with severe CRF (i.e., glomerular filtration rate < 30 mL/min) and with ESRD, however, were excluded from the trials that have established their efficacy and safety. The advent of new oral anticoagulants raises the important question if patients with severe CRF and ESRD should be excluded or not from this new therapeutic opportunity. © 2013 Informa UK, Ltd.
Chawla L.S.,Nephrology |
Chawla L.S.,George Washington University
Clinica Chimica Acta | Year: 2015
Purpose of the review: Acute kidney injury (AKI) and chronic kidney disease (CKD) are conditions that substantially increase morbidity and mortality. Although novel biomarkers are being used in practice, the diagnosis of AKI and CKD is still made with surrogate markers of GFR, such as serum creatinine (SCr), urine output and creatinine based estimating equations. SCr is limited as a marker of kidney dysfunction in both settings and may be inaccurate in several situations, such as in patients with low muscle mass or with fluid overload. New biomarkers have the potential to identify earlier patients with AKI and CKD and in the future potentially intervene to modify outcomes. Recent findings: In particular KIM-1 and NGAL are considered excellent biomarkers in urine and plasma for the early prediction of AKI; however cycle arrest biomarkers have emerged as novel markers for risk stratification of AKI. Urine TIMP-2 and IGFBP7 performed better than any other biomarkers reported to date for predicting the development of moderate or severe AKI. Biomarker combinations are required to increase diagnostic accuracy in an acute setting. NGAL, cystatin C, and FGF-23 are promising and accurate biomarkers for CKD detection. Equations combining cystatin C and SCr perform better than the equations using either cystatin C or SCr alone, especially in situations where CKD needs to be confirmed. Combining creatinine, cystatin C and urine albumin to creatinine ratio improves risk stratification for kidney disease progression and mortality. Summary: Recent advances in molecular biology have resulted in promising biomarkers for AKI and CKD diagnoses; however more research is necessary to implement them successfully into clinical practice in order to facilitate early diagnosis, guide interventions and monitor disease progression. The following review describes the most important biomarkers studied in kidney disease and will discuss the use and the value of these biomarkers in different clinical settings. © 2014 Elsevier B.V.
Seminars in Dialysis | Year: 2010
The Hemodialysis Reliable Outflow (HeRO®) Vascular Access Device is a novel long-term subcutaneous dialysis graft, ideally suited for catheter-dependent patients and patients dialyzing with failing fistulas or grafts due to venous outflow stenosis. This case presentation depicts the clinical course of the first patient to enter a Food and Drug Administration approved clinical trial and receive the HeRO device. The course of this patient over 56 months of follow-up provides the longest experience with the HeRO device to-date. In this patient, the HeRO device provided long-term dialysis access patency in conjunction with adequate dialysis and a low intervention rate. © 2010 Wiley Periodicals, Inc.
Johnson R.J.,Developmental and Behavioral science |
Pediatric Nephrology | Year: 2013
Background: End-stage renal disease (ESRD) during infancy has been associated with poor short-term neurocognitive outcomes. Limited information exists regarding long-term outcomes. Methods: Neurocognitive outcomes for 12 patients diagnosed with ESRD during the first 16 months of life were assessed. Nine patients (mean age: 11 years) were compared to their healthy siblings (mean age: 10 years) on measures of intellectual and executive functioning, memory, and academic achievement using paired-samples t tests. Results: Patients' Full Scale IQ (FSIQ) scores (M = 78, SD = 16.1) were significantly lower than sibling controls (M = 94, SD = 18.9; p < 0.03). For patients, FSIQ negatively correlated with total months on dialysis (r = -0.6, p < 0.04), as did WISC-IV Processing Speed (r = -0.6, p < 0.05). Patients' scores on the Metacognition Index of the BRIEF (M = 61.4, SD = 16.3) were significantly higher (indicating greater risk for dysfunction) than siblings (M = 46.7, SD = 6.4; p < 0.04). Patients' scores (M = 84, SD = 19) on the WIAT-II-A Total Achievement were significantly lower than siblings (M = 103, SD = 20, p < 0.01). Younger age at transplant was associated with higher scores on measures of Processing Speed (r = -0.7, p < 0.05), as well as higher scores on measures of executive functioning, memory, and academic achievement. Conclusions: In summary, patients diagnosed with ESRD as infants had intellectual and metacognitive functioning significantly lower than sibling controls. Fewer months on dialysis and younger age at transplant were associated with better outcomes. © 2013 IPNA.
Karras A.,Nephrology |
Jayne D.,Vasculitis and Lupus Clinic
Nephron - Clinical Practice | Year: 2014
The major advances achieved in immunology and cellular biology have led to the development of biotherapies that specifically target different mediators and pathways involved in the physiopathology of renal diseases. After the major breakthroughs obtained with B-cell depletion in autoantibody-mediated glomerulopathies, several other immunomodulation strategies are being tested in autoimmune glomerulonephritides, such as blockade of B-cell costimulation and activation, inhibition of complement pathways or modification of the T-B-lymphocyte crosstalk. Other drugs, inhibiting proinflammatory cytokines, are being developed in order to control the inflammatory response initiating and amplifying the kidney tissue injury observed in different systemic diseases. Finally, several promising therapeutic agents target specific renal cells such as podocytes or fibroblasts, blocking the common final steps of the deleterious pathological process underlying various types of nephropathy. Although several of these drugs are still under evaluation in phase 2/3 clinical trials, biotherapies have undoubtedly opened a new era in the treatment of glomerular disease. © 2014 S. Karger AG, Basel.