Seminars in nephrology最新文献_第4页

Pediatric Kidney Transplantation: Cancer and Cancer Risk 小儿肾移植：癌症与癌症风险

IF 2.8 3区医学

Seminars in nephrology Pub Date : 2024-01-01 DOI: 10.1016/j.semnephrol.2024.151501

Kaitlyn E. Order MD, Nancy M. Rodig MD

引用次数: 0

Avoiding Systemic Heparinization During Hemodialysis: How the Dialysis Setup Might Help 在血液透析过程中避免全身肝素化：透析装置如何提供帮助？

IF 2.8 3区医学

Seminars in nephrology Pub Date : 2023-11-01 DOI: 10.1016/j.semnephrol.2023.151483

Florine V. Janssens MD , Björn Meijers MD, PhD , Karlien François MD, PhD

{"title":"Avoiding Systemic Heparinization During Hemodialysis: How the Dialysis Setup Might Help","authors":"Florine V. Janssens MD , Björn Meijers MD, PhD , Karlien François MD, PhD","doi":"10.1016/j.semnephrol.2023.151483","DOIUrl":"10.1016/j.semnephrol.2023.151483","url":null,"abstract":"<div><div><span><span>Heparin is the most widely used anticoagulant for maintaining patency of the </span>extracorporeal blood circuit during </span>intermittent hemodialysis<span><span>. Inadvertently, this leads to systemic heparinization of the patient. Repeated intermittent heparinization during hemodialysis has been associated with increased bleeding risks and metabolic and immunologic effects. Alternative strategies for minimizing systemic </span>anticoagulation encompass dilution methods, regional citrate anticoagulation, priming of the extracorporeal circuit, and modifications to dialyzer membranes and dialysate composition. The effectiveness of these alternatives in maintaining patency of the extracorporeal circuit varies substantially. Although most studies have focused on particular changes in the hemodialysis setup, several combined interventions for adapting the hemodialysis setup are now being studied. This narrative review aims to present an overview of the current landscape of hemodialysis setup strategies aimed at limiting or avoiding systemic anticoagulation during treatment. Additionally, this review intends to shed light on the underlying pathophysiological mechanisms that contribute to variations observed in reported outcomes.</span></div></div>","PeriodicalId":21756,"journal":{"name":"Seminars in nephrology","volume":"43 6","pages":"Article 151483"},"PeriodicalIF":2.8,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139466992","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Lipid and Bone Effects of Heparin Use During Hemodialysis 血液透析期间使用肝素对血脂和骨骼的影响

IF 2.8 3区医学

Seminars in nephrology Pub Date : 2023-11-01 DOI: 10.1016/j.semnephrol.2023.151480

Bernd Stegmayr MD, PhD , Li Zuo MD, PhD , Ward Zadora MD

引用次数: 0

Clotting Propensity of Surface-Treated Membranes in a Hemodialysis Set-up That Avoids Systemic Anticoagulation 避免全身抗凝的血液透析装置中表面处理膜的凝血倾向

IF 2.8 3区医学

Seminars in nephrology Pub Date : 2023-11-01 DOI: 10.1016/j.semnephrol.2023.151482

Hideki Kawanishi MD , Masahide Koremoto , Casper F.M. Franssen MD, PhD , Marco van Londen MD, PhD

引用次数: 0

Anticoagulation for Hemodialysis: A Hidden Quest to Ensure Safe Dialysis 血液透析中的抗凝治疗：确保安全透析的隐性探索。

IF 2.8 3区医学

Seminars in nephrology Pub Date : 2023-11-01 DOI: 10.1016/j.semnephrol.2023.151485

Karlien François MD, PhD, Björn Meijers MD, PhD

引用次数: 0

Patient Perspectives on Clotting in the Extracorporeal Circuit and Decision-Making Regarding Anticoagulation Therapy 患者对体外循环凝血的看法以及抗凝疗法的决策。

IF 2.8 3区医学

Seminars in nephrology Pub Date : 2023-11-01 DOI: 10.1016/j.semnephrol.2023.151475

Chandana Guha MA , Daniel Gallego , Amanda Grandinetti MPH , Madeleine Warren , Allison Jaure PhD

{"title":"Patient Perspectives on Clotting in the Extracorporeal Circuit and Decision-Making Regarding Anticoagulation Therapy","authors":"Chandana Guha MA , Daniel Gallego , Amanda Grandinetti MPH , Madeleine Warren , Allison Jaure PhD","doi":"10.1016/j.semnephrol.2023.151475","DOIUrl":"10.1016/j.semnephrol.2023.151475","url":null,"abstract":"<div><div><span><span><span>Clotting of the extracorporeal circuit is a complication in the process of </span>hemodialysis that can result in missed or shortened dialysis sessions, higher nursing workload, and elevated cost of treatment. Repercussions of inadequate dialysis may include patient </span>blood loss<span>, fluid overload<span>, build-up of minerals, higher hospitalization rates, and poor quality of life, contributing to increased patient distress. Preventing clotting through </span></span></span>anticoagulation therapy<span><span> is the key to maintaining patency of the dialysis circuit<span> and supporting dialysis adequacy. Despite the severe consequences of clotting in the extracorporeal circuit patients encounter, their perspectives on decision-making regarding </span></span>anticoagulation therapy<span> are not well known. In this article, we discuss patients’ perspectives and priorities around clotting and anticoagulation therapy and outline ways to support their treatment through shared decision-making. Insights into patients’ perspectives on addressing thrombotic complications of the extracorporeal circuit can inform strategies to improve care and outcomes for patients receiving hemodialysis.</span></span></div></div>","PeriodicalId":21756,"journal":{"name":"Seminars in nephrology","volume":"43 6","pages":"Article 151475"},"PeriodicalIF":2.8,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139486355","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Clotting of the Extracorporeal Circuit in Hemodialysis: Beyond Contact-Activated Coagulation 血液透析中体外循环的凝血：超越接触激活凝血

IF 2.8 3区医学

Seminars in nephrology Pub Date : 2023-11-01 DOI: 10.1016/j.semnephrol.2023.151473

Matthias M. Engelen MD, PhD , Peter Verhamme MD, PhD , Thomas Vanassche MD, PhD

引用次数: 0

Factor XI Inhibitors: Potential Role in End-Stage Kidney Disease 因子 XI 抑制剂：在终末期肾病中的潜在作用。

IF 2.8 3区医学

Seminars in nephrology Pub Date : 2023-11-01 DOI: 10.1016/j.semnephrol.2023.151484

Matthew Ades MDCM , Camille Simard MDCM , Thomas Vanassche MD, PhD , Peter Verhamme MD, PhD , John Eikelboom MBBS, MSc , Thomas A. Mavrakanas MD, MSc

{"title":"Factor XI Inhibitors: Potential Role in End-Stage Kidney Disease","authors":"Matthew Ades MDCM , Camille Simard MDCM , Thomas Vanassche MD, PhD , Peter Verhamme MD, PhD , John Eikelboom MBBS, MSc , Thomas A. Mavrakanas MD, MSc","doi":"10.1016/j.semnephrol.2023.151484","DOIUrl":"10.1016/j.semnephrol.2023.151484","url":null,"abstract":"<div><div><span><span>Patients with end-stage kidney disease (ESKD) experience a high thrombotic risk but are also at increased risk of bleeding. There is an unmet need for safer antithrombotic therapy<span> in patients with ESKD on hemodialysis<span>. Factor XI (FXI) represents an attractive therapeutic target for </span></span></span>anticoagulation because of the potential to mitigate the bleeding risks associated with currently approved </span>anticoagulants<span><span>, especially in patients at high risk of bleeding. FXI inhibition is also an attractive option in settings where coagulation is activated by exposure of the blood to artificial surfaces, including the extracorporeal<span> circuit during hemodialysis. Therapies targeting FXI that are in the most advanced stages of clinical development include </span></span>antisense oligonucleotides<span><span>, monoclonal antibodies, and synthetic small molecules, which serve either to lower FXI levels or block its physiological effects. This review article presents the most recent pharmacological data with FXI inhibitors, briefly describes phase 2 and 3 </span>clinical trials with these agents, and critically examines the potential future use of FXI inhibitors for extracorporeal circuit anticoagulation in patients with ESKD. In addition, laboratory monitoring and reversal of FXI inhibitors are briefly discussed.</span></span></div></div>","PeriodicalId":21756,"journal":{"name":"Seminars in nephrology","volume":"43 6","pages":"Article 151484"},"PeriodicalIF":2.8,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139565007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Immunologic Effects of Heparin Associated With Hemodialysis: Focus on Heparin-Induced Thrombocytopenia 与血液透析有关的肝素免疫效应：关注肝素诱发的血小板减少症。

IF 2.8 3区医学

Seminars in nephrology Pub Date : 2023-11-01 DOI: 10.1016/j.semnephrol.2023.151479

Theodore E. Warkentin MD

{"title":"Immunologic Effects of Heparin Associated With Hemodialysis: Focus on Heparin-Induced Thrombocytopenia","authors":"Theodore E. Warkentin MD","doi":"10.1016/j.semnephrol.2023.151479","DOIUrl":"10.1016/j.semnephrol.2023.151479","url":null,"abstract":"<div><div><span><span><span>Intermittent hemodialysis (HD) is almost invariably performed with heparin, and thus HD patients are at risk of developing the immune-mediated </span>adverse effect<span> heparin-induced thrombocytopenia (HIT), caused by anti-platelet factor 4/heparin IgG, which strongly activates platelets. HIT patients develop hypercoagulability<span> with greatly increased risk of thrombosis, both venous and arterial. Certain HIT-associated complications are more likely to develop among HD patients, including hemofilter thrombosis despite heparin, intravascular catheter and/or arteriovenous fistula-associated thrombosis, post-heparin bolus anaphylactoid/anaphylactic reactions, and thrombotic stroke and acute limb artery thrombosis (reflecting the high frequency of underlying </span></span></span>arteriopathy<span> in many patients with renal failure). Management of HIT in HD usually requires use of an alternative (non-heparin) anticoagulant; for example, </span></span>danaparoid sodium<span> (outside the USA) or argatroban (USA and elsewhere). Whether heparin-grafted hemodialyzers (without systemic heparin) can be used safely in acute HIT is unknown. The HIT immune response is remarkably transient and usually not retriggered by subsequent heparin administration. Accordingly, since renal failure patients often require long-term HD, there may be the opportunity—following seroreversion (loss of platelet-activating HIT antibodies)—to restart heparin for HD, a practice that appears to have a low likelihood of retriggering HIT.</span></div></div>","PeriodicalId":21756,"journal":{"name":"Seminars in nephrology","volume":"43 6","pages":"Article 151479"},"PeriodicalIF":2.8,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139404282","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

How to Ensure Patency of the Extracorporeal Circuit in Hemodialysis: Global Perspectives 如何确保血液透析中体外循环的通畅：全球视角。

IF 2.8 3区医学

Seminars in nephrology Pub Date : 2023-11-01 DOI: 10.1016/j.semnephrol.2023.151476

Alba Santos MD, PhD , Almudena Vega MD, PhD , Andrew Davenport MD

{"title":"How to Ensure Patency of the Extracorporeal Circuit in Hemodialysis: Global Perspectives","authors":"Alba Santos MD, PhD , Almudena Vega MD, PhD , Andrew Davenport MD","doi":"10.1016/j.semnephrol.2023.151476","DOIUrl":"10.1016/j.semnephrol.2023.151476","url":null,"abstract":"<div><div>An adequate knowledge of anticoagulants<span><span><span><span> used to prevent clotting in the extracorporeal circuit is crucial to provide optimal </span>hemodialysis<span>. Drugs can potentially prevent extracorporeal circuit clotting, but administration, half-life, and potential side effects differ. However, there is a lack of concise recommendations to guide </span></span>anticoagulation<span><span> and to avoid side effects. Because of the development of newer anticoagulant agents, </span>direct thrombin inhibitors, and </span></span>heparinoids<span><span>, some of the side effects related to heparin may be overcome, but a deeper knowledge of these newer drugs is necessary. Moreover, types of heparin used, routes of administration, and </span>health care economics<span><span> vary around the world. We performed an extensive review of the literature, and the present article focuses on available anticoagulant drugs, exploring doses, side effects, particular use in hemodialysis, mechanism of action, </span>pharmacokinetic properties, and use in special situations. Classical anticoagulants are still the standard of anticoagulation, but many questions remain unanswered; for example, is there real superiority of one treatment over another in terms of efficacy, safety, and health care economics? Anticoagulant protocols for hemodialysis need to be standardized and further studies performed to answer all of these questions.</span></span></span></div></div>","PeriodicalId":21756,"journal":{"name":"Seminars in nephrology","volume":"43 6","pages":"Article 151476"},"PeriodicalIF":2.8,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139562630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0