Seminars in nephrology最新文献

{"title":"Bleeding Risk in Hemodialysis Patients","authors":"Anita van Eck van der Sluijs MD, PhD ,&nbsp;Pearl Pai MD, FRCP ,&nbsp;Wenjuan Zhu MD ,&nbsp;Gurbey Ocak MD, PhD","doi":"10.1016/j.semnephrol.2023.151478","DOIUrl":"10.1016/j.semnephrol.2023.151478","url":null,"abstract":"<div><div><span>Cardiovascular diseases are highly prevalent among patients on dialysis. For these diseases, antiplatelets<span> and antithrombotic therapies<span> including heparin, vitamin K antagonists, and </span></span></span>direct oral anticoagulants<span><span><span>, are being used. However, the benefit–risk balance of these therapies could differ for dialysis patients compared with the general population. This review article focuses on the bleeding risk associated with the use of heparin, </span>antiplatelets<span>, vitamin K antagonists<span>, and direct oral anticoagulants in patients receiving </span></span></span>hemodialysis.</span></div></div>","PeriodicalId":21756,"journal":{"name":"Seminars in nephrology","volume":"43 6","pages":"Article 151478"},"PeriodicalIF":2.8,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139491969","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}

{"title":"Laboratory Monitoring of Heparin Anticoagulation in Hemodialysis: Rationale and Strategies","authors":"Thita Chiasakul MD, MSc ,&nbsp;François Mullier PharmD, PhD ,&nbsp;Thomas Lecompte MD, PhD ,&nbsp;Philippe Nguyen MD, PhD ,&nbsp;Adam Cuker MD, MS","doi":"10.1016/j.semnephrol.2023.151477","DOIUrl":"10.1016/j.semnephrol.2023.151477","url":null,"abstract":"<div><div><span>Unfractionated heparin (UFH) and low-molecular-weight heparins (LMWHs) are commonly used to prevent clotting of the hemodialysis<span> extracorporeal<span><span> circuit and optimize hemodialysis<span><span> adequacy. There is no consensus on the optimal dosing for UFH and LMWHs during hemodialysis. In clinical practice, semiquantitative clotting scoring of the dialyzer and venous chamber may help to guide UFH and LMWH dose adjustment. Laboratory monitoring has not been shown to improve clinical outcomes and is therefore not routinely indicated in most hemodialysis patients. It might, however, be considered in select patients, such as those with extremes of body weight or history of repeated clotting or bleeding. Methods for laboratory monitoring include the activated </span>partial thromboplastin time, activated </span></span>clotting time, and antifactor Xa assays for UFH and antifactor Xa assay for LMWHs. Target ranges for </span></span></span>anticoagulation in hemodialysis have been suggested but not clearly defined. When utilizing these tests, issues such as availability, standardization, interfering factors, and interpretation must be considered. In this narrative review, we discuss the rationale and methods of monitoring anticoagulation in hemodialysis.</div></div>","PeriodicalId":21756,"journal":{"name":"Seminars in nephrology","volume":"43 6","pages":"Article 151477"},"PeriodicalIF":2.8,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139642914","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}

{"title":"Regional Citrate Anticoagulation: A Tale of More Than Two Stories","authors":"Thomas Demuynck MD ,&nbsp;Muriel Grooteman MD, PhD ,&nbsp;Piet Ter Wee MD, PhD ,&nbsp;Mario Cozzolino MD, PhD ,&nbsp;Björn Meijers MD, PhD","doi":"10.1016/j.semnephrol.2023.151481","DOIUrl":"10.1016/j.semnephrol.2023.151481","url":null,"abstract":"<div><div><span>Calcium is a key clotting factor, and several inorganic molecules that bind to calcium have been found to reduce the clotting propensity of blood. Citrate, a </span>calcium chelator<span><span><span>, is used as inhibitor of the coagulation cascade in blood transfusion. Also, it is used as an anaticoagulant during dialysis to maintain patency of the </span>extracorporeal circuit, known as regional citrate </span>anticoagulation (RCA). The amount of citrate should be chosen such that ionized calcium concentrations in the extracorporeal circuit are reduced enough to minimize propagation of the coagulation cascade. The dialytic removal of the calcium–citrate complexes combined with reduced ionized calcium concentrations makes necessary calcium supplementation of the blood returning to the patient. This can be achieved in different ways. In classical RCA, citrate and calcium are infused in the afferent and efferent tubing, respectively, whereas the dialysate does not contain calcium. This setup has been shown to be highly efficacious with a very low clotting propensity. Strict monitoring of blood electrolytes is required. Alternatively, the use of a high-calcium dialysate leads to calcium loading, obviating the need for a separate calcium infusion pump. The main advantages are simplified delivery of RCA and less fluctuation of systemic calcium concentrations. Currently, citric acid is sometimes added to the acid concentrate as a replacement for acetic acid. Differences and similarities between RCA and citrate-containing dialysate are discussed. RCA is an excellent alternative to heparin for patients at high risk of bleeding.</span></div></div>","PeriodicalId":21756,"journal":{"name":"Seminars in nephrology","volume":"43 6","pages":"Article 151481"},"PeriodicalIF":2.8,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139425463","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}

{"title":"Detection and Scoring of Extracorporeal Circuit Clotting During Hemodialysis","authors":"Floris Vanommeslaeghe MD, PhD ,&nbsp;Wim Van Biesen MD, PhD ,&nbsp;Karlien François MD, PhD","doi":"10.1016/j.semnephrol.2023.151474","DOIUrl":"10.1016/j.semnephrol.2023.151474","url":null,"abstract":"<div><div><span>Maintaining patency of the extracorporeal </span>hemodialysis<span> (HD) circuit is a prerequisite to perform HD. Unfractionated heparin and low-molecular-weight heparins are the most used anticoagulants<span> in maintenance HD, but their administration comes with a major trade-off of bleeding complications. This narrative review article discusses technical factors impacting on HD circuit patency, such as tubings, dialyzer membranes, priming practices, and treatment settings. Strategies for monitoring extracorporeal circuit clotting during and after treatment are also reviewed, as these are essential tools for optimizing anticoagulation.</span></span></div></div>","PeriodicalId":21756,"journal":{"name":"Seminars in nephrology","volume":"43 6","pages":"Article 151474"},"PeriodicalIF":2.8,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139547023","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}

{"title":"Strategies to Prevent Infections in Dialysis Patients","authors":"Daniela Ponce PhD ,&nbsp;Dorothea Nitsch PhD ,&nbsp;Talat Alp Ikizler PhD","doi":"10.1016/j.semnephrol.2023.151467","DOIUrl":"10.1016/j.semnephrol.2023.151467","url":null,"abstract":"<div><div><span><span>Infections are the second leading cause of death among patients with end-stage kidney disease, behind only cardiovascular disease. In addition, patients on chronic dialysis are at a higher risk for acquiring infection caused by multidrug-resistant organisms and for death resulting from infection owing to their likelihood of requiring treatment that involves invasive devices, their frequent exposure to antibiotics, and their impaired immunity. </span>Vascular access is a major risk factor for </span>bacteremia<span><span>, hospitalization, and mortality among hemodialysis<span> (HD) patients. Catheter-related bacteremia is the most severe </span></span>central venous catheter<span> (CVC)-related infection and increases linearly with the duration of catheter use. Given the high prevalence of CVC use and its direct association with catheter-related bacteremia, which adversely impacts morbidity and mortality rates<span><span> among HD patients, several prevention measures aimed at reducing the rates of CVC-related infection have been proposed and implemented. As a result, a large number of clinical trials, </span>systematic reviews, and meta-analyses have been conducted to assess the effectiveness, clinical applicability, and long-term adverse effects of such measures.</span></span></span></div><div><span><span>Peritoneal dialysis </span>chronic treatment without the occurence of </span>peritonitis<span><span> is rare. Although most cases of peritonitis can be treated adequately with antibiotics, some cases are complicated by hospitalization or a temporary or permanent need to abstain from using the peritoneal </span>dialysis catheter<span><span>. Severe and long-lasting peritonitis can lead to peritoneal membrane failure, requiring the treatment method to be switched to HD. Some measures as patients training, </span>early diagnosis, and choice of antibiotics can contribute to the successful treatment of peritonitis. Finally, medical directors are key leaders in infection prevention and are an important resource to implement programs to monitor and improve infection prevention practices at all levels within the dialysis clinic.</span></span></div></div>","PeriodicalId":21756,"journal":{"name":"Seminars in nephrology","volume":"43 5","pages":"Article 151467"},"PeriodicalIF":2.8,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139418070","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}

{"title":"Infection-Related Glomerulonephritis in Children and Adults","authors":"Arpana Iyengar MD, DNB, FRCP, PhD ,&nbsp;Nivedita Kamath MD, DM ,&nbsp;Jai Radhakrishnan MD, PhD ,&nbsp;Blanca Tarragon Estebanez MD","doi":"10.1016/j.semnephrol.2023.151469","DOIUrl":"10.1016/j.semnephrol.2023.151469","url":null,"abstract":"<div><div>Infection-related glomerulonephritis is an immunologically mediated glomerular injury after an infection. Glomerulonephritis may occur with the infection or after a variable latent period. Poststreptococcal glomerulonephritis<span> (PSGN) is the prototype of infection-related glomerulonephritis. The streptococcal antigens<span>, nephritis-associated plasmin-like receptor and streptococcal exotoxin<span> B, have emerged as major players in the pathogenesis of PSGN. Although PSGN is the most common infection-related glomerulonephritis in children, in adults, glomerulonephritis is secondary to bacteria such as staphylococci, viruses such as hepatitis C, and human immunodeficiency virus, and, rarely, parasitic infections. Supportive therapy is the mainstay of treatment in most infection-related glomerulonephritis. Treatment of the underlying infection with specific antibiotics and antiviral medications is indicated in some infections. Parasitic infections, although rare, may be associated with significant morbidity. Poststreptococcal glomerulonephritis is a self-limiting condition with a good prognosis. However, bacterial, viral, and parasitic infections may be associated with significant morbidity and long-term consequences. Epidemiologic studies are required to assess the global burden of infection-related glomerulonephritis. A better understanding of the pathogenesis of infection-related glomerulonephritis may unravel more treatment options and preventive strategies.</span></span></span></div></div>","PeriodicalId":21756,"journal":{"name":"Seminars in nephrology","volume":"43 5","pages":"Article 151469"},"PeriodicalIF":2.8,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139502954","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}

{"title":"COVID and the Kidney: An Update","authors":"Samira Bell MBChB, FRCP, MD ,&nbsp;Griffith B. Perkins BSc (Adv), PhD ,&nbsp;Urmila Anandh MBBS, MD ,&nbsp;P. Toby Coates MBBS, FRACP, PhD","doi":"10.1016/j.semnephrol.2023.151471","DOIUrl":"10.1016/j.semnephrol.2023.151471","url":null,"abstract":"<div><div>Coronavirus disease-2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2, has led to a global pandemic that continues to be responsible for ongoing health issues for people worldwide. Immunocompromised individuals such as kidney transplant recipients and dialysis patients have been and continue to be among the most affected, with poorer outcomes after infection, impaired response to COVID-19 vaccines, and protracted infection. The pandemic also has had a significant impact on patients with underlying chronic kidney disease (CKD), with CKD increasing susceptibility to COVID-19, risk of hospital admission, and mortality. COVID-19 also has been shown to lead to acute kidney injury (AKI) through both direct and indirect mechanisms. The incidence of COVID-19 AKI has been decreasing as the pandemic has evolved, but continues to be associated with adverse patient outcomes correlating with the severity of AKI. There is also increasing evidence examining the longer-term effect of COVID-19 on the kidney demonstrating continued decline in kidney function several months after infection. This review summarizes the current evidence examining the impact of COVID-19 on the kidney, covering both the impact on patients with CKD, including patients receiving kidney replacement therapy, in addition to discussing COVID-19 AKI.</div></div>","PeriodicalId":21756,"journal":{"name":"Seminars in nephrology","volume":"43 5","pages":"Article 151471"},"PeriodicalIF":2.8,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139417993","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neglected and Emerging Infections of The Kidney","authors":"Ifeoma I. Ulasi MBBS, MSc ,&nbsp;Emmanuel A. Burdmann MD, PhD ,&nbsp;Chinwuba K. Ijoma MD ,&nbsp;Li-Fang Chou PhD ,&nbsp;Chih-Wei Yang MD","doi":"10.1016/j.semnephrol.2023.151472","DOIUrl":"10.1016/j.semnephrol.2023.151472","url":null,"abstract":"<div><div><span>Individuals, societies, and the environment are affected by neglected and emerging diseases. These diseases result in a variety of severe outcomes, including permanent disabilities, chronic diseases such as chronic kidney disease<span><span>, and even mortality. Consequences include high health care expenditures, loss of means of support, </span>social stigma<span>, and social exclusion. The burden of these diseases is exacerbated in low- and middle-income countries owing to poverty, inadequate fundamental infrastructure, and the absence of health and social protection systems. The World Health Organization is committed to promoting the following public health strategies to prevent and control </span></span></span>neglected tropical diseases<span><span>: preventive chemotherapy; intensive case management; vector control; provision of safe drinkable water, sanitation, and hygiene; and veterinary public health. In addition, it promotes a One Health strategy, which is a collaborative, multisectoral, and interdisciplinary approach to achieving the greatest health outcomes by recognizing the interdependence of human beings, animals, plants, and their shared environment. This article provides knowledge and strategies for the prevention and treatment of neglected and emerging diseases, with a particular concentration on </span>kidney diseases, as part of a comprehensive approach to One Health.</span></div></div>","PeriodicalId":21756,"journal":{"name":"Seminars in nephrology","volume":"43 5","pages":"Article 151472"},"PeriodicalIF":2.8,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139432593","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}

{"title":"Diagnosis, Prevention, and Treatment of Infections in Kidney Transplantation","authors":"Joyita Bharati MD ,&nbsp;Urmila Anandh MD ,&nbsp;Camille N. Kotton MD ,&nbsp;Thomas Mueller MD ,&nbsp;Aakash K. Shingada DNB ,&nbsp;Raja Ramachandran MD","doi":"10.1016/j.semnephrol.2023.151486","DOIUrl":"10.1016/j.semnephrol.2023.151486","url":null,"abstract":"<div><div><span><span><span>Kidney transplant often is complicated by infections in the recipient from therapy-related and patient-related risk factors. Infections in kidney transplant recipients are associated with increased morbidity, mortality, and </span>allograft<span> dysfunction. There is a predictable timeline after kidney transplant regarding the types of pathogens causing infections, reflecting the net state of </span></span>immunosuppression<span><span><span>. In the early post-transplant period, bacterial infections comprise two thirds of all infections, followed by viral and fungal infections. Infections occurring early after </span>kidney transplantation are generally the result of </span>postoperative complications<span><span>. In most cases, opportunistic infections occur within 6 months after kidney transplantation. They may be caused by a new infection, a donor-derived infection, or reactivation of a latent infection. Community-acquired pneumonia, </span>upper respiratory tract infections, urinary tract infections, and </span></span></span>gastrointestinal infections are the most common infections in the late period after transplantation when the net immunosuppression is minimal. It is crucial to seek information on the time after transplant, reflecting the net state of immunosuppression, previous history of exposure/infections, geography, and seasonal outbreaks. It is imperative that we develop regionally specific guidelines on screening, prevention, and management of infections after kidney transplantation.</div></div>","PeriodicalId":21756,"journal":{"name":"Seminars in nephrology","volume":"43 5","pages":"Article 151486"},"PeriodicalIF":2.8,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139913405","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}

{"title":"Infections and Acute Kidney Injury: A Global Perspective","authors":"Anthony Batte MBChB, MMed ,&nbsp;Lubaba Shahrin MBBS, FCPS ,&nbsp;Rolando Claure-Del Granado MD ,&nbsp;Valerie A. Luyckx MD, PhD ,&nbsp;Andrea L. Conroy PhD","doi":"10.1016/j.semnephrol.2023.151466","DOIUrl":"10.1016/j.semnephrol.2023.151466","url":null,"abstract":"<div><div><span><span>Globally, there are an estimated 13.3 million cases of acute kidney injury (AKI) annually. Although infections are a common cause of AKI globally, most infection-associated AKI occurs in low- and lower-middle-income countries. There are marked differences in the etiology of infection-associated AKI across age groups, populations at risk, and geographic location. This article provides a global overview of different infections that are associated commonly with AKI, including </span>severe acute respiratory syndrome coronavirus 2<span><span> (SARS-CoV-2), human immunodeficiency virus, malaria, dengue, </span>leptospirosis<span>, tick-borne illnesses, and viral hemorrhagic fevers. Further discussion focuses on infectious conditions associated with AKI including sepsis, diarrheal diseases and pregnancy, peripartum and neonatal AKI. This article also discusses the future of infection-associated AKI in the framework of climate change. It explores how increased investment in achieving the sustainable development goals may contribute to the International Society of </span></span></span>Nephrology's 0 by 25 objective to curtail avoidable AKI-related fatalities by 2025.</div></div>","PeriodicalId":21756,"journal":{"name":"Seminars in nephrology","volume":"43 5","pages":"Article 151466"},"PeriodicalIF":2.8,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139068524","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}