Seminars in nephrology最新文献_第8页

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

Bleeding Risk in Hemodialysis Patients 血液透析患者的出血风险。

IF 2.8 3区医学

Seminars in nephrology Pub Date : 2023-11-01 DOI: 10.1016/j.semnephrol.2023.151478

Anita van Eck van der Sluijs MD, PhD , Pearl Pai MD, FRCP , Wenjuan Zhu MD , Gurbey Ocak MD, PhD

引用次数: 0

Laboratory Monitoring of Heparin Anticoagulation in Hemodialysis: Rationale and Strategies 血液透析中肝素抗凝的实验室监测：原理与策略。

IF 2.8 3区医学

Seminars in nephrology Pub Date : 2023-11-01 DOI: 10.1016/j.semnephrol.2023.151477

Thita Chiasakul MD, MSc , François Mullier PharmD, PhD , Thomas Lecompte MD, PhD , Philippe Nguyen MD, PhD , Adam Cuker MD, MS

{"title":"Laboratory Monitoring of Heparin Anticoagulation in Hemodialysis: Rationale and Strategies","authors":"Thita Chiasakul MD, MSc , François Mullier PharmD, PhD , Thomas Lecompte MD, PhD , Philippe Nguyen MD, PhD , 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}

引用次数: 0