American journal of kidney diseases : the official journal of the National Kidney Foundation
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Case Reports
Successful treatment of bleeding from colonic angiodysplasias with tranexamic acid in a hemodialysis patient.
Colonic angiodysplasias are a common source of gastrointestinal bleeding in patients with end-stage renal disease (ESRD). It is well known that bleeding from angiodysplasias can be a difficult therapeutic problem. ⋯ A successful management of both the acute and chronic bleeding was achieved. No complications in terms of arterial or venous thrombosis were observed.
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Withholding and withdrawing dialysis are subjects of major concern to nephrologists, because both result in a significant number of end-stage renal disease (ESRD) patient deaths. The medical literature on withholding dialysis is extremely limited, and that on withdrawing dialysis consists mainly of retrospective studies from the 1980s. The present study was conducted to identify ways to improve dialysis decision making by providing a current understanding of how decisions to withhold or withdraw dialysis are being made and by examining whether some patients who might benefit from dialysis are not being referred. ⋯ In deciding not to refer a patient for a dialysis evaluation, 25% of primary care physicians did not consult a nephrologist; 60% cited age as a reason not to refer. These findings suggest that dialysis decision making might be improved by educating nephrologists about the ethics and law of withdrawing dialysis and about how to implement successfully advance care planning so that advance directives will be present and helpful when decisions need to be made for incapacitated dialysis patients. Education of primary care physicians about when to refer patients with chronic renal failure for a dialysis evaluation might also result in more referrals for patients who will benefit from dialysis.