Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association
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Nephrol. Dial. Transplant. · Oct 2012
Review Meta AnalysisSystematic review and meta-analysis of incidence, prevalence and outcomes of atrial fibrillation in patients on dialysis.
The reported incidence, prevalence and outcomes of atrial fibrillation (AF) in patients with end-stage renal disease (ESRD) are variable. The risks and benefits of warfarin anticoagulation need to be defined as the risk of bleeding in ESRD patients may overwhelm the benefits of embolic stroke prevention. We undertook a systematic literature review to clarify these issues. ⋯ The incidence and prevalence of AF in ESRD patients are higher than in the general population and are associated with an increased risk of stroke and mortality. An appropriately designed randomized controlled trial is required to determine whether anticoagulation is an appropriate therapeutic strategy in patients with end-stage renal disease and atrial fibrillation.
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Nephrol. Dial. Transplant. · Oct 2012
ReviewAntidepressants for depression in stage 3-5 chronic kidney disease: a systematic review of pharmacokinetics, efficacy and safety with recommendations by European Renal Best Practice (ERBP).
The prevalence of major depression in stage 5 chronic kidney disease (CKD) varies between 14 and 30%. Patients with CKD who are depressed have a worse quality of life, are hospitalized more often and die sooner than those who are not depressed. Antidepressant drugs are effective in the general population, but whether they improve outcomes in CKD is uncertain. Drug pharmacokinetics are altered in CKD, which may necessitate dose adjustment. We aimed to systematically review available evidence of the pharmacokinetics, efficacy and safety of antidepressant drugs when used in patients with CKD3 to CKD5 (CKD3-5). ⋯ Dose reduction in CKD3-5 is necessary for selegiline, amitriptylinoxide, venlafaxine, desvenlafaxine, milnacipran, bupropion, reboxetine and tianeptine. The evidence on effectiveness of antidepressants versus placebo in patients with CKD3-5, and with the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV)-defined depression is insufficient, and in view of the high prevalence, a well-designed RCT is greatly needed.
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Nephrol. Dial. Transplant. · Oct 2012
Circulating cell-free DNA in hemodialysis patients predicts mortality.
Circulating cell-free DNA (CFD) appears following cell damage and DNA release, and increases in hemodialysis (HD) patients particularly following HD. We hypothesized that CFD is an integrative marker of tissue damage and can be an independent predictor for all-cause mortality in HD patients. ⋯ Post-dialysis CFD level is an independent predictor of all-cause mortality in patients undergoing HD. We propose that CFD detection is an inexpensive applicable tool for identifying patients at risk and their follow-up.
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Nephrol. Dial. Transplant. · Oct 2012
Glycohemoglobin not as predictive as fasting glucose as a measure of prediabetes in predicting proteinuria.
There is little data on the assessment of prediabetes with proteinuria. ⋯ Prediabetes is a significant risk factor for proteinuria compared with completely normal glucose level, and subjects with prediabetes defined using IFG are at significantly higher risk for proteinuria than those defined by HbA1c only.
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Nephrol. Dial. Transplant. · Oct 2012
Short-term change in kidney function and risk of end-stage renal disease.
It is unclear what degree of change in the eGFR over a 1-year period indicates clinically significant progression, and whether this change adds additional information beyond that obtained by a single eGFR measure alone. ⋯ A change in eGFR category accompanied by ≥25% decline (certain drop) is associated with increased ESRD risk. However, this elevated risk is captured by patient characteristics and eGFR at the last visit, suggesting that eGFR trajectories based on more than two serum creatinine measurements over a period longer than 1 year are required to determine ESRD risk and allow more reliable risk prediction.