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Yoshioka T, Nishida T, Tsujii M, Kato M, Hayashi Y, Komori M, Yoshihara H, Nakamura T, Egawa S, Yoshio T, Yamada T, Yabuta T, Yamamoto K, Kinoshita K, Kawai N, Ogiyama H, Nishihara A, Michida T, Iijima H, Shintani A, Takehara T. Renal dysfunction is an independent risk factor for bleeding after gastric ESD. Endosc Int Open 2015; 3:E39-45. [PMID: 26134770 PMCID: PMC4423257 DOI: 10.1055/s-0034-1390762] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 08/26/2014] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND AND STUDY AIMS The number of patients with chronic kidney disease (CKD) is increasing worldwide and gastric cancer sometimes occurs with CKD. However, the safety and feasibility of endoscopic submucosal dissection (ESD) for patients with CKD are not clear. The aim of this study is to clarify the feasibility and safety of gastric ESD for patients with CKD. PATIENTS AND METHODS This was a multicenter retrospective cohort study. In total, 144 patients with CKD who underwent gastric ESD between May 2003 and October 2012 were enrolled. The patients were divided into three groups: stage 3 (estimated glomerular filtration rate [eGFR]: 30 - 59 mL/min), stage 4 (eGFR: 15 - 29 mL/min), and stage 5 (eGFR: < 15 mL/min) according to the Kidney Disease Improving Global Outcomes Guidelines. The en bloc and curative resection rates and complications were assessed as short-term outcomes. Overall survival was analyzed using Kaplan - Meier methods. RESULTS In total, 92 patients were in stage 3 CKD; 23 in stage 4; and 29 in stage 5, including 19 patients in hemodialysis. The en bloc resection rate was 95.8 %. Post-ESD bleeding was observed in four patients with stage 5 CKD (13.8 %), three with stage 4 (13.0 %), and one with stage 3 (1.1 %). All bleeding could be controlled by endoscopic hemostasis, but five patients required blood transfusion. Perforation occurred in two patients (6.9 %) with stage 5 CKD, none (0 %) with stage 4, and two (4.3 %) with stage 3. Multivariate Poisson regression analysis revealed CKD stage 4 was a critical factor related to bleeding, whereas diabetes mellitus and CKD stage 5, which largely consist of patients receiving hemodialysis, were not. The median observation period of patients who achieved curative resection was 25.9 months (range 0.8-112.7 months) and the 3-year overall survival rate was 92.5 %. CONCLUSIONS Estimated GFR is a significant independent predictive factor of post-ESD bleeding in patients with CKD.
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Affiliation(s)
- Teppei Yoshioka
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Tsutomu Nishida
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Masahiko Tsujii
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Motohiko Kato
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yoshito Hayashi
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Masato Komori
- Department of Gastroenterology, Osaka Rosai Hospital, Sakai, Japan
| | | | - Takeshi Nakamura
- Department of Gastroenterology, Kansai Rosai Hospital, Amagasaki, Japan
| | - Satoshi Egawa
- Department of Gastroenterology, Kansai Rosai Hospital, Amagasaki, Japan
| | - Toshiyuki Yoshio
- Department of Gastroenterology, Osaka National Hospital, National Hospital Organization, Osaka, Japan
| | - Takuya Yamada
- Department of Gastroenterology, Osaka National Hospital, National Hospital Organization, Osaka, Japan
| | - Takamasa Yabuta
- Department of Gastroenterology, Sakai City Hospital, Sakai, Japan
| | - Katsumi Yamamoto
- Department of Gastroenterology, Toyonaka Municipal Hospital, Toyonaka, Japan
| | - Kazuo Kinoshita
- Department of Gastroenterology, Sumitomo Hospital, Osaka, Japan
| | - Naoki Kawai
- Department of Gastroenterology, Osaka Police Hospital, Osaka, Japan
| | - Hideharu Ogiyama
- Department of Gastroenterology, Itami City Hospital, Itami, Japan
| | | | - Tomoki Michida
- Department of Gastroenterology, Osaka Kosei-Nenkin Hospital, Osaka, Japan
| | - Hideki Iijima
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Ayumi Shintani
- Department of Clinical Epidermiology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Tetsuo Takehara
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Suita, Japan,Corresponding author Tetsuo Takehara Department of Gastroenterology and HepatologyOsaka University Graduate School of MedicineOsakaJapan+81-6-68793629
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Osikov MV. Effect of erythropoietin on free radical oxidation and glycoprotein expression in platelets under conditions of chronic renal failure. Bull Exp Biol Med 2014; 157:25-7. [PMID: 24913571 DOI: 10.1007/s10517-014-2483-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Indexed: 11/25/2022]
Abstract
A short-term open prospective study examined 62 patients at the terminal stage of chronic renal failure. The experimental group received erythropoietin in a total dose of about 40,000 U. The expression of glycoproteins IIb-IIIa, IIb, and Ib was enhanced, the content of LPO products was elevated, and SOD and catalase activities were reduced in platelets from patients with chronic renal failure. Administration of erythropoietin partially restored free radical oxidation and expression of glycoproteins IIb-IIIa, IIb, and Ib in platelets. A significant correlation was revealed between the expression of platelet receptors on the one hand, and content of LPO products and SOD and catalase activities, on the other hand.
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Affiliation(s)
- M V Osikov
- Department of Phatological Phisiology, Chelyabinsk State Medical Academy, Ministry of Health of the Russian Federation, Chelyabinsk, Russia,
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Sadjadi SA, Sharif-Hassanabadi M. Fatal pulmonary embolism after hemodialysis vascular access declotting. AMERICAN JOURNAL OF CASE REPORTS 2014; 15:172-5. [PMID: 24790686 PMCID: PMC4004792 DOI: 10.12659/ajcr.890364] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 01/24/2014] [Indexed: 11/16/2022]
Abstract
Patient: Male, 59 Final Diagnosis: Pulmonary embolism Symptoms: Cardiac arrest • chest pain • dyspnea Medication: — Clinical Procedure: Angioplasty Specialty: Nephrology
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Affiliation(s)
- Seyed-Ali Sadjadi
- Nephrology Section, Jerry L. Pettis Memorial Veterans Medical Center, Loma Linda University School of Medicine, Loma Linda, CA, U.S.A
| | - Maryam Sharif-Hassanabadi
- Nephrology Section, Jerry L. Pettis Memorial Veterans Medical Center, Loma Linda University School of Medicine, Loma Linda, CA, U.S.A
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Aliasgharzadeh A, Gharehbaghian A, Taherian AA, Ghasemzadeh M, Salimian M. Modulation of hyperthermia-induced platelet aggregation inhibition in the presence of urea. Int J Hyperthermia 2013; 29:256-8. [PMID: 23517402 DOI: 10.3109/02656736.2013.772252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE This study has been conducted to evaluate the effect of urea on aggregation responses of heat-treated platelets. MATERIALS AND METHODS The urea was added to platelet-rich plasma (PRP) samples in final concentrations of 50 and 100 mM. PRP samples, with or without exogenous urea, were incubated at 37 °C, 39 °C and 41 °C for 90 min and then were stimulated with adenosine diphosphate (ADP) or epinephrine for measuring of platelet aggregation responses. The average reduction in aggregability of heat-treated samples with reference to mean value obtained for control samples treated at 37 °C was expressed as inhibition percentage. RESULTS Aggregation responses of the samples treated in the presence of 50 mM and 100 mM urea were significantly less inhibited by hyperthermia treatments compared with those treated without exogenous urea. CONCLUSION The results indicate that the inhibitory effect of hyperthermia on platelet aggregation responses could be significantly modulated by urea.
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Affiliation(s)
- Akbar Aliasgharzadeh
- Platelet Research Laboratory, Kashan University of Medical Sciences, Kashan, Iran
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Management of regional citrate anticoagulation in pediatric high-flux dialysis: activated coagulation time versus post-filter ionized calcium. Pediatr Nephrol 2010; 25:1305-10. [PMID: 20221775 DOI: 10.1007/s00467-010-1483-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2009] [Revised: 01/29/2010] [Accepted: 02/01/2010] [Indexed: 10/19/2022]
Abstract
Recent years has seen an increasing use of regional citrate anticoagulation in pediatric dialysis. Several approaches have been described for monitoring anticoagulation in the extracorporeal circuit, such as serum citrate levels, post-filter ionized calcium (iCa), and activated coagulation time (ACT). However, no standard recommendations have yet been established for applying any of these parameters, especially for iCa. The objective of this retrospective analysis was to establish adequate coagulation management using post-filter iCa values. Normal values for ACTester-based ACT were established using a group of 64 children who were divided into two subgroups, with one subgroup comprising children without chronic kidney disease or coagulation disorder (age 1.2-17.5 years, median 9.7 years) and one consisting of 32 uremic patients (age 0.6-17.5 years, median 13.7 years). In a second group of 13 patients (aged 7-17 years), all of whom were undergoing high-flux dialysis (HD) with regional citrate anticoagulation (RCA), we assessed 73 post-filter blood samples for ionized calcium and ACT. A receiver operating characteristic graph was used to identify the iCa threshold needed to achieve adequate anticoagulation. Normal values for ACT were 90 s [2 standard deviations (SD) 72-109] in healthy children and 94 s (2 SD 75-113) in the uremic children. There was no statistically significant difference between the groups. In the children undergoing HD with RCA, the post-filter iCa level correlated with ACT (r = -0.94, p < 0.001). A post-filter iCa level of < or = 0.30 mmol/l reliably predicted an ACT >120 s. Our citrate protocol [citrate 3% rate (ml/h) approximately blood flow rate (ml/min) x 2] meets the established criteria with a high sensitivity. Based on these results, we conclude that the post-filter iCa level can be reliably used for the management of extracorporeal anticoagulation with citrate in pediatric HD. We recommend the application of our citrate prescription protocol in the setting of pediatric intermittent hemodialysis.
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Maurin N. [The role of platelets in atherosclerosis, diabetes mellitus, and chronic kidney disease. An attempt at explaining the TREAT study results]. ACTA ACUST UNITED AC 2010; 105:339-44. [PMID: 20503008 DOI: 10.1007/s00063-010-1062-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2010] [Accepted: 02/15/2010] [Indexed: 01/09/2023]
Abstract
Erythropoiesis-stimulating agents (ESA) are used to treat renal anemia. The TREAT study (Trial to Reduce Cardiovascular Events with Aranesp Ther- apy) of diabetic patients with chronic kidney disease (CKD) found that the risk of stroke was significantly higher than in the control arm. This raises the question as to what causes this phenomenon. Platelets may play a crucial role in this context. Atherogenesis involves complex interactions between platelets and monocytes (platelet-monocyte crosstalk) and with endothelial cells. Platelets are activated in cases of diabetes mellitus, especially. During atherogenesis, partial functions of platelets other than those inhibited by aspirin, as a cyclooxygenase inhibitor, or by adenosine diphosphate receptor P2Y(12)antagonists, such as thienopyridines, are of relevance. During platelet-monocyte crosstalk, specifically, an important role is played by adhesion receptors such as selectins and integrins. In addition, ESA cause platelet activation by direct and indirect mechanisms. Antagonistic thereto is a renal bleeding tendency in cases of severe CKD, due to platelet dysfunction, which can be remedied with appropriate renal replacement therapy and administration of ESA in order to reach a hemoglobin (Hb) level of 10 g/dl. However, if the Hb level exceeds 10 g/dl, the even stronger platelet activation caused by ESA, combined with the activation caused by diabetes, leads to a prothrombotic state, which in patients with severe atherosclerosis can result in acute atherothrombotic complications, in the genesis of which platelets play a key role. This would be one hypothesis for explaining the increased incidence of strokes in the TREAT study.
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Kreuzer M, Bonzel KE, Büscher R, Offner G, Ehrich JHH, Pape L. Regional citrate anticoagulation is safe in intermittent high-flux haemodialysis treatment of children and adolescents with an increased risk of bleeding. Nephrol Dial Transplant 2010; 25:3337-42. [PMID: 20466660 DOI: 10.1093/ndt/gfq225] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Regional citrate anticoagulation (RCA) is strongly recommended for adults with an increased risk of bleeding complications. The objective of this retrospective analysis was to evaluate an RCA protocol concerning feasibility and safety in intermittent high-flux haemodialysis (iHD) treatment in children and adolescents. METHODS Eighteen children and adolescents aged 5-17 years (median 15 years) underwent 74 iHD treatment sessions with RCA. Twelve of 18 patients presented with overt local or diffuse haemorrhage before beginning the HD sessions, and six had an increased risk of haemorrhagic complications. Forty children on acute haemodialysis with general heparin anticoagulation, matched for bleeding risk, age and body surface area, served as a control group. Citrate 3% solution was begun with 3.3% blood flow rate, and calcium gluconate 10% substitution was started with 0.4% of blood flow rate. Citrate flow was adapted to achieve a post-filter ionized calcium of ≤0.30 mmol/L; calcium substitution was adapted to maintain the patients' serum calcium levels within the physiological range. Calcium-free dialysis fluid was used. The blood flow rate ranged from 3 to 5 mL per minute and kilogram body weight. RESULTS Regional anticoagulation was successfully achieved within the extracorporeal blood circuit, while the coagulation of all 18 patients remained within physiological parameters. No adverse effects of RCA were observed. In all 18 children, neither new haemorrhage nor worsening of the bleeding situation occurred, and in 10/12 patients, bleeding stopped during dialysis with RCA. In contrast, one-third of the control group developed new haemorrhagic complications or presented with worsening of pre-existing bleeding during haemodialysis (P = 0.006). CONCLUSION RCA is feasible, safe and effective in paediatric intermittent haemodialysis treatment.
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Affiliation(s)
- Martin Kreuzer
- Department of Paediatric Nephrology, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany.
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