1
|
Saeed Z, Sirolli V, Bonomini M, Gallina S, Renda G. Hallmarks for Thrombotic and Hemorrhagic Risks in Chronic Kidney Disease Patients. Int J Mol Sci 2024; 25:8705. [PMID: 39201390 PMCID: PMC11354877 DOI: 10.3390/ijms25168705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2024] [Revised: 07/31/2024] [Accepted: 08/06/2024] [Indexed: 09/02/2024] Open
Abstract
Chronic kidney disease (CKD) is a global health issue causing a significant health burden. CKD patients develop thrombotic and hemorrhagic complications, and cardiovascular diseases are associated with increased hospitalization and mortality in this population. The hemostatic alterations are multifactorial in these patients; therefore, the results of different studies are varying and controversial. Endothelial and platelet dysfunction, coagulation abnormalities, comorbidities, and hemoincompatibility of the dialysis membranes are major contributors of hypo- and hypercoagulability in CKD patients. Due to the tendency of CKD patients to exhibit a prothrombotic state and bleeding risk, they require personalized clinical assessment to understand the impact of antithrombotic therapy. The evidence of efficacy and safety of antiplatelet and anticoagulant treatments is limited for end-stage renal disease patients due to their exclusion from major randomized clinical trials. Moreover, designing hemocompatible dialyzer membranes could be a suitable approach to reduce platelet activation, coagulopathy, and thrombus formation. This review discusses the molecular mechanisms underlying thrombotic and hemorrhagic risk in patients with CKD, leading to cardiovascular complications in these patients, as well as the evidence and guidance for promising approaches to optimal therapeutic management.
Collapse
Affiliation(s)
- Zeeba Saeed
- Center for Advanced Studies and Technology, G. d’Annunzio University of Chieti-Pescara, 66100 Chieti, Italy;
| | - Vittorio Sirolli
- Nephrology and Dialysis Unit, Department of Medicine, G. d’Annunzio University of Chieti-Pescara, SS. Annunziata Hospital, Via dei Vestini, 66100 Chieti, Italy; (V.S.); (M.B.)
| | - Mario Bonomini
- Nephrology and Dialysis Unit, Department of Medicine, G. d’Annunzio University of Chieti-Pescara, SS. Annunziata Hospital, Via dei Vestini, 66100 Chieti, Italy; (V.S.); (M.B.)
| | - Sabina Gallina
- Department of Neuroscience, Imaging and Clinical Sciences, G. d’Annunzio University of Chieti-Pescara, 66100 Chieti, Italy;
| | - Giulia Renda
- Center for Advanced Studies and Technology, G. d’Annunzio University of Chieti-Pescara, 66100 Chieti, Italy;
- Department of Neuroscience, Imaging and Clinical Sciences, G. d’Annunzio University of Chieti-Pescara, 66100 Chieti, Italy;
| |
Collapse
|
2
|
Roux C, Verollet K, Prouvot J, Prelipcean C, Pambrun E, Moranne O. Choosing the right chronic medication for hemodialysis patients. A short ABC for the dialysis nephrologist. J Nephrol 2023; 36:521-536. [PMID: 36472789 DOI: 10.1007/s40620-022-01477-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 10/01/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Adapting drug treatments for patients on hemodialysis with multiple chronic pathologies is a complex affair. When prescribing a medication, the risk-benefit analysis usually focuses primarily on the indication of the drug class prescribed. However, the pharmacokinetics of the chosen drug should also be taken into account. The purpose of our review was to identify the drugs to be favored in each therapeutic class, according to their safety and pharmacokinetic profiles, for the most common chronic diseases in patients on chronic hemodialysis. METHODS We conducted a narrative review of the literature using Medline and Web of Science databases, targeting studies on the most commonly-prescribed drugs for non-communicable diseases in patients on chronic hemodialysis. RESULTS The search identified 1224 articles, 95 of which were further analyzed. The main classes of drugs included concern the cardiovascular system (anti-hypertensives, anti-arrhythmics, anti-thrombotics, hypocholesterolemics), the endocrine and metabolic pathways (anti-diabetics, gastric anti-secretory, anticoagulant, thyroid hormones, anti-gout) and psychiatric and neurological disorders (antidepressants, anxiolytics, antipsychotics and anti-epileptics). CONCLUSION We report on the most often prescribed drugs for chronic pathologies in patients on chronic hemodialysis. Most of them require adaptation, and in some cases one better alternative stands out among the drug class. More pharmacokinetic data are needed to define the pharmacokinetics in the various dialysis techniques.
Collapse
Affiliation(s)
- Clarisse Roux
- Service Pharmacie, Hopital Universitaire de Nimes, CHU Carémeau, Nîmes, France.
- Institut Desbrest d'Epidemiologie et Santé publique (IDESP), INSERM, Montpellier, France.
| | - Kristelle Verollet
- Service Pharmacie, Hopital Universitaire de Nimes, CHU Carémeau, Nîmes, France
| | - Julien Prouvot
- Institut Desbrest d'Epidemiologie et Santé publique (IDESP), INSERM, Montpellier, France
- Service Néphrologie Dialyse Apherese, Hopital Universitaire de Nimes, CHU Carémeau, Nîmes, France
| | - Camelia Prelipcean
- Service Néphrologie Dialyse Apherese, Hopital Universitaire de Nimes, CHU Carémeau, Nîmes, France
| | - Emilie Pambrun
- Service Néphrologie Dialyse Apherese, Hopital Universitaire de Nimes, CHU Carémeau, Nîmes, France
| | - Olivier Moranne
- Institut Desbrest d'Epidemiologie et Santé publique (IDESP), INSERM, Montpellier, France.
- Service Néphrologie Dialyse Apherese, Hopital Universitaire de Nimes, CHU Carémeau, Nîmes, France.
| |
Collapse
|
3
|
Eikelboom J, Floege J, Thadhani R, Weitz JI, Winkelmayer WC. Anticoagulation in patients with kidney failure on dialysis: factor XI as a therapeutic target. Kidney Int 2021; 100:1199-1207. [PMID: 34600964 DOI: 10.1016/j.kint.2021.08.028] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 08/23/2021] [Accepted: 08/26/2021] [Indexed: 12/18/2022]
Abstract
Chronic kidney disease is present in almost 10% of the world population and is associated with excess mortality and morbidity. Reduced glomerular filtration rate and the presence and extent of proteinuria, key domains of chronic kidney disease, have both been shown to be strong and independent risk factors for cardiovascular disease. Patients with kidney failure requiring dialysis are at highest risk for cardiovascular events (e.g., stroke or myocardial infarction), and of developing chronic cardiovascular conditions, such as heart failure. Despite the high burden of cardiovascular disease, there is a paucity of evidence supporting therapies to reduce this risk. Although long-term anticoagulant treatment has the potential to prevent thromboembolism in persons with kidney failure on dialysis, this possibility remains understudied. The limited data available on anticoagulation in patients with kidney failure has focused on vitamin K antagonists or direct oral anticoagulants that inhibit thrombin or factor (F) Xa. The risk of bleeding is a major concern with these agents. However, FXI is emerging as a potential safer target for new anticoagulants because FXI plays a greater part in thrombosis than in hemostasis. In this article, we (i) explain the rationale for considering anticoagulation therapy in patients with kidney failure to reduce atherothrombotic events, (ii) highlight the limitations of current anticoagulants in this patient population, (iii) explain the potential benefits of FXI inhibitors, and (iv) summarize ongoing studies investigating FXI inhibition in patients with kidney failure on dialysis.
Collapse
Affiliation(s)
- John Eikelboom
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Jürgen Floege
- Department of Nephrology, RWTH University of Aachen, Aachen, Germany
| | - Ravi Thadhani
- Division of Nephrology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jeffrey I Weitz
- Departments of Medicine and Biochemistry and Biomedical Sciences, McMaster University, Hamilton, Ontario, Canada; Thrombosis and Atherosclerosis Research Institute, Hamilton General Hospital, Hamilton, Ontario, Canada
| | - Wolfgang C Winkelmayer
- Department of Medicine, Section of Nephrology and Selzman Institute for Kidney Health, Baylor College of Medicine, Houston, Texas, USA.
| |
Collapse
|
4
|
Königsbrügge O, Schmaldienst S, Auinger M, Klauser-Braun R, Lorenz M, Tabernig S, Kletzmayr J, Enzenberger B, Eigner M, Hecking M, Siller-Matula JM, Pabinger I, Säemann M, Ay C. Antithrombotic agents for primary and secondary prevention of cardiovascular events in patients with end-stage renal disease on chronic hemodialysis. Atherosclerosis 2020; 298:1-6. [DOI: 10.1016/j.atherosclerosis.2020.02.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 02/03/2020] [Accepted: 02/12/2020] [Indexed: 01/17/2023]
|
5
|
Ferreira JP, Couchoud C, Gregson J, Tiple A, Glowacki F, London G, Agarwal R, Rossignol P. Angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, β-blockers or both in incident end-stage renal disease patients without cardiovascular disease: a propensity-matched longitudinal cohort study. Nephrol Dial Transplant 2020; 34:1216-1222. [PMID: 30590716 DOI: 10.1093/ndt/gfy378] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND End-stage renal disease (ESRD) patients even without known cardiovascular (CV) disease have high mortality rates. Whether neurohormonal blockade treatments improve outcomes in this population remains unknown. The aim of this study was to assess the effect of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEi/ARBs), β-blockers or both in all-cause mortality rates in incident ESRD patients without known CV disease starting renal replacement therapy (RRT) between 2009 and 2015 in the nationwide Réseau Epidémiologie et Information en Néphrologie registry. METHODS Patients with known CV disease and those who started emergency RRT, stopped RRT or died within 6 months were excluded. Propensity score matching models were used. The main outcome was all-cause mortality. RESULTS A total of 13 741 patients were included in this analysis. The median follow-up time was 24 months. When compared with matched controls without antihypertensive treatment, treatment with ACEi/ARBs, β-blockers and ACEi/ARBs + β-blockers was associated with an event-rate reduction per 100 person-years: ACEi/ARBs 7.6 [95% confidence interval (CI) 7.1-8.2] versus matched controls 9.5 (8.8-10.1) [HR 0.76 (95% CI 0.69-0.84)], β-blocker 7.1 (6.6-7.7) versus matched controls 9.5 (8.5-10.2) [HR 0.72 (0.65-0.80)] and ACEi/ARBs + β-blockers 5.8 (5.4-6.4) versus matched controls 7.8 (7.2-8.4) [HR 0.68 (0.61-0.77)]. CONCLUSIONS Neurohormonal blocking therapies were associated with death rate reduction in incident ESRD without CV disease. Whether these relationships are causal will require randomized controlled trials.
Collapse
Affiliation(s)
- João Pedro Ferreira
- Université de Lorraine, INSERM, Centre d'Investigations Cliniques Plurithématique, UMR, CHRU de Nancy, Nancy, France.,F-CRIN INI-CRCT Cardiovascular and Renal Clinical Trialists, France, Nancy.,Department of Physiology and Cardiothoracic Surgery, Cardiovascular Research and Development Unit, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Cécile Couchoud
- Agence de la biomédecine, Avenue du Stade-de-France, Saint-Denis-La-Plaine Cedex, France
| | - John Gregson
- London School of Hygiene and Tropical Medicine, London, UK
| | - Aurélien Tiple
- Service de Néphrologie, CHRU de Clermont-Ferrand, Clermont-Ferrand, France
| | - François Glowacki
- EA 4483-IMPECS-IMPact of Environmental Chemicals on Human Health, Faculté de Médecine/Pôle Recherche, Univ. Lille, place de Verdun, Lille Cedex, France
| | - Gerard London
- F-CRIN INI-CRCT Cardiovascular and Renal Clinical Trialists, France, Nancy.,Department of Nephrology, Hospital Manhes, Fleury-Mérogis, France and
| | - Rajiv Agarwal
- Department of Medicine, Indiana University School of Medicine and Richard L. Roudebush Veterans Administration Medical Center, Indianapolis, IN, USA
| | - Patrick Rossignol
- Université de Lorraine, INSERM, Centre d'Investigations Cliniques Plurithématique, UMR, CHRU de Nancy, Nancy, France.,F-CRIN INI-CRCT Cardiovascular and Renal Clinical Trialists, France, Nancy
| |
Collapse
|
6
|
Uso de anticoagulantes orales en situaciones clínicas complejas con fibrilación auricular. Med Clin (Barc) 2018; 150 Suppl 1:8-24. [DOI: 10.1016/s0025-7753(18)30666-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
|
7
|
Abstract
More than half of all deaths among end stage renal disease (ESRD) patients are due to cardiovascular disease (CVD). Cardiovascular changes secondary to renal dysfunction, including fluid overload, uremic cardiomyopathy, secondary hyperparathyroidism, anemia, altered lipid metabolism, and accumulation of gut microbiota-derived uremic toxins like trimethylamine N-oxidase, contribute to the high risk for CVD in the ESRD population. In addition, conventional hemodialysis (HD) itself poses myocardial stress and injury on the already compromised cardiovascular system in uremic patients. This review will provide an overview of cardiovascular changes in chronic kidney disease and ESRD, a description of reported mechanisms for HD-induced myocardial injury, comparison of HD with other treatment modalities in the context of CVD, and possible management strategies.
Collapse
Affiliation(s)
- Shadi Ahmadmehrabi
- Cleveland Clinic Lerner College of Medicine at Case Western Reserve University, Cleveland, OH, USA
| | - W H Wilson Tang
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA.,Center for Clinical Genomics, Cleveland Clinic, Cleveland, OH, USA.,Department of Cellular and Molecular Medicine, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| |
Collapse
|
8
|
Cicora F, Petroni J, Roberti J. Prophylaxis of Pulmonary Embolism in Kidney Transplant Recipients. Curr Urol Rep 2018; 19:17. [DOI: 10.1007/s11934-018-0759-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
|