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Raeesi V, Mohammadi Moghaddam M, Naghavi A, Mozafari G. The effect of scaling and root planning on the periodontal condition in hemodialysis patients: A clinical trial study. Health Sci Rep 2023; 6:e1520. [PMID: 37636284 PMCID: PMC10448737 DOI: 10.1002/hsr2.1520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 08/06/2023] [Accepted: 08/07/2023] [Indexed: 08/29/2023] Open
Abstract
Background and Aims Periodontitis is very common in kidney patients undergoing hemodialysis. The two diseases interact with each other so that kidney failure exacerbates periodontal disease and periodontal disease increases the severity of the renal failure. This study aimed to compare the effect of scaling and root planning on the periodontal status of hemodialysis patients and the healthy control group. Methods A clinical trial study of 60 subjects, 30 subjects in the dialysis group with chronic periodontitis, and 30 with chronic periodontitis who were systemically healthy was conducted. After a health education session, gingival pocket depth (PD) measurement, and clinical attachment level (CAL), scaling was performed for both groups. Then, the mentioned indices were measured consequently, at 4 and 8 weeks of treatment. Improvement in both groups was analyzed by Mann-Whitney and paired sample t-test at the significance level of 0.05 by SPSS software. Results In both groups, the decrease in PD and CAL was steadily observed from the first to the third time and the changes from the first to the second and the first to the third time were significant however it was not significant between the second and third time. Mean PD and CAL in the dialysis group were higher than in the nondialysis group, which was significant (p < 0.001) for the mean PD. The mean improvement of PD and CAL in dialysis patients was 14.31 ± 10.48 and 17.60 ± 7.83%, respectively, and the mean improvement of PD in the nondialysis group was significantly higher than in the dialysis group (p = 0.008). Conclusion Periodontal treatment (scaling) causes more improvement in periodontal clinical parameters in healthy people with periodontitis than in dialysis patients.
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Affiliation(s)
- Vajehallah Raeesi
- Department of Internal Medicine, School of Medicine, Cardiovascular Diseases Research CenterBirjand University of Medical SciencesBirjandIran
| | | | - Ali Naghavi
- Department of Periodontics, School of DentistryBirjand University of Medical SciencesBirjandIran
| | - Ghazale Mozafari
- Department of Periodontics, School of DentistryBirjand University of Medical SciencesBirjandIran
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Taguchi K, Ishiyama K, Ide K, Ohira M, Tahara H, Ohdan H. Simultaneous Liver-Kidney Transplantation in Patient with a History of Heparin-Induced Thrombocytopenia: A Case Report and Literature Review. AMERICAN JOURNAL OF CASE REPORTS 2019; 20:980-987. [PMID: 31285416 PMCID: PMC6640169 DOI: 10.12659/ajcr.916717] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Patient: Male, 58 Final Diagnosis: Heparin-induced thrombocytopenia Symptoms: Liver and kidney failure Medication: — Clinical Procedure: Simultaneous liver-kidney transplantation Specialty: Transplantology
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Affiliation(s)
- Kazuhiro Taguchi
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima City, Hiroshima, Japan.,Institute for Clinical Research, National Hospital Organization, Kure Medical Center and Chugoku Cancer Center, Kure, Hiroshima, Japan
| | - Kohei Ishiyama
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima City, Hiroshima, Japan.,Department of Surgery, National Hospital Organization, Kure Medical Center and Chugoku Cancer Center, Kure, Hiroshima, Japan
| | - Kentaro Ide
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima City, Hiroshima, Japan
| | - Masahiro Ohira
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima City, Hiroshima, Japan
| | - Hiroyuki Tahara
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima City, Hiroshima, Japan
| | - Hideki Ohdan
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima City, Hiroshima, Japan
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Lim JH, Kang KP, Lee S, Park SK, Kim W. Recurrent heparin-induced thrombocytopenia due to heparin rinsing before priming the machine in a hemodialysis patient: A case report. Hemodial Int 2016; 21:E30-E33. [DOI: 10.1111/hdi.12507] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 09/13/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Jin Han Lim
- Department of Internal Medicine; Chonbuk National University Medical School; Jeonju Republic of Korea
| | - Kyung Pyo Kang
- Department of Internal Medicine; Chonbuk National University Medical School; Jeonju Republic of Korea
- Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital; Jeonju Republic of Korea
| | - Sik Lee
- Department of Internal Medicine; Chonbuk National University Medical School; Jeonju Republic of Korea
- Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital; Jeonju Republic of Korea
| | - Sung Kwang Park
- Department of Internal Medicine; Chonbuk National University Medical School; Jeonju Republic of Korea
- Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital; Jeonju Republic of Korea
| | - Won Kim
- Department of Internal Medicine; Chonbuk National University Medical School; Jeonju Republic of Korea
- Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital; Jeonju Republic of Korea
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Zhao D, Sun X, Yao L, Lin H, Li J, Zhao J, Zhang Z, Lun L, Zhang J, Li M, Huang Q, Yang Y, Jiang S, Wang Y, Zhu H, Chen X. The clinical significance and risk factors of anti-platelet factor 4/heparin antibody on maintenance hemodialysis patients: a two-year prospective follow-up. PLoS One 2013; 8:e62239. [PMID: 23646121 PMCID: PMC3639940 DOI: 10.1371/journal.pone.0062239] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Accepted: 03/19/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Heparin-induced thrombocytopenia is an immune response mediated by anti-PF4/heparin antibody, which is clinically characterized by thrombocytopenia and thromboembolic events. In this study, a prospective and multi-center clinical investigation 1) determined the positive rate of anti-PF4/heparin antibody in maintenance hemodialysis patients in China, 2) identified the related risk factors, and 3) further explored the effect of the anti-PF4/heparin antibody on bleeding, thromboembolic events, and risk of death in the patients. METHODS The serum anti-PF4/heparin antibody was measured in 661 patients from nine hemodialysis centers, detected by IgG-specific ELISA and followed by confirmation with excess heparin. Risk factors of these patients were analyzed. Based on a two-year follow-up, the association between the anti-PF4/heparin antibody and bleeding, thromboembolic events, and risk of death in the patients was investigated. RESULTS 1) The positivity rate of the anti-PF4/heparin antibody in maintenance hemodialysis patients was 5.6%. With diabetes as an independent risk factor, the positivity rate of the anti-PF4/heparin antibody decreased in the patients undergoing weekly dialyses ≥3 times. 2) The positivity rate of the anti-PF4/heparin antibody was not related to the occurrence of clinical thromboembolic events and was not a risk factor for death within two years in maintenance hemodialysis patients. 3) Negativity for the anti-PF4/heparin antibody combined with a reduction of the platelet count or combined with the administration of antiplatelet drugs yielded a significant increase in bleeding events. However, the composite determination of the anti-PF4/heparin antibody and thrombocytopenia, as well as the administration of antiplatelet drugs, was not predictive for the risk of thromboembolic events in the maintenance hemodialysis patients. CONCLUSIONS A single detection of the anti-PF4/heparin antibody did not predict the occurrence of clinical bleeding, thromboembolic events, or risk of death in the maintenance hemodialysis patients.
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Affiliation(s)
- Delong Zhao
- Department of Nephrology, Chinese PLA General Hospital, State Key Laboratory of Kidney Disease (2011DAV00088), Beijing, China
| | - Xuefeng Sun
- Department of Nephrology, Chinese PLA General Hospital, State Key Laboratory of Kidney Disease (2011DAV00088), Beijing, China
- * E-mail: (XS); (XC)
| | - Li Yao
- Department of Nephrology, The First Affiliated Hospital, Chinese Medical University, Shenyang, China
| | - Hongli Lin
- Department of Nephrology, The First Affiliated Hospital, Dalian Medical College, Dalian, China
| | - Jijun Li
- Department of Nephrology, The First Affiliated Hospital, General Hospital of PLA, Beijing, China
| | - Jiuyang Zhao
- Department of Nephrology, The Second Affiliated Hospital, Dalian Medical College, Dalian, China
| | - Zhimin Zhang
- Department of Nephrology, General Hospital of the General Headquarters, Beijing, China
| | - Lide Lun
- Department of Nephrology, General Hospital of the Air Force, Beijing, China
| | - Jianrong Zhang
- Department of Nephrology, General Hospital of the Force Police Army, Beijing, China
| | - Mingxu Li
- Department of Nephrology, General Hospital of the Navy, Beijing, China
| | - Qi Huang
- Department of Nephrology, Chinese PLA General Hospital, State Key Laboratory of Kidney Disease (2011DAV00088), Beijing, China
| | - Yang Yang
- Department of Nephrology, Chinese PLA General Hospital, State Key Laboratory of Kidney Disease (2011DAV00088), Beijing, China
| | - Shimin Jiang
- Department of Nephrology, Chinese PLA General Hospital, State Key Laboratory of Kidney Disease (2011DAV00088), Beijing, China
| | - Yong Wang
- Department of Nephrology, Chinese PLA General Hospital, State Key Laboratory of Kidney Disease (2011DAV00088), Beijing, China
| | - Hanyu Zhu
- Department of Nephrology, Chinese PLA General Hospital, State Key Laboratory of Kidney Disease (2011DAV00088), Beijing, China
| | - Xiangmei Chen
- Department of Nephrology, Chinese PLA General Hospital, State Key Laboratory of Kidney Disease (2011DAV00088), Beijing, China
- * E-mail: (XS); (XC)
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Bakchoul T, Greinacher A. Recent advances in the diagnosis and treatment of heparin-induced thrombocytopenia. Ther Adv Hematol 2013; 3:237-51. [PMID: 23606934 DOI: 10.1177/2040620712443537] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Heparin-induced thrombocytopenia (HIT) is a drug-mediated, prothrombotic disorder caused by immunization against platelet factor 4 (PF4) after complex formation with heparin or other polyanions. After their binding to PF4/heparin complexes on the platelet surface, HIT antibodies are capable of intravascular platelet activation by cross-linking Fcγ receptor IIA leading to a platelet count decrease and/or thrombosis. Diagnosis of HIT is often difficult. This, and the low specificity of the commercially available immunoassays, leads currently to substantial overdiagnosis of HIT. Timing of onset, the moderate nature of thrombocytopenia, and the common concurrence of thrombosis are very important factors, which help to differentiate HIT from other potential causes of thrombocytopenia. A combination of a clinical pretest scoring system and laboratory investigation is usually necessary to diagnose HIT. Although HIT is considered to be a rare complication of heparin treatment, the very high number of hospital inpatients, and increasingly also hospital outpatients receiving heparin, still result in a considerable number of patients developing HIT. If HIT occurs, potentially devastating complications such as life-threatening thrombosis make it one of the most serious adverse drug reactions. If HIT is strongly suspected, all heparin must be stopped and an alternative nonheparin anticoagulant started at a therapeutic dose to prevent thromboembolic complications. However, the nonheparin alternative anticoagulants bear a considerable bleeding risk, especially if given to patients with thrombocytopenia due to other reasons than HIT. While established drugs for HIT are disappearing from the market (lepirudin, danaparoid), bivalirudin, fondaparinux and potentially the new anticoagulants such as dabigatran, rivaroxaban and apixaban provide new treatment options.
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Affiliation(s)
- Tamam Bakchoul
- Department of Immunology and Transfusion Medicine, Ernst-Moritz-Arndt niversity, Greifswald, Germany
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Solak Y, Demircioglu S, Polat I, Biyik Z, Gaipov A, Acar K, Turk S. Heparin‐induced thrombocytopenia in a hemodialysis patient treated with fondaparinux: Nephrologists between two fires. Hemodial Int 2012; 17:320-3. [DOI: 10.1111/j.1542-4758.2012.00710.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Yalcin Solak
- Division of Nephrology, Department of Internal Medicine, Meram School of MedicineKonya University Konya Turkey
| | - Sinan Demircioglu
- Department of Internal Medicine, Meram School of MedicineKonya University Konya Turkey
| | - Ilker Polat
- Department of Internal Medicine, Meram School of MedicineKonya University Konya Turkey
| | - Zeynep Biyik
- Division of Nephrology, Department of Internal Medicine, Meram School of MedicineKonya University Konya Turkey
| | - Abduzhappar Gaipov
- Division of Nephrology, Department of Internal Medicine, Meram School of MedicineKonya University Konya Turkey
| | - Kadir Acar
- Division of Hematology, Department of Internal Medicine, Meram School of MedicineKonya University Konya Turkey
| | - Suleyman Turk
- Division of Nephrology, Department of Internal Medicine, Meram School of MedicineKonya University Konya Turkey
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Morel-Kopp MC, Tan CW, Brighton TA, McRae S, Baker R, Tran H, Mollee P, Kershaw G, Joseph J, Ward C. Validation of whole blood impedance aggregometry as a new diagnostic tool for HIT: results of a large Australian study. Thromb Haemost 2012; 107:575-83. [PMID: 22234599 DOI: 10.1160/th11-09-0631] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2011] [Accepted: 12/01/2011] [Indexed: 11/05/2022]
Abstract
Heparin-induced thrombocytopenia (HIT) remains a challenge, with diagnosis confirmed only by functional assays. The gold standard 14C-serotonin release assay (SRA) is highly sensitive but technically challenging and unsuitable for routine use. We conducted a large study to validate whole blood impedance aggregometry (WBIA) as a suitable diagnostic tool for HIT. WBIA and SRA were used to test 181 samples positive for H-PF4 antibodies by PaGIA or ELISA. Using the same high responder donor, 77 samples were positive by WBIA (aggregation with low-dose but not high-dose heparin). Using the strict definition for SRA positivity, 72 samples were true HIT. In nine samples, serotonin release with high-dose heparin dropped by > 50% but was still >20%; these were retested after a one-half dilution and 8/9 became positive. Ten other samples were discrepant between the two assays: one strongly positive (89% release) and six weakly positive samples by SRA (average release 56%) were WBIA negative. When these samples were retested using a random donor, only two remained SRA positive. Three samples were strongly WBIA positive but SRA negative; two were retested by SRA with 0.5IU/ml heparin and one became positive. Under controlled conditions, using the same selected high-responder donor, WBIA and SRA performed similarly with slightly increased sensitivity of the WBIA when using the strict definition of SRA positivity. WBIA is easy to perform with rapid turn-around time and warrants a multi-laboratory trial to complete its validation as a confirmatory assay for platelet-activating HIT antibodies.
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Affiliation(s)
- Marie-Christine Morel-Kopp
- Northern Blood Research Centre, Kolling Institute of Medical Research, University of Sydney, Sydney, Australia.
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Shantsila E, Lip GYH, Chong BH. Heparin-induced thrombocytopenia. A contemporary clinical approach to diagnosis and management. Chest 2009; 135:1651-1664. [PMID: 19497901 DOI: 10.1378/chest.08-2830] [Citation(s) in RCA: 99] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Thrombocytopenia following heparin administration can be associated with an immune reaction, now referred to as heparin-induced thrombocytopenia (HIT). HIT is essentially a prothrombotic disorder mediated by an IgG antiplatelet factor 4/heparin antibody, which induces platelet, endothelial cell, monocyte, and other cellular activation, leading to thrombin generation and thrombotic complications. Indeed, HIT can also be regarded as a serious adverse drug effect. Importantly, HIT can be a life-threatening and limb-threatening condition frequently associated with characteristically severe and extensive thromboembolism (both venous and arterial) rather than with bleeding. This article provides an overview of HIT, with an emphasis on the clinical diagnosis and management.
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Affiliation(s)
- Eduard Shantsila
- Haemostasis Thrombosis and Vascular Biology Unit, University Department of Medicine, City Hospital, Birmingham, UK.
| | - Gregory Y H Lip
- Haemostasis Thrombosis and Vascular Biology Unit, University Department of Medicine, City Hospital, Birmingham, UK
| | - Beng H Chong
- Department of Haematology, St. George Hospital, Kogarah, NSW, Australia; SGCS, University of New South Wales, Kensington, NSW, Australia
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Davenport A. Antibodies to heparin-platelet factor 4 complex: pathogenesis, epidemiology, and management of heparin-induced thrombocytopenia in hemodialysis. Am J Kidney Dis 2009; 54:361-74. [PMID: 19481318 DOI: 10.1053/j.ajkd.2009.03.012] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2009] [Accepted: 03/24/2009] [Indexed: 11/11/2022]
Affiliation(s)
- Andrew Davenport
- UCL Center for Nephrology, University College London Medical School, Royal Free Campus, London, UK.
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