Abstract:
PURPOSE OF REVIEW:Non-valvular atrial fibrillation is common in patients with severe chronic kidney disease (CKD) and historically patients have been treated with vitamin K antagonists (VKA). However, these agents have questionable efficacy and are associated with increased bleeding risk. Non-vitamin K oral anticoagulants (NOAC) have advantages over VKA in early stage CKD. In this review, we sought to establish evidence for best practice in patients with severe CKD (creatinine clearance <30 ml/min including dialysis patients) and nonvalvular atrial fibrillation. RECENT FINDINGS:Registry studies have shown that the relative risk of stroke in untreated atrial fibrillation in dialysis patients is lower than in patients in the general population, but VKA are associated with increased haemorrhagic stroke in this high-risk population. A large meta-analysis of dialysis patients found no benefit of VKA in reducing stroke, but an increased bleeding risk. However, studies from Scandinavia have emphasized that risk of VKA are mitigated by increasing the time in anticoagulant therapeutic range (TTR). The consensus from the Kidney Disease: Improving Global Outcomes conference on arrhythmia in CKD was that if dialysis patients required OAC for atrial fibrillation then apixaban could be considered in preference to VKA. SUMMARY:Best practice prophylaxis against stroke risk in dialysis patients with atrial fibrillation is still an area of uncertainty. If OAC is indicated because of high risk, then treatment options include VKA with careful attention to increased TTR, or reduced dose apixaban, which would be off label in Europe. No RCT evidence currently exists to guide therapy, but RCTS of apixaban versus VKA in dialysis patients are currently underway.
journal_name
Curr Opin Nephrol Hypertensjournal_title
Current opinion in nephrology and hypertensionauthors
Kalra PA,Burlacu A,Ferro CJ,Covic Adoi
10.1097/MNH.0000000000000443subject
Has Abstractpub_date
2018-11-01 00:00:00pages
420-425issue
6eissn
1062-4821issn
1473-6543journal_volume
27pub_type
杂志文章,评审abstract:PURPOSE OF REVIEW:Hypertension is an important risk factor for adverse cardiovascular and renal outcomes particularly in patients with chronic kidney disease. This review compares blood pressure measurements obtained in the clinic with those obtained outside the clinic to predict cardiovascular and renal injury and out...
journal_title:Current opinion in nephrology and hypertension
pub_type: 杂志文章,评审
doi:10.1097/01.mnh.0000222700.14960.18
更新日期:2006-05-01 00:00:00
abstract:PURPOSE OF REVIEW:This review examines recent advances in understanding of how clinical outcomes for hemodialysis patients may be improved by achieving longer or more frequent treatment times, lower ultrafiltration rates (UFRs), improving nutritional status, and individualizing dialysate composition. This review also d...
journal_title:Current opinion in nephrology and hypertension
pub_type: 杂志文章,评审
doi:10.1097/MNH.0b013e328365b34c
更新日期:2013-11-01 00:00:00
abstract::Volume regulatory mechanisms are reviewed for both short- and long-term adaptation of renal cells to anisotonic media. Within minutes after exposure to hypotonic solutions a common feature of many renal cells is the increase in plasma membrane potassium and chloride conductances. Although extrusion of intracellular po...
journal_title:Current opinion in nephrology and hypertension
pub_type: 杂志文章
doi:10.1097/00041552-199609000-00007
更新日期:1996-09-01 00:00:00
abstract::The parathyroid hormone (PTH)/parathyroid hormone-related peptide (PTHrP) receptor belongs to a newly discovered family of G protein-coupled receptors. Members of this family, which have been isolated from mammals, include the receptors for PTH/PTHrP, calcitonin, secretin, growth hormone-releasing hormone, vasoactive ...
journal_title:Current opinion in nephrology and hypertension
pub_type: 杂志文章,评审
doi:
更新日期:1994-07-01 00:00:00
abstract:PURPOSE OF REVIEW:Patients with chronic kidney disease (CKD) have an increased risk of hyperkalemia that increases both short-term and long-term mortality. Historically, managing hyperkalemia has relied upon dietary modifications, augmentation of urinary potassium excretion and enhanced enteral potassium elimination. T...
journal_title:Current opinion in nephrology and hypertension
pub_type: 杂志文章,评审
doi:10.1097/MNH.0000000000000320
更新日期:2017-05-01 00:00:00
abstract:PURPOSE OF REVIEW:We discuss how recent findings obtained in disorders of phosphate metabolism in humans and in animal models have provided insights into the pathogenesis of renal stone formation and bone demineralization. RECENT FINDINGS:Mice that are null for the sodium-phosphate cotransporter (NPT)2a gene (NPT2a(-/...
journal_title:Current opinion in nephrology and hypertension
pub_type: 杂志文章,评审
doi:10.1097/00041552-200411000-00015
更新日期:2004-11-01 00:00:00
abstract::Tests have become available that not only give an index of iron stores and availability but also provide an integrated assessment of the efficacy of its utilization. This has allowed the revision of previously accepted criteria of iron deficiency as well as the most appropriate strategies for iron administration. By o...
journal_title:Current opinion in nephrology and hypertension
pub_type: 杂志文章,评审
doi:10.1097/00041552-200011000-00013
更新日期:2000-11-01 00:00:00
abstract:PURPOSE OF THIS REVIEW:To discuss new insights regarding chronic antibody-mediated rejection (CAMR) and its progression to transplant glomerulopathy. We will describe the progression to transplant glomerulopathy from a histologic perspective and provide updates on what is known about its pathophysiology, prognosis, and...
journal_title:Current opinion in nephrology and hypertension
pub_type: 杂志文章,评审
doi:10.1097/MNH.0000000000000070
更新日期:2014-11-01 00:00:00
abstract:PURPOSE OF REVIEW:The direct oral anticoagulants (DOACs) have emerged as an effective and safe alternative to vitamin K antagonists (VKAs) for stroke and venous thromboembolism (VTE) prevention. However, patients with chronic kidney disease (CKD) experience an increase in the risk of both thromboembolism and bleeding, ...
journal_title:Current opinion in nephrology and hypertension
pub_type: 杂志文章,评审
doi:10.1097/MNH.0000000000000493
更新日期:2019-05-01 00:00:00
abstract::The ability to record sympathetic nerve activity in conscious human subjects using intraneural microelectrodes (microneurography) has proven to be a powerful clinical research tool, which has shed new light on the pathophysiology of important blood pressure problems as exemplified in studies of patients with chronic r...
journal_title:Current opinion in nephrology and hypertension
pub_type: 杂志文章,评审
doi:10.1097/00041552-199411000-00014
更新日期:1994-11-01 00:00:00
abstract:PURPOSE OF REVIEW:Simultaneous liver kidney transplantation (SLK) has taken center stage since the initiation of the new kidney allocation system (KAS). This review places SLK in the context of the changing landscape of organ allocation. RECENT FINDINGS:The introduction of the Mayo End-Stage Liver Disease score into l...
journal_title:Current opinion in nephrology and hypertension
pub_type: 杂志文章,评审
doi:10.1097/MNH.0000000000000260
更新日期:2016-11-01 00:00:00
abstract:PURPOSE OF REVIEW:There has been significant progress in our understanding of the structural and functional properties and regulation of the electrogenic sodium bicarbonate cotansporter NBCe1, a membrane transporter that plays a key role in renal acid-base physiology. The NBCe1 variant NBCe1-A mediates basolateral elec...
journal_title:Current opinion in nephrology and hypertension
pub_type: 杂志文章,评审
doi:10.1097/MNH.0b013e328363ff43
更新日期:2013-09-01 00:00:00
abstract:PURPOSE OF REVIEW:Renal acid-base homeostasis, to a very large extent, depends on renal ammonia production and transport. A putative ammonia transporter family of proteins has recently been identified, and at least two members of this family are expressed in the renal connecting segment and collecting duct. The purpose...
journal_title:Current opinion in nephrology and hypertension
pub_type: 杂志文章,评审
doi:10.1097/00041552-200409000-00009
更新日期:2004-09-01 00:00:00
abstract::The immunosuppressants cyclosporine and FK506 (tacrolimus) are extremely potent inhibitors of T-lymphocyte activation. Recent studies have shown that these agents are actually prodrugs that become active only when bound to specific members of the cyclophilin or FK506 binding protein receptor gene families. The cyclosp...
journal_title:Current opinion in nephrology and hypertension
pub_type: 杂志文章,评审
doi:10.1097/00041552-199212000-00008
更新日期:1992-12-01 00:00:00
abstract:PURPOSE OF REVIEW:Frailty is highly prevalent in the dialysis population and is associated with mortality. Recent studies have suggested that other dialysis outcomes are compromised in frail individuals. While we do not yet have a consensus as to the best measure of frailty, identification of these poor outcomes and th...
journal_title:Current opinion in nephrology and hypertension
pub_type: 杂志文章,评审
doi:10.1097/MNH.0000000000000364
更新日期:2017-11-01 00:00:00
abstract:PURPOSE OF REVIEW:Both cognitive and physical function are commonly impaired in individuals with chronic kidney disease (CKD), resulting in important impacts on their quality of life and overall health. This review summarizes the burden of cognitive and physical impairment in CKD, focusing on recent research that highl...
journal_title:Current opinion in nephrology and hypertension
pub_type: 杂志文章,评审
doi:10.1097/01.mnh.0000444821.87873.7b
更新日期:2014-05-01 00:00:00
abstract::There has been an increasing focus on renovascular disease, particularly in renal failure, and on the role of renal angioplasty and stenting. Significant improvements have occurred in non-invasive imaging techniques. This review concentrates on the recent developments in imaging that specifically targets the renal art...
journal_title:Current opinion in nephrology and hypertension
pub_type: 杂志文章,评审
doi:10.1097/00041552-200211000-00011
更新日期:2002-11-01 00:00:00
abstract:PURPOSE OF REVIEW:The renin-angiotensin system plays an important role in cardiovascular disease via the production of angiotensin II. Over the past decades, however, more and more evidence has accumulated suggesting an important role for another angiotensin: Angiotensin-(1-7) [Ang-(1-7)]. In this review, we discuss th...
journal_title:Current opinion in nephrology and hypertension
pub_type: 杂志文章,评审
doi:10.1097/MNH.0000000000000050
更新日期:2014-09-01 00:00:00
abstract:PURPOSE OF REVIEW:With the increasing incidence and prevalence of ESRD in the elderly, we are now transplanting more elderly patients. Although we know from previous reports that transplantation provides increased survival advantage and/or quality of life when compared to being on dialysis, we also know that transplant...
journal_title:Current opinion in nephrology and hypertension
pub_type: 杂志文章,评审
doi:10.1097/MNH.0000000000000548
更新日期:2019-11-01 00:00:00
abstract:PURPOSE OF REVIEW:In advanced chronic kidney disease (CKD) patients with progressive uremia, dialysis has traditionally been the dominant treatment paradigm. However, there is increasing interest in conservative and preservative management of kidney function as alternative patient-centered treatment approaches in this ...
journal_title:Current opinion in nephrology and hypertension
pub_type: 杂志文章
doi:10.1097/MNH.0000000000000670
更新日期:2021-01-01 00:00:00
abstract::Mesangial cells possess Ca(2+)-activated Cl- channels, Ca(2+)-activated K+ channels, voltage-gated Ca2+ channels, ATP-sensitive K+ channels, and two types of nonselective cation channels. Angiotensin II and arginine vasopressin depolarize the membrane. This membrane depolarization is caused by the activation of Ca(2+)...
journal_title:Current opinion in nephrology and hypertension
pub_type: 杂志文章,评审
doi:10.1097/00041552-199409000-00007
更新日期:1994-09-01 00:00:00
abstract:PURPOSE OF REVIEW:Autonomic dysfunction is well recognized in chronic kidney disease. The baroreflex arc is an important component of the autonomic nervous system and influences vasodilatation and heart rate in response to information derived from baroreceptors located in the aorta and common carotid arteries. Appropri...
journal_title:Current opinion in nephrology and hypertension
pub_type: 杂志文章,评审
doi:10.1097/01.mnh.0000185981.02578.0e
更新日期:2005-11-01 00:00:00
abstract:PURPOSE OF REVIEW:This review summarizes recent advances in the understanding of the molecular physiology and regulation of the thiazide-sensitive sodium-chloride cotransporter (NCC). RECENT FINDINGS:Mutations of with-no-lysine (WNK) kinases 1 and 4 result in hyperactivity of NCC and familial hyperkalemic hypertension...
journal_title:Current opinion in nephrology and hypertension
pub_type: 杂志文章,评审
doi:10.1097/MNH.0b013e32832f2fcb
更新日期:2009-09-01 00:00:00
abstract:PURPOSE OF REVIEW:To summarize recent evidence regarding the role of distal nephron segments other than the macula densa in sensing the tubular environment and transmitting this signal to the adjacent vasculature. RECENT FINDINGS:In addition to the classical contact site between the macula densa plaque and the afferen...
journal_title:Current opinion in nephrology and hypertension
pub_type: 杂志文章,评审
doi:10.1097/MNH.0b013e32831daf54
更新日期:2009-01-01 00:00:00
abstract:PURPOSE OF REVIEW:The examination of urine sediment is a diagnostic test which is frequently neglected by nephrologists. With this review the authors wanted to demonstrate that it can provide useful and relevant information in a wide spectrum of clinical situations. RECENT FINDINGS:The authors reviewed the main contri...
journal_title:Current opinion in nephrology and hypertension
pub_type: 杂志文章,评审
doi:10.1097/00041552-200311000-00009
更新日期:2003-11-01 00:00:00
abstract::The target hematocrit to be achieved when treating anemia in hemodialysis patients with erythropoietin is controversial. Current evidence-based recommendations suggest a target hematocrit range of 33% to 36%. Small studies suggest that normalization of hematocrit with erythropoietin may benefit hemodialysis patients i...
journal_title:Current opinion in nephrology and hypertension
pub_type: 杂志文章,评审
doi:10.1097/00041552-199909000-00007
更新日期:1999-09-01 00:00:00
abstract:PURPOSE OF REVIEW:Hyperphosphatemia remains an important aspect in the management of end-stage renal disease patients. Consequently, there is a need for new, efficient and well-tolerated phosphate binders. In this review, a new phosphate-binding drug, lanthanum carbonate, with an attractive preclinical efficacy profile...
journal_title:Current opinion in nephrology and hypertension
pub_type: 杂志文章,评审
doi:10.1097/01.mnh.0000133973.86816.e9
更新日期:2004-07-01 00:00:00
abstract:PURPOSE OF REVIEW:Membranous nephropathy is an autoimmune disease caused by antibodies mostly directed to podocyte antigens. PLA2R and THSD7A antigens were described in 2009 and 2014 using classical immunochemical techniques. In the last 2 years, thanks to the combination of laser microdissection of glomeruli and mass ...
journal_title:Current opinion in nephrology and hypertension
pub_type: 杂志文章
doi:10.1097/MNH.0000000000000697
更新日期:2021-01-21 00:00:00
abstract:PURPOSE OF REVIEW:microRNAs (miRNAs) are short noncoding RNAs that function as sequence-specific inhibitors of gene expression. Autosomal dominant polycystic kidney disease (ADPKD) is the most frequent genetic cause of end-stage kidney failure with limited treatment options. The realization that miRNA upregulation, and...
journal_title:Current opinion in nephrology and hypertension
pub_type: 杂志文章,评审
doi:10.1097/MNH.0000000000000333
更新日期:2017-07-01 00:00:00
abstract:PURPOSE OF REVIEW:Assessment of fluid status to reach normovolemia in patients with chronic kidney disease (CKD) continues to be a tough task. Besides clinical observation, technological methods have been introduced, yet, the best approach is still uncertain. The present review looks at fluid overload in CKD from three...
journal_title:Current opinion in nephrology and hypertension
pub_type: 杂志文章
doi:10.1097/MNH.0000000000000640
更新日期:2020-11-01 00:00:00