HEMATOLOGY: ISSUES IN THE DIALYSIS PATIENT: Platelet Dysfunction and End‐Stage Renal Disease

Kaw, Dinkar; Malhotra, Deepak

doi:10.1111/j.1525-139x.2006.00179.x

Cited by 338 publications

(126 citation statements)

References 75 publications

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“…A history of CKD has been reported to be associated with increased risk for re-bleeding in previous studies [15, 17], and it was also a risk factor in our study. The possible mechanisms of bleeding in patients with CKD may be platelet abnormalities and platelet-vessel wall interaction [30, 31]. We also found that a history of CDB would be a risk factor.…”

Section: Discussionmentioning

confidence: 57%

Initial Management of Colonic Diverticular Bleeding: Observational Study

et al. 2018

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Background/Aims: Although colonic diverticular bleeding (CDB) often ceases spontaneously, re-bleeding occurs in about 30%. Bleeding diverticulum can be treated directly by endoscopic hemostasis; however, it is difficult to perform colonoscopy in all cases with limited medical resource and certain risks. The aim of this study was to clarify who should undergo colonoscopy as well as appropriate methods of initial management in CDB patients. Methods: A total of 285 patients who were diagnosed as CDB and underwent colonoscopy from March 2004 to October 2015 were retrospectively analyzed. First, the association between re-bleeding and various factors including patients’ background and initial management were analyzed. Second, the examination conditions that influenced bleeding point identification were analyzed. Results: Of 285 patients, 187 were men and 98 were women. Median age was 75 years, and the median observation period was 17.5 months. Re-bleeding was observed in 79 patients (28%). A history of CDB (OR 2.1, p = 0.0090) and chronic kidney disease (CKD; OR 2.3, p = 0.035) were risk factors, and bleeding point identification (OR 0.20, p = 0.0037) was a preventive factor for re-bleeding. Bleeding point identification significantly reduced approximately 80% of re-bleeding. Furthermore, extravasation on CT (OR 3.7, p = 0.031) and urgent colonoscopy (OR 5.3, p < 0.001) were predictors for identification of bleeding point. Compared to bleeding point identification of 11% in all patients who underwent colonoscopy, identification rate in those who had extravasation on CT and underwent urgent colonoscopy was as high as 70%. Conclusions: Contrast-enhanced CT upon arrival is suggested, and patients with extravasation on CT would be good candidates for urgent colonoscopy, as well as patients who have a history of CDB and CKD.

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Section: Discussionmentioning

confidence: 57%

Initial Management of Colonic Diverticular Bleeding: Observational Study

et al. 2018

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“…The limited quality and heterogeneity of available data mean that all we can reasonably conclude from current evidence is that the baseline incidence of major bleeding in hemodialysis patients is substantially higher than for the general population, and that antiplatelet and anticoagulant use increases this yet further. This is as expected, given that these patients are known to have both preexisting platelet dysfunction and a higher rate of invasive procedures [4]. …”

Section: Introductionsupporting

confidence: 54%

Increased Iron Requirement in Hemodialysis Patients on Antiplatelet Agents or Warfarin

Flint¹,

Taylor²,

Beavis³

et al. 2009

Nephron Clin Pract

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Background/Aims: Many hemodialysis patients receive antiplatelet therapy or warfarin; however, little is known about the effect of this on iron requirements. Given the association of antiplatelet therapy with bleeding we hypothesized that there should be a greater need for iron in such patients, which we tested in this study. Methods: Retrospective 1-year cohort study of 205 chronic hemodialysis patients. The primary outcome variable was total iron dose, which was analyzed according to antiplatelet/warfarin use. Data were also collected on potential confounders, allowing for both unadjusted and adjusted (multiple regression) analysis. Results: 97/205 patients received antiplatelet/warfarin therapy. This group was older, with a higher incidence of macrovascular disease and diabetes and a higher median C-reactive protein (6.0 vs. 3.75 mg/l). Overall, median iron requirement was 1,300 mg/year. In a multiple regression analysis, antiplatelet/warfarin use was associated with an additional iron requirement of 703 mg (95% confidence interval 188–1,220 mg), with the strongest effect observed in patients with normal inflammatory markers. Conclusion: We found a high requirement for iron in patients receiving antiplatelet agents/warfarin. We argue that the most likely mechanism for this association is chronic, low-grade blood loss, although further study is required before causality can be established.

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“…However, to the best of our knowledge, this is the first report demonstrating an independent relationship between HD and early death in ICH patients, adjusted for renal dysfunction. Maintenance HD patients have increased inflammatory activation [21] and disturbances of the coagulation system [22]. Inflammation and blood coagulation abnormalities are known to play a key role in early hematoma expansion and perihematoma brain edema after ICH [23].…”

Section: Discussionmentioning

confidence: 99%

Maintenance Hemodialysis Independently Increases the Risk of Early Death after Acute Intracerebral Hemorrhage

et al. 2013

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Background: It is unknown whether the clinical features and outcomes of intracerebral hemorrhage (ICH) patients who undergo maintenance hemodialysis (HD) at the time of ICH are similar to those of general ICH patients. Methods: We retrospectively examined the medical records of ICH patients admitted to the Stroke Center of Kawasaki Medical School Hospital within 7 days ofICHonset between April 2004 and June 2011. Patients were classed as HD or non-HD, and clinical characteristics were compared between the two groups. ICH volume was measured on admission CT and follow-up CT scan (<24 h after admission). Hematoma enlargement was defined as a hematoma that increased by more than 33% of its initial volume. Early death was defined as all-causedeath within 14 days of ICH onset. The factors associated with early death were determined using multivariate logistic regression analysis. Results: Five hundred and seven patients (320 males; 69.0 years old, interquartile range 59.0-79.0) were enrolled in the study. Thirty-six (7.2%) were receiving maintenance HD at the time of ICH and formed the HD group, and the remaining 471 patients formed the non-HD group. Use of antithrombotic agents prior to ICH was more common in the HD group than in the non-HD group (41.7 vs. 21.9%; p = 0.012). Brainstem (30.6 vs. 11.3%; p = 0.003) and lobar (19.4 vs. 6.6%; p = 0.013) hematoma locations were more common in the HD group than in the non-HD group. Enlargement of ICH volume was more common in the HD group than in the non-HD group (25.8 vs. 10.2%; p = 0.015). Early death was more common in the HD group than in the non-HD group (33.3 vs. 9.3%; p < 0.001). On the multivariate logistic regression analysis adjusted for age, sex and renal dysfunction, National Institutes of Health Stroke Scale score >20 [odds ratio (OR) 27.40, 95% confidence interval (CI) 9.69-77.44; p < 0.001], ICH volume >30 ml (OR 9.53, 95% CI 3.82-23.77; p < 0.001), HD (OR 6.42, 95% CI 1.39-29.76; p = 0.017), the use of antithrombotic agents (OR 3.04, 95% CI 1.22-7.56; p = 0.017) and glucose >150 mg/dl (OR 2.51, 95% CI 1.01-6.26; p = 0.047) were independent factors associated with early death. Conclusion: Maintenance HD is independently associated with early death in ICH patients.

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HEMATOLOGY: ISSUES IN THE DIALYSIS PATIENT: Platelet Dysfunction and End‐Stage Renal Disease

Cited by 338 publications

References 75 publications

Initial Management of Colonic Diverticular Bleeding: Observational Study

Initial Management of Colonic Diverticular Bleeding: Observational Study

Increased Iron Requirement in Hemodialysis Patients on Antiplatelet Agents or Warfarin

Maintenance Hemodialysis Independently Increases the Risk of Early Death after Acute Intracerebral Hemorrhage

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