Japanese Society for Dialysis Therapy Guidelines for Management of Cardiovascular Diseases in Patients on Chronic Hemodialysis

Hirakata, Hideki; Nitta, Kosaku; Inaba, Masaaki; Shoji, Tetsuo; Fujii, Hideki; Kobayashi, Shuzo; Tabei, Kaoru; Joki, Nobuhiko; Hase, Hiroki; Nishimura, Masato; Ozaki, Shigeyuki; Ikari, Yuji; Kumada, Yoshitaka; Tsuruya, Kazuhiko; Fujimoto, Shouichi; Inoue, Tohru; Yokoi, Hiroyoshi; Hirata, Sumio; Shimamoto, Kazuaki; Kugiyama, Kiyotaka; Akiba, Takashi; Iseki, Kunitoshi; Tsubakihara, Yoshiharu; Tomo, Tadashi; Akizawa, Tadao

doi:10.1111/j.1744-9987.2012.01088.x

Cited by 112 publications

(86 citation statements)

References 283 publications

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“…Therefore, the Japanese Society for Dialysis Therapy (JSDT) guidelines recommends that PT-INR be maintained at less than 2.0 in hemodialysis patients who are taking warfarin (16). In our case, the excessive anticoagulation with a PT-INR of 3.91 was due to warfarinization.…”

Section: Discussionmentioning

confidence: 82%

Retroperitoneal Hematoma in a Patient with Advanced Chronic Kidney Disease Receiving Warfarin Therapy

et al. 2016

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A 73-year-old man with chronic kidney disease stage G5 was admitted to our hospital because of a worsening kidney dysfunction. He had undergone prosthetic valve replacement of the mitral valve 5 years previously and was currently taking warfarin. He showed excessive anticoagulation on admission, with a prothrombin time-international normalized ratio (PT-INR) of 3.91. The use of warfarin was ceased and PT-INR decreased to 2.1. Since the patient would need renal replacement therapy, he underwent arteriovenous fistula surgery for hemodialysis access on day 16. However, on day 18, he suddenly complained of lumbago and went into shock. His blood pressure dropped to 73/49 mmHg, and the hemoglobin level fell to 4.9 g/dL.Computed tomography revealed a huge retroperitoneal hematoma. Emergent lumbar artery embolization was performed on two consecutive days; however, the bleeding persisted, with subsequent development of abdominal compartment syndrome with impaired respiratory and cardiovascular function, and the patient died. Autopsy revealed a hematoma measuring 30×20×20 cm involving the psoas muscle and external iliac artery; the hematoma was covered with fibrous tissue instead of muscle. The psoas muscle is supplied by the internal iliac artery; however, a collapsed artery could not be confirmed in our patient. The closest major artery to the hematoma was located at the intersection of the psoas muscle and the external iliac artery. All arteries showed severe atherosclerosis. In patients with advanced chronic kidney disease, anticoagulant therapy should be administered carefully, and the etiology of retroperitoneal hematoma should be further investigated.

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Section: Discussionmentioning

confidence: 82%

Retroperitoneal Hematoma in a Patient with Advanced Chronic Kidney Disease Receiving Warfarin Therapy

et al. 2016

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“…These reports also demonstrated that among the CKD components, a higher urinary protein level was associated with an elevated risk of each outcome. Severity of cerebrovascular disease is more prominent in dialysis patients compared to those with non-dialysis dependent CKD, and brain hematoma after hemorrhagic stroke is larger and the prognosis is poorer in hemodialysis patients [1,2,6].…”

Section: Effect Of Ckd On the Severity Of Cerebrovascular Diseasementioning

confidence: 99%

“…A decrease in blood pressure has been reported to be more pronounced in patients who developed infarction soon after the end of dialysis than those who developed it 6 h or longer after the end of dialysis [1]. The mechanisms of hemodialysis-induced cerebral infarction include a reduction in cerebral blood flow due to increased blood viscosity and a fall in blood pressure associated with water removal or orthopedic hypotension following sitting up or standing up after dialysis.…”

Section: Effect Of a Decrease In Brain Blood Volume On Cerebrovasculamentioning

confidence: 99%

“…2) [17]. In Japan, guidelines for management of cardiovascular disease in patients on chronic hemodialysis published by the Japanese Society for Dialysis Therapy [1] suggest that warfarin therapy should not be routinely performed for atrial fibrillation. However, if considered beneficial, such therapy is desirable to use by maintaining the prothrombin time-international normalized ratio at <2.0.…”

Section: Prevention Of Cerebrovascular Disease Anticoagulant Therapy mentioning

confidence: 99%

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Cerebrovascular disease in end-stage kidney disease

Tsuruya

Fujisaki

2016

Ren Replace Ther

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Chronic kidney disease (CKD) is an independent risk factor for cardiovascular disease and also increases the incidence of cerebrovascular disease. Prevention and management of cerebrovascular disease in patients with CKD, especially endstage kidney disease (ESKD), are different from those without CKD because of their specific pathophysiology. In patients with ESKD on hemodialysis, a decrease in brain blood flow due to a decline in blood pressure during hemodialysis might cause incident cerebrovascular disease. Cerebral microbleeds detected by magnetic resonance imaging, which are much more prevalent in patients with CKD compared with the general population, might also cause incident brain hemorrhage. For management for the hyperacute phase of brain infarction, thrombolytic therapy using recombinant tissue plasminogen activator has been recently indicated for those patients. However, this indication should be carefully evaluated because the risk of adverse events is higher in patients with CKD, especially ESKD. More recently, mechanical thrombectomy has also been applied clinically. However, the efficacy of this treatment remains unknown in CKD and ESKD patients. With regard to prevention, carotid endarterectomy and carotid artery stenting are performed for severe carotid artery stenosis. Similarly to the treatment described above, the indication for these procedures should be carefully evaluated because the incidence of stroke, myocardial infarction, and mortality is considered to be high in patients with CKD. Administration of warfarin to hemodialysis patients with atrial fibrillation is controversial because whether atrial fibrillation is involved in incident brain infarction and whether warfarin prevents cerebrovascular disease remain unknown in those patients. Novel oral anticoagulants are now available but are prohibited in severe CKD patients. Further investigation and accumulation of evidence are required for prevention and management of cerebrovascular disease in patients with CKD, especially ESKD.

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“…However, renin-angiotensin system (RAS) inhibitors, including ARBs, have been reported to induce critical hyperkalemia in normokalemic patients with chronic kidney disease or heart failure [1,2]. In dialysis patients, excessive hyperkalemia has been known as one of the causes of sudden death [3] and hypokalemia lower than 4.0 mEq/L has been reported to be associated with poor prognosis [4]. Therefore, the appropriate control of pre-dialysis serum potassium (K) at a level of 4.6-5.5 mEq/L is important for good prognosis in dialysis patients [5].…”

Section: Introductionmentioning

confidence: 99%

Impact of serum potassium on therapeutic prognosis of maintenance hemodialysis patients on angiotensin receptor antagonists

et al. 2016

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Background: In chronic kidney disease patients, angiotensin receptor blockers (ARBs) have been known to increase serum potassium (K) levels. On the other hand, it has been reported that in patients on maintenance dialysis, both hyperkalemia and hypokalemia were related to poor prognosis. In this study, the prognosis with ARB treatment was investigated using a prospective cohort of dialysis patients that were divided into two groups according to pre-dialysis serum K levels: these were the low serum K group (below 4.6 mEq/L) and the high serum K group (4.6 mEq/L and higher).

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Japanese Society for Dialysis Therapy Guidelines for Management of Cardiovascular Diseases in Patients on Chronic Hemodialysis

Cited by 112 publications

References 283 publications

Retroperitoneal Hematoma in a Patient with Advanced Chronic Kidney Disease Receiving Warfarin Therapy

Retroperitoneal Hematoma in a Patient with Advanced Chronic Kidney Disease Receiving Warfarin Therapy

Cerebrovascular disease in end-stage kidney disease

Impact of serum potassium on therapeutic prognosis of maintenance hemodialysis patients on angiotensin receptor antagonists

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