Renal disease among males with haemophilia

Kulkarni, Roshni; Soucie, J. Michael; Evatt, Bruce L.

doi:10.1046/j.1351-8216.2003.00821.x

Cited by 89 publications

(87 citation statements)

References 22 publications

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“…Another possible explanation could be the increased risk of chronic kidney disease in elderly hemophilia patients [20]. Kulkarni et al [20] noted a strong association between hypertension with chronic kidney disease, which is not unexpected, given that renal disease is known to cause hypertension.…”

Section: Discussionmentioning

confidence: 97%

Cardiovascular disease risk factors

Lim¹,

Pruthi

2011

Blood Coagulation & Fibrinolysis

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With increasing longevity, the prevalence of cardiovascular disease (CVD) risk factors in hemophilia patients is expected to increase; however, evidence-based guidelines on management are lacking. The aim of the study was to determine the prevalence and management of CVD risk factors in hemophilia patients. A retrospective study of 58 adult hemophilia patients (≥35 years) attending Mayo Comprehensive Hemophilia Center between 1 January 2006 and 15 October 2009 were reviewed. The prevalence of CVD risk factors was hypertension 65.5%, diabetes 10.3%, smoking 12.5% and obesity 19.6%. A total of 31% did not have a lipid profile on record. Management of risk factors included antihypertensive medications in 84.2% and lipid-lowering agents in 12.1%. During their medical evaluation, four of seven active smokers received smoking cessation counseling and four of 11 obese patients received lifestyle modification advice. Eight patients (13.8%) experienced a CVD event: myocardial infarction (MI) (n=3), coronary artery disease (n=2), both MI and ischemic stroke (n=1) and hemorrhagic strokes (n=2). Only five of eight patients were on low-dose aspirin, of which aspirin was discontinued in one patient after he was diagnosed with hemophilia following a bleeding work-up. Another patient on dual antiplatelet therapy post stent placement developed epistaxis resulting in clopidogrel cessation. Hemophilia patients are at risk for CVD, similar to the general age-matched male population. Screening for CVD risk factors, with preventive dietary and pharmacologic interventions, play a key role in the prevention and long-term management of CVD. Collaborative efforts between primary care providers, cardiologists and hemophilia center specialists remain essential in managing these complex patients.

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Section: Discussionmentioning

confidence: 97%

Cardiovascular disease risk factors

Lim¹,

Pruthi

2011

Blood Coagulation & Fibrinolysis

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“…This is not unexpected because if, on one hand, PWHs may be protected from thrombus formation by their hypocoagulability, on the other hand, they are exposed at least as much as normal males to such risk factors for atherosclerosis as aging, smoking, and overweight. 51 Other risk factors, such as hypertension, physical inactivity, and chronic renal disease, 52 may be even more frequent in PWHs than in the general aging population. Finally, HIV infection and cART may per se increase the risk of the metabolic syndrome, diabetes, renal insufficiency, and hence of atherothrombotic diseases.…”

Section: Cardiovascular Diseasementioning

confidence: 99%

“…52 Hence, there may be an increasing need to resort to dialysis. In theory, peritoneal dialysis is preferable to hemodialysis because it does not require the placement of an arterovenous fistula or the administration of heparin to prevent clot formation in the dialyzer, so that coverage with replacement therapy is needed only at the time of catheter insertion.…”

Section: Other Morbidities In Elderly Persons With Hemophiliamentioning

confidence: 99%

How I treat age-related morbidities in elderly persons with hemophilia

Mannucci

Schutgens

Santagostino

et al. 2009

Blood

165

191

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In persons with hemophilia, life expectancy is now approaching that of the general male population, at least in countries that can afford regular replacement therapy with coagulation factor concentrates. The new challenges for comprehensive treatment centers are thus to provide optimal health care for this aging population of patients, who often present not only with the comorbidities typically associated with hemophilia (arthropathy, chronic pain, blood-borne infections), but also with common age-related illnesses such as cardiovascular disease and cancer. There are no evidence-based guidelines for the management of these conditions, which often require drugs that interfere with hemostasis, enhance the bleeding tendency, and warrant more intensive replacement therapy. At the moment, elderly patients with hemophilia affected by other diseases should be managed like their age-group peers without hemophilia, provided replacement therapy is tailored to the heightened risk of bleeding associated with the need for invasive procedures and drugs that further compromise the deranged hemostasis. More detailed advice is provided on the schedules of replacement therapy needed to tackle cardiovascular diseases, such as acute coronary syndromes and nonvalvular atrial fibrillation, because these conditions will become more and more frequent challenges for the comprehensive treatment centers. (Blood. 2009;114: 5256-5263)

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“…Regarding hematuria and its effects on the kidney which is still unknown, 15 among the patients in this study with HBDs, 11 (1.8%) had periodic hematuria; only 1 patient (0.2), however, had chronic renal disease and required dialysis. Khleif et al determined the prevalence of chronic renal disease to be 8% in their study.…”

Section: Discussionmentioning

confidence: 99%