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- Jönsson, Karl, et al.
(författare)
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Glomerular filtration rate in patients with atrial fibrillation on warfarin treatment: A subgroup analysis from the AURICULA registry in Sweden.
- 2011
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Ingår i: Thrombosis Research. - : Elsevier BV. - 1879-2472 .- 0049-3848. ; 128:4, s. 341-345
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: Numerous associations between chronic kidney disease (CKD) and atrial fibrillation (AF) have been reported and patients with CKD on anticoagulation therapy have an increased risk of bleeding. Currently, new anticoagulant agents are emerging in clinical practice, some of which are excreted by the kidneys. The proportion of AF patients on anticoagulant treatment with reduced renal function is, however, unknown. MATERIALS AND METHODS: Using AURICULA, a Swedish registry for anticoagulation, estimated glomerular filtration rate (eGFR) was investigated in AF patients on warfarin treatment (n=2,603). The study group was compared with a healthy sample from the population (n=2,261). Two different creatinine prediction equations were used for calculating eGFR: the Lund-Malmö (LM) and MDRD Study equation. RESULTS: The fraction of AF patients with eGFR <30 and <45ml/min/1.73m(2) were 8.1% and 22.9% with the LM and 4.3% and 16.3% with the MDRD equation, respectively, and significantly higher than corresponding values in the reference population. GFR decreased with increasing age, where 11.4% and 5.6% of AF patients aged≥75years had eGFR <30ml/min/1.73m(2) according to the LM and MDRD equations, respectively. CONCLUSIONS: Severe renal impairment is common among AF patients on anticoagulant treatment with warfarin, especially at higher ages. Monitoring of renal function should be implemented in clinical practice for AF patients treated with new anticoagulants eliminated by the kidneys.
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| 5. |
- Alhadad, Alaa, et al.
(författare)
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Behandling av aterosklerotisk njurartärstenos i förändring. Lågdos ACE-hämmare och angiotensin- receptorblockare motiverat i vissa fall.
- 2009
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Ingår i: Läkartidningen. - 0023-7205. ; 106:44, s. 8-2840
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Forskningsöversikt (refereegranskat)abstract
- Renovascular hypertension (RVH) is the direct consequence of renal artery stenosis (RAS). Most RAS patients have dis¬seminated atherosclerosis, with > 6 times greater risk of cardiovascular death than age-matched controls. Elevated levels of angiotensin II and aldosterone lead to detrimental effects both through hypertensive injury and activation of profibrotic and atherosclerotic pathways. The recent primary report from the ASTRAL study supports the conservative treatment in patients with non-severe RAS (on average 2.8 antihypertensive drugs). Consequently, many patients with RVH will be candidates for ACE inhibitor /ARB. In patients at risk of atherosclerotic RAS, treatment with ACE inhibitors may cause acute renal failure 1-14 days after the initiation of treatment with ACE inhibitors. Determination of serum creatinine is obligatory within two weeks after the administration of ACEi/AII blockers in patients with suspected RVH. In patients with severe hypertension in the presence of other atherosclerotic manifestations unilateral renal artery stenosis should be suspected and further investigated before treatment with ACEi/ARB is initiated.
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| 6. |
- Alhadad, Alaa, et al.
(författare)
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Incidence of nephrogenic systemic fibrosis at a large university hospital in Sweden.
- 2012
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Ingår i: Scandinavian Journal of Urology and Nephrology. - : Informa UK Limited. - 1651-2065 .- 0036-5599. ; 46, s. 48-53
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Tidskriftsartikel (refereegranskat)abstract
- Objective. Nephrogenic systemic fibrosis (NSF) is a rare condition that may follow administration of gadolinium-based contrast media (Gd-CM) in patients with renal insufficiency. This study was initiated to determine the incidence of NSF at Skåne University Hospital, Malmö, in Sweden. Material and methods. During the period January 2001 to December 2008 10 650 patients underwent magnetic resonance imaging (MRI) examinations. The re-expressed four-variable Modification of Diet in Renal Disease (MDRD) equation was used to calculate the estimated glomerular filtration rate (eGFR). The 272 patients with an eGFR <30 ml/min/1.73 m2 who were given Gd-CM were selected for final analysis. A diagnosis of NSF or other dermatological diagnoses in the 272 patients was searched for in the database of the Departments of Dermatology and Pathology. Results. The 272 patients, of whom 26 patients were on dialysis, had undergone 406 MRI examinations with Gd-CM. Mean follow-up time was 3.9 (±2.7 SD) years. Assuming a mean body weight of 70 kg, the overall median dose of the 406 examinations with Gd-CM was 0.14 mmol/kg body weight (0.06, 0.34; 2.5-97.5 percentiles). In this retrospective study of patients with eGFR <30 ml/min/1.73 m(2), none developed NSF (the upper 95% confidence limit for zero cases of NSF in the 272 patients was 2.3%). Conclusion. Although it is premature to claim that Gd-CM using the regimen employed in this institution is safe to use in all patients with eGFR <30 ml/min/1.73 m(2), the results.indicate that development of NSF is extremely uncommon.
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