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Greater decline in renal function with warfarin in A-fib - Medical Xpress
Greater decline in renal function with warfarin in A-fib

(HealthDay)—For patients with atrial fibrillation, decline in renal function is significantly greater with warfarin versus dabigatran etexilate (DE), according to a study published in the June 16 issue of the Journal of the American College of Cardiology.

Michael Böhm, M.D., from the Universitätsklinikum des Saarlandes in Homburg, Germany, and colleagues examined changes in (GFR) during long-term treatment with or DE in 18,113 patients enrolled in the Randomized Evaluation of Long Term Anticoagulation Therapy trial. Participants were randomized to DE (110 mg or 150 mg twice daily) or warfarin and followed for up to 30 months.

The researchers observed a decrease in GFR in all treatment groups. The mean decline in GFR was significantly greater with warfarin (?3.68 ml/min) versus DE 110 mg (?2.57 ml/min; P = 0.0009 versus warfarin) or DE 150 mg (?2.46 ml/min; P = 0.0002 versus warfarin), after an average of 30 months. In the observation period >18 months, the likelihood of a decrease in GFR >25 percent was lower with DE 110 mg (hazard ratio, 0.81; P = 0.017) or DE 150 mg (hazard ratio, 0.79; P = 0.0056) versus warfarin. The decline in GFR was more pronounced with previous warfarin use and presence of diabetes. "Patients with receiving exhibited a decline in that was greater in those taking warfarin versus DE, and it was amplified by diabetes and previous vitamin K antagonist use," the authors write. Several authors disclosed financial ties to the pharmaceutical industry.
Explore further: Post-CABG predictors of stroke identified for diabetes patients More information: Full Text (subscription or payment may be required)
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Journal reference: Journal of the American College of Cardiology 4 shares Copyright © 2015 HealthDay. All rights reserved.

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Dialysis Market Global Research Trends, Size, Segments And Opportunities ... - Medgadget.com (blog)
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Global Dialysis MarketReport: 2015 Edition provides information on pricing, market analysis, shares, forecast, and company profiles for key industry participants. – MarketResearchReports.biz

To Read the Complete Report with Toc Visit: http://www.marketresearchreports.biz/analysis/245499

Dialysis is the artificial process of eliminating waste and unwanted water from the blood. It is carried out by using a special fluid called dialysate, a mixture of pure water and chemicals, is carefully controlled to pull wastes out of your blood without removing substances your body needs. There are two types of dialysis: hemodialysis and peritoneal dialysis. Hemodialysis removes wastes and water by circulating blood outside the body through an external filter, called a dialyzer and in peritoneal dialysis, wastes and water are removed from the blood inside the body using the peritoneum as a natural semipermeable membrane.

End stage renal disease (ESRD) is the last stage of chronic kidney disease. This is the situation when kidney is functioning below 10% of their normal function and they can no longer support a person’s day to day life. The common causes of ESRD include high blood pressure, atherosclerosis, and genetic disorders. ESRD treatment is carried out either by dialysis or kidney transplant.

The report analyzes the global and regional dialysis markets. Some of the factors driving the growth of dialysis market include: growing number of diabetic patients, increasing dialysis population and incidences of chronic and infectious diseases which has further increased the healthcare expenditure and pharmaceutical sales. Market dynamics like key trends and development, challenges and growth drivers are discussed in detail. The key players having the vicious competition with each other are: DaVita, Baxter, and Fresenius. These players are being profiled in the report along with their key financials and strategies for growth.

Download The sample Copy Of This Report: http://www.marketresearchreports.biz/sample/sample/245499

By combining SPSS Inc.’s data integration and analysis capabilities with our relevant findings, we have predicted the future growth of the market. We employed various significant variables that have an impact on this industry and created regression models with SPSS Base to determine the future direction of the industry. Before deploying the regression model, the relationship between several independent or predictor variables and the dependent variable was analyzed using standard SPSS output, including charts, tables and tests.

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Bladen County man celebrates 2500 dialysis treatments - WECT-TV6
BLADEN COUNTY, NC (WECT) - This week marks a unique milestone for a Bladen County man. On Monday, Marvin Burney received his 2,500th dialysis treatment. He celebrated with cake.

It's a rare celebration. The average life expectancy on dialysis is 5-10 years.

Burney has now been on dialysis for 20 years, much of it is done at home.

"I put in about 15 hours a week doing dialysis and taking care of my machine," Burney says. "That's not a bad trade-off for all of the other hours in the week when I'm very 'normal' and have a very good life."

He discovered his kidney problems in 1995.

"I thought I had a bad case of the flu, but I never could shake it," Burney says.

He was in complete kidney failure.

"I had my first dialysis treatment four days later at Duke Hospital," he says.

In July of 2000, he received his first kidney transplant. His donor was no stranger. It was his wife, Marsha. While she was a match, doctors at Duke said she was a 'low match." Still, they rolled the dice.

"Against the odds, this transplant contracted the same disease that destroyed my original kidneys," Burney says.

The transplant was short-lived. By 2003, he was back on dialysis. He would continue to get the treatments for 7 1/2 years until receiving a second kidney, this time from a stranger. It was from a young man who died as a registered donor.

"It was a 'perfect match' kidney, and I was very lucky," Burney says. I had this kidney for 4 1/2 years before I lost it this past January."

The same disease that claimed his original kidneys and the one from his wife, destroyed his second transplant. Just recently, he was denied the chance to sign up for a third.

Burney says while he's disappointed, dialysis is not a way of life for him, rather a small part of it.

Burney says he hopes the snapshot of his celebration of 2500 treatments will not be a deterrent to someone just learning that they have kidney disease, rather a sign of hope.

"Most importantly, dialysis is NOT, NOT, NOT a 'death sentence.' It is a chance for a little more LIFE. Make it a quality life and keep a positive attitude."

Copyright 2015 WECT. All rights reserved.

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Exercise During Dialysis Delivers Major Gains - Medscape

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Medscape uses cookies to customize the site based on the information we collect at registration. The cookies contain no personally identifiable information and have no effect once you leave the Medscape site.

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Oral anticoagulation linked to renal function decline in elderly - Healio

Elderly patients with atrial fibrillation who received treatment with warfarin or dabigatran experienced a decline in renal function, according to results of a post-hoc analysis of the RE-LY study.

At 30-month follow-up, the observed decline in renal function was greater among patients treated with warfarin compared with dabigatran (Pradaxa, Boehringer Ingelheim). Further, the change in renal function was most pronounced among patients previously treated with vitamin K antagonists and in those with diabetes.

Researchers analyzed changes in glomerular filtration rate during long-term anticoagulation treatment among 16,490 patients with AF enrolled in the RE-LY trial. Of those, 5,594 had received treatment with warfarin, 5,424 had received dabigatran 110 mg and 5,472 had received dabigatran 150 mg. Each patient had creatinine measurements collected at baseline and during one or more follow-up visits. Observation periods ranged from 12 to 37 months.

Regardless of treatment, all patients experienced a decline in glomerular filtration rate during oral anticoagulation treatment. The mean decline after an average of 30 months of follow-up was greater among those treated with warfarin (–3.68 mL/min) compared with dabigatran 110 mg (–2.57 mL/min; P = .0009 vs. warfarin) and dabigatran 150 mg (–2.46 mL/min; P = .0002 vs. warfarin).

The treatment groups did not differ significantly with regard to glomerular filtration rate during the first 18 months. Later in the observation period, patients treated with dabigatran 110 mg or 150 mg were significantly less likely than those treated with warfarin to exhibit a decrease in glomerular filtration rate of greater than 25% (HR = 0.81; 95% CI, 0.69-0.96 for 110 mg; HR = 0.79; 95% CI, 0.68-0.93 for 150 mg). The researchers also noted that the glomerular filtration rate was further decreased among patients who spent less than 65% of the time in therapeutic range, both at 24 and 30 months (P <.005 for all).

Patients with diabetes had a lower glomerular filtration rate compared with those without diabetes at baseline and experienced a greater decline during treatment with oral anticoagulation. Among those with diabetes, the decline in glomerular filtration rate was significantly greater during treatment with warfarin compared with dabigatran (P < .005).

The researchers also observed a more pronounced decline in glomerular filtration rate among patients who had previously used vitamin K antagonists compared with those who did use vitamin K antagonists.

“The decline in renal function with both treatments indicates the need for monitoring of renal function at regular intervals … during oral anticoagulation treatment with warfarin as well as with [dabigatran],” the researchers wrote. “The more rapid reduction in renal function during warfarin treatment may be relevant in the selection of anticoagulants for long-term treatment.”

In a related editorial published in the Journal of the American College of Cardiology, Richard W. Asinger, MD,and Gautam R. Shroff, MBBS, from the division of cardiology at Hennepin County Medical Center and the University of Minnesota, Minneapolis, noted that this study “raises provocative questions” about the influence of pharmacotherapy for AF on renal function, but also indicates that the decrease in glomerular filtration rate among patients treated with warfarin does not outweigh the benefits of its use.

“The extraordinarily large number of patients from the RE-LY trial needed to demonstrate these findings highlight the fact that any absolute reduction in [estimated glomerular filtration rate] with warfarin is really quite modest compared with both doses of dabigatran,” Asinger and Shroff wrote. “Thus, even though these observations probably are not a ‘game-changer’ for clinicians, fine-tuning of clinical practice would be appropriate with attention to these findings.” – by Adam Taliercio

Disclosure:The researchers report receiving scientific support from Boehringer Ingelheim. Asinger reports serving as a member of the data and safety monitor board for the Watchman trials, Boston Scientific. Shroff reports no relevant financial disclosures.

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