Hypertension and nephrology

[Anticoagulation in hemodialysis]

LADÁNYI Erzsébet

JULY 29, 2021

Hypertension and nephrology - 2021;25(01 klsz)



Further articles in this publication

Hypertension and nephrology

[ Epidemiology of dialysis patients]


Hypertension and nephrology

[Hemodialízis, hemodiafiltráció, hemofiltráció – alapfogalmak]


Hypertension and nephrology

[Chronic dialysis as a process]


Hypertension and nephrology

[Indication for dialysis in chronic kidney disease]


Hypertension and nephrology

[Modalities of chronic dialysis treatment in the care of end-stage renal disease]


All articles in the issue

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[Practical aspects of anticoagulant treatment during the COVID-19 pandemic]


[Coronavirus infection has a multiple im­pact on the coagulation system and anti­coagulant therapies. Patients admitted with COVID-19 have un­usually high incidence of coagulation ab­normalities. The incidence of atrial fibrillation (AF) seems also to be more frequent among COVID-19 out- and especially in-patients. Among COVID-19 patients receiving oral anticoagulant therapy, for minimizing the risk of bleeding or thromboembolic complications there should also be considered the renal and hepatic functions and drug-drug interactions of oral anticoagulant and COVID-19 therapy. In case of direct anticoagulants, in addition to the benefits of better safety, more favorable treatment ad­he­rence, and fixed dosing, the use of this class of drugs does not require laboratory mo­nitoring of efficacy, which may be of exp­licit benefit in terms of social distancing and health network burdens. This study reviews the possible interactions of drugs used for viral infection and anticoagulation, and in addition to the issues of coagulopathy associated with COVID-19, we discuss also the concerning difficulties of continued anticoagulant therapy related to the social distancing measures.]

Hypertension and nephrology

[Dialyzed patients with Covid-19 infection in Hungary in 2020]


[We have observed the number and mortality of dialyzed patients with Covid-19 infection in 2020 in Hungary. We have summarized all of 54 dialysis facility where adult patients were treated. During the year, 1242 cases of infection were confirmed in patients undergoing dialysis. 16% (753/4704) of incident dialysis patients were infected. The number of dialysis patients with all Covid-19 infections was 1995. 31.1% of infected patients have died. The mortality was higher in large hemodialysis centers (patient transport, isolation difficulties, increased risk of contamination). Covid-19 positive patients treated with peritoneal dialysis (PD) had significantly lower mortality than those treated with hemodialysis (HD). Chronic kidney disease (CKD) is the most common risk factor for serious Covid-19 infections worldwide, which is why these patients require increased attention (especially for dialysis and transplant recipients). In 2020, there was no vaccine available in our country]

Hypertension and nephrology

[Risk of drug-drug interactions in hemodialyzed patien]

SZABÓ Alexandra, HARIS Ágnes

[Hemodialysis patients usually need large number of medications fór treatment of their multiple comorbidities. Because of the polypharmacy we have to count on several drug-drug interactions, which might necessitate modification of types and dosages of drugs, based on the patient's actual condition and current treatment. The use of anticoagulants causes everyday problems, because these drugs have high pharmacokinetics potency, and on the other hand their administration is indispensable. In our investigation we aimed to analyze the drug therapy of chronic hemodialysis patients in the Szent Margit Hospital Taraba István Dialysis Unit, and present the clinical pharmacist's role in the hospital team.]

Hypertension and nephrology

[Hungarian dialysis statistics: changing trends in the renal epidemiology]


[In the last 30-35 years, dialysis care in Hungary has been a major development: both the incidence and prevalence of patients have increased year by year. Over the last decade, growth has slowed and is becoming more and more stabilized (similar trends can be seen in dialysis statistics in developed countries). Behind the dialysis indication the acute kidney injury (AKI) is more common than the end-stage renal disease (ESRD). The latter incidence has been stable for last 6 years (200-230 patient/million population). The annual average growth rate of prevalent dialysis patients was only 0.9%/year in the last 6 years. Among prevalent dialysis patients, the proportion of diabetic patients has remained unchanged for 10 years (26-27%), but those have increased who had hypertension nephropahty. The average age of incident and prevalent dialyzed patients has decreased gradually over the past 8 years (between 2009 and 2017 incident rate was from 67.1 to 63.0 years, prevalent rate was from 65.6 to 61.8 years). Unfortunately, just over half of the patients who dialyzed due to chronic kidney disease (CKD) have reached dialysis day 91. This is due to the high proportion of patient who was in urgent need of dialysis. In chronic hemodialysis (HD) program, the proportion of patients treated with arterovenous fistulas (AVF) decreases, while the rate of central venous catheter (CVC) users increases. The Hungarian peritoneal dialysis program in Europe is very good. The number of prevalent patients receiving renal replaement therapy (RRT) in Hungary in 2017 was 1005 for 1 million inhabitants.]

Clinical Neuroscience

[The importance of anticoagulant therapy in patients with artial fibrillation in stroke prevention – summary of international data and novel therapeutic modalities]


[The most common cardiogenic cause of ischaemic stroke is atrial fibrillation which increases the probability of stroke five-fold and doubles case fatality. Based on international data the incidence of atrial fibrillation is approx. 2% however this rapidly increases with age. The necessity of using oral anticoagulants in the prevention of non-valvular atrial fibrillation related stroke is decided based on estimated stroke risk. The CHADS2 and the more predictive CHA2DS2-VASc scales are used for this purpose while the bleeding risk of patients treated with anticoagulant may be estimated by the HAS-BLED scoring scale. For decades oral anticoagulation meant using vitamin-K antagonists. Based on international data we can see that rate of anticoagulation is unacceptably low, furthermore most of the anticoagulated patients aren’t within the therapeutic range of INR (INR: 2-3). A lot of disadvantages of vitamin-K antagonists are known (e.g. food-drug interaction, need for regular coagulation monitoring, increased risk of bleeding), therefore compounds with new therapeutic target have been developed. The novel oral anticoagulants (NOAC) can be divided in two major subgroups: direct thrombin inhibitors (dabigatran etexilate) and Xa-factor inhibitors (rivaroxaban, apixaban, edoxaban). These products are administered in fix doses, they less frequently interact with other medications or food, and regular coagulation monitoring is not needed when using these drugs. Moreover several studies have shown that they are at least as effective in the prevention of ischaemic stroke than the vitamin-K antagonists, with no more haemorrhagic complications.]