Introduction: The delicate balance of risk versus benefit of oral anticoagulation in the general population is well established but the decision to use these agents in end-stage renal disease (ESRD) remains complex and difficult owing to the paucity of clinical trials and lack of substantial evidence in literature for its safe and effective use in the hemodialysis population. This study aims to determine the difference in clinical outcomes between oral anticoagulation and no anticoagulation therapy among ESRD patients on maintenance hemodialysis with atrial fibrillation. Methods: This is a prospective, single-center, observational study conducted in Perpetual Succour Hospital that included all ESRD patients on maintenance hemodialysis for at least 3 months with atrial fibrillation. Out of the 188 identified patients, only 69 patients were included in the study and were grouped according to how the cardiac dysrhythmia was approached either with oral anticoagulation or no use of oral anticoagulation. Basic demographic information were obtained as well as the etiology of ESRD, CHA2DS2-VASc Score and the HAS-BLED Score. Lastly, patients were prospectively followed for a period of 12 months and were then assessed for new onset of thromboembolic events, hemorrhagic events, calciphylaxis and all-cause mortality. Results: At enrollment, 59 (85.5%) patients were identified to have no oral anticoagulation therapy and 10 (14.5%) were already receiving oral anticoagulation. Ischemic strokes were more prevalent among patients who were on oral anticoagulant (80%, p <0.0001). Patient outcomes differ significantly in terms of intracranial hemorrhage (30%, p= 0.0004) and gastrointestinal bleeding (50%, p <0.00001) which were noted among patients on oral anticoagulation. In relation to over-all mortality, acute myocardial infarction, peripheral arterial occlusive disease and calciphylaxis, there was no significant difference between the two groups. Conclusion This study suggests that the use of oral anticoagulation did not prevent ischemic strokes in ESRD patients on maintenance hemodialysis with atrial fibrillation and its use was associated with increased risk for intracranial hemorrhage and gastrointestinal bleeding. There was no significant difference in relation to all-cause mortality, acute myocardial infarction, peripheral arterial occlusive disease and calciphylaxis between the two study groups.
Kidney Failure, Chronic ; Atrial Fibrillation

Introduction: Acute kidney injury (AKI) is a lethal complication of critical illness characterized by the rapid loss of the kidney's excretory function encountered in 50% of intensive care unit (ICU) admissions. Its impact on the outcome of critically ill patients makes AKI a significant cause of morbidity and mortality. Objectives: To develop and validate an acute kidney injury risk prediction score based on routinely available variables and common laboratories of admitted critically-ill septic Filipino patients. Methods: This is a prospective cohort study conducted in a tertiary hospital in Cebu from February to September 2020. The data of 2545 patients were identified by chart review but only 607 patients with a quick Sepsis Organ Failure Assessment Score (qSOFA) score of >2 were included in the pre-screening. After stratified sampling, a total of 198 septic ICU patients were enrolled. Demographic profile, laboratory results and outcome data were collated. Variables were screened then stepwise forward elimination was done to identify the significant predictors. An AKI risk score model was developed with binomial regression analysis by identifying independent prognostic factors. The diagnostic ability of the model was determined by the Area under the Receiver Operating Characteristics (AuROC). Results: AKI developed in 155 (78%) patients. The significant predictors for Acute Kidney Injury were age, hypertension, atherosclerotic cardiovascular disease, weight, white blood count, creatinine, and BUN. An AKI prediction model with a cut off score of 161.9 was made with a fair diagnostic ability for predicting AKI at 0.79 based on AuROC. Conclusion The developed risk prediction tool using routinely available variables is found to be fairly accurate to predict the development of AKI among critically ill septic patients.
Acute Kidney Injury ; Sepsis