Wisit Cheungpasitporn

Safety and efficacy of apixaban versus warfarin in patients with end‐stage renal disease: Meta‐analysis

At the present, apixaban is the only nonvitamin K oral anticoagulant approved by the Food and Drug Administration for use with patients with creatinine clearance <15 mL/min or end‐stage renal disease (ESRD). However, the recommendations are based on pharmacokinetic and pharmacodynamic data and there was lack of clinical trial evidence. We aimed to assess safety and efficacy of apixaban in patients with advanced chronic kidney disease (CKD) or ESRD.

Associations of Proton-Pump Inhibitors and H2 Receptor Antagonists with Chronic Kidney Disease: A Meta-Analysis

Background/AimsThe aim of this meta-analysis was to assess the risks of chronic kidney disease (CKD) and/or end-stage kidney disease (ESRD) in patients who are taking proton-pump inhibitors (PPIs) and/or H2 receptor antagonists (H2RAs).MethodsComprehensive literature review was conducted utilizing MEDLINE and EMBASE databases through April 2017 to identify all studies that investigated the risks of CKD or ESRD in patients taking PPIs/H2RAs versus those without PPIs/H2RAs. Pooled risk ratios (RR) and 95% confidence interval (CI) were calculated using a random-effect, generic inverse variance method of DerSimonian and Laird. The protocol for this study is registered with PROSPERO (International Prospective Register of Systematic Reviews; no. CRD42017067252).ResultsFive studies with 536,902 participants were patients were identified and included in the data analysis. When compared with non-PPIs users, the pooled risk ratio (RR) of CKD or ESRD in patients with PPI use was 1.33 (95% CI 1.18–1.51). Pre-specified subgroup analysis (stratified by CKD or ESRD status) demonstrated pooled RRs of 1.22 (95% CI 1.14–1.30) for association between PPI use and CKD and 1.88 (95% CI 1.71–2.06) for association between PPI use and ESRD, respectively. However, there was no association between the use of H2RAs and CKD with a pooled RR of 1.02 (95% CI 0.83–1.25). When compared with the use of H2RAs, the pooled RR of CKD in patients with PPI use was 1.29 (95% CI 1.22–1.36).ConclusionsOur study demonstrates statistically significant 1.3-fold increased risks of CKD and ESRD in patients using PPIs, but not in patients using H2RAs.

Safety and efficacy of apixaban versus warfarin in patients with end-stage renal disease: Meta-analysis: CHOKESUWATTANASKUL et al.

Dear Editor, We thank the reader for very important comments to our article.1 We acknowledge and apologize for the error statement in our manuscript: “At the present, apixaban is the only non-vitamin K oral anticoagulant (NOAC) approved by the food and drug administration (FDA) for use with patients with creatinine clearance< 15mL/min or end-stage renal disease (ESRD).” Referring to the latest consensus by KDIGO published in the European Heart Journal in 2018, they put the recommendation about the use of both apixaban and rivaroxaban in atrial fibrillation patientswithESRDondialysis.2 Recognizing that no clinical safety trial supporting the use of both direct oral anticoagulant (DOACs) in ESRD on dialysis exists, both of the DOACs may be used by the FDA recommendation with clinical judgment between risk and benefit in individual patients. The reader is correct and gives us an in-depth review of the pharmacokinetic and pharmacodynamic study of both apixaban and rivaroxaban which make our manuscript become an even more comprehensive article. In the absence of a randomized controlled trial data, we still believe, with repeated researching of themost up-to-date data from available search engines, that our manuscript provided all available observational studies related to the use of apixaban in the real-world practice. A further search regarding the use of rivaroxaban that we did not include in our study was performed with the purpose to make our article and its related comment give further detail about this curious topic. What we found is a study that retrieved data from a large ESRD database by Chan et al. published in Circulation in 2015.3 They reported the use of rivaroxaban in the patient with ESRD on dialysis and discourage the use of rivaroxaban by the findings that rivaroxaban and dabigatran use are associated with a higher risk of hospitalization and death from bleeding compared to those with vitamin K antagonists.3 However, a lot of confounding factors generated by observational study likely contributed to conflicting results varying from study to study (e.g., pharmacological study vs clinical study, among observational studies). In summary, a well-designed trial, that has already been launched and is enrolling, is needed to be done to answer this unmet definite question (AVKDIAL NCT: 02886962, AXADIANCT:02933697, and RENAL-AFNCT:02942407).4–6 We again thank the editor and the reader for making very helpful feedback to provide the useful information to the reader.We also apologize for the inaccurate message in our literature that may make the reader misinterpret the actual information.

Association of Helicobacter pylori with the Risk of Hepatic Encephalopathy

Background/ObjectivesHepatic encephalopathy is the common manifestation of decompensated cirrhosis. The association between Helicobacter pylori (H. pylori) infection and hepatic encephalopathy has been shown in many epidemiologic studies. This meta-analysis was conducted to summarize all available studies to estimate the association between H. pylori infection and hepatic encephalopathy.MethodsA comprehensive literature review was conducted using MEDLINE and EMBASE database through March 2017 to identify studies that reported the association between H. pylori infection and hepatic encephalopathy. Effect estimates from the individual study were extracted and combined using random-effect, generic inverse variance method of DerSimonian and Laird.ResultsOf 15,233 studies, eleven studies (four cross-sectional, four case–control, and three cohort studies) met the eligibility criteria and were included in the meta-analysis. The pooled OR of hepatic encephalopathy in patients with H. pylori infection was 1.73 (95% CI 1.09–2.73) when compared with the patients without H. pylori infection. The association between H. pylori and hepatic encephalopathy was not statistically significant after the sensitivity analysis, excluding those using ELISA alone, with a pooled OR of 1.92 (95% CI 0.91–4.05, I2xa0=xa062%). There was no publication bias of overall included studies assessed by the funnel plots and Egger’s regression asymmetry test.ConclusionsThis study demonstrated a potential association between H. pylori infection and risk of hepatic encephalopathy. Future studies are required to assess the effect of chronicity of infection on the development of hepatic encephalopathy.

Association between smoking and risk of primary sclerosing cholangitis: A systematic review and meta-analysis:

Background/Objectives Studies have suggested that smokers may have a lower risk of primary sclerosing cholangitis (PSC) although the results have been inconsistent. This systematic review and meta-analysis was conducted to summarize all available data to better characterize this association. Methods A comprehensive literature review was conducted using Medline and Embase databases through January 2018 to identify all studies that compared the risk of PSC among current/former smokers versus nonsmokers. Effect estimates from each study were extracted and combined using the random-effect, generic inverse variance method of DerSimonian and Laird. Results Seven case-control studies with 2,307,393 participants met the eligibility criteria and were included in the meta-analysis. The risk of PSC among current smokers and former smokers was significantly lower than nonsmokers with the pooled odds ratio of 0.31 (95% CI, 0.18–0.53) and 0.52 (95% CI, 0.44–0.61), respectively. The risk remained significantly lower among current smokers and former smokers compared with nonsmokers even when only patients with PSC without inflammatory bowel disease were included. Conclusions A significantly decreased risk of PSC among current and former smokers was demonstrated in this study.

Associations of sleep quality with incident atrial fibrillation: a meta‐analysis

The strong relationship between sleep apnoea and atrial fibrillation (AF) is well known. However, it remains unclear whether the sleep quality is related with AF.

Impact of admission serum calcium levels on mortality in hospitalized patients

ABSTRACT Objectives: To assess the relationship between admission serum calcium levels and in-hospital mortality in all hospitalized patients. Methods: All adult hospitalized patients who had admission serum calcium levels available between years 2009 and 2013 were enrolled. Admission serum calcium was categorized based on its distribution into six groups (<7.9, 7.9 to <8.4, 8.4 to <9.0, 9.0 to <9.6, 9.6 to <10.1, and ≥10.1 mg/dL). The odds ratio (OR) of in-hospital mortality by admission serum calcium, using the calcium category of 9.6–10.1 mg/dL as the reference group, was obtained by logistic regression analysis. Results: 18,437 patients were studied. The lowest incidence of in-hospital mortality was associated with admission serum calcium within 9.6 to <10.1 mg/dL. A higher in-hospital mortality rate was observed in patients with serum calcium <9.6 and ≥10.1 mg/dL. Also, 38% and 33% of patients with admission serum calcium <7.9 and ≥10.1 mg/dL were on calcium supplements before admission, respectively. After adjusting for potential confounders, both serum calcium <8.4 and ≥10.1 mg/dL were associated with an increased risk of in-hospital mortality with ORs of 2.86 [95% confidence interval (CI) 1.98–4.17], 1.74 (95% CI 1.21–2.53), and 1.69 (95% CI 1.10–2.59) when serum calcium were within <7.9, 7.9 to <8.4, and ≥10.1 mg/dL, respectively. Conclusion: Hypocalcemia and hypercalcemia on admission were associated with in-hospital mortality. Highest mortality risk is observed in patients with admission hypocalcemia (<7.9 mg/dL). One-third of patients with hypercalcemia on admission were on calcium supplements.

Cigarette smoking and risk of celiac disease: A systematic review and meta-analysis

Background/Objectives A negative association between cigarette smoking and celiac disease has been observed but results were inconsistent across the published studies. A meta-analysis was conducted with the aim to identify all studies that investigated this association and to summarize the results of those studies. Methods A comprehensive literature review was conducted utilizing MEDLINE and Embase databases through March 2018 to identify all cohort studies and case-control studies that compared the risk of celiac disease among current and/or former smokers versus never-smokers. Effect estimates from each study were extracted and combined together using the random-effect, generic inverse variance method of DerSimonian and Laird. Results A total of seven studies with 307,924 participants fulfilled the eligibility criteria and were included in the meta-analysis. The pooled analysis found a significantly decreased risk of celiac disease among current smokers compared with never-smokers with the pooled odds ratio (OR) of 0.52 (95% confidence interval (CI), 0.32–0.84; I2 86%). However, the risk of celiac disease among former smokers was not significantly different from never-smokers with the pooled OR of 1.10 (95% CI, 0.76–1.60; I2 of 73%). Conclusions A significantly decreased risk of celiac disease among current smokers compared with never-smokers was demonstrated in this meta-analysis.

Benefits, challenges, and opportunities using home hemodialysis with a focus on Mississippi, a rural southern state

The prevalence of end‐stage renal disease continues to increase in the United States with commensurate need for renal replacement therapies. Hemodialysis continues to be the predominant modality, though less than 2% of these patients will receive hemodialysis in their own home. While home modalities utilizing peritoneal dialysis have been growing, home hemodialysis (HHD) remains underutilized despite studies showing regression in left ventricular mass, improved quality of life, reduced depressive symptoms, and decreased postdialysis recovery time. To increase penetration of HHD will require a proactive approach from both physicians and dialysis networks to address barriers both in the system and on the level of the patients and families. We are reviewing these issues with a focus on the state of Mississippi.

Risk of Fall in Patients Taking Proton Pump Inhibitors: A Meta-Analysis

BackgroundnFall prevention among older adults is a worldwide public health advocacy because of negative consequences of fall. Recent studies have shown that proton pump inhibitors (PPIs) increase the risk of fall. PPIs are among the widely prescribed medications oftentimes without clear indications. Concerns for safety of long-term use of PPIs have been raised by numerous studies.nnnMethodsnA systematic review was conducted in MEDLINE and EMBASE databases from inception through March 2018 to identify studies that assessed the association between the use of PPIs and the risk of fall. Effect estimates from the individual study were extracted and combined using random-effect, generic inverse variance method of DerSimonian and Laird.nnnResultsnEight observational studies with a total of 367,068 patients were enrolled. There was a significant association between the use of PPIs and the risk of fall with the pooled OR of 1.27 (95% CI, 1.07-1.50). Meta-regression showed significant positive correlations between risk of fall in patients using PPIs and year of study (slopes = +0.25, p <0.001). The data on the risk of fall in patients using H2 receptor antagonists (H2RAs) were limited in 3 studies. The pooled OR of fall in patients using H2RAs was 0.95 (95% CI, 0.75-1.20).nnnConclusionsnWe demonstrate a significant association between the use of PPIs and increased risk of fall. There is a significant positive correlation between the risk of fall in patients using PPIs and year of study. In addition, there is potentially higher risk of fall among PPIs users over time.