Anticoagulation in chronic kidney disease patients-the practical aspects.

There is an increasing awareness about the risks of arterial and venous thromboembolism (TE) in hospital patients and general public which has led to consideration of thrombosis prevention measures in earnest. Early recognition of the symptoms of TE disease has led to timely administration of antiplatelet and anticoagulant drugs, translating to better outcome in many of these patients. In this respect, patients with chronic kidney disease (CKD) represent a special group. They indeed represent a high-risk group for thrombosis both in the cardiovascular territory and also in the venous circulation. At the same time, abnormalities in the platelet membranes put them at risk of bleeding which is significantly more than other patients with chronic diseases. Anticoagulation may be ideal to prevent the former, but the co-existing bleeding risk and also that the commonly used drugs for inhibiting coagulation are eliminated by renal pathways pose additional problems. In this review, we try to explain the complex thrombotic-haemorrhagic state of chronic kidney disease patients, and practical considerations for the management of anticoagulation in them with a focus on heparins.

Lanthanum carbonate for hyperphosphatemia in patients with advanced CKD and patients receiving dialysis.

Reduced renal excretion of phosphate leads to hyperphosphatemia, which is prevalent in patients with end-stage renal disease, and is associated with increased morbidity and mortality. Dialysis alone is unable to adequately remove the ingested phosphate contained in food. It is therefore usually necessary to supplement food with drugs that reduce the intestinal absorption of dietary phosphate in order to control serum phosphate. Lanthanum carbonate is a recently introduced nonaluminum, noncalcium phosphate binder licensed for the management of serum phosphate in end-stage renal failure. It appears safe and effective, with data demonstrating no toxic effects in man after continuous exposure for up to 6 years. It is well tolerated and has a positive effect on bone histology in the context of renal osteodystrophy. Lanthanum carbonate's high affinity for phosphate rapid binding, palatability, low pill burden and absence of evident toxicity compare favorably with what are considered to be the ideal characteristics of an oral phosphate binder.