Chronic kidney disease

End-stage renal disease patients have a higher prevalence of diabetes mellitus, hypertension, congestive heart failure and advanced age, along with an increased incidence of non-valvular atrial fibrillation, thereby increasing the risk for cerebrovascular accidents. The most frequent arrhythmia treated is atrial fibrillation, which necessitates the use of novel oral anticoagulants that have been approved to reduce the risk of thromboembolism and stroke. So, compared to traditional anticoagulants, apixaban was associated with a significantly lower risk of stroke or systemic embolism (2).Patients with chronic kidney disease are more likely to develop AF, with a 10% frequency among those on chronic dialysis. Warfarin is the most widely prescribed OAC for individuals with end-stage kidney disease. On the other hand, DOACs are generally safer than warfarin, with fewer fatal bleeding events and a fixed dose that does not require close international normalized ratio monitoring (1). Several studies have investigated the safety and efficacy of apixaban in patients with ESRD and NVAF. The goal of this study is to determine the patterns of apixaban use and its associated outcomes in dialysis-dependent patients with ESKD and AF (3). This article gives an overview of clinical presentations, diagnostic procedures, complications and management of end stage renal disease.

Chronic kidney disease (CKD) is defined as any abnormality in kidney structure or function present for three months or longer, with implication for health. Anemia, which affects most patients with CKD, is caused by a decreased production of erythropoietin (EPO), a glycoprotein that stimulates red blood cell production in the bone marrow and is released in response to hypoxia. A 68 years old female came with complaints of generalized tiredness, left side chest pain during inspiration, pedal oedema and breathing difficulty .Her past medication history include CKD, diabetes mellitus, hypertension, recurrent UTI, gastritis. A diagnosis of CKD-end stage renal disease associated with anemia was made following the review of her clinical examination and laboratory findings. She was subsequently managed for anemia with recombinant human erythropoietin and intravenous iron , monitored, and expected result was not found. In this study we conclude that the patient is resistant to erythropoietin so packed RBC is given for the management.