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Stenson EK, Alhamoud I, Alobaidi R, Bottari G, Fernandez S, Fuhrman DY, Guzzi F, Haga T, Kaddourah A, Marinari E, Mohamed T, Morgan C, Mottes T, Neumayr T, Ollberding NJ, Raggi V, Ricci Z, See E, Stanski NL, Zang H, Zangla E, Gist KM. Factors associated with successful liberation from continuous renal replacement therapy in children and young adults: analysis of the worldwide exploration of renal replacement outcomes collaborative in Kidney Disease Registry. Intensive Care Med 2024:10.1007/s00134-024-07336-4. [PMID: 38436726 DOI: 10.1007/s00134-024-07336-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 01/25/2024] [Indexed: 03/05/2024]
Abstract
PURPOSE Continuous renal replacement therapy (CRRT) is used for supportive management of acute kidney injury (AKI) and disorders of fluid balance (FB). Little is known about the predictors of successful liberation in children and young adults. We aimed to identify the factors associated with successful CRRT liberation. METHODS The Worldwide Exploration of Renal Replacement Outcomes Collaborative in Kidney Disease study is an international multicenter retrospective study (32 centers, 7 nations) conducted from 2015 to 2021 in children and young adults (aged 0-25 years) treated with CRRT for AKI or FB disorders. Patients with previous dialysis dependence, tandem extracorporeal membrane oxygenation use, died within the first 72 h of CRRT initiation, and those who never had liberation attempted were excluded. Patients were categorized based on first liberation attempt: reinstituted (resumption of any dialysis within 72 h) vs. success (no receipt of dialysis for ≥ 72 h). Multivariable logistic regression was used to identify factors associated with successful CRRT liberation. RESULTS A total of 622 patients were included: 287 (46%) had CRRT reinstituted and 335 (54%) were successfully liberated. After adjusting for sepsis at admission and illness severity parameters, several factors were associated with successful liberation, including higher VIS (vasoactive-inotropic score) at CRRT initiation (odds ratio [OR] 1.35 [1.12-1.63]), higher PELOD-2 (pediatric logistic organ dysfunction-2) score at CRRT initiation (OR 1.71 [1.24-2.35]), higher urine output prior to CRRT initiation (OR 1.15 [1.001-1.32]), and shorter CRRT duration (OR 0.19 [0.12-0.28]). CONCLUSIONS Inability to liberate from CRRT was common in this multinational retrospective study. Modifiable and non-modifiable factors were associated with successful liberation. These results may inform the design of future clinical trials to optimize likelihood of CRRT liberation success.
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Affiliation(s)
- Erin K Stenson
- Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA.
| | - Issa Alhamoud
- Carver College of Medicine, University of Iowa Stead Family Children's Hospital, Iowa City, IA, USA
| | | | | | - Sarah Fernandez
- School of Medicine, Gregorio Marañón University Hospital, Madrid, Spain
| | - Dana Y Fuhrman
- University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | | | - Taiki Haga
- Osaka City General Hospital, Osaka, Japan
| | | | | | - Tahagod Mohamed
- Nationwide Children's Hospital, The Kidney and Urinary Tract Center, The Ohio State University College of Medicine, Columbus, OH, USA
| | | | - Theresa Mottes
- Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Tara Neumayr
- St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, MO, USA
| | - Nicholas J Ollberding
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Valeria Raggi
- Bambino Gesù, Children's Hospital, IRCCS, Rome, Italy
| | - Zaccaria Ricci
- Department of Pediatrics, Pediatric Intensive Care Unit, Meyer Children's Hospital, IRCCS, Florence, Italy
| | - Emily See
- Royal Children's Hospital, Murdoch Children's Research Institute, University of Melbourne, Melbourne, VIC, Australia
| | - Natalja L Stanski
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Huaiyu Zang
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | | | - Katja M Gist
- St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, MO, USA
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Parker SH, Jesso MN, Wolf LD, Leigh KA, Booth S, Gualandi N, Garrick RE, Kliger AS, Patel PR. Human Factors Contributing to Infection Prevention in Outpatient Hemo dialysis Centers: A Mixed Methods Study. Am J Kidney Dis 2024:S0272-6386(24)00626-7. [PMID: 38447708 DOI: 10.1053/j.ajkd.2023.12.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 12/18/2023] [Accepted: 12/23/2023] [Indexed: 03/08/2024]
Abstract
RATIONALE & OBJECTIVE Infection prevention efforts in dialysis centers can avert patient morbidity and mortality but are challenging to implement. The objective of this study was to better understand how the design of the work system might contribute to infection prevention in outpatient dialysis centers. STUDY DESIGN Mixed methods, observational study. SETTING & PARTICIPANTS Six dialysis facilities across the United States visited by a multidisciplinary team over 8 months. ANALYTICAL APPROACH At each facility, structured macroergonomic observations were undertaken by a multidisciplinary team using the SEIPS 1.0 model. Ethnographic observations were collected about staff encounters with dialysis patients including the content of staff conversations. Selective and axial coding were used for qualitative analysis and quantitative data were reported using descriptive statistics. RESULTS Organizational and sociotechnical barriers and facilitators to infection prevention in the outpatient dialysis setting were identified. Features related to human performance, (eg, alarms, interruptions, and task stacking), work system design (eg, physical space, scheduling, leadership, and culture), and extrinsic factors (eg, patient-related characteristics) were identified. LIMITATIONS This was an exploratory evaluation with a small sample size. CONCLUSIONS This study used a systematic macroergonomic approach in multiple outpatient dialysis facilities to identify infection prevention barriers and facilitators related to human performance. Several features common across facilities were identified that may influence infection prevention in outpatient care and warrant further exploration.
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Affiliation(s)
| | | | | | | | - Stephanie Booth
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Nicole Gualandi
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Renee E Garrick
- New York Medical and Westchester Medical Center, Valhalla, New York
| | - Alan S Kliger
- Department of Medicine, Section of Nephrology, School of Medicine, Yale University, New Haven, Connecticut
| | - Priti R Patel
- Centers for Disease Control and Prevention, Atlanta, Georgia
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Chow CM, Persad AH, Karnik R. Effect of Membrane Permeance and System Parameters on the Removal of Protein-Bound Uremic Toxins in Hemo dialysis. Ann Biomed Eng 2024; 52:526-541. [PMID: 37993752 PMCID: PMC10859350 DOI: 10.1007/s10439-023-03397-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 10/25/2023] [Indexed: 11/24/2023]
Abstract
Inadequate clearance of protein-bound uremic toxins (PBUTs) during dialysis is associated with morbidities in chronic kidney disease patients. The development of high-permeance membranes made from materials such as graphene raises the question whether they could enable the design of dialyzers with improved PBUT clearance. Here, we develop device-level and multi-compartment (body) system-level models that account for PBUT-albumin binding (specifically indoxyl sulfate and p-cresyl sulfate) and diffusive and convective transport of toxins to investigate how the overall membrane permeance (or area) and system parameters including flow rates and ultrafiltration affect PBUT clearance in hemodialysis. Our simulation results indicate that, in contrast to urea clearance, PBUT clearance in current dialyzers is mass-transfer limited: Assuming that the membrane resistance is dominant, raising PBUT permeance from 3 × 10-6 to 10-5 m s-1 (or equivalently, 3.3 × increase in membrane area from ~ 2 to ~ 6 m2) increases PBUT removal by 48% (from 22 to 33%, i.e., ~ 0.15 to ~ 0.22 g per session), whereas increasing dialysate flow rates or adding adsorptive species have no substantial impact on PBUT removal unless permeance is above ~ 10-5 m s-1. Our results guide the future development of membranes, dialyzers, and operational parameters that could enhance PBUT clearance and improve patient outcomes.
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Affiliation(s)
- Chun Man Chow
- Department of Chemical Engineering, Massachusetts Institute of Technology, 25 Ames St, Cambridge, MA, 02142, USA
| | - Aaron H Persad
- Department of Mechanical Engineering, Massachusetts Institute of Technology, 77 Massachusetts Ave, Cambridge, MA, 02139, USA
| | - Rohit Karnik
- Department of Mechanical Engineering, Massachusetts Institute of Technology, 77 Massachusetts Ave, Cambridge, MA, 02139, USA.
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Sam R, Rankin L, Ulasi I, Frantzen L, Nitsch D, Henner D, Molony D, Wagner J, Chen J, Agarwal SK, Howard A, Atkinson R, Landry D, Pastan SO, Kalantar-Zadeh K. Vaccination for Patients Receiving Dialysis. Kidney Med 2024; 6:100775. [PMID: 38435066 PMCID: PMC10906410 DOI: 10.1016/j.xkme.2023.100775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024] Open
Abstract
Vaccinating patients receiving dialysis may prevent morbidity and mortality in this vulnerable population. The National Forum of End-Stage Renal Disease Networks (the Forum) published a revised vaccination toolkit in 2021 to update evidence and recommendations on vaccination for patients receiving dialysis. Significant changes in the last 10 years include more data supporting the use of a high-dose influenza vaccine, the introduction of the Heplisav-B vaccine for hepatitis B, and changes in pneumococcal vaccines, including the approval of the PCV15 and PCV20 to replace the PCV13 and PPSV23 vaccines. Additional key items include the introduction of vaccines against severe acute respiratory syndrome coronavirus 2, the virus that causes coronavirus disease 2019 (COVID-19), and a new vaccine to prevent respiratory syncytial virus disease. Historically, influenza and pneumococcal vaccinations were routinely administered by dialysis facilities, and because of possible risks of hematogenous spread of hepatitis B, dialysis providers often have detailed hepatitis B vaccine protocols. In March 2021, COVID-19 vaccines were made available for dialysis facilities to administer, although with the end of the public health emergency, vaccine policies by dialysis facilities against COVID-19 remains uncertain. The respiratory syncytial virus vaccine was authorized in 2023, and how dialysis facilities will approach this vaccine also remains uncertain. This review summarizes the Forum's vaccination toolkit and discusses the role of the dialysis facility in vaccinating patients to reduce the risk of severe infections.
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Affiliation(s)
- Ramin Sam
- Division of Nephrology, Zuckerberg San Francisco General Hospital, University of California, San Francisco
| | - Laura Rankin
- Kidney Specialists of Central Oklahoma, Oklahoma City, Oklahoma
| | - Ifeoma Ulasi
- Division of Nephrology, University of Nigeria, Enugu, Nigeria
- College of Medicine, University of Nigeria, Ituku-Ozalla Campus, Enugu, Nigeria
| | - Luc Frantzen
- Service de Nephrologie, Hopital Saint Joseph, Marseilles, France
| | - Dorothea Nitsch
- Department of Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - David Henner
- Division of Nephrology, Berkshire Medical Center, Pittsfield, Massachusetts
| | - Donald Molony
- Division of Nephrology, University of Texas McGovern Medical School, Houston, Texas
- Division of Renal Diseases and Hypertension, McGovern Medical School, University of Texas Health, Houston, Texas
| | - John Wagner
- Division of Nephrology, New York City Health + Hospitals/Kings County, Brooklyn, New York
| | - Jing Chen
- Division of Nephrology, Huashan Hospital, Fudan University, Shanghai, China
| | - Sanjay Kumar Agarwal
- Division of Nephrology, All India Institute of Medical Sciences, New Delhi, India
- Nephrology and Renal Transplant Medicine, Marengo Asia Hospital, Gurugram and Faridabad, Haryana, India
| | - Andrew Howard
- Metropolitan Nephrology Associates PC, Clinton, Maryland
| | | | - Daniel Landry
- Division of Nephrology, University of Massachusetts Chan Medical School-Baystate, Springfield, Massachusetts
| | - Stephen O. Pastan
- Division of Nephrology, Emory University School of Medicine, Atlanta, Georgia
- Renal Division, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Kamyar Kalantar-Zadeh
- Division of Nephrology, University of California, School of Medicine, Los Angeles, California
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Wakasugi M, Narita I. Higher participation rates for specific health checkups are associated with a lower incidence of treated ESKD in Japan. Clin Exp Nephrol 2024; 28:201-207. [PMID: 37806975 PMCID: PMC10881630 DOI: 10.1007/s10157-023-02412-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 09/18/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND A Japanese cohort study previously reported that not attending health checkups was associated with an increased risk of treated end-stage kidney disease (ESKD). The present study aimed to examine this association at the prefecture level. METHODS We conducted an ecological study of all prefectures in Japan (n = 47) using five sources of nationwide open data. We explored associations of participation rates for Specific Health Checkups (SHC participation rates), the estimated prevalence of chronic kidney disease (CKD), and the ratio of nephrology specialists for each prefecture with prefecture-specific standardized incidence rates (SIRs) of treated ESKD using structural equation modeling. RESULTS Prefecture-specific SHC participation rates ranged from 44.2% to 65.9%, and were negatively correlated with prefecture-specific SIRs and prevalence of CKD, and positively correlated with the ratio of nephrology specialists. SHC participation rates had significant negative effects on prefecture-specific SIRs (standardized estimate (β) = - 0.38, p = 0.01) and prefecture-specific prevalence of CKD (β = - 0.32, p = 0.02). Through SHC participation rates, the ratio of nephrology specialists had a significant indirect negative effect on prefecture-specific SIRs (β= - 0.14, p = 0.02). The model fitted the data well and explained 14% of the variance in SIRs. CONCLUSIONS Our findings support the importance of increasing SHC participation rates at the population level and may encourage people to undergo health checkups.
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Affiliation(s)
- Minako Wakasugi
- Department of Inter-Organ Communication Research, 1-757 Asahimachi, Chuo-ku, Niigata, 951-8510, Japan.
| | - Ichiei Narita
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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Jung JY. Which blood pressure metrics should be used in patients on dialysis? Kidney Res Clin Pract 2024; 43:133-142. [PMID: 38062622 PMCID: PMC11016667 DOI: 10.23876/j.krcp.23.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 07/06/2023] [Accepted: 07/20/2023] [Indexed: 04/12/2024] Open
Abstract
Remarkable progress has recently been achieved in blood pressure (BP) control based on key research findings in the general population. It has been observed that maintaining BP slightly lower than previously recommended goals leads to better clinical outcomes, provided that patients can tolerate it. Previously, BP control targets for dialysis patients were extrapolated from studies conducted on the general population. However, dialysis patients are considered a distinct group with unique characteristics, which makes defining appropriate BP targets a matter of debate. Several observational studies measuring BP in hemodialysis (HD) patients within dialysis units have shown that lower peridialysis BP (pre-, post-, and interdialytic BP) is associated with worse clinical outcomes. However, this association is likely confounded by factors specific to dialysis patients. The relationship between BP and mortality appears to be more linear in patients with fewer underlying cardiovascular diseases and longer survival. Recent studies have indicated that BP measurements taken outside of dialysis sessions, such as standardized BP on nondialysis days, home BP, and ambulatory BP monitoring between HD sessions, are more predictive of clinical outcomes. Due to the varied effects of dialysis-related treatment practices on BP, there is a lack of data from large-scale clinical trials. As a result, it is challenging to provide strong recommendations for BP targets directly applicable to dialysis patients. This review addresses various factors influencing BP in dialysis patients, including the establishment of individualized target BP levels and discussions on maintenance strategies, while incorporating a recent literature review.
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Affiliation(s)
- Ji Yong Jung
- Division of Nephrology, Department of Internal Medicine, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
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57
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Mukoyama M, Kuwabara T. Pre- dialysis blood pressure and cardiovascular mortality in Japan: need for much stricter control? Hypertens Res 2024; 47:811-812. [PMID: 38062201 DOI: 10.1038/s41440-023-01523-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 10/26/2023] [Indexed: 01/06/2024]
Affiliation(s)
- Masashi Mukoyama
- Department of Nephrology, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan.
| | - Takashige Kuwabara
- Department of Nephrology, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan
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Imberti S, Comoretto R, Ceschia G, Longo G, Benetti E, Amigoni A, Daverio M. Impact of the first 24 h of continuous kidney replacement therapy on hemodynamics, ventilation, and analgo-sedation in critically ill children. Pediatr Nephrol 2024; 39:879-887. [PMID: 37723304 DOI: 10.1007/s00467-023-06155-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 07/25/2023] [Accepted: 08/17/2023] [Indexed: 09/20/2023]
Abstract
BACKGROUND In a group of children admitted to the paediatric intensive care unit (PICU) receiving continuous kidney replacement therapy (CKRT), we aim to evaluate the data about their hemodynamic, ventilation and analgo-sedation profile in the first 24 h of treatment and possible associations with mortality. METHODS Retrospective cohort study of children admitted to the PICU of the University Hospital of Padova undergoing CKRT between January 2011 and March 2021. Data was collected at baseline (T0), after 1 h (T1) and 24 h (T24) of CKRT treatment. The differences in outcome measures were compared between these time points, and between survivors and non-survivors. RESULTS Sixty-nine patients received CKRT, of whom 38 (55%) died during the PICU stay. Overall, the vasoactive inotropic score and the adrenaline dose increased at T1 compared to T0 (p = 0.012 and p = 0.022, respectively). Compared to T0, at T24 patients showed an improvement in the following ventilatory parameters: Oxygenation Index (p = 0.005), Oxygenation Saturation Index (p = 0.013) PaO2/FiO2 ratio (p = 0.005), SpO2/FiO2 ratio (p = 0.002) and Mean Airway Pressure (p = 0.016). These improvements remained significant in survivors (p = 0.01, p = 0.027, p = 0.01 and p = 0.015, respectively) but not in non-survivors. No changes in analgo-sedative drugs have been described. CONCLUSIONS CKRT showed a significant impact on hemodynamics and ventilation in the first 24 h of treatment. We observed a significant rise in the inotropic/vasoactive support required after 1 h of treatment in the overall population, and an improvement in the ventilation parameters at 24 h only in survivors.
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Affiliation(s)
- Simona Imberti
- Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Rosanna Comoretto
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - Giovanni Ceschia
- Department of Women's and Children's Health, University of Padua, Padua, Italy
- Pediatric Nephrology, Department of Women's and Children's Health, Padua University Hospital, Padua, Italy
| | - Germana Longo
- Pediatric Nephrology, Department of Women's and Children's Health, Padua University Hospital, Padua, Italy
| | - Elisa Benetti
- Pediatric Nephrology, Department of Women's and Children's Health, Padua University Hospital, Padua, Italy
| | - Angela Amigoni
- Pediatric Intensive Care Unit, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Marco Daverio
- Pediatric Intensive Care Unit, Department of Women's and Children's Health, University of Padua, Padua, Italy.
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Wang Z, Huang K, Zheng Y, Ye H, Wang J, Tao X, Zhou J, Dang Z, Lu G. Efficient removal of heavy metals in water utilizing facile cross-link conjugated linoleic acid micelles. Environ Sci Pollut Res Int 2024; 31:20665-20677. [PMID: 38381288 DOI: 10.1007/s11356-024-32517-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 02/14/2024] [Indexed: 02/22/2024]
Abstract
Micellar-enhanced ultrafiltration (MEUF) technology is an effective method to treat low-concentration heavy metal wastewater. However, the leakage of surfactants in the ultrafiltration (UF) process will inevitably cause secondary pollution. In this study, a biosurfactant of conjugated linoleic acid (CLA) with conjugated double bonds was selected to bind its micelles by simple thermal crosslinking to obtain morphologically stable stearic acid (SA) nanoparticles. The pure SA nanoparticles were obtained by repeated dialysis. The stability of the SA nanoparticles was verified by comparing the particle size distribution and solubility of the materials before and after crosslinking at different pH levels. The effectiveness of SA nanoparticle-enhanced UF in removing heavy metals was verified by exploring the adsorption performance of SA nanoparticles. The dialysis device was used to simplify the UF device, wherein SA nanoparticles were assessed as adsorbents for the elimination of Cu2+, Pb2+, and Cd2+ ions from aqueous solutions under diverse process parameters, including pH, contact time, metal ion concentration, and coexisting ions. The findings indicate that the SA nanoparticles have no evidence of secondary contamination in UF and exhibit compatibility with a broad pH range and coexisting ions. The maximum adsorption capacities for Cu2+, Pb2+, and Cd2+ were determined to be 152.77, 403.56, and 271.46 mg/g, respectively.
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Affiliation(s)
- Zufei Wang
- School of Environment and Energy, South China University of Technology, Guangzhou, 510006, China
| | - Kaibo Huang
- School of Ecology and Environment, Hainan University, Haikou, 570228, People's Republic of China
- Key Laboratory of Agro-Forestry Environmental Processes and Ecological Regulation of Hainan Province (Hainan University), Haikou, 570228, China
| | - Yanjie Zheng
- School of Environment and Energy, South China University of Technology, Guangzhou, 510006, China
| | - Han Ye
- School of Environment and Energy, South China University of Technology, Guangzhou, 510006, China
| | - Juan Wang
- School of Environment and Energy, South China University of Technology, Guangzhou, 510006, China
| | - Xueqin Tao
- College of Resources and Environment, Zhongkai University of Agriculture and Engineering, Guangzhou, 510225, China
| | - Jiangmin Zhou
- College of Life and Environmental Science, Wenzhou University, Wenzhou, 325035, China
| | - Zhi Dang
- School of Environment and Energy, South China University of Technology, Guangzhou, 510006, China
- The Key Lab of Pollution Control and Ecosystem Restoration in Industry Clusters, Ministry of Education, South China University of Technology, Guangzhou, 510006, China
| | - Guining Lu
- School of Environment and Energy, South China University of Technology, Guangzhou, 510006, China.
- The Key Lab of Pollution Control and Ecosystem Restoration in Industry Clusters, Ministry of Education, South China University of Technology, Guangzhou, 510006, China.
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Filippo MG, Melo MFDGG, da Silva DM, Nunes MADJ, Chun JSS, Maia ABDAP, Furtado ALM, Kimura LHDS, Alves HFA. Case report: Arteriovenous graft for hemo dialysis using abdominal vessels. J Vasc Access 2024; 25:677-680. [PMID: 36517938 DOI: 10.1177/11297298221141498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024] Open
Abstract
The improvement of dialysis therapy and clinical support has increased the life expectancy of patients with end stage renal disease (ESRD) over the last years. However, in Brazil, the renal transplant rate cannot follow this growth. This fact, in association with the unavailability of adequate healthcare services in the country, substantially enlarges the use of dual lumen catheters and, consequently, access-related complications. The result is a high rate of patients with access failure, which brings a challenge: how to maintain dialysis in this group? This case report describes a non-conventional surgical approach to create a definite access using abdominal vessels, in an end stage vascular access patient.
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Chlorogiannis DD, Bousi SE, Zachiotis M, Chlorogiannis A, Kyriakoulis I, Bellos I. Pre-operative ultrasound mapping before arteriovenous fistula formation: an updated systematic review and meta-analysis. J Nephrol 2024; 37:281-292. [PMID: 38133741 PMCID: PMC11043143 DOI: 10.1007/s40620-023-01814-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 10/19/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Arteriovenous fistula represents the preferred vascular access for patients with kidney failure requiring hemodialysis. Surgeons have traditionally used physical examination to identify the most suitable vessels. This meta-analysis aims to evaluate whether ultrasound mapping should be routinely performed before arteriovenous fistula creation. METHODS Medline, Scopus, Web of Science and CENTRAL were systematically searched from inception to November 1, 2022. Randomized controlled trials and cohort studies comparing routine ultrasound mapping to physical examination in terms of arteriovenous fistula patency were included. Meta-analysis was performed by fitting random-effects models. The study protocol has been prospectively registered in PROSPERO (CRD42023402390). RESULTS Overall, 18 studies were included, comprising 3655 participants. Routine pre-operative ultrasound mapping was associated with significantly lower rates of primary arteriovenous fistula failure (Risk Ratio-RR: 0.56, 95% confidence intervals-CI: 0.37-0.84, low certainty). A significant outcome was observed by separately pooling randomized controlled trials (RR: 0.37, 95% CI: 0.25-0.54). Routine ultrasound mapping was also associated with significantly higher rates of 1-year primary arteriovenous fistula patency (RR: 1.33, 95% CI: 1.19-1.47, moderate certainty). This effect remained significant in the analysis of randomized controlled trials (RR: 1.26, 95% CI: 1.02-1.56). CONCLUSIONS Implementing routine pre-operative ultrasound mapping of vessels is associated with significantly better outcomes in terms of early arteriovenous fistula failure and primary patency rates at 12 months. Further research should confirm the long-term benefits of routine ultrasound examination and evaluate its cost-effectiveness in different populations.
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Affiliation(s)
- David-Dimitris Chlorogiannis
- Department of Research Methodology and Biostatistics, Aristotle University of Thessaloniki, 541 24, Thessaloniki, Greece
| | - Stelios-Elion Bousi
- First Department of Surgery, National and Kapodistrian University of Athens, Laiko General Hospital, National and Kapodistrian University of Athens, 11527, Athens, Greece
| | - Marinos Zachiotis
- First Department of Surgery, National and Kapodistrian University of Athens, Laiko General Hospital, National and Kapodistrian University of Athens, 11527, Athens, Greece
| | - Anargyros Chlorogiannis
- Department of Health Economics, Policy and Management, Karolinska Institutet, Stockholm, Sweden
| | - Ioannis Kyriakoulis
- Department of Internal Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Ioannis Bellos
- Department of Nephrology and Renal Transplantation, Laiko General Hospital, National and Kapodistrian University of Athens, 11527, Athens, Greece.
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 17, Agiou Thoma Str., 11527, Athens, Greece.
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Alfano G, Bergesio F, Lombardi M, Piccoli GB, Salomone M, Bonucchi D, Cusinato S, Colturi C, Quintaliani P, Santoro A, D'Alessandro C, Ciciani AM. Eco- dialysis in Italy: where are we? National survey on the eco-sustainability of dialysis across Italian dialysis centers. J Nephrol 2024:10.1007/s40620-023-01882-8. [PMID: 38427306 DOI: 10.1007/s40620-023-01882-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 12/26/2023] [Indexed: 03/02/2024]
Affiliation(s)
- Gaetano Alfano
- Nephrology Dialysis and Transplant Unit, Ospedale-Universitario di Modena, Modena, Italy.
| | - Franco Bergesio
- Project Group On Green Nephrology of the Italian Society of Nephrology, Florence, Italy
| | - Marco Lombardi
- Nefrologia e Dialisi Ospedale Mugello, ASL Toscana Centro, Florence, Italy
| | | | - Mario Salomone
- Project Group On Green Nephrology of the Italian Society of Nephrology, Turin, Italy
| | | | | | - Carla Colturi
- Nefrologia e Dialisi, Sondrio Hospital, Sondrio, Italy
| | - Pino Quintaliani
- Project Group On Green Nephrology of the Italian Society of Nephrology, Perugia, Italy
| | - Antonio Santoro
- Project Group On Green Nephrology of the Italian Society of Nephrology, Bologna, Italy
| | - Claudia D'Alessandro
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italia
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Furuya M, Nagamoto Y, Okuda S, Matsumoto T, Takahashi Y, Takenaka S, Iwasaki M. Long-term outcomes of spine surgery in dialysis patients, focusing on activities of daily living, life expectancy, and the risk factors for postoperative mortality. J Orthop Sci 2024; 29:508-513. [PMID: 36894404 DOI: 10.1016/j.jos.2023.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 02/14/2023] [Accepted: 02/21/2023] [Indexed: 03/11/2023]
Abstract
BACKGROUND Because of the high incidence of major perioperative adverse events, spine surgery in dialysis patients should be recommended carefully after consideration of its risks and benefits. However, the benefits of spine surgery in dialysis patients remain unclear because of the lack of long-term outcomes. The purpose of this study is to elucidate the long-term outcomes of spine surgery in dialysis patients, focusing on activities of daily living (ADLs), life expectancy, and risk factors for postoperative mortality. METHODS Data for 65 dialysis patients who underwent spine surgery at our institution and were followed up for a mean duration of 6.2 years were retrospectively reviewed. ADLs, number of surgeries, and survival times were recorded. The postoperative survival rate was calculated using the Kaplan-Meier method, and risk factors for postoperative mortality were investigated using a generalized Wilcoxon test and multivariate Cox proportional-hazards model. RESULTS Compared with preoperative ADLs, ADLs significantly improved at discharge after surgery and at the final follow-up. However, 16 of the 65 patients (24.6%) underwent multiple surgeries, and 34 (52.3%) died during the follow-up period. Kaplan-Meier analysis revealed that the survival rate after spine surgery was 95.4% at 1 year, 86.2% at 3 years, 69.6% at 5 years, 59.7% at 7 years, and 28.7% at 10 years, and the overall median survival time was 99 months. Multivariate Cox regression analysis showed that a dialysis period of ≥10 years was a significant risk factor. CONCLUSIONS Spine surgery in dialysis patients improved and maintained ADLs in the long term and did not shorten life expectancy. However, dialysis patients undergoing spine surgery require multiple surgeries more frequently, and a dialysis period of ≥10 years is a significant risk factor for postoperative mortality.
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Affiliation(s)
- Masayuki Furuya
- Department of Orthopaedic Surgery, Osaka Rosai Hospital, 1179-3 Nagasonecho, Kita-ku, 591-8025, Sakai, Japan.
| | - Yukitaka Nagamoto
- Department of Orthopaedic Surgery, Osaka Rosai Hospital, 1179-3 Nagasonecho, Kita-ku, 591-8025, Sakai, Japan
| | - Shinya Okuda
- Department of Orthopaedic Surgery, Osaka Rosai Hospital, 1179-3 Nagasonecho, Kita-ku, 591-8025, Sakai, Japan
| | - Tomiya Matsumoto
- Department of Orthopaedic Surgery, Osaka Rosai Hospital, 1179-3 Nagasonecho, Kita-ku, 591-8025, Sakai, Japan
| | - Yoshifumi Takahashi
- Department of Orthopaedic Surgery, Osaka Rosai Hospital, 1179-3 Nagasonecho, Kita-ku, 591-8025, Sakai, Japan
| | - Shota Takenaka
- Department of Orthopaedics, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, 565-0871, Osaka, Japan
| | - Motoki Iwasaki
- Department of Orthopaedic Surgery, Osaka Rosai Hospital, 1179-3 Nagasonecho, Kita-ku, 591-8025, Sakai, Japan
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Pelusio C, Endres P, Neyra JA, Allegretti AS. Renal Replacement Therapy in Cirrhosis: A Contemporary Review. Adv Kidney Dis Health 2024; 31:133-138. [PMID: 38649217 DOI: 10.1053/j.akdh.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 12/20/2023] [Accepted: 01/02/2024] [Indexed: 04/25/2024]
Abstract
Acute kidney injury is a common complication of decompensated cirrhosis, frequently requires hospitalization, and carries a high short-term mortality. This population experiences several characteristic types of acute kidney injury: hypovolemic-mediated (prerenal), ischemic/nephrotoxic-mediated (acute-tubular necrosis), and hepatorenal syndrome. Prerenal acute kidney injury is treated with volume resuscitation. Acute-tubular necrosis is treated by optimizing perfusion pressure and discontinuing the offending agent. Hepatorenal syndrome, a unique physiology of decreased effective arterial circulation leading to renal vasoconstriction and ultimately acute kidney injury, is treated with plasma expansion with albumin and splanchnic vasoconstrictors such as terlipressin or norepinephrine. Common acute stressors such as bleeding, infection, and volume depletion often contribute to multifactorial acute kidney injury. Even with optimal medical management, many clinicians are faced with the challenge of initiating renal replacement therapy in these patients. This article reviews the epidemiology, indications, and complex considerations of renal replacement therapy for acute kidney injury in decompensated cirrhosis.
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Affiliation(s)
- Caterina Pelusio
- Department of Health Sciences, Section of Anesthesiology and Intensive Care, University of Florence, Florence, Italy; Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Paul Endres
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Javier A Neyra
- Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Andrew S Allegretti
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, MA.
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Tomioka Y, Sugimoto S, Shiotani T, Matsubara K, Choshi H, Ishihara M, Tanaka S, Miyoshi K, Otani S, Toyooka S. Long-term outcomes of lung transplantation requiring renal replacement therapy: A single-center experience. Respir Investig 2024; 62:240-246. [PMID: 38241956 DOI: 10.1016/j.resinv.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 12/22/2023] [Accepted: 01/08/2024] [Indexed: 01/21/2024]
Abstract
BACKGROUND Life-long immunosuppressive therapy after lung transplantation (LT) may lead to end-stage renal disease (ESRD), requiring renal replacement therapy (RRT). We aimed to investigate the characteristics and long-term outcomes of patients undergoing LT and requiring RRT. METHODS This study was a single-center, retrospective cohort study. The patients were divided into the RRT (n = 15) and non-RRT (n = 170) groups. We summarized the clinical features of patients in the RRT group and compared patient characteristics, overall survival, and chronic lung allograft dysfunction (CLAD)-free survival between the two groups. RESULTS The cumulative incidences of ESRD requiring RRT after LT at 5, 10, and 15 years were 0.8 %, 7.6 %, and 25.2 %, respectively. In the RRT group, all 15 patients underwent hemodialysis but not peritoneal dialysis, and two patients underwent living-donor kidney transplantation. The median follow-up period was longer in the RRT group than in the non-RRT group (P < 0.001). The CLAD-free survival and overall survival did not differ between the two groups. The 5-year survival rate even after the initiation of hemodialysis was 53.3 %, and the leading cause of death in the RRT group was infection. CONCLUSIONS Favorable long-term outcomes can be achieved by RRT for ESRD after LT.
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Affiliation(s)
- Yasuaki Tomioka
- Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan; Department of General Thoracic Surgery and Organ Transplant Center, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan
| | - Seiichiro Sugimoto
- Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan; Department of General Thoracic Surgery and Organ Transplant Center, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan.
| | - Toshio Shiotani
- Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan; Department of General Thoracic Surgery and Organ Transplant Center, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan
| | - Kei Matsubara
- Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan; Department of General Thoracic Surgery and Organ Transplant Center, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan
| | - Haruki Choshi
- Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan; Department of General Thoracic Surgery and Organ Transplant Center, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan
| | - Megumi Ishihara
- Department of General Thoracic Surgery and Organ Transplant Center, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan
| | - Shin Tanaka
- Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan; Department of General Thoracic Surgery and Organ Transplant Center, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan
| | - Kentaroh Miyoshi
- Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan
| | - Shinji Otani
- Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan; Department of Cardiovascular and Thoracic Surgery, Ehime University Medical School, 454 Shizugawa, Toon, Ehime 791-0295, Japan
| | - Shinichi Toyooka
- Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan
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Wu H, Cheng H, Wang C, Yao L, Qin S, Zuo L, Hu Z, Zhang C, Wu Y, Hofherr A, Mohan K, Rush S, Li X. Roxadustat and Oral Iron Absorption in Chinese Patients with Anemia of Chronic Kidney Disease: A Randomized, Open-Label, Phase 4 Study (ALTAI). Adv Ther 2024; 41:1168-1183. [PMID: 38280066 PMCID: PMC10879385 DOI: 10.1007/s12325-023-02741-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 11/15/2023] [Indexed: 01/29/2024]
Abstract
INTRODUCTION Anemia of chronic kidney disease (CKD) has a high incidence and is associated with many disease conditions. Iron dysmetabolism is an important contributor to anemia in CKD patients. METHODS ALTAI, a randomized, active-controlled, phase 4 trial, investigated the efficacy of roxadustat versus recombinant human erythropoietin (rHuEPO) on gastrointestinal iron absorption in patients with anemia of CKD (stage 4/5). The primary endpoint was change from baseline to day 15 in gastrointestinal iron absorption (serum iron area under the concentration-time curve; AUC0-3h) following single-dose oral iron. RESULTS Twenty-five patients with a mean age of 55.1 years were randomized 1:1 to roxadustat (n = 13) or rHuEPO (n = 12). Baseline iron profiles were similar between treatment groups. Change from baseline to day 15 in serum iron AUC0-3h was not statistically significantly different between the roxadustat and rHuEPO groups. Mean (SD) change from baseline in serum iron AUC0-3h was 11.3 (28.2) g × 3 h/dl in the roxadustat group and - 0.3 (9.7) g × 3 h/dl in the rHuEPO group. Roxadustat treatment was associated with decreased hepcidin and also increased transferrin, soluble transferrin receptor, and total iron-binding capacity (TIBC), with nominal significance. The proportion of patients experiencing one or more adverse events was 38.5% when treated with roxadustat and 16.7% with rHuEPO. CONCLUSIONS The study showed no significant difference between roxadustat and rHuEPO in iron absorption but was underpowered because of recruitment challenges. TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT04655027.
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Affiliation(s)
- Haiting Wu
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Hong Cheng
- Beijing Anzhen Hospital, Chaoyang District, Beijing, China
| | - Caili Wang
- The First Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology, Kundulun District, Baotou, Inner Mongolia, China
| | - Li Yao
- The First Hospital of China Medical University, Heping District, Shenyang, Liaoning, China
| | - Shuguang Qin
- Guangzhou First People's Hospital, Yuexiu District, Guangzhou, Guangdong, China
| | - Li Zuo
- Peking University People's Hospital, Xicheng District, Beijing, China
| | - Zhao Hu
- Qilu Hospital of Shandong University, Lixia District, Jinan, Shandong, China
| | - Chun Zhang
- Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yiqing Wu
- FibroGen (China), Medical Technology Development Company Ltd., Beijing, China
| | - Alexis Hofherr
- Research and Early Clinical Development, Cardiovascular, Renal and Metabolism (CVRM), BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Katie Mohan
- BioPharmaceuticals Medical Evidence, Cardiovascular, Renal and Metabolism (CVRM), AstraZeneca, Cambridge, UK
| | - Stephen Rush
- Late-Stage Development, Cardiovascular, Renal and Metabolism (CVRM), BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Xuemei Li
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China.
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Vanorio-Vega I, Constantinou P, Bret V, Gentile S, Finne P, Sautenet B, Tuppin P, Couchoud C. Effect of comorbidities on healthcare expenditures for patients on kidney replacement therapy considering the treatment modality and duration in a French cohort. Eur J Health Econ 2024; 25:269-279. [PMID: 37004630 DOI: 10.1007/s10198-023-01585-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 03/16/2023] [Indexed: 06/19/2023]
Abstract
End-stage kidney disease (ESKD) is associated with a substantial economic burden. In France, the cost of care for such patients represents 2.5% of the total French healthcare expenditures but serves less than 1% of the population. These patients' healthcare expenditures are high because of the specialized and complex treatment needed as well as the presence of multiple comorbidities. This study aims to describe and assess the effect of comorbidities on healthcare expenditures (direct medical cost and non-medical costs including transportation and compensatory allowances) for patients with ESKD in France while considering the modality and duration of renal replacement therapy (RRT). This study included adults who started RRT for the first time between 2012 and 2014 in France and were followed for 5 years. Generalized linear models were built to predict mean monthly cost (MMC) by integrating first the time duration in the cohort, then patient characteristics and finally the duration of use of each treatment modalities. Comorbidities with the highest effect on MMC were inability to walk (+ 1435€), active cancer (+ 593€), HIV positivity (+ 507€) and diabetes (+ 396€). These effects vary according to age or treatment modalities. This study confirms the importance of considering patient characteristics, comorbidities and type of RRT when assessing healthcare expenditures for patients with ESKD.
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Affiliation(s)
- Isabella Vanorio-Vega
- Direction de la Stratégie des Études et des Statistiques, Caisse Nationale de L'assurance Maladie (CNAM), 75986, Paris, France.
- Agence de la Biomédecine, 1 Avenue du Stade de France, 93212, Saint-Denis, France.
| | - Panayotis Constantinou
- Direction de la Stratégie des Études et des Statistiques, Caisse Nationale de L'assurance Maladie (CNAM), 75986, Paris, France
| | - Victor Bret
- Direction de la Stratégie des Études et des Statistiques, Caisse Nationale de L'assurance Maladie (CNAM), 75986, Paris, France
| | - Stéphanie Gentile
- School of Medicine-La Timone Medical Campus, EA 3279: CEReSS-Health Service Research and Quality of Life Center, Aix Marseille University, Marseille, France
| | - Patrik Finne
- Department of Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Bénédicte Sautenet
- MCU-PH Service Néphrologie-Hypertension Artérielle, Dialyses, Transplantation Rénale INSERM U1246 SPHERE, Nantes, France
| | - Philippe Tuppin
- Direction de la Stratégie des Études et des Statistiques, Caisse Nationale de L'assurance Maladie (CNAM), 75986, Paris, France
| | - Cécile Couchoud
- Agence de la Biomédecine, 1 Avenue du Stade de France, 93212, Saint-Denis, France
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Neumayr TM, Bayrakci B, Chanchlani R, Deep A, Morgan J, Arikan AA, Basu RK, Goldstein SL, Askenazi DJ. Programs and processes for advancing pediatric acute kidney support therapy in hospitalized and critically ill children: a report from the 26th Acute Disease Quality Initiative (ADQI) consensus conference. Pediatr Nephrol 2024; 39:993-1004. [PMID: 37930418 PMCID: PMC10817827 DOI: 10.1007/s00467-023-06186-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 09/24/2023] [Accepted: 09/25/2023] [Indexed: 11/07/2023]
Abstract
Pediatric acute kidney support therapy (paKST) programs aim to reliably provide safe, effective, and timely extracorporeal supportive care for acutely and critically ill pediatric patients with acute kidney injury (AKI), fluid and electrolyte derangements, and/or toxin accumulation with a goal of improving both hospital-based and lifelong outcomes. Little is known about optimal ways to configure paKST teams and programs, pediatric-specific aspects of delivering high-quality paKST, strategies for transitioning from acute continuous modes of paKST to facilitate rehabilitation, or providing effective short- and long-term follow-up. As part of the 26th Acute Disease Quality Initiative Conference, the first to focus on a pediatric population, we summarize here the current state of knowledge in paKST programs and technology, identify key knowledge gaps in the field, and propose a framework for current best practices and future research in paKST.
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Affiliation(s)
- Tara M Neumayr
- Department of Pediatrics, Divisions of Pediatric Critical Care Medicine and Pediatric Nephrology, Washington University School of Medicine, St. Louis, MO, USA
| | - Benan Bayrakci
- Department of Pediatric Intensive Care Medicine, The Center for Life Support Practice and Research, Hacettepe University, Ankara, Türkiye
| | - Rahul Chanchlani
- Department of Pediatrics, Division of Pediatric Nephrology, McMaster University, McMaster Children's Hospital, Hamilton, ON, Canada
| | - Akash Deep
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK.
- Pediatric Intensive Care Unit, King's College Hospital NHS Foundation Trust, London, UK.
| | - Jolyn Morgan
- Center for Acute Care Nephrology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Ayse Akcan Arikan
- Department of Pediatrics, Divisions of Critical Care Medicine and Nephrology, Baylor College of Medicine, Houston, TX, USA
| | - Rajit K Basu
- Department of Pediatrics, Division of Critical Care Medicine, Northwestern University Feinberg School of Medicine, Ann & Robert Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Stuart L Goldstein
- Department of Pediatrics, Division of Nephrology & Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - David J Askenazi
- Department of Pediatrics, Division of Pediatric Nephrology, Pediatric and Infant Center for Acute Nephrology, Children's of Alabama, University of Alabama at Birmingham, Birmingham, AL, USA
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Nakayama M. Why should we use a low sodium dialysis solution for peritoneal dialysis? Perit Dial Int 2024; 44:89-97. [PMID: 38265014 DOI: 10.1177/08968608231222141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024] Open
Abstract
Overhydration is highly prevalent in patients on peritoneal dialysis (PD), with inappropriately high sodium load supposedly playing a central role in the pathophysiology of the conditions. Recent studies have revealed the novel role of the interstitium as a buffer system for sodium ions, and it has been reported that patients on dialysis, including PD, present increased levels of sodium in the interstitium, such as in subcutaneous tissue and muscle. Hence, therapy for correction of overhydration should target the excess extracellular volume and the excess sodium storage in the interstitium. The ultrafiltrate obtained using the currently available PD solutions is hypo- to isonatric as compared to serum, which is disadvantageous for prompt and efficient sodium removal from the body in patients with overhydration. In contrast, use of low sodium PD solutions is characterised by iso- to hypernatric ultrafiltrate, which may beneficial for reducing sodium storage in the interstitium. Trials of low sodium PD solutions have reported possible clinical merits, for example, decreased blood pressure, reduced dryness of mouth and decreased body water content as assessed using bioimpedance methods. Given these observations and the high prevalence of overhydration in current PD populations, it makes medical sense that low sodium solutions be positioned as the new standard solution in the future. However, for medical safety, that is, to avoid hyponatremia and excessive decreases in blood pressure, further studies are needed to establish the appropriate compositions and applications of low sodium solutions.
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Aljawadi MH, Babaeer AA, Alghamdi AS, Alhammad AM, Almuqbil MS, Alonazi KF. Quality of life tools among patients on dialysis: A systematic review. Saudi Pharm J 2024; 32:101958. [PMID: 38322149 PMCID: PMC10845059 DOI: 10.1016/j.jsps.2024.101958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 01/11/2024] [Indexed: 02/08/2024] Open
Abstract
Introduction The universal increase in obesity and diabetes has increased the chronic kidney disease (CKD) rate. In 2017, almost 800 million individuals suffered from CKD worldwide. Kidney dialysis becomes necessary as the disease progresses. Dialysis negatively impacts CKD patients' quality of life (QoL). It causes several complications that affect patients' physical, social, psychological, and spiritual aspects of life. This systematic review aims to identify condition-specific tools used to assess CKD patients' quality of life on dialysis. Material and Methods A systematic literature search was conducted to investigate studies using QoL tools among patients on dialysis from February 2000 to June 2023. The search was conducted in several databases and followed the PRISMA guidelines. The focus was to identify tools that capture intrinsic factors, such as spiritual subdomains, rather than extrinsic factors, such as environmental subdomains. Results The review identified five studies and seven dialysis-specific tools for assessing the QoL of CKD patients on dialysis. The physical domain was the most assessed, followed by the psychological and social domains. Fatigue, muscle weakness, sleep disorders, and pain were identified as the most common concerns in the physical domain. Conclusion Dialysis negatively impacts all aspects of QoL in CKD patients. This review can guide clinicians in understanding the disease and treatment burden by identifying the most appropriate tools for assessing the QoL of adult CKD patients undergoing dialysis. There is a need for further studies to explore the detrimental effects of CKD treatment and better understand its impact on patients' QoL.
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Affiliation(s)
- Mohammad H. Aljawadi
- Clinical Pharmacy Department, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | | | | | - Abdullah M. Alhammad
- Clinical Pharmacy Department, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Mansour S. Almuqbil
- Clinical Pharmacy Department, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
- Department of Pharmacy Practice, College of Pharmacy, AlMaarefa University, Riyadh, Saudi Arabia
| | - Khalid F Alonazi
- Clinical Pharmacy Department, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
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Lee DH, Kim YJ, Kim H, Lee HS. Validation of operational definitions of mortality in a nationwide hemo dialysis population using the Health Insurance Review and Assessment Service databases of Korea. Kidney Res Clin Pract 2024; 43:156-164. [PMID: 36908201 PMCID: PMC11016677 DOI: 10.23876/j.krcp.22.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 08/19/2022] [Accepted: 09/09/2022] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND Health Insurance Review and Assessment Service's (HIRA) claims data have been used in studies of hemodialysis patients even though information about mortality is not provided in this database. Mortality analysis using HIRA data has been conducted using various operational definitions that have not been validated. This study aimed to validate operational definitions of mortality for maintenance hemodialysis patients that have been used when analyzing the Korean HIRA database. METHODS This study utilized claims data of the Korean National Health Insurance Service (NHIS) between January 2008 and December 2019. We estimated mortality based on operational definitions applied in previous studies using the HIRA database and compared it with NHIS mortality information to validate accuracy. RESULTS A total of 128,876 patients who started maintenance hemodialysis between January 2009 and December 2019 were analyzed. The accuracy of estimated mortality was the highest at 96% in the group where mortality was defined as an absence of claims data for 150 days. If the period of no claims data was set to 90 days or less, there was a risk of overestimating the mortality for the entire study period. When it was set to 180 days or more, there was a risk of underestimating the mortality, as the follow-up time was close to the end of the study period. CONCLUSION When mortality analysis of maintenance hemodialysis patients is performed using HIRA data, it is most accurate to set the operational definition period as the absence of claims data for 150 days.
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Affiliation(s)
- Dong Hee Lee
- Division of Nephrology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
| | - Ye-Jee Kim
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hyangkyoung Kim
- Department of Surgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Republic of Korea
| | - Hyung Seok Lee
- Division of Nephrology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
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Eftekhari H, Haghdar Saheli Y, Ashoobi MT, Mahjoob M, Kazemnezhad Leyli E, Bagheri Toolaroud P. The prevalence of onychomycosis in patients with chronic renal failure undergoing dialysis: A cross-sectional study. Heliyon 2024; 10:e25737. [PMID: 38434055 PMCID: PMC10906168 DOI: 10.1016/j.heliyon.2024.e25737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 01/29/2024] [Accepted: 02/01/2024] [Indexed: 03/05/2024] Open
Abstract
Onychomycosis is one of the most common cutaneous symptoms in patients with chronic renal failure. In the present study, we aimed to investigate the prevalence and determine the factors likely associated with developing onychomycosis among dialysis patients. This cross-sectional study was conducted between 2022 and 2023 with 312 chronic renal failure patients undergoing dialysis visiting the dialysis departments of Guilan University of Medical Sciences. Participants were selected by consecutive sampling method. A dermatologist subjected the patients to a detailed clinical assessment of the fingernails and toenails to find evidence of Onychomycosis. Periodic acid-Schiff (PAS) staining was performed in case of suspicion of Onychomycosis. A total of 312 inpatients were investigated during the time frame of the present study. Among study patients, 62.5% were male, the average age of the patients was 59.3 ± 13.9 years, and the mean duration of dialysis was 37.5 ± 38.5 months. A total of 12.8% (n = 40) of patients undergoing dialysis had Onychomycosis. Diabetes mellitus was present in 37.5% of dialysis patients. Diabetes and Onychomycosis were significantly associated, so the prevalence rate of Onychomycosis in diabetic patients was almost twice that of non-diabetic patients (17.9% vs. 9.7%; P < 0.001). Logistic regression analysis revealed that age, sex, education level, and type of dialysis access were the predictors of Onychomycosis development. Onychomycosis puts people at risk for more severe infections, including erysipelas, cellulitis, and amputations; thus, dialysis patients need to learn how to take care of their toenails properly.
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Affiliation(s)
- Hojat Eftekhari
- Skin Research Center, Department of Dermatology, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Yalda Haghdar Saheli
- Department of Internal Medicine, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Mohammad Taghi Ashoobi
- Razi Clinical Research Development Unit, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Mahsa Mahjoob
- School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Ehsan Kazemnezhad Leyli
- Department of Biostatistics, School of Health, Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Parissa Bagheri Toolaroud
- Burn and Regenerative Medicine Research Center, Guilan University of Medical Sciences, Rasht, Iran
- Health Information Management Research Center, Kashan University of Medical Sciences, Kashan, Iran
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73
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Rosner MH, Ronco C. It Is All in the Name: Standard Nomenclature for Extracorporeal Purification. Blood Purif 2024; 53:327-328. [PMID: 38412842 DOI: 10.1159/000537909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 02/15/2024] [Indexed: 02/29/2024]
Affiliation(s)
- Mitchell H Rosner
- Department of Medicine, University of Virginia Health, Charlottesville, Virginia, USA
| | - Claudio Ronco
- International Renal Research Institute of Vicenza (IRRIV), Vicenza, Italy,
- Department of Nephrology, Dialysis and Kidney Transplantation, San Bortolo Hospital, Vicenza, Italy,
- Department of Medicine (DIMED), Università Degli Studi di Padova, Padua, Italy,
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Ballegaard ELF, Lindhard K, Lindhardt M, Peters CD, Thomsen Nielsen F, Tietze IN, Borg R, Boesby L, Bertelsen MC, Brøsen JMB, Cibulskyte-Ninkovic D, Rantanen JM, Mose FH, Kampmann JD, Nielsen AS, Breinholt JK, Kofod DH, Bressendorff I, Clausen PV, Lange T, Køber L, Kamper AL, Bang CNF, Torp-Pedersen C, Hansen D, Grove EL, Gislason G, Dam Jensen J, Olesen JB, Hornum M, Rix M, Schou M, Carlson N. Protocol for a randomised controlled trial comparing warfarin with no oral anticoagulation in patients with atrial fibrillation on chronic dialysis: the Danish Warfarin-Dialysis (DANWARD) trial. BMJ Open 2024; 14:e081961. [PMID: 38413147 PMCID: PMC10900386 DOI: 10.1136/bmjopen-2023-081961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 02/12/2024] [Indexed: 02/29/2024] Open
Abstract
INTRODUCTION Atrial fibrillation is highly prevalent in patients on chronic dialysis. It is unclear whether anticoagulant therapy for stroke prevention is beneficial in these patients. Vitamin K-antagonists (VKA) remain the predominant anticoagulant choice. Importantly, anticoagulation remains inconsistently used and a possible benefit remains untested in randomised clinical trials comparing oral anticoagulation with no treatment in patients on chronic dialysis. The Danish Warfarin-Dialysis (DANWARD) trial aims to investigate the safety and efficacy of VKAs in patients with atrial fibrillation on chronic dialysis. The hypothesis is that VKA treatment compared with no treatment is associated with stroke risk reduction and overall benefit. METHODS AND ANALYSIS The DANWARD trial is an investigator-initiated trial at 13 Danish dialysis centres. In an open-label randomised clinical trial study design, a total of 718 patients with atrial fibrillation on chronic dialysis will be randomised in a 1:1 ratio to receive either standard dose VKA targeting an international normalised ratio of 2.0-3.0 or no oral anticoagulation. Principal analyses will compare the risk of a primary efficacy endpoint, stroke or transient ischaemic attack and a primary safety endpoint, major bleeding, in patients allocated to VKA treatment and no treatment, respectively. The first patient was randomised in October 2019. Patients will be followed until 1 year after the inclusion of the last patient. ETHICS AND DISSEMINATION The study protocol was approved by the Regional Research Ethics Committee (journal number H-18050839) and the Danish Medicines Agency (case number 2018101877). The trial is conducted in accordance with the Helsinki declaration and standards of Good Clinical Practice. Study results will be disseminated to participating sites, at research conferences and in peer-reviewed journals. TRIAL REGISTRATION NUMBERS NCT03862859, EUDRA-CT 2018-000484-86 and CTIS ID 2022-502500-75-00.
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Affiliation(s)
- Ellen Linnea Freese Ballegaard
- Department of Nephrology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Kristine Lindhard
- Department of Nephrology, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
| | - Morten Lindhardt
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Internal Medicine 1, Holbæk Hospital, Holbæk, Denmark
| | - Christian Daugaard Peters
- Dept. of Clinical Medicine, Aarhus University, Aarhus N, Denmark
- Department of Renal Medicine, Aarhus University Hospital, Aarhus N, Denmark
| | - Finn Thomsen Nielsen
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Medicine, Bornholms Hospital, Ronne, Denmark
| | | | - Rikke Borg
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Medicine, Zealand University Hospital, Roskilde, Denmark
| | - Lene Boesby
- Department of Medicine, Zealand University Hospital, Roskilde, Denmark
| | - Marianne Camilla Bertelsen
- Department of Endocrinology and Nephrology, Copenhagen University Hospital - North Zealand, Hillerød, Denmark
| | - Julie Maria Bøggild Brøsen
- Department of Endocrinology and Nephrology, Copenhagen University Hospital - North Zealand, Hillerød, Denmark
| | | | | | - Frank Holden Mose
- Department of Nephrology, Gødstrup Regional Hospital, Herning, Denmark
| | - Jan Dominik Kampmann
- Internal medicine, Hospital of Southern Jutland Sonderborg Branch, Sonderborg, Denmark
| | - Alice Skovhede Nielsen
- Department of Medicine, Esbjerg Hospital, University Hospital of Southern Denmark, Esbjerg, Denmark
| | - Johanne Kodal Breinholt
- Department of Clinical Biochemistry, Esbjerg Hospital, University Hospital of Southern Denmark, Esbjerg, Denmark
| | - Dea Haagensen Kofod
- Department of Nephrology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Iain Bressendorff
- Department of Nephrology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Nephrology, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
| | - Peter Vilhelm Clausen
- Department of Nephrology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Theis Lange
- Section of Biostatistics, University of Copenhagen, Kobenhavns, Denmark
| | - Lars Køber
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Anne-Lise Kamper
- Department of Nephrology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Casper Niels Furbo Bang
- Department of Cardiology, Copenhagen University Hospital - Frederiksberg and Bispebjerg, Copenhagen, Denmark
| | | | - Ditte Hansen
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Nephrology, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
| | - Erik L Grove
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
- Faculty of Health, Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Gunnar Gislason
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
- The Danish Heart Foundation, Copenhagen, Denmark
| | - Jens Dam Jensen
- Department of Renal Medicine, Aarhus University Hospital, Aarhus N, Denmark
| | - Jonas Bjerring Olesen
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
| | - Mads Hornum
- Department of Nephrology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Marianne Rix
- Department of Nephrology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Morten Schou
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
| | - Nicholas Carlson
- Department of Nephrology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
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Shankar R, Luo N, Lim YW, Khatri P, Leong L, Teo GYX, Mukhopadhyay A, Choo J, Chua HR, Teng GG, Phua J, Hong WZ. Assessing caregiver burden in advanced kidney disease: protocol for a systematic review of the measurement properties of instruments and tools. BMJ Open 2024; 14:e078767. [PMID: 38413158 PMCID: PMC10900375 DOI: 10.1136/bmjopen-2023-078767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 02/08/2024] [Indexed: 02/29/2024] Open
Abstract
INTRODUCTION Caregiver burden is a significant issue in the care of patients with advanced kidney disease. Its assessment is crucial for evaluating the needs of caregivers and for the development of interventions to support them. Several instruments have been developed to measure caregiver burden in these patients. However, the measurement properties of these instruments have not been systematically reviewed. METHODS AND ANALYSIS This systematic review will include a comprehensive search of databases including PubMed, CINAHL, Embase, Cochrane Library, SCOPUS and Web of Science by using keywords and MeSH terms to identify relevant studies starting from each database inception to 1 January 2024 and covering papers in English. The search strategy will combine relevant keywords and database-specific subject headings related to the following concepts: (1) caregivers, (2) burden, stress, distress, (3) chronic kidney disease, end-stage kidney disease, dialysis. Reference lists of eligible articles will also be hand searched. We will include quantitative and qualitative studies evaluating measurement properties of instruments assessing caregiver burden in caregivers of adult patients (aged ≥18 years). Data will be extracted from the selected studies and analysed using the COnsensus-based Standards for the selection of health Measurement INstruments checklist as the study quality assessment tool. Subsequently, the van der Vleuten utility index will be used to critique and categorise the instruments. A narrative that synthesises the utility of all instruments will be presented along with recommendations for the selection of instruments depending on specific clinical contexts. This systematic review will provide an overview of the measurement properties of available instruments, including discussion on reliability, validity and responsiveness. Results from the review may give rise to the subsequent development of most appropriate instrument that could be applied to the assessment of caregiver burden in advanced kidney disease. ETHICS AND DISSEMINATION Ethics approval is not required as this study will merely synthesise data from published studies. The results will be disseminated through peer-reviewed publications as well as conference presentations. PROSPERO REGISTRATION NUMBER CRD42023433906.
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Affiliation(s)
- Ravi Shankar
- Medical Affairs - Research, Innovation and Enterprise, Alexandra Hospital, National University Health System, Singapore
| | - Nan Luo
- Saw Swee Hock School of Public Health, National University Singapore, Singapore
| | - Yee Wei Lim
- Medical Affairs - Research, Innovation and Enterprise, Alexandra Hospital, National University Health System, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Priyanka Khatri
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Nephrology, Department of Medicine, National University Hospital, National University Health System, Singapore
- Chronic Programme, Alexandra Hospital, National University Health System, Singapore
- Fast Programme, Alexandra Hospital, National University Health System, Singapore
| | - Leanne Leong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Nephrology, Department of Medicine, National University Hospital, National University Health System, Singapore
- Chronic Programme, Alexandra Hospital, National University Health System, Singapore
- Fast Programme, Alexandra Hospital, National University Health System, Singapore
| | - Geraldine Yu-Xuan Teo
- Chronic Programme, Alexandra Hospital, National University Health System, Singapore
- Fast Programme, Alexandra Hospital, National University Health System, Singapore
| | - Amartya Mukhopadhyay
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Chronic Programme, Alexandra Hospital, National University Health System, Singapore
- Fast Programme, Alexandra Hospital, National University Health System, Singapore
- Division of Respiratory and Critical Care Medicine, Department of Medicine, National University Hospital, National University Health System, Singapore
| | - Jason Choo
- Department of Renal Medicine, Singapore General Hospital, Singapore
| | - Horng Ruey Chua
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Nephrology, Department of Medicine, National University Hospital, National University Health System, Singapore
| | - Gim-Gee Teng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Chronic Programme, Alexandra Hospital, National University Health System, Singapore
- Fast Programme, Alexandra Hospital, National University Health System, Singapore
- Division of Rheumatology, Department of Medicine, National University Hospital, National University Health System, Singapore
| | - Jason Phua
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Chronic Programme, Alexandra Hospital, National University Health System, Singapore
- Fast Programme, Alexandra Hospital, National University Health System, Singapore
- Division of Respiratory and Critical Care Medicine, Department of Medicine, National University Hospital, National University Health System, Singapore
| | - Wei Zhen Hong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Nephrology, Department of Medicine, National University Hospital, National University Health System, Singapore
- Chronic Programme, Alexandra Hospital, National University Health System, Singapore
- Fast Programme, Alexandra Hospital, National University Health System, Singapore
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Tsujimoto Y, Aoki T, Shimizu S, Kawarazaki H, Kohatsu K, Nakata T, O'Hare AM, Shibagaki Y, Yamamoto Y, Miyashita J. Perspectives on the optimal timing of advance care planning among Japanese patients undergoing dialysis and clinicians: a cross-sectional study. Clin Exp Nephrol 2024:10.1007/s10157-024-02458-x. [PMID: 38402499 DOI: 10.1007/s10157-024-02458-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 01/03/2024] [Indexed: 02/26/2024]
Abstract
KEY MESSAGES The majority of dialysis patients and clinicians favor early advance care planning in our sample. Yet, there is a disconnect: only 11% of patients discussed future care with their clinicians. Our findings indicate Japanese dialysis patients and clinicians support proactive advance care planning at or before dialysis initiation. BACKGROUND Little is known about the optimal timing of discussions about advance care planning among dialysis patients and clinicians engaged in dialysis care. We aimed to explore the preferred timing for advance care planning and assess actual participation in advance care planning among dialysis patients and their clinicians. METHODS A scenario-based survey on Japanese patients aged ≥65 years on dialysis and clinicians involved in their dialysis care was performed. Participants were asked if they would feel prepared to engage in advance care planning with their clinicians, offering a choice among four hypothetical stages within the illness trajectory, extending from the initiation of dialysis to a later phase characterized by the patient's extreme frailty. RESULTS Overall, 181 patients and 128 clinicians participated in the study. Among these, 131 (72%) patients, and 84 (66%) clinicians indicated that they would prefer to initiate advance care planning around the time of dialysis initiation. Only 20 patients (11%) indicated that they had participated in advance care planning with at least one clinician, including 11 (6%) who indicated that they had discussed their preferences around life-sustaining treatments and 8 (4%) who had discussed their preferences around dialysis continuation. CONCLUSIONS While fewer than 11% of patients undergoing dialysis and their clinicians enrolled in our study had participated in advance care planning, most indicated that they would be comfortable initiating the discussion around the time of dialysis initiation. These findings suggest untapped opportunities to engage patients in advance care planning early in the course of their dialysis.
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Affiliation(s)
- Yasushi Tsujimoto
- Oku Medical Clinic, Osaka, Japan.
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan.
- Scientific Research Works Peer Support Group, Osaka, Japan.
| | - Takuya Aoki
- Section of Clinical Epidemiology, Department of Community Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Division of Clinical Epidemiology, The Jikei University School of Medicine, Tokyo, Japan
| | - Sayaka Shimizu
- Section of Clinical Epidemiology, Department of Community Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiroo Kawarazaki
- Department of Nephrology, Inagi Municipal Hospital, Inagi, Japan
- Department of Internal Medicine, Teikyo University Mizonokuchi Hospital, Kanagawa, Japan
| | - Kaori Kohatsu
- Division of Nephrology and Hypertension, St Marianna University School of Medicine, Kanagawa, Japan
| | - Takeshi Nakata
- Department of Endocrinology, Metabolism, Rheumatology and Nephrology, Faculty of Medicine, Oita University, Yufu, Japan
| | - Ann M O'Hare
- Hospital and Specialty Medicine Service, Veteran Affairs Puget Sound Health Care System and University of Washington, Seattle, WA, USA
| | - Yugo Shibagaki
- Division of Nephrology and Hypertension, St Marianna University School of Medicine, Kanagawa, Japan
| | - Yosuke Yamamoto
- Department of Healthcare Epidemiology, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Jun Miyashita
- Department of General Medicine, Shirakawa Satellite for Teaching And Research (STAR), Fukushima Medical University, Fukushima, Japan
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Banigan MA, Keim G, Traynor D, Yehya N, Lindell RB, Fitzgerald JC. Association of continuous kidney replacement therapy timing and mortality in critically ill children. Pediatr Nephrol 2024:10.1007/s00467-024-06320-w. [PMID: 38396090 DOI: 10.1007/s00467-024-06320-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 02/04/2024] [Accepted: 02/07/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND Acute kidney injury (AKI) is a common complication of critical illness and associated with high morbidity and mortality. Optimal timing of continuous kidney replacement therapy (CKRT) in children is unknown. We aimed to measure the association between timing of initiation and mortality. METHODS This is a single-center retrospective cohort study of pediatric patients receiving CKRT from 2013 to 2019. The primary exposure, time to CKRT initiation, was measured from onset of stage 3 AKI during hospitalization (defined using Kidney Disease: Improving Global Outcomes creatinine and urine output criteria) and analyzed as both a continuous and categorical variable. The primary outcome was ICU mortality. RESULTS Ninety-nine patients met criteria for analysis. Overall mortality was 39% (39/99). Median time from stage 3 AKI onset to CKRT initiation was 1.5 days in survivors and 5.5 days in nonsurvivors (p < 0.001). In multivariable analysis, increased time to CKRT initiation was independently associated with mortality [OR 1.02 per hour (95% CI 1.01-1.04), p < 0.001]. Longer time to CKRT initiation was associated with higher odds of mortality in ascending time intervals. Patients started on CKRT > 2 days compared to < 2 days after stage 3 AKI onset had higher mortality (65% vs. 5%, p < 0.001), longer median ICU length of stay (25 vs. 12 d, p < 0.001), longer median CKRT duration (11 vs. 5 d, p < 0.001), and fewer AKI-free days (0 vs. 14 d, p < 0.001). CONCLUSIONS Longer time to initiation of CKRT after development of severe AKI is independently associated with mortality. Consideration of early CKRT in this high-risk population may be a strategy to reduce mortality and improve recovery of kidney function. However, there remains significant heterogeneity in the definition of early versus late initiation and the optimal timing of CKRT remains unknown.
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Affiliation(s)
- Maureen A Banigan
- Department of Anesthesiology and Critical Care, The University of Pennsylvania Perelman School of Medicine and Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - Garrett Keim
- Department of Anesthesiology and Critical Care, The University of Pennsylvania Perelman School of Medicine and Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Danielle Traynor
- Department of Anesthesiology and Critical Care, The University of Pennsylvania Perelman School of Medicine and Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Nadir Yehya
- Department of Anesthesiology and Critical Care, The University of Pennsylvania Perelman School of Medicine and Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Robert B Lindell
- Department of Anesthesiology and Critical Care, The University of Pennsylvania Perelman School of Medicine and Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Julie C Fitzgerald
- Department of Anesthesiology and Critical Care, The University of Pennsylvania Perelman School of Medicine and Children's Hospital of Philadelphia, Philadelphia, PA, USA
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Kanai O, Koizumi M, Ito T, Mio T. Afatinib treatment of severe respiratory failure due to malignant lymphangitis in a dialysis patient with squamous cell carcinoma of the lung. BMJ Case Rep 2024; 17:e253308. [PMID: 38378591 PMCID: PMC10882448 DOI: 10.1136/bcr-2022-253308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024] Open
Abstract
Patients on dialysis have limited treatment options for advanced lung cancer because some chemotherapeutic agents are unavailable due to renal dysfunction. A man in his 70s on peritoneal dialysis presented with persistent fever refractory to antibiotics for 2 weeks. Subsequent whole-body CT showed a 5 cm diameter mass in the right lower lobe of the lung with right-sided pleural effusion and osteolytic metastasis of the right iliac bone. The patient was diagnosed with squamous cell carcinoma (cT3N2M1b, stage IVB) harbouring the p.Gly719Ala point mutation on exon 18 of the epidermal growth factor receptor. The patient developed severe respiratory failure due to malignant lymphangitis after a bronchoscopy. He received 30 mg/day of afatinib, resulting in tumour shrinkage and recovery from respiratory failure. We advocate for aggressive screening of driver oncogenes in patients with lung cancer on dialysis, including those with squamous cell lung cancer.
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Affiliation(s)
- Osamu Kanai
- Respiratory Medicine, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Mitsuteru Koizumi
- Nephrology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Takanori Ito
- Respiratory Medicine, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Tadashi Mio
- Respiratory Medicine, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
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Zeuschner P, Mihm J, Sester U, Stöckle M, Friedersdorff F, Budde K, Yakac A, Thomas C, Huber J, Putz J, Flegar L. Old for young kidney transplantation: a responsible option for our patients to reduce waiting time? World J Urol 2024; 42:85. [PMID: 38363345 PMCID: PMC10873431 DOI: 10.1007/s00345-024-04779-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 01/09/2024] [Indexed: 02/17/2024] Open
Abstract
PURPOSE The Eurotransplant Senior program allocating grafts from donors ≥ 65 years to recipients aged ≥ 65 years has proven good results within the last 20 years. However, "old" grafts are also allocated to younger recipients < 65 years, and this outcome of "old for young" kidney transplantations (KT) still lacks detailed investigations. METHODS All "old for young" KT performed at four tertiary referral centers were retrospectively compared including a recent follow-up, stratifying for "old for young" (donor ≥ 65 years to recipient < 65 years) vs. "very old for young" KT (donor ≥ 70 years to recipient < 65 years). RESULTS Overall, 99 patients were included with 56 (56.6%) "old for young" and 43 (43.4%) "very old for young" KT. The median waiting time did not differ (60.7 vs. 45.8 months, respectively) at comparable living donation rates (57.1% vs. 44.2%) as well as intra- and postoperative results. At a median follow-up of 44 months (range 1; 133), the 3-year graft survival of 91% vs. 87% did not significantly vary. In subgroup analyses assessing living donation or donation after brain death (DBD) KT only, the graft survival was significantly longer for "old for young" KT within the living donation subgroup. In multivariate Cox regression analyses, the presence of panel-reactive antibodies was the only significant impact factor on graft survival (HR 8.32, p = 0.001). CONCLUSION This analysis clearly demonstrates the effectiveness of the "old for young" approach, enabling favorable perioperative results as well as comparable data of graft- and overall survival, while reducing waiting time for eligible patients.
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Affiliation(s)
- Philip Zeuschner
- Department of Urology and Pediatric Urology, Saarland University, Kirrberger Street 100, 66421, Homburg/Saar, Germany.
| | - Janine Mihm
- Medical Department III: Renal and Hypertensive Diseases, Immunology and Dialysis, SHG Kliniken Völklingen, Richardstraße 5-9, 66333, Völklingen, Germany
| | - Urban Sester
- Medical Department III: Renal and Hypertensive Diseases, Immunology and Dialysis, SHG Kliniken Völklingen, Richardstraße 5-9, 66333, Völklingen, Germany
| | - Michael Stöckle
- Department of Urology and Pediatric Urology, Saarland University, Kirrberger Street 100, 66421, Homburg/Saar, Germany.
| | - Frank Friedersdorff
- Department of Urology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany.
| | - Klemens Budde
- Department of Nephrology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Abdulbaki Yakac
- Department of Urology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Christian Thomas
- Department of Urology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Johannes Huber
- Department of Urology, Philipps University of Marburg, Baldingerstraße, 35043, Marburg, Germany
| | - Juliane Putz
- Department of Urology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Luka Flegar
- Department of Urology, Philipps University of Marburg, Baldingerstraße, 35043, Marburg, Germany
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Chess J, Roberts G, McLaughlin L, Williams G, Noyes J. What are the factors that determine treatment choices in patients with kidney failure: a retrospective cohort study using data linkage of routinely collected data in Wales. BMJ Open 2024; 14:e082386. [PMID: 38355196 PMCID: PMC10868286 DOI: 10.1136/bmjopen-2023-082386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 01/29/2024] [Indexed: 02/16/2024] Open
Abstract
OBJECTIVES To identify the factors that determine treatment choices following pre-dialysis education. DESIGN Retrospective cohort study using data linkage with univariate and multivariate analyses using linked data. SETTING Secondary care National Health Service Wales healthcare system. PARTICIPANTS All people in Wales over 18 years diagnosed with established kidney disease, who received pre-dialysis education between 1 January 2016 and 12 December 2018. MAIN OUTCOME MEASURES Patient choice of dialysis modality and any kidney replacement therapy started. RESULTS Mean age was 67 years; n=1207 (60%) were male, n=878 (53%) had ≥3 comorbidities, n=805 (66%) had mobility problems, n=700 (57%) had pain symptoms, n=641 (52%) had anxiety or were depressed, n=1052 (61.6%) lived less than 30 min from their treatment centre, n=619 (50%) were on a spectrum of frail to extremely vulnerable. n=424 (25%) chose home dialysis, n=552 (32%) chose hospital-based dialysis, n=109 (6%) chose transplantation, n=231 (14%) chose maximum conservative management and n=391 (23%) were 'undecided'. Main reasons for not choosing home dialysis were lack of motivation/low confidence in capacity to self-administer treatment, lack of home support and unsuitable housing. Patients who choose home dialysis were younger, had lower comorbidities, lower frailty and higher quality of life scores. Multivariate analysis found that age and frailty were predictors of choice, but we did not find any other demographic associations. Of patients who initially chose home dialysis, only n=150 (54%) started on home dialysis. CONCLUSION There is room for improvement in current pre-dialysis treatment pathways. Many patients remain undecided about dialysis choice, and others who may have chosen home dialysis are still likely to start on unit haemodialysis.
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Affiliation(s)
- James Chess
- Renal Unit, Morriston Hospital, Swansea Bay University Health Board, Swansea, UK
| | | | - Leah McLaughlin
- School of Medical and Health Sciences, Bangor University, Bangor, UK
| | - Gail Williams
- Welsh Kidney Network (Retired), NHS Wales Cwm Taf Morgannwg University Health Board, Abercynon, UK
| | - Jane Noyes
- School of Medical and Health Sciences, Bangor University, Bangor, UK
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Mitsuno R, Nakayama T, Uchiyama K, Yoshimoto N, Kusahana E, Morimoto K, Yoshino J, Yoshida T, Kanda T, Yamaguchi S, Hayashi K. Hemo dialysis treatment of vancomycin-induced drug reaction with eosinophilia and systemic symptoms/drug-induced hypersensitivity syndrome in a patient undergoing peritoneal dialysis. CEN Case Rep 2024:10.1007/s13730-023-00847-x. [PMID: 38337109 DOI: 10.1007/s13730-023-00847-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 12/25/2023] [Indexed: 02/12/2024] Open
Abstract
Drug reaction with eosinophilia and systemic symptoms (DRESS), also known as drug-induced hypersensitivity syndrome (DIHS), is a severe drug-induced hypersensitivity reaction with 10% mortality. To date, there is insufficient evidence regarding the association between DRESS/DIHS and serum levels of vancomycin (VCM). Here, we report the case of a 46-year-old woman undergoing peritoneal dialysis who developed VCM-induced DRESS/DIHS. She was hospitalized for peritonitis with abdominal pain and treated with VCM. On day 10 of hospitalization, her abdominal symptoms improved; however, fever, skin rash, lymphadenopathy, eosinophilia, atypical lymphocytes, and liver and renal dysfunction developed. Based on the clinical course and laboratory findings, we diagnosed the patient with DRESS/DIHS due to VCM. Since her serum VCM concentration was high at 39.8 μg/mL, hemodialysis (HD) was performed to remove VCM, which caused her symptoms to improve. However, serum levels of VCM rebounded and the same symptoms recurred. Therefore, we re-performed HD; no further relapse occurred. This clinical course showed that increased serum VCM levels were associated with DRESS/DIHS onset and severity, suggesting that it is a blood level-dependent disease and that removal of VCM by HD is a potential therapeutic option.
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Affiliation(s)
- Ryunosuke Mitsuno
- Division of Endocrinology, Metabolism and Nephrology, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
- Apheresis and Dialysis Center, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Takashin Nakayama
- Division of Endocrinology, Metabolism and Nephrology, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Kiyotaka Uchiyama
- Division of Endocrinology, Metabolism and Nephrology, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Norifumi Yoshimoto
- Division of Endocrinology, Metabolism and Nephrology, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Ei Kusahana
- Division of Endocrinology, Metabolism and Nephrology, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Kohkichi Morimoto
- Apheresis and Dialysis Center, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Jun Yoshino
- Division of Endocrinology, Metabolism and Nephrology, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Tadashi Yoshida
- Apheresis and Dialysis Center, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Takeshi Kanda
- Division of Endocrinology, Metabolism and Nephrology, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Shintaro Yamaguchi
- Division of Endocrinology, Metabolism and Nephrology, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan.
| | - Kaori Hayashi
- Division of Endocrinology, Metabolism and Nephrology, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
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Uchida H, Hidaka T, Endo S, Kasuga H, Masuishi Y, Kakamu T, Fukushima T. Association between home meal preparers and salt intake in haemo dialysis patients: a cross-sectional study. BMJ Open 2024; 14:e075214. [PMID: 38326261 PMCID: PMC10860055 DOI: 10.1136/bmjopen-2023-075214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 01/17/2024] [Indexed: 02/09/2024] Open
Abstract
OBJECTIVES This study aimed to examine the association between home meal preparer and salt intake among haemodialysis patients, including daily dietary status. We hypothesised that salt intake is higher among individuals who rely on meal preparation from others than those who prepare meals by themselves. DESIGN Cross-sectional study. SETTING Two medical facilities in Fukushima Prefecture, Japan. PARTICIPANTS 237 haemodialysis outpatients who visited one of the medical facilities between February 2020 and August 2021 and were diagnosed with anuria, defined as urination of <100 mL/day, were the potential participants of the present study. Finally, 181 participants (131 male and 50 female) were included in the analysis. OUTCOME MEASURE Salt intake amount was calculated from the results of predialysis and postdialysis blood draws, using Watson's formula based on predialysis weight, predialysis serum sodium level, postdialysis weight and serum sodium level at the end of dialysis. RESULTS Salt intake was significantly higher in participants who relied on meal preparation from others ('relying on others') than those who prepared meals by themselves ('self-prepared') (B=1.359; 95% CI: 0.495 to 2.222). No statistical difference was found between individuals who ate out or ate takeout ('outsourcing') and those who prepared their own meals ('self-prepared'). These results were robust after adjustment for confounding factors. CONCLUSIONS The present study revealed an association between self-preparation of meals at home and reduced salt intake among dialysis patients. Our findings suggest that whoever is the home meal preparer is possibly a social determinant of salt intake. To improve the prognosis of haemodialysis patients, actively reaching out to the family and assessing their social environment, such as identifying the home meal preparer and, if the patient relies on others for meal preparation, conducting nutritional/dietary guidance for that person, are effective in enhancing salt reduction.
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Affiliation(s)
- Haruna Uchida
- Department of Hygiene and Preventive Medicine, School of Medicine, Fukushima Medical University, Fukushima, Japan
- Medical Support Department, Jyoban Hospital of Tokiwa Foundation, Fukushima, Japan
| | - Tomoo Hidaka
- Department of Hygiene and Preventive Medicine, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Shota Endo
- Department of Hygiene and Preventive Medicine, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Hideaki Kasuga
- Department of Hygiene and Preventive Medicine, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Yusuke Masuishi
- Department of Hygiene and Preventive Medicine, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Takeyasu Kakamu
- Department of Hygiene and Preventive Medicine, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Tetsuhito Fukushima
- Department of Hygiene and Preventive Medicine, School of Medicine, Fukushima Medical University, Fukushima, Japan
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Mathew RO, Kretov EI, Huang Z, Jones PG, Sidhu MS, O’Brien SM, Prokhorikhin AA, Rangaswami J, Newman J, Stone GW, Fleg JL, Spertus JA, Maron DJ, Hochman JS, Bangalore S. Body Mass Index and Clinical and Health Status Outcomes in Chronic Coronary Disease and Advanced Kidney Disease in the ISCHEMIA-CKD Trial. Am J Med 2024; 137:163-171.e24. [PMID: 37925061 PMCID: PMC10872316 DOI: 10.1016/j.amjmed.2023.10.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 10/12/2023] [Accepted: 10/16/2023] [Indexed: 11/06/2023]
Abstract
OBJECTIVE This study aimed to assess whether an obesity paradox (lower event rates with higher body mass index [BMI]) exists in participants with advanced chronic kidney disease (CKD) and chronic coronary disease in the International Study of Comparative Health Effectiveness of Medical and Invasive Approaches (ISCHEMIA)-CKD, and whether BMI modified the effect of initial treatment strategy. METHODS Baseline BMI was analyzed as both a continuous and categorical variable (< 25, ≥ 25 to < 30, ≥ 30 kg/m2). Associations between BMI and the primary outcome of all-cause death or myocardial infarction (D/MI), and all-cause death, cardiovascular death, and MI individually were estimated. Associations with health status were also evaluated using the Seattle Angina Questionnaire-7, the Rose Dyspnea Scale, and the EuroQol-5D Visual Analog Scale. RESULTS Body mass index ≥ 30 kg/m2 vs < 25 kg/m2 demonstrated increased risk for MI (hazard ratio [HR] [95% confidence interval] = 1.81 [1.12-2.92]) and for D/MI (HR 1.45 [1.06-1.96]) with a HR for MI of 1.22 (1.05-1.40) per 5 kg/m2 increase in BMI in unadjusted analysis. In multivariate analyses, a BMI ≥ 30 kg/m2 was marginally associated with D/MI (HR 1.43 [1.00-2.04]) and greater dyspnea throughout follow-up (P < .05 at all time points). Heterogeneity of treatment effect between baseline BMI was not evident for any outcome. CONCLUSIONS In the ISCHEMIA-CKD trial, an obesity paradox was not detected. Higher BMI was associated with worse dyspnea, and a trend toward increased D/MI and MI risk. Larger studies to validate these findings are warranted.
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Affiliation(s)
- Roy O. Mathew
- Department of Medicine, Loma Linda VA Health Care System, Loma Linda, CA, USA
| | - Evgeny I. Kretov
- National Medical Research Center of Ministry of Health of Russia, Novosibirsk, Russia
| | - Zhen Huang
- Duke Clinical and Research Institute and Duke University, Durham, NC, USA
| | - Philip G. Jones
- University of Missouri – Kansas City (UMKC)’s Healthcare Institute for Innovations in Quality and Saint Luke’s Mid America Heart Institute/, Kansas City, MO, USA
| | | | - Sean M. O’Brien
- Duke Clinical and Research Institute and Duke University, Durham, NC, USA
| | | | - Janani Rangaswami
- George Washington University School of Medicine, Washington, DC, USA
- Washington DC Veteran Affairs Medical Center, Washington, DC, USA
| | - Jonathan Newman
- Cardiovascular Clinical Research Center, NYU Grossman School of Medicine, New York, NY, USA
| | - Gregg W. Stone
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jerome L. Fleg
- National Heart, Lung, and Blood Institute, Bethesda, MD, USA
| | - John A. Spertus
- University of Missouri – Kansas City (UMKC)’s Healthcare Institute for Innovations in Quality and Saint Luke’s Mid America Heart Institute/, Kansas City, MO, USA
| | - David J. Maron
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Judith S. Hochman
- Cardiovascular Clinical Research Center, NYU Grossman School of Medicine, New York, NY, USA
| | - Sripal Bangalore
- Cardiovascular Clinical Research Center, NYU Grossman School of Medicine, New York, NY, USA
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84
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Ghandour H, Cataneo JL, Asha A, Jaeger JK, Jacobs CE, Schwartz LB, El Khoury R. Slowly moving the needle away from Fistula First. J Vasc Surg 2024; 79:382-387. [PMID: 37952784 DOI: 10.1016/j.jvs.2023.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 11/02/2023] [Accepted: 11/05/2023] [Indexed: 11/14/2023]
Abstract
OBJECTIVE In 2019, the management of end-stage kidney disease (ESKD) shifted away from "Fistula First" (FF) to "ESKD Life-Plan: Patient Life-Plan First then Access Needs." Indeed, some patients exhibit such excessive comorbidity that even relatively minor vascular surgery may be complicated. The purpose of this study was to retrospectively assess complications and mortality (and delineate operative futility) in patients undergoing arteriovenous fistula (AVF) creation in the FF era. METHODS Consecutive AVFs created in a single institution before 2021 were retrospectively reviewed. Operative futility was defined as never-accessed fistula, no initiation of dialysis, failure of access maturation (despite secondary intervention), hemodialysis access-induced distal ischemia requiring ligation, early loss of secondary patency, and/or patient mortality within the first 6 postoperative months. RESULTS A total of 401 AVFs were created including radial-cephalic (44%), brachial-cephalic (41%), and brachial-basilic (15%) constructions. Patients exhibited a mean age of 69 ± 15 years; 63% were male, and most (74%) were already being hemodialyzed at the time of fistula creation. Forty-five patients (11%) suffered a cardiac event, and five patients died (1%) within 90 days of their access surgery. Perioperative cardiac events were significantly more common after age 80 (19% vs 8%; P = .004); age >80 years was an independent predictor of major 90-day complications (odds ratio [OR], 1.88; 95% confidence interval [CI], 1.04-3.39; P = .036) and the sole independent predictor of major morbidity defined as cardiopulmonary complications, stroke, or death within the first year (OR, 2.01; 95% CI, 1.24-3.25; P = .004). Operative futility was encountered in 52% of the cohort (n = 208 patients): 40% (n = 160) of primary AVFs failed to mature despite assistance, 19% (n = 77) had lost secondary patency by 6 months, 13% of patients (n = 53) were never started on dialysis after access creation, 4% (n = 16) were dead by 6 months, 2% of AVFs (n = 10) matured but were never accessed, and 2% (n = 9) required ligation for hemodialysis access-induced distal ischemia. Not surprisingly, the sole independent protector against operative futility was that catheter-based dialysis had been established prior to AVF creation (OR, 0.36; 95% CI, 0.22-0.59; P < .01). CONCLUSIONS Approximately 50% of primary AVF operations performed in the aggressive FF era were deemed futile. Octogenarians were particularly prone to futility and complications during this era. A paradigm shift, from FF to an "ESKD Life-Plan" will, hopefully, more thoughtfully match vascular access strategies to individual patient needs.
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Affiliation(s)
- Hani Ghandour
- Department of Surgery, Advocate Lutheran General Hospital, Park Ridge, IL
| | - Jose L Cataneo
- Department of Surgery, Advocate Lutheran General Hospital, Park Ridge, IL
| | - Ahmad Asha
- Department of Surgery, Advocate Lutheran General Hospital, Park Ridge, IL
| | - Jessica K Jaeger
- Department of Surgery, Advocate Lutheran General Hospital, Park Ridge, IL
| | - Chad E Jacobs
- Department of Surgery, Advocate Lutheran General Hospital, Park Ridge, IL
| | - Lewis B Schwartz
- Department of Surgery, Advocate Lutheran General Hospital, Park Ridge, IL
| | - Rym El Khoury
- Department of Surgery, Division of Vascular Surgery, NorthShore University Health Systems, Evanston, IL.
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85
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Barbosa ACC, Brison RS, Gomes CC, Wilkinson TJ, Duarte MP, Gruezo ND, Ribeiro HS. Should we consider sarcopenia in pediatric patients with chronic kidney disease? A preliminary cross-sectional analysis. Pediatr Nephrol 2024; 39:539-545. [PMID: 37566115 DOI: 10.1007/s00467-023-06111-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 07/20/2023] [Accepted: 07/21/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Pediatric patients with chronic kidney disease (CKD) frequently present an inadequate nutritional profile and musculoskeletal impairments. We investigated sarcopenia and its related traits in children and adolescents with CKD. METHODS A cross-sectional study that enrolled pediatric patients with CKD (≥ 4 and < 18 years old). Physical function was assessed by handgrip strength and the 60-s sit-to-stand (STS-60) tests. Body composition measurement was performed by bioelectrical impedance analysis and anthropometry through mid-upper arm circumference (MUAC). Normative reference values from healthy pediatrics were used for identifying poor physical function and low MUAC. Probable sarcopenia was considered as low handgrip strength, whereas sarcopenia was defined by adding low MUAC. RESULTS Twenty-two pediatric patients with CKD (11 ± 4 years and 59% boys) were evaluated; eight on peritoneal dialysis (36%), six on hemodialysis (27%), and eight non-dialysis (36%). Regarding sarcopenia traits, we observed low physical function by handgrip strength and STS-60 in 59% and 100% of the patients, respectively, while low MUAC in 77%. Probable sarcopenia was found in 9% and sarcopenia in 50%, but prevalence did not differ among stages. Handgrip strength was strongly associated with MUAC (r = 0.90; p < 0.001); on the other hand, the STS-60 was not significantly associated with any of the body composition variables. CONCLUSION Among pediatric patients with CKD, the prevalence of sarcopenia and its related traits was high. Nephrology professionals should consider the assessment of sarcopenia in this population, while more evidence is needed to determine its prognostic value. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
| | - Raquel S Brison
- Hospital da Criança de Brasília José Alencar, Brasília, Federal District, Brazil
- Faculty of Health Sciences, University of Brasília, Brasília, Federal District, 70910-900, Brazil
| | - Carolina C Gomes
- Hospital da Criança de Brasília José Alencar, Brasília, Federal District, Brazil
| | - Thomas J Wilkinson
- NIHR Applied Research Collaboration East Midlands (ARC-EM), Leicester Diabetes Centre, University of Leicester, Leicester, UK
| | - Marvery P Duarte
- Faculty of Health Sciences, University of Brasília, Brasília, Federal District, 70910-900, Brazil
| | - Nádia Dias Gruezo
- Hospital da Criança de Brasília José Alencar, Brasília, Federal District, Brazil
| | - Heitor S Ribeiro
- Faculty of Health Sciences, University of Brasília, Brasília, Federal District, 70910-900, Brazil.
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86
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Tung GK, Gandhi G. Baseline and oxidatively damaged DNA in end-stage renal disease patients on varied hemo dialysis regimens: a comet assay assessment. Mol Cell Biochem 2024; 479:199-211. [PMID: 37004640 DOI: 10.1007/s11010-023-04720-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 03/21/2023] [Indexed: 04/04/2023]
Abstract
Global estimates exhibit that one million people have end-stage renal disease, a disease-state characterized by irreversible loss of kidney structure and function, thus necessitating renal replacement therapy. The disease-state, oxidative stress, inflammatory responses, as well as the treatment procedure can have damaging effects on the genetic material. Therefore, the present study was carried out to investigate DNA damage (basal and oxidative) using the comet assay in peripheral blood leukocytes of patients (n = 200) with stage V Chronic Kidney Disease (on dialysis and those recommended but yet to initiate dialysis) and compare it to that in controls (n = 210). Basal DNA damage was significantly elevated (1.13x, p ≤ 0.001) in patients (46.23 ± 0.58% DNA in tail) compared to controls (40.85 ± 0.61% DNA in tail). Oxidative DNA damage was also significantly (p ≤ 0.001) higher in patients (9.18 ± 0.49 vs. 2.59 ± 0.19% tail DNA) compared to controls. Twice-a-week dialysis regimen patients had significantly elevated % tail DNA and Damage Index compared to the non-dialyzed and to the once-a-week dialysis group implying dialysis- induced mechanical stress and blood-dialyzer membrane interactions as probable contributors to elevated DNA damage. The present study with a statistically significant power implies higher disease-associated as well as maintenance therapy (hemodialysis)-induced basal and oxidatively damaged DNA, which if not repaired has the potential to initiate carcinogenesis. These findings mark the need for improvement and development of interventional therapies for delaying disease progression and associated co-morbidities so as to improve life expectancy of patients with kidney disease.
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Affiliation(s)
- Gurleen Kaur Tung
- Department of Human Genetics, Guru Nanak Dev University, Amritsar, 143001, India.
| | - Gursatej Gandhi
- Department of Human Genetics, Guru Nanak Dev University, Amritsar, 143001, India
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Habte-Asres HH, Jiang Y, Rosenthal M, Wheeler DC. Burden of impaired awareness of hypoglycemia in people with diabetes undergoing hemo dialysis. BMJ Open Diabetes Res Care 2024; 12:e003730. [PMID: 38302432 PMCID: PMC10836342 DOI: 10.1136/bmjdrc-2023-003730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 12/08/2023] [Indexed: 02/03/2024] Open
Abstract
INTRODUCTION Impaired awareness of hypoglycemia (IAH) refers to a diminished capacity to detect hypoglycemia. IAH can result in severe and even life-threatening outcomes for individuals with diabetes, especially those in advanced stages of the disease. This study aimed to assess the prevalence of IAH in people with diabetes on hemodialysis. RESEARCH DESIGN AND METHODS We conducted a single-center audit to assess the prevalence of IAH using the Clarke questionnaire. Simultaneously, we measured fear of hypoglycemia with an adapted version of the Hypoglycemia Survey and recorded the incidence of severe hypoglycemia. Data were presented as mean±SD or counts/percentages. Logistic regression was then employed to analyze the association between IAH and various sociodemographic and clinical factors. RESULTS We included 56 participants with diabetes on hemodialysis, with a mean age of 67.2 years (±12.9), of whom 51.8% were male. The ethnic distribution was 23.2% white, 23.2% black, 19.6% Asian, and 33.9% unspecified. The mean HbA1c was 52 mmol/mol (±18.6). The majority (91.1%) had a diagnosis of type 2 diabetes, and 55.4% of those were treated with insulin. The use of diabetes technology was low, with 2.8% of the participants using a continuous glucose monitor. IAH prevalence was 23.2%, and among the 57 participants, 23.6% had a history of severe hypoglycemia, and 60.6% reported fear of hypoglycemia. There were no significant differences in sociodemographic and clinical characteristics between those with IAH and normal hypoglycemia awareness. CONCLUSIONS We observed that 23.2% of individuals with diabetes undergoing hemodialysis had IAH. IAH was more prevalent in people who reported a fear of hypoglycemia and had a history of severe hypoglycemia episode. The study highlights the unmet needs and disparities in access to diabetes technology within this population.
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Affiliation(s)
- Hellena Hailu Habte-Asres
- Royal Free London NHS Foundation Trust, London, UK
- Diabetes, King's College London Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, London, UK
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88
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Starr MC, Voivodas M, Hains DS. Using aquapheresis with continuous hematocrit monitoring to guide ultrafiltration. Pediatr Nephrol 2024; 39:597-601. [PMID: 37661234 DOI: 10.1007/s00467-023-06143-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/15/2023] [Accepted: 08/15/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND Management of edema and volume overload in patients with hypoalbuminemia, either due to nephrotic syndrome or other disease processes, can be extremely challenging. METHODS We describe the management of five patients with hypoalbuminemia and severe fluid overload using the Aquadex FlexFlow device with continuous hematocrit monitoring to guide ultrafiltration. RESULTS We report five pediatric patients ranging in age from 7 days to 11 years and in size from 2.7 to 65 kg with hypoalbuminemia due to a variety of etiologies treated with slow continuous ultrafiltration with continuous hematocrit monitoring to guide ultrafiltration using the Aquadex device. Treatment allowed successful fluid removal in all cases, without hypotension or other hemodynamic complications. CONCLUSIONS In a variety of clinical circumstances and in patients from infants to adolescence, we report that patients with diuretic-resistant fluid overload can be treated with Aquadex using continuous hematocrit monitoring to guide management to allow fluid removal without hemodynamic instability or other complications. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Michelle C Starr
- Division of Pediatric Nephrology, Department of Pediatrics, Indiana University School of Medicine, 410 W 10Th Street, Suite 2000A, Indianapolis, IN, 46202, USA.
- Pediatric and Adolescent Comparative Effectiveness Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Michelle Voivodas
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - David S Hains
- Division of Pediatric Nephrology, Department of Pediatrics, Indiana University School of Medicine, 410 W 10Th Street, Suite 2000A, Indianapolis, IN, 46202, USA
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89
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Abstract
Secondary hyperparathyroidism (SHPT) does not initiate as a primary dysfunction of parathyroid glands resulting from an intrinsic defect or disease but is the physiologic response of parathyroids to metabolic changes elsewhere in the body occurring over time. SHPT is a manifestation of a chronic condition that classically occurs from chronic kidney disease. In fact, given the relatively recent transition of populations from outside (agrarian) to indoor (industrial, information technology, and so forth) employment and a consequent reduction in sun exposure, combined with diets of highly processed food, vitamin D and calcium deficiencies are now the leading causes of SHPT.
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Affiliation(s)
- Brendan C Stack
- Department of Otolaryngology-HNS Southern Illinois University/SIU Medicine, 720 North Bond Street, PO Box 19662, Springfield, IL 62794-9662, USA.
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90
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La Marca MA, Dinoto E, Rodriquenz E, Pecoraro F, Turchino D, Mirabella D. Brachial artery aneurysm after hemo dialysis fistula ligation: Case reports and review of literature. Int J Surg Case Rep 2024; 115:109306. [PMID: 38280341 PMCID: PMC10839962 DOI: 10.1016/j.ijscr.2024.109306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 01/20/2024] [Accepted: 01/23/2024] [Indexed: 01/29/2024] Open
Abstract
INTRODUCTION Brachial artery aneurysm (BAA) following long-standing arteriovenous fistula (AVF) ligation after renal transplantation is odd. CASE PRESENTATION Two cases of brachial artery aneurysm treated with bypass (a saphenous vein graft and a PTFE graft). In the first patient no complications were recorded whereas an infection was diagnosed after 6 months from the procedure in the second treatment. CLINICAL DISCUSSION Multiple factors activated by stress on the vessel wall followed by fistula ligation are the cause of vascular remodeling of the three layers making up the wall with possible evolution in aneurysmatic lesions. In literature the gold standard for this lesion is the surgical approach, only one endovascular procedure is reported. The traditional surgical approach uses the autologous vein or prosthetic PTFE grafts. CONCLUSION Brachial artery aneurysm is a complication that affects patients undergoing renal transplantation who have already undergone AVF ligation. In our experience autologous vein graft represented the best solution.
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Affiliation(s)
- M A La Marca
- Vascular Surgery Unit - AOUP Policlinico 'P. Giaccone', Palermo, Italy
| | - E Dinoto
- Vascular Surgery Unit - AOUP Policlinico 'P. Giaccone', Palermo, Italy.
| | - E Rodriquenz
- Vascular Surgery Unit - AOUP Policlinico 'P. Giaccone', Palermo, Italy
| | - F Pecoraro
- Vascular Surgery Unit - AOUP Policlinico 'P. Giaccone', Palermo, Italy; Department of Surgical, Oncological and Oral Sciences - University of Palermo, Italy
| | - D Turchino
- Department of Public Health, Vascular Surgery Unit, University Federico II of Naples, Italy
| | - D Mirabella
- Vascular Surgery Unit - AOUP Policlinico 'P. Giaccone', Palermo, Italy
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91
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Heinen A, Erlebach R, Schrimpf C, Bonani M, Ganter CC, David S, Andermatt R. [OCT, Triple H or anything else?]. Inn Med (Heidelb) 2024; 65:176-179. [PMID: 37407743 PMCID: PMC10830584 DOI: 10.1007/s00108-023-01559-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/12/2023] [Indexed: 07/07/2023]
Abstract
Hyperammonemia is a life-threatening condition, the prognosis of which depends on a rapid reduction of ammonia. If a hepatic cause is excluded, the differential diagnosis is broad and even in adulthood includes hereditary metabolic diseases. Here, the case of a 25-year-old female patient with severe hyperammonemia refractory to standard therapy is described and the relevance of extracorporeal elimination of ammonia emphasized.
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Affiliation(s)
- Anna Heinen
- Institut für Intensivmedizin, Universitätsspital Zürich, Rämistr. 100, 8091, Zürich, Schweiz
| | - Rolf Erlebach
- Institut für Intensivmedizin, Universitätsspital Zürich, Rämistr. 100, 8091, Zürich, Schweiz
| | - Claudia Schrimpf
- Klinik für Gefässchirurgie, Universitätsspital Zürich, Rämistr. 100, 8091, Zürich, Schweiz
| | - Marco Bonani
- Klinik für Nephrologie, Universitätsspital Zürich, Rämistr. 100, 8091, Zürich, Schweiz
| | - Christoph C Ganter
- Institut für Intensivmedizin, Universitätsspital Zürich, Rämistr. 100, 8091, Zürich, Schweiz
| | - Sascha David
- Institut für Intensivmedizin, Universitätsspital Zürich, Rämistr. 100, 8091, Zürich, Schweiz.
| | - Rea Andermatt
- Institut für Intensivmedizin, Universitätsspital Zürich, Rämistr. 100, 8091, Zürich, Schweiz
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92
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Shahri HA, Salmi IA, Rajhi WA, Shemshaki H. Effectiveness of the Eutectic Mixture of Local Anaesthetics Cream in the Management of Arteriovenous Fistula Needle Insertion Pain in Patients Undergoing Haemo dialysis. Sultan Qaboos Univ Med J 2024; 24:7-19. [PMID: 38434453 PMCID: PMC10906758 DOI: 10.18295/squmj.10.2023.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 08/27/2023] [Accepted: 10/03/2023] [Indexed: 03/05/2024] Open
Abstract
This review aimed to assess the effectiveness of the eutectic mixture of local anaesthetics (EMLA) cream in the management of arteriovenous fistula (AVF) needle insertion pain in adult patients undergoing haemodialysis (HD) compared with other alternative interventions. The main search was conducted in November 2020 and updated in December 2021. In the search strategy, keywords and synonyms were used and multiple databases were searched with no date limitation to ensure a comprehensive search that would yield all studies relevant to the review and minimise location bias. A total of 209 studies were found in this search and filtered. After filtering through these studies, only five studies were finally included in the review. EMLA-cream was found to be effective in reducing AVF needle insertion pain among adult patients undergoing HD. Despite EMLA cream's effectiveness in reducing HD needle insertion pain and its fewer side effects, the findings of the included studies should be interpreted with caution, as there are some limitations, and further research is required.
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Affiliation(s)
- Hamed Al Shahri
- Renal Medicine Department, Sultan Qaboos Hospital, Salalah, Oman
| | - Issa Al Salmi
- Department of Renal Medicine, The Royal Hospital, Muscat, Oman
| | - Waleed Al Rajhi
- College of Pharmacy and Nursing, Nizwa University, Nizwa, Oman
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93
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Hashmi SA, Hudar SA, Stephen E, Riyami DA, Maawali HA, Abdelhady I, Wahaibi KA, Rizvi S. Factors Affecting the Early Maturation of Arteriovenous Fistulae Created at a Tertiary Centre in Oman. Sultan Qaboos Univ Med J 2024; 24:37-43. [PMID: 38434458 PMCID: PMC10906777 DOI: 10.18295/squmj.9.2023.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 07/11/2023] [Accepted: 07/18/2023] [Indexed: 03/05/2024] Open
Abstract
Objectives This study aimed to determine the risk factors associated with the failure of arteriovenous fistulae (AVF) maturation. Methods This retrospective cohort study was conducted from January 2014 to December 2018 in Sultan Qaboos University Hospital, Muscat, Oman. Patients were followed-up 3 months after surgery, and their electronic medical records were accessed for demographic and clinical data. Univariate analysis was used to determine the risk factors associated with early AVF maturation and multivariant analysis was used to determine the predictive factors for AVF failure. Results A total of 269 patients were included. Female gender was a significant factor affecting AVF maturity (P = 0.049), while age (P = 0.626), diabetes (P = 0.954), hypertension (P = 0.378), dyslipidaemia (P = 0.907), coronary artery disease (P = 0.576), cerebrovascular accident (P = 0.864), congestive heart failure (P = 0.685), previous central venous catheterisation (P = 0.05), fistula type (P = 0.863) and fistula site (P = 0.861) did not affect AVF maturation. Binary logistic regression showed that all the risk factors were insignificant. Failure of early AVF maturation affected 11.5% in the cohort. Conclusion This study found that the proportion of early AVF maturation at our hospital is at par with that in the international literature. Failure of AVF maturation was significantly associated with the female gender. These findings can help nephrologists and vascular surgeons prognosticate AVF maturation rates. However, a larger study is needed for definitive conclusions.
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Affiliation(s)
| | | | - Edwin Stephen
- Department of Surgery, Sultan Qaboos University, Muscat, Oman
| | - Dawood Al Riyami
- Department of Internal Medicine, Sultan Qaboos University Hospital, Sultan Qaboos University, Muscat, Oman
| | | | | | | | - Syed Rizvi
- Department of Family Medicine & Public Health, Sultan Qaboos University, Muscat, Oman
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94
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Zahr RS, Ataga KI, Lebensburger JD, Winer JC. Kidney failure outcomes in children and young adults with sickle cell disease in the United States Renal Data System. Pediatr Nephrol 2024; 39:619-623. [PMID: 37653351 PMCID: PMC10752499 DOI: 10.1007/s00467-023-06136-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 08/09/2023] [Accepted: 08/09/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND Children and young adults with sickle cell disease (SCD) develop kidney disease early in childhood, with some patients progressing to require dialysis and kidney transplantation. The prevalence and outcomes of children with kidney failure (chronic kidney disease stage 5) due to SCD are not well described. This study aimed to assess the outcome of children and young adults with SCD with kidney failure compared to matched children and young adults without SCD with kidney failure in a large national database. METHODS Utilizing the United States Renal Data System (USRDS), we retrospectively examined kidney failure outcomes in children and young adults with SCD from 1998 to 2019. RESULTS We identified 97 patients with SCD who developed kidney failure and identified 96 matched controls with a median age of 19 years (IQR 17, 21) at the time of kidney failure diagnosis. SCD patients had significantly shorter survival (8.4 years vs. 14.0 years, p < 0.001) and had a longer waiting time for their first transplant when compared to matched non-SCD kidney failure patients (12.1 years vs. 7.3 years, p < 0.001). CONCLUSIONS Children and young adults with SCD kidney failure have significantly higher mortality when matched to non-SCD kidney failure children and experience a longer mean time to kidney transplant.
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Affiliation(s)
- Rima S Zahr
- Division of Pediatric Nephrology and Hypertension, University of Tennessee Health Science Center, Memphis, TN, USA.
| | - Kenneth I Ataga
- Center for Sickle Cell Disease, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Jeffrey D Lebensburger
- Division of Pediatric Hematology and Oncology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jeffrey C Winer
- Division of Academic Hospital Medicine, Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, USA
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95
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Jaccard A, Bridoux F, Roeloffzen W, Minnema MC, Bergantim R, Hájek R, João C, Cibeira MT, Palladini G, Schönland S, Merlini G, Milani P, Dimopoulos MA, Ravichandran S, Hegenbart U, Agis H, Gros B, Asra A, Magarotto V, Cheliotis G, Psarros G, Sonneveld P, Wechalekar A, Kastritis E. Healthcare Resource Utilization and Cost-of-Illness in Systemic Light Chain (AL) Amyloidosis in Europe: Results From the Real-World, Retrospective EMN23 Study. Clin Lymphoma Myeloma Leuk 2024:S2152-2650(24)00057-0. [PMID: 38453615 DOI: 10.1016/j.clml.2024.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 01/18/2024] [Accepted: 01/24/2024] [Indexed: 03/09/2024]
Abstract
OBJECTIVES To report healthcare resource utilization (HCRU) and safety outcomes in systemic light chain (AL) amyloidosis from the EMN23 study. MATERIALS AND METHODS The retrospective, observational, multinational EMN23 study included 4,480 patients initiating first-line treatment for AL amyloidosis in 2004-2018 and assessed, among other objectives, HCRU and safety outcomes. HCRU included hospitalizations, examinations, and dialysis; safety included serious adverse events (SAEs) and adverse events of special interest (AESIs). Data were descriptively analyzed by select prognostic factors (e.g., cardiac staging by Mayo2004/European) for 2004-2010 and 2011-2018. A cost-of-illness analysis was conducted for the UK and Spain. RESULTS HCRU/safety and dialysis data were extracted for 674 and 774 patients, respectively. Of patients with assessed cardiac stage (2004-2010: 159; 2011-2018: 387), 67.9% and 61.0% had ≥ 1 hospitalization, 56.0% and 51.4% had ≥ 1 SAE, and 31.4% and 28.9% had ≥ 1 AESI across all cardiac stages in 2004-2010 and 2011-2018, respectively. The per-patient-per-year length of hospitalization increased with disease severity (cardiac stage). Of patients with dialysis data (2004-2010: 176; 2011-2018: 453), 23.9% and 14.8% had ≥ 1 dialysis session across all cardiac stages in 2004-2010 and 2011-2018, respectively. The annual cost-of-illness was estimated at €40,961,066 and €31,904,386 for the UK and Spain, respectively; dialysis accounted for ∼28% (UK) and ∼35% (Spain) of the total AL amyloidosis costs. CONCLUSIONS EMN23 showed that the burden of AL amyloidosis is substantial, highlighting the need for early disease diagnosis and effective treatments targeting the underlying pathology.
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Affiliation(s)
- Arnaud Jaccard
- CHU Limoges, National Amyloidosis Center and Hematology Unit, Limoges, France
| | | | - Wilfried Roeloffzen
- Amyloidosis Centre of Expertise Department of Internal Medicine, Faculty of Medical Sciences, University Medical Center Groningen, Groningen, Netherlands
| | - Monique C Minnema
- Department of Hematology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Rui Bergantim
- Department of Hematology, Hospital São João, Porto, Portugal
| | - Roman Hájek
- Department of Haematooncology, University Hospital Ostrava, Ostrava, Czech Republic
| | - Cristina João
- Department of Hematology, Hospital Clinic, IDIBAPS, Champalimaud Center for the Unknown, Lisbon, Portugal
| | - M Teresa Cibeira
- Amyloidosis and Myeloma Unit, Department of Hematology, Hospital Clinic, IDIBAPS, Barcelona, Spain
| | - Giovanni Palladini
- Department of Molecular Medicine, University of Pavia, Pavia, Italy; Amyloidosis Research and Treatment Center, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Stefan Schönland
- Medical Department V, Amyloidosis Center Heidelberg, University of Heidelberg, Heidelberg, Germany
| | - Giampaolo Merlini
- Department of Molecular Medicine, University of Pavia, Pavia, Italy; Amyloidosis Research and Treatment Center, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Paolo Milani
- Department of Molecular Medicine, University of Pavia, Pavia, Italy; Amyloidosis Research and Treatment Center, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Meletios A Dimopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Sriram Ravichandran
- National Amyloidosis Centre, University College London, London, United Kingdom
| | | | - Hermine Agis
- Department of Internal Medicine I, Division of Hematology & Hemostaseology, Medical University Vienna, Vienna, Austria
| | | | | | | | | | | | | | - Ashutosh Wechalekar
- National Amyloidosis Centre, University College London, London, United Kingdom
| | - Efstathios Kastritis
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece.
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96
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Gill JK, Pucci M, Samudio A, Ahmed T, Siddiqui R, Edwards N, Marticorena RM, Donnelly S, Lok C, Wentlandt K, Wolofsky K, Mucsi I. Self-reported MeasUrement of Physical and PsychosOcial Symptoms Response Tool (SUPPORT- dialysis): systematic symptom assessment and management in patients on in-centre haemodialysis - a parallel arm, non-randomised feasibility pilot study protocol. BMJ Open 2024; 14:e080712. [PMID: 38296283 PMCID: PMC10828879 DOI: 10.1136/bmjopen-2023-080712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 01/17/2024] [Indexed: 02/03/2024] Open
Abstract
INTRODUCTION Patients with kidney failure experience symptoms that are often under-recognised and undermanaged. These symptoms negatively impact health-related quality of life and are associated with adverse clinical outcomes. Regular symptom assessment, using electronic patient reported outcomes measure (ePROMs) linked to systematic symptom management, could improve such outcomes. Clinical implementation of ePROMs have been successful in routine oncology care, but not used for patients on dialysis. In this study, we describe a pilot study of ePROM-based systematic symptom monitoring and management intervention in patients treated with in-centre haemodialysis. METHODS AND ANALYSIS This is a parallel-arm, controlled pilot of adult patients receiving in-centre maintenance haemodialysis. Participants in the intervention arm will complete ePROMs once a month for 6 months. ePROMs will be scored real time and the results will be shared with participants and with the clinical team. Moderate-severe symptoms will be flagged using established cut-off scores. Referral options for those symptoms will be shared with the clinical team, and additional symptom management resources will also be provided for both participants and clinicians. Participants in the control arm will be recruited at a different dialysis unit, to prevent contamination. They will receive usual care, except that they will complete ePROMs without the presentation of results to participants of the clinical team. The primary objectives of the pilot are to assess (1) the feasibility of a larger, randomised clinical effectiveness trial and (2) the acceptability of the intervention. Interviews conducted with participants and staff will be assessed using a content analysis approach. ETHICS AND DISSEMINATION Ethical approval for this study was obtained from the University Health Network (REB#21-5199) and the William Osler Health System (#23-0005). All study procedures will be conducted in accordance with the standards of University Health Network research ethics board and with the 1964 Helsinki declaration and its later amendments. Results of this study will be shared with participants, patients on dialysis and other stakeholders using lay language summaries, oral presentations to patients and nephrology professionals. We will also be publishing the results in a peer-reviewed journal and at scientific meetings. PROTOCOL VERSION 4 (16 November 2022). TRIAL REGISTRATION NUMBER NCT05515991.
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Affiliation(s)
- Jasleen Kaur Gill
- Institute of Medical Science, University of Toronto-St George Campus, Toronto, Ontario, Canada
- Multi-organ Transplant, UHN, Toronto, Ontario, Canada
| | - Maria Pucci
- Multi-organ Transplant, UHN, Toronto, Ontario, Canada
| | - Ana Samudio
- Multi-organ Transplant, UHN, Toronto, Ontario, Canada
| | - Tibyan Ahmed
- Multi-organ Transplant, UHN, Toronto, Ontario, Canada
| | | | | | - Rosa M Marticorena
- Nephrology Program, Sir William Osler Health System, Brampton, Ontario, Canada
| | - Sandra Donnelly
- Nephrology Program, Sir William Osler Health System, Brampton, Ontario, Canada
| | - Charmaine Lok
- Division of Nephrology, UHN, Toronto, Ontario, Canada
| | | | - Kayla Wolofsky
- Department of Supportive Care, UHN, Toronto, Ontario, Canada
| | - Istvan Mucsi
- Medicine, Multiorgan Transplant Program, University of Toronto, Toronto, Ontario, Canada
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Andrade FP, Borges S, da Silva Filho CA, Martins TF, Benvenutti H, de Freitas JDMC, Thomé FS, Karohl C, Souza GC, Cipriano GFB, Rovedder PME. Respiratory sarcopenia screening in dialysis patients: cross-sectional and multicentre study protocol. BMC Nephrol 2024; 25:41. [PMID: 38287281 PMCID: PMC10826040 DOI: 10.1186/s12882-023-03390-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 11/06/2023] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND Respiratory sarcopenia is characterized by the weakness of respiratory muscles associated with sarcopenia due to aging or systemic diseases such as chronic kidney disease (CKD). Patients with CKD undergoing dialysis are particularly susceptible to respiratory muscle weakness caused by factors such as fluid overload and electrolyte imbalance. This weakness not only affects ventilation but also impairs oxygen uptake and delivery to muscle tissue, potentially leading to severe sarcopenia. Thus, the objective of this study is to conduct a respiratory sarcopenia screening in patients with CKD undergoing haemodialysis (HD) and peritoneal dialysis (PD). METHODS This is an observational, cross-sectional and multicentre study conducted between March 2023 and March 2025. The study was approved by the Research Ethics Committee at two centres. Sarcopenia diagnosis is determined based on low handgrip strength and amount of appendicular skeletal muscle mass, assessed through bioelectrical impedance analysis. Respiratory sarcopenia is diagnosed in patients with sarcopenia who have low inspiratory muscle strength, evaluated through a manovacuometry test. The severity of sarcopenia and respiratory sarcopenia is defined, respectively, by low physical performance (measured using the Short Physical Performance Battery and Timed-Up and Go test) and pulmonary performance (measured through spirometry). Thus, this study will include 81 patients undergoing dialysis (41 on HD and 40 on PD) from three participating centres. DISCUSSION The literature has been focused on respiratory function in CKD; however, the relationship with sarcopenia remains understudied. We believe that, similar to appendicular skeleton muscles, the axial skeleton muscles are also likely to weaken with the presence of chronic disease, such as CKD.
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Affiliation(s)
- Francini Porcher Andrade
- Ciências Pneumológicas Post-Graduation Programme, Federal University of Rio Grande do Sul (UFRGS), Rua Ramiro Barcelos, 2400 2º andar, Porto Alegre, RS, 90035-003, Rio Grande do Sul, Brazil.
- Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil.
- Research Center in Sports Sciences, Health Sciences and Human Development, University of Maia (CIDESD-UMAIA), Maia, Portugal.
| | - Sheila Borges
- Science and Technology in Health Programme, University of Brasília (UnB), Brasília, Distrito Federal, Brazil
| | - César Alencar da Silva Filho
- Ciências Pneumológicas Post-Graduation Programme, Federal University of Rio Grande do Sul (UFRGS), Rua Ramiro Barcelos, 2400 2º andar, Porto Alegre, RS, 90035-003, Rio Grande do Sul, Brazil
- Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil
| | - Taís Ferreira Martins
- Sciences of Rehabilitation Post-Graduation Programme, University of Brasília (UnB), Brasilia, Distrito Federal, Brazil
| | - Heloíse Benvenutti
- Ciências Pneumológicas Post-Graduation Programme, Federal University of Rio Grande do Sul (UFRGS), Rua Ramiro Barcelos, 2400 2º andar, Porto Alegre, RS, 90035-003, Rio Grande do Sul, Brazil
- Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil
| | - Júlia de Melo Cardoso de Freitas
- Medical Sciences Focused on Endocrinology Post-Graduation Programme, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil
| | - Fernando Saldanha Thomé
- Faculty of Medicine, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil
- Instituto de Doenças Renais (IDR), Porto Alegre, Rio Grande do Sul, Brazil
| | - Cristina Karohl
- Faculty of Medicine, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil
| | - Gabriela Correa Souza
- Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil
- Graduate Program in Food, Nutrition and Health, Medical School, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Graziella França Bernardelli Cipriano
- Science and Technology in Health Programme, University of Brasília (UnB), Brasília, Distrito Federal, Brazil
- Sciences of Rehabilitation Post-Graduation Programme, University of Brasília (UnB), Brasilia, Distrito Federal, Brazil
| | - Paula Maria Eidt Rovedder
- Ciências Pneumológicas Post-Graduation Programme, Federal University of Rio Grande do Sul (UFRGS), Rua Ramiro Barcelos, 2400 2º andar, Porto Alegre, RS, 90035-003, Rio Grande do Sul, Brazil
- Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil
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98
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Fukumi A, Tanaka M, Sugae A, Ishida Y, Yamamoto H, Watanabe T, Fukushima C, Miyauchi M, Teragaki M, Maeda K, Takami Y, Iwanari S, Ikeda M, Takeoka H. Hypereosinophilia-associated acute intradialytic hypotension: a report of three cases and literature review. CEN Case Rep 2024:10.1007/s13730-024-00850-w. [PMID: 38277067 DOI: 10.1007/s13730-024-00850-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 12/31/2023] [Indexed: 01/27/2024] Open
Abstract
Occasionally, patients undergoing dialysis develop acute severe hypotension that requires interruption of dialysis within minutes of initiating every dialysis session. Although the underlying causes of recurrent intradialytic hypotension are evaluated extensively, including dialysis-associated allergic reactions or other possible causes, the definitive cause is sometimes missed. Dialysis is a life-sustaining procedure; therefore, prompt identification and management of the underlying cause of dialysis intolerance are crucial. Herein, we report three cases of patients undergoing dialysis who presented with hypereosinophilia-associated acute intradialytic hypotension. All three patients developed acute severe hypotension within minutes after the start of every dialysis session. The prescriptions for dialysis were changed, but episodes of intradialytic hypotension persisted. Pretreatment with methylprednisolone given intravenously before the dialysis session was also ineffective. All patients had hypereosinophilia (> 1500/μL) of different etiology. Eosinophil-lowering therapy with 0.5 mg/kg of prednisolone given orally daily was initiated, and all of them could restart dialysis without any hypotensive episodes within a few days. Our case report and literature review indicated that hypereosinophilia, regardless of its etiology, could result in severe acute hypotension shortly after the start of dialysis session. The oral administration of prednisolone daily was highly effective on hypereosinophilia-associated intradialytic hypotension, while pretreatment with intravenous corticosteroid therapy just before dialysis had no effect. Hypereosinophilia-associated acute intradialytic hypotension is an under-recognized condition; therefore, clinicians need to be aware of this clinical entity and initiate effective treatment strategies. We also provide a brief summary of previously published cases.
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Affiliation(s)
- Awaisshafiq Fukumi
- Department of Nephrology and Dialysis, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77 Higashinaniwa-Cho, Amagasaki, Hyogo, 660-8550, Japan.
| | - Mari Tanaka
- Department of Nephrology and Dialysis, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77 Higashinaniwa-Cho, Amagasaki, Hyogo, 660-8550, Japan
| | - Akane Sugae
- Department of Nephrology and Dialysis, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77 Higashinaniwa-Cho, Amagasaki, Hyogo, 660-8550, Japan
| | - Yuki Ishida
- Department of Nephrology and Dialysis, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77 Higashinaniwa-Cho, Amagasaki, Hyogo, 660-8550, Japan
| | - Hiroko Yamamoto
- Department of Nephrology and Dialysis, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77 Higashinaniwa-Cho, Amagasaki, Hyogo, 660-8550, Japan
| | - Tomoka Watanabe
- Department of Nephrology and Dialysis, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77 Higashinaniwa-Cho, Amagasaki, Hyogo, 660-8550, Japan
| | - Chiho Fukushima
- Department of Nephrology and Dialysis, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77 Higashinaniwa-Cho, Amagasaki, Hyogo, 660-8550, Japan
| | - Miho Miyauchi
- Department of Nephrology and Dialysis, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77 Higashinaniwa-Cho, Amagasaki, Hyogo, 660-8550, Japan
| | - Mariko Teragaki
- Department of Nephrology and Dialysis, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77 Higashinaniwa-Cho, Amagasaki, Hyogo, 660-8550, Japan
| | - Kotaro Maeda
- Department of Nephrology and Dialysis, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77 Higashinaniwa-Cho, Amagasaki, Hyogo, 660-8550, Japan
| | - Yohtaro Takami
- Department of Nephrology and Dialysis, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77 Higashinaniwa-Cho, Amagasaki, Hyogo, 660-8550, Japan
| | - Sachio Iwanari
- Department of Nephrology and Dialysis, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77 Higashinaniwa-Cho, Amagasaki, Hyogo, 660-8550, Japan
| | - Masaki Ikeda
- Department of Nephrology and Dialysis, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77 Higashinaniwa-Cho, Amagasaki, Hyogo, 660-8550, Japan
| | - Hiroya Takeoka
- Department of Nephrology and Dialysis, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77 Higashinaniwa-Cho, Amagasaki, Hyogo, 660-8550, Japan
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99
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Majouni S, Tennankore K, Abidi SSR. Predicting Urgent Dialysis at Ambulance Transport to the Emergency Department Using Machine Learning Methods. Stud Health Technol Inform 2024; 310:891-895. [PMID: 38269937 DOI: 10.3233/shti231093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
Hemodialysis patients frequently require ambulance transport to the hospital for dialysis. Some patients require urgent dialysis (UD) within 24 hours of transport to hospital to avoid morbidity and mortality. UD is not available in all hospitals; therefore, predicting patients who need UD prior to hospital transport can help paramedics with destination planning. In this paper, we developed machine learning models for paramedics to predict whether a patient needs UD based on patient characteristics available at the time of ambulance transport. This paper presented a study based on ambulance data collected in Halifax, Canada. Given that relatively few patients need UD, a class imbalance problem is addressed by up-sampling methods and prediction models are developed using multiple machine learning methods. The achieved prediction scores are F1-score=0.76, sensitivity=0.76, and specificity=0.97, confirming that models can predict UD with limited patient characteristics.
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Affiliation(s)
- Sheida Majouni
- NICHE Research Group, Faculty of Computer Science, Dalhousie University, Canada
| | - Karthik Tennankore
- Division of Nephrology, Department of Medicine, Dalhousie University, Canada
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100
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Inaguma D, Tatematsu Y, Okamoto N, Ogata S, Kawai H, Watanabe E, Yuzawa Y, Hasegawa M, Tsuboi N. Multicentre, open-label, randomised, controlled trial to compare early intervention with calcimimetics and conventional therapy in preventing coronary artery calcification in patients with secondary hyperparathyroidism (UPCOMING): a study protocol. BMJ Open 2024; 14:e076962. [PMID: 38267238 PMCID: PMC10823999 DOI: 10.1136/bmjopen-2023-076962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 01/07/2024] [Indexed: 01/26/2024] Open
Abstract
INTRODUCTION Coronary artery and heart valve calcification is a risk factor for cardiovascular death in haemodialysis patients, so calcification prevention should be started as early as possible. Treatment with concomitant calcimimetics and low-dose vitamin D receptor activators (VDRAs) is available, but not enough evidence has been obtained on the efficacy of this regimen, particularly in patients with short dialysis duration. Therefore, this study will evaluate the efficacy and safety of early intervention with upacicalcet, a calcimimetic used to prevent coronary artery calcification in this patient population. METHODS AND ANALYSIS This multicentre, open-label, randomised, parallel-group controlled study will compare an early intervention group, which received upacicalcet and a low-dose VDRA, with a conventional therapy group, which received a VDRA. The primary endpoint is a change in log coronary artery calcium volume score from baseline to 52 weeks. The main inclusion criteria are as follows: (1) age 18 years or older; (2) dialysis is planned or dialysis duration is less than 60 months; (3) intact parathyroid hormone (PTH) >240 pg/mL or whole PTH level>140 pg/mL; (4) serum-corrected calcium≥8.4 mg/dL and (5) Agatston score >30. The main exclusion criteria are as follows: (1) history of parathyroid intervention or fracture in the past 12 weeks; (2) history of myocardial infarction, stroke or leg amputation in the past 12 weeks; (3) history of coronary angioplasty and (4) heart failure of New York Heart Association class III or worse. ETHICS AND DISSEMINATION The study will comply with the Declaration of Helsinki and the Japanese Clinical Trials Act. The study protocol has been approved by the Fujita Health University Certified Review Board (file no. CR22-052). Written informed consent will be obtained from all participants. Study results will be presented in academic meetings and peer-reviewed academic journals. TRIAL REGISTRATION NUMBER jRCTs041220126.
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Affiliation(s)
- Daijo Inaguma
- Nephrology, Fujita Health University Bantane Hospital, Nagoya, Japan
| | | | - Naoki Okamoto
- Nephrology, Fujita Health University Bantane Hospital, Nagoya, Japan
| | - Soshiro Ogata
- Preventive Medicine & Epidemiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Hideki Kawai
- Cardiology, Fujita Health University, Toyoake, Japan
| | - Eiichi Watanabe
- Cardiology, Fujita Health University Bantane Hospital, Nagoya, Japan
| | - Yukio Yuzawa
- Nephrology, Fujita Health University, Toyoake, Japan
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