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Kirkeskov L, Carlsen RK, Lund T, Buus NH. Employment of patients with kidney failure treated with dialysis or kidney transplantation-a systematic review and meta-analysis. BMC Nephrol 2021; 22:348. [PMID: 34686138 PMCID: PMC8532382 DOI: 10.1186/s12882-021-02552-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 10/06/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Patients with kidney failure treated with dialysis or kidney transplantation experience difficulties maintaining employment due to the condition itself and the treatment. We aimed to establish the rate of employment before and after initiation of dialysis and kidney transplantation and to identify predictors of employment during dialysis and posttransplant. METHODS This systematic review and meta-analysis were carried out according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines for studies that included employment rate in adults receiving dialysis or a kidney transplant. The literature search included cross-sectional or cohort studies published in English between January 1966 and August 2020 in the PubMed, Embase, and Cochrane Library databases. Data on employment rate, study population, age, gender, educational level, dialysis duration, kidney donor, ethnicity, dialysis modality, waiting time for transplantation, diabetes, and depression were extracted. Quality assessment was performed using the Newcastle-Ottawa Scale. Meta-analysis for predictors for employment, with odds ratios and confidence intervals, and tests for heterogeneity, using chi-square and I2 statistics, were calculated. PROSPERO registration number: CRD42020188853. RESULTS Thirty-three studies included 162,059 participants receiving dialysis, and 31 studies included 137,742 participants who received kidney transplantation. Dialysis patients were on average 52.6 years old (range: 16-79; 60.3% male), and kidney transplant patients were 46.7 years old (range: 18-78; 59.8% male). The employment rate (weighted mean) for dialysis patients was 26.3% (range: 10.5-59.7%); the employment rate was 36.9% pretransplant (range: 25-86%) and 38.2% posttransplant (range: 14.2-85%). Predictors for employment during dialysis and posttransplant were male, gender, age, being without diabetes, peritoneal dialysis, and higher educational level, and predictors of posttransplant: pretransplant employment included transplantation with a living donor kidney, and being without depression. CONCLUSIONS Patients with kidney failure had a low employment rate during dialysis and pre- and posttransplant. Kidney failure patients should be supported through a combination of clinical and social measures to ensure that they remain working.
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Affiliation(s)
- Lilli Kirkeskov
- Centre of Social Medicine, University Hospital Bispebjerg-Frederiksberg, Nordre Fasanvej 57, Vej 8, Opgang 2.2., 2000, Frederiksberg, Denmark.
| | - Rasmus K Carlsen
- Department of Transplantation Medicine, Oslo University Hospital, Sognsvannsveien 20, OUS, Rikshospitalet, 0372, Oslo, Norway
| | - Thomas Lund
- Centre of Social Medicine, University Hospital Bispebjerg-Frederiksberg, Nordre Fasanvej 57, Vej 8, Opgang 2.2., 2000, Frederiksberg, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Niels Henrik Buus
- Department of Renal Medicine, Aarhus University Hospital, Palle Juul-Jensnes Boulevard 35, indgang C, plan 2, 8200, Aarhus, Denmark
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Chang YT, Wang F, Huang WY, Hsiao H, Wang JD, Lin CC. Estimated Loss of Lifetime Employment Duration for Patients Undergoing Maintenance Dialysis in Taiwan. Clin J Am Soc Nephrol 2021; 16:746-756. [PMID: 33858826 PMCID: PMC8259483 DOI: 10.2215/cjn.13480820] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 02/08/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND OBJECTIVES An accurate estimate of the loss of lifetime employment duration resulting from kidney failure can facilitate comprehensive evaluation of societal financial burdens. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS All patients undergoing incident dialysis in Taiwan during 2000-2017 were identified using the National Health Insurance Research Database. The corresponding age-, sex-, and calendar year-matched general population served as the referents. The survival functions and the employment states of the index cohort (patients on dialysis) and their referents for each age strata were first calculated, and then extrapolated until age 65 years, where the sum of the product of the survival function and the employment states was the lifetime employment duration. The difference in lifetime employment duration between the index and referent cohort was the loss of lifetime employment duration. Extrapolation of survival function and relative employment-to-population ratios were estimated by the restricted cubic spline models and the quadratic/linear models, respectively. RESULTS A total of 83,358 patients with kidney failure were identified. Men had a higher rate of employment than women in each age strata. The expected loss of lifetime employment duration for men with kidney failure was 11.8, 7.6, 5.7, 3.8, 2.3, 1.0, and 0.2 years for those aged 25-34, 35-40, 41-45, 46-50, 51-55, 56-60, and 61-64 years, respectively; and the corresponding data for women was 10.5, 10.1, 7.9, 5.6, 3.3, 1.5, and 0.3 years, respectively. The values for loss of lifetime employment duration divided by loss of life expectancy were all >70% for women and >88% for men across the different age strata. The sensitivity analyses indicated that the results were robust. CONCLUSIONS The loss of lifetime employment duration in patients undergoing dialysis mainly originates from loss of life expectancy.
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Affiliation(s)
- Yu-Tzu Chang
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Fuhmei Wang
- Department of Economics, College of Social Sciences, National Cheng Kung University, Tainan, Taiwan
| | - Wen-Yen Huang
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Hsuan Hsiao
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jung-Der Wang
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan,Department of Environmental and Occupational Health, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Chang-Ching Lin
- Department of Economics, College of Social Sciences, National Cheng Kung University, Tainan, Taiwan
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3
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Blake PG, Finkelstein FO. Why is the Proportion of Patients Doing Peritoneal Dialysis Declining in North America? Perit Dial Int 2020. [DOI: 10.1177/089686080102100201] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Peter G. Blake
- Optimal Dialysis Research Unit London Health Sciences Centre and University of Western Ontario London, Ontario, Canada
| | - Fredric O. Finkelstein
- New Haven CAPD, Renal Research Institute Hospital of St. Raphael, Yale School of Medicine New Haven, Connecticut, U.S.A
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4
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Nissenson AR. Quality of Life in Elderly and Diabetic Patients on Peritoneal Dial Ysis. Perit Dial Int 2020. [DOI: 10.1177/089686089601601s78] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Allen R. Nissenson
- Dialysis Program, UCLA School of Medicine, Los Angeles, California, U.S.A
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5
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Korevaar JC, Jansen MA, Merkus MP, Dekker FW, Boeschoten EW, Krediet RT. Quality of Life in Predialysis End-Stage Renal Disease Patients at the Initiation of Dialysis Therapy. Perit Dial Int 2020. [DOI: 10.1177/089686080002000113] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective To assess health-related quality of life (QL) in a group of Dutch predialysis end-stage renal disease (ESRD) patients prior to the initiation of dialysis, and to compare QL between patients with different intended initial dialysis treatments. Design In a prospective cohort study, demographic, clinical, and QL data were obtained from Dutch adult patients who were consecutively enrolled from 27 different centers 0 – 4 weeks prior to the beginning of their chronic dialysis treatment. Patients Of the 301 patients who completed the QL questionnaires (of a possible 337 enrolled patients), 152 intended to start with hemodialysis (pre-HD) and 149 patients with peritoneal dialysis (pre-PD). Main Outcome Measure Perceived QL of pre-HD and pre-PD patients. Quality of life was assessed with two generic health assessment instruments: the SF-36 and the EuroQol. Results After correction for group differences, pre-HD patients scored consistently, but not significantly, lower for all separate dimensions of the SF-36 and the overall health score of the EuroQol compared to pre-PD patients. However, analyzing the dimensions of the SF-36 together, adjusted for case-mix, pre-HD patients scored significantly lower than pre-PD patients. Mean difference was 6.5 points ( p = 0.04). Conclusion Multivariate adjustment for known case-mix differences at the start of dialysis therapy was not sufficient to adjust for all patient selection effects on QL. Consequently, published QL comparisons between HD and PD in nonrandomized cohort studies should be interpreted with caution. Assessment of QL just before start of dialysis therapy and subsequent adjustment for baseline values may be the only valid alternative for randomized studies.
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Affiliation(s)
| | - Johanna C. Korevaar
- Department of Clinical Epidemiology and Biostatistics, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Maarten A.M. Jansen
- Department of Nephrology, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Maruschka P. Merkus
- Department of Clinical Epidemiology and Biostatistics, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Friedo W. Dekker
- Department of Clinical Epidemiology and Biostatistics, Academic Medical Center, University of Amsterdam, The Netherlands
| | | | - Raymond T. Krediet
- Department of Nephrology, Academic Medical Center, University of Amsterdam, The Netherlands
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6
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Salek S. Quality-Of-Life Assessment in Patients on Peritoneal Dialysis: A Review of the State of the Art. Perit Dial Int 2020. [DOI: 10.1177/089686089601601s76] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Sam Salek
- Medicines Research Unit, University of Wales, Cardiff, Wales
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7
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Su-Hernández L, Abascal-Macías A, Méndez-Bueno FJ, Paniagua R, Amato D. Epidemiologic and Demographic Aspects of Peritoneal Dialysis in Mexico. Perit Dial Int 2020. [DOI: 10.1177/089686089601600407] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective To assess some epidemiological and demographic aspects of peritoneal dialysis (PD) at the Instituto Mexicano del Seguro Social (IMSS), the major institution of social security in Mexico, that provides health care services for 57% of the Mexican population at the time of the study. Study Design A cross-sectional analysis of data about patients under peritoneal dialysis in 1992. Data Sources A national survey containing demographic data, dialysis modality, type of catheter, peritonitis and death rates, and questions on costs, medical staff, and physical facilities for PD in all of the hospitals of the IMSS. Results All hospitals returned the information re quested. Intermittent peritoneal dialysis (IPD) was performed in 19 hospitals, continuous ambulatory peritoneal dialysis (CAPD) in 11, and both modalities in 90. In 61 hospitals, a special area was designed for PD; in the rest of them, beds from general internal medicine departments were used. All hospitals had a head for the PD programs; overall, teams had 240 physicians and 765 nurses for IPD, and 182 physicians and 313 nurses for CAPD. CAPD prescription was four 2-L bags/day. For IPD, patients were hospitalized once a week and received 28 manually performed exchanges of 2– L bags; the mean time of hospitalization was 2.7 days, and 878 beds were used. The number of patients receiving PD was 7785, with a prevalence of 199.6 per million population. Ofthem, 4011 were on IPD and 3774 on CAPD; 54% of the patients were males. IPD patients’ mean age was 49 ± 17 yr, and that of CAPD patients’ was 42 ± 17 yr (NS). Diabetic nephropathy was the most frequent cause of ESRD (44%). Infection was the most important complication detected. Rates of peritonitis were 0.5/patient/yr on IPD and 0.8/patient/yr on CAPD. Annual mortality rates without stratification for specific causes were 34% in IPD and 17% in CAPD. Mortality rates may have been influenced by malnutrition and cardiovascular complications of diabetes, but specific causes of death were not investigated. All of the PD programs costs were covered by the institution. The cost per patient was not calculated, but IPD is known to be more expensive, due to its higher hospitalization rate. Conclusion In spite of its higher cost and mortality, the institutions still use IPD, notso much on medical basis, but as the only alternative available for patients with adverse environmental, social, educational, and economic conditions for CAPD or HD.
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Affiliation(s)
- Lilia Su-Hernández
- Coordinación de Atención Medica, Instituto Mexicano del Seguro Social. Mexico, D.F. Mexico
| | - Antonio Abascal-Macías
- Coordinación de Atención Medica, Instituto Mexicano del Seguro Social. Mexico, D.F. Mexico
| | | | - Ramon Paniagua
- Coordinación de Investigación Medica, Instituto Mexicano del Seguro Social. Mexico, D.F. Mexico
| | - Dante Amato
- Coordinación de Investigación Medica, Instituto Mexicano del Seguro Social. Mexico, D.F. Mexico
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Iordanidis P, Alivanis P, Lakovidis A, Dombros N, Tsagalidis I, Balaskas E, Derveniotis V, Lerodiakonou C, Tourkantonis A. Psychiatric and Psychosocial Status of Elderly Patients Undergoing Dialysis. Perit Dial Int 2020. [DOI: 10.1177/089686089301302s46] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We Investigated the psychiatric and psychosocial status of 31 elderly (age >65 years) end-stage renal disease patients undergoing hemodialysis (HO) (17 patients) and continuous ambulatory peritoneal dialysis (CAPO) (14 patients). There was no difference between the two groups In terms of age (67.3:1:.2.3 and 68.5:1:.4.3 In HO and CAPO groups, respectively), duration of dialysis treatment, and biochemical profile. The psychiatric and psychosocial status of the patients was assessed using the standardized psychiatric Interview (SPI), Hamilton's depression scale (HRS-O), and a questionnaire for the evaluation of the psychosocial Impact of the method of treatment. Sixteen of 31 patients presented with psychiatric morbidity (9 mild, 5 moderate, 2 severe). However, there was no significant relationship between psychiatric morbidity and method of dialysis (HO or CAPO). The mean values of SPI (21.47:1:.16.38 and 17.14:1:.13) and HRS-O (20.91:1:.17.33 and 15.41:1:.13.13) scores for the HO and CAPO groups, respectively, did not differ significantly. The analysis of the results of the questionnaire regarding the Impact of the method of treatment on psychosocial status Indicated that the HO patients felt that their lives were more dependent on factors that they could not Influence (I.e., the dialysis equipment, etc.). Our findings suggest that the psychiatric status of elderly patients undergoing chronic dialysis treatment Is not affected by the method of treatment, a factor that should be taken Into consideration when deciding the proper dialysis treatment for these patients.
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Affiliation(s)
- Pantazis Iordanidis
- Third Department of Psychiatry and First Department of Internal Medicine, Aristotelian University of Thessalomki, AHEPA Hospital, Thessalom'ki, Greece
| | - Polichronis Alivanis
- Third Department of Psychiatry and First Department of Internal Medicine, Aristotelian University of Thessalomki, AHEPA Hospital, Thessalom'ki, Greece
| | - Apostolos Lakovidis
- Third Department of Psychiatry and First Department of Internal Medicine, Aristotelian University of Thessalomki, AHEPA Hospital, Thessalom'ki, Greece
| | - Nicholas Dombros
- Third Department of Psychiatry and First Department of Internal Medicine, Aristotelian University of Thessalomki, AHEPA Hospital, Thessalom'ki, Greece
| | - Ioannis Tsagalidis
- Third Department of Psychiatry and First Department of Internal Medicine, Aristotelian University of Thessalomki, AHEPA Hospital, Thessalom'ki, Greece
| | - Elias Balaskas
- Third Department of Psychiatry and First Department of Internal Medicine, Aristotelian University of Thessalomki, AHEPA Hospital, Thessalom'ki, Greece
| | - Vasilis Derveniotis
- Third Department of Psychiatry and First Department of Internal Medicine, Aristotelian University of Thessalomki, AHEPA Hospital, Thessalom'ki, Greece
| | - Charalambos Lerodiakonou
- Third Department of Psychiatry and First Department of Internal Medicine, Aristotelian University of Thessalomki, AHEPA Hospital, Thessalom'ki, Greece
| | - Achilles Tourkantonis
- Third Department of Psychiatry and First Department of Internal Medicine, Aristotelian University of Thessalomki, AHEPA Hospital, Thessalom'ki, Greece
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9
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Nissenson AR. Assessing the Effects of Peritoneal Dialysis on the Health-Related Quality of Life of the Adult Patient. Perit Dial Int 2020. [DOI: 10.1177/089686089701703s08] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Allen R. Nissenson
- Dialysis Program, UCLA School of Medicine, Los Angeles, California, U.S.A
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10
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Harris SA, Lamping DL, Brown EA, Constantinovici N. Clinical outcomes and Quality of Life in Elderly Patients on Peritoneal Dialysis versus Hemodialysis. Perit Dial Int 2020. [DOI: 10.1177/089686080202200404] [Citation(s) in RCA: 110] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
♦ Objective To compare clinical outcomes and quality of life (QOL) in elderly patients on peritoneal dialysis (PD) and hemodialysis (HD) in the North Thames Dialysis Study. ♦ Design A 12-month prospective cohort study. ♦ Setting Four hospital-based renal units in London, UK. ♦ Patients 174 patients that were 70 years or older at the start of dialysis, separated into two cohorts: 78 new patients (36 PD, 42 HD) that were recruited after 90 days of chronic dialysis; and 96 stock patients (42 PD, 54 HD) that were already on dialysis during the recruitment period. ♦ Main Outcome Measures 12-month survival and hospitalization rate, and QOL assessed at baseline and at 6 and 12 months by the SF-36 and the Symptoms/Problems scale of the Kidney Disease Quality of Life Questionnaire (KDQOL). ♦ Results Peritoneal dialysis and HD patients were similar for sociodemographic and clinical characteristics. Annual mortality and hospitalization rates in PD versus HD patients were 26.1 versus 26.4 deaths/100 person–years and 1.9 versus 2.0 admissions/person–year, respectively. Adjusted relative risks showed no effect of modality on clinical outcomes. Multiple linear regression analyses of QOL at baseline showed similar SF-36 scores between PD and HD patients, but higher KDQOL scores in PD patients (3.5 points higher, 95% confidence interval 0.3 – 6.6). There was, however, no effect of dialysis modality on QOL at 6 or 12 months. ♦ Conclusions Clinical outcomes and QOL are similar in elderly people on PD and HD. Peritoneal dialysis is a viable option for more than a carefully selected minority of elderly people requiring dialysis.
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Affiliation(s)
| | - Susan A.C. Harris
- Department of Renal Medicine, Charing Cross Hospital, Royal Free and University College Medical School, London, United Kingdom
| | - Donna L. Lamping
- Health Services Research Unit, London School of Hygiene & Tropical Medicine, Royal Free and University College Medical School, London, United Kingdom
| | - Edwina A. Brown
- Department of Renal Medicine, Charing Cross Hospital, Royal Free and University College Medical School, London, United Kingdom
| | - Niculae Constantinovici
- Department of Primary Care and Population Sciences, Royal Free and University College Medical School, London, United Kingdom
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11
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Nomoto Y, Kawaguchi Y, Kubota M, Tagawa H, Kubo K, Ogura Y, Shoji T, Kawada Y, Koshikawa S, Mimura N, Maeda T. A Multicenter Study with Once a Week Or Once Every Two Weeks High Dose Subcutaneous Administration of Recombinant Human Erythropoietin in Continuous Ambulatory Peritoneal Dialysis. Perit Dial Int 2020. [DOI: 10.1177/089686089401400111] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective To investigate the effectiveness of administering relatively high doses of r-HuEPO subcutaneously once a week or once every 2 weeks in patients undergoing continuous ambulatory peritoneal dialysis (CAPD). Design Multicenter prospective analysis. The trial was divided into two phases: an initial 8-week phase (once a week dosing) followed by a 12-week maintenance phase (once every 2 weeks dosing). A response was defined as a change in hematocrit (Ht) of 3% or more. Results were analyzed using Sheffe's test, Mantel-Haenszel's test, and Dunnett's test. Setting Eleven renal units in Japan providing a CAPD program. Patients Forty-one CAPD patients with a Ht of 28% or less. Results After the initial 8 weeks, 13 (81.3%) of 16 patients showed a response to 6000 U (106.9±20.0 U/kg) subcutaneously (sc), once a week. Eleven (84.6%) of 13 in the 9000 U (166.5±27.7 U/kg) group and all 12 (100%) in the 12 000 U (210.7 ±42.1 U/kg) group also showed responses. At the end of both phases, that is, at 20 weeks, 7 (53.8%) of 13 patients in the 6000 U group with once every 2 weeks dosing, 7 (63.6%) of 11 in the 9000 U group, and 10(90.9%) of 11 in the 12 000 U group maintained responses with the same dosing interval. There were no significant changes in mean blood pressure during the study period, and only 2 patients developed treatable hypertension with mild headache. Conclusion Administration of relatively high doses of r-HuEPO to CAPD patients once a week or once every 2 weeks is safe and potentially an effective regimen for the correction of renal anemia.
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Affiliation(s)
- Yasuo Nomoto
- Department of Internal Medicine, School of Medicine, Tokai University, Isehara City
| | | | - Minoru Kubota
- Department of Internal Medicine, Juntendo University, Tokyo
| | - Hitoshi Tagawa
- Department of Internal Medicine, Mitsui Memorial Hospital, Tokyo
| | - Kazuo Kubo
- Department of Internal Medicine, Tokyo Women's Medical College, Tokyo
| | | | - Takao Shoji
- Kidney Center, Yokosuka Kyosai Hospital, Yokosuka
| | - Yukimichi Kawada
- Department of Urology, School of Medicine, Gifu University, Gifu
| | - Shozo Koshikawa
- Department of Internal Medicine, Fujigaoka Hospital, Showa University, Yokohama
| | - Nobuhide Mimura
- Department of Internal Medicine, Sakura National Hospital, Sakura
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12
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Manen van JG, Korevaar JC, Dekker FW, Reuselaars MC, Boeschoten EW, Krediet RT. Changes in Employment Status in End-Stage Renal Disease Patients during Their First Year of Dialysis. Perit Dial Int 2020. [DOI: 10.1177/089686080102100610] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective To assess employment status in new end-stage renal disease (ESRD) patients at the start of dialysis and after 1 year, and to determine whether demographic and clinical variables and physical and psychosocial functioning at the start of dialysis are risk factors for loss of employment after 1 year of dialysis. Design Prospective follow-up study in which 38 of 48 Dutch dialysis centers participate. Patients 659 patients who had started on dialysis and who were between 18 and 65 years old were included. Patients were re-examined after 12 months. Main Outcome Measures Demographic data, physical and psychosocial functioning with the Short-Form Health Survey (SF-36), and data on employment status were obtained using questionnaires. Nephrologists provided the clinical data. Results At the start of dialysis, 35% of patients were employed, in contrast to 61% of the general Dutch population. Within 1 year, the proportion of employed patients decreased from 31% to 25% of hemodialysis patients, and from 48% to 40% of peritoneal dialysis patients. In patients who were working at the start of dialysis, independent risk factors for loss of work within 1 year were impaired physical and psychosocial functioning [odds ratio physical: 3.4, 95% confidence interval (%CI), 1.0 – 11.2; odds ratio psychosocial: 4.2, 95% CI, 1.2 – 14.2]. Conclusions As the percentage of employed patients at the start of dialysis is about half the expected percent-age, loss of work is an important issue in both predialysis and dialysis patients. Improvements in physical and psychosocial functioning are potentially preventive of loss of work in patients who are employed when they start dialysis.
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Affiliation(s)
| | - Jeannette G. Manen van
- Department of Clinical Epidemiology and Biostatistics, Academic Medical Center, University of Amsterdam
| | - Johanna C. Korevaar
- Department of Clinical Epidemiology and Biostatistics, Academic Medical Center, University of Amsterdam
| | - Friedo W. Dekker
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden
| | - Margot C. Reuselaars
- Department of Clinical Epidemiology and Biostatistics, Academic Medical Center, University of Amsterdam
| | - Elisabeth W. Boeschoten
- Department of Nephrology, Academic Medical Center, University of Amsterdam
- Dianet Dialysis Centers, Amsterdam, The Netherlands
| | - Raymond T. Krediet
- Department of Nephrology, Academic Medical Center, University of Amsterdam
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13
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14
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Nakamoto H, Kawaguchi Y, Suzuki H. Is Technique Survival on Peritoneal Dialysis Better in Japan? Perit Dial Int 2020. [DOI: 10.1177/089686080602600203] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Technique failure resulting in transfer to hemodialysis (HD) remains one of the most important challenges in long-term peritoneal dialysis (PD). In general, the proportion of patients transferring from PD to HD is much greater than the proportion transferring from HD to PD. However, technique failure rates differ considerably between and within countries. The question arises as to how technique failure rates in Japan compare with those in other countries. To address this issue, we reviewed the literature and our experience of 139 incident continuous ambulatory peritoneal dialysis (CAPD) patients from January 1995 to December 1999. Based on our review, we estimate that the 5-year technique survival rate in Japanese CAPD patients is approximately 70%, and that technique failure rate is around 7% per year. This rate is significantly lower than that in many other countries. The most common reasons for technique failure in Japan are peritoneal membrane failure, ultrafiltration loss, and inadequate dialysis. Another factor contributing to the low technique failure rate in Japan is an extremely low peritonitis rate. This may be related to good sanitation and excellent PD training programs. Peritoneal membrane failure continues to be the major challenge for long-term technique survival on PD in Japan.
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15
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Oren B, Enç N. Quality of life in chronic haemodialysis and peritoneal dialysis patients in Turkey and related factors. Int J Nurs Pract 2013; 19:547-56. [PMID: 24330205 DOI: 10.1111/ijn.12098] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Turkey is the fifth country in Europe with regard to the number of patients receiving haemodialysis (HD). However, only a limited number of studies have comparatively investigated the factors that affect quality of life in haemodialysis and peritoneal dialysis (PD) patients in Turkey. The purpose of the study was to investigate the factors that affect quality of life in haemodialysis and peritoneal dialysis patients, as well as providing a comparison of quality of life between these groups. In this cross-sectional study, Quality of Life Scale and a data form was completed by 300 dialysis patients who received treatment at five hospital-based dialysis units in Istanbul, Turkey. The data were evaluated using arithmetic mean values, standard deviations, minimums, maximums, percentages, independent groups t-tests, Spearman correlation analyses and one-way variance analyses. The quality of life values in peritoneal dialysis patients were found to be higher than those of haemodialysis patients (P < 0.05). It was concluded that the quality of life in chronic dialysis patients was affected by various factors.
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Affiliation(s)
- Besey Oren
- Health Science Faculty, Istanbul University, Istanbul, Turkey
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16
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Purnell TS, Auguste P, Crews DC, Lamprea-Montealegre J, Olufade T, Greer R, Ephraim P, Sheu J, Kostecki D, Powe NR, Rabb H, Jaar B, Boulware LE. Comparison of life participation activities among adults treated by hemodialysis, peritoneal dialysis, and kidney transplantation: a systematic review. Am J Kidney Dis 2013; 62:953-73. [PMID: 23725972 DOI: 10.1053/j.ajkd.2013.03.022] [Citation(s) in RCA: 165] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Accepted: 03/06/2013] [Indexed: 12/17/2022]
Abstract
BACKGROUND A comprehensive assessment of the association of patients' renal replacement therapy (RRT) modality with their participation in life activities (physical function, travel, recreation, freedom, and work) is needed. STUDY DESIGN Systematic review of peer-reviewed published studies. SETTING & POPULATION Adults undergoing RRT (hemodialysis, peritoneal dialysis, or transplantation). SELECTION CRITERIA FOR STUDIES We searched PubMed, Cochrane Library, and EMBASE from January 1980 through April 2012 for English-language articles that compared participation in life activities among patients receiving: (1) hemodialysis compared with peritoneal dialysis, (2) hemodialysis compared with kidney transplantation, or (3) peritoneal dialysis compared with kidney transplantation. PREDICTOR RRT modality. OUTCOMES Reported rates of physical function, travel, recreation, freedom, and work-related activities by RRT modality. RESULTS 46 studies (6 prospective cohort, 38 cross-sectional, and 2 pre-post transplantation) provided relevant comparisons of life participation activities among patients treated with hemodialysis, peritoneal dialysis, and kidney transplantation. Studies were conducted in 1985-2011 among diverse patient populations in 16 distinct locations. A majority of studies reported greater life participation rates for patients with kidney transplants compared with patients receiving either hemodialysis or peritoneal dialysis. In contrast, a majority of studies reported no differences in outcomes between patients receiving hemodialysis and patients receiving peritoneal dialysis. These results were consistent throughout the study period, across diverse populations, and among the subset of studies that performed appropriate adjustments for potential confounding factors. LIMITATIONS Many studies included in the review had significant design weaknesses. CONCLUSIONS Evidence suggests that patients with kidney transplants may experience better rates of life participation compared with patients receiving dialysis, whereas patients receiving hemodialysis and patients receiving peritoneal dialysis may experience similar rates of life participation. Rigorously performed studies are needed to better inform patients about the association of RRT with these important patient-reported outcomes.
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Affiliation(s)
- Tanjala S Purnell
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD; Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD.
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Theofilou P, Synodinou C, Panagiotaki H. Undergoing Haemodialysis: A Qualitative Study to Investigate the Lived Experiences of Patients. EUROPES JOURNAL OF PSYCHOLOGY 2013. [DOI: 10.5964/ejop.v9i1.338] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Oyekçin DG, Gülpek D, Sahin EM, Mete L. Depression, anxiety, body image, sexual functioning, and dyadic adjustment associated with dialysis type in chronic renal failure. Int J Psychiatry Med 2012; 43:227-41. [PMID: 22978081 DOI: 10.2190/pm.43.3.c] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Depression is the most widely studied complication in dialysis patients. In patients with chronic renal failure, changes in body image are considered to be associated with invasive treatment interventions. In addition, sexual problems are common in dialysis patients. In this study, hemodialysis and peritoneal dialysis patients are investigated for depression, anxiety, body image, sexual satisfaction, and dyadic adjustment. METHODS Hemodialysis patients (n = 36), peritoneal dialysis patients (n = 54), and healthy controls (n = 30) were included in the study. All the subjects were assessed with Structured Clinical Interview for DSM-IV, Body Image Scale, Beck Depression Inventory, Beck Anxiety Scale, Golombok-Rust Inventory for Sexual Satisfaction, and Dyadic Adjustment Scale. RESULTS Depression (20.64 +/- 15.20) and anxiety levels (14.72 +/- 12.36) were significantly higher in hemodialysis group compared to peritoneal dialysis (13.54 +/- 12.51; 12.74 +/- 11.21) and control groups (7.17 +/- 5.58; 9.86 +/- 9.19). In peritoneal dialysis group, as depression and anxiety levels increased, body image was disturbed and sexual satisfaction decreased. In peritoneal dialysis group, body image (86.98 +/- 23.63) was better than hemodialysis group (101.58 +/- 26.51) and was not different from the control group (83.67 +/- 22.11). In hemodialysis group, as depression and anxiety levels increased, body image was disturbed. In both groups, long-term dialysis disturbed body image. CONCLUSION Patients should be informed about the impacts of dialysis. Clinicians may wish to monitor dialysis-users for anxiety, depression, dyadic adjustment, and body image difficulties at follow-up appointments. Interventions that target intimate partner interventions, appearance-related beliefs, and anxiety depression may be of benefit to this population.
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Böhlke M. Dialysis and kidney transplantation: why have our rehabilitation hopes not been achieved fully? Am J Kidney Dis 2012; 59:598-600. [PMID: 22507648 DOI: 10.1053/j.ajkd.2012.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2012] [Accepted: 02/08/2012] [Indexed: 11/11/2022]
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Helanterä I, Haapio M, Koskinen P, Grönhagen-Riska C, Finne P. Employment of Patients Receiving Maintenance Dialysis and After Kidney Transplant: A Cross-sectional Study From Finland. Am J Kidney Dis 2012; 59:700-6. [DOI: 10.1053/j.ajkd.2011.08.025] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2011] [Accepted: 08/16/2011] [Indexed: 11/11/2022]
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[Peritoneal dialysis: a satisfactory experience of a misknown technique in Rabat University Hospital]. Nephrol Ther 2010; 6:569-75. [PMID: 20920897 DOI: 10.1016/j.nephro.2010.07.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2010] [Revised: 07/14/2010] [Accepted: 07/15/2010] [Indexed: 11/20/2022]
Abstract
UNLABELLED Peritoneal dialysis (PD) is a renal replacement therapy method that could be proposed in the first intention for the treatment of end stage renal disease (ESRD). The aim of the study is to describe the beginning and development of PD in "Ibn Sina" University Hospital in Rabat, and to evaluate the outcome of the patients treated by this technique. PATIENTS AND METHODS It is a descriptive study between July 2006 and December 2009, including 41 ESRD patients treated by PD. PD parameters as well as clinical and biological data were collected and analyzed. RESULTS The average age of our patients was 45.8±17.4-year-old. The sex-ratio (M/F) was 1.9. Professionally active patients (50%) as well as students (14) kept their activity throughout the study. Initially, 68.2% of the patients had hypertension whereas, at the end of the study, only 25.8% still suffered from hypertension. A better quality of dialysis as well as the conservation of a residual renal function were ensured in PD with 92.6% of the patients having a residual clearance higher than 2 mL/min. A correction of anemia was noted with higher rates of hemoglobin after the beginning of the treatment by peritoneal dialysis. None of our cases presented a denutrition and all our diabetic patients did not worsen with the exchanges in PD. DISCUSSION AND CONCLUSION PD has recently been introduced in Morocco. It must be encouraged and sustained. In our study, we noted a good quality of dialysis and a conservation of the residual renal function. These results should encourage the promotion of this technique, especially that there is an inequality of distribution of hemodialysis centers in Morocco and the inability to deal with all ESRD patients. Furthermore, renal transplantation is not always possible in our country. For that, a specific program of information of both generalists and specialists, especially nephrologists must be established.
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Walker DR, Inglese GW, Sloand JA, Just PM. Dialysis facility and patient characteristics associated with utilization of home dialysis. Clin J Am Soc Nephrol 2010; 5:1649-54. [PMID: 20634324 DOI: 10.2215/cjn.00080110] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Nonmedical factors influencing utilization of home dialysis at the facility level are poorly quantified. Home dialysis is comparably effective and safe but less expensive to society and Medicare than in-center hemodialysis. Elimination of modifiable practice variation unrelated to medical factors could contribute to improvements in patient outcomes and use of scarce resources. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Prevalent dialysis patient data by facility were collected from the 2007 ESRD Network's annual reports. Facility characteristic data were collected from Medicare's Dialysis Facility Compare file. A multivariate regression model was used to evaluate associations between the use of home dialysis and facility characteristics. RESULTS The utilization of home dialysis was positively associated with facility size, percent patients employed full- or part-time, younger population, and years a facility was Medicare certified. Variables negatively associated include an increased number of hemodialysis patients per hemodialysis station, chain association, rural location, more densely populated zip code, a late dialysis work shift, and greater percent of black patients within a zip code. CONCLUSIONS Improved understanding of factors affecting the frequency of use of home dialysis may help explain practice variations across the United States that result in an imbalanced use of medical resources within the ESRD population. In turn, this may improve the delivery of healthcare and extend the ability of an increasingly overburdened medical financing system to survive.
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Affiliation(s)
- David R Walker
- Baxter Healthcare Corporation, McGaw Park, Illinois, USA
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Oreopoulos DG, Thodis E, Passadakis P, Vargemezis V. Home dialysis as a first option: a new paradigm. Int Urol Nephrol 2009; 41:595-605. [DOI: 10.1007/s11255-009-9575-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2009] [Accepted: 04/15/2009] [Indexed: 11/24/2022]
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Ginieri-Coccossis M, Theofilou P, Synodinou C, Tomaras V, Soldatos C. Quality of life, mental health and health beliefs in haemodialysis and peritoneal dialysis patients: investigating differences in early and later years of current treatment. BMC Nephrol 2008; 9:14. [PMID: 19014597 PMCID: PMC2611965 DOI: 10.1186/1471-2369-9-14] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2008] [Accepted: 11/14/2008] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The study examines differences regarding quality of life (QoL), mental health and illness beliefs between in-centre haemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD/PD) patients. Differences are examined between patients who recently commenced treatment compared to patients on long term treatment. METHODS 144 End-Stage Renal Disease (ESRD) patients were recruited from three treatment units, of which 135 provided full data on the variables studied. Patients consisted of: a) 77 in-centre haemodialysis (HD) and 58 continuous ambulatory peritoneal dialysis (CAPD/PD) patients, all currently being treated by dialysis for varied length of time. Patients were compared for differences after being grouped into those who recently commenced treatment (< 4 years) and those on long term treatment (> 4 years). Next, cases were selected as to form two equivalent groups of HD and CAPD/PD patients in terms of length of treatment and sociodemographic variables. The groups consisted of: a) 41 in-centre haemodialysis (HD) and b) 48 continuous ambulatory peritoneal dialysis (CAPD/PD) patients, fitting the selection criteria of recent commencement of treatment and similar sociodemographic characteristics. Patient-reported assessments included: WHOQOL-BREF, GHQ-28 and the MHLC, which is a health locus of control inventory. RESULTS Differences in mean scores were mainly observed in the HD patients with > 4 years of treatment, providing lower mean scores in the QoL domains of physical health, social relationships and environment, as well as in overall mental health. Differences in CAPD/PD groups, between those in early and those in later years of treatment, were not found to be large and significant. Concerning the analysis on equivalent groups derived from selection of cases, HD patients indicated significantly lower mean scores in the QoL domain of environment and higher scores in the GHQ-28 subscales of anxiety/insomnia and severe depression, indicating more symptoms in these areas of mental health. With regards to illness beliefs, HD patients who recently commenced treatment provided higher mean scores in the dimension of internal health locus of control, while CAPD/PD patients on long term treatment indicated higher mean scores in the dimension of chance. Regarding differences in health beliefs between equivalent groups of HD and CAPD/PD patients, HD patients focused more on the dimension of internal health locus of control. CONCLUSION The results provide evidence that patients in HD treatment modality, particularly those with many years of treatment, were experiencing a more compromised QoL in comparison to CAPD/PD patients.
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Affiliation(s)
- M Ginieri-Coccossis
- 1st Department of Psychiatry, Medical School, University of Athens, Athens, Greece.
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Asif A, Pflederer TA, Vieira CF, Diego J, Roth D, Agarwal A. American Society of Diagnostic and Interventional Nephrology Section Editor: Stephen Ash: Does Catheter Insertion by Nephrologists Improve Peritoneal Dialysis Utilization? A Multicenter Analysis. Semin Dial 2008; 18:157-60. [PMID: 15771662 DOI: 10.1111/j.1525-139x.2005.18204.x] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In contrast to hemodialysis (HD), peritoneal dialysis (PD) remains an underutilized form of renal replacement therapy in the United States. Although a variety of factors have been deemed responsible, timely insertion of a PD catheter may also be a contributory factor. We conducted a multicenter analysis to examine whether the establishment of a program for PD catheter insertion by nephrologists has a positive impact on the growth in the number of patients using PD. Data for catheter insertion performed by nephrologists were collected from three centers. Any change in the prevalent PD population at each respective center was compared to the number of PD patients during the period having the traditional surgical approach. Nephrologists at the three centers used the peritoneoscopic technique and performed catheter insertion under local anesthesia. In center 1, the PD population remained stable at between 38 and 45 patients (approximately 16% of the total end-stage renal disease [ESRD] population) from 1993 to 2001. Nephrologists initiated a program for PD catheter insertion in 2001. The number of PD patients has increased to 101 (32% of the ESRD population). In center 2, the PD population remained stable at between 70 and 78 patients (approximately 17%) between 1988 and 1990. Catheter insertion by interventional nephrologists began in 1991. The number of PD patients has increased to 125 (22%). In center 3, the PD population remained at 20-30 patients (approximately 18%) between 1988 and 1991. Catheter placement by nephrologists was initiated in 1991. The number of PD patients increased to 97 (27%). Catheter insertion by interventional nephrologists was suspended in 2001. The number of PD patients has gradually declined to 25 (6%). This study suggests that catheter insertion by the nephrologist can have a positive impact on the utilization of PD.
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Affiliation(s)
- Arif Asif
- Department of Medicine, Division of Nephrology, University of Miami School of Medicine, Miami, Florida 33136, USA.
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Goh BL, Ganeshadeva YM, Chew SE, Dalimi MS. Does peritoneal dialysis catheter insertion by interventional nephrologists enhance peritoneal dialysis penetration? Semin Dial 2008; 21:561-6. [PMID: 18764787 DOI: 10.1111/j.1525-139x.2008.00478.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Traditionally peritoneal dialysis (PD) catheter was implanted by surgeons using mini-laparotomy or open technique in Malaysia. We introduced peritoneoscopic Tenckhoff catheter insertion technique since the beginning of our PD program. Data were collected from the start of our PD program in February 2006 until April 2008. All Tenckhoff catheters were inserted by nephrologists using the peritoneoscope technique. We also compare the penetration rate of PD versus hemodialysis (HD) in our center, as well as comparing to national PD penetration rate. There were 83 patients who underwent 91 peritoneoscope Tenckhoff catheter insertion procedures from March 2006 until April 2008. The patients were mostly female (66%) with the mean age of 51.99 +/- 1.78 years and the majority (67%) of them were diabetics. All together there were 749.7 patient-months at risk and the overall peritonitis rate was 1 in 93.7 patient-months. The 1-year catheter survival was 86.5%. Primary catheter failure (defined as failure of the catheter within 1 month of insertion) occurred in 16 procedures (17.6%). The main cause of catheter malfunction was catheter tip migration and omentum wrap. The penetration ratio of PD when compared with HD in our center is 44.8%, which is about 4.5 times the national average. With our integrated care approach where nephrologist was heavily involved from the outset of renal replacement therapy discussion, PD access implantation to the assistance of spoke person to whom new patient can identify with, we were able to achieve PD penetration rate which far exceeds that of the national average.
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Affiliation(s)
- Bak Leong Goh
- Department of Nephrology, Serdang Hospital, Jalan Puchong, Kajang, Malaysia.
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Liem YS, Bosch JL, Hunink MGM. Preference-based quality of life of patients on renal replacement therapy: a systematic review and meta-analysis. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2008; 11:733-41. [PMID: 18194399 DOI: 10.1111/j.1524-4733.2007.00308.x] [Citation(s) in RCA: 125] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
OBJECTIVES Various utility measures have been used to assess preference-based quality of life of patients with end-stage renal disease (ESRD). The purposes of this study were to summarize the literature on utilities of hemodialysis (HD), peritoneal dialysis (PD), and renal transplantation (RTx) patients, to compare utilities between these patient groups, and to obtain estimates for quality-of-life adjustment in economic analyses. METHODS We searched the English literature for studies that reported visual analog scale (VAS), time trade-off (TTO), standard gamble (SG), EuroQol-5D (EQ-5D), and health utilities index (HUI) values of ESRD patients. We extracted patient characteristics and utilities and calculated mean utilities and 95% confidence intervals (CIs) for categories defined by utility measure and treatment modality using random-effects models. RESULTS We identified 27 articles that met the inclusion criteria. VAS articles were too heterogeneous to summarize quantitatively and we found only one study reporting HUI values. Thus, we summarized utilities from TTO, SG, and EQ-5D studies. Mean TTO and EQ-5D-index values were lower for dialysis compared to RTx patients, though not statistically significant for TTO values (TTO values: HD 0.61, 95% CI 0.54-0.68; PD 0.73, 95% CI 0.61-0.85; RTx 0.78, 95% CI 0.63-0.93; EQ-5D-index values: HD 0.56, 95% CI 0.49-0.62; PD 0.58, 95% CI 0.50-0.67; RTx 0.81, 95% CI 0.72-0.90). Mean HD versus PD associated TTO, EQ-5D-index and EQ-VAS values were not statistically significantly different. CONCLUSION RTx patients tended to have a higher utility than dialysis patients. Among HD and PD patients, there were no statistically significant differences in utility.
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Affiliation(s)
- Ylian S Liem
- Assessment of Radiological Technology Program (ART Program), Department of Epidemiology and Biostatistics, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
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Just PM, de Charro FT, Tschosik EA, Noe LL, Bhattacharyya SK, Riella MC. Reimbursement and economic factors influencing dialysis modality choice around the world. Nephrol Dial Transplant 2008; 23:2365-73. [PMID: 18234844 PMCID: PMC2441769 DOI: 10.1093/ndt/gfm939] [Citation(s) in RCA: 111] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2007] [Accepted: 12/18/2007] [Indexed: 11/21/2022] Open
Abstract
The worldwide incidence of kidney failure is on the rise and treatment is costly; thus, the global burden of illness is growing. Kidney failure patients require either a kidney transplant or dialysis to maintain life. This review focuses on the economics of dialysis. Alternative dialysis modalities are haemodialysis (HD) and peritoneal dialysis (PD). Important economic factors influencing dialysis modality selection include financing, reimbursement and resource availability. In general, where there is little or no facility or physician reimbursement or payment for PD, the share of PD is very low. Regarding resource availability, when centre HD capacity is high, there is an incentive to use that capacity rather than place patients on home dialysis. In certain countries, there is interest in revising the reimbursement structure to favour home-based therapies, including PD and home HD. Modality selection is influenced by employment status, with an association between being employed and PD as the modality choice. Cost drivers differ for PD and HD. PD is driven mainly by variable costs such as solutions and tubing, while HD is driven mainly by fixed costs of facility space and staff. Many cost comparisons of dialysis modalities have been conducted. A key factor to consider in reviewing cost comparisons is the perspective of the analysis because different costs are relevant for different perspectives. In developed countries, HD is generally more expensive than PD to the payer. Additional research is needed in the developing world before conclusive statements may be made regarding the relative costs of HD and PD.
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Affiliation(s)
- Paul M Just
- Baxter Healthcare Corporation, 1620 Waukegan Road, MPGR-A2E, McGaw Park, IL 60085, USA.
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Abstract
The author reviews briefly the history of peritoneal dialysis, and highlights the significance of the work of two Hungarian nephrologists, Stephen I. Vas and István Taraba . By now, peritoneal dialysis has been considered as equal renal replacement modality compared to haemodialysis. It is even more advantageous in the protection of the patients' residual renal function, morbidity-mortality indices, and quality of life peritoneal dialysis in the first two years. From economical point of view peritoneal dialysis is less expensive than hemodialysis, therefore in the future its greater role can be expected in the treatment of more and more renal patients. The recently achieved technical development, and also the more widespread use of the automated peritoneal dialysis machines contribute to quality improvement. The peritoneal dialysis therapy, by the patients' self-treatment, establishes a new kind of relationship between the patients and the medical personnel; there is a growing requirement for patient education, the patients' self-esteem and cooperation increase, which altogether provides better results in rehabilitation and higher quality of life. Our national peritoneal dialysis utilization falls behind the European achievements, but has been growing dynamically, and we can expect an increase of the number of renal patients on peritoneal dialysis.
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Affiliation(s)
- Kálmán Polner
- Szent Margit Kórház, II. Belgyógyászati-Nefrológiai Osztály, Budapest.
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Grenêche S, D'Andon A, Jacquelinet C, Faller B, Fouque D, Laville M. Le choix entre dialyse péritonéale et hémodialyse : une revue critique de la littérature. Nephrol Ther 2005; 1:213-20. [PMID: 16895687 DOI: 10.1016/j.nephro.2005.01.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2004] [Accepted: 01/07/2005] [Indexed: 11/15/2022]
Abstract
In France, incidence and prevalence of end-stage renal disease (ESRD) are increasing, requiring a more rational use of available replacement therapies. To help practitioners make their choice between treatment modalities of peritoneal dialysis (PD) and haemodialysis (HD), critical appraisal of relevant literature has been conducted. Although few absolute or relative contraindications for PD and HD exist, arguments in favour of one versus the other dialysis technique can be made. When patients receive adequate and complete information, their preference is neutral between PD and HD. To date, no trial presenting a convincing level of evidence has been published which demonstrates the superiority of one technique compared to the other. Relative to mortality, it appears that no difference can be observed between the two modalities. However, in those instances where patients expect a rapid transplantation, PD is the preferred technique. This analysis suggests that peritoneal dialysis and haemodialysis are not competitive but rather complementary treatments. It is therefore interesting to identify the reasons supporting the various choices between the two different treatment modalities amongst France's regions. Access to transplant, economic or organizational factors must be considered.
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Affiliation(s)
- Sylvie Grenêche
- JNB-Développement, 6, rue du Général-de-Larminat, 75015 Paris, France.
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Abstract
Traditionally the placement of a peritoneal dialysis (PD) catheter in a patient with end-stage renal disease (ESRD) has been accomplished by a surgeon and using general anesthesia. This approach often introduces delays in starting PD, incurs additional costs in utilizing an operating room as well as anesthesia services, and introduces the mortality risk associated with general anesthesia. Recent data have emphasized that interventional nephrologists can safely and successfully perform PD access procedures. In this context, operating room facilities and staff and anesthesia services are not required and catheter insertion can be performed in a procedure room using local anesthesia, thereby reducing costs and completely bypassing the mortality risk associated with general anesthesia. When performed by a nephrologist, the catheter insertion can be accomplished swiftly and dialysis therapy initiated in a timely manner. Once begun, the success of PD hinges on reliable and long-term access to the peritoneal cavity. Prospective randomized and nonrandomized studies have shown that PD catheters peritoneoscopically placed by nephrologists have fewer complications (infection, exit site leak) and longer catheter survival rates than those inserted surgically. Although PD offers a variety of advantages, it remains an underutilized form of renal replacement therapy. To counteract PD underutilization, at least two separate centers have demonstrated a positive impact on the growth of the PD population when catheter insertion is performed by nephrologists. This article presents PD access-related procedures currently performed by interventional nephrologists. Furthermore, some of the complicating issues (bowel perforation, catheter migration, prior abdominal surgery) related to PD catheter insertion and management are also discussed.
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Affiliation(s)
- Arif Asif
- Division of Nephrology, Department of Medicine, University of Miami School of Medicine, Miami, Florida, USA.
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Korevaar JC, Feith GW, Dekker FW, van Manen JG, Boeschoten EW, Bossuyt PMM, Krediet RT. Effect of starting with hemodialysis compared with peritoneal dialysis in patients new on dialysis treatment: a randomized controlled trial. Kidney Int 2004; 64:2222-8. [PMID: 14633146 DOI: 10.1046/j.1523-1755.2003.00321.x] [Citation(s) in RCA: 285] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Up-until-now, the survival and health-related quality of life of hemodialysis and peritoneal dialysis patients has only been compared in observational studies. These studies have reported small and opposing differences between both modalities. The aim of this study was to compare the outcome of hemodialysis as initial chronic dialysis treatment with that of peritoneal dialysis in a randomized controlled trial. METHODS All new dialysis patients from 38 dialysis centers in The Netherlands without indications against either modality were invited to participate. Patients were assigned to start with hemodialysis or peritoneal dialysis. The primary outcome was mean quality-adjusted life year (QALY) score. Secondary outcome was survival. RESULTS Due to the low inclusion rate, the trial was prematurely stopped after which 38 patients had been randomized: 18 patients to hemodialysis and 20 to peritoneal dialysis. The mean QALY score in the first 2 years was 59.1 (SD 12) for hemodialysis patients versus 54.0 (SD 19) for peritoneal dialysis patients, which constitutes a small difference in favor of hemodialysis of 5.1 (95%CI -7.3 to 17.6) After 5 years of follow-up, nine hemodialysis and five peritoneal dialysis patients had died, a significant difference in survival; hazard ration of hemodialysis versus peritoneal dialysis of 3.8 (95%CI 1.1 to 12.6). After adjustment for age, comorbidity, and primary kidney disease the hazard ratio was 3.6 (0.8 to 15.4). CONCLUSION Only a small difference in QALY score was observed between patients who started with hemodialysis compared to patients who started with peritoneal dialysis, lending support for the equivalence hypothesis. The significant difference in longer-term survival, which favored peritoneal dialysis in this small group of patients, could be used to posit that incident dialysis patients might benefit from starting on peritoneal dialysis.
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Affiliation(s)
- Johanna C Korevaar
- Department of Clinical Epidemiology and Biostatistics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
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Jager KJ, Korevaar JC, Dekker FW, Krediet RT, Boeschoten EW. The effect of contraindications and patient preference on dialysis modality selection in ESRD patients in The Netherlands. Am J Kidney Dis 2004; 43:891-9. [PMID: 15112180 DOI: 10.1053/j.ajkd.2003.12.051] [Citation(s) in RCA: 205] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Patients with end-stage renal disease (ESRD) who are about to start long-term dialysis therapy are faced with the question of modality choice. The aim of the current study is to determine the influence of different factors on long-term dialysis modality choice. METHODS As part of a large Dutch prospective multicenter study, the Netherlands Cooperative Study on the Adequacy of Dialysis, we consecutively included all new patients with ESRD. Nephrologists indicated the most important reason for the modality selection. RESULTS Of 1,347 included patients, 36% (n = 483) had a contraindication to either peritoneal dialysis (PD) or hemodialysis (HD) therapy. Eighty percent (n = 386) of all contraindications were directed to PD therapy. The most frequently mentioned contraindication was a social one; ie, the expected incapability of patients to perform PD exchanges themselves. Patients with contraindications were older, had more comorbidity, and lived alone more often compared with patients without contraindications. In patients without contraindications (64%), modality choice was based on patient preference. Older age increased the odds of choosing HD, whereas receipt of predialysis care was associated with a lower preference for HD. CONCLUSION Older age was associated with more contraindications to PD therapy and stronger patient preference for HD therapy. An elderly patient therefore was more likely to start with HD therapy. Results from the current study suggest that an increase in provision of predialysis care, in combination with a reduction in social contraindications to PD therapy, may be associated with an increase in likelihood of starting with PD therapy. In a time of an aging population, increasing demand on dialysis capacity, and limited amount of financial supplies, we may reconsider current strategies to provide future patients with ESRD the possibility to start with the dialysis modality they prefer.
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Affiliation(s)
- Kitty J Jager
- Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
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Hirth RA, Chernew ME, Turenne MN, Pauly MV, Orzol SM, Held PJ. Chronic illness, treatment choice and workforce participation. ACTA ACUST UNITED AC 2003; 3:167-81. [PMID: 14625998 DOI: 10.1023/a:1025332802736] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Choices with respect to labor force participation and medical treatment are increasingly intertwined. Technological advances present patients with new choices and may facilitate continued employment for the growing number of chronically ill individuals. We examine joint work/treatment decisions of end stage renal disease patients, a group for whom these tradeoffs are particularly salient. Using a simultaneous equations probit model, we find that treatment choice is a significant predictor of employment status. However, the effect size is considerably smaller than in models that do not consider the joint nature of these choices.
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Affiliation(s)
- Richard A Hirth
- Department of Health Policy and Management, University of Michigan School of Public Health, 109 S. Observatory, Ann Arbor, MI 48109-2029, USA.
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Parker KP, Kutner NG, Bliwise DL, Bailey JL, Rye DB. Nocturnal sleep, daytime sleepiness, and quality of life in stable patients on hemodialysis. Health Qual Life Outcomes 2003; 1:68. [PMID: 14633280 PMCID: PMC320494 DOI: 10.1186/1477-7525-1-68] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2003] [Accepted: 11/21/2003] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although considerable progress has been made in the treatment of chronic kidney disease, compromised quality of life continues to be a significant problem for patients receiving hemodialysis (HD). However, in spite of the high prevalence of sleep complaints and disorders in this population, the relationship between these problems and quality of life remains to be well characterized. Thus, we studied a sample of stable HD patients to explore relationships between quality of life and both subjective and objective measures of nocturnal sleep and daytime sleepiness METHODS The sample included forty-six HD patients, 24 men and 22 women, with a mean age of 51.6 (10.8) years. Subjects underwent one night of polysomnography followed the next morning by a Multiple Sleep Latency Test (MSLT), an objective measure of daytime sleepiness. Subjects also completed: 1) a brief nocturnal sleep questionnaire; 2) the Epworth Sleepiness Scale; and, 3) the Quality of Life Index (QLI, Dialysis Version) which provides an overall QLI score and four subscale scores for Health & Functioning (H&F), Social & Economic (S&E), Psychological & Spiritual (P&S), and Family (F). (The range of scores is 0 to 30 with higher scores indicating better quality of life.) RESULTS The mean (standard deviation; SD) of the overall QLI was 22.8 (4.0). The mean (SD) of the four subscales were as follows: H&F - 21.1 (4.7); S&E - 22.0 (4.8); P&S - 24.5 (4.4); and, F - 26.8 (3.5). H&F (rs = -0.326, p = 0.013) and F (rs = -0.248, p = 0.048) subscale scores were negatively correlated with periodic limb movement index but not other polysomnographic measures. The H&F subscale score were positively correlated with nocturnal sleep latency (rs = 0.248, p = 0.048) while the H&F (rs = 0.278, p = 0.030) and total QLI (rs = 0.263, p = 0.038) scores were positively associated with MSLT scores. Both of these latter findings indicate that higher life quality is associated with lower sleepiness levels. ESS scores were unrelated to overall QLI scores or the subscale scores. Subjective reports of difficulty falling asleep and waking up too early were significantly correlated with all four subscale scores and overall QLI. Feeling rested in the morning was positively associated with S&E, P&S, and Total QLI scores. CONCLUSION Selected measures of both poor nocturnal sleep and increased daytime sleepiness are associated with decreased quality of life in HD patients, underscoring the importance of recognizing and treating these patients' sleep problems.
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Affiliation(s)
- Kathy P Parker
- Nell Hodgson Woodruff, School of Nursing, 1520 Clifton Road, USA
- Department of Neurology, Renal Division, Emory University, Atlanta, Georgia, USA
| | - Nancy G Kutner
- Department of Rehabilitation Medicine, Renal Division, Emory University, Atlanta, Georgia, USA
| | - Donald L Bliwise
- Nell Hodgson Woodruff, School of Nursing, 1520 Clifton Road, USA
- Department of Neurology, Renal Division, Emory University, Atlanta, Georgia, USA
| | - James L Bailey
- Department of Medicine, Renal Division, Emory University, Atlanta, Georgia, USA
| | - David B Rye
- Nell Hodgson Woodruff, School of Nursing, 1520 Clifton Road, USA
- Department of Neurology, Renal Division, Emory University, Atlanta, Georgia, USA
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Asif A, Byers P, Gadalean F, Roth D. Peritoneal dialysis underutilization: the impact of an interventional nephrology peritoneal dialysis access program. Semin Dial 2003; 16:266-71. [PMID: 12753690 DOI: 10.1046/j.1525-139x.2003.16051.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Peritoneal dialysis (PD) is an underutilized form of renal replacement therapy. Recent data have emphasized that only 12% of end-stage renal disease (ESRD) patients are initiated on this form of therapy in the United States. Patients requiring PD have most often been referred to general surgeons for catheter placement. This has incurred additional delays in starting treatment and loss of decision-making control by the referring nephrologist. To address this issue, we developed and incorporated our own PD access placement program into the preexisting chronic kidney disease (CKD) education program. To date, 46 patients have undergone 71 procedures. These included 51 (72%) PD catheter insertions, 14 (20%) removals, and 6 (8%) repositioning procedures for poor drainage. PD catheter insertion was performed peritoneoscopically under local anesthesia and a Fogarty catheter was used to reposition a migrated catheter. All of the procedures were performed by nephrologists in a dedicated interventional nephrology (IN) laboratory. All six repositioning procedures failed to restore optimal drainage. Five of these patients had the catheter removed and a new catheter placed during the same procedure. Of these five patients, one had recurrence of poor drainage and opted for hemodialysis (HD). The sixth patient declined reinsertion and chose HD. Of the remaining seven removal procedures, three were due to fungal peritonitis, one due to bowel perforation, one due to severe depression, one due to transplant, and one catheter was removed at the request of the primary physician in a terminally ill patient. Eight of the 51 catheter insertions were during the initial admission of a catastrophic dialysis start. Two of these patients started acute PD and avoided catheter placement for HD. Thirty-seven of 46 patients have a functional PD catheter with a follow-up of 8.6 +/- 0.8 (mean +/- SE) months. During an 18-month period our PD population has increased from 43 to 80 patients. We conclude that a dedicated PD access placement program coupled with a CKD education program can have a dramatic impact on patient choice and PD growth.
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Affiliation(s)
- Arif Asif
- Division of Nephrology, Department of Medicine, University of Miami School of Medicine, Miami, Florida 33136, USA
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Rebollo P, Ortega F. New trends on health related quality of life assessment in end-stage renal disease patients. Int Urol Nephrol 2003; 33:195-202. [PMID: 12090331 DOI: 10.1023/a:1014419122558] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Health related quality of life (HRQOL) is a useful measure in the analysis of the output of medical interventions in groups of chronic patients like end-stage renal disease (ESRD) patients. From the 1980s to the present day, the interest in evaluating the HRQOL of ESRD patients has been continually growing. A review of published studies shows the existence of important differences in the applied conceptual model of HRQOL, in the assessment instruments used, in the methods of data collection recording, and in the results and conclusions. In this paper we tried to answer some of the main questions which could appear when nephrologists begin to use the HRQOL measures with renal patients: we clearly define the concept of HRQOL; we made recommendations about the instruments to evaluate HRQOL (generic vs specific instruments); and we show how to refine a HRQOL score to make it practical and comprehensible (the standardization of the scores by age and gender).
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Affiliation(s)
- Pablo Rebollo
- Institute Reina Sofía for Nephrological Research, Nephrology Unit, Hospital Central de Asturias, Oviedo, Spain
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41
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Iacovides A, Fountoulakis KN, Balaskas E, Manika A, Markopoulou M, Kaprinis G, Tourkantonis A. Relationship of age and psychosocial factors with biological ratings in patients with end-stage renal disease undergoing dialysis. Aging Clin Exp Res 2002; 14:354-60. [PMID: 12602569 DOI: 10.1007/bf03324462] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND AIMS Dialysis is a time-consuming procedure and may cause psychological distress. The aim of the present study was to investigate the relationship between age, emotional state, life satisfaction, sexual functioning and the method of dialysis in patients suffering from end-stage renal failure. METHODS Eighty-two patients of 97 with end-stage chronic renal failure entered the study; 56 were under hemodialysis (HD), and 26 were under continuous ambulatory peritoneal dialysis (CAPD). Zung Depression Rating Scale (ZDRS), the Life Satisfaction Inventory (LSI), the Lasry Sexual Functioning Scale (LSFS), and a protocol aiming to register sociodemographic variables and variables considering the physical disorders were used. RESULTS No significant differences between groups were found in the ZDRS (HD patients: 40.7 +/- 8.2, CAPD patients: 41.88 +/- 10.44; p = 0.57), LSI scores (HD patients: 87.9 +/- 14.7, CAPD patients: 87.03 +/- 5.25; p = 0.7) and LSFS scores. Multiple linear regression analysis showed that LSI scores depended only on gender (females were less satisfied) and individual items on level of albumins and the presence of other physical disorders; ZDRS individual items depended on leukomatine level, gender, diabetes mellitus, albumins, age, creatinine and duration of disease; sexual functioning on age, and urea and sleep on albumin level (all with p < 0.001). DISCUSSION No statistically significant differences were detected in depressive symptomatology, sexual function and life satisfaction between patients undergoing HD or CAPD. Some aspects of depressive symptomatology, sexual functioning and life satisfaction may be influenced by age, the kind of treatment and its effectiveness. Age was positively related with satisfaction from general quality of life, frequency of sexual activity, tiredness and feelings of usefulness.
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Affiliation(s)
| | - Donald L. Bliwise
- Department of Neurology, Sleep Disorders Center, School of Medicine, Emory University, Atlanta, Georgia
| | - David Rye
- Department of Neurology, Sleep Disorders Center, School of Medicine, Emory University, Atlanta, Georgia
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Abstract
Patients with end-stage renal disease have reduced quality of life, high levels of morbidity, and an annual mortality of about 22%. Because the high morbidity and mortality of dialysis patients might be reduced substantially if patients were healthier at the time of initiating renal replacement therapy, this article will present treatment recommendations designed to retard the progression of chronic renal disease, to optimize the medical management of comorbid medical conditions, such as cardiovascular disease, diabetes, and lipid disorders, and to reduce the complications of renal insufficiency, including hypertension, anemia, hyperparathyroidism, and malnutrition. Given the lack of prospective clinical studies in this area, these recommendations are derived from consensus standards for managing dialysis patients or patients with cardiovascular disease, hypertension, diabetes, and lipid disorders, and from expert opinion derived from laboratory investigations of pathophysiology and relevant experimental disease models.
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Affiliation(s)
- J P Pennell
- Division of Nephrology and Hypertension, Department of Medicine, University of Miami, Miami, Florida 33101, USA
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Abstract
We investigated the correlation between descriptive and valuational measures of health-related quality of life (HRQL) and assessed determinants affecting these measures. Our suspicion was that there is little similarity in the content of descriptive and valuational measures of HRQL. We thus conducted a cross-sectional observational study of 56 hemodialysis patients. All underwent structured interviews. Dependent variables were patients utilities [time trade-off (TTO)], global rating of HRQL and generic HRQL (SF-36). Independent variables were socioeconomic details, disease severity, comorbidity, symptoms, depression, social support, and laboratory data. The correlation between TTO and global HRQL was -0.33 (P = .0178) and between TTO and the SF-36 physical and mental summary scores -0.16 (P = .2383) and -0.20 (P = .1443), respectively. The regression models for the SF-36 physical and mental summary scores explained 75% and 64% of the variance, and for global HRQL 29% of the variance. The independent variables had no effect on the TTO. This confirmed our suspicion that a qualitative difference exists between TTO and descriptive quality of life tools. The TTO content could not be explained by the variables that entail the content of HRQL instruments.
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Affiliation(s)
- Y Maor
- The Center for the Study of Clinical Reasoning, The Gertner Institute for Epidemiology and Health Policy Research, Sackler School of Medicine, Tel Aviv University, Sheba Medical Center, 52621, Tel Hashomer, Israel.
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Wu AW, Fink NE, Cagney KA, Bass EB, Rubin HR, Meyer KB, Sadler JH, Powe NR. Developing a health-related quality-of-life measure for end-stage renal disease: The CHOICE Health Experience Questionnaire. Am J Kidney Dis 2001; 37:11-21. [PMID: 11136162 DOI: 10.1053/ajkd.2001.20631] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The Choices for Healthy Outcomes in Caring for End-Stage Renal Disease ([ESRD] CHOICE) Study was designed to evaluate the effectiveness of alternative dialysis prescriptions. As part of CHOICE, we developed an instrument for measuring health-related quality of life (HRQOL) for patients with ESRD that would complement the Medical Outcomes Study 36-Item Short-Form Survey (SF-36) and be sensitive to differences in dialysis modality (hemodialysis [HD] and peritoneal dialysis [PD]) and dialysis dose. The selection of HRQOL domains to be included was based on: (1) a structured literature review of 47 articles describing 53 different instruments; (2) content analysis of five focus groups with HD and PD patients, nephrologists, and other providers; (3) a survey of 110 dialysis providers about features of different modalities that affect patient HRQOL; and (4) a semistructured survey of 25 patients with ESRD on the effects of dialysis on functioning and HRQOL. To help prioritize domains and items identified by these methods, a representative sample of 136 dialysis patients rated each item for frequency and bother. A panel of nephrologists provided advice about the salience of items to modality or dose. Items and scales were selected with a preference for existing measures tested in patients with ESRD and were tested for reliability and validity. The first four steps yielded 22 HRQOL domains that included 96 items: 8 generic domains in the SF-36 (health perceptions, physical, social, physical and emotional role function, pain, mental health, and energy); 8 additional generic domains (cognitive functioning, sexual functioning, sleep, work, recreation, travel, finances, and general quality of life); and 6 ESRD-specific domains (diet, freedom, time, body image, dialysis access [catheters and/or vascular], and symptoms). New items were developed or adapted to assess ESRD-specific domains. Scales for these items showed adequate internal consistency (Cronbach's alpha > 0.70, except for time [alpha = 0.57] and quality of life [alpha = 0.68]), as well as convergent and discriminant construct validity in a sample of 928 patients. The final questionnaire included 21 domains (time was deleted) and 83 items. We have designed a patient-centered instrument, the CHOICE Health Experience Questionnaire, that addresses domains that may be sensitive to differences in dialysis modality and dose and shows evidence for reliability and validity as a measure of HRQOL in ESRD.
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Affiliation(s)
- A W Wu
- Departments of Health Policy and Management and Epidemiology, Johns Hopkins University School of Hygiene and Public Health, Baltimore, MD 21205-2223, USA
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Nielens H, Lejeune TM, Lalaoui A, Squifflet JP, Pirson Y, Goffin E. Increase of physical activity level after successful renal transplantation: a 5 year follow-up study. Nephrol Dial Transplant 2001; 16:134-40. [PMID: 11209007 DOI: 10.1093/ndt/16.1.134] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Physical activity (PA) level of end-stage renal disease (ESRD) patients after renal transplantation (TP) is a largely unexplored field, although it is an important component of quality of life. METHODS Using the Baecke self-administered and the Five-City Project 7-day PA recall questionnaires, PA level was estimated in 32 consecutive ESRD patients (12 males, 20 females; mean age 45.9+/-13.1 years; mean dialysis duration 23.5+/-21.8 months) admitted for renal TP and to whom no exercise programme of any kind was proposed. PA were recorded 1, 3, 6, 12 and 60 months after TP. RESULTS Immediate pre-TP PA level of renal transplant candidates was between 18 and 35% less than that of age-matched healthy subjects (P < 0.05), depending on gender and questionnaire. After an immediate decrease in PA level 1 month post-TP, mean PA level increased and reached a plateau 1 year after TP. This gain in PA capacity reached 30%, as compared with pre-TP values (P = 0.06 to P < 0.01). During the fifth year after TP, the mean level of PA was unchanged. A more qualitative analysis, allowed by the sub-score comparisons, showed that although the occupational status of the patients remained the same, they participated significantly more in moderate and even high intensity PA (leisure, sports, household chores) after TP. CONCLUSIONS Most renal graft recipients are spontaneously more active after TP, an observation consistent with a better quality of life. Therefore, they should be advised precisely about how to resume more strenuous activities such as sports in order to avoid cardiac or musculoskeletal disorders in relation to their weakened pre-TP condition.
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Affiliation(s)
- H Nielens
- Physical Medicine and Rehabilitation, Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium
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Tanna MM, Vonesh EF, Korbet SM. Patient survival among incident peritoneal dialysis and hemodialysis patients in an urban setting. Am J Kidney Dis 2000; 36:1175-82. [PMID: 11096042 DOI: 10.1053/ajkd.2000.19832] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
We retrospectively evaluated 432 patients (336 black; 78%; and 96 white; 22%) incident to our peritoneal dialysis (PD; 195 patients; 45%) and hemodialysis (HD; 237 patients; 55%) programs from January 1987 to December 1997 who survived their first 90 days of dialysis therapy. Black patients comprised 70% of the PD and 84% of the HD patients (P: < 0.01). PD patients were more often men and younger than HD patients and less often had diabetes (40% versus 56% of HD patients; P: < 0.01) and cardiac disease (44% versus 58% of HD patients; P: < 0.01) than HD patients. Adjusting for baseline clinical and comorbid features, patient survival was determined by Cox regression analysis. Survival was better on PD therapy overall (relative risk [RR] for PD versus HD, 0.80; 1-, 2-, and 5-year survival rates, 90%, 77%, and 43% on PD versus 88%, 72%, and 35% on HD, respectively; P: = 0.21) and among black patients (RR for PD versus HD, 0.69; 1-, 2-, and 5-year survival rates, 92%, 80%, and 52% on PD versus 88%, 74%, and 40% on HD, respectively; P: = 0.09), but these were not statistically significant. The RR for PD versus HD was 1.08 for white patients (1-, 2-, and 5-year survival rates, 82%, 61%, and 23% for PD versus 82%, 62%, and 24% for HD; P: = 0.79). Significant predictors of mortality were race (RR for whites versus blacks, 1.51), age (RR, 1.03), cardiac disease (RR, 1.57), baseline albumin level (RR, 0.60), baseline serum creatinine level (RR, 0.91), baseline blood urea nitrogen level (RR, 1.01), and baseline weight (RR, 0.98). In conclusion, patient survival on dialysis therapy is significantly better for black patients and for patients entering dialysis with signs of adequate nutrition (increased weight and creatinine and albumin levels) and without evidence of cardiac disease. In an urban dialysis program, we find that adjusted patient survival on PD equals or is better than that on HD therapy, particularly among black patients, making PD a viable alternative to HD in our patient population.
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Affiliation(s)
- M M Tanna
- Department of Medicine, Section of Nephrology, Rush-Presbyterian-St Lukes Medical Center, Chicago, USA
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Abstract
BACKGROUND The proposition that hemodialysis may induce alterations in the sleep-wake cycle is based on two clinical observations: (a) Patients on dialysis frequently sleep during and after dialysis, and (b) the procedure often is associated with temperature elevations. A review of pertinent literature showed that sleepiness and temperature are physiologically related, and that these two variables are important indicators of sleep and circadian regulatory processes. OBJECTIVES To describe possible associations among hemodialysis, body temperature, and sleepiness; to assist in building hypotheses; and to provide direction for future research. METHODS Three exploratory studies were performed to investigate (a) dialysis-associated elevations in body temperature, (b) changes in body temperature patterns across the day, and (c) alterations in daytime sleepiness. RESULTS The current study demonstrated that many patients manifest dialysis-associated episodic elevations of body temperature, changes in the circadian pattern of body temperature, and increases in daytime sleep propensity. In the context of the Two-Process Model of Sleep Regulation, these alterations provide a parsimonious explanation for the poor subjective sleep quality, prolonged sleep latency, and daytime sleepiness reported by these patients. CONCLUSIONS These preliminary studies lead to the suggestion that hemodialysis may disrupt basic sleep regulatory mechanisms, and that further investigation in this area is warranted.
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Affiliation(s)
- K P Parker
- Emory University, Atlanta, Georgia, USA.
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Cagney KA, Wu AW, Fink NE, Jenckes MW, Meyer KB, Bass EB, Powe NR. Formal literature review of quality-of-life instruments used in end-stage renal disease. Am J Kidney Dis 2000; 36:327-36. [PMID: 10922311 DOI: 10.1053/ajkd.2000.8982] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Although quality-of-life assessment is an important complement to conventional clinical evaluation, there are limited opportunities for researchers in end-stage renal disease (ESRD) to examine evidence for a range of quality-of-life measures. To better understand how quality of life has been conceptualized, measured, and evaluated for ESRD, we conducted a structured literature review. Eligible articles were identified from a MEDLINE search, expert input, and review of references from eligible articles. A standardized instrument was created for article review and included type of measure, instrument development process, study sample characteristics, quality-of-life domains, and reliability and validity testing. From 436 citations, 78 articles were eligible for final review, and of those, 47 articles contained evidence of reliability or validity testing. Within this set, there were 113 uses of 53 different instruments: 82% were generic and 18% were disease specific. Only 32% defined quality of life. The most frequently assessed domains were depression (41%), social functioning (32%), positive affect (30%), and role functioning (27%). Testing was completed for test-retest reliability (20%), interrater reliability (13%), internal consistency (22%), content validity (24%), construct validity (41%), criterion validity (55%), and responsiveness (59%). Few articles measuring quality of life in ESRD defined quality-of-life domains or adequately described instrument development and testing. Generic measures, such as the Sickness Impact Profile, and disease-specific measures, such as the Kidney Disease Questionnaire, had been tested more thoroughly than others. Standardized reporting and more rigorous testing could help researchers make informed choices about instruments that would best serve their own and their patients' needs.
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Affiliation(s)
- K A Cagney
- Department of Health Studies, University of Chicago, Chicago, IL, USA
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50
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Kimmel PL. Psychosocial factors in adult end-stage renal disease patients treated with hemodialysis: correlates and outcomes. Am J Kidney Dis 2000; 35:S132-40. [PMID: 10766011 DOI: 10.1016/s0272-6386(00)70240-x] [Citation(s) in RCA: 136] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The first three decades of the ESRD program were devoted to extending patient survival. Few data have been generated regarding the factors associated with successful patient adjustment. Depression and perception of the effects of illness are important responses to the experience of ESRD and may be associated with differential survival. Perception and extent of social support can moderate these factors. The association of psychosocial factors and assessments of quality of life are incompletely understood and are topics of research interest. The role of variation in socioeconomic status in association with these factors has not been extensively studied. The challenges for the next 30 years include understanding the relationship of psychosocial factors to demographic and medical factors in large ESRD patient populations and the refinement of associations between psychosocial factors and patient outcomes, including adjustment, compliance, morbidity, and mortality.
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Affiliation(s)
- P L Kimmel
- Department of Medicine, George Washington University Medical Center, Washington, DC, USA.
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