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Kazes I, Solignac J, Lassalle M, Mercadal L, Couchoud C. Twenty years of the French Renal Epidemiology and Information Network. Clin Kidney J 2024; 17:sfad240. [PMID: 38186909 PMCID: PMC10768769 DOI: 10.1093/ckj/sfad240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Indexed: 01/09/2024] Open
Abstract
Background The French Renal Epidemiology and Information Network (REIN) is 20 years old. It is not just a national data registry, but rather an epidemiological and informational network serving patients with chronic kidney disease, nephrology teams and health services. Methods The past 10-year trends of the incidence and prevalence of renal replacement therapy by dialysis or kidney transplantation and waitlist activity are presented. To detect potential significant changes in trends from 2012 and 2021, a Joinpoint regression model was used. Results The overall incidence of treated end-stage kidney disease (ESKD) was 169 per million population (pmp) in 2021. It was stable despite an increase in the incidence of diabetes. We found a decreasing trend in the proportion of patients starting dialysis in an emergency but an increase in those starting haemodialysis (HD) with a temporary catheter. Peritoneal dialysis decreased by 1.7% each year, whereas home HD, although involving only 1% of dialysis patients, increased by 10% each year. For patients not treated at home, the median time to drive from the patient's home to the dialysis unit was 17 min. The proportion of patients on the transplantation waitlist at the start of dialysis increased from 7% to 12%. Among the 111 263 new ESKD patients from 2012 to 2021, 8% received a first transplant at 1 year and 20% at 5 years. Among kidney transplant recipients, the mean time on the waitlist increased from 13.8 to 22.6 months. Living donor transplants increased in frequency, representing 15% of kidney transplants. Conclusions Data from the REIN registry allow for the evaluation of needs and provide a planning tool for French authorities. The progressive implementation of automatic data retrieval from dialysis informatics charts might alleviate the burden of data collection. Furthermore, the research activity the REIN engenders, resulting in renewed confidence by health authorities in the dynamism of French nephrology, allows for an optimistic outlook for the REIN.
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Affiliation(s)
- Isabelle Kazes
- Service de Néphrologie, Centre Hospitalo-Universitaire de Reims, Reims, France
| | - Justine Solignac
- Service de Néphrologie, Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - Mathilde Lassalle
- Registre REIN, Agence de la biomédecine, Saint Denis La Plaine, France
| | - Lucile Mercadal
- Service de Néphrologie, Hôpital de la Pitié Salpêtrière, APHP, Paris, France
| | - Cécile Couchoud
- Registre REIN, Agence de la biomédecine, Saint Denis La Plaine, France
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Ovwasa H, Aiwuyo HO, Okoye OA, Umuerri EM, Obasohan A, Unuigbe E, Rajora N. Risk Assessment of Pre-dialysis Chronic Kidney Disease (CKD) Patients for Cardiovascular Disease (CVD) in a Tertiary Hospital in Nigeria: A Case-Controlled Cross-Sectional Study. Cureus 2023; 15:e36725. [PMID: 37123714 PMCID: PMC10132851 DOI: 10.7759/cureus.36725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2023] [Indexed: 03/29/2023] Open
Abstract
INTRODUCTION Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in the chronic kidney disease (CKD) population. CKD patients are more likely to die from CVD before ever reaching end-stage renal disease (ESRD). The study, therefore, seeks to identify the prevalence of risk factors of CVD in CKD patients such as systemic hypertension, anemia, dyslipidemia, hypoalbuminemia, albuminuria, and abnormal calcium/phosphate products. METHODS The study was a case-control cross-sectional study where one hundred fifty hypertensive CKD patients and age- and sex-matched hypertensive non-CKD subjects were consecutively enrolled at the renal unit of Delta State University Teaching Hospital (DELSUTH), Oghara. RESULTS The findings of the study revealed the mean ages of cases and controls to be 48.91±11.93 years and 51.0±15.45 years respectively (p-value 0.182). There was an equal number of males and females among the study group and controls (92 males and 58 females) making a male-to-female ratio of 3:2. The prevalence of CVD risk factors such as diabetes mellitus, hypercholesterolemia, hypertriglyceridemia, elevated low-density lipoprotein, anemia, hypocalcemia, hyperphosphatemia, albuminuria, and hypoalbuminemia was significantly higher among the CKD group compared to controls. Similarly, the prevalence of reduced high-density lipoprotein (HDL) was higher among cases than controls, the difference was however not statistically significant. CONCLUSION The study has shown that systemic hypertension, diabetes, anemia, dyslipidemia, hypoalbuminemia, albuminuria, and abnormal calcium/phosphate products increases the risk for CVD in the general population but is more expressed and significant in CKD patients.
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Wakasugi M, Narita I. Trends in the incidence of renal replacement therapy by type of primary kidney disease in Japan, 2006-2020. Nephrology (Carlton) 2023; 28:119-129. [PMID: 36461735 DOI: 10.1111/nep.14134] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 11/11/2022] [Accepted: 11/25/2022] [Indexed: 12/04/2022]
Abstract
AIM Age-standardized incidence of end stage kidney disease requiring renal replacement therapy (RRT) has stabilized in men and declined in women in Japan since 1996. However, recent trends by primary kidney disease are unknown. The present study aimed to examine recent trends in incidence rates of RRT by primary kidney disease in Japan. METHODS Numbers of incident RRT patients aged ≥20 years by sex and primary kidney disease from 2006 to 2020 were extracted from the Japanese Society of Dialysis Therapy registry. Using the census population as the denominator, annual incidence rates of RRT were calculated and standardized to the WHO World Standard Population (2000-2025). Average annual percentage change (AAPC) and corresponding 95% confidence intervals (CIs) were calculated for trends using Joinpoint regression analysis. RESULTS From 2006 to 2020, the crude number of incident RRT patients due to nephrosclerosis increased by 132% for men and 62% for women. Age-standardized incidence rates of RRT due to nephrosclerosis increased significantly, by 3.3% (95% CI: 2.9-3.7) and 1.4% (95% CI: 0.8-1.9) per year for men and women, respectively. The AAPC of chronic glomerulonephritis (-4.4% [95% CI: -5.3 to -3.8] for men and -5.1% [95% CI: -5.5 to -4.6] for women) and diabetic nephropathy (-0.6% [95% CI: -0.9 to -0.3] for men and -2.8% [95% CI: -3.1 to -2.6] for women) significantly decreased from 2006 to 2020. CONCLUSION Incident RRT due to chronic glomerulonephritis and diabetic nephropathy decreased, while the number and incident rates of RRT due to nephrosclerosis increased, from 2006 to 2020 in Japan.
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Affiliation(s)
- Minako Wakasugi
- Department of Inter-Organ Communication Research, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Ichiei Narita
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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Huijben JA, Kramer A, Kerschbaum J, de Meester J, Collart F, Arévalo OLR, Helve J, Lassalle M, Palsson R, Ten Dam M, Casula A, Methven S, Ortiz A, Ferraro PM, Segelmark M, Mingo PU, Arici M, Reisæter AV, Stendahl M, Stel VS, Jager KJ. Increasing numbers and improved overall survival of patients on kidney replacement therapy over the last decade in Europe: an ERA Registry study. Nephrol Dial Transplant 2022; 38:1027-1040. [PMID: 35974693 PMCID: PMC10064979 DOI: 10.1093/ndt/gfac165] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION The aim of this study was to describe the trends in the incidence, prevalence and survival of patients on kidney replacement therapy (KRT) for end-stage kidney disease (ESKD) across Europe from 2008 to 2017. METHODS Data from renal registries in 9 countries and 16 regions that provided individual patient data to the ERA Registry from 2008 to 2017 were included. These registries cover 34% of the general population in Europe. Crude and standardized incidence and prevalence per million population (pmp) were determined. Trends over time were studied using Joinpoint regression. Survival probabilities were estimated using Kaplan-Meier analysis and hazard ratios (HRs) using Cox regression analysis. RESULTS The standardized incidence of KRT was stable (annual percentage change [APC]: -1.48 [-3.15; 0.21]) from 2008 (146.0 pmp) to 2011 (141.6 pmp), followed by a slight increase (APC: 1.01 [0.43; 1.60]) to 148.0 pmp in 2017, although trends in incidence varied across countries. This increase was primarily due to a rise in the incidence of KRT in men older than 65 years. Moreover, as a cause of kidney failure, diabetes mellitus is increasing. The standardized prevalence increased from 2008 (990.0 pmp) to 2017 (1166.8 pmp) (APC: 1.82 [1.75; 1.89]). Patient survival on KRT improved in the time period 2011-2013 compared with 2008-2010 (adjusted HR: 0.94 [0.93; 0.95). CONCLUSION This study showed an overall increase in the incidence and prevalence of KRT for ESKD as well as an increase in the KRT patient survival over the last decade in Europe.
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Affiliation(s)
- Jilske A Huijben
- Department of Medical Informatics, ERA-EDTA Registry, Amsterdam UMC, Academic Medical Center, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Anneke Kramer
- Department of Medical Informatics, ERA-EDTA Registry, Amsterdam UMC, Academic Medical Center, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Julia Kerschbaum
- Austrian Dialysis and Transplant Registry, Department of Internal Medicine IV - Nephrology and Hypertension, Medical University Innsbruck, Austria
| | - Johan de Meester
- Department of Nephrology, Dialysis and Hypertension, Dutch-speaking Belgian Renal Registry (NBVN), Sint-Niklaas, Belgium
| | | | - Olga Lucía Rodríguez Arévalo
- Valencia Region Renal Registry, Dirección General de Salut Publica i Adiccions, Valencia, Spain.,Doctoral student of the Technologies for Health and Well-being program, Universidad Politécnica de Valencia, Valencia, Spain
| | - Jaakko Helve
- Finnish Registry for Kidney Diseases, Helsinki, Finland.,Abdominal Center Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Mathilde Lassalle
- REIN Registry, Agence de la Biomédecine, Saint-Denis La Plaine, France
| | - Runolfur Palsson
- Division of Nephrology, Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland.,Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Marc Ten Dam
- Dutch Registry RENINE, Nefrovisie, Utrecht, The Netherlands
| | - Anna Casula
- UK Renal Registry, the Renal Association, Bristol, UK
| | - Shona Methven
- Department of Renal Medicine, Aberdeen Royal Infirmary, Foresterhill Health Campus, Aberdeen, UK
| | - Alberto Ortiz
- School of Medicine, IIS-Fundacion Jimenez Diaz, University Autonoma of Madrid, FRIAT and REDINREN, Madrid, Spain
| | - Pietro Manuel Ferraro
- U.O.S. Terapia Conservativa della Malattia Renale Cronica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Mårten Segelmark
- Department of Clinical Sciences, Division of Nephrology, Lund University and Skane University Hospital, Lund, Sweden.,Swedish Renal Registry, Department of Internal Medicine, Ryhov County Hospital, Jönköping, Sweden
| | - Pablo Ucio Mingo
- Coordinador Autonómico de Trasplantes de Castilla y León, Dirección General de Planificación y Asistencia Sanitaria, Valladolid, Castilla y León, Spain
| | - Mustafa Arici
- Department of Nephrology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Anna Varberg Reisæter
- Department of Transplantation Medicine, Oslo University hospital, Rikshospitalet, Norway
| | - Maria Stendahl
- Swedish Renal Registry, Department of Internal Medicine, Ryhov County Hospital, Jönköping, Sweden
| | - Vianda S Stel
- Department of Medical Informatics, ERA-EDTA Registry, Amsterdam UMC, Academic Medical Center, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Kitty J Jager
- Department of Medical Informatics, ERA-EDTA Registry, Amsterdam UMC, Academic Medical Center, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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Lazareth H, Capuano F, Calmus S, Erbault M, Morin S, Thervet E, May-Michelangeli L, Grenier C. Quality indicators in hemodialysis: A 5-year experience of national campaigns in France. Semin Dial 2022; 35:511-521. [PMID: 35604779 DOI: 10.1111/sdi.13095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 01/21/2022] [Accepted: 04/22/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND End stage kidney disease (ESKD) is associated with increased morbidity and mortality. Hemodialysis (HD) is the main technique used for kidney replacement therapy. Dialyzed patients are expected to live less than one half as long as their counterparts without ESKD. Improving quality of care may help to improve mortality in this population. METHODS The French National Authority for Health has carried out three consecutive national campaigns over 5 years for the assessment of quality indicators (QCI) during HD. QCI included anemia management, iron status evaluation, nutritional status assessment, and annual transplantation access. RESULTS From 2013 to 2017, 227 health facilities participated, and 33,319 files were analyzed. Median age was 72 years old (IQR25-75 = 61-81), and 58.25% of patients were men. Median time in HD was 39.4 months (IQR25-75 = 20.7-72.7). Most of the patients underwent in-center HD (85.41%). Overweight and obese patients accounted, respectively, for 28.39% and 21.32%, and malnutrition was present in 38.61%. A contra-indication for renal transplantation was found in 68.3% of patients. All QCI improved over 5 years. CONCLUSION Developing QCI based on guidelines is crucial to assure appropriate care of HD patients. Repeating campaigns over 5 years in France improves the quality of care among physicians.
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Affiliation(s)
- Hélène Lazareth
- Service Évaluation et outils pour la qualité et la sécurité des soins (EvOQSS), direction de l'amélioration de la qualité et de la sécurité des soins, Haute Autorité de santé, Saint-Denis-La-Plaine, France.,Service de Néphrologie, Hôpital Européen Georges Pompidou, Assistance Publique Hôpitaux de Paris, Paris, France.,Université de Paris, Paris, France
| | - Frédéric Capuano
- Service Évaluation et outils pour la qualité et la sécurité des soins (EvOQSS), direction de l'amélioration de la qualité et de la sécurité des soins, Haute Autorité de santé, Saint-Denis-La-Plaine, France
| | - Sophie Calmus
- Service Évaluation et outils pour la qualité et la sécurité des soins (EvOQSS), direction de l'amélioration de la qualité et de la sécurité des soins, Haute Autorité de santé, Saint-Denis-La-Plaine, France
| | - Marie Erbault
- Service Évaluation et outils pour la qualité et la sécurité des soins (EvOQSS), direction de l'amélioration de la qualité et de la sécurité des soins, Haute Autorité de santé, Saint-Denis-La-Plaine, France
| | - Sandrine Morin
- Service Évaluation et outils pour la qualité et la sécurité des soins (EvOQSS), direction de l'amélioration de la qualité et de la sécurité des soins, Haute Autorité de santé, Saint-Denis-La-Plaine, France
| | - Eric Thervet
- Service de Néphrologie, Hôpital Européen Georges Pompidou, Assistance Publique Hôpitaux de Paris, Paris, France.,Université de Paris, Paris, France
| | - Laetitia May-Michelangeli
- Service Évaluation et outils pour la qualité et la sécurité des soins (EvOQSS), direction de l'amélioration de la qualité et de la sécurité des soins, Haute Autorité de santé, Saint-Denis-La-Plaine, France
| | - Catherine Grenier
- Direction de l'amélioration de la qualité et de la sécurité des soins, Haute Autorité de santé, Saint-Denis-La-Plaine, France
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Trends in the incidence and prevalence of end-stage kidney disease requiring dialysis in Taiwan: 2010–2018. J Formos Med Assoc 2022; 121 Suppl 1:S5-S11. [DOI: 10.1016/j.jfma.2021.12.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 12/03/2021] [Accepted: 12/16/2021] [Indexed: 11/16/2022] Open
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7
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Bonthuis M, Vidal E, Bjerre A, Aydoğ Ö, Baiko S, Garneata L, Guzzo I, Heaf JG, Jahnukainen T, Lilien M, Mallett T, Mirescu G, Mochanova EA, Nüsken E, Rascher K, Roussinov D, Szczepanska M, Tsimaratos M, Varvara A, Verrina E, Veselinović B, Jager KJ, Harambat J. Ten-year trends in epidemiology and outcomes of pediatric kidney replacement therapy in Europe: data from the ESPN/ERA-EDTA Registry. Pediatr Nephrol 2021; 36:2337-2348. [PMID: 33483800 PMCID: PMC8260419 DOI: 10.1007/s00467-021-04928-w] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 11/23/2020] [Accepted: 01/06/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND For 10 consecutive years, the ESPN/ERA-EDTA Registry has included data on children with stage 5 chronic kidney disease (CKD 5) receiving kidney replacement therapy (KRT) in Europe. We examined trends in incidence and prevalence of KRT and patient survival. METHODS We included all children aged <15 years starting KRT 2007-2016 in 22 European countries participating in the ESPN/ERA-EDTA Registry since 2007. General population statistics were derived from Eurostat. Incidence and prevalence were expressed per million age-related population (pmarp) and time trends studied with JoinPoint regression. We analyzed survival trends using Cox regression. RESULTS Incidence of children commencing KRT <15 years remained stable over the study period, varying between 5.5 and 6.6 pmarp. Incidence by treatment modality was unchanged over time: 2.0 for hemodialysis (HD) and peritoneal dialysis (PD) and 1.0 for transplantation. Prevalence increased in all age categories and overall rose 2% annually from 26.4 pmarp in 2007 to 32.1 pmarp in 2016. Kidney transplantation prevalence increased 5.1% annually 2007-2009, followed by 1.5% increase/year until 2016. Prevalence of PD steadily increased 1.4% per year over the entire period, and HD prevalence started increasing 6.1% per year from 2011 onwards. Five-year unadjusted patient survival on KRT was around 94% and similar for those initiating KRT 2007-2009 or 2010-2012 (adjusted HR: 0.98, 95% CI:0.71-1.35). CONCLUSIONS We found a stable incidence and increasing prevalence of European children on KRT 2007-2016. Five-year patient survival was good and was unchanged over time. These data can inform patients and healthcare providers and aid health policy makers on future resource planning of pediatric KRT in Europe.
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Affiliation(s)
- Marjolein Bonthuis
- ESPN/ERA-EDTA Registry, Amsterdam UMC, University of Amsterdam, Department of Medical Informatics, Amsterdam Public Health Research Institute, Meibergdreef 9, Amsterdam, The Netherlands.
| | - Enrico Vidal
- Division of Pediatrics, Department of Medicine, University of Udine, Udine, Italy
| | - Anna Bjerre
- Division of Pediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Özlem Aydoğ
- Department of Pediatric Nephrology, 19 Mayis University Medical School, Samsun, Turkey
| | - Sergey Baiko
- Department of Pediatrics, Belarusian State Medical University, Minsk, Belarus
| | - Liliana Garneata
- Department of Internal Medicine and Nephrology "Dr Carol Davila" Teaching Hospital of Nephrology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Isabella Guzzo
- Nephrology and Dialysis Unit, Pediatric Subspecialties Department, Institute for Scientific Research, Bambino Gesù Children's Hospital, Rome, Italy
| | - James G Heaf
- Department of Medicine, Zealand University Hospital, Roskilde, Denmark
| | - Timo Jahnukainen
- Department of Pediatric Nephrology and Transplantation, New Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Marc Lilien
- Wilhelmina Children's Hospital, University Medical Center, Utrecht, The Netherlands
| | - Tamara Mallett
- Department of Paediatric Nephrology, Royal Belfast Hospital for Sick Children, Belfast, UK
- Department of Paediatric Nephrology, Royal Bristol Hospital for Children, Bristol, UK
| | - Gabriel Mirescu
- Department of Nephrology and Internal Medicine, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
- Department of Nephrology, "Dr. Carol Davila" Teaching Hospital of Nephrology, Bucharest, Romania
| | - Elena A Mochanova
- Department of Kidney Transplantation, Russian Children's Federal Clinical Hospital of Pirogov Russian National Research Medical University, Moscow, Russia
| | - Eva Nüsken
- Pediatric Nephrology, Department of Pediatrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Katherine Rascher
- QiN-Group, Department of Medicine II, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Dimitar Roussinov
- SBAL Pediatric Diseases, Nephrology and Hemodialysis Clinic, Department of Pediatrics, Medical University of Sofia, 1606, Sofia, Bulgaria
| | - Maria Szczepanska
- Department of Pediatrics, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Katowice, Poland
| | - Michel Tsimaratos
- Department of Multidisciplinary Pediatrics, Pediatric Nephrology Unit, Assistance Publique des Hôpitaux de Marseille, Marseille, France
| | - Askiti Varvara
- Nephrology Unit, Kyriakou Children's Hospital, Athens, Greece
| | - Enrico Verrina
- Dialysis Unit, Department of Pediatrics, IRCCS Giannina Gaslini, Genoa, Italy
| | | | - Kitty J Jager
- ESPN/ERA-EDTA Registry, Amsterdam UMC, University of Amsterdam, Department of Medical Informatics, Amsterdam Public Health Research Institute, Meibergdreef 9, Amsterdam, The Netherlands
| | - Jérôme Harambat
- Department of Pediatrics, Bordeaux University Hospital, Bordeaux Population Health Research Center UMR 1219, University of Bordeaux, Bordeaux, France
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Hellemans R, Kramer A, De Meester J, Collart F, Kuypers D, Jadoul M, Van Laecke S, Le Moine A, Krzesinski JM, Wissing KM, Luyckx K, van Meel M, de Vries E, Tieken I, Vogelaar S, Samuel U, Abramowicz D, Stel VS, Jager KJ. Does kidney transplantation with a standard or expanded criteria donor improve patient survival? Results from a Belgian cohort. Nephrol Dial Transplant 2021; 36:918-926. [PMID: 33650633 PMCID: PMC8075371 DOI: 10.1093/ndt/gfab024] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Changes in recipient and donor factors have reopened the question of survival benefits of kidney transplantation versus dialysis. METHODS We analysed survival among 3808 adult Belgian patients waitlisted for a first deceased donor kidney transplant from 2000 to 2012. The primary outcome was mortality during the median waiting time plus 3 years of follow-up after transplantation or with continued dialysis. Outcomes were analysed separately for standard criteria donor (SCD) and expanded criteria donor (ECD) kidney transplants. We adjusted survival analyses for recipient age (20-44, 45-64 and ≥65 years), sex and diabetes as the primary renal disease. RESULTS Among patients ≥65 years of age, only SCD transplantation provided a significant survival benefit compared with dialysis, with a mortality of 16.3% [95% confidence interval (CI) 13.2-19.9] with SCD transplantation, 20.5% (95% CI 16.1-24.6) with ECD transplantation and 24.6% (95% CI 19.4-29.5) with continued dialysis. Relative mortality risk was increased in the first months after transplantation compared with dialysis, with equivalent risk levels reached earlier with SCD than ECD transplantation in all age groups. CONCLUSIONS The results of this study suggest that older patients might gain a survival benefit with SCD transplantation versus dialysis, but any survival benefit with ECD transplantation versus dialysis may be small.
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Affiliation(s)
- Rachel Hellemans
- Department of Nephrology, Antwerp University Hospital, Edegem, Belgium
| | - Anneke Kramer
- Department of Medical Informatics, ERA-EDTA Registry, Amsterdam UMC, Academic Medical Center, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Johan De Meester
- Nederlandstalige Belgische Vereniging voor Nefrologie, Sint-Niklaas, Belgium
| | - Frederic Collart
- Groupement des Néphrologues Francophones de Belgique, Liège, Belgium
| | - Dirk Kuypers
- Department of Nephrology, University Hospitals Leuven, Leuven, Belgium
| | - Michel Jadoul
- Département de Néphrologie, Cliniques Universitaires Saint-Luc, Bruxelles, Belgium
| | - Steven Van Laecke
- Department of Internal Medicine, Renal Division, Ghent University Hospital, Ghent, Belgium
| | - Alain Le Moine
- Département de Néphrologie, Hôpital Erasme-Université Libre de Bruxelles, Bruxelles, Belgium
| | | | | | - Kim Luyckx
- Department of Informatics, Antwerp University Hospital, Edegem, Belgium
| | - Marieke van Meel
- Eurotransplant International Foundation, Leiden, The Netherlands
| | - Erwin de Vries
- Eurotransplant International Foundation, Leiden, The Netherlands
| | - Ineke Tieken
- Eurotransplant International Foundation, Leiden, The Netherlands
| | - Serge Vogelaar
- Eurotransplant International Foundation, Leiden, The Netherlands
| | - Undine Samuel
- Eurotransplant International Foundation, Leiden, The Netherlands
| | - Daniel Abramowicz
- Department of Nephrology, Antwerp University Hospital, Edegem, Belgium
| | - Vianda S Stel
- Department of Medical Informatics, ERA-EDTA Registry, Amsterdam UMC, Academic Medical Center, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Kitty J Jager
- Department of Medical Informatics, ERA-EDTA Registry, Amsterdam UMC, Academic Medical Center, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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9
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Vanorio-Vega I, Constantinou P, Tuppin P, Couchoud C. Additional cost of end-stage kidney disease in diabetic patients according to renal replacement therapy modality: a systematic review. RENAL REPLACEMENT THERAPY 2021. [DOI: 10.1186/s41100-021-00346-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
AbstractThe prevalence of end-stage kidney disease (ESKD) is growing worldwide; the survival of these patients requires renal replacement therapy (RRT, a complex and costly treatment). Over 20% of the patients that start RTT had diabetes. Limited evidence on the effect of comorbidities on the cost of RRT exists. This review summarizes the available evidence on the effect of diabetes mellitus (DM) on the cost of RRT. Electronic databases were searched using key words that combined RRT with DM and cost. References were identified with title, abstract, and full-text screening. The studies included were published in English and presented data on the cost of RRT in ESKD patients with comparison between DM status. Seventeen studies were included in this review. The crude and adjusted cost of care estimates for patients on dialysis was generally higher for DM patients. The cost of care of ESKD patients differed according to various treatment modalities and these differences, mainly driven by inpatient costs. Overall, we found an increased cost of RRT care in patients with DM regardless of the type of treatment. Future analysis of the effects of multiple comorbidities should be considered to better understand the effect of DM on the cost of RRT.
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Jaques DA, Davenport A. High-flow arteriovenous fistula is not associated with increased extracellular volume or right ventricular dysfunction in haemodialysis patients. Nephrol Dial Transplant 2021; 36:536-543. [PMID: 33011786 DOI: 10.1093/ndt/gfaa188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 05/27/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND High-output congestive heart failure secondary to high-flow arteriovenous fistula (AVF) has been reported in haemodialysis (HD) patients. As high-flow AVF (HFA) would be expected to result in fluid retention, we conducted an observational study to characterize the relationship between AVF flow (Qa) and extracellular water (ECW) in HD patients. METHODS We measured Qa by ultrasound dilution in prevalent HD outpatients with an AVF in two dialysis centres. The ECW:total body water (TBW) ratio was measured both pre- and post-dialysis by multifrequency bioimpedance analysis. Transthoracic echocardiograms (TTEs) were performed as part of routine clinical management. RESULTS We included 140 patients, mean age 62.7 ± 15.7 years, 60.7% male, 47.9% diabetic and 22.9% with coronary revascularization. Mean Qa was 1339 ± 761 mL/min and 22 (15.7%) patients had HFA defined as Qa >2.0 L/min. Qa was positively associated with an upper arm AVF (P = 0.005), body mass index (P = 0.012) and N-terminal pro-brain natriuretic peptide (NT-proBNP) (P = 0.047) and negatively associated with diabetes (P < 0.001) and coronary revascularization (P = 0.005). The ECW:TBW ratio was positively associated with age (P < 0.001), Davies comorbidity index (P = 0.034), peripheral vascular disease (P = 0.030) and NT-proBNP (P = 0.002) and negatively associated with serum albumin (P < 0.001). Qa was not associated with the ECW:TBW ratio (P = 0.744). TTE parameters were not associated with Qa. CONCLUSIONS In our outpatient HD cohort, high AVF flow was not associated with ECW expansion, either pre- or post-dialysis when accounting for potential confounders. By controlling ECW, high access flow should not necessarily be perceived as a threat to cardiovascular physiology.
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Affiliation(s)
- David A Jaques
- Division of Nephrology, Geneva University Hospitals, Geneva, Switzerland.,UCL Department of Nephrology, Royal Free Hospital, University College London, London, UK
| | - Andrew Davenport
- UCL Department of Nephrology, Royal Free Hospital, University College London, London, UK
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11
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Sánchez-Álvarez E, Rodríguez-García M, Locatelli F, Zoccali C, Martín-Malo A, Floege J, Ketteler M, London G, Górriz JL, Rutkowski B, Ferreira A, Pavlovic D, Cannata-Andía JB, Fernández-Martín JL. Survival with low- and high-flux dialysis. Clin Kidney J 2020; 14:1915-1923. [PMID: 34345415 PMCID: PMC8323142 DOI: 10.1093/ckj/sfaa233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 10/02/2020] [Indexed: 11/14/2022] Open
Abstract
Background Besides advances in haemodialysis (HD), mortality rates are still high. The effect of the different types of HD membranes on survival is still a controversial issue. The aim of this COSMOS (Current management Of Secondary hyperparathyroidism: a Multicentre Observational Study) analysis was to survey, in HD patients, the relationship between the use of conventional low- or high-flux membranes and all-cause and cardiovascular mortality. Methods COSMOS is a multicentre, open-cohort, 3-year prospective study, designed to evaluate mineral and bone disorders in the European HD population. The present analysis included 5138 HD patients from 20 European countries, 3502 randomly selected at baseline (68.2%), plus 1636 new patients with <1 year on HD (31.8%) recruited to replace patients who died, were transplanted, switched to peritoneal dialysis or lost to follow-up by other reasons. Cox-regression analysis with time-dependent variables, propensity score matching and the use of an instrumental variable (facility-level analysis) were used. Results After adjustments using three different multivariate models, patients treated with high-flux membranes showed a lower all-cause and cardiovascular mortality risks {hazard ratio (HR) = 0.76 [95% confidence interval (CI) 0.61-0.96] and HR = 0.61 (95% CI 0.42-0.87), respectively}, that remained significant after matching by propensity score for all-cause mortality (HR = 0.69, 95% CI 0.52-0.93). However, a facility-level analysis showed no association between the case-mix-adjusted facility percentage of patients dialysed with high-flux membranes and all-cause and cardiovascular mortality. Conclusions High-flux dialysis was associated with a lower relative risk of all-cause and cardiovascular mortality. However, dialysis facilities using these dialysis membranes to a greater extent did not show better survival.
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Affiliation(s)
- Emilio Sánchez-Álvarez
- Department of Nephrology, Hospital Universitario de Cabueñes, REDinREN del ISCIII, Gijón, Spain
| | - Minerva Rodríguez-García
- Department of Nephrology, REDinREN del ISCIII, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Francesco Locatelli
- Department of Nephrology, Dialysis and Renal Transplant, Alessandro Manzoni Hospital, Lecco, Italy
| | - Carmine Zoccali
- CNR National Research Council (Italy), Clinical Epidemiology and Physiopathology of Renal Disease and Hypertension and Renal and Transplantation Unit, Ospedali Riuniti, Ancona, Italy
| | - Alejandro Martín-Malo
- Nephrology Service, University Hospital Reina Sofia, Maimonides Institute for Biomedical Research of Cordoba (IMIBIC), University of Cordoba, REDinREN del ISCIII, Córdoba, Spain
| | - Jürgen Floege
- Department of Nephrology and Clinical Immunology, RWTH Aachen University, Aachen, Germany
| | - Markus Ketteler
- Department of General Internal Medicine and Nephrology Stuttgart, Robert-Bosch-Krankenhaus GmbH, Baden-Württemberg, Germany
| | - Gerard London
- Centre Hospitalier FH Manhes, Fleury-Mérogis, France
| | - José L Górriz
- Department of Nephrology, Hospital Clinico Universitario, Valencia, Spain.,Department of Medicine, Health Research Institute INCLIVA, University of Valencia, Valencia, Spain
| | - Boleslaw Rutkowski
- Department of Nephrology, Transplantology and Internal Medicine, Gdańsk Medical University, Gdańsk, Poland
| | - Anibal Ferreira
- Nephrology Department, Hospital Curry Cabral and Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Drasko Pavlovic
- Department of Nephrology and Dialysis, Sestre Milosrdnice University Hospital, Zagreb, Croatia
| | - Jorge B Cannata-Andía
- Bone and Mineral Research Unit, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), REDinREN del ISCIII, Hospital Universitario Central de Asturias, Universidad de Oviedo, Oviedo, Spain
| | - José L Fernández-Martín
- Department of Nephrology and Dialysis, Sestre Milosrdnice University Hospital, Zagreb, Croatia
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12
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Jakulj L, Kramer A, Åsberg A, de Meester J, Santiuste de Pablos C, Helve J, Hemmelder MH, Hertig A, Arici M, Bell S, Mercadal L, Diaz-Corte C, Palsson R, Benitez Sanchez M, Kerschbaum J, Collart F, Massy ZA, Jager KJ, Noordzij M. Recovery of kidney function in patients treated with maintenance dialysis-a report from the ERA-EDTA Registry. Nephrol Dial Transplant 2020; 36:1078-1087. [PMID: 33355661 DOI: 10.1093/ndt/gfaa368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Literature on recovery of kidney function (RKF) in patients with end-stage kidney disease treated with maintenance dialysis (i.e. >90 days) is limited. We assessed the incidence of RKF and its associated characteristics in a European cohort of dialysis patients. METHODS We included adult patients from the European Renal Association-European Dialysis and Transplant Association Registry who started maintenance dialysis in 1997-2016. Sustained RKF was defined as permanent discontinuation of dialysis. Temporary discontinuation of ≥30 days (non-sustained RKF) was also evaluated. Factors associated with RKF adjusted for potential confounders were studied using Cox regression analyses. RESULTS RKF occurred in 7657 (1.8%) of 440 996 patients, of whom 71% experienced sustained RKF. Approximately 90% of all recoveries occurred within the first 2 years after Day 91 of dialysis. Of patients with non-sustained RKF, 39% restarted kidney replacement therapy within 1 year. Sustained RKF was strongly associated with the following underlying kidney diseases (as registered by the treating physician): tubular necrosis (irreversible) or cortical necrosis {adjusted hazard ratio [aHR] 20.4 [95% confidence interval (CI) 17.9-23.1]}, systemic sclerosis [aHR 18.5 (95% CI 13.8-24.7)] and haemolytic uremic syndrome [aHR 17.3 (95% CI 13.9-21.6)]. Weaker associations were found for haemodialysis as a first dialysis modality [aHR 1.5 (95% CI 1.4-1.6)] and dialysis initiation at an older age [aHR 1.8 (95% CI 1.6-2.0)] or in a more recent time period [aHR 2.4 (95% CI 2.1-2.7)]. CONCLUSIONS Definitive discontinuation of maintenance dialysis is a rare and not necessarily an early event. Certain clinical characteristics, but mostly the type of underlying kidney disease, are associated with a higher likelihood of RKF.
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Affiliation(s)
- Lily Jakulj
- Department of Internal Medicine and Nephrology, Dianet Dialysis Center, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Anneke Kramer
- Department of Medical Informatics, European Renal Association-European Dialysis and Transplant Association Registry, Amsterdam University Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Anders Åsberg
- Department of Transplantation Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Johan de Meester
- Department of Nephrology, Dialysis and Hypertension, Dutch-speaking Belgian Renal Registry (NBVN), Sint-Niklaas, Belgium
| | - Carmen Santiuste de Pablos
- Department of Epidemiology, Murcia Renal Registry, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain.,CIBER Epidemiologíca y Salud Públican, Madrid, Spain
| | - Jaakko Helve
- Finnish Registry for Kidney Diseases and Abdominal Center Nephrology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Marc H Hemmelder
- Dutch Renal Registry Renine, Nefrovisie Foundation, Utrecht, The Netherlands
| | - Alexandre Hertig
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Kidney Transplantation, Hôpital de la Pitié Salpêtrière, Paris, France
| | - Mustafa Arici
- Department of Nephrology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Samira Bell
- Scottish Renal Registry, Meridian Court, ISD Scotland, Glasgow, UK
| | - Lucile Mercadal
- Institut National de la Santé et de la Recherche Médicale, Center for Renal and Cardiovascular Epidemiology, Villejuif, France.,Department of Nephrology and Renal Transplantation, Assistance Publique-Hôpitaux de Paris, Hôpital de La Pitié Salpêtrière Hospital, Paris, France
| | - Carmen Diaz-Corte
- Nephrology Department, Hospital Universitario Central de Asturias, Oviedo, Spain.,Red de Investigación Renal, Madrid, Spain
| | - Runolfur Palsson
- Division of Nephrology, Landspítali-The National University Hospital of Iceland, Reykjavik, Iceland.,Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | | | - Julia Kerschbaum
- Department for Internal Medicine IV-Nephrology and Hypertension, Austrian Dialysis and Transplant Registry, Medical University Innsbruck, Innsbruck, Austria
| | | | - Ziad A Massy
- Division of Nephrology, Ambroise Paré University Hospital, Boulogne-Billancourt, Paris, France.,Institut National de la Santé et de la Recherche Médicale Unit 1018 Team 5, Research Centre in Epidemiology and Population Health, University of Paris Ouest-Versailles-St Quentin-en-Yveline, Villejuif, France
| | - Kitty J Jager
- Department of Medical Informatics, European Renal Association-European Dialysis and Transplant Association Registry, Amsterdam University Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Marlies Noordzij
- Department of Medical Informatics, European Renal Association-European Dialysis and Transplant Association Registry, Amsterdam University Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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13
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Parra E, Arenas MD, Fernandez-Reyes Luis MJ, Blasco Forcén A, Alvarez-Ude F, Aguarón Joven J, Altuzarra Casas A, Moreno-Jiménez JM. Evaluation of dialysis centres: values and criteria of the stakeholders. BMC Health Serv Res 2020; 20:297. [PMID: 32290836 PMCID: PMC7155312 DOI: 10.1186/s12913-020-05085-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 03/09/2020] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Evaluation of renal replacement therapy with haemodialysis is essential for its improvement. Remarkably, outcomes vary across centres. In addition, the methods used have important epistemological limitations, such as ignoring significant features (e.g., quality of life) or no relevance given to the patient’s perspective in the indicator’s selection. The present study aimed to determine the opinions and preferences of stakeholders (patients, clinicians, and managers) and establish their relative importance, considering the complexity of their interactions, to facilitate a comprehensive evaluation of haemodialysis centres.
Methods
Successive working groups (WGs) were established using a multicriteria methodology. WG1 created a draft of criteria and sub-criteria, WG2 agreed, using a qualitative structured analysis with pre-established criteria, and WG3 was composed of three face-to-face subgroups (WG3-A, WG3-B, and WG3-C) that weighted them using two methodologies: weighted sum (WS) and analytic hierarchy process (AHP). Subsequently, they determined a preference for the WS or AHP results. Finally, via the Internet, WG4 weighted the criteria and sub-criteria by the method preferred by WG3, and WG5 analysed the results.
Results
WG1 and WG2 identified and agreed on the following evaluation criteria: evidence-based variables (EBVs), annual morbidity, annual mortality, patient-reported outcome measures (PROMs), and patient-reported experience measures (PREMs). The EBVs consisted of five sub-criteria: type of vascular access, dialysis dose, haemoglobin concentration, ratio of catheter bacteraemia, and bone mineral disease. The patients rated the PROMs with greater weight than the other stakeholders in both face-to-face WG3 (WS and AHP) and WG4 via the Internet. The type of vascular access was the most valued sub-criterion. A performance matrix of each criterion and sub-criterion is presented as a reference for assessing the results based on the preferences of the stakeholders.
Conclusions
The use of a multicriteria methodology allows the relative importance of the indicators to be determined, reflecting the values of the different stakeholders. In a performance matrix, the inclusion of values and intangible aspects in the evaluation could help in making clinical and organizational decisions.
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14
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Abd ElHafeez S, Noordzij M, Kramer A, Bell S, Savoye E, Abad Diez JM, Lundgren T, Reisaeter AV, Kerschbaum J, Santiuste de Pablos C, Ortiz F, Collart F, Palsson R, Arici M, Heaf JG, Massy ZA, Jager KJ. The association of living donor source with patient and graft survival among kidney transplant recipients in the ERA-EDTA Registry - a retrospective study. Transpl Int 2020; 34:76-86. [PMID: 33022814 PMCID: PMC7821376 DOI: 10.1111/tri.13759] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 07/21/2020] [Accepted: 09/28/2020] [Indexed: 11/28/2022]
Abstract
In this study we aimed to compare patient and graft survival of kidney transplant recipients who received a kidney from a living‐related donor (LRD) or living‐unrelated donor (LUD). Adult patients in the ERA‐EDTA Registry who received their first kidney transplant in 1998–2017 were included. Ten‐year patient and graft survival were compared between LRD and LUD transplants using Cox regression analysis. In total, 14 370 patients received a kidney from a living donor. Of those, 9212 (64.1%) grafts were from a LRD, 5063 (35.2%) from a LUD and for 95 (0.7%), the donor type was unknown. Unadjusted five‐year risks of death and graft failure (including death as event) were lower for LRD transplants than for LUD grafts: 4.2% (95% confidence interval [CI]: 3.7–4.6) and 10.8% (95% CI: 10.1–11.5) versus 6.5% (95% CI: 5.7–7.4) and 12.2% (95% CI: 11.2–13.3), respectively. However, after adjusting for potential confounders, associations disappeared with hazard ratios of 0.99 (95% CI: 0.87–1.13) for patient survival and 1.03 (95% CI: 0.94–1.14) for graft survival. Unadjusted risk of death‐censored graft failure was similar, but after adjustment, it was higher for LUD transplants (1.19; 95% CI: 1.04–1.35). In conclusion, patient and graft survival of LRD and LUD kidney transplant recipients was similar, whereas death‐censored graft failure was higher in LUD. These findings confirm the importance of both living kidney donor types.
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Affiliation(s)
- Samar Abd ElHafeez
- Epidemiology Department, High Institute of Public Health, Alexandria University, Alexandria, Egypt
| | - Marlies Noordzij
- Department of Medical Informatics, ERA-EDTA Registry, Amsterdam UMC, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, the Netherlands
| | - Anneke Kramer
- Department of Medical Informatics, ERA-EDTA Registry, Amsterdam UMC, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, the Netherlands
| | - Samira Bell
- Scottish Renal Registry, Meridian Court, Information Services Division Scotland, Glasgow, UK.,Division of Population Health and Genomics, University of Dundee, Dundee, UK
| | - Emilie Savoye
- Agence de la biomédecine, Direction Prélèvement Greffe Organes-Tissus, Saint-Denis La Plaine, France
| | | | - Torbjörn Lundgren
- Division of Transplantation Surgery, CLINTEC, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Anna Varberg Reisaeter
- Department of Transplantation Medicine, Oslo University hospital, Rikshospitalet, Norway
| | - Julia Kerschbaum
- Austrian Dialysis and Transplant Registry, Department for Internal Medicine IV - Nephrology and Hypertension, Medical University Innsbruck, Innsbruck, Austria
| | - Carmen Santiuste de Pablos
- Murcia Renal Registry, Department of Epidemiology, Murcia Regional Health Authority, IMIB-Arrixaca, Murcia, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Fernanda Ortiz
- Abdominal Center Unit, HUS Helsinki University Hospital, Helsinki, Finland
| | | | - Runolfur Palsson
- Division of Nephrology, Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland.,Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Mustafa Arici
- Department of Nephrology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - James G Heaf
- Department of Medicine, Zealand University Hospital, Roskilde, Denmark
| | - Ziad A Massy
- Division of Nephrology, Ambroise Paré University Hospital, APHP, Boulogne-Billancourt, Paris, France.,Institut National de la Santé et de la Recherche Médicale (INSERM) Unit 1018 team5, Research Centre in Epidemiology and Population Health (CESP), University of Paris Ouest-Versailles-St Quentin-en-Yveline, Villejuif, France
| | - Kitty J Jager
- Department of Medical Informatics, ERA-EDTA Registry, Amsterdam UMC, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, the Netherlands
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15
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Dolati S, Tarighat F, Pashazadeh F, Shahsavarinia K, Gholipouri S, Soleimanpour H. The Role of Opioids in Pain Management in Elderly Patients with Chronic Kidney Disease: A Review Article. Anesth Pain Med 2020; 10:e105754. [PMID: 34150565 PMCID: PMC8207885 DOI: 10.5812/aapm.105754] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 07/19/2020] [Accepted: 08/20/2020] [Indexed: 12/13/2022] Open
Abstract
Chronic kidney disease (CKD) is a global public health problem. Pain is one of the most generally experienced symptoms by CKD patients. Pain management is a key clinical activity; nonetheless, insufficient pain management by health professionals keeps it up. Opioids as pain relievers are a class of naturally-derived and synthetic medications. They act through interactions with receptors in peripheral nerves. Numerous pharmacokinetic alterations happen with aging that influence drug disposition, metabolism, and quality of life. Acetaminophen alone, or combined with low-potency opioid dose is regarded as the safest pain-relieving choice for CKD. Morphine and codeine are probably eluded in renal impairment patients and used with excessive carefulness. Tramadol, oxycodone, and hydromorphone can be used by patient monitoring, while methadone, transdermal fentanyl, and buprenorphine seem to be safe to use in older non-dialysis patients with renal impairment. Consistent with the available literature, the main aim of this review was to explore the occurrence of chronic pain and its opioid treatment in CKD patients. According to this review, more and well-made randomized controlled trials are necessary to find appropriate opioid doses and explore the occurrence of side effects.
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Affiliation(s)
- Sanam Dolati
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
- Physical Medicine and Rehabilitation Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Faezeh Tarighat
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fariba Pashazadeh
- Research Center for Evidence-Based Medicine, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Kavous Shahsavarinia
- Emergency Medicine Research Team, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Saina Gholipouri
- Department of Medical Sciences, University of Western Ontario, Ontario, Canada
| | - Hassan Soleimanpour
- Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
- Corresponding Author: Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran. ,
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16
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De Meyer V, Abramowicz D, De Meester J, Collart F, Bosmans JL, Cools W, Wissing KM. Variability in the incidence of renal replacement therapy over time in Western industrialized countries: A retrospective registry analysis. PLoS One 2020; 15:e0235004. [PMID: 32584849 PMCID: PMC7316284 DOI: 10.1371/journal.pone.0235004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 06/06/2020] [Indexed: 11/18/2022] Open
Abstract
Introduction A growing number of patients started renal replacement therapy (RRT) in Western industrialized countries between 1980 an early 2000s. Thereafter reports from national and international registries suggest a trend towards stabilization and sometimes a decrease in the incidence rate. Aim To investigate the differences in overall and age-specific incidence rates between industrialized countries from 1998 until 2013. Secondly, to investigate changes in incidence rates over time and their association with specific age categories. Method We extracted the unadjusted overall incidence of RRT and age-specific incidence rates from renal registry reports in Europe, the United States, Canada, Australia and New Zealand. Time trends in the incidence rate by country and age categories were analyzed by Joinpoint regression analysis. Results The incidence rate in 2013 ranged from 89 per million population (pmp) in Finland to 363 pmp in the US. Incidence rates in the lower age categories (20–64 year) were similar between countries and remained stable over time. Higher incidence countries were characterized by higher numbers of patients in both the 65–74 and ≥75 year categories starting RRT. Joinpoint analysis confirmed that most countries had significant reductions in the incidence rate at the end of the study period. These reductions were explained by lower numbers of older patients starting RRT and were observed also in countries with lower overall incidence rates. Conclusion This study confirmed different incidence rates of RRT between industrialized countries worldwide. Countries with the highest overall incidence rates also had the highest incidence rates in the oldest age categories. Since the early 2000’s the number of older patients starting RRT is either stabilizing or even decreasing in most countries. This reduction is universal and is also observed in countries with previously low incidence rates.
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Affiliation(s)
- Vicky De Meyer
- Department of Nephrology and Hypertension, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel, Brussels, Belgium
- * E-mail:
| | - Daniel Abramowicz
- Department of Nephrology, Universitair Ziekenhuis Antwerpen, Antwerpen, Belgium
- Laboratory of Medicine and Pediatrics, Universiteit Antwerpen, Antwerpen, Belgium
| | | | | | - Jean-Louis Bosmans
- Department of Nephrology, Universitair Ziekenhuis Antwerpen, Antwerpen, Belgium
| | - Wilfried Cools
- Interfaculty Center Data Processing & Statistics, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Karl Martin Wissing
- Department of Nephrology and Hypertension, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel, Brussels, Belgium
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17
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Association between Renal Podocalyxin Expression and Renal Dysfunction in Patients with Diabetic Nephropathy: A Single-Center, Retrospective Case-Control Study. BIOMED RESEARCH INTERNATIONAL 2020; 2020:7350781. [PMID: 32337271 PMCID: PMC7157790 DOI: 10.1155/2020/7350781] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 01/23/2020] [Accepted: 02/12/2020] [Indexed: 01/16/2023]
Abstract
This retrospective study investigated whether podocalyxin expression in renal biopsies and urine of patients with diabetic nephropathy (DN) is associated with renal function. This retrospective study included 32 patients with nephropathy, secondary to type 2 diabetes treated at the First Hospital of Lanzhou University (January 2010 to January 2015). Compared with the control group, the DN group had a significantly lower renal expression of podocalyxin and higher urinary podocalyxin/creatinine ratio. Patients with DN were divided into the high and low expression groups according to podocalyxin expression in renal tissues. Patients in the low expression group had longer diabetes duration, lower plasma albumin and eGFR, higher glycated hemoglobin (HbA1c), 24 h urinary protein, serum creatinine, and urinary podocalyxin/creatinine ratio, and more severe glomerular, tubulointerstitial, and renal interstitial inflammation than patients in the high expression group (all P < 0.01). The renal survival rate was significantly lower in the low expression group than in the high expression group (P < 0.01). Single-factor Cox regression analysis showed that reduced podocalyxin expression and increased urinary podocalyxin excretion were associated with poor renal outcome. Measuring podocalyxin levels in renal tissues and urine could help evaluate the progression of DN.
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18
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One-year clinical outcomes in patients with renal insufficiency after contemporary PCI: data from a multicenter registry. Clin Res Cardiol 2019; 109:845-856. [PMID: 31792571 PMCID: PMC7308257 DOI: 10.1007/s00392-019-01575-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Accepted: 11/15/2019] [Indexed: 12/18/2022]
Abstract
Background Chronic kidney disease (CKD) is highly prevalent in patients with coronary artery disease (CAD). Objective The outcome following revascularization using contemporary technologies (new-generation abluminal sirolimus-eluting stents with thin struts) in patients with CKD (i.e., glomerular filtration rate of < 60 mL/min/1.73m2) and in patients with hemodialysis (HD) is unknown. Methods e-Ultimaster is a prospective, single-arm, multi-center registry with clinical follow-up at 3 months and 1 year. Results A total of 19,475 patients were enrolled, including 1466 patients with CKD, with 167 undergoing HD. Patients with CKD had a higher prevalence of overall comorbidities, multiple/small vessel disease (≤ 2.75 mm), bifurcation lesions, and more often left main artery treatments (all p < 0.0001) when compared with patients with normal renal function (reference). CKD patients had a higher risk of target lesion failure (unadjusted OR, 2.51 [95% CI 2.04–3.08]), target vessel failure (OR, 2.44 [95% CI 2.01–2.96]), patient-oriented composite end point (OR, 2.19 [95% CI 1.87–2.56]), and major adverse cardiovascular events (OR, 2.34 [95% CI 1.93–2.83, p for all < 0.0001]) as reference. The rates of target lesion revascularization (OR, 1.17 [95% CI 0.79–1.73], p = 0.44) were not different. Bleeding complications were more frequently observed in CKD than in the reference (all p < 0.0001). Conclusion In this worldwide registry, CKD patients presented with more comorbidities and more complex lesions when compared with the reference population. They experienced higher rate of adverse events at 1-year follow-up. Graphic abstract One-year summary outcomes of contemporary PCI in renal insufficiency. CKD chronic kidney disease, POCE patient oriented composite endpoint, MACE major adverse cardiovascular events, TLF target lesion failure, TLR target lesion revascularization, ST stent thrombosis ![]()
Electronic supplementary material The online version of this article (10.1007/s00392-019-01575-y) contains supplementary material, which is available to authorized users.
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Uteza S, Thuillier Lecouf A, Videloup L, Béchade C, Henri P, Guillouët S. [Descriptive study of practices with patients in conservative care practices in a French district, the Normandy]. Nephrol Ther 2019; 15:517-523. [PMID: 31718994 DOI: 10.1016/j.nephro.2019.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 05/31/2019] [Accepted: 06/10/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Renal replacement therapy and renal transplantation can't be considered as the only way to treat old end-stage renal disease patients. Nowadays conservative management has to be considered and proposed as a treatment option to patients with a chronic kidney disease. The aim of this study was to describe nephrologists' practices concerning conservative management care in a French department. MATERIAL AND METHOD A cross-sectional practices survey has been conducted in 2015. A survey was sent to 66 nephrologists in 14 treatment centers in the Normandy region. RESULTS 49 of the 66 nephrologists responded to the questionnaire. Among the 48 nephrologists who responded to the questionnaire, 38 out of 48 (79.2%) did not use decision support tools to implement conservative treatment. In all, 42/48 (87.5%) nephrologists did not discuss with their colleagues before providing conservative treatment. Meeting dedicated to the decision of conservative treatment did not exist in any center surveyed in this study. When conservative management was chosen, 34/48 nephrologists (70.8%) discussed end-of-life. And 31/48 nephrologists (64.6%) used the term "death". CONCLUSION The results of this study show that the course of the patients in conservative treatment is heterogeneous and is not formalized. Improvements are needed to integrate conservative treatment for patients with chronic kidney disease.
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Affiliation(s)
- Sophie Uteza
- Normandie Univ, UNICAEN, CHU de Caen Normandie, néphrologie,14000 Caen, France
| | | | - Ludivine Videloup
- Normandie Univ, UNICAEN, CHU de Caen Normandie, néphrologie,14000 Caen, France
| | - Clémence Béchade
- Normandie Univ, UNICAEN, CHU de Caen Normandie, néphrologie, Inserm ANTICIPE 1086, avenue de la Côte-de-Nacre, 14000 Caen, France
| | - Patrick Henri
- Normandie Univ, UNICAEN, CHU de Caen Normandie, néphrologie,14000 Caen, France
| | - Sonia Guillouët
- Normandie Univ, UNICAEN, CHU de Caen Normandie, néphrologie, Inserm ANTICIPE 1086, avenue de la Côte-de-Nacre, 14000 Caen, France.
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Torino C, Raso FM, van Saase JL, Panuccio V, Tripepi R, Vilasi A, Postorino M, Tripepi G, Mallamaci F, Zoccali C. Physical functioning and mortality in very old patients on dialysis. Arch Gerontol Geriatr 2019; 85:103918. [PMID: 31376743 DOI: 10.1016/j.archger.2019.103918] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 07/08/2019] [Accepted: 07/23/2019] [Indexed: 10/26/2022]
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Wang W, Jiang S, Tang X, Cai L, Epstein PN, Cheng Y, Sun W, Xu Z, Tan Y. Sex differences in progression of diabetic nephropathy in OVE26 type 1 diabetic mice. Biochim Biophys Acta Mol Basis Dis 2019; 1866:165589. [PMID: 31678163 DOI: 10.1016/j.bbadis.2019.165589] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Revised: 09/28/2019] [Accepted: 10/07/2019] [Indexed: 12/22/2022]
Abstract
AIMS OVE26 mice (FVB background), genetically overexpressing calmodulin in pancreatic beta cells, develop early onset type 1 diabetes, leading to progressive diabetic nephropathy (DN), with features of established human DN. The role of gender in characteristics of renal lesions has remained unexplored. METHODS Male and female OVE26 mice were compared to age and sex matched wild-type, nondiabetic FVB mice at ages of 4, 12, 24 and 36 weeks. Nephropathy was examined by measuring urine albumin-to-creatinine ratio, histopathology, expression of pathological markers and immunochemistry in the same cohort of mice. RESULTS Progression of diabetic kidney disease was evident first in the OVE26 glomerulus, initially as mesangial matrix expansion at 4 weeks followed by loss of podocytes, glomerular volume expansion and severe albuminuria at 12 weeks. Tubule dilation and initiation of interstitial fibrosis did not become significant until 24 weeks. T-lymphocyte infiltration into the renal parenchyma appeared at 36 weeks. OVE26 female mice developed more advanced DN than male OVE26 mice, such as more severe albuminuria, greater podocyte loss, additional fibrosis and significantly more inflammatory cell infiltration. The female OVE26 mice had lowest level of plasma estradiol in all 36 weeks old mice, as well as renal estrogen receptors. CONCLUSIONS This demonstration of the role of gender, combined with the detailed characterization of DN progression illustrates the value of OVE26 mice for understanding gender effects on DN and provides the basis for researchers to better select the age and sex of OVE26 mice in future studies of type 1 DN. RESEARCH IN CONTEXT What is already known about this subject? What is the key question? What are the new findings? How might this impact on clinical practice in the foreseeable future?
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Affiliation(s)
- Wanning Wang
- Department of Nephrology, the First Hospital of Jilin University, Changchun 130021, China; Pediatric Research Institute, Department of Pediatrics, the University of Louisville School of Medicine, Louisville, KY 40292, USA
| | - Saizhi Jiang
- Pediatric Research Institute, Department of Pediatrics, the University of Louisville School of Medicine, Louisville, KY 40292, USA; Pediatric Department, the First affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Xiaoqiang Tang
- Pediatric Research Institute, Department of Pediatrics, the University of Louisville School of Medicine, Louisville, KY 40292, USA; Department of Cardiology, the First Hospital of Jilin University, Changchun 130021, China
| | - Lu Cai
- Pediatric Research Institute, Department of Pediatrics, the University of Louisville School of Medicine, Louisville, KY 40292, USA; Departments of Pharmacology and Toxicology and Wendy Novak Diabetes Center, the University of Louisville School of Medicine, Louisville, KY 40292, USA
| | - Paul N Epstein
- Pediatric Research Institute, Department of Pediatrics, the University of Louisville School of Medicine, Louisville, KY 40292, USA; Departments of Pharmacology and Toxicology and Wendy Novak Diabetes Center, the University of Louisville School of Medicine, Louisville, KY 40292, USA
| | - Yanli Cheng
- Department of Nephrology, the First Hospital of Jilin University, Changchun 130021, China
| | - Weixia Sun
- Department of Nephrology, the First Hospital of Jilin University, Changchun 130021, China.
| | - Zhonggao Xu
- Department of Nephrology, the First Hospital of Jilin University, Changchun 130021, China.
| | - Yi Tan
- Pediatric Research Institute, Department of Pediatrics, the University of Louisville School of Medicine, Louisville, KY 40292, USA; Departments of Pharmacology and Toxicology and Wendy Novak Diabetes Center, the University of Louisville School of Medicine, Louisville, KY 40292, USA
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Scholz SS, Böhm M, Mahfoud F. Arteriovenous Fistula, Blood Pressure, and Shunt Flow: A Thin Line That Separates Beneficial From Detrimental Effects. Am J Hypertens 2019; 32:935-937. [PMID: 31179486 DOI: 10.1093/ajh/hpz094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 06/06/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
- Sean S Scholz
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Saarland University Hospital, Homburg/Saar, Germany
| | - Michael Böhm
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Saarland University Hospital, Homburg/Saar, Germany
| | - Felix Mahfoud
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Saarland University Hospital, Homburg/Saar, Germany
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
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Wakasugi M, Kazama JJ, Narita I. Secular trends in end‐stage kidney disease requiring renal replacement therapy in Japan: Japanese Society of Dialysis Therapy Registry data from 1983 to 2016. Nephrology (Carlton) 2019; 25:172-178. [DOI: 10.1111/nep.13595] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Minako Wakasugi
- Division of Comprehensive Geriatrics in CommunityNiigata University Graduate School of Medical and Dental Sciences Niigata Japan
| | - Junichiro J Kazama
- Department of Nephrology and HypertensionFukushima Medical University Fukushima Japan
| | - Ichiei Narita
- Division of Clinical Nephrology and RheumatologyNiigata University Graduate School of Medical and Dental Science Niigata Japan
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24
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Stel VS, Awadhpersad R, Pippias M, Ferrer-Alamar M, Finne P, Fraser SD, Heaf JG, Hemmelder MH, Martínez-Castelao A, de Meester J, Palsson R, Prischl FC, Segelmark M, Traynor JP, Santamaria R, Reisaeter AV, Massy ZA, Jager KJ. International comparison of trends in patients commencing renal replacement therapy by primary renal disease. Nephrology (Carlton) 2019; 24:1064-1076. [PMID: 30456883 DOI: 10.1111/nep.13531] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2018] [Indexed: 01/05/2023]
Abstract
AIM To examine international time trends in the incidence of renal replacement therapy (RRT) for end-stage renal disease (ESRD) by primary renal disease (PRD). METHODS Renal registries reporting on patients starting RRT per million population for ESRD by PRD from 2005 to 2014, were identified by internet search and literature review. The average annual percentage change (AAPC) with a 95% confidence interval (CI) of the time trends was computed using Joinpoint regression. RESULTS There was a significant decrease in the incidence of RRT for ESRD due to diabetes mellitus (DM) in Europe (AAPC = -0.9; 95%CI -1.3; -0.5) and to hypertension/renal vascular disease (HT/RVD) in Australia (AAPC = -1.8; 95%CI -3.3; -0.3), Canada (AAPC = -2.9; 95%CI -4.4; -1.5) and Europe (AAPC = -1.1; 95%CI -2.1; -0.0). A decrease or stabilization was observed for glomerulonephritis in all regions and for autosomal dominant polycystic kidney disease (ADPKD) in all regions except for Malaysia and the Republic of Korea. An increase of 5.2-16.3% was observed for DM, HT/RVD and ADPKD in Malaysia and the Republic of Korea. CONCLUSION Large international differences exist in the trends in incidence of RRT by primary renal disease. Mapping of these international trends is the first step in defining the causes and successful preventative measures of CKD.
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Affiliation(s)
- Vianda S Stel
- ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Ryan Awadhpersad
- ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Maria Pippias
- ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | | | - Patrik Finne
- Department of Nephrology, Helsinki University Hospital, Helsinki, Finland.,Finnish Registry for Kidney Diseases, Helsinki, Finland
| | - Simon D Fraser
- Academic Unit of Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, UK
| | - James G Heaf
- Department of Medicine, Zealand University Hospital, Roskilde, Denmark
| | - Marc H Hemmelder
- Dutch Renal Registry Renine, Nefrovisie Foundation, Utrecht, the Netherlands
| | | | - Johan de Meester
- Department of Nephrology & Dialysis & Hypertension, Dutch-speaking Belgian Renal Registry (NBVN), Sint-Niklaas, Belgium
| | - Runolfur Palsson
- Division of Nephrology, Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland.,Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Friedrich C Prischl
- Department of Nephrology, Fourth Department of Internal Medicine, Klinikum Wels-Grieskirchen, Wels, Austria
| | - Mårten Segelmark
- Department of Clinical Sciences Lund, Nephrology, Lund University, Skane University Hospital, Lund, Sweden
| | | | - Rafael Santamaria
- Nephrology Service, Reina Sofia University Hospital/Maimonides Biomedical Research Institute of Cordoba (IMIBIC), University of Cordoba, Cordoba, Spain
| | - Anna Varberg Reisaeter
- Norwegian Renal Registry, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | - Ziad A Massy
- Division of Nephrology, Ambroise Pare University Hospital, APHP, University of Paris Ouest-Versailles-St-Quentin-en-Yvelines (UVSQ), Paris, France.,Institut National de la Sante et de la Recherche Medicale (INSERM) U1018, Team 5, CESP UVSQ, University Paris Saclay, Villejuif, France
| | - Kitty J Jager
- ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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Scholz SS, Vukadinović D, Lauder L, Ewen S, Ukena C, Townsend RR, Wagenpfeil S, Böhm M, Mahfoud F. Effects of Arteriovenous Fistula on Blood Pressure in Patients With End-Stage Renal Disease: A Systematic Meta-Analysis. J Am Heart Assoc 2019; 8:e011183. [PMID: 30764686 PMCID: PMC6405662 DOI: 10.1161/jaha.118.011183] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 01/11/2019] [Indexed: 01/21/2023]
Abstract
Background Central arteriovenous fistula ( AVF ) creation is under investigation for treatment of severe hypertension. We evaluated the effects of AVF for initiation of hemodialysis on systolic, diastolic, and mean arterial blood pressure in patients with end-stage renal disease. Methods and Results Data search included PubMed, Web of Science, and the Cochrane Library. A systematic review and meta-analysis of peer-reviewed studies reporting the effects of the creation/ligation of an AVF on blood pressure in patients with end-stage renal disease was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis), PRISMA -P (PRISMA for systematic review protocols), and ROBINS-I (Risk of Bias in Non-Randomized Studies) criteria by the Cochrane Bias Methods Group. All studies in which the results could have been biased by hemodialysis were excluded. A total of 14 trials including 412 patients with end-stage renal disease ( AVF creation, n=185; AVF ligation, n=227) fulfilled the criteria and were subsequently analyzed. Average blood pressure in patients with no/closed AVF was 140.5/77.6 mm Hg with a mean arterial blood pressure of 96.1 mm Hg. Following creation of AVF , systolic blood pressure significantly decreased by 8.7 mm Hg ( P<0.001), diastolic blood pressure by 5.9 mm Hg ( P<0.001), and mean arterial blood pressure by 6.6 mm Hg ( P=0.02), whereas after ligation systolic blood pressure increased by 5.2 mm Hg ( P=0.07), diastolic blood pressure by 3.8 mm Hg ( P=0.02), and mean arterial blood pressure by 3.7 mm Hg ( P=0.07) during short- to long-term follow-up. Conclusions Creation of AVF significantly decreases blood pressure in patients with end-stage renal disease, whereas blood pressure tends to increase after ligation. These findings illustrate the hemodynamic consequences of AVF which are under investigation for severe hypertension.
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Affiliation(s)
- Sean S. Scholz
- Klinik für Innere Medizin IIIKardiologie, Angiologie und Internistische IntensivmedizinSaarland University HospitalHomburg/SaarGermany
| | - Davor Vukadinović
- Klinik für Innere Medizin IIIKardiologie, Angiologie und Internistische IntensivmedizinSaarland University HospitalHomburg/SaarGermany
| | - Lucas Lauder
- Klinik für Innere Medizin IIIKardiologie, Angiologie und Internistische IntensivmedizinSaarland University HospitalHomburg/SaarGermany
| | - Sebastian Ewen
- Klinik für Innere Medizin IIIKardiologie, Angiologie und Internistische IntensivmedizinSaarland University HospitalHomburg/SaarGermany
| | - Christian Ukena
- Klinik für Innere Medizin IIIKardiologie, Angiologie und Internistische IntensivmedizinSaarland University HospitalHomburg/SaarGermany
| | - Raymond R. Townsend
- Perelman School of MedicineUniversity of Pennsylvania Medical CenterPhiladelphiaPA
| | - Stefan Wagenpfeil
- Institut für Medizinische BiometrieEpidemiologie und Medizinische Informatik (IMBEI)Saarland UniversityCampus Homburg/SaarGermany
| | - Michael Böhm
- Klinik für Innere Medizin IIIKardiologie, Angiologie und Internistische IntensivmedizinSaarland University HospitalHomburg/SaarGermany
| | - Felix Mahfoud
- Klinik für Innere Medizin IIIKardiologie, Angiologie und Internistische IntensivmedizinSaarland University HospitalHomburg/SaarGermany
- Institute for Medical Engineering and ScienceMassachusetts Institute of TechnologyCambridgeMA
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Seidowsky A, Vilaine È, Mansencal N, Ébel A, Villain C, Cheddani L, Massy ZA. [Pulmonary ultrasound and dialysis]. Nephrol Ther 2018; 14 Suppl 1:S73-S81. [PMID: 29606266 DOI: 10.1016/j.nephro.2018.02.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Accepted: 02/09/2018] [Indexed: 01/08/2023]
Abstract
Profound deficit of the body fluid composition regulation system is present at the end stage kidney disease, leading to the increase the risk of acute or chronic volume overload, which impacts the morbidity and mortality in these patients. Pulmonary ultrasound by its ability to estimate extrapulmonary water at an infraclinical stage has helped to make progress in this area. Line B is the element of fundamental semiology that reflects the presence of water in the pulmonary alveoli. The alteration of left ventricular function and the increase of pulmonary capillary permeability are the determining factors in the genesis of subclinical pulmonary congestion and are positively correlated with B-lines. Because of its non-invasive nature, its ease of use, its intra- and interoperability reproducibility and its ease of learning, nephrologists can be efficiently and quickly trained to use it to measure pulmonary congestion. Recent data have shown an epidemiological association between B-lines and mortality in end stage kidney disease patients. The causal role of subclinical pulmonary congestion assessed by these B lines in the genesis of detrimental events is being evaluated by a randomized, multicentre, open-label European clinical trial (Lung water by ultra-sound guided treatment [LUST] trial). The clinical usefulness of pulmonary ultrasound in the management of subclinical pulmonary congestion in patients with end stage kidney disease remains to be determined, but it could be considered from now as an additional tool to improve the management of this congestion, possibly by complementing bioimpedancemetry data.
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Affiliation(s)
- Alexandre Seidowsky
- Service de néphrologie-dialyse, CHU Ambroise-Paré, 9, avenue du Général-de-Gaulle, 92104 Boulogne-Billancourt, France; Service de néphrologie-hémodialyse, hôpital américain de Paris, 63, boulevard Victor-Hugo, 92200 Neuilly-sur-Seine, France
| | - Ève Vilaine
- Service de néphrologie-dialyse, CHU Ambroise-Paré, 9, avenue du Général-de-Gaulle, 92104 Boulogne-Billancourt, France; Inserm U1018, Team 5, centre de recherche en épidémiologie et santé des populations (CESP), 16, avenue Paul-Vaillant-Couturier, 94807 Villejuif cedex, France; Université Versailles-Saint-Quentin, 16, avenue Paul-Vaillant-Couturier, 94807 Villejuif cedex, France; Paris-Saclay université 16, avenue Paul-Vaillant-Couturier, 94807 Villejuif cedex, France
| | - Nicolas Mansencal
- Service de cardiologie, CHU Ambroise-Paré, 9, avenue du Général-de-Gaulle, 92104 Boulogne-Billancourt, France
| | - Alexandre Ébel
- Service de néphrologie-dialyse, CHU Ambroise-Paré, 9, avenue du Général-de-Gaulle, 92104 Boulogne-Billancourt, France
| | - Cédric Villain
- Service de néphrologie-dialyse, CHU Ambroise-Paré, 9, avenue du Général-de-Gaulle, 92104 Boulogne-Billancourt, France; Inserm U1018, Team 5, centre de recherche en épidémiologie et santé des populations (CESP), 16, avenue Paul-Vaillant-Couturier, 94807 Villejuif cedex, France; Université Versailles-Saint-Quentin, 16, avenue Paul-Vaillant-Couturier, 94807 Villejuif cedex, France; Paris-Saclay université 16, avenue Paul-Vaillant-Couturier, 94807 Villejuif cedex, France
| | - Lynda Cheddani
- Service de néphrologie-dialyse, CHU Ambroise-Paré, 9, avenue du Général-de-Gaulle, 92104 Boulogne-Billancourt, France; Inserm U1018, Team 5, centre de recherche en épidémiologie et santé des populations (CESP), 16, avenue Paul-Vaillant-Couturier, 94807 Villejuif cedex, France; Université Versailles-Saint-Quentin, 16, avenue Paul-Vaillant-Couturier, 94807 Villejuif cedex, France; Paris-Saclay université 16, avenue Paul-Vaillant-Couturier, 94807 Villejuif cedex, France
| | - Ziad A Massy
- Service de néphrologie-dialyse, CHU Ambroise-Paré, 9, avenue du Général-de-Gaulle, 92104 Boulogne-Billancourt, France; Inserm U1018, Team 5, centre de recherche en épidémiologie et santé des populations (CESP), 16, avenue Paul-Vaillant-Couturier, 94807 Villejuif cedex, France; Université Versailles-Saint-Quentin, 16, avenue Paul-Vaillant-Couturier, 94807 Villejuif cedex, France; Paris-Saclay université 16, avenue Paul-Vaillant-Couturier, 94807 Villejuif cedex, France.
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Chaabouni Y, Yaich S, Khedhiri A, Zayen MA, Kharrat M, Kammoun K, Jarraya F, Hmida MB, Damak J, Hachicha J. [Epidemiological profile of terminal chronic renal failure in the region of Sfax]. Pan Afr Med J 2018; 29:64. [PMID: 29875945 PMCID: PMC5987075 DOI: 10.11604/pamj.2018.29.64.12159] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Accepted: 06/25/2017] [Indexed: 11/11/2022] Open
Abstract
Introduction Terminal chronic renal failure is a truly global public health problem. In 2011, the cost of management of patients on dialysis has surpassed 90 million dinars (37.000 euro) in Tunisia, nearly 5% of the overall health spending. A better knowledge of the epidemiological profile of terminal chronic renal failure contributes to the implementation and evaluation of health strategies aimed to improve prevention and disease management. This study aimed to describe the epidemiological profile of incident cases in the Sfax Governorate over the period of 10 years. Methods We conducted a descriptive retrospective study over the period from January 2003 to December 2012. The incident cases of terminal chronic renal failure in the Sfax Governorate were included in the study. Results The diagnosis of terminal chronic renal failure was made in 1708 cases: 957 men and 751 women (sex-ratio = 1.27). The average age was 58.4 years [10-100 years]. The study of the evolution of the average age during the study period showed a tendency to increase with positive correlation coefficient (0.749) and p = 0.006. The main causal nephropathy was diabetic nephropathy (21.5%), with a significant increase in its frequency from one year to the other (positive correlation coefficient (0.770) with p = 0.009). Hemodialysis was the dialysis technique of choice, performed in 96% of patients. Conclusion A national registry is indispensable in order to better understand the epidemiological profile of terminal chronic renal failure in Tunisia and to improve its management.
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Affiliation(s)
- Yosr Chaabouni
- Service de Néphrologie, CHU Hedi Chaker, Sfax, Tunisie, Unité de Recherche de Pathologie Rénale, Faculté de Médecine, Sfax, Tunisie
| | - Sourour Yaich
- Service de Médecine Communautaire, CHU Hedi Chaker, Sfax, Tunisie
| | - Azza Khedhiri
- Service de Néphrologie, CHU HediChaker, Sfax, Tunisie
| | | | - Mahmoud Kharrat
- Service de Néphrologie, CHU Hedi Chaker, Sfax, Tunisie, Unité de Recherche de Pathologie Rénale, Faculté de Médecine, Sfax, Tunisie
| | - Khawla Kammoun
- Service de Néphrologie, CHU Hedi Chaker, Sfax, Tunisie, Unité de Recherche de Pathologie Rénale, Faculté de Médecine, Sfax, Tunisie
| | - Faical Jarraya
- Service de Néphrologie, CHU Hedi Chaker, Sfax, Tunisie, Unité de Recherche de Pathologie Rénale, Faculté de Médecine, Sfax, Tunisie
| | - Mohamed Ben Hmida
- Service de Néphrologie, CHU Hedi Chaker, Sfax, Tunisie, Unité de Recherche de Pathologie Rénale, Faculté de Médecine, Sfax, Tunisie
| | - Jamal Damak
- Service de Médecine Communautaire, CHU Hedi Chaker, Sfax, Tunisie
| | - Jamil Hachicha
- Service de Néphrologie, CHU Hedi Chaker, Sfax, Tunisie, Unité de Recherche de Pathologie Rénale, Faculté de Médecine, Sfax, Tunisie
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Kusztal M, Trafidło E, Madziarska K, Augustyniak-Bartosik H, Karczewski M, Weyde W, Krajewska M, Rymaszewska J, Klinger M. Depressive symptoms but not chronic pain have an impact on the survival of patients undergoing maintenance hemodialysis. Arch Med Sci 2018; 14:265-275. [PMID: 29593798 PMCID: PMC5868660 DOI: 10.5114/aoms.2016.59765] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Accepted: 10/05/2015] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION More than 1/3 of patients with end-stage renal disease who are in a chronic dialysis program suffer from chronic pain and depression/anxiety. The aim of the study was to determine the impacts of symptoms of depression/anxiety, chronic pain and quality of life (QoL) on 6-year patient survival. MATERIAL AND METHODS Observational study of end-stage renal disease patients on maintenance hemodialysis (n = 205) who met the inclusion criteria. Patients from three dialysis centers in Lower Silesia were asked to complete a battery of validated questionnaires: the Hospital Anxiety and Depression Scale (HADS), the 36-item Short Form Health Survey Questionnaire, the Verbal Rating Scale (VRS) and the Visual Analog Scale (VAS). Clinical and biochemical data (dialysis adequacy) were recorded. RESULTS One hundred thirty from 205 enrolled hemodialysis patients (63.4%) suffered from chronic pain. Patients with pain were on maintenance dialysis for longer times and had higher levels of parathyroid hormone, more depressive symptoms and a lower QoL than those without pain. In the 6-year period, 96 (46.8%) patients died. The most common cause of death was cardiovascular disease in 44 (45.8%) patients. Highly depressed patients (HADS depression score > 8) exhibited higher mortality (< 8 vs. > 8 points; p = 0.016) independent of age, diabetes, cardiovascular disease, C-reactive protein or albumin level. CONCLUSIONS Chronic pain, although common among hemodialysis patients, did not lower survival. Depressive symptoms are an important predictor for all-cause mortality in hemodialysis patients, with the relationship independent of nutritional or inflammatory status.
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Affiliation(s)
- Mariusz Kusztal
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland
| | | | - Katarzyna Madziarska
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland
| | | | - Maciej Karczewski
- Manteion – Statistical Laboratory, Regional Specialist Hospital in Wroclaw, Research and Development Center, Poland
| | - Waclaw Weyde
- Faculty of Dentistry, Wroclaw Medical University, Wroclaw, Poland
| | - Magdalena Krajewska
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland
| | | | - Marian Klinger
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland
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de Beus E, van der Sande NGC, Bots ML, Spiering W, Voskuil M, Visseren FLJ, Blankestijn PJ. Prevalence and clinical characteristics of apparent therapy-resistant hypertension in patients with cardiovascular disease: a cross-sectional cohort study in secondary care. BMJ Open 2017; 7:e016692. [PMID: 28882918 PMCID: PMC5589036 DOI: 10.1136/bmjopen-2017-016692] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES Our aim was to investigate the prevalence of apparent therapy-resistant hypertension (aTRH) in patients with clinical manifest cardiovascular disease (CVD), and to study clinical characteristics related to aTRH in this population. SETTING The SMART (Second Manifestations of ARTerial disease) study is a large, single-centre cohort study in secondary care. PARTICIPANTS Office blood pressure (BP) at inclusion was used to evaluate BP control in 6191 hypertensive patients with clinical manifest (cardio)vascular disease. Therapy-resistant hypertension was defined as BP ≥140/90 mm Hg despite use of antihypertensive drugs from ≥3 drug classes including a diuretic or use of ≥4 antihypertensive drugs irrespective of BP. Logistic regression analysis was used to explore the relationship between clinical characteristics measured at baseline and presence of aTRH. RESULTS The prevalence of aTRH was 9.1% (95% CI 8.4 to 9.8). Prevalence increased with age and when albuminuria was present and was higher in patients with lower estimated glomerular filtration rate (eGFR). Presence of aTRH was related to diabetes, female sex, duration and multiple locations of vascular disease, body mass index and waist circumference. Carotid intima-media thickness was higher (0.99±0.28 vs 0.93±0.28 mm) and ankle-brachial index lower (1.07±0.20 vs 1.10±0.19) in patients with aTRH compared with patients without aTRH. CONCLUSION aTRH is prevalent in patients with clinical manifest CVD and is related to clinical factors known to be related with increased vascular risk, and with lower eGFR.
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Affiliation(s)
- Esther de Beus
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Michiel L Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Wilko Spiering
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Michiel Voskuil
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Frank L J Visseren
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Peter J Blankestijn
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands
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Parra E, Arenas MD, Alonso M, Martínez MF, Gamen Á, Aguarón J, Escobar MT, Moreno-Jiménez JM, Alvarez-Ude F. Assessing value-based health care delivery for haemodialysis. J Eval Clin Pract 2017; 23:477-485. [PMID: 26662940 PMCID: PMC6084341 DOI: 10.1111/jep.12483] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/26/2015] [Indexed: 11/27/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Disparities in haemodialysis outcomes among centres have been well-documented. Besides, attempts to assess haemodialysis results have been based on non-comprehensive methodologies. This study aimed to develop a comprehensive methodology for assessing haemodialysis centres, based on the value of health care. The value of health care is defined as the patient benefit from a specific medical intervention per monetary unit invested (Value = Patient Benefit/Cost). This study assessed the value of health care and ranked different haemodialysis centres. METHOD A nephrology quality management group identified the criteria for the assessment. An expert group composed of stakeholders (patients, clinicians and managers) agreed on the weighting of each variable, considering values and preferences. Multi-criteria methodology was used to analyse the data. Four criteria and their weights were identified: evidence-based clinical performance measures = 43 points; yearly mortality = 27 points; patient satisfaction = 13 points; and health-related quality of life = 17 points (100-point scale). Evidence-based clinical performance measures included five sub-criteria, with respective weights, including: dialysis adequacy; haemoglobin concentration; mineral and bone disorders; type of vascular access; and hospitalization rate. The patient benefit was determined from co-morbidity-adjusted results and corresponding weights. The cost of each centre was calculated as the average amount expended per patient per year. RESULTS The study was conducted in five centres (1-5). After adjusting for co-morbidity, value of health care was calculated, and the centres were ranked. A multi-way sensitivity analysis that considered different weights (10-60% changes) and costs (changes of 10% in direct and 30% in allocated costs) showed that the methodology was robust. The rankings: 4-5-3-2-1 and 4-3-5-2-1 were observed in 62.21% and 21.55%, respectively, of simulations, when weights were varied by 60%. CONCLUSIONS Value assessments may integrate divergent stakeholder perceptions, create a context for improvement and aid in policy-making decisions.
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Reddy YNV, Obokata M, Dean PG, Melenovsky V, Nath KA, Borlaug BA. Long-term cardiovascular changes following creation of arteriovenous fistula in patients with end stage renal disease. Eur Heart J 2017; 38:1913-1923. [DOI: 10.1093/eurheartj/ehx045] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 01/24/2017] [Indexed: 11/12/2022] Open
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Heaf J. Current trends in European renal epidemiology. Clin Kidney J 2017; 10:149-153. [PMID: 28396733 PMCID: PMC5381210 DOI: 10.1093/ckj/sfw150] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 12/22/2016] [Indexed: 01/01/2023] Open
Abstract
The incidence of end-stage renal disease (ESRD) continues to vary substantially between the countries in Europe that contribute data to the ERA-EDTA Registry. Differences can be attributed to socioeconomic factors and prophylaxis programs for patients with chronic kidney disease (CKD) and may also express real differences in CKD incidence. Recently, age-adjusted ESRD incidence has begun to fall in many countries, probably related to improved prophylaxis. However, absolute rates may increase, partly due to socioeconomic advances in countries with a low gross domestic product and partly due to continuing increases in the proportion of elderly patients. Prevalence rates are expected to continue to increase, mainly due to increases in relative transplant prevalence, improved graft survival times and continuing improvements in both dialysis and transplant patient survival. Overall treatment results continue to improve.
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Affiliation(s)
- James Heaf
- Department of Medicine, Zealand University Hospital, Roskilde, Denmark
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Kiss I, Kiss Z, Kerkovits L, Paksy A, Ambrus C. Smoking has no impact on survival and it is not associated with ACE gene I/D polymorphism in hemodialysis patients. J Renin Angiotensin Aldosterone Syst 2017; 18:1470320316667831. [PMID: 28058974 PMCID: PMC5843857 DOI: 10.1177/1470320316667831] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION The relationship between smoking and mortality in patients on hemodialysis is controversial. Earlier studies showed that the insertion/deletion (I/D) polymorphism of the ACE gene might have an effect on mortality. The aim of this study was to test the impact of smoking on survival and whether this association was influenced by ACE gene I/D polymorphism in patients on maintenance hemodialysis. PARTICIPANTS AND METHODS In this prospective, multicenter cohort study we analyzed 709 prevalent patients on maintenance hemodialysis. Patients were allocated into groups based on their smoking habit. Outcome data were collected during the 144-month follow-up period. Outcomes of current smokers and lifelong non-smokers were compared. In order to control for interactions between predictor variables, we also identified 160 matched pairs for further sub-analysis. RESULTS The vast majority of patients (67%) were non-smokers, followed by current smokers (22.2%) and ex-smokers (9.8%). Smoking had no impact on survival in the matched pair analysis ( p = 0.99). After adjustment for ACE I/D polymorphism and other co-variates, smoking had no effect on survival. CONCLUSION Our data suggest that smoking has no impact on survival; neither is it associated with ACE gene I/D polymorphism in hemodialysis patients.
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Affiliation(s)
- István Kiss
- School for PhD Candidates of Aesculap Academy, Hungary
- Division Section of Geriatrics, 2nd Dept. of Internal Medicine, Semmelweis University Faculty of Medicine, Hungary
- István Kiss, South-Buda Nephrology Centre (Department of Nephrology-Hypertension and Division of Geriatrics, St. Imre University Teaching Hospital; 1st Dialysis Centre of B. Braun Avitum Hungary CPLC) and Division Section of Geriatrics, 2nd Department of Internal Medicine, Semmelweis University Faculty of Medicine, Budapest, Halmi St. 20–22. H-1115 Budapest, Hungary.
| | - Zoltán Kiss
- School for PhD Candidates of Aesculap Academy, Hungary
- Department of Nephrology–Hypertension and Division of Geriatrics, Saint Imre University Teaching Hospital, Hungary
| | - Lóránt Kerkovits
- School for PhD Candidates of Aesculap Academy, Hungary
- B. Braun Avitum Hungary CPLC Dialysis Network, Hungary
| | - András Paksy
- School for PhD Candidates of Aesculap Academy, Hungary
| | - Csaba Ambrus
- Department of Nephrology–Hypertension and Division of Geriatrics, Saint Imre University Teaching Hospital, Hungary
- Division Section of Geriatrics, 2nd Dept. of Internal Medicine, Semmelweis University Faculty of Medicine, Hungary
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El-Sheikh M, El-Ghazaly G. Assessment of hemodialysis adequacy in patients with chronic kidney disease in the hemodialysis unit at Tanta University Hospital in Egypt. Indian J Nephrol 2016; 26:398-404. [PMID: 27942169 PMCID: PMC5131376 DOI: 10.4103/0971-4065.168141] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Worldwide, hemodialysis (HD) constitutes the most common form of renal replacement therapy. Many studies have shown strong correlation between HD dose and clinical outcome. The cross-sectional study was conducted on 100 patients in Hemodialysis Unit at Tanta University Hospital, Egypt. Data were collected using a reliable questionnaire (including clinical, demographic, dialysis, laboratory, and radiological data). SpKt/V was used to assess the adequacy of HD. The results revealed inadequate HD dose among 60% of the study population. The results also showed that increasing time and frequency of dialysis, blood flow rates, low recirculation percentages, reduction of intradialytic complaints, and well-functioning vascular access are associated with better HD adequacy. Our findings showed a positive correlation between dialysis dose and hemoglobin, serum albumin, normalized protein catabolic rate, and physical health. A great percentage of patients had inadequate HD. HD adequacy was influenced by several factors such as duration and frequency of dialysis session, patients' complaints, and well-functioning vascular access.
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Affiliation(s)
- M. El-Sheikh
- Department of Internal Medicine, Nephrology and Hemodialysis Unit, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - G. El-Ghazaly
- Department of Internal Medicine, Nephrology and Hemodialysis Unit, Faculty of Medicine, Tanta University, Tanta, Egypt
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Finding the right hemodialysis vascular access in the elderly: a patient-centered approach. J Vasc Access 2016; 17:386-391. [PMID: 27516143 DOI: 10.5301/jva.5000590] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2016] [Indexed: 11/20/2022] Open
Abstract
Vascular access preparation in the elderly with advanced kidney disease needs a nuanced approach. Recent studies indicate that age, along with comorbidity, modify the outcomes associated with the type of access placed or used for hemodialysis (HD). Options ranging from permanent vascular access (arteriovenous fistula [AVF] or graft [AVG]) to tunneled central venous catheter (TCVC) or conservative medical care must be weighed on an individual basis and reassessed longitudinally. The potential benefits derived from AVF compared with AVG and TCVC are not always seen in this population. Herein, we review the literature concerning patient and vascular access outcomes in the elderly with advanced kidney disease or on HD. A multidimensional approach that takes into consideration the burden of comorbid diseases, functional status and patient-reported views on quality of life ought to be incorporated in the process of vascular access planning in the elderly.
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Sugisawa H, Shimizu Y, Kumagai T, Sugisaki H, Ohira S, Shinoda T. Effects of socioeconomic status on physical and mental health of hemodialysis patients in Japan: differences by age, period, and cohort. Int J Nephrol Renovasc Dis 2016; 9:171-82. [PMID: 27471405 PMCID: PMC4948840 DOI: 10.2147/ijnrd.s107031] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Study purpose Whether or not socioeconomic status (SES)-related differences in the health of hemodialysis patients differ by age, period, and birth cohort remains unclear. We examined whether SES-related gaps in physical and mental health change with age, period, and birth cohort for hemodialysis patients. Methods Data were obtained from repeated cross-sectional surveys conducted in 1996, 2001, 2006, and 2011, with members of a national patients’ association as participants. We used raking adjustment to create a database which had similar characteristics to the total sample of dialysis patients in Japan. SES was assessed using family size-adjusted income levels. We divided patients into three groups based on their income levels: below the first quartile, over the second quartile and under the third quartile, and over the fourth quartile. We used the number of dialysis complications as a physical health indicator and depressive symptoms as a mental health indicator. We used a cross-classified random-effects model that estimated fixed effects of age categories and period as level-1 factors, and random effects of birth cohort as level-2 factors. Results Relative risk of dialysis complications in respondents below the first quartile compared with ones over the fourth quartile was reduced in age categories >60 years. Mean differences in depressive symptoms between respondents below the first quartile and ones over the fourth quartile peaked in the 50- to 59-year-old age group, and were reduced in age groups >60 years. In addition, mean differences varied across periods, widening from 1996 to 2006. There were no significant birth cohort effects on income differences for dialysis complications or depressive symptoms. Conclusion The number of dialysis complications and depressive symptoms in dialysis patients were affected by income differences, and the degree of these differences changed with age category and period.
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Affiliation(s)
| | - Yumiko Shimizu
- Faculty of Nursing, The Jikei University School of Medicine, Chofu
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Yodchai K, Dunning T, Savage S, Hutchinson AM. The role of religion and spirituality in coping with kidney disease and haemodialysis in Thailand. Scand J Caring Sci 2016; 31:359-367. [DOI: 10.1111/scs.12355] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 03/19/2016] [Indexed: 01/18/2023]
Affiliation(s)
- Kantaporn Yodchai
- Medical Nursing Department; Faculty of Nursing; Prince of Songkla University; Songkla Hatyai Thailand
| | - Trisha Dunning
- School of Nursing and Midwifery; Faculty of Health and Centre for Nursing and Allied Health Barwon Health; Deakin University; Geelong Victoria Australia
| | - Sally Savage
- School of Nursing and Midwifery; Centre for Nursing and Allied Health Research, Barwon Health; Deakin University; Geelong Victoria Australia
| | - Alison M. Hutchinson
- School of Nursing and Midwifery; Deakin University; Geelong Victoria Australia
- Centre for Nursing Research; Deakin University and Monash Health Partnership, Monash Health; Clayton Victoria Australia
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Phan K, Zhao DF, Zhou JJ, Karagaratnam A, Phan S, Yan TD. Bioprosthetic versus mechanical prostheses for valve replacement in end-stage renal disease patients: systematic review and meta-analysis. J Thorac Dis 2016; 8:769-77. [PMID: 27162649 DOI: 10.21037/jtd.2016.02.74] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Patients with end-stage renal disease (ESRD) indicated for dialysis are increasingly requiring cardiac valve surgery. The choice of bioprosthetic or mechanic valve prosthesis for such patients requires careful risk assessment. A systematic review and meta-analysis was performed to assess current evidence available. METHODS A comprehensive search from six electronic databases was performed from their inception to February 2015. Results from patients with ESRD undergoing cardiac surgery for bioprosthetic or mechanical valve replacement were identified. RESULTS Sixteen studies with 8,483 patients with ESRD undergoing cardiac valve replacement surgery were included. No evidence of publication bias was detected. Prior angioplasty by percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) surgery was significantly higher in the bioprosthetic group compared to the mechanical group (16.0% vs. 12.0%, P=0.04); all other preoperative baseline patient characteristics were similar. There was no significant difference in 30-day mortality or all-cause mortality between the two comparisons. Compared with the mechanical group, the frequency of bleeding (5.2% vs. 6.4%, P=0.04) and risk of thromboembolism (2.7% vs. 12.8%, P=0.02) were significantly lower in the bioprosthetic group. There were similar rates of reoperation and valve endocarditis. CONCLUSIONS The present study demonstrated that patients with ESRD undergoing bioprosthetic or mechanical valve replacement had similar mid-long term survival. The bioprosthetic group had lower rates of bleeding and thromboembolism. Further studies are required to differentiate the impact of valve location. The presented results may be applicable for ESRD patients requiring prosthetic valve replacement.
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Affiliation(s)
- Kevin Phan
- 1 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 2 The University of Sydney, Sydney, Australia
| | - Dong Fang Zhao
- 1 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 2 The University of Sydney, Sydney, Australia
| | - Jessie J Zhou
- 1 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 2 The University of Sydney, Sydney, Australia
| | - Aran Karagaratnam
- 1 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 2 The University of Sydney, Sydney, Australia
| | - Steven Phan
- 1 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 2 The University of Sydney, Sydney, Australia
| | - Tristan D Yan
- 1 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 2 The University of Sydney, Sydney, Australia
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Seppi T, Prajczer S, Dörler MM, Eiter O, Hekl D, Nevinny-Stickel M, Skvortsova I, Gstraunthaler G, Lukas P, Lechner J. Sex Differences in Renal Proximal Tubular Cell Homeostasis. J Am Soc Nephrol 2016; 27:3051-3062. [PMID: 27127188 DOI: 10.1681/asn.2015080886] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 01/22/2016] [Indexed: 12/15/2022] Open
Abstract
Studies in human patients and animals have revealed sex-specific differences in susceptibility to renal diseases. Because actions of female sex hormones on normal renal tissue might protect against damage, we searched for potential influences of the female hormone cycle on basic renal functions by studying excretion of urinary marker proteins in healthy human probands. We collected second morning spot urine samples of unmedicated naturally ovulating women, postmenopausal women, and men daily and determined urinary excretion of the renal tubular enzymes fructose-1,6-bisphosphatase and glutathione-S-transferase-α Additionally, we quantified urinary excretion of blood plasma proteins α1-microglobulin, albumin, and IgG. Naturally cycling women showed prominent peaks in the temporal pattern of urinary fructose-1,6-bisphosphatase and glutathione-S-transferase-α release exclusively within 7 days after ovulation or onset of menses. In contrast, postmenopausal women and men showed consistently low levels of urinary fructose-1,6-bisphosphatase excretion over comparable periods. We did not detect changes in urinary α1-microglobulin, albumin, or IgG excretion. Results of this study indicate that proximal tubular tissue architecture, representing a nonreproductive organ-derived epithelium, undergoes periodical adaptations phased by the female reproductive hormone cycle. The temporally delimited higher rate of enzymuria in ovulating women might be a sign of recurring increases of tubular cell turnover that potentially provide enhanced repair capacity and thus, higher resistance to renal damage.
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Affiliation(s)
- Thomas Seppi
- Department of Therapeutic Radiology and Oncology and
| | - Sinikka Prajczer
- Division of Physiology, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Oliver Eiter
- Division of Physiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Daniel Hekl
- Department of Therapeutic Radiology and Oncology and
| | | | | | | | - Peter Lukas
- Department of Therapeutic Radiology and Oncology and
| | - Judith Lechner
- Division of Physiology, Medical University of Innsbruck, Innsbruck, Austria
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Laplante S, Liu FX, Culleton B, Bernardo A, King D, Hudson P. The Cost Effectiveness of High-Dose versus Conventional Haemodialysis: a Systematic Review. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2016; 14:185-193. [PMID: 26691659 DOI: 10.1007/s40258-015-0212-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND End-stage renal disease (ESRD) is fatal if untreated. In the absence of transplant, approximately 50 % of dialysis patients die within 5 years. Although more frequent and/or longer haemodialysis (high-dose HD) improves survival, this regimen may add to the burden on dialysis services and healthcare costs. This systematic review summarised the cost effectiveness of high-dose HD compared with conventional HD. METHODS English language publications reporting the cost-utility/effectiveness of high-dose HD in adults with ESRD were identified via a search of MEDLINE, Embase, and the Cochrane Library. Publications comparing any form of high-dose HD with conventional HD were reviewed. RESULTS Seven publications (published between 2003 and 2014) reporting cost-utility analyses from the public healthcare payer perspective were identified. High-dose HD in-centre was compared with in-centre conventional HD in one US model; all other analyses (UK, Canada) compared high-dose HD at home with in-centre conventional HD (n = 5) or in-centre/home conventional HD (n = 1). The time horizon varied from one year to lifetime. Similar survival for high-dose HD and conventional HD was assumed, with the impact of higher survival only assessed in the sensitivity analyses of three models. High-dose HD at home was found to be cost effective compared with conventional HD in all six analyses. The analysis comparing high-dose HD in-centre with conventional in-centre HD produced an incremental cost-effectiveness ratio generally acceptable for the USA, but not for Europe, Canada or Australia. CONCLUSION High-dose HD can be cost effective when performed at home. Future analyses assuming survival benefits for high-dose HD compared with conventional HD are needed.
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Affiliation(s)
- S Laplante
- Baxter Healthcare Corporation, Deerfield, IL, 60015, USA
| | - F X Liu
- Baxter Healthcare Corporation, Deerfield, IL, 60015, USA
| | - B Culleton
- Baxter Healthcare Corporation, Deerfield, IL, 60015, USA
| | - A Bernardo
- Baxter Healthcare Corporation, Deerfield, IL, 60015, USA
| | | | - P Hudson
- Abacus International, Bicester, UK
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Peritoneal dialysis in centenarian patients: no age limitation? J Vasc Access 2016; 17 Suppl 1:S53-5. [PMID: 26951905 DOI: 10.5301/jva.5000499] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2015] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The majority of dialysis patients are elderly, and the trend towards even more elderly people with end-stage renal disease (ESRD) will further determine the dialysis field in the future. METHOD If these elderly ESRD patients do not opt for conservative ESRD care, they may still qualify for peritoneal dialysis (PD), which may be assisted or unassisted. RESULTS Although they may be more frail and have a greater co-morbidity burden compared to their younger counterparts, elderly patients with ESRD may still be able to maintain a good functionality level with adequate quality of life by performing PD, which may be assisted (treatment performed or supported e.g. by partner or nurse) or unassisted (without support). PD may indeed further contribute to maintaining autonomy, and enhance quality of life compared to in-center conventional hemodialysis. In order to illustrate this strategy, we hereby describe a centenarian patient with ESRD who received assisted PD successfully. CONCLUSIONS With appropriate management and infrastructure, (very) high age is not a contra-indication for PD.
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Kramer A, Pippias M, Stel VS, Bonthuis M, Abad Diez JM, Afentakis N, Alonso de la Torre R, Ambuhl P, Bikbov B, Bouzas Caamaño E, Bubic I, Buturovic-Ponikvar J, Caskey FJ, Castro de la Nuez P, Cernevskis H, Collart F, Comas Farnés J, Garcia Bazaga MDLÁ, De Meester J, Ferrer Alamar M, Finne P, Garneata L, Golan E, G Heaf J, Hemmelder M, Ioannou K, Kantaria N, Kolesnyk M, Kramar R, Lassalle M, Lezaic V, Lopot F, Macário F, Magaz A, Martín-Escobar E, Metcalfe W, Ots-Rosenberg M, Palsson R, Piñera Celestino C, Resić H, Rutkowski B, Santiuste de Pablos C, Spustová V, Stendahl M, Strakosha A, Süleymanlar G, Torres Guinea M, Varberg Reisæter A, Vazelov E, Ziginskiene E, Massy ZA, Wanner C, Jager KJ, Noordzij M. Renal replacement therapy in Europe: a summary of the 2013 ERA-EDTA Registry Annual Report with a focus on diabetes mellitus. Clin Kidney J 2016; 9:457-69. [PMID: 27274834 PMCID: PMC4886899 DOI: 10.1093/ckj/sfv151] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 12/11/2015] [Indexed: 12/14/2022] Open
Abstract
Background This article provides a summary of the 2013 European Renal Association–European Dialysis and Transplant Association (ERA-EDTA) Registry Annual Report (available at http://www.era-edta-reg.org), with a focus on patients with diabetes mellitus (DM) as the cause of end-stage renal disease (ESRD). Methods In 2015, the ERA-EDTA Registry received data on renal replacement therapy (RRT) for ESRD from 49 national or regional renal registries in 34 countries in Europe and bordering the Mediterranean Sea. Individual patient data were provided by 31 registries, while 18 registries provided aggregated data. The total population covered by the participating registries comprised 650 million people. Results In total, 72 933 patients started RRT for ESRD within the countries and regions reporting to the ERA-EDTA Registry, resulting in an overall incidence of 112 per million population (pmp). The overall prevalence on 31 December 2013 was 738 pmp (n = 478 990). Patients with DM as the cause of ESRD comprised 24% of the incident RRT patients (26 pmp) and 17% of the prevalent RRT patients (122 pmp). When compared with the USA, the incidence of patients starting RRT pmp secondary to DM in Europe was five times lower and the incidence of RRT due to other causes of ESRD was two times lower. Overall, 19 426 kidney transplants were performed (30 pmp). The 5-year adjusted survival for all RRT patients was 60.9% [95% confidence interval (CI) 60.5–61.3] and 50.6% (95% CI 49.9–51.2) for patients with DM as the cause of ESRD.
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Affiliation(s)
- Anneke Kramer
- Department of Medical Informatics, Academic Medical Center , ERA-EDTA Registry, University of Amsterdam , 1100 DE Amsterdam , The Netherlands
| | - Maria Pippias
- Department of Medical Informatics, Academic Medical Center , ERA-EDTA Registry, University of Amsterdam , 1100 DE Amsterdam , The Netherlands
| | - Vianda S Stel
- Department of Medical Informatics, Academic Medical Center , ERA-EDTA Registry, University of Amsterdam , 1100 DE Amsterdam , The Netherlands
| | - Marjolein Bonthuis
- Department of Medical Informatics, Academic Medical Center , ESPN/ERA-EDTA Registry, Universiteit van Amsterdam , Amsterdam , The Netherlands
| | | | - Nikolaos Afentakis
- Hellenic Renal Registry, Board of Registry, Coordination and Control of RRT , General Hospital of Athens 'G. Gennimatas' , Athens , Greece
| | | | - Patrice Ambuhl
- Swiss Dialysis Registry, Renal Division, Stadtspital Waid Zürich , Zurich , Switzerland
| | - Boris Bikbov
- A.I. Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russian Federation; Department of Nephrology Issues of Transplanted Kidney, Academician V.I. Shumakov Federal Research Center of Transplantology and Artificial Organs, Moscow, Russian Federation
| | | | - Ivan Bubic
- Department of Nephrology, Dialysis and Transplantation, Clinical Hospital Center Rijeka , School of Medicine University of Rijeka , Rijeka , Croatia
| | - Jadranka Buturovic-Ponikvar
- Department of Nephrology, University Medical Center Ljubljana, Ljubljana, Slovenia; Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | | | - Pablo Castro de la Nuez
- Information System of Regional Transplant Coordination in Andalucia (SICATA) , Andalucia , Spain
| | - Harijs Cernevskis
- Department of Internal Medicine , Riga Stradins University , Riga , Latvia
| | | | - Jordi Comas Farnés
- Catalan Renal Registry, Catalan Transplant Organization, Health Department , Generalitat of Catalonia , Barcelona , Spain
| | - Maria de Los Ángeles Garcia Bazaga
- Dirección General de Salud Pública, Servicio Extremeño de Salud , Consejería de Sanidad y Políticas Sociales, Junta de Extremadura , Spain
| | - Johan De Meester
- Department of Nephrology, Dialysis and Hypertension , Dutch-speaking Belgian Renal Registry (NBVN) , Sint-Niklaas , Belgium
| | - Manuel Ferrer Alamar
- Técnico Registro de Enfermos Renales Comunitat Valenciana, Servicio de Estudios Epidemiológicos y Registros Sanitarios, Subdirección General Epidemiología, Dirección General Salut Pública, Consellería Sanitat , Valencian Region , Spain
| | - Patrik Finne
- Abdominal Center, Nephrology and Finnish Registry for Kidney Diseases , Helsinki University Central Hospital , Helsinki , Finland
| | - Liliana Garneata
- "Carol Davila" University of Medicine and Pharmacy , "Dr C Davila" Teaching Hospital of Nephrology, Romanian Renal Registry , Bucharest , Romania
| | - Eliezer Golan
- Department of Nephrology and Hypertension , Meir Medical Center, Kfar-Saba and Sackler Faculty of Medicine , Tel-Aviv , Israel
| | - James G Heaf
- Department of Medicine , Roskilde Hospital, University of Copenhagen , Copenhagen , Denmark
| | - Marc Hemmelder
- Nefrovisie Renine, Dutch Renal Registry , Leiden , The Netherlands
| | - Kyriakos Ioannou
- Nephrology Department , Nicosia General Hospital , Nicosia , Cyprus
| | - Nino Kantaria
- Department of Internal Medicine , Tbilisi State Medical University , Tbilisi , Georgia
| | | | | | | | - Visnja Lezaic
- Department of Nephrology, Clinical Centre of Serbia , Belgrade University , Belgrade , Serbia
| | - Frantisek Lopot
- General University Hospital and 1st Medical Faculty, Department of Medicine , Charles University , Prague - Strahov , Czech Republic
| | - Fernando Macário
- Portuguese Society of Nephrology, Nephrology Department , University Hospital of Coimbra , Coimbra , Portugal
| | - Angela Magaz
- Unidad de Información Sobre Pacientes Renales de la Comunidad Autónoma del País Vasco (UNIPAR) , Basque Country , Spain
| | - Eduardo Martín-Escobar
- Registro Español de Enfermos Renales (REER), Organización Nacional de Trasplantes , Madrid , Spain
| | - Wendy Metcalfe
- Scottish Renal Registry, Meridian Court , Glasgow , Scotland
| | - Mai Ots-Rosenberg
- Department of Internal Medicine , Tartu University , Tartu , Estonia
| | - Runolfur Palsson
- Division of Nephrology, Landspitali - National University Hospital of Iceland, Reykjavik, Iceland; Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | | | - Halima Resić
- Clinic for Hemodialysis, Clinical Center , University of Sarajevo , Sarajevo , Bosnia and Herzegovina
| | - Boleslaw Rutkowski
- Polish Renal Registry, Department of Nephrology, Transplantology and Internal Medicine , Medical University , Gdansk , Poland
| | - Carmen Santiuste de Pablos
- Registro de Enfermos Renales de la Región de Murcia, Servicio de Epidemiología, Consejería de Sanidad , IMIB-Arrixaca , Murcia , Spain
| | | | - Maria Stendahl
- Department of Internal Medicine, Ryhov County Hospital, Jönköping, Sweden; Swedish Renal Registry, Jönköping, Sweden
| | - Ariana Strakosha
- Service of Nephrology, Dialysis and Transplant , University Hospital Center , Tirana , Albania
| | - Gültekin Süleymanlar
- Division of Nephrology, Department of Medicine, Medical School , Akdeniz University , Antalya , Turkey
| | - Marta Torres Guinea
- Registro de Enfermos Renales en Tratamiento Sustitutivo de Castilla-La Mancha , Hospital Virgen de la Salud , Castilla-La Mancha , Spain
| | - Anna Varberg Reisæter
- Norwegian Renal Registry, Renal Unit, Department for Transplant Medicine , Oslo University Hospital, Rikshospitalet , Oslo , Norway
| | - Evgueniy Vazelov
- Dialysis Clinic , "Alexandrovska" University Hospital , Sofia Medical University , Sofia , Bulgaria
| | - Edita Ziginskiene
- Department of Nephrology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania; Lithuanian Nephrology, Dialysis and Transplantation Association, Nephrological Clinic, Hospital of Lithuanian University of Health Sciences Kaunas Clinics, Kaunas, Lithuania
| | - Ziad A Massy
- Division of Nephrology, Ambroise Paré University Hospital, APHP, University of Paris Ouest-Versailles-St-Quentin-en-Yvelines (UVSQ), Boulogne-Billancourt/Paris, France; Institut National de la Santé et de la Recherche Médicale (INSERM) U1018, CESP, Team 5, Villejuif, France
| | - Christoph Wanner
- Division of Nephrology , University Clinic , University of Würzburg , Würzburg , Germany
| | - Kitty J Jager
- Department of Medical Informatics, Academic Medical Center , ERA-EDTA Registry, University of Amsterdam , 1100 DE Amsterdam , The Netherlands
| | - Marlies Noordzij
- Department of Medical Informatics, Academic Medical Center , ERA-EDTA Registry, University of Amsterdam , 1100 DE Amsterdam , The Netherlands
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Effects of CYP3A5 Genetic Polymorphism on the Pharmacokinetics of Tacrolimus in Renal Transplant Recipients. Transplant Proc 2016; 48:81-7. [DOI: 10.1016/j.transproceed.2016.01.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 01/04/2016] [Indexed: 11/17/2022]
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Moura LD, Andrade SSCDA, Malta DC, Pereira CA, Passos JEF. Prevalência de autorrelato de diagnóstico médico de doença renal crônica no Brasil: Pesquisa Nacional de Saúde, 2013. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2015; 18 Suppl 2:181-91. [DOI: 10.1590/1980-5497201500060016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 08/18/2015] [Indexed: 11/22/2022] Open
Abstract
RESUMO: Objetivo: Descrever o perfil dos adultos que referiram diagnóstico médico de doença renal crônica (DRC), segundo variáveis selecionadas. Métodos: Estudo transversal em que foram incluídos indivíduos entrevistados pela Pesquisa Nacional de Saúde de 2013, estudo de base populacional e domiciliar realizado no Brasil, representativo da zona rural e urbana. Foram avaliados 60.202 indivíduos com idade ≥ 18 anos que referiram diagnóstico médico de insuficiência renal crônica ou doença renal. Foi realizada estatística descritiva, incluindo cálculos de prevalências e respectivos intervalos de confiança de 95% (IC95%). Resultados: A prevalência de DRC foi de 1,4% (IC95% 1,3 - 1,6), semelhantes entre os sexos; masculino: 1,4% (IC95% 1,1 - 1,6) e feminino 1,5% ((IC95% 1,3 - 1,7). A região Sul apresentou a maior frequência desse indicador (2,1%; IC95% 1,6 - 2,7). A prevalência de tratamento dialítico dentre as pessoas com diagnóstico médico autorreferido de DRC foi de 7,4% (IC95% 4,4 - 10,3), sendo maior no sexo masculino (12,4%; IC95% 6,5 - 18,3) e não houve diferença entre as faixas etárias e os níveis de escolaridade. DRC foi referida por 8,9% (IC95% 3,5 - 14,3) dos pardos, sem diferença entre as raças/cor da pele. Conclusão: Esses resultados revelam os diversos aspectos da DRC no país. Observou-se que a distribuição foi desigual, onerando principalmente os de menor escolaridade, o que demanda maior investimento em programas de saúde para o enfrentamento dessa enfermidade. Dessa forma, esses dados permitem direcionar o planejamento de políticas públicas voltadas à prevenção dessa doença e à promoção da saúde.
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[Conservative treatment, hemodialysis or peritoneal dialysis for elderly patients: The choice of treatment does not influence the survival]. Nephrol Ther 2015; 12:32-7. [PMID: 26631312 DOI: 10.1016/j.nephro.2015.07.473] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 07/15/2015] [Accepted: 07/15/2015] [Indexed: 11/22/2022]
Abstract
Hemodialysis is the predominant replacement therapy in the 70 year-old French population (18% in peritoneal dialysis, 72% in hemodialysis from the REIN registry). Managing older patients reaching the end stage renal disease poses many ethical questions, since outcomes balanced regarding survival and quality of life. The aim of this study was to compare the survival of patients aged over 70 years according to the ESRD treatment choice: conservative treatment without dialysis (CT), hemodialysis (HD) and peritoneal dialysis (PD). We included all patients over 70 years reaching stade IV CKD integrated in a predialysis information program between 01/01/2005 and 31/12/2010. We compared their survival from the start of their program, in function of their treatment choice: HD, PD or CT. On this period, 148 patients were included, we excluded from analysis 17 patients who had a contraindication to PD, 26 patients who did not make a choice because their kidney function was stabilized, 4 patients lost to follow-up and 12 patients who died before the treatment choice. The average age was 79±6 years, 40% of patients were women, and the mean eGFR was 16±9 mL/min/1.73 m(2) at the entry in the program. Among the 89 patients, 21 choose CT (24%), 68 accepted dialysis (76%), including 48 HD (71%) and 20 PD (29%). No significant eGFR difference at the inclusion time between the groups. The time initiation of dialysis was significantly shorter in the PD group (146 days vs 442 in the HD group; P=0.004). Survival between the groups of patients who accepted or refused dialysis was not statistically different (749 days or 2 years in the HD + PD group vs 562 days, or 1 year and 6 months in the CT group; P=0.95) and between the HD group (760 days or 2 years and 2 months) and the PD group (343 days or 11 months; P=0.32). As measured from the time they entered in the predialysis program, the survival of older patients over 70 years does not seem to depend on their choice of treatment modality. Whether they accepted or refused dialysis, whatever their choice concerning hemodialysis or peritoneal dialysis, their survival was close to one year.
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Otero González A, Iglesias Forneiro A, Camba Caride MJ, Pérez Melón C, Borrajo Prol MP, Novoa Fernández E, Arenas Moncaleano IG, Uribe Moya S, Lagoa Labrador F. Supervivencia en hemodiálisis vs. diálisis peritoneal y por transferencia de técnica. Experiencia en Ourense 1976-2012. Nefrologia 2015; 35:562-6. [DOI: 10.1016/j.nefro.2015.10.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 03/03/2015] [Indexed: 10/22/2022] Open
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Angiotensinogen gene polymorphisms and progression of chronic kidney disease in ADPKD patients. Clin Exp Nephrol 2015; 20:561-568. [DOI: 10.1007/s10157-015-1183-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 10/07/2015] [Indexed: 11/28/2022]
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48
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Hruskova Z, Stel VS, Jayne D, Aasarød K, De Meester J, Ekstrand A, Eller K, Heaf JG, Hoitsma A, Martos Jimenéz C, Ravani P, Wanner C, Tesar V, Jager KJ. Characteristics and Outcomes of Granulomatosis With Polyangiitis (Wegener) and Microscopic Polyangiitis Requiring Renal Replacement Therapy: Results From the European Renal Association–European Dialysis and Transplant Association Registry. Am J Kidney Dis 2015; 66:613-20. [DOI: 10.1053/j.ajkd.2015.03.025] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 03/06/2015] [Indexed: 12/21/2022]
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Do elderly recipients really benefit from kidney transplantation? Transplant Rev (Orlando) 2015; 29:197-201. [DOI: 10.1016/j.trre.2015.09.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 09/14/2015] [Indexed: 01/09/2023]
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Hu W, Hao H, Yu W, Wu X, Zhou H. Association of elevated glycosylated hemoglobin A1c with hyperfiltration in a middle-aged and elderly Chinese population with prediabetes or newly diagnosed diabetes: a cross-sectional study. BMC Endocr Disord 2015; 15:47. [PMID: 26363801 PMCID: PMC4568072 DOI: 10.1186/s12902-015-0043-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 09/04/2015] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND To examine whether elevated glycosylated hemoglobin A1c (HbA1c) is associated with hyperfiltration in a middle-aged and elderly Chinese population. METHODS Anthropometric and biochemical examinations were performed in 2491 individuals from the general population, aged 40-79 years, who participated in the Huaian Diabetes Prevention Program. The estimated glomerular filtration rate (eGFR) was calculated from creatinine levels using the CKD-EPI formula. Hyperfiltration was defined as eGFR >90(th) percentile. RESULTS After adjustment [for age, gender, waistline, body mass index, blood pressure, smoking, alcohol consumption, cholesterol, log(triglycerides), high-density lipoprotein, low-density lipoprotein, serum uric acid, sodium intake, hypertension, and use of angiotensin converting enzyme inhibitors or angiotensin receptor blockers], HbA1c and fasting plasma glucose (FPG) were found to be independently positively associated with eGFR. Additionally, after multivariate adjustment, the odds ratios (95 % CI) for hyperfiltration calculated for a 1-unit increase in HbA1c and FPG were 1.396 (1.089-1.790) and 1.306 (1.117-1.526), respectively. Compared with participants with HbA1c levels <5.7%, the odds ratios (95 % CI) for hyperfiltration were 2.344 (1.025-5.364) in participants with HbA1c levels of 6.21-6.49%, and 2.965 (1.537-5.720) in those with HbA1c levels ≥ 6.5%. CONCLUSION Elevated HbA1c (≥ 6.21%) is associated with an increased odds of hyperfiltration in middle-aged and elderly Chinese. Longitudinal studies are needed to explore whether hyperfiltration increases the odds of diabetic nephropathy in individuals with prediabetes.
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Affiliation(s)
- Wen Hu
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, , Jiangsu Province, China
- Department of Endocrinology and Metabolism, Huai'an Hospital Affiliated to Xuzhou Medical College and Huai'an Second People's Hospital, Huai'an, 223002, China
| | - Hairong Hao
- Department of Endocrinology and Metabolism, Huai'an Hospital Affiliated to Xuzhou Medical College and Huai'an Second People's Hospital, Huai'an, 223002, China
| | - Weinan Yu
- Department of Endocrinology and Metabolism, Huai'an Hospital Affiliated to Xuzhou Medical College and Huai'an Second People's Hospital, Huai'an, 223002, China
| | - Xiaojuan Wu
- Department of Endocrinology and Metabolism, Huai'an Hospital Affiliated to Xuzhou Medical College and Huai'an Second People's Hospital, Huai'an, 223002, China
| | - Hongwen Zhou
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, , Jiangsu Province, China.
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