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Saiki T, Sasaki K, Doi S, Takahashi A, Osaki Y, Ishiuchi N, Maeoka Y, Kawai T, Kawaoka K, Takahashi S, Nagai T, Irifuku T, Nakashima A, Masaki T. Comparison between the 0- and 30-s balloon dilation time in percutaneous transluminal angioplasty for restenosed arteriovenous fistula among hemodialysis patients: a multicenter, prospective, randomized trial (CARP study). Clin Exp Nephrol 2024; 28:647-655. [PMID: 38416340 PMCID: PMC11189949 DOI: 10.1007/s10157-024-02469-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 01/22/2024] [Indexed: 02/29/2024]
Abstract
BACKGROUND This study aims to compare patency rates of the 0- and 30-s (sec) balloon dilation time in hemodialysis (HD) patients with restenosis after percutaneous transluminal angioplasty (PTA). METHODS The patients who underwent PTA within 6 months for failed arteriovenous fistula at the forearm were randomly assigned the 0-s or 30-s dilation time group. Effect of dilation time on the 3- and 6-month patency rates after PTA was examined. RESULTS Fifty patients were enrolled in this study. The 3-month patency rate in the 30-s dilation group was better than that in the 0-s dilation group (P = 0.0050), while the 6-month patency rates did not show a significant difference between the two groups (P = 0.28). Cox's proportional hazard model revealed that 30-s of inflation time (hazard ratio 0.027; P = 0.0072), diameter of the proximal (hazard ratio 0.32; P = 0.031), and dilation pressure (hazard ratio 0.63; P = 0.014) were associated with better 3-month patency. Dilation pressure between previous and present PTA did not differ in the 0-s (P = 0.15) and 30-s dilation groups (P = 0.16). The 6-month patency rate of the present PTA in the 30-s dilation group was higher than that of the previous PTA (P = 0.015). The visual analog scale did not differ between the two groups (P = 0.51). CONCLUSION The presenting data suggest that 30-s dilation potentially results in a better 3-month patency rate than 0-s dilation in HD patients with restenosis after PTA.
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Affiliation(s)
- Tomoki Saiki
- Department of Nephrology, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Kensuke Sasaki
- Department of Nephrology, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
| | - Shigehiro Doi
- Department of Nephrology, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Akira Takahashi
- Department of Nephrology, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Yosuke Osaki
- Department of Nephrology, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Naoki Ishiuchi
- Department of Nephrology, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Yujiro Maeoka
- Department of Nephrology, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | | | | | - Shunsuke Takahashi
- Department of Nephrology, National Hospital Organization Kure Medical Center, Kure, Japan
| | | | - Taisuke Irifuku
- Department of Nephrology, National Hospital Organization Higashihiroshima Medical Center, Higashihiroshima, Japan
| | - Ayumu Nakashima
- Department of Nephrology, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Takao Masaki
- Department of Nephrology, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
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Okada H, Ono A, Tomori K, Inoue T, Hanafusa N, Sakai K, Narita I, Moriyama T, Isaka Y, Fukami K, Itano S, Kanda E, Kashihara N. Development of a prognostic risk score to predict early mortality in incident elderly Japanese hemodialysis patients. PLoS One 2024; 19:e0302101. [PMID: 38603695 PMCID: PMC11008820 DOI: 10.1371/journal.pone.0302101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 03/26/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND Information of short-term prognosis after hemodialysis (HD) introduction is important for elderly patients with chronic kidney disease (CKD) and their families choosing a modality of renal replacement therapy. Therefore, we developed a risk score to predict early mortality in incident elderly Japanese hemodialysis patients. MATERIALS AND METHODS We analyzed data of incident elderly HD patients from a nationwide cohort study of the Japanese Society for Dialysis Therapy Renal Data Registry (JRDR) to develop a prognostic risk score. Candidate risk factors for early death within 1 year was evaluated using multivariate logistic regression analysis. The risk score was developed by summing up points derived from parameter estimate values of independent risk factors. The association between risk score and early death was tested using Cox proportional hazards models. This risk score was validated twice by using an internal validation cohort derived from the JRDR and an external validation cohort collected for this study. RESULTS Using the development cohort (n = 2,000), nine risk factors were retained in the risk score: older age (>85), yes = 2, no = 0; sex, male = 2, female = 0; lower body mass index (<20), yes = 2, no = 0; cancer, yes = 1, no = 0; dementia, yes = 3, no = 0; lower creatinine (<6.5 mg/dL), yes = 1, no = 0; lower albumin (<3.0 g/dL), yes = 3, no = 0; normal or high calcium (≥8.5 mg/dL), yes = 1, no = 0; and higher C reactive protein (>2.0 mg/dL), yes = 2, no = 0. In the internal and external validation cohorts (n = 739, 140, respectively), the medium- and high-risk groups (total score, 6 to 10 and 11 or more, respectively) showed significantly higher risk of early death than the low-risk group (total score, 0 to 5) (p<0.001). CONCLUSION We developed a prognostic risk score predicting early death within 1 year in incident elderly Japanese HD patients, which may help detect elderly patients with a high-risk of early death after HD introduction.
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Affiliation(s)
- Hirokazu Okada
- Department of Nephrology, Saitama Medical University, Irumagun, Japan
| | - Atsushi Ono
- Department of Nephrology, Saitama Medical University, Irumagun, Japan
- Department of Nephrology, SUBARU Health Insurance Association Ota Memorial Hospital, Ota, Japan
| | - Koji Tomori
- Department of Nephrology, Saitama Medical University, Irumagun, Japan
| | - Tsutomu Inoue
- Department of Nephrology, Saitama Medical University, Irumagun, Japan
| | - Norio Hanafusa
- Department of Medicine, Blood Purification, Tokyo Women’s Medical University, Tokyo, Japan
| | - Ken Sakai
- Department of Nephrology, Toho University, Tokyo, Japan
| | - Ichiei Narita
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | | | - Yoshitaka Isaka
- Department of Nephrology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kei Fukami
- Department Medicine, Division of Nephrology, Kurume University School of Medicine, Fukuoka, Japan
| | - Seiji Itano
- Department of Nephrology and Hypertension, Kawasaki Medical School, Kurashiki, Japan
| | - Eiichiro Kanda
- Department of Medical Science, Kawasaki Medical School, Kurashiki, Japan
| | - Naoki Kashihara
- Department of Medical Science, Kawasaki Medical School, Kurashiki, Japan
- Geriatric Medical Center, Kawasaki Medical School, Okayama, Japan
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Okita J, Nakata T, Uchida H, Kudo A, Fukuda A, Ueno T, Tanigawa M, Sato N, Shibata H. Development and validation of a machine learning model to predict time to renal replacement therapy in patients with chronic kidney disease. BMC Nephrol 2024; 25:101. [PMID: 38493099 PMCID: PMC10943785 DOI: 10.1186/s12882-024-03527-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 02/28/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND Predicting time to renal replacement therapy (RRT) is important in patients at high risk for end-stage kidney disease. We developed and validated machine learning models for predicting the time to RRT and compared its accuracy with conventional prediction methods that uses the rate of estimated glomerular filtration rate (eGFR) decline. METHODS Data of adult chronic kidney disease (CKD) patients who underwent hemodialysis at Oita University Hospital from April 2016 to March 2021 were extracted from electronic medical records (N = 135). A new machine learning predictor was compared with the established prediction method that uses the eGFR decline rate and the accuracy of the prediction models was determined using the coefficient of determination (R2). The data were preprocessed and split into training and validation datasets. We created multiple machine learning models using the training data and evaluated their accuracy using validation data. Furthermore, we predicted the time to RRT using a conventional prediction method that uses the eGFR decline rate for patients who had measured eGFR three or more times in two years and evaluated its accuracy. RESULTS The least absolute shrinkage and selection operator regression model exhibited moderate accuracy with an R2 of 0.60. By contrast, the conventional prediction method was found to be extremely low with an R2 of -17.1. CONCLUSIONS The significance of this study is that it shows that machine learning can predict time to RRT moderately well with continuous values from data at a single time point. This approach outperforms the conventional prediction method that uses eGFR time series data and presents new avenues for CKD treatment.
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Affiliation(s)
- Jun Okita
- Department of Endocrinology, Metabolism, Rheumatology and Nephrology, Faculty of Medicine, Oita University, 8795593, 1-1 idaigaoka Hasama-cho, Yufu-shi, Oita-ken, Japan
| | - Takeshi Nakata
- Department of Endocrinology, Metabolism, Rheumatology and Nephrology, Faculty of Medicine, Oita University, 8795593, 1-1 idaigaoka Hasama-cho, Yufu-shi, Oita-ken, Japan.
| | - Hiroki Uchida
- Department of Endocrinology, Metabolism, Rheumatology and Nephrology, Faculty of Medicine, Oita University, 8795593, 1-1 idaigaoka Hasama-cho, Yufu-shi, Oita-ken, Japan
| | - Akiko Kudo
- Department of Endocrinology, Metabolism, Rheumatology and Nephrology, Faculty of Medicine, Oita University, 8795593, 1-1 idaigaoka Hasama-cho, Yufu-shi, Oita-ken, Japan
| | - Akihiro Fukuda
- Department of Endocrinology, Metabolism, Rheumatology and Nephrology, Faculty of Medicine, Oita University, 8795593, 1-1 idaigaoka Hasama-cho, Yufu-shi, Oita-ken, Japan
| | - Tamio Ueno
- Department of Medical Technology and Sciences, School of Health Sciences at Fukuoka, International University of Health and Welfare, Okawa, Japan
| | - Masato Tanigawa
- Department of Biophysics, Faculty of Medicine, Oita University, Oita, Japan
| | - Noboru Sato
- Department of Healthcare AI Data Science, Faculty of Medicine, Oita University, Oita, Japan
| | - Hirotaka Shibata
- Department of Endocrinology, Metabolism, Rheumatology and Nephrology, Faculty of Medicine, Oita University, 8795593, 1-1 idaigaoka Hasama-cho, Yufu-shi, Oita-ken, Japan
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Anzai A, Takaki S, Yokoyama N, Kashiwagi S, Yokose M, Goto T. Creatinine Reduction Ratio Is a Prognostic Factor for Acute Kidney Injury following Cardiac Surgery with Cardiopulmonary Bypass: A Single-Center Retrospective Cohort Study. J Clin Med 2023; 13:9. [PMID: 38202016 PMCID: PMC10779757 DOI: 10.3390/jcm13010009] [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: 10/30/2023] [Revised: 12/16/2023] [Accepted: 12/17/2023] [Indexed: 01/12/2024] Open
Abstract
Acute kidney injury (AKI) after cardiac surgery is a common complication that can lead to death. We previously reported that the creatinine reduction ratio (CRR) serves as a useful prognostic factor for AKI. The primary objective of this study was to determine the predictors of AKI after surgery. The secondary objective was to determine the reliability of the CRR for short- and long-term outcomes. We retrospectively collected information about cardiac surgery patients who underwent cardiopulmonary bypass. Patients were divided into AKI and non-AKI groups based on the AKIN and RIFLE criteria. We analyzed the two groups regarding the preoperative patient data and operative information. The CRR was calculated as follows: (preoperative creatinine-postoperative creatinine)/preoperative creatinine. The prognostic factors of AKI-CS were surgery time, CPB time, aorta clamp time, platelet transfusion, and CRR < 20%. In the multivariate logistical analysis, CRR was an independent predictor of AKI (adjusted odds ratio: 0.90 [0.87-0.93], p < 0.001). However, there were no significant differences in CRR in terms of the rate of new onset chronic kidney disease (CKD). After cardiac surgery with cardiopulmonary bypass, CRR has good diagnostic power for predicting perioperative AKI. However, we cannot use it as a prognostic factor over a long-term period.
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Affiliation(s)
| | - Shunsuke Takaki
- Department of Anesthesiology and Critical Care Medicine, Yokohama City University Hospital, 3-9 Fukuura Kanazawaku, Yokohama 236-0004, Japan; (A.A.)
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Kato K, Nakashima A, Ohkido I, Kasai K, Yokoo T. Association between serum phosphate levels and anemia in non-dialysis patients with chronic kidney disease: a retrospective cross-sectional study from the Fuji City CKD Network. BMC Nephrol 2023; 24:244. [PMID: 37605118 PMCID: PMC10463297 DOI: 10.1186/s12882-023-03298-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 08/14/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND Patients with chronic kidney disease (CKD) present high mortality and morbidity rates despite the availability of various therapies. Although CKD-mineral and bone disorder (MBD) and renal anemia are important factors in patients with CKD, only few studies have analyzed the relationship between them. Therefore, this study aimed to evaluate the relationship between CKD-MBD and anemia in patients with CKD who did not receive erythropoiesis-stimulating agent or iron therapies. METHODS This retrospective cross-sectional study included patients with CKD aged ≥ 20 years with estimated glomerular filtration rate (eGFR) categories G2a to G5 who were referred to the Fuji City General Hospital between April 2018 and July 2019. The exclusion criterion was ongoing treatment for CKD-MBD and/or anemia. RESULTS The data of 300 patients with CKD were analyzed in this study. The median age of patients was 71 (range, 56.5-79) years. The median eGFR was 34 (range, 20-48) mL/min/1.73 m2, and the mean hemoglobin (Hb) level was 12.7 g/dL (standard deviation, 2.3), which decreased as the CKD stage increased. In a multivariate linear regression analysis of anemia-related factors, including age, renal function (eGFR), nutritional status, inflammation, and iron dynamics (serum iron level, total iron-binding capacity, ferritin levels), the serum phosphate levels were significantly associated with the Hb levels (coefficient [95% confidence interval], -0.73 [-1.1, -0.35]; P < 0.001). Subgroup analysis revealed a robust association between serum phosphate levels and Hb levels in the low-ferritin (coefficient [95% confidence interval], -0.94 [-1.53, -0.35]; P = 0.002) and advanced CKD groups (coefficient [95% confidence interval], -0.89 [-1.37, -0.41]; P < 0.001). CONCLUSIONS We found an association between high serum phosphate levels and low Hb levels in patients with CKD not receiving treatment for anemia. These results underscore the possibility of a mechanistic overlap between CKD-MBD and anemia.
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Affiliation(s)
- Kazuhiko Kato
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi Minato-Ku, Tokyo, 105-8461, Japan.
- Department of Internal Medicine, Fuji City General Hospital, Takashima-Cho 50, Fuji-Shi, Shizuoka, Japan.
| | - Akio Nakashima
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi Minato-Ku, Tokyo, 105-8461, Japan
| | - Ichiro Ohkido
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi Minato-Ku, Tokyo, 105-8461, Japan
| | - Kenji Kasai
- Department of Internal Medicine, Fuji City General Hospital, Takashima-Cho 50, Fuji-Shi, Shizuoka, Japan
| | - Takashi Yokoo
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi Minato-Ku, Tokyo, 105-8461, Japan
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Jia X, Tang X, Li Y, Xu D, Moreira P. Update of dialysis initiation timing in end stage kidney disease patients: is it a resolved question? A systematic literature review. BMC Nephrol 2023; 24:162. [PMID: 37286965 DOI: 10.1186/s12882-023-03184-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 04/27/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND The exact optimal timing of dialysis for ESKD patients remains unknown. This study systematically reviewed the available evidence with regard to the optimal initiation of maintenance dialysis in ESKD patients. METHODS An electronic search was performed in Embase, PubMed and the Cochrane Library in order to find studies investigating associations between variables reference to "start of dialysis" and outcomes. Quality assessment and bias assessment were performed by the Newcastle-Ottawa scale and the ROBINSI tool. Due to the heterogeneity of studies, a meta-analysis could not be performed. RESULTS Thirteen studies were included; four studies included only haemodialysis patients, three peritoneal dialysis, six both; study outcomes included mortality, cardiovascular events, technique failure, quality of life and others. Nine studies mainly focused on the optimal GFR of maintenance dialysis initiation; five studies showed none association between GFR and mortality or other adverse outcomes, two studies showed dialysis initiation at higher GFR levels were with poor prognosis, and 2 studies showed higher GFR levels with better prognosis. Three studies paid attention to comprehensive assessment of uremic signs and/or symptoms for optimal dialysis initiation; uremic burden based on 7 uremic indicators (hemoglobin, serum albumin, blood urea nitrogen, serum creatinine, potassium, phosphorus, and bicarbonate) were not associated with mortality; another equation (combination of sex, age, serum creatinine, blood urea nitrogen, serum albumin, haemoglobin, serum phosphorus, diabetes mellitus, and heart failure) based on fuzzy mathematics to assess the timing of haemodialysis initiation was accuracy to prognose 3-year survival; the third study found that volume overload or hypertension was associated with the highest risk for subsequent mortality. Two studies compared urgent or optimal start in dialysis, a study reported increased survival in optimal start patients, another reported no differences between Urgent-Start-PD and Early-Start-PD regarding 6-month outcomes. LIMITATIONS Heterogeneity among the studies was quite high, with differences in sample size, variable and group characteristics; no RCT studies were included, which weakened the strength of evidences. CONCLUSIONS The criteria for dialysis initiation were varied. Most studies proved that GFR at dialysis initiation was not associated with mortality, timing of dialysis initiation should not be based on GFR, assessments of volume load and patient's tolerance to volume overload are prospective approaches.
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Affiliation(s)
- Xiaoyan Jia
- Department of Nephrology, the First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, 250014, China
- Shandong Institute of Nephrology, No.16766 Jingshi Road, Jinan, 250014, China
| | - Xueqing Tang
- Department of Nephrology, the First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, 250014, China
- Shandong Institute of Nephrology, No.16766 Jingshi Road, Jinan, 250014, China
| | - Yunfeng Li
- Department of Nursing, the First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, 250014, China
| | - Dongmei Xu
- Department of Nephrology, the First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, 250014, China.
- Shandong Institute of Nephrology, No.16766 Jingshi Road, Jinan, 250014, China.
| | - Paulo Moreira
- International Healthcare Management Research & Development Centre, Shandong Provincial Qianfoshan Hospital AND Atlantica Instituto Universitario, Gestao em Saude, Oeiras, Portugal, Jinan, 250014, China.
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Referral pattern to nephrologist and prognosis in diabetic kidney disease patients: Single center retrospective cohort study. PLoS One 2023; 18:e0282163. [PMID: 36827357 PMCID: PMC9956043 DOI: 10.1371/journal.pone.0282163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 02/09/2023] [Indexed: 02/26/2023] Open
Abstract
BACKGROUND Management of diabetic kidney disease (DKD) to prevent end-stage kidney disease (ESKD) has become a major challenge for health care professionals. This study aims to investigate the characteristics of patients with DKD when they are first referred to a nephrologist and the subsequent prognoses. METHODS A total of 307 patients who were referred to our department from October 2010 to September 2014 at Osaka General Medical Center were analyzed. Independent risk factors associated with renal replacement therapy (RRT) and cardiovascular composite events (CVE) following their nephrology referral were later identified using Cox proportional hazards analysis. RESULTS Of 307 patients, 26 (8.5%), 67 (21.8%), 134 (43.6%), and 80 (26.1%) patients were categorized as having chronic kidney disease (CKD) stages 3a, 3b, 4, and 5, respectively. The median estimated glomerular filtration rate (eGFR) and urinary protein levels were 22.3 mL/min/1.73 m2 and 2.83 g/gCr, respectively, at the time of the nephrology referral. During the follow-up period (median, 30 months), 121 patients required RRT, and more than half of the patients with CKD stages 5 and 4 reached ESKD within 60 months following their nephrology referral; 30% and <10% of the patients with CKD stages 3b and 3a, respectively, required RRT within 60 months following their nephrology referral. CONCLUSION Patients with DKD were referred to nephrologist at CKD stage 4. Although almost half of the patients with CKD stage 5 at the time of nephrology referral required RRT within one-and-a-half years after the referral, kidney function of patients who were referred to nephrologist at CKD stage 3 and 4 were well preserved.
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The Characteristics of Dialysis Membranes: Benefits of the AN69 Membrane in Hemodialysis Patients. J Clin Med 2023; 12:jcm12031123. [PMID: 36769771 PMCID: PMC9917867 DOI: 10.3390/jcm12031123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/11/2023] [Accepted: 01/18/2023] [Indexed: 02/04/2023] Open
Abstract
Patients undergoing hemodialysis (HD) experience serious cardiovascular complications, through malnutrition, inflammation, and atherosclerosis. Amputation for peripheral arterial disease (PAD) is more prevalent in patients undergoing HD than in the general population. In addition, revascularization procedures in dialysis patients are often associated with subsequent amputation and high mortality rates. To improve the prognosis of dialysis patients, malnutrition and inflammation must be properly treated, which necessitates a better understanding of the characteristics of dialysis membranes. Herein, the characteristics of several dialysis membranes were studied, with a special reference to the AN69 membrane, noting several similarities to low-density lipoprotein (LDL)-apheresis, which is also applicable for the treatment of PAD. Both systems (LDL-apheresis and AN69) have anti-inflammatory and anti-thrombogenic effects because they use a negatively charged surface for extracorporeal adsorptive filtration from the blood/plasma, and contact phase activation. The concomitant use of both these therapeutic systems may have additive therapeutic benefits in HD patients. Here, we reviewed the characteristics of dialysis membranes and benefits of the AN69 membrane in dialysis patients.
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Kano T, Io H, Nakata J, Sasaki Y, Muto M, Shimizu Y, Fukao Y, Fukuzaki H, Maeda T, Hosoya R, Suzuki Y. Impact of Transferrin Saturation and Anemia on Radial Artery Calcification in Patients with End-Stage Kidney Disease. Nutrients 2022; 14:nu14204269. [PMID: 36296953 PMCID: PMC9606998 DOI: 10.3390/nu14204269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 10/10/2022] [Accepted: 10/11/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Arterial calcification is an important factor in determining the prognosis of patients with chronic kidney disease (CKD). Few studies on aortic calcification have involved radial artery calcification (RAC). This study aimed to analyze risk factors for RAC in patients with end-stage kidney disease (ESKD) and investigate the relationship between subsequent cardiovascular events (CVE) and vascular access trouble (VAT). Methods: This cohort study included 64 consecutive patients with ESKD who initiated hemodialysis and underwent a procedure for the creation of a primary radiocephalic arteriovenous fistula (RCAVF). Small arterial specimens were obtained from patients during RCAVF surgery. Tissue samples were stained with von Kossa, and arterial microcalcification was evaluated. We analyzed the association between preexisting arterial microcalcifications, clinical characteristics, CVE, and VAT. Results: In the univariate analysis, RAC patients demonstrated high systolic blood pressure (sBP), low hemoglobin (Hb), and low transferrin saturation (TSAT) (<0.05, <0.05, and <0.05, respectively). In the multivariate analysis, Hb (HR−0.516 (0.278−0.959), p < 0.05), TSAT (HR−0.0012 (0.00000248−0.597), p < 0.05), and sBP (HR−1.037 (1.001−1.073), p < 0.05) were independent risk factors for RAC. The cumulative incidence rate of CVE/VAT was not associated with RAC for one year. Conclusion: RAC was associated with sBP, TSAT, and anemia; however, no association with CVE/VAT was observed.
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Affiliation(s)
- Toshiki Kano
- Department of Nephrology, Juntendo University Nerima Hospital, Tokyo 177-8521, Japan
| | - Hiroaki Io
- Department of Nephrology, Juntendo University Nerima Hospital, Tokyo 177-8521, Japan
- Correspondence: ; Tel.: +81-3-5923-3111
| | - Junichiro Nakata
- Department of Nephrology, Juntendo University Faculty of Medicine, Tokyo 113-8421, Japan
| | - Yu Sasaki
- Department of Nephrology, Juntendo University Nerima Hospital, Tokyo 177-8521, Japan
| | - Masahiro Muto
- Department of Nephrology, Juntendo University Nerima Hospital, Tokyo 177-8521, Japan
| | - Yuki Shimizu
- Department of Nephrology, Juntendo University Faculty of Medicine, Tokyo 113-8421, Japan
| | - Yusuke Fukao
- Department of Nephrology, Juntendo University Nerima Hospital, Tokyo 177-8521, Japan
| | - Haruna Fukuzaki
- Department of Nephrology, Juntendo University Faculty of Medicine, Tokyo 113-8421, Japan
| | - Takuya Maeda
- Department of Nephrology, Juntendo University Faculty of Medicine, Tokyo 113-8421, Japan
| | - Reina Hosoya
- Department of Nephrology, Juntendo University Nerima Hospital, Tokyo 177-8521, Japan
| | - Yusuke Suzuki
- Department of Nephrology, Juntendo University Faculty of Medicine, Tokyo 113-8421, Japan
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Views and practices of renal nurses in monitoring residual renal function for haemodialysis patients. Collegian 2022. [DOI: 10.1016/j.colegn.2022.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Tsuji K, Kitamura M, Chiba K, Muta K, Yokota K, Okazaki N, Osaki M, Mukae H, Nishino T. Comparison of bone microstructures via high-resolution peripheral quantitative computed tomography in patients with different stages of chronic kidney disease before and after starting hemodialysis. Ren Fail 2022; 44:381-391. [PMID: 35220856 PMCID: PMC8890516 DOI: 10.1080/0886022x.2022.2043375] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Chronic kidney disease (CKD) negatively affects bone strength; however, the osteoporotic conditions in patients with CKD are not fully understood. Moreover, the changes in bone microstructure between pre-dialysis and dialysis are unknown. High-resolution peripheral quantitative computed tomography (HR-pQCT) reveals the three-dimensional microstructures of the bone. We aimed to evaluate bone microstructures in patients with different stages of CKD. This study included 119 healthy men and 40 men admitted to Nagasaki University Hospital for inpatient education or the initiation of hemodialysis. The distal radius and tibia were scanned with HR-pQCT. Patient clinical characteristics and bone microstructures were evaluated within 3 months of initiation of hemodialysis (in patients with CKD stage 5 D), patients with CKD stage 4–5, and healthy volunteers. Cortical bone parameters were lower in the CKD group than in healthy controls. Tibial cortical and trabecular bone parameters (cortical thickness, cortical area, trabecular volumetric bone mineral density, trabecular-bone volume fraction, and trabecular thickness) differed between patients with CKD stage 5 D and those with CKD stage 4–5 (p < 0.01). These differences were also observed between patients with CKD stage 5 and those with CKD stage 5 D (p < 0.017), but not between patients with CKD stage 4 and those with CKD stage 5, suggesting that the bone microstructure rapidly changed at the start of hemodialysis. Patients with CKD stage 5 D exhibited tibial microstructural impairment compared with those with CKD stage 4–5. HR-pQCT is useful for elucidation of the pathology of bone microstructures in patients with renal failure.
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Affiliation(s)
- Kiyokazu Tsuji
- Department of Nephrology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Mineaki Kitamura
- Department of Nephrology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Ko Chiba
- Department of Orthopedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Kumiko Muta
- Department of Nephrology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Kazuaki Yokota
- Department of Orthopedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Narihiro Okazaki
- Department of Orthopedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Makoto Osaki
- Department of Orthopedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Hiroshi Mukae
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Tomoya Nishino
- Department of Nephrology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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12
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Steinwandel U, Davies H, Gibson N. Haemodiafiltration and haemodialysis should be reported separately by kidney replacement therapy registries. Clin Kidney J 2022; 15:1211-1212. [PMID: 35664284 PMCID: PMC9155220 DOI: 10.1093/ckj/sfac039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Indexed: 11/29/2022] Open
Affiliation(s)
- Ulrich Steinwandel
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia
| | - Hugh Davies
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia
| | - Nick Gibson
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia
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13
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Steinwandel U, Kheirkhah H, Davies H. Residual Renal Function - How Fast Does the Residual Urine Output Function Decline in the First Year of Haemodialysis? - A Scoping Review. FRONTIERS IN NEPHROLOGY 2022; 1:808909. [PMID: 37674814 PMCID: PMC10479663 DOI: 10.3389/fneph.2021.808909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 12/23/2021] [Indexed: 09/08/2023]
Abstract
Background Haemodialysis is the most common treatment method in Australia for individuals requiring renal replacement therapy. Although it is known that the residual renal function in these patients has many advantages for their overall health outcomes and that the residual urine volume production is also declining over time, it is unknown how fast this functional decline occurs when patients are embarking on their first year on haemodialysis. Aim This scoping review sought to determine if the functional decline in renal residual function in the first year of haemodialysis has been previously investigated, documented or quantified. Method The scoping review was performed using variety of nursing and medical databases comprising MEDLINE, Embase, Web of Science and CINAHL Plus with Full Text. Results The decline of renal residual function in patients on Peritoneal dialysis over the first year of treatment has previously been described, but not in detail for patients receiving haemodialysis. There is a paucity of knowledge how fast residual urine production can decline in patients receiving haemodialysis during their first year of treatment. A PRISMA checklist has been used to validate the results of this scoping review. Conclusions The extended preservation of renal residual function in patients on haemodialysis is crucial for their survival and may have a positive impact on their quality of life. An observational study is needed to examine how fast the functional decrease of the residual urine production function within patients receiving haemodialysis generally occurs. This information could prove to be useful in the context of treatment goals and could inform clinical practice.
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Affiliation(s)
- Ulrich Steinwandel
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, WA, Australia
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14
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Kubo S, Noda T, Myojin T, Nishioka Y, Kanno S, Higashino T, Nishimoto M, Eriguchi M, Samejima K, Tsuruya K, Imamura T. Tracing all patients who received insured dialysis treatment in Japan and the present situation of their number of deaths. Clin Exp Nephrol 2022; 26:360-367. [PMID: 34973086 PMCID: PMC8930944 DOI: 10.1007/s10157-021-02163-z] [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: 05/01/2021] [Accepted: 11/17/2021] [Indexed: 11/29/2022]
Abstract
Background The survival rate of chronic dialysis patients in Japan remains the highest worldwide, so there is value in presenting Japan’s situation internationally. We examined whether aggregate figures on dialysis patients in the National Database of Health Insurance Claims and Special Health Checkups of Japan (NDB), which contains data on insured procedures of approximately 100 million Japanese residents, complement corresponding figures in the Japanese Society for Dialysis Therapy Renal Data Registry (JRDR). Methods Subjects were patients with medical fee points for dialysis recorded in the NDB during 2014–2018. We analyzed annual numbers of dialysis cases, newly initiated dialysis cases– and deaths. Results Compared with the JRDR, the NDB had about 6–7% fewer dialysis cases but a similar number of newly initiated dialysis cases. In the NDB, the number of deaths was about 6–10% lower, and the number of hemodialysis cases was lower, while that of peritoneal dialysis cases was higher. The cumulative survival rate at dialysis initiation was approximately 6 percentage points lower in the NDB than in the JRDR, indicating that some patients die at dialysis initiation. Cumulative survival rate by age group was roughly the same between the NDB and JRDR in both sexes. Conclusion The use of the NDB enabled us to aggregate data of dialysis patients. With the definition of dialysis patients used in this study, analyses of concomitant medications, comorbidities, surgeries, and therapies will become possible, which will be useful in many future studies. Supplementary Information The online version contains supplementary material available at 10.1007/s10157-021-02163-z.
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Affiliation(s)
- Shinichiro Kubo
- Department of Public Health, Health Management and Policy, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8521, Japan
| | - Tatsuya Noda
- Department of Public Health, Health Management and Policy, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8521, Japan.
| | - Tomoya Myojin
- Department of Public Health, Health Management and Policy, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8521, Japan
| | - Yuichi Nishioka
- Department of Public Health, Health Management and Policy, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8521, Japan
| | - Saho Kanno
- Department of Public Health, Health Management and Policy, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8521, Japan
| | - Tsuneyuki Higashino
- Management Innovation Division, Mitsubishi Research Institute, Inc, 10-3, Nagatacho 2-Chome, Chiyoda-Ku, Tokyo, 100-8141, Japan
| | - Masatoshi Nishimoto
- Department of Nephrology, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8521, Japan
| | - Masahiro Eriguchi
- Department of Nephrology, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8521, Japan
| | - Kenichi Samejima
- Department of Nephrology, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8521, Japan
| | - Kazuhiko Tsuruya
- Department of Nephrology, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8521, Japan
| | - Tomoaki Imamura
- Department of Public Health, Health Management and Policy, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8521, Japan
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15
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Jung JY, Yoo KD, Kang E, Kang HG, Kim SH, Kim H, Kim HJ, Park TJ, Suh SH, Jeong JC, Choi JY, Hwang YH, Choi M, Kim YL, Oh KH. Korean Society of Nephrology 2021 Clinical Practice Guideline for Optimal Hemodialysis Treatment. Kidney Res Clin Pract 2021; 40:S1-S37. [PMID: 34923803 PMCID: PMC8694695 DOI: 10.23876/j.krcp.21.600] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 10/19/2021] [Indexed: 01/06/2023] Open
Affiliation(s)
- Ji Yong Jung
- Division of Nephrology, Department of Internal Medicine, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Kyung Don Yoo
- Division of Nephrology, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Eunjeong Kang
- Division of Nephrology, Department of Internal Medicine, Ewha Womans University Seoul Hospital, Ewha Womans College of Medicine, Seoul, Republic of Korea
| | - Hee Gyung Kang
- Division of Pediatric Nephrology, Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Republic of Korea
| | - Su Hyun Kim
- Division of Nephrology, Department of Internal Medicine, Chung-Ang University Hospital, Seoul, Republic of Korea
| | - Hyoungnae Kim
- Division of Nephrology, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
| | - Hyo Jin Kim
- Division of Nephrology, Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea
| | - Tae-Jin Park
- Asan Jin Internal Medicine Clinic, Seoul, Republic of Korea
| | - Sang Heon Suh
- Division of Nephrology, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Jong Cheol Jeong
- Division of Nephrology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Ji-Young Choi
- Division of Nephrology, Department of Internal Medicine, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea
| | | | - Miyoung Choi
- Division for Healthcare Technology Assessment Research, National Evidence-Based Healthcare Collaborating Agency, Seoul, Republic of Korea
| | - Yae Lim Kim
- Department of Biostatistics, Korea University College of Medicine, Seoul, Republic of Korea
| | - Kook-Hwan Oh
- Division of Nephrology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
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16
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Taira H, Noguchi H, Ueki K, Kaku K, Tsuchimoto A, Okabe Y, Ohya Y, Nakamura M. Initiation of dialysis for kidney graft failure: A retrospective single-center cohort study. Ther Apher Dial 2021; 26:806-814. [PMID: 34779578 DOI: 10.1111/1744-9987.13756] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 04/22/2021] [Accepted: 10/26/2021] [Indexed: 11/30/2022]
Abstract
Few studies have focused on the outcome of dialysis for kidney graft failure. We investigated the outcomes of dialysis for graft failure. We retrospectively studied 52 patients undergoing dialysis for graft failure at our facility from January 2004 to December 2018. The mean age at initiation of dialysis was 51.8 ± 13.5 years. The patient survival rates after initiation of dialysis at 1, 3, and 5 years were 96.0%, 93.8%, and 82.4%, respectively. The rate of unplanned initiation was 44.2%. In multivariate logistic analysis, lack of follow-up by nephrologists and pre-emptive kidney transplantation (PEKT) tended to be risk factors for unplanned initiation (P = 0.065 and P = 0.014, respectively). Our study suggests that the prognosis of patients with dialysis for graft failure is acceptable. Dialysis for graft failure, especially in patients with PEKT, tends to be unplanned, and for safe initiation, early involvement of nephrologists may be necessary.
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Affiliation(s)
- Hirona Taira
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Department of Cardiovascular Medicine, Nephrology and Neurology, Graduate School of Medicine, University of the Ryukyus, Nishihara, Okinawa, Japan
| | - Hiroshi Noguchi
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kenji Ueki
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Keizo Kaku
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Akihiro Tsuchimoto
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yasuhiro Okabe
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yusuke Ohya
- Department of Cardiovascular Medicine, Nephrology and Neurology, Graduate School of Medicine, University of the Ryukyus, Nishihara, Okinawa, Japan
| | - Masafumi Nakamura
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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17
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Zaki HM, Sliem HA, Ibrahim HR, Yassine IA. Silent neurological lesions detected by magnetic resonance imaging: Relationship to hyperparathyroidism among end-stage renal disease young patients on haemodialysis. Int J Clin Pract 2021; 75:e14569. [PMID: 34165847 DOI: 10.1111/ijcp.14569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 06/23/2021] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND End-stage renal disease (ESRD) patients on haemodialysis (HD) suffer from several peripheral and central neurological complications. They are at high risk for developing silent neurological lesions (SNL) that may be detected accidentally by magnetic resonance imaging (MRI). Many factors are implicated in the development of neurological deficits in ESRD patients on HD. AIM OF THE WORK Evaluation of SNL in young ESRD patients by using MRI and assessing its correlation with hyperparathyroidism. METHODS The study involved 48 young ESRD patients (mean age of 19.6 ± 6 years) with HD and do not have any apparent abnormalities in the neurological examination. Laboratory investigations and conventional brain MRI were done on all. RESULTS 79.2% have SBI and 45.8% have white matter lesions. Regression analysis revealed that calcium level and duration of dialysis were independent predictor factors for the presence of silent brain MRI lesions (P = .034 & 0.045 respectively). ROC curve showed that parathyroid hormone (PTH) level >585 pg/mL, duration of dialysis >2 years, and calcium level >7.5 mg/dL predicted the presence of SNL. CONCLUSION The duration of HD and hyperparathyroidism (HPT) were independent predictors for the presence of SNL. MRI brain is considered as a mandatory affordable tool for HD patients >2 years and has HPT for early detection of SNL to help early intervention and avoid neurological complications and disabilities.
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Affiliation(s)
- Heba M Zaki
- Department of Internal Medicine, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Hamdy A Sliem
- Department of Internal Medicine, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Heba R Ibrahim
- Department of Diagnostic Radiology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Imane A Yassine
- Department of Neurology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
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18
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Abe M, Masakane I, Wada A, Nakai S, Nitta K, Nakamoto H. Super high-flux membrane dialyzers improve mortality in patients on hemodialysis: a 3-year nationwide cohort study. Clin Kidney J 2021; 15:473-483. [PMID: 35211304 PMCID: PMC8862063 DOI: 10.1093/ckj/sfab177] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Indexed: 12/03/2022] Open
Abstract
Introduction In Japan, dialyzers are classified based on β2-microglobulin clearance. Type I dialyzers are classified as low-flux dialyzers (<10 mL/min clearance), type II and III as high-flux dialyzers (≥10 to <30 mL/min and ≥30 to <50 mL/min clearance, respectively), and type IV and V as super high-flux dialyzers (≥50 to <70 mL/min and ≥70 mL/min clearance, respectively). Super high-flux dialyzers are commonly used, but their superiority over low-flux dialyzers is controversial. Methods In this nationwide prospective cohort study, we analyzed Japanese Society for Dialysis Therapy Renal Data Registry data collected at the end of 2008 and 2011. We enrolled 242,467 patients on maintenance hemodialysis and divided them into five groups by dialyzer type. We assessed the associations of each dialyzer type with 3-year all-cause mortality using Cox proportional hazards models and performed propensity score matching analysis, adjusting for potential confounders. Results By the end of 2011, 53,172 (21.9%) prevalent dialysis patients had died. Mortality significantly decreased according to dialyzer type. Hazard ratios (HRs) were significantly higher for type I, II and III compared with type IV (reference) after adjustment for basic factors and further adjustment for dialysis-related factors. HR was significantly higher for type I, but significantly lower for type V, after further adjustment for nutrition- and inflammation-related factors. These significant findings were also evident after propensity score matching. Conclusions Hemodialysis using super high-flux dialyzers might reduce mortality. Randomized controlled trials are warranted to clarify whether these type V dialyzers can improve prognosis.
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Affiliation(s)
- Masanori Abe
- The Committee of Renal Data Registry, Japanese Society for Dialysis Therapy, Tokyo, Japan
- Division of Nephrology, Hypertension and Endocrinology, Department of Internal Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Ikuto Masakane
- The Committee of Renal Data Registry, Japanese Society for Dialysis Therapy, Tokyo, Japan
- Yabuki Hospital, Yamagata, Japan
| | - Atsushi Wada
- The Committee of Renal Data Registry, Japanese Society for Dialysis Therapy, Tokyo, Japan
- Department of Nephrology, Kitasaito Hospital, Asahikawa, Japan
| | - Shigeru Nakai
- The Committee of Renal Data Registry, Japanese Society for Dialysis Therapy, Tokyo, Japan
- Department of Clinical Engineering, Fujita Health University, Aichi, Japan
| | - Kosaku Nitta
- The Committee of Renal Data Registry, Japanese Society for Dialysis Therapy, Tokyo, Japan
- Department of Nephrology, Tokyo Women's Medical University, Tokyo, Japan
| | - Hidetomo Nakamoto
- The Committee of Renal Data Registry, Japanese Society for Dialysis Therapy, Tokyo, Japan
- Department of General Internal Medicine, Saitama Medical University, Saitama, Japan
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19
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Oba M, Minakuchi H, Yoshida T. Prevalence of diarrhea in end-stage renal disease patients initiating hemodialysis. RENAL REPLACEMENT THERAPY 2021. [DOI: 10.1186/s41100-021-00358-4] [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
Abstract
Background
Diarrhea is one of the symptoms occasionally seen in patients initiating hemodialysis. When they have diarrhea, they need several additional cares for defecation during the hemodialysis sessions and for infection control at dialysis facilities.
Methods
We retrospectively examined the prevalence and the characteristics of the patients with diarrhea initiating hemodialysis. Data were collected from medical records.
Results
Of 243 patients who initiated hemodialysis therapy, 46 patients (19%) had diarrhea. The age, gender, and etiology of end-stage renal disease did not differ between the patients with diarrhea and those without diarrhea. Body weight in the patients with diarrhea was lighter than those without diarrhea. The prevalence of concomitant diseases, such as cardiovascular diseases, malignancies, and diabetes, was not different between the groups, whereas the patients with diarrhea were complicated more frequently with infectious diseases. Antibiotics and steroids had been used more frequently in the patients with diarrhea (59% and 26%, respectively) than those without diarrhea (10% and 10%, respectively). Inflammatory markers, such as white blood cell numbers, C-reactive protein levels, and body temperature, were significantly higher in the patients with diarrhea. Serum levels of total protein, albumin, and creatinine were significantly lower in the patients with diarrhea, while urea nitrogen levels did not differ between the groups.
Conclusion
Results of the present study showed, for the first time, that 19% of the patients initiating hemodialysis had diarrhea and suggest that incident hemodialysis patients with infectious diseases and those under treatment with antibiotics and/or steroids are high-risk for diarrhea.
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20
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Iida O, Takahara M, Mano T. Evidence-Experience Gap and Future Perspective on the Treatment of Peripheral Artery Disease. J Atheroscler Thromb 2021; 28:1251-1259. [PMID: 34078765 PMCID: PMC8629708 DOI: 10.5551/jat.rv17058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Peripheral artery disease (PAD) is a systemic disease associated with impaired limb function, poor quality of life, and increased cardiovascular morbidity. Its incidence has been dramatically increasing over years because of the emergence of an aging society and the increase in the number of patients with atherosclerotic risk factors. The clustering of these risk factors promotes disease development, reportedly leading to the differential location of atherosclerotic lesions in lower extremity arteries. The clinical presentations of PAD include intermittent claudication and chronic limb-threatening ischemia (CLTI). PAD is associated with a high risk of mortality and morbidity from both cardiovascular and limb events. The therapeutic goals for patients with PAD include 1) relief from PAD-related limb symptoms, 2) the prevention of new-onset and the development and recurrence of PAD, and 3) the prevention of concomitant adverse events due to coronary artery disease (CAD) and cerebrovascular disease (CVD). There are several types of antithrombotic agents, and their main role in patients with PAD is to reduce systemic events mainly including cardiovascular and lower extremity-related events. Currently, the efficacy of direct oral anticoagulant (DOAC) is also suggested by recent clinical trials. Although endovascular therapy (EVT) has been a first-line revascularization strategy for symptomatic PAD, whether clinical outcomes after EVT are comparable to those after surgical bypass therapy remains inconclusive.
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Affiliation(s)
- Osamu Iida
- Cardiovascular Center, Kansai Rosai Hospital
| | - Mitsuyoshi Takahara
- Department of Diabetes Care Medicine, Osaka University Graduate School of Medicine
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21
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Yilmaz U, Unal A, Gul S, Demirtas G, Inci A, Sahinturk Y. Using two-holed needles for both arterial and venous accesses to the arteriovenous fistula to improve flow during hemodialysis. Ther Apher Dial 2021; 26:191-196. [PMID: 34018667 DOI: 10.1111/1744-9987.13689] [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: 04/17/2021] [Revised: 05/08/2021] [Accepted: 05/19/2021] [Indexed: 11/27/2022]
Abstract
This prospective study compared methods using both arterial and venous needles with back eyes with those using only arterial needle with back eye for arteriovenous fistula cannulation. Sixty-one patients receiving hemodialysis (HD) via an arteriovenous fistula were evaluated. All patients underwent arteriovenous fistula puncture using only arterial needle with back eye in first 3 months and both arterial and venous needles with back eyes in following 3 months. Arterial and venous pressures, blood flow velocities, total blood volume cleared, and Kt/V values were compared. Mean blood flow velocity, arterial pressure, Kt/V, and cleared total blood volume values were higher and venous pressure was lower in patients who underwent cannulation using both needles with back eyes than in those with only the arterial needle with back eye. For arteriovenous fistula cannulation, using both arterial and venous needles with back eyes provides adequate HD more successfully.
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Affiliation(s)
- Ustun Yilmaz
- Department of Nephrology, University of Health Sciences, Antalya Training and Research Hospital, Antalya, Turkey
| | - Aysun Unal
- Department of Nephrology, University of Health Sciences, Antalya Training and Research Hospital, Antalya, Turkey
| | - Semih Gul
- Department of Nephrology, University of Health Sciences, Antalya Training and Research Hospital, Antalya, Turkey
| | - Gulay Demirtas
- Department of Nephrology, University of Health Sciences, Antalya Training and Research Hospital, Antalya, Turkey
| | - Ayca Inci
- Department of Nephrology, University of Health Sciences, Antalya Training and Research Hospital, Antalya, Turkey
| | - Yasin Sahinturk
- Department of Internal Medicine, University of Health Sciences, Antalya Training and Research Hospital, Antalya, Turkey
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22
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Aono T, Shinya Y, Miyawaki S, Sugiyama T, Kumagai I, Takenobu A, Shin M, Saito N, Teraoka A. Changes in the Risk of Stroke in Dialysis Patients: A Retrospective Analysis over the Last 40 Years. Toxins (Basel) 2021; 13:350. [PMID: 34068165 PMCID: PMC8170903 DOI: 10.3390/toxins13050350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 05/06/2021] [Accepted: 05/11/2021] [Indexed: 11/17/2022] Open
Abstract
The stroke incidence in hemodialysis (HD) patients is high, but the associated factors remain largely unknown. This study aimed to analyze stroke incidence in HD patients and changes in risk factors. Data of 291 patients were retrospectively analyzed. The cumulative stroke incidences were 21.6% at 10 years and 31.5% at 20. Diabetic nephropathy (DN) significantly increased overall stroke (hazard ratio (HR), 2.24; 95% confidence interval (CI), 1.21-4.12; p = 0.001) and ischemic stroke (HR, 2.16; 95% CI, 1.00-4.64; p = 0.049). Patients treated with online HDF were less likely to have overall stroke (HR, 0.13; 95% CI, 0.03-0.56; p = 0.006) and ischemic stroke (HR, 0.08; 95% CI, 0.01-0.60; p = 0.014). DN (HR, 1.56; 95% CI, 1.08-2.27; p = 0.019) and age >80 years at HD initiation (20-49 years old; HR 0.13, 95% CI, 0.05-0.35, p < 0.001 and age 50-79 years; HR 0.42, 95% CI, 0.26-0.66, p < 0.001 (reference: age >80 years)) were significantly associated with stroke and/or death events. Over time, stroke risk increased in HD patients, due to the increasing number of DN. Although dialysis technology has advanced over time, these advances could not overcome other risk factors for stroke. Further increase in stroke and mortality due to aging remains a concern.
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Affiliation(s)
- Toshiya Aono
- Department of Neurosurgery, Teraoka Memorial Hospital, Hiroshima 729-3103, Japan; (T.A.); (A.T.); (A.T.)
| | - Yuki Shinya
- Department of Neurosurgery, Teraoka Memorial Hospital, Hiroshima 729-3103, Japan; (T.A.); (A.T.); (A.T.)
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo 113-8655, Japan; (S.M.); (M.S.); (N.S.)
| | - Satoru Miyawaki
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo 113-8655, Japan; (S.M.); (M.S.); (N.S.)
| | - Takehiro Sugiyama
- Diabetes and Metabolism Information Center, Research Institute, National Center for Global Health and Medicine, Tokyo 162-8655, Japan;
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Ibaraki 305-8575, Japan
| | - Isao Kumagai
- Department of Nephrology, Teraoka Memorial Hospital, Hiroshima 729-3103, Japan;
| | - Atsumi Takenobu
- Department of Neurosurgery, Teraoka Memorial Hospital, Hiroshima 729-3103, Japan; (T.A.); (A.T.); (A.T.)
| | - Masahiro Shin
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo 113-8655, Japan; (S.M.); (M.S.); (N.S.)
| | - Nobuhito Saito
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo 113-8655, Japan; (S.M.); (M.S.); (N.S.)
| | - Akira Teraoka
- Department of Neurosurgery, Teraoka Memorial Hospital, Hiroshima 729-3103, Japan; (T.A.); (A.T.); (A.T.)
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Bozorgmehri S, Aboud H, Chamarthi G, Liu IC, Tezcan OB, Shukla AM, Kazory A, Rupam R, Segal MS, Bihorac A, Mohandas R. Association of early initiation of dialysis with all-cause and cardiovascular mortality: A propensity score weighted analysis of the United States Renal Data System. Hemodial Int 2021; 25:188-197. [PMID: 33644974 DOI: 10.1111/hdi.12912] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 12/15/2020] [Accepted: 01/30/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Early initiation of maintenance hemodialysis has been associated with excess mortality in some studies, but the effects on cardiovascular (CV) mortality has not been studied. Moreover, whether the increased mortality is due to co-morbidities or early initiation of dialysis is unclear. We used a propensity score weighted analysis of the United States Renal Data System (USRDS) to examine how the estimated glomerular filtration rate (eGFR) at initiation of dialysis affects total and CV mortality. METHODS Association between tertiles of eGFR at initiation of hemodialysis and all-cause and CV mortality were assessed in 676,196 adult patients who initiated hemodialysis between 2006 and 2014, using inverse probability of treatment weighting (IPTW) weighted multivariable regression models. RESULTS The intermediate (eGFR 8.7 to <13.0 mL/min) and early start groups (eGFR ≥13.0 mL/min) had a 42% and 93% increased all-cause mortality, respectively compared to late (eGFR < 8.7), start group (unadjusted hazard ratio (HR) = 1.42; 95% CI, 1.41-1.43 and HR = 1.93; 95%CI, 1.91-1.94, respectively). This association was attenuated but remained significant in propensity weighted multivariable analysis (adjusted HR = 1.13; 95%CI, 1.12-1.14 for intermediate and HR = 1.37; 95%CI, 1.36-1.39, for early start, respectively). The CV mortality was similarly increased (adjusted HR = 1.08; 95%CI, 1.07-1.10 and HR = 1.23; 95%CI, 1.21-1.24, for intermediate and early start, respectively). In patients with cystic kidney disease, all-cause mortality was increased with early start, but there were no differences in CV mortality between groups. CONCLUSIONS Early initiation of dialysis is associated with increased all-cause and CV mortality. Our observations support delaying hemodialysis according to the eGFR values.
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Affiliation(s)
- Shahab Bozorgmehri
- Division of Nephrology, Hypertension & Transplantation, University of Florida, Gainesville, Florida, USA
| | - Hussain Aboud
- Division of Nephrology, Hypertension & Transplantation, University of Florida, Gainesville, Florida, USA.,Department of Neurology, University of Chicago, Chicago, Illinois, USA
| | - Gajapathiraju Chamarthi
- Division of Nephrology, Hypertension & Transplantation, University of Florida, Gainesville, Florida, USA
| | - I-Chia Liu
- Division of Nephrology, Hypertension & Transplantation, University of Florida, Gainesville, Florida, USA
| | - Ozrazgat-Baslanti Tezcan
- Division of Nephrology, Hypertension & Transplantation, University of Florida, Gainesville, Florida, USA
| | - Ashutosh M Shukla
- Division of Nephrology, Hypertension & Transplantation, University of Florida, Gainesville, Florida, USA.,Renal Section, North Florida / South Georgia Veterans Administration, Gainesville, Florida, USA
| | - Amir Kazory
- Division of Nephrology, Hypertension & Transplantation, University of Florida, Gainesville, Florida, USA
| | - Ruchi Rupam
- Division of Nephrology, Hypertension & Transplantation, University of Florida, Gainesville, Florida, USA
| | - Mark S Segal
- Division of Nephrology, Hypertension & Transplantation, University of Florida, Gainesville, Florida, USA.,Renal Section, North Florida / South Georgia Veterans Administration, Gainesville, Florida, USA
| | - Azra Bihorac
- Division of Nephrology, Hypertension & Transplantation, University of Florida, Gainesville, Florida, USA
| | - Rajesh Mohandas
- Division of Nephrology, Hypertension & Transplantation, University of Florida, Gainesville, Florida, USA.,Renal Section, North Florida / South Georgia Veterans Administration, Gainesville, Florida, USA
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24
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Peng Y, Ye H, Yi C, Xiao X, Huang X, Liu R, Diao X, Mao H, Yu X, Yang X. Early initiation of PD therapy in elderly patients is associated with increased risk of death. Clin Kidney J 2020; 14:1649-1656. [PMID: 34084460 PMCID: PMC8162869 DOI: 10.1093/ckj/sfaa214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Indexed: 12/17/2022] Open
Abstract
Background The effect of early initiation of dialysis on outcomes of patients with end-stage renal disease (ESRD) remains controversial. We conducted this study to investigate the association between the timing of peritoneal dialysis (PD) initiation and mortality in different age groups. Methods In this single-centre cohort study, incident patients receiving PD from 1 January 2006 to 31 December 2016 were enrolled. Patients were categorized into three groups according to the estimated glomerular filtration rate (eGFR) at the initiation of PD, with early, mid and late initiation of PD defined as eGFR ≥7.5, 5–7.5 and <5 mL/min/1.73 m2, respectively. Results A total of 2133 incident patients receiving PD were enrolled with a mean age of 47.1 years, 59.6% male and 25.3% with diabetes, of whom 1803 were young (age <65 years) and 330 were elderly (age ≥65 years). After multivariable adjustment, the overall and cardiovascular (CV) mortality risks for young patients receiving PD were not significantly different between these three groups. However, for elderly patients, early initiation of PD therapy was associated with increased risks of all-cause {hazard ratio [HR} 1.54 [95% confidence interval (CI) 1.06–2.25]} and CV [HR 2.07 (95% CI 1.24–3.48)] mortality compared with late initiation of PD, while no significant difference was observed in overall or CV mortality between the mid- and late-start groups. Conclusions No significant difference in mortality risk was found among the three levels of eGFR at PD therapy initiation in young patients, while early initiation of PD was associated with a higher risk of overall and CV mortality among elderly patients.
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Affiliation(s)
- Yuan Peng
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, China
| | - Hongjian Ye
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, China
| | - Chunyan Yi
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, China
| | - Xi Xiao
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, China
| | - Xuan Huang
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, China
| | - Ruihua Liu
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, China
| | - Xiangwen Diao
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, China
| | - Haiping Mao
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, China
| | - Xueqing Yu
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, China
| | - Xiao Yang
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, China
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25
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Hsu CY, Parikh RV, Pravoverov LN, Zheng S, Glidden DV, Tan TC, Go AS. Implication of Trends in Timing of Dialysis Initiation for Incidence of End-stage Kidney Disease. JAMA Intern Med 2020; 180:1647-1654. [PMID: 33044519 PMCID: PMC7551228 DOI: 10.1001/jamainternmed.2020.5009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
IMPORTANCE In the last 2 decades, there have been notable changes in the level of estimated glomerular filtration rate (eGFR) at which patients initiate long-term dialysis in the US and around the world. How changes over time in the likelihood of dialysis initiation at any given eGFR level in at-risk patients are associated with the population burden of end-stage kidney disease (ESKD) has not been not well defined. OBJECTIVE To examine temporal trends in long-term dialysis initiation by level of eGFR and to quantify how these patterns are associated with the number of patients with ESKD. DESIGN, SETTING, AND PARTICIPANTS Retrospective cohort study analyzing data obtained from a large, integrated health care delivery system in Northern California from 2001 to 2018 in successive 3-year intervals. Included individuals, ranging in number from as few as 983 122 (2001-2003) to as many as 1 844 317 (2016-2018), were adult members with 1 or more outpatient serum creatinine levels determined in the prior year. MAIN OUTCOMES AND MEASURES One-year risk of initiating long-term dialysis stratified by eGFR levels. Multivariable logistic regression was performed to assess temporal trends in each 3-year cohort with adjustment for age, sex, race, and diabetes status. The potential change in dialysis initiation in the final cohort (2016-2018) was estimated using the relative difference between the standardized risks in the initial cohort (2001-2003) and the final cohort. RESULTS In the initial 3-year cohort, the mean (SD) age was 55.4 (16.3) years, 55.0% were women, and the prevalence of diabetes was 14.9%. These characteristics, as well as the distribution of index eGFR, were stable across the study period. The likelihood of receiving dialysis at eGFR levels of 10 to 24 mL/min/1.73 m2 generally increased over time. For example, the 1-year odds of initiating dialysis increased for every 3-year interval by 5.2% (adjusted odds ratio, 1.052; 95% CI, 1.004-1.102) among adults with an index eGFR of 20 to 24 mL/min/1.73 m2, by 6.6% (adjusted odds ratio, 1.066; 95% CI, 1.007-1.130) among adults with an eGFR of 16 to 17 mL/min/1.73 m2, and by 5.3% (adjusted odds ratio, 1.053; 95% CI, 1.008-1.100) among adults with an eGFR of 10 to 13 mL/min/1.73 m2, adjusting for age, sex, race, and diabetes. The incidence of new cases of ESKD was estimated to have potentially been 16% (95% CI, 13%-18%) lower if there were no changes in system-level practice patterns or other factors besides timing of initiating long-term dialysis from the initial 3-year interval (2001-2003) to the final interval (2016-2018) assessed in this study. CONCLUSIONS AND RELEVANCE The present results underscore the importance the timing of initiating long-term dialysis has on the size of the population of individuals with ESKD.
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Affiliation(s)
- Chi-Yuan Hsu
- Division of Nephrology, Department of Medicine, University of California, San Francisco, San Francisco.,Division of Research, Kaiser Permanente Northern California, Oakland
| | - Rishi V Parikh
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Leonid N Pravoverov
- Department of Nephrology, Kaiser Permanente Oakland Medical Center, Oakland, California
| | - Sijie Zheng
- Division of Research, Kaiser Permanente Northern California, Oakland.,Department of Nephrology, Kaiser Permanente Oakland Medical Center, Oakland, California.,Division of Medical Education, Department of Medicine, University of California, San Francisco, San Francisco
| | - David V Glidden
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco
| | - Thida C Tan
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Alan S Go
- Division of Nephrology, Department of Medicine, University of California, San Francisco, San Francisco.,Division of Research, Kaiser Permanente Northern California, Oakland.,Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco.,Department of Medicine, Stanford University, Stanford, California.,Department of Health Research and Policy, Stanford University, Stanford, California
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26
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Recent Updates and Advances in the Use of Glycated Albumin for the Diagnosis and Monitoring of Diabetes and Renal, Cerebro- and Cardio-Metabolic Diseases. J Clin Med 2020; 9:jcm9113634. [PMID: 33187372 PMCID: PMC7697299 DOI: 10.3390/jcm9113634] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 11/06/2020] [Accepted: 11/09/2020] [Indexed: 12/16/2022] Open
Abstract
Diabetes mellitus is a heterogeneous and dysmetabolic chronic disease in which the laboratory plays a fundamental role, from diagnosis to monitoring therapy and studying complications. Early diagnosis and good glycemic control should start as early as possible to delay and prevent metabolic and cardio-vascular complications secondary to this disease. Glycated hemoglobin is currently used as the reference parameter. The accuracy of the glycated hemoglobin dosage may be compromised in subjects suffering from chronic renal failure and terminal nephropathy, affected by the reduction in the survival of erythrocytes, with consequent decrease in the time available for glucose to attach to the hemoglobin. In the presence of these renal comorbidities as well as hemoglobinopathies and pregnancy, glycated hemoglobin is not reliable. In such conditions, dosage of glycated albumin can help. Glycated albumin is not only useful for short-term diagnosis and monitoring but predicts the risk of diabetes, even in the presence of euglycemia. This protein is modified in subjects who do not yet have a glycemic alteration but, as a predictive factor, heralds the risk of diabetic disease. This review summarizes the importance of glycated albumin as a biomarker for predicting and stratifying the cardiovascular risk linked to multiorgan metabolic alterations.
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27
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Abdu A, Mahmood IM, Audi KY, Umar MS. Clinical Characteristics and Outcomes of Hemodialysis in a New Center in Northern Nigeria. Niger Med J 2020; 61:340-344. [PMID: 33888932 PMCID: PMC8040938 DOI: 10.4103/nmj.nmj_148_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 10/06/2019] [Accepted: 08/15/2020] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Hemodialysis is the most common renal replacement therapy (RRT) modality in Africa and few countries enjoy reimbursement from the government to fund it. Africa contributes <10% of the total RRT patients worldwide this is mainly due to high cost. AIMS AND OBJECTIVES We aimed to review the clinical characteristics and outcomes of patients requiring hemodialysis in our center over a 7 years period, to highlight the enormous challenges encountered. MATERIALS AND METHODS This is a retrospective study of patients aged 15 years and above that was seen between April 2010 and March 2017 at the Hemodialysis unit of Abubakar Tafawa Balewa University Teaching Hospital. Information was extracted from the patient's case folders and dialysis charts. RESULTS In total, 226 patients had hemodialysis over the period, 124 (54.9%) were male and 102 (49.1%) were female. Sixty-one (27%) patients had acute kidney injury (AKI), 143 (63.3%) had chronic kidney disease (CKD), whereas 22 (9.7%) had acute-on-CKD. A total of 2215 sessions of hemodialysis were done in the period, of which 782 (35.3%) were for AKI and 469 (21.2%) for acute on CKD. A total of 138 (60.6%) patients were discharged and 58 deaths were recorded. CONCLUSION Although there is rapid proliferation of hemodialysis facilities in the country, many patients could not afford adequate hemodialysis. Inadequate dialysis due to finances was the main cause of death in these category of patients.
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Affiliation(s)
- Alhaji Abdu
- Department of Internal Medicine, Abubakar Tafawa Balewa University Teaching Hospital, Bauchi, Nigeria
| | - Ibrahim Maigari Mahmood
- Department of Internal Medicine, Abubakar Tafawa Balewa University Teaching Hospital, Bauchi, Nigeria
| | - Kabeer Yakubu Audi
- Department of Internal Medicine, Abubakar Tafawa Balewa University Teaching Hospital, Bauchi, Nigeria
| | - Mustapha Sabo Umar
- Department of Internal Medicine, Abubakar Tafawa Balewa University Teaching Hospital, Bauchi, Nigeria
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Moradi M, Daneshzad E, Najafabadi MM, Bellissimo N, Suitor K, Azadbakht L. Association between adherence to the Mediterranean diet and renal function biomarkers and cardiovascular risk factors among diabetic patients with nephropathy. Clin Nutr ESPEN 2020; 40:156-163. [PMID: 33183530 DOI: 10.1016/j.clnesp.2020.09.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 09/08/2020] [Accepted: 09/24/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIM Although the relationship between a Mediterranean diet (Med diet) and cardiovascular disease (CVD) risk factors has been widely established, no reports exist regarding this association in patients with Diabetes Nephropathy (DN). The aim of this study was to determine the association between level of adherence to a Med diet and renal and CVD risk factors among patients with DN. STUDY DESIGN A cross-sectional study. METHODS The current study was conducted in 270 patients with DN. A validated food frequency questionnaire was used to assess dietary intake. The Med diet score was determined based on the eight characteristics of a traditional Med diet. Anthropometrics, fasting blood glucose (FBS), total cholesterol (TC), low-density lipoproteins (LDL-c), triacylglycerol (TG), hemoglobin A1C (HbA1c), creatinine (Cr) and blood urea nitrogen (BUN) were detected using standard methods. Kidney function was estimated using the Modification of Diet in Renal Disease (MDRD) formula for estimated glomerular filtration rate (eGFR). RESULTS In fully-adjusted models, high serum TC and diastolic blood pressure (DBP) were reduced in participants that demonstrated a greater adherence to a Med diet, but did not reach statistical significance (OR: 0.20; 95% CI: 0.01, 5.52; P = 0.299; OR: 0.81; 95% CI: 0.28, 2.36; P = 0.667). Waist circumference (WC) was non-significantly lower in male participants (OR: 0.91; 95% CI: 0.27, 3.05; P = 0.889). Greater compliance with a Med diet showed a non-significant reduced risk for increased bodyweight (OR: 0.82; 95% CI: 0.23, 2.85; P = 0.730) and obesity (OR: 0.45; 95% CI: 0.03, 6.06; P = 0.493). CONCLUSION Adherence to a Med diet was not significantly associated with cardiovascular risk factors and renal function among patients with Diabetes Nephropathy.
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Affiliation(s)
- Maedeh Moradi
- Food Security Research Center and Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Elnaz Daneshzad
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Mozhgan Mortazavi Najafabadi
- Kidney Diseases Research Center and Division of Nephrology, Department of Internal Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | | | - Leila Azadbakht
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran; Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran; Food Security Research Center and Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran.
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29
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Arai Y, Shioji S, Tanaka H, Katagiri D, Hinoshita F. A Novel Uremic Score Reflecting Accumulation of Specific Uremic Toxins More Precisely Predicts One-Year Mortality after Hemodialysis Commencement: A Retrospective Cohort Study. Toxins (Basel) 2020; 12:toxins12100634. [PMID: 33019590 PMCID: PMC7601006 DOI: 10.3390/toxins12100634] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 09/24/2020] [Accepted: 09/30/2020] [Indexed: 11/16/2022] Open
Abstract
Uremic toxins (UTs) generally accumulate in patients developing end-stage renal disease (ESRD). Although some kinds of UTs cause early death after starting hemodialysis (HD), it remains unknown whether the degree of excessive accumulation of various UTs is associated with worsening of prognosis. We retrospectively conducted this cohort study consisting of adult patients developing ESRD who initiated HD at the National Center for Global Health and Medicine from 2010 to 2019. We created a new uremic score, which was defined as the aggregate score of the following variables reflecting uremic state: elevated blood urea nitrogen, β2-microglobulin, and anion gap before starting HD. The primary outcome was early mortality within 1-year after HD commencement. The hazard ratio (HR) and 95% confidence interval (CI) for a one-point increase in uremic score was calculated with Cox proportional hazard models adjusted by baseline conditions. We included 230 participants, 16 of whom experienced the primary outcome of early mortality after HD commencement. Uremic score was significantly associated with the primary outcome (crude HR: 1.91, 95% CI 1.16–3.14; adjusted HR: 4.19, 95% CI 1.79–9.78). Our novel uremic score, reflecting accumulation of specific UTs, more precisely predicts early mortality after HD commencement.
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Affiliation(s)
- Yohei Arai
- Department of Nephrology, National Center for Global Health and Medicine, Tokyo 162-8655, Japan; (D.K.); (F.H.)
- Department of Nephrology, Tokyo Medical and Dental University, Tokyo 113-8510, Japan
- Correspondence: ; Tel.: +81-3-3202-7181
| | - Shingo Shioji
- Department of Nephrology, Yokosuka Kyosai Hospital, Kanagawa 238-8558, Japan; (S.S.); (H.T.)
| | - Hiroyuki Tanaka
- Department of Nephrology, Yokosuka Kyosai Hospital, Kanagawa 238-8558, Japan; (S.S.); (H.T.)
| | - Daisuke Katagiri
- Department of Nephrology, National Center for Global Health and Medicine, Tokyo 162-8655, Japan; (D.K.); (F.H.)
| | - Fumihiko Hinoshita
- Department of Nephrology, National Center for Global Health and Medicine, Tokyo 162-8655, Japan; (D.K.); (F.H.)
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30
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Duration of predialysis nephrological care and mortality after dialysis initiation. Clin Exp Nephrol 2020; 24:705-714. [DOI: 10.1007/s10157-020-01889-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 02/28/2020] [Indexed: 11/26/2022]
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31
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Tatematsu M, Inaguma D, Yamada T, Sakamoto I, Sakakibara M. The impact of gender difference on the relationship between serum high-density lipoprotein level and cardiovascular events in incident dialysis patients: a multicenter prospective cohort study. Int Urol Nephrol 2020; 52:1357-1365. [DOI: 10.1007/s11255-020-02498-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 05/06/2020] [Indexed: 12/24/2022]
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32
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Shinya Y, Miyawaki S, Kumagai I, Sugiyama T, Takenobu A, Saito N, Teraoka A. Risk Factors and Outcomes of Cerebral Stroke in End-Stage Renal Disease Patients Receiving Hemodialysis. J Stroke Cerebrovasc Dis 2020; 29:104657. [PMID: 32037266 DOI: 10.1016/j.jstrokecerebrovasdis.2020.104657] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 01/04/2020] [Accepted: 01/10/2020] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE Dialysis patients have a higher incidence of stroke, and outcomes are often poor. Diabetic nephropathy (DN) is a stroke risk-factor, but the importance is unclear in dialysis patients. This study investigated the stroke features and risk factors in hemodialysis (HD) patients. METHODS All end-stage renal disease patients undergoing HD at Teraoka Memorial Hospital dialysis center were identified, with 195 recruited. Baseline clinical characteristics were collected, and the clinical outcomes and related factors of stroke in HD patients were retrospectively analyzed. The incidence rate of stroke and mortality were calculated using Kaplan-Meier survival analysis. Factors potentially related to stroke were analyzed by the log-rank test and Cox proportional hazards model for univariate and multivariate analysis. RESULTS In total, 21.0% (41 of 195) patients developed stroke. The incidence rates of stroke per 1000 patient-years were 53.6, 65.2, and 34.0 in all HD patients, DN patients, and non-DN patients, respectively. The cumulative incidence rates of stroke in all HD patients, DN patients, and non-DN patients per 5 years, and per 10 years were 22.6%, 43.5%; 28.8%, 59.6%; and 17.6%, 31.1%, respectively. The incidence rate of stroke in the DN patients was significantly higher than in the non-DN patients (P = .013). DN was the significant risk factor for stroke by multivariate analysis (hazard ratio 2.63, 95% confidence interval 1.08-7.85; P = .032). CONCLUSIONS This study revealed the trends of stroke in HD patients at a single institution in Japan. DN was shown to be a significant risk factor for stroke in HD patients.
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Affiliation(s)
- Yuki Shinya
- Departments of Neurosurgery, Teraoka Memorial Hospital, Fukuyama, Hiroshima, Japan; Department of Neurosurgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan.
| | - Satoru Miyawaki
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Isao Kumagai
- Departments of Nephrology, Teraoka Memorial Hospital, Fukuyama, Hiroshima, Japan
| | - Takehiro Sugiyama
- Diabetes and Metabolism Information Center, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan; Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan; Department of Public Health/Health Policy, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Atsumi Takenobu
- Departments of Neurosurgery, Teraoka Memorial Hospital, Fukuyama, Hiroshima, Japan
| | - Nobuhito Saito
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Akira Teraoka
- Departments of Neurosurgery, Teraoka Memorial Hospital, Fukuyama, Hiroshima, Japan
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33
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Liu Y, Wang L, Han X, Wang Y, Sun X, Jiang H, Shi W, Liu W, Fu P, Ding X, Lin H, Chen X. The Profile of Timing Dialysis Initiation in Patients with End-stage Renal Disease in China: A Cohort Study. Kidney Blood Press Res 2020; 45:180-193. [PMID: 32000162 DOI: 10.1159/000504671] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 05/12/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Hemodialysis is the main approach for renal replacement therapy in patients with end-stage renal disease (ESRD) in China. The timing of dialysis initiation is one of the key factors influencing patient survival and prognosis. Over the past decade, the relationship between the timing of dialysis initiation and mortality has remained unclear in patients with ESRD in China. METHODS Patients who commenced maintenance hemodialysis from 2009 to 2014 from 24 hemodialysis centers in Mainland China were enrolled in the study (n = 1,674). Patients were divided into 2 groups based on the year they started hemodialysis (patients who started hemodialysis from 2009 to 2011, and patients who started hemodialysis from 2012 to 2014). Analysis of the yearly change in the estimated glomerular filtration rate (eGFR) at the initiation of dialysis was performed for the 2 groups. Meanwhile, the patients were divided into 3 groups based on their eGFR at the initiation of dialysis (<4, 4-8, and >8 mL/min/1.73 m2). For these 3 groups, the relationship between the eGFR at the start of dialysis and mortality were analyzed. RESULTS The average eGFRs were 5.68 and 5.94 mL/min/1.73 m2 for 2009-2011 and 2012-2014, respectively. Compared with the 2009-2011 group, the proportion of patients with diabetes in 2012-2014 increased from 26.7 to 37.7%. The prognosis of patients with different eGFRs at the start of dialysis was analyzed using Kaplan-Meier survival curves. After adjusting for confounding factors through a Cox regression model, no significant difference was demonstrated among the 3 groups (<4 mL/min/1.73 m2 was used as the reference, in comparison with 4-8 mL/min/1.73 m2 [p = 0.681] and >8 mL/min/1.73 m2 [p = 0.403]). CONCLUSION In Mainland China, the eGFR at the start of dialysis did not change significantly over time from 2008 to 2014 and had no association with the mortality of patients with ESRD.
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Affiliation(s)
- Ying Liu
- Graduate School of Dalian Medical University, Dalian, China.,Department of Nephrology, The First Affiliated Hospital, Institute for Nephrology Research of Dalian Medical University, Center for Kidney Diseases Translational Medicine of Liaoning Province, Dalian, China
| | - Luping Wang
- Department of Nephrology, The First Affiliated Hospital, Institute for Nephrology Research of Dalian Medical University, Center for Kidney Diseases Translational Medicine of Liaoning Province, Dalian, China
| | - Xianfeng Han
- Department of Nephrology, The First Affiliated Hospital, Institute for Nephrology Research of Dalian Medical University, Center for Kidney Diseases Translational Medicine of Liaoning Province, Dalian, China
| | - Yang Wang
- Medical Research and Biometrics Center, Cardiovascular Institute and Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xuefeng Sun
- Department of Nephrology, Chinese PLA General Hospital, National Clinical Research Center for Kidney Diseases, State Key Laboratory of Kidney Diseases, Chinese PLA Institute of Nephrology, Beijing, China
| | - Hongli Jiang
- Blood Purification Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Wei Shi
- Division of Nephrology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Wenhu Liu
- Division of Nephrology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Ping Fu
- Kidney Research Institute, Division of Nephrology, West China Hospital of Sichuan University, Chengdu, China
| | - Xiaoqiang Ding
- Division of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Hongli Lin
- Graduate School of Dalian Medical University, Dalian, China, .,Department of Nephrology, The First Affiliated Hospital, Institute for Nephrology Research of Dalian Medical University, Center for Kidney Diseases Translational Medicine of Liaoning Province, Dalian, China,
| | - Xiangmei Chen
- Department of Nephrology, Chinese PLA General Hospital, National Clinical Research Center for Kidney Diseases, State Key Laboratory of Kidney Diseases, Chinese PLA Institute of Nephrology, Beijing, China
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Karaboyas A, Morgenstern H, Li Y, Bieber BA, Hakim R, Hasegawa T, Jadoul M, Schaeffner E, Vanholder R, Pisoni RL, Port FK, Robinson BM. Estimating the Fraction of First-Year Hemodialysis Deaths Attributable to Potentially Modifiable Risk Factors: Results from the DOPPS. Clin Epidemiol 2020; 12:51-60. [PMID: 32021471 PMCID: PMC6974411 DOI: 10.2147/clep.s233197] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 12/12/2019] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Mortality among first-year hemodialysis (HD) patients remains unacceptably high. To address this problem, we estimate the proportions of early HD deaths that are potentially preventable by modifying known risk factors. METHODS We included 15,891 HD patients (within 60 days of starting HD) from 21 countries in the Dialysis Outcomes and Practice Patterns Study (1996-2015), a prospective cohort study. Using Cox regression adjusted for potential confounders, we estimated the fraction of first-year deaths attributable to one or more of twelve modifiable risk factors (the population attributable fraction, AF) identified from the published literature by comparing predicted survival based on risk factors observed vs counterfactually set to reference levels. RESULTS The highest AFs were for catheter use (22%), albumin <3.5 g/dL (19%), and creatinine <6 mg/dL (12%). AFs were 5%-9% for no pre-HD nephrology care, no residual urine volume, systolic blood pressure <130 or ≥160 mm Hg, phosphorus <3.5 or ≥5.5 mg/dL, hemoglobin <10 or ≥12 g/dL, and white blood cell count >10,000/μL. AFs for ferritin, calcium, and PTH were <3%. Overall, 65% (95% CI: 59%-71%) of deaths were attributable to these 12 risk factors. Additionally, the AF for C-reactive protein >10 mg/L was 21% in facilities where it was routinely measured. CONCLUSION A substantial proportion of first-year HD deaths could be prevented by successfully modifying a few risk factors. Highest priorities should be decreasing catheter use and limiting malnutrition/inflammation whenever possible.
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Affiliation(s)
| | - Hal Morgenstern
- Departments of Epidemiology and Environmental Health Sciences, School of Public Health, and Department of Urology, Medical School, University of Michigan, Ann Arbor, MI, USA
| | - Yun Li
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Brian A Bieber
- Arbor Research Collaborative for Health, Ann Arbor, MI, USA
| | - Raymond Hakim
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Takeshi Hasegawa
- Division of Nephrology, Department of Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan, and Showa University Research Administration Center (SURAC), Showa University, Tokyo, Japan
| | - Michel Jadoul
- Cliniques universitaires St Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Elke Schaeffner
- Institute of Public Health, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | | | | | - Friedrich K Port
- Department of Epidemiology, University of Michigan School of Public Health, and Department of Internal Medicine-Nephrology, University of Michigan Medical School, Ann Arbor, MI, USA
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Zhao X, Wang P, Wang L, Chen X, Huang W, Mao Y, Hu R, Cheng X, Wang C, Wang L, Zhang P, Li D, Wang Y, Ye W, Chen Y, Jia Q, Yan X, Zuo L. Protocol for a prospective, cluster randomized trial to evaluate routine and deferred dialysis initiation (RADDI) in Chinese population. BMC Nephrol 2019; 20:455. [PMID: 31818266 PMCID: PMC6902500 DOI: 10.1186/s12882-019-1627-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 11/15/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The timing of when to initiate dialysis for progressive chronic kidney disease (CKD) patients has not been well established. There has been a strong trend for early dialysis initiation for these patients over the past decades. However, the perceived survival advantage of early dialysis has been questioned by a series of recent observational studies. The only randomized controlled trial (RCT) research on this issue found the all-cause mortality, comorbidities, and quality of life showed no difference between early and late dialysis starters. To better understand optimal timing for dialysis initiation, our research will evaluate the efficacy and safety of deferred dialysis initiation in a large Chinese population. METHODS The trial adopts a multicenter, cluster randomized, single-blind (outcomes assessor), and endpoint-driven design. Eligible participants are 18-80 years old, in stable CKD stages 4-5 (eGFR > 7 ml/min /1.73 m2), and with good heart function (NYHA grade I or II). Participants will be randomized into a routine or deferred dialysis group. The reference eGFR at initiating dialysis for asymptomatic patients is 7 ml/min /1.73 m2 (routine dialysis group) and 5 ml/min/1.73 m2 or less (deferred dialysis group) in each group. The primary endpoint will be the difference of all-cause mortality and acute nonfatal cerebro-cardiovascular events between the two groups. The secondary outcomes include hospitalization rate and other safety indices. The primary and secondary outcomes will be analyzed by appropriate statistical methods. DISCUSSION This study protocol represents a large, cluster randomized study evaluating deferred and routine dialysis intervention for an advanced CKD population. The reference eGFR to initiate dialysis for both treatment groups is targeted at less than 7 ml/min/1.73m2. With this design, we aim to eliminate lead-time and survivor bias and avoid selection bias and confounding factors. We acknowledge that the study has limitations. Even so, given the low-targeted eGFR values of both arms, this study still has potential economic, health, and scientific implications. This research is unique in that such a low targeted eGFR value has never been studied in a clinical trial. TRIAL REGISTRATION The trial has been approved by ClinicalTrials.gov (Trial registration ID NCT02423655). The date of registration was April 22, 2015.
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Affiliation(s)
- Xinju Zhao
- Department of Nephrology, Peking University People’s Hospital, Beijing, China
| | - Pei Wang
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Lining Wang
- Department of Nephrology, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Xiaonong Chen
- Department of Nephrology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, China
| | - Wen Huang
- Department of Nephrology, Beijing Tongren Hospital Capital Medical University, Beijing, China
| | - Yonghui Mao
- Department of Nephrology, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Rihong Hu
- Department of Nephrology, Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, China
| | - Xiaohong Cheng
- Department of Nephrology, Shaanxi Hospital of Traditional Chinese Medicine, Shaanxi, China
| | - Caili Wang
- Department of Nephrology, The First Affiliated Hospital of Baotou Medical College, Baotou, China
| | - Li Wang
- Department of Nephrology, Sichuan Academy of Medical Sciences, Chengdu, China
| | - Ping Zhang
- Kidney disease center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Detian Li
- Department of Nephrology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yuzhu Wang
- Department of Nephrology, Beijing Haidian Hospital (Beijing Haidian Section of Peking University Third Hospital), Beijing, China
| | - Wenling Ye
- Department of Nephrology, Peking Union Medical College Hospital, Beijing, China
| | - Yuqing Chen
- Renal Division, Peking University First Hospital, Beijing, China
| | - Qiang Jia
- Department of Nephrology, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Xiaoyan Yan
- Peking University Clinical Research Institute, Beijing, China
| | - Li Zuo
- Department of Nephrology, Peking University People’s Hospital, Beijing, China
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Osimertinib in a patient with non-small cell lung cancer and renal failure undergoing hemodialysis: a case report. Invest New Drugs 2019; 38:1192-1195. [DOI: 10.1007/s10637-019-00851-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Accepted: 08/28/2019] [Indexed: 12/18/2022]
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Chan CT, Blankestijn PJ, Dember LM, Gallieni M, Harris DCH, Lok CE, Mehrotra R, Stevens PE, Wang AYM, Cheung M, Wheeler DC, Winkelmayer WC, Pollock CA. Dialysis initiation, modality choice, access, and prescription: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference. Kidney Int 2019; 96:37-47. [PMID: 30987837 DOI: 10.1016/j.kint.2019.01.017] [Citation(s) in RCA: 203] [Impact Index Per Article: 40.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 12/21/2018] [Accepted: 01/04/2019] [Indexed: 02/06/2023]
Abstract
Globally, the number of patients undergoing maintenance dialysis is increasing, yet throughout the world there is significant variability in the practice of initiating dialysis. Factors such as availability of resources, reasons for starting dialysis, timing of dialysis initiation, patient education and preparedness, dialysis modality and access, as well as varied "country-specific" factors significantly affect patient experiences and outcomes. As the burden of end-stage kidney disease (ESKD) has increased globally, there has also been a growing recognition of the importance of patient involvement in determining the goals of care and decisions regarding treatment. In January 2018, KDIGO (Kidney Disease: Improving Global Outcomes) convened a Controversies Conference focused on dialysis initiation, including modality choice, access, and prescription. Here we present a summary of the conference discussions, including identified knowledge gaps, areas of controversy, and priorities for research. A major novel theme represented during the conference was the need to move away from a "one-size-fits-all" approach to dialysis and provide more individualized care that incorporates patient goals and preferences while still maintaining best practices for quality and safety. Identifying and including patient-centered goals that can be validated as quality indicators in the context of diverse health care systems to achieve equity of outcomes will require alignment of goals and incentives between patients, providers, regulators, and payers that will vary across health care jurisdictions.
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Affiliation(s)
| | - Peter J Blankestijn
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Laura M Dember
- Renal-Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Maurizio Gallieni
- Department of Clinical and Biomedical Sciences "Luigi Sacco", University of Milan, Milan, Italy
| | | | - Charmaine E Lok
- University Health Network, University of Toronto, Ontario, Canada
| | - Rajnish Mehrotra
- Division of Nephrology, Kidney Research Institute and Harborview Medical Center, University of Washington, Seattle, Washington, USA
| | - Paul E Stevens
- Kent Kidney Care Centre, East Kent Hospitals, University NHS Foundation Trust, Canterbury, Kent, UK
| | - Angela Yee-Moon Wang
- Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, China
| | | | | | - Wolfgang C Winkelmayer
- Selzman Institute for Kidney Health, Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
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Kimura M, Toyoda M, Saito N, Kaneyama N, Miyatake H, Tanaka E, Komaba H, Hara M, Fukagawa M. A Liquid-Based Cytology System, without the Use of Cytocentrifugation, for Detection of Podocytes in Urine Samples of Patients with Diabetic Nephropathy. J Diabetes Res 2019; 2019:9475637. [PMID: 30911554 PMCID: PMC6398024 DOI: 10.1155/2019/9475637] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Revised: 12/03/2018] [Accepted: 12/25/2018] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE Podocytes have highly differentiated functions and are extremely difficult to grow; thus, damage of podocytes is associated with glomerular dysfunction. Desquamated podocytes can be detected in urine of patients with severe renal impairment. Unlike the rapidly progressive glomerular damage in glomerulonephritis, only a few desquamated podocytes are usually detected in diabetic nephropathy (DN). It is not clear whether the low podocyte count in DN is due to limitation of the conventional method or true pathological feature. The aim of this study was to compare the conventional method with a newly modified method in detecting podocytes in morning urine samples of patients with DN. MATERIALS AND METHODS The study subjects were patients with type 2 diabetes. Urine samples from these patients were analyzed by the conventional method (Cytospin®) and the modified method (SurePath™). We determined the rate of detection of urinary podocytes and the number of detected cells. RESULTS The detection rate and podocyte count were significantly higher by the modified method than by the conventional method. The differences in the detection rates and numbers of podocytes were not significant between patients with normoalbuminuria and those with macroalbuminuria. However, they were significant in patients with microalbuminuria. The number of podocytes in the urine correlated significantly with the albumin-to-creatinine ratio, but not with the estimated glomerular filtration rate. CONCLUSIONS The true number of urinary podocytes, as measured by the modified SurePath™-based method, in patients with DN is much higher than that estimated by the conventional method.
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Affiliation(s)
- Moritsugu Kimura
- Division of Nephrology, Endocrinology and Metabolism, Department of Internal Medicine, Tokai University School of Medicine, Isehara, Japan
| | - Masao Toyoda
- Division of Nephrology, Endocrinology and Metabolism, Department of Internal Medicine, Tokai University School of Medicine, Isehara, Japan
| | - Nobumichi Saito
- Division of Nephrology, Endocrinology and Metabolism, Department of Internal Medicine, Tokai University School of Medicine, Isehara, Japan
| | - Noriko Kaneyama
- Division of Nephrology, Endocrinology and Metabolism, Department of Internal Medicine, Tokai University School of Medicine, Isehara, Japan
| | - Han Miyatake
- Division of Nephrology, Endocrinology and Metabolism, Department of Internal Medicine, Tokai University School of Medicine, Isehara, Japan
| | - Eitaro Tanaka
- Division of Nephrology, Endocrinology and Metabolism, Department of Internal Medicine, Tokai University School of Medicine, Isehara, Japan
| | - Hirotaka Komaba
- Division of Nephrology, Endocrinology and Metabolism, Department of Internal Medicine, Tokai University School of Medicine, Isehara, Japan
| | | | - Masafumi Fukagawa
- Division of Nephrology, Endocrinology and Metabolism, Department of Internal Medicine, Tokai University School of Medicine, Isehara, Japan
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Iseki K. CKD 5D Asia—what is common and what is different from the West? RENAL REPLACEMENT THERAPY 2018. [DOI: 10.1186/s41100-018-0175-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Zhu LN, Mou LJ, Ying-Hu, Wei GN, Sun JF. Failure to place a tunneled hemodialysis catheter due to malformation of right internal jugular vein draining to subclavian vein. J Int Med Res 2018; 46:2481-2485. [PMID: 29690817 PMCID: PMC6023040 DOI: 10.1177/0300060518766649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 03/01/2018] [Indexed: 11/15/2022] Open
Abstract
The right internal jugular vein (IJV) is an important access site for hemodialysis catheterization. Venous cannulation failure is usually caused by central venous stenosis and is rarely related to vessel malformation. We herein present a case of failure to place a tunneled hemodialysis catheter into the right IJV. The patient had an arteriovenous fistula in the right arm with inadequate flow and a history of multiple central venous catheterizations. The guidewire was repeatedly misplaced into the right subclavian vein (SV) regardless of the technique used. Computed tomography venography revealed that the inferior segment of the right IJV drained into the ipsilateral SV. To the best of our knowledge, this is the first report of catheterization failure due to abnormal drainage of the right IJV into the ipsilateral SV.
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Affiliation(s)
- Li-na Zhu
- Department of Nephrology, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Li-jun Mou
- Department of Nephrology, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Ying-Hu
- Department of Nephrology, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Gui-na Wei
- Department of Nephrology, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jun-feng Sun
- Department of Anesthesiology, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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Abe M, Hamano T, Wada A, Nakai S, Masakane I. Effect of dialyzer membrane materials on survival in chronic hemodialysis patients: Results from the annual survey of the Japanese Nationwide Dialysis Registry. PLoS One 2017; 12:e0184424. [PMID: 28910324 PMCID: PMC5598977 DOI: 10.1371/journal.pone.0184424] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 08/23/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Little information is available regarding which type of dialyzer membrane results in good prognosis in patients on chronic hemodialysis. Therefore, we conducted a cohort study from a nationwide registry of hemodialysis patients in Japan to establish the association between different dialyzer membranes and mortality rates. METHODS We followed 142,412 patients on maintenance hemodialysis (female, 39.1%; mean age, 64.8 ± 12.3 years; median dialysis duration, 7 [4-12] years) for a year from 2008 to 2009. We included patients treated with seven types of high-flux dialyzer membranes at baseline, including cellulose triacetate (CTA), ethylene vinyl alcohol (EVAL), polyacrylonitrile (PAN), polyester polymer alloy (PEPA), polyethersulfone (PES), polymethylmethacrylate (PMMA), and polysulfone (PS). Cox regression was used to estimate the association between baseline dialyzers and all-cause mortality as hazard ratios (HRs) and 95% confidence intervals for 1-year mortality adjusting for potential confounders, and propensity score matching analysis was performed. RESULTS The distribution of patients treated with each membrane was as follows: PS (56.0%), CTA (17.3%), PES (12.0%), PEPA (7.5%), PMMA (4.9%), PAN (1.2%), and EVAL (1.1%). When data were adjusted using basic factors, with PS as a reference group, the mortality rate was significantly higher in all groups except for the PES group. When data were further adjusted for dialysis-related factors, HRs were significantly higher for the CTA, EVAL, and PEPA groups. When the data were further adjusted for nutrition-and inflammation-related factors, HRs were significantly lower for the PMMA and PES groups compared with the PS group. After propensity score matching, HRs were significantly lower for the PMMA group than for the PS group. CONCLUSION The results suggest that the use of different membrane types may affect mortality in hemodialysis patients. However, further long-term prospective studies are needed to clarify these findings, including whether the use of the PMMA membrane can improve prognosis.
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Affiliation(s)
- Masanori Abe
- Division of Nephrology, Hypertension and Endocrinology, Nihon University School of Medicine, Tokyo, Japan
| | - Takayuki Hamano
- Department of Comprehensive Kidney Disease Research, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Atsushi Wada
- Department of Nephrology, Kitasaito Hospital, Asahikawa, Japan
| | - Shigeru Nakai
- Department of Clinical Engineering, Fujita Health University, Aichi, Japan
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Ratio of blood urea nitrogen to serum creatinine at initiation of dialysis is associated with mortality: a multicenter prospective cohort study. Clin Exp Nephrol 2017; 22:353-364. [DOI: 10.1007/s10157-017-1458-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Accepted: 07/24/2017] [Indexed: 12/30/2022]
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Abe M, Hamano T, Wada A, Nakai S, Masakane I. High-Performance Membrane Dialyzers and Mortality in Hemodialysis Patients: A 2-Year Cohort Study from the Annual Survey of the Japanese Renal Data Registry. Am J Nephrol 2017; 46:82-92. [PMID: 28675885 DOI: 10.1159/000478032] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 05/30/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Little information is available regarding the type of dialyzer which results in good prognosis. This study is aimed at investigating the association between 7 types of dialyzers and 2-year mortality. METHODS We conducted a cohort study using data from a nationwide registry of the Japanese Society for Dialysis Therapy. Subjects were 136,676 patients on maintenance hemodialysis (HD) between 2009 and 2011 who underwent maintenance HD for at least 2 years and were treated with one of the following 7 types of high-performance membrane dialyzers: cellulose triacetate (CTA), ethylene vinyl alcohol (EVAL), polyacrylonitrile (PAN), polyester polymer alloy (PEPA), polyethersulfone (PES), polymethylmethacrylate (PMMA), and polysulfone (PS). Cox regression was used to estimate the association between baseline dialyzers and all-cause 2-year mortality, adjusting for potential confounders. RESULTS Data were adjusted using basic factors, with PS as a reference group, and the hazard ratio (HR) was significantly higher in CTA, PMMA, PAN, and EVAL groups. Further data adjustment for Kt/V yielded the same results as were obtained from data adjusted for basic factors. After further adjustment for nutrition- and inflammation-related factors, HR was significantly lowered for the PES and PMMA groups compared with the PS group (HR 0.88; 95% CI 0.82-0.94 and HR 0.84 95% CI 0.76-0.93, respectively). After propensity score matching, HR for the PES and PMMA groups was significantly lowered compared with the PS group. CONCLUSIONS The use of different membrane types may affect mortality. Further long-term prospective studies are needed to clarify whether the PES and PMMA membranes can improve prognosis.
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Affiliation(s)
- Masanori Abe
- The Renal Data Registry Committee, The Japanese Society for Dialysis Therapy, Nihon University School of Medicine, Tokyo, Japan
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Higuchi S, Nakaya I, Yoshikawa K, Chikamatsu Y, Sada KE, Yamamoto S, Takahashi S, Sasaki H, Soma J. Potential Benefit Associated With Delaying Initiation of Hemodialysis in a Japanese Cohort. Kidney Int Rep 2017; 2:594-602. [PMID: 29318218 PMCID: PMC5720530 DOI: 10.1016/j.ekir.2017.01.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 01/23/2017] [Accepted: 01/31/2017] [Indexed: 11/29/2022] Open
Abstract
Introduction Late referral to a nephrologist, the type of vascular access, nutritional status, and the estimated glomerular filtration rate (eGFR) at the start of hemodialysis (HD) have been reported as independent risk factors of survival for patients who begin HD. The aim of this study was to clarify the influence of the HD-free interval from the time of an eGFR of 10 ml/min per 1.73 m2 (IGFR10-HD) on patient outcome. Methods We enrolled 124 patients aged older than 20 years who had HD initiated in a general hospital. The predictive factor was the HD-free IGFR10-HD. The primary outcome was the relationship of the HD-free interval on death or the onset of a cardiovascular event. Survival analysis was performed using the Cox regression model. Results The median IGFR10-HD was 159 days (range: 2–1687 days). The median eGFR at the initiation of HD was 5.48 ml/min per 1.73 m2. Sixty-seven of 124 patients (54.0%) reached the primary outcome. Of these, 29 died and 38 experienced a cardiovascular event. In univariate analysis, older age, a history of cardiovascular disease, nephrologic care for <6 months, higher modified Charlson comorbidity index score, poor performance status, temporary catheter, edema, diabetic retinopathy, and nonuse of erythropoiesis-stimulating agent were statistically related to the primary outcome. The unadjusted hazard ratio per log-transformed IGFR10-HD was 0.393 (95% confidence interval [CI]; 0.244−0.635; P < 0.001) and the hazard ratio adjusted for confounding factors was 0.507 (95% CI: 0.267−0.956; P = 0.036). Discussion A longer HD-free IGFR10-HD was associated with a lower risk of death or a cardiovascular event. The interval could be considered an independent prognostic factor for outcomes in patients on HD.
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Prasad N, Patel MR, Chandra A, Rangaswamy D, Sinha A, Bhadauria D, Sharma RK, Kaul A, Gupta A. Measured Glomerular Filtration Rate at Dialysis Initiation and Clinical Outcomes of Indian Peritoneal Dialysis Patients. Indian J Nephrol 2017; 27:301-306. [PMID: 28761233 PMCID: PMC5514827 DOI: 10.4103/ijn.ijn_75_16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The optimal time for dialysis initiation remains controversial. Studies have failed to show better outcomes with early initiation of hemodialysis; even a few had shown increased adverse outcomes including poorer survival. Few studies have examined the same in patients on peritoneal dialysis (PD). Measured glomerular filtration rate (mGFR) not creatinine-based estimated GFR is recommended as the measure of kidney function in end-stage renal disease (ESRD) patients. The objective of this observational study was to compare the outcomes of Indian patients initiated on PD with different residual renal function (RRF) as measured by 24-h urinary clearance method. A total of 352 incident patients starting on chronic ambulatory PD as the first modality of renal replacement therapy were followed prospectively. Patients were categorized into three groups as per mGFR at the initiation of PD (≤5, >5-10, and >10 ml/min/1.73 m2). Patient survival and technique survival were compared among the three groups. Patients with GFR of ≤5 ml/min/1.73 m2 (hazard ratio [HR] - 3.42, 95% confidence interval [CI] - 1.85-6.30, P = 0.000) and >5-10 ml/min/1.73 m2 (HR - 2.16, 95% CI - 1.26-3.71, P = 0.005) had higher risk of mortality as compared to those with GFR of >10 ml/min/1.73 m2. Each increment of 1 ml/min/1.73 m2 in baseline GFR was associated with 10% reduced risk of death (HR - 0.90, 95% CI - 0.85-0.96, P = 0.002). Technique survival was poor in those with an initial mGFR of ≤5 ml/min/1.73 m2 as compared to other categories. RRF at the initiation was also an important factor predicting nutritional status at 1 year of follow-up. To conclude, initiation of PD at a lower baseline mGFR is associated with poorer patient and technique survival in Indian ESRD patients.
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Affiliation(s)
- N. Prasad
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - M. R. Patel
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - A. Chandra
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - D. Rangaswamy
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - A. Sinha
- Department of Dietetics, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - D. Bhadauria
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - R. K. Sharma
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - A. Kaul
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - A. Gupta
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Naruishi K, Oishi K, Inagaki Y, Horibe M, Bando M, Ninomiya M, Kawahara K, Minakuchi J, Kawashima S, Shima K, Kido J, Nagata T. Association between periodontal condition and kidney dysfunction in Japanese adults: A cross-sectional study. Clin Exp Dent Res 2016; 2:200-207. [PMID: 29744168 PMCID: PMC5839219 DOI: 10.1002/cre2.39] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 05/06/2016] [Accepted: 06/10/2016] [Indexed: 12/25/2022] Open
Abstract
Recent studies have demonstrated that chronic kidney disease (CKD) may be associated with the progression of periodontal disease. Diabetes mellitus (DM) is a major risk factor for CKD. The objective of this study was to clarify the relationship between periodontal condition and kidney dysfunction in patients who had kidney failure with or without DM. One hundred sixty-four patients with kidney dysfunction were enrolled (male: N = 105; female: N = 59), and the relationship between periodontal condition and kidney dysfunction was analyzed in a cross-sectional study. The subjects were divided into three groups: (a) patients with DM, (b) dialysis patients with nephropathy due to various kidney diseases, and (c) dialysis patient with nephropathy due to DM (diabetic nephropathy). Then, the effect of DM on the periodontal condition was analyzed. The patients were also stratified by CKD stage (into G1-G5) using the estimated glomerular filtration rate (eGFR), and the G5 group was divided in patients with or without DM. Correlations between eGFR and parameters of periodontal condition were calculated in patients from G1 to G4. The number of missing teeth was significantly higher in dialysis patients with diabetic nephropathy than in patients with DM, whereas alveolar bone loss did not show a significant difference among the three groups. In addition, the G5 patients with DM had a significantly higher number of missing teeth than the other CKD groups, whereas alveolar bone loss did not show a significant difference. In G5 patients with DM, Community Periodontal Index and Oral Hygiene Index scores were significantly higher than in G1-4 patients with DM. There was a significant negative correlation between eGFR and the number of missing teeth. Patients with diabetic nephropathy have a higher rate of periodontal problems such as missing teeth in Japanese adults.
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Affiliation(s)
- Koji Naruishi
- Department of Periodontology and Endodontology, Institute of Biomedical SciencesTokushima University Graduate SchoolTokushimaTokushima PrefectureJapan
| | - Keiji Oishi
- Department of Periodontology and Endodontology, Institute of Biomedical SciencesTokushima University Graduate SchoolTokushimaTokushima PrefectureJapan
| | - Yuji Inagaki
- Department of Periodontology and Endodontology, Institute of Biomedical SciencesTokushima University Graduate SchoolTokushimaTokushima PrefectureJapan
| | - Masumi Horibe
- Department of Periodontology and Endodontology, Institute of Biomedical SciencesTokushima University Graduate SchoolTokushimaTokushima PrefectureJapan
| | - Mika Bando
- Department of Periodontology and Endodontology, Institute of Biomedical SciencesTokushima University Graduate SchoolTokushimaTokushima PrefectureJapan
| | - Masami Ninomiya
- Department of Periodontology and Endodontology, Institute of Biomedical SciencesTokushima University Graduate SchoolTokushimaTokushima PrefectureJapan
| | - Kazuhiko Kawahara
- Kawashima HospitalKitasako IchibanchoTokushimaTokushima PrefectureJapan
| | - Jun Minakuchi
- Kawashima HospitalKitasako IchibanchoTokushimaTokushima PrefectureJapan
| | - Shu Kawashima
- Kawashima HospitalKitasako IchibanchoTokushimaTokushima PrefectureJapan
| | - Kenji Shima
- Kawashima HospitalKitasako IchibanchoTokushimaTokushima PrefectureJapan
| | - Jun‐ichi Kido
- Department of Periodontology and Endodontology, Institute of Biomedical SciencesTokushima University Graduate SchoolTokushimaTokushima PrefectureJapan
| | - Toshihiko Nagata
- Department of Periodontology and Endodontology, Institute of Biomedical SciencesTokushima University Graduate SchoolTokushimaTokushima PrefectureJapan
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Abstract
AIM Renal failure is a growing public health problem, and is mainly treated by hemodialysis. This study aims to estimate the societal costs of hemodialysis in Lebanon. METHODS This was a quantitative, cross-sectional cost-of-illness study conducted alongside the Nutrition Education for Management of Osteodystrophy trial. Costs were assessed with a prevalence-based, bottom-up approach, for the period of June-December 2011. The data of 114 patients recruited from six hospital-based units were collected through a questionnaire measuring healthcare costs, costs to patients and family, and costs in other sectors. Recall data were used for the base-case analysis. Sensitivity analyses employing various sources of resources use and costs were performed. Costs were uprated to 2015US$. Multiple linear regression was conducted to explore the predictors of societal costs. RESULTS The mean 6-month societal costs were estimated at $9,258.39. The larger part was attributable to healthcare costs (91.7%), while costs to patient and family and costs in other sectors poorly contributed to the total costs (4.2% and 4.1%, respectively). In general, results were robust to sensitivity analyses. Using the maximum value for hospitalization resulted in the biggest difference (+15.5% of the base-case result). Female gender, being widowed/divorced, having hypertension comorbidity, and higher weekly time on dialysis were significantly associated with greater societal costs. LIMITATIONS Information regarding resource consumption and cost were not readily available. Rather, they were obtained from a variety of sources, with each having its own strengths and limitations. CONCLUSION Hemodialysis represents a high societal burden in Lebanon. Using extrapolation, its total annual cost for the Lebanese society is estimated at $61,105,374 and the mean total annual cost ($18,516.7) is 43.70% higher than the gross domestic product per capita forecast for 2015. Measures to reduce the economic burden of hemodialysis should be taken, by promoting chronic kidney disease's prevention and encouraging transplantation.
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Affiliation(s)
- Rana Rizk
- a Department of Health Services Research, CAPHRI School of Public Health and Primary Care , Maastricht University , Maastricht , The Netherlands
| | - Mickaël Hiligsmann
- a Department of Health Services Research, CAPHRI School of Public Health and Primary Care , Maastricht University , Maastricht , The Netherlands
| | - Mirey Karavetian
- b Department of Natural Sciences in Public Health, College of Sustainability Sciences and Humanities , Zayed University , Dubai , United Arab Emirates
| | - Pascale Salameh
- c Faculty of Pharmacy , Lebanese University , Hadath , Lebanon
| | - Silvia M A A Evers
- a Department of Health Services Research, CAPHRI School of Public Health and Primary Care , Maastricht University , Maastricht , The Netherlands
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Lin X, Zeng XZ, Ai J. The Glomerular Filtration Rate (GFR) at Dialysis Initiation and Mortality in Chronic Kidney Disease (CKD) in East Asian Populations: A Meta-analysis. Intern Med 2016; 55:3097-3104. [PMID: 27803401 PMCID: PMC5140856 DOI: 10.2169/internalmedicine.55.6520] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Accepted: 02/24/2016] [Indexed: 11/06/2022] Open
Abstract
Objective The impact of dialysis initiation on survival is still somewhat controversial. Given that race or ethnicity has been observed to be a predictor of mortality and the rate of progression of chronic kidney disease, we conducted a meta-analysis to investigate the effect of early vs. late dialysis initiation on mortality in East Asian populations. Methods All eligible cohort studies of target were selected from the MEDLINE (PubMed), EMBASE, The Cochrane Library and the Clinical Trials Registry databases from inception to October 2014. The data were extracted with all-cause mortality rates as the primary outcome, and pooled adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated. Results Ten studies examined the association between early vs. late dialysis initiation and mortality. Compared to late dialysis initiation, patients who received early dialysis initiation had a higher overall mortality risk (adjusted HR, 1.36; 95% CI, 1.0-1.85; p<0.05) in East Asian populations. In a subgroup analysis, baseline characteristic differences (adjusted HR, 2.0; 95%CI, 1.56-2.57; p<0.001), initial dialysis modalities (adjusted HR, 2.12; 95% CI, 1.72-2.62; p<0.001) and follow up duration (adjusted HR, 1.59; 95% CI, 1.19-2.12; p=0.002), demonstrated that the association between early dialysis initiation and mortality were significant. Conclusion A higher glomerular filtration rate (early) at the initiation of dialysis is associated with a higher all-cause mortality risk in East Asian populations.
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Affiliation(s)
- Xin Lin
- Department of Nephrology, People's Hospital of Guizhou Province, China
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Robinson BM, Akizawa T, Jager KJ, Kerr PG, Saran R, Pisoni RL. Factors affecting outcomes in patients reaching end-stage kidney disease worldwide: differences in access to renal replacement therapy, modality use, and haemodialysis practices. Lancet 2016; 388:294-306. [PMID: 27226132 PMCID: PMC6563337 DOI: 10.1016/s0140-6736(16)30448-2] [Citation(s) in RCA: 247] [Impact Index Per Article: 30.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
More than 2 million people worldwide are being treated for end-stage kidney disease (ESKD). This Series paper provides an overview of incidence, modality use (in-centre haemodialysis, home dialysis, or transplantation), and mortality for patients with ESKD based on national registry data. We also present data from an international cohort study to highlight differences in haemodialysis practices that affect survival and the experience of patients who rely on this therapy, which is both life-sustaining and profoundly disruptive to their quality of life. Data illustrate disparities in access to renal replacement therapy of any kind and in the use of transplantation or home dialysis, both of which are widely considered preferable to in-centre haemodialysis for many patients with ESKD in settings where infrastructure permits. For most patients with ESKD worldwide who are treated with in-centre haemodialysis, overall survival is poor, but longer in some Asian countries than elsewhere in the world, and longer in Europe than in the USA, although this gap has reduced. Commendable haemodialysis practice includes exceptionally high use of surgical vascular access in Japan and in some European countries, and the use of longer or more frequent dialysis sessions in some countries, allowing for more effective volume management. Mortality is especially high soon after ESKD onset, and improved preparation for ESKD is needed including alignment of decision making with the wishes of patients and families.
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Affiliation(s)
- Bruce M Robinson
- Arbor Research Collaborative for Health, Ann Arbor, MI, USA; Department of Internal Medicine and Nephrology, University of Michigan, Ann Arbor, MI, USA.
| | - Tadao Akizawa
- Showa University School of Medicine, Shinagawa, Tokyo, Japan
| | - Kitty J Jager
- ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam-Zuidoost, Netherlands
| | - Peter G Kerr
- Monash Medical Centre and Monash University Clayton, Clayton, VIC, Australia
| | - Rajiv Saran
- Department of Internal Medicine and Nephrology, University of Michigan, Ann Arbor, MI, USA
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Inaguma D, Tanaka A, Shinjo H. Physical function at the time of dialysis initiation is associated with subsequent mortality. Clin Exp Nephrol 2016; 21:425-435. [PMID: 27392911 DOI: 10.1007/s10157-016-1307-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 07/03/2016] [Indexed: 01/04/2023]
Abstract
BACKGROUND In dialysis patients, physical function is associated with mortality. However, the association between physical function at the time of dialysis initiation and subsequent mortality remains unknown. METHODS A total of 1496 patients with chronic kidney disease who initiated dialysis at 17 centers participating in the Aichi Cohort Study of the Prognosis in Patients Newly Initiated into Dialysis, a multicenter prospective cohort study, were included. The patients were divided into the high (H)-, middle (M)-, and low (L)-score groups according to Barthel index (BI) at the time of dialysis initiation, and the all-cause, cardiovascular disease (CVD)-related, and infection-related mortality rates were compared. Moreover, factors affecting all-cause mortality were investigated. The effects of BI on mortality were assessed in the patients stratified by age, sex, and history of CVD or cerebral infarction. RESULTS A log-rank test for the Kaplan-Meier survival curve showed significant differences between the three groups in all-cause, CVD-related, and infection-related mortality rates (p < 0.001). Cox proportional hazard regression analysis with the step-wise method showed a significantly higher risk of all-cause mortality in the M and L groups than in the H group (M group: HR 1.612, 95 % CI 1.075-2.417; L group: HR 1.994, 95 % CI 1.468-2.709). Regardless of the age categories and the history of CVD, the risk of all-cause mortality was significantly higher in the L group than in the H group. CONCLUSION Physical function assessed by BI at the time of dialysis initiation was found to be associated with subsequent mortality.
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Affiliation(s)
- Daijo Inaguma
- Department of Nephrology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan. .,Aichi Cohort Study of Prognosis in Patients Newly Initiated Into Dialysis (AICOPP), Aichi, Japan.
| | - Akihito Tanaka
- Japanese Red Cross Nagoya Daini Hospital, Nagoya, Aichi, Japan
| | - Hibiki Shinjo
- Japanese Red Cross Nagoya Daini Hospital, Nagoya, Aichi, Japan
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