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Chan FHF, Goh ZZS, Zhu X, Tudor Car L, Newman S, Khan BA, Griva K. Subjective cognitive complaints in end-stage renal disease: a systematic review and meta-analysis. Health Psychol Rev 2023; 17:614-640. [PMID: 36200562 DOI: 10.1080/17437199.2022.2132980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 09/30/2022] [Indexed: 11/04/2022]
Abstract
Cognitive impairment is common in patients with end-stage renal disease (ESRD) and is associated with compromised quality of life and functional capacity, as well as worse clinical outcomes. Most previous research and reviews in this area were focused on objective cognitive impairment, whereas patients' subjective cognitive complaints (SCCs) have been less well-understood. This systematic review aimed to provide a broad overview of what is known about SCCs in adult ESRD patients. Electronic databases were searched from inception to January 2022, which identified 221 relevant studies. SCCs appear to be highly prevalent in dialysis patients and less so in those who received kidney transplantation. A random-effects meta-analysis also shows that haemodialysis patients reported significantly more SCCs than peritoneal dialysis patients (standardised mean difference -0.20, 95% confidence interval -0.38 to -0.03). Synthesis of longitudinal studies suggests that SCCs remain stable on maintenance dialysis treatment but may reduce upon receipt of kidney transplant. Furthermore, SCCs in ESRD patients have been consistently associated with hospitalisation, depression, anxiety, fatigue, and poorer quality of life. There is limited data supporting a strong relation between objective and subjective cognition but preliminary evidence suggests that this association may be domain-specific. Methodological limitations and future research directions are discussed.
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Affiliation(s)
- Frederick H F Chan
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Zack Z S Goh
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Xiaoli Zhu
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- Nursing Services, National Healthcare Group Polyclinics, Singapore
| | - Lorainne Tudor Car
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- Department of Primary Care and Public Health, Imperial College London School of Public Health, London, UK
| | - Stanton Newman
- School of Health Sciences, Division of Health Services Research and Management, City University of London, London, UK
| | - Behram A Khan
- National Kidney Foundation, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Konstadina Griva
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
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2
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Aljenaidi H, Alayoobi L, Alqassab W, Alfehaid A, Albuainain M, AlMuhanadi R, Alotaibi S, Almutiri M, Jaradat A, El-Agroudy AE. Quality of Life in Hemodialysis Versus Peritoneal Dialysis Patients in Bahrain. Cureus 2023; 15:e49408. [PMID: 38149127 PMCID: PMC10750137 DOI: 10.7759/cureus.49408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2023] [Indexed: 12/28/2023] Open
Abstract
INTRODUCTION Chronic diseases, including chronic kidney disease, affect patients' quality of life (QOL). Hemodialysis (HD) and peritoneal dialysis (PD) are renal replacement methods in these patients. This work aimed to study the relationship between QOL scores in patients with end-stage renal disease (ESRD) on HD and PD. METHODS This study was done at Salmaniya Medical Complex (SMC), Bahrain, from May to July 2023. A standard QOL index score instrument in Arabic form was used on 76 HD and 38 PD patients. The inclusion criteria included dialysis for at least three months and an age of more than 18 years with no severe morbidities or psychological diseases. RESULTS The mean age of HD and PD patients was 58.7 ± 11.2 and 55.9 ± 12.1 years, respectively. Thirty-five (46.1%) of the HD patients and 17 (44.7%) of the PD patients were females. In most dimensions, the QOL score of the patients treated with PD was better than that of the HD group. The number of hospital admissions was statistically significantly higher in the HD group (p = 0.007); however, there was no significant difference in the causes of admissions (p = 0.131). In this study, we observed the highest QOL score in the family subscale (93.2 ± 9.2 and 98.6 ± 4.7), followed by the psychological/spiritual subscale (81.1 ± 16.7 and 97.6 ± 3.9) in the HD and PD groups, respectively), but it was statistically significantly higher in the PD group (p < 0.001). CONCLUSION Our findings show that patients starting PD had better QOL scores in all domains than patients starting HD. Moreover, patients on PD maintained more active social support and ultimately felt better emotional well-being and physical health than those undergoing HD.
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Affiliation(s)
| | | | | | - Ali Alfehaid
- Internal Medicine, Arabian Gulf University, Manama, BHR
| | | | | | - Saad Alotaibi
- Internal Medicine, Arabian Gulf University, Manama, BHR
| | | | - Ahmed Jaradat
- Family and Community Medicine, Arabian Gulf University, Manama, BHR
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Schaeffner E. Smoothing transition to dialysis to improve early outcomes after dialysis initiation among old and frail adults-a narrative review. Nephrol Dial Transplant 2021; 37:2307-2313. [PMID: 34865111 PMCID: PMC9681923 DOI: 10.1093/ndt/gfab342] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Indexed: 12/31/2022] Open
Abstract
The number of patients ≥65 years of age suffering from advanced chronic kidney disease and transitioning to end-stage kidney disease (ESKD) is increasing. However, elderly patients often have poor outcomes once haemodialysis is initiated, including high mortality within the first year as well as fast cognitive and functional decline and diminished quality of life. The question is how we can smooth this transition to ESKD in older patients who also exhibit much higher proportions of frailty when compared with community-dwelling non-dialysis older adults and who are generally more vulnerable to invasive treatment such as kidney replacement therapy. To avoid early death and poor quality of life, a carefully prepared smooth transition should precede the initiation of treatment. This involves pre-dialysis physical and educational care, as well as mental and psychosocial preparedness of the patient to enable an informed and shared decision about the individual choice of treatment modality. Communication between a healthcare professional and patient plays a pivotal role but can be challenging given the high rate of cognitive impairment in this particular population. In order to practise patient-centred care, adapting treatment tailored to the individual patient should include comprehensive conservative care. However, structured treatment pathways including multidisciplinary teams for such conservative care are still rare and may be difficult to establish outside of large cities. Generally, geriatric nephrology misses data on the comparative effectiveness of different treatment modalities in this population of old and very old age on which to base recommendations and decisions.
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Altun E, Paydas S, Kaya B, Balal M, Seydaoğlu G. Blood pressure, inflammation, and quality of life in patients treated with different renal replacement therapies. Ther Apher Dial 2021; 26:115-121. [PMID: 34032378 DOI: 10.1111/1744-9987.13692] [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: 03/12/2021] [Revised: 05/18/2021] [Accepted: 05/21/2021] [Indexed: 11/28/2022]
Abstract
Our aim was to determine the relationship between the modality of renal replacement therapy and inflammation markers, BP control, and quality of life (QoL). Sixteen hemodialysis, 17 peritoneal dialysis patients, and 27 kidney transplant receivers (KTr) have been included in this study. Short Form-36 (SF-36) for the evaluation of QoL and ambulatory BP monitoring were performed on the same day. Erythrocyte sedimentation rate, CRP, IL-6, and IL-10 were measured. While the mean IL-10, IL-6, and CRP levels were the highest in the dialysis groups, there were no significantly differences any parameters for all groups. QoL was better in the KTr almost as in healthy controls but worse in the dialysis patients. It should be taken into account that hypertension may occur at night even if the daytime BP is normal in KTr.
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Affiliation(s)
- Eda Altun
- Department of Nephrology, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Saime Paydas
- Department of Nephrology, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Bülent Kaya
- Department of Nephrology, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Mustafa Balal
- Department of Nephrology, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Gülsah Seydaoğlu
- Department of Biostatistics, Faculty of Medicine, Cukurova University, Adana, Turkey
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5
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Budhram B, Sinclair A, Komenda P, Severn M, Sood MM. A Comparison of Patient-Reported Outcome Measures of Quality of Life By Dialysis Modality in the Treatment of Kidney Failure: A Systematic Review. Can J Kidney Health Dis 2020; 7:2054358120957431. [PMID: 33149924 PMCID: PMC7580133 DOI: 10.1177/2054358120957431] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 07/15/2020] [Indexed: 12/19/2022] Open
Abstract
Background: There is an increasing demand to incorporate patient-reported outcome measures (PROMs) such as quality of life (QOL) in decision-making when selecting a chronic dialysis modality. Objective: To compare the change in QOL over time among similar patients on different dialysis modalities to provide unique and novel insights on the impact of dialysis modality on PROMs. Design: Systematic reviews, randomized controlled trials, and nonrandomized controlled trials were examined via a comprehensive search strategy incorporating multiple bibliographic databases. Setting: Data were extracted from relevant studies from January 1, 2000 to December 31, 2019 without limitations on country of study conduction. Patients: Eligible studies included adults (≥18 years) with end-stage kidney disease of any cause who were prescribed dialysis treatment (either as lifetime treatment or bridge to transplant). Measurements: The 5 comparisons were peritoneal dialysis (PD) vs in-center hemodialysis (ICHD), home hemodialysis (HHD) vs ICHD, HHD modalities compared with one another, HHD vs PD, and self-care ICHD vs traditional nurse-based ICHD. Methods: Included studies compared adults on different dialysis modalities with repeat measures within individuals to determine changes in QOL between dialysis modalities (in-center or home dialysis). Methodological quality was assessed by the Scottish Intercollegiate Guidelines Network (SIGN 50) checklist. A narrative synthesis was conducted, synthesizing the direction and size of any observed effects across studies. Results: Two randomized controlled trials and 9 prospective cohort studies involving a combined total of 3711 participants were included. Comparing PD and ICHD, 5 out of 9 studies found significant differences (P < .05) favoring PD in the change of multiple QOL domains, including “physical component score,” “role of social component score,” “cognitive status,” “role limitation due to emotional function,” “role limitation due to physical function,” “bodily pain,” “burden of kidney disease,” “effects of kidney disease on daily life,” “symptoms/problems,” “sexual function,” “finance,” and “patient satisfaction.” Conversely, 3 of these studies demonstrated statistically significant differences (P < .05) favoring ICHD in the domains of “role limitation due to physical function,” “general health,” “support from staff,” “sleep quality,” “social support,” “health status,” “social interaction,” “body image,” and “overall health.” Comparing HHD and ICHD, significant differences (P < .05) favoring HHD for the QOL domains of “general health,” “burden of kidney disease,” and the visual analogue scale were reported. Limitations: Our study is constrained by the small sample sizes of included studies, as well as heterogeneity among both study populations and validated QOL scales, limiting inter-study comparison. Conclusions: We identified differences in specific QOL domains between dialysis modalities that may aid in patient decision-making based on individual priorities. Trial registration: PROSPERO Registration Number: CRD42016046980. Primary funding source: The original research for this study was derived from the Canadian Agency for Drugs and Technologies in Health (CADTH) 2017 optimal use report, titled “Dialysis Modalities for the Treatment of End-Stage Kidney Disease: A Health Technology Assessment.” The CADTH receives funding from Canada’s federal, provincial, and territorial governments, with the exception of Quebec.
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Affiliation(s)
- Brandon Budhram
- The Ottawa Hospital Research Institute, The Ottawa Hospital, ON, Canada
| | - Alison Sinclair
- Canadian Agency for Drugs and Technologies in Health, Ottawa, ON, Canada
| | - Paul Komenda
- Seven Oaks General Hospital, Winnipeg, MB, Canada
| | - Melissa Severn
- Canadian Agency for Drugs and Technologies in Health, Ottawa, ON, Canada
| | - Manish M Sood
- The Ottawa Hospital Research Institute, The Ottawa Hospital, ON, Canada
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6
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Quinn RR, Oliver MJ. Is Assisted Peritoneal Dialysis an Alternative to In-Center Hemodialysis? Perit Dial Int 2020. [DOI: 10.1177/089686080602600607] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Abstract
On haemodialysis, my life was not my own — handing control to nursing staff for 4 hours, 3 days a week, surrounded by noisy machines and unhappy patients, returning home after 11 hours, too exhausted to eat and falling into bed. However, peritoneal dialysis has given me back my life. I am in control of me and am treated like a human being, not just a patient. There are minor drawbacks, such as storage for the fluids and being unable to have a bath, but it is a small price to pay.
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Affiliation(s)
- Edwina A. Brown
- Department of Renal Medicine, Hammersmith Hospital, London, United Kingdom
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8
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Couchoud C, Savoye E, Frimat L, Ryckelynck JP, Chalem Y, Verger C. Variability in Case Mix and Peritoneal Dialysis Selection in Fifty-Nine French Districts. Perit Dial Int 2020. [DOI: 10.1177/089686080802800515] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
In France, the use of peritoneal dialysis (PD) as the first-choice treatment varies greatly between districts, as it is already known to do between countries. Baseline clinical factors associated with choice of first modality were analyzed in 10815 new end-stage renal disease patients in 59 districts. To describe practices at the district level, we used an agglomerative hierarchical classification, with proximity defined by a likelihood-ratio test that compared multivariate logistic regressions of the following factors: age, gender, diabetes, congestive heart failure, severe behavioral disorders, mobility, and employment. To propose a typology, each cluster of districts was described by a multivariate logistic regression. While populations starting PD in France, as elsewhere, are more likely to be young or employed, they are also more likely to be elderly or have congestive heart failure or severe behavioral disorders. Overall, 14% of patients start with PD, but this rate varies significantly across districts, from 0% to 45%. A specific combination of factors was associated with the first-choice modality in each group of districts. This study highlights the lack of consensual medical criteria for this choice and the likelihood that nonmedical factors may explain the observed differences. The high variability suggests that PD can be used in almost all clinical conditions. Accordingly, patient preference should play a more important role in the decision-making process.
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Affiliation(s)
- Cécile Couchoud
- The French REIN Registry, Biomedicine Agency, Saint-Denis La Plaine
| | - Emilie Savoye
- National Coordinating Centre, and Medical and Scientific Department, Biomedicine Agency, Saint-Denis La Plaine
| | - Luc Frimat
- Nephrology Department, Nancy University Hospital, Vandoeuvre les Nancy
| | | | - Ylana Chalem
- National Coordinating Centre, and Medical and Scientific Department, Biomedicine Agency, Saint-Denis La Plaine
| | - Christian Verger
- The French-Speaking Peritoneal Dialysis Registry René Dubos Hospital, Cergy Pontoise, France
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9
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Jung HY, Jeon Y, Park Y, Kim YS, Kang SW, Yang CW, Kim NH, Choi JY, Cho JH, Park SH, Kim CD, Kim YL. Better Quality of Life of Peritoneal Dialysis compared to Hemodialysis over a Two-year Period after Dialysis Initiation. Sci Rep 2019; 9:10266. [PMID: 31312004 PMCID: PMC6635359 DOI: 10.1038/s41598-019-46744-1] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 07/03/2019] [Indexed: 11/25/2022] Open
Abstract
This study aimed to compare health-related quality of life (HRQOL) over time in patients initiating hemodialysis (HD) or peritoneal dialysis (PD). A total of 989 incident patients starting HD or PD were included from a prospective nationwide cohort study. HRQOL was assessed 3, 12, and 24 months after the start of dialysis. The scores of questionnaires were adjusted for clinical and socioeconomic parameters. The adjusted three months scores of patients on PD showed better HRQOL in eight end-stage renal disease (ESRD), three physical component summary and one mental component summary domains compared with patients on HD. Both patients on HD and PD experienced significant decreases in different HRQOL domains over two years and the degree of changes in HRQOL over time was not different between dialysis modality. However, the scores of three (effects of kidney disease, burden of kidney disease, and dialysis staff encouragement, all P < 0.05) and two (sexual function and dialysis staff encouragement, all P < 0.05) ESRD domains were still higher in patients on PD compared with patients on HD at one and two years after initiation of dialysis, respectively. PD shows better HRQOL during the initial period after dialysis even after adjusting for clinical and socioeconomic characteristics, and the effect lasts up to two years. It was similar in terms of changes in HRQOL over time between HD and PD.
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Affiliation(s)
- Hee-Yeon Jung
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea.,Clinical Research Center for End Stage Renal Disease, Daegu, South Korea
| | - Yena Jeon
- Clinical Research Center for End Stage Renal Disease, Daegu, South Korea.,Department of Statistics, Kyungpook National University, Daegu, South Korea
| | - Yeongwoo Park
- Clinical Research Center for End Stage Renal Disease, Daegu, South Korea.,Department of Statistics, Kyungpook National University, Daegu, South Korea
| | - Yon Su Kim
- Clinical Research Center for End Stage Renal Disease, Daegu, South Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Shin-Wook Kang
- Clinical Research Center for End Stage Renal Disease, Daegu, South Korea.,Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Chul Woo Yang
- Clinical Research Center for End Stage Renal Disease, Daegu, South Korea.,Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, South Korea
| | - Nam-Ho Kim
- Clinical Research Center for End Stage Renal Disease, Daegu, South Korea.,Department of Internal Medicine, Chonnam National University Medical School, Gwangju, South Korea
| | - Ji-Young Choi
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea.,Clinical Research Center for End Stage Renal Disease, Daegu, South Korea
| | - Jang-Hee Cho
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea.,Clinical Research Center for End Stage Renal Disease, Daegu, South Korea
| | - Sun-Hee Park
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea.,Clinical Research Center for End Stage Renal Disease, Daegu, South Korea
| | - Chan-Duck Kim
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea.,Clinical Research Center for End Stage Renal Disease, Daegu, South Korea
| | - Yong-Lim Kim
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea. .,Clinical Research Center for End Stage Renal Disease, Daegu, South Korea. .,Bk21 Plus KNU Biomedical Convergence Program, Department of Biomedical Science, Kyungpook National University, Daegu, South Korea.
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10
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Eneanya ND, Maddux DW, Reviriego-Mendoza MM, Larkin JW, Usvyat LA, van der Sande FM, Kooman JP, Maddux FW. Longitudinal patterns of health-related quality of life and dialysis modality: a national cohort study. BMC Nephrol 2019; 20:7. [PMID: 30621634 PMCID: PMC6325821 DOI: 10.1186/s12882-018-1198-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Accepted: 12/28/2018] [Indexed: 12/18/2022] Open
Abstract
Background Health-related quality of life (HrQoL) varies among dialysis patients. However, little is known about the association of dialysis modality with HrQoL over time. We describe longitudinal patterns of HrQoL among chronic dialysis patients by treatment modality. Methods National retrospective cohort study of adult patients who initiated in-center dialysis or a home modality (peritoneal or home hemodialysis) between 1/2013 and 6/2015. Patients remained on the same modality for the first 120 days of the first two years. HrQoL was assessed by the Kidney Disease and Quality of Life-36 (KDQOL) survey in the first 120 days of the first two years after dialysis initiation. Home modality patients were matched to in-center patients in a 1:5 fashion. Results In-center (n=4234) and home modality (n=880) patients had similar demographic and clinical characteristics. In-center dialysis patients had lower mean KDQOL scores across several domains compared to home modality patients. For patients who remained on the same modality, there was no change in HrQoL. However, there were trends towards clinically meaningful changes in several aspects of HrQoL for patients who switched modalities. Specifically, physical functioning decreased for patients who switched from home to in-center dialysis (p< 0.05). Conclusions Among a national cohort of chronic dialysis patients, there was a trend towards different patterns of HrQoL life that were only observed among patients who changed modality. Patients who switched from home to in-center modalities had significant lower physical functioning over time. Providers and patients should be mindful of HrQoL changes that may occur with dialysis modality change. Electronic supplementary material The online version of this article (10.1186/s12882-018-1198-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nwamaka D Eneanya
- Renal-Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, 307 Blockley Hall, 423 Guardian Drive, Philadelphia, PA, 19104, USA.
| | | | | | - John W Larkin
- Fresenius Medical Care North America, Waltham, MA, USA
| | - Len A Usvyat
- Fresenius Medical Care North America, Waltham, MA, USA
| | - Frank M van der Sande
- Division of Nephrology, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, Netherlands
| | - Jeroen P Kooman
- Division of Nephrology, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, Netherlands
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11
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Quality of Life After Kidney Transplantation: A Prospective Study. Transplant Proc 2016; 48:50-4. [PMID: 26915842 DOI: 10.1016/j.transproceed.2015.10.058] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 10/28/2015] [Indexed: 11/22/2022]
Abstract
BACKGROUND The purpose of renal transplantation is to achieve a maximal improvement in quality of life (QoL) and life expectancy in patients with end-stage renal disease (ESRD) while minimizing the potential side effects of this procedure. It is important to achieve an optimal balance between graft function and the patient's QoL. This study was designed to assess the changes in the QoL after kidney transplantation (KTx) in patients with ESRD previously treated with hemodialysis (HD) or peritoneal dialysis (PD). METHODS QoL was prospectively analyzed in 69 patients after kidney transplantation in a single-center study. Patients with ESRD were divided into 2 groups: those previously treated with HD (n = 44 patients; group 1) or PD (n = 25 patients; group 2). Both groups were asked to complete the KDQOL-SFtm questionnaire before and 12 months after kidney transplantation. RESULTS We observed significant differences in many parameters of QoL in both groups after KTx but more positive changes of most parameters in question exhibited by patients previously treated by means of HD than PD. Patients treated with HD and PD demonstrated improvement after KTx in 74% of dimensions. There were no statistical differences in the QoL between group 1 and group 2 before or after KTx. CONCLUSIONS The study demonstrated post- to pre-transplant improvements of QoL independently of previous treatment.
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12
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[Comparison of peritoneal dialysis and hemodialysis survival in Provence-Alpes-Côte d'Azur]. Nephrol Ther 2016; 12:221-8. [PMID: 27320372 DOI: 10.1016/j.nephro.2016.01.015] [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: 10/23/2015] [Revised: 01/05/2016] [Accepted: 01/05/2016] [Indexed: 11/20/2022]
Abstract
PURPOSE To analyze and compare survival of patients initially treated with peritoneal dialysis (PD) or hemodialysis (HD). METHODS We used data from the French REIN registry. We included all patients aged 18 years or more who started dialysis between 1st January 2004 and 12 December 2012 in Provence-Alpes-Côte d'Azur Region (PACA). These patients were followed up until 30 June 2014. Survival curves were generated using the Kaplan-Meier technique and tested using the log-rank test. Variables predictive of all-cause mortality were determined using Cox regression models. The propensity score was used. MAIN RESULTS Survival was similar between initial dialysis modalities: PD and HD, even after adjusting for the propensity score. But, when we exclude the patients who had switched from one technique of dialysis to another, survival was better in HD patients. According to the multivariate analysis, advanced age and the lack of walking autonomy appear to be associated with an increase in mortality in dialysis patients. But, the presence of hypertension improve the survival in this cohort. CONCLUSION The survival is similar between hemodialysis and peritoneal dialysis.
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13
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Effectiveness of a day care program in supporting patients on peritoneal dialysis and their caregivers. Int Urol Nephrol 2016; 48:799-805. [DOI: 10.1007/s11255-016-1241-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 02/05/2016] [Indexed: 10/22/2022]
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Liu FX, Gao X, Inglese G, Chuengsaman P, Pecoits-Filho R, Yu A. A Global Overview of the Impact of Peritoneal Dialysis First or Favored Policies: An Opinion. Perit Dial Int 2015; 35:406-20. [PMID: 25082840 PMCID: PMC4520723 DOI: 10.3747/pdi.2013.00204] [Citation(s) in RCA: 89] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Accepted: 02/25/2014] [Indexed: 01/03/2023] Open
Abstract
Given the ever-increasing burden of end-stage renal disease (ESRD) in a global milieu of limited financial and health resources, interested parties continue to search for ways to optimize dialysis access. Government and payer initiatives to increase access to renal replacement therapies (RRTs), particularly peritoneal dialysis (PD) and hemodialysis (HD), may have meaningful impacts from clinical and health-economic perspectives; and despite similar clinical and humanistic outcomes between the two dialysis modalities, PD may be the more convenient and resource-conscious option. This review assessed country-specific PD-First/Favored policies and their associated background, implementation, and outcomes. It was found that barriers to policy-implementation are broadly associated with government policy, economics, provider or healthcare professional education, modality-related factors, and patient-related factors. Notably, the success of a given country's PD-Favored policy was inversely associated with the extent of HD infrastructure. It is hoped that this review will provide a foundation across countries to share lessons learned during the development and implementation of PD-First/Favored policies.
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Affiliation(s)
| | - Xin Gao
- Pharmerit International, Bethesda, MD, USA
| | | | | | - Roberto Pecoits-Filho
- Pontificia Universidade Católica do Paraná, School of Medicine, Curitiba, Parana, Brazil
| | - Alex Yu
- Hong Kong Baptist Hospital, Hong Kong, China
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15
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Heaf JG, Wehberg S. Relative survival of peritoneal dialysis and haemodialysis patients: effect of cohort and mode of dialysis initiation. PLoS One 2014; 9:e90119. [PMID: 24614569 PMCID: PMC3948631 DOI: 10.1371/journal.pone.0090119] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Accepted: 01/27/2014] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Epidemiological studies consistently show an initial survival advantage for PD patients compared to HD. It has recently been suggested that this is due to the fact that many HD patients are referred late, and start dialysis on an acute, in-patient basis. The present study was performed to investigate (1) whether, and if so, how, PD and HD prognosis had changed in recent years, (2) whether a potential survival advantage of PD versus HD is constant over dialysis duration, and (3) whether differences in prognosis could be explained by patient age, renal diagnosis of diabetic nephropathy, or mode of dialysis initiation. PATIENTS AND METHODS 12095 patients starting dialysis therapy between 1990 and 2010 in Denmark were studied. Prognosis was assessed according to initial dialysis modality on an intention-to-treat basis, censored for transplantation. Results were adjusted for age, sex, renal diagnosis, Charlson Comorbidity Index (CCI), and mode of dialysis initiation. RESULTS Overall adjusted prognosis improved by 34% (HD 30%, PD 42%). PD prognosis relative to HD improved, and was 16% better at the end of the period. Final PD prognosis improved consistently from 1990-99 to 2000-10 in all subgroups. PD was associated with a significant initial survival advantage, both overall and for all subgroups For the latter cohort, overall PD prognosis was better than HD for the first 4 years, after which it was insignificantly worse. The initial survival advantage was also present in a subgroup analysis of patients with early & routine ESRD initiation. CONCLUSIONS Dialysis survival has increased during the past 20 years. PD survival since 2000 has been better than HD, overall and for all subgroups. The difference in survival is not explained by mode of dialysis initiation.
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Affiliation(s)
- James G. Heaf
- Department of Nephrology B, Copenhagen University Hospital at Herlev, Herlev, Denmark
| | - Sonja Wehberg
- Department of Epidemiology, Odense University Hospital, Odense, Denmark
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16
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Production scientifique du REIN. Nephrol Ther 2013; 9 Suppl 1:S193-7. [DOI: 10.1016/s1769-7255(13)70046-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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17
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Couchoud C, Dantony E, Elsensohn MH, Villar E, Ecochard R. Modelling treatment trajectories to optimize the organization of renal replacement therapy and public health decision-making. Nephrol Dial Transplant 2013; 28:2372-82. [DOI: 10.1093/ndt/gft204] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Cécile Couchoud
- REIN Registry, Agence de la Biomédecine, Saint Denis La Plaine, France
| | - Emmanuelle Dantony
- Service de Biostatistique, Hospices Civils de Lyon, Lyon, France
- Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique Santé, Université Lyon I, CNRS, UMR 5558, Villeurbanne, France
| | - Mad-Hélénie Elsensohn
- Service de Biostatistique, Hospices Civils de Lyon, Lyon, France
- Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique Santé, Université Lyon I, CNRS, UMR 5558, Villeurbanne, France
| | - Emmanuel Villar
- Service de Biostatistique, Hospices Civils de Lyon, Lyon, France
- Service de néphrologie, Centre hospitalier Saint-Joseph Saint-Luc, Lyon, France
| | - René Ecochard
- Service de Biostatistique, Hospices Civils de Lyon, Lyon, France
- Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique Santé, Université Lyon I, CNRS, UMR 5558, Villeurbanne, France
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18
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Brown EA. How to address barriers to peritoneal dialysis in the elderly. Perit Dial Int 2011; 31 Suppl 2:S83-5. [PMID: 21364214 DOI: 10.3747/pdi.2009.00160] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Older patients on dialysis have unique needs and characteristics and their outcomes vary from that of their younger counterparts. Comparatively fewer will start or be maintained on peritoneal dialysis (PD) compared to younger patients, despite the fact that hemodialysis is often poorly tolerated. Barriers to PD for older patients include poor vision, frailty, cognitive dysfunction, accommodation issues, and a bias from renal teams that older patients cannot do PD. The development of assisted PD can overcome many of these barriers. The ability of older patients to use PD as their dialysis modality should not be determined by whether they live in an area where the nephrologist is a PD enthusiast. All patients should be given nonbiased information so they can choose the dialysis modality that gives them the best quality of life and suits their and their family's lifestyle.
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Affiliation(s)
- Edwina A Brown
- Imperial College Kidney and Transplant Institute, Hammersmith Hospital, Du Cane Road, London, United Kingdom.
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19
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Boateng EA, East L. THE IMPACT OF DIALYSIS MODALITY ON QUALITY OF LIFE: A SYSTEMATIC REVIEW. J Ren Care 2011; 37:190-200. [DOI: 10.1111/j.1755-6686.2011.00244.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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20
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Abstract
The interdependence of cardiac and renal dysfunction has emerged as a focus of intense interest in heart failure management due to the substantial associated morbidity and mortality. Captured in the clinical entity known as cardiorenal syndrome, recent definitions afford discussion of the acute and longitudinal evaluation and management of these patients. This article discusses potential pathophysiologic mechanisms of cardiorenal syndrome, epidemiology, inpatient and long-term care (including investigational therapies and mechanical fluid removal), and end-of-life and palliative care.
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21
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Quinn RR, Hux JE, Oliver MJ, Austin PC, Tonelli M, Laupacis A. Selection bias explains apparent differential mortality between dialysis modalities. J Am Soc Nephrol 2011; 22:1534-42. [PMID: 21784891 DOI: 10.1681/asn.2010121232] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The relative risk of death for patients treated with peritoneal dialysis compared with those treated with hemodialysis appears to change with duration of dialysis therapy. Patients who start dialysis urgently are at high risk for mortality and are treated almost exclusively with hemodialysis, introducing bias to such mortality comparisons. To better isolate the association between dialysis treatment modality and patient mortality, we examined the relative risk for mortality for peritoneal dialysis compared with hemodialysis among individuals who received ≥4 months of predialysis care and who started dialysis electively as outpatients. From a total of 32,285 individuals who received dialysis in Ontario, Canada during a nearly 8-year period, 6,573 patients met criteria for elective, outpatient initiation. We detected no difference in survival between peritoneal dialysis and hemodialysis after adjusting for relevant baseline characteristics. The relative risk of death did not change with duration of dialysis therapy in our primary analysis, but it did change with time when we defined our patient population using the more inclusive criteria typical of previous studies. These results suggest that peritoneal dialysis and hemodialysis associate with similar survival among incident dialysis patients who initiate dialysis electively, as outpatients, after at least 4 months of predialysis care. Selection bias, rather than an effect of the treatment itself, likely explains the previously described change in the relative risk of death over time between hemodialysis and peritoneal dialysis.
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Affiliation(s)
- Robert R Quinn
- University of Calgary, Foothills Medical Centre, Calgary, Alberta, T2N 2T9 Canada.
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22
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Chanliau J, Kessler M. [Peritoneal dialysis for ESRD patients: financial aspects]. Nephrol Ther 2010; 7:32-7. [PMID: 21112269 DOI: 10.1016/j.nephro.2010.10.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2010] [Revised: 10/10/2010] [Accepted: 10/14/2010] [Indexed: 11/18/2022]
Abstract
Peritoneal dialysis (PD) is as least as good as hemodialysis (HD) for the treatment of end stage kidney disease, considering morbidity and mortality, and better for quality of life. The best result is obtained when the patient can benefit of the sequential treatment, PD first and then HD if necessary. Furthermore, the cost of a patient treated by PD is less than the cost of the same patient treated by HD, at least in developed countries. But, all around the word, the rate of usage of PD don't grow, or decline. One can expect that, as no medical reason can explain this, the cause is economic. Multiple economics aspects and expenses posts for DP are analyzed, as the results of some financial decisions taken in one country or the other, keeping in mind the French system or reimbursement. We conclude that economic incitations may help for the development of PD, if they don't penalize one of the partners (insurance, clinics, doctors of patients), and if in the same time there is an improvement of the formation and information of doctors and patient.
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Affiliation(s)
- Jacques Chanliau
- Association lorraine de traitement de l'insuffisance rénale (ALTIR), BP 149, 54504 Vandœuvre cedex, France.
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23
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Abstract
The interdependence of cardiac and renal dysfunction has emerged as a focus of intense interest in heart failure management due to the substantial associated morbidity and mortality. Captured in the clinical entity known as cardiorenal syndrome, recent definitions afford discussion of the acute and longitudinal evaluation and management of these patients. This article discusses potential pathophysiologic mechanisms of cardiorenal syndrome, epidemiology, inpatient and long-term care (including investigational therapies and mechanical fluid removal), and end-of-life and palliative care.
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Affiliation(s)
- Robert J Mentz
- Department of Internal Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
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24
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[Anxiety and depression in hemodialysis: validation of the Hospital Anxiety and Depression Scale (HADS)]. Nephrol Ther 2009; 5:193-200. [PMID: 19346177 DOI: 10.1016/j.nephro.2009.01.007] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2008] [Revised: 12/26/2008] [Accepted: 01/14/2009] [Indexed: 10/20/2022]
Abstract
Anxiety and depression are considered as frequent disorders in end-stage renal disease patients. However studies on this topic are almost nonexistent in France. The Hospital Anxiety and Depression Scale (HADS, Zigmond & Snaith, 1983) is a well-used instrument in the international literature. Fast and easy to administer, it measures anxiety and depression symptomatology in physically ill patients. The purpose of the present study was to test the psychometric properties of the scale within a French sample of 207 hemodialysis patients. Exploratory factor analysis yielded two factors: anxiety and depression. Further analysis showed that the two factors presented good internal consistency, were significantly correlated to patient's age and quality of life, but were not associated with years on dialysis. Moreover, differences were found for gender and dialysis modality (self-care units versus in center). The results of this study underline the relevance of using the HADS to identify anxiety and depression and confirm the importance to take into account these disorders to enhance patient's quality of life and global care.
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Spécificités méthodologiques de l’analyse de survie des patients dialysés. Nephrol Ther 2008; 4:553-61. [DOI: 10.1016/j.nephro.2008.02.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2007] [Revised: 02/18/2008] [Accepted: 02/20/2008] [Indexed: 11/23/2022]
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Cridlig J, Selton-Suty C, Alla F, Chodek A, Pruna A, Kessler M, Frimat L. Cardiac impact of the arteriovenous fistula after kidney transplantation: a case-controlled, match-paired study. Transpl Int 2008; 21:948-54. [DOI: 10.1111/j.1432-2277.2008.00707.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Frimat L, Stengel B. Comment évaluer la prise en charge de la maladie rénale chronique ? Nephrol Ther 2008; 4:86-8. [DOI: 10.1016/j.nephro.2007.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2007] [Accepted: 11/30/2007] [Indexed: 11/15/2022]
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28
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Kessler M. Une approche intégrée de la suppléance rénale. Nephrol Ther 2007. [DOI: 10.1016/s1769-7255(07)78751-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Alenabi F, Genestier S, Verger C, Duman M, Faller B. Quelle modalité de suppléance chez les patients très âgés : la dialyse péritonéale ? Nephrol Ther 2007. [DOI: 10.1016/s1769-7255(07)78757-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Frimat L, Thilly N, Boini S, Loos-Ayav C, Kessler M, Briançon S. Insuffisance rénale chronique terminale traitée : gestion du patient non planifié. Nephrol Ther 2007. [DOI: 10.1016/s1769-7255(07)78752-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Loos-Ayav C, Frimat L, Kessler M, Chanliau J, Durand PY, Briançon S. Changes in health-related quality of life in patients of self-care vs. in-center dialysis during the first year. Qual Life Res 2007; 17:1-9. [DOI: 10.1007/s11136-007-9286-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2007] [Accepted: 11/12/2007] [Indexed: 11/28/2022]
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Butt Z, Yount SE, Caicedo JC, Abecassis MM, Cella D. Quality of life assessment in renal transplant: review and future directions. Clin Transplant 2007; 22:292-303. [DOI: 10.1111/j.1399-0012.2007.00784.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Villar E, Remontet L, Labeeuw M, Ecochard R. Effect of Age, Gender, and Diabetes on Excess Death in End-Stage Renal Failure. J Am Soc Nephrol 2007; 18:2125-34. [PMID: 17582163 DOI: 10.1681/asn.2006091048] [Citation(s) in RCA: 121] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Life expectancy is short in elderly individuals with end-stage renal failure (ESRF). This study aimed to compare mortality in patients with ESRF versus the general population (GP) to assess the evolution of excess mortality by age, gender, nephropathy, and dialysis modality after first dialysis. All incident adult dialysis patients from January 1,1999, to December 31, 2003, who lived in Rhône-Alpes Region (France) were included and followed up to death or December 31, 2005. Standardized mortality ratios (SMR) in comparison with GP were computed in the first to the fifth years after first dialysis. In the whole cohort (3025 incident patients), SMR decreased during these 5 yr from 7.4 to 5.2 (P = 0.002). In the 18- to 44-, 45- to 64-, 65- to 74-, 75- to 84-, and > or =85-yr-old groups, SMR decreased from 26.7 to 6.2 (P = 0.01), from 12.8 to 8.1 (P = 0.03), from 8.6 to 5.6 (P = 0.051), from 7.1 to 4.5 (P = 0.02), and from 3.5 to 1.2 (P = 0.14), respectively. Among age categories, differences were significant in the first 3 yr (P < 0.05). SMR were higher 1.5-fold in women than in men in the first 4 yr (P < 0.05). In patients with diabetic nephropathy (DN), SMR increased during the first 3 yr (P = 0.045) and were higher than in patients without DN in the second, third, and fourth years (P < 0.05). SMR were higher in the peritoneal dialysis than in the hemodialysis group in the fourth year (P < 0.01). Patients with ESRF have a high excess mortality compared with the GP. Older patients with ESRF experienced less excess mortality. ESRF cancels out women's survival advantage noted in the GP. SMR evolution in patients with DN was different from that in patients without DN.
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Affiliation(s)
- Emmanuel Villar
- Department of Nephrology, Dialysis and Transplantation, Lyon Sud Hospital, Pierre-Bénite, Lyon, France.
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Bayat S, Frimat L, Thilly N, Loos C, Briançon S, Kessler M. Medical and non-medical determinants of access to renal transplant waiting list in a French community-based network of care. Nephrol Dial Transplant 2006; 21:2900-7. [PMID: 16861245 DOI: 10.1093/ndt/gfl329] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Evaluation of adult candidates for kidney transplantation diverges from one centre to another. Concurrently, ethnic background, female gender, late referral to a nephrologist, distance from transplantation department and private ownership of a dialysis facility have been associated with poor access to kidney transplantation. We assessed determinants of access to a waiting list in a French community-based network of care. METHODS From July 1997 to June 2003, 1725 adults living in Lorraine, who started renal replacement therapy in one of the 13 facilities of the network, were included. We compared, first, the patients registered on the waiting list with those not registered and, second, the patients registered before starting dialysis with those registered after. RESULTS Using logistic regression, registration on the waiting list was exclusively associated with age and medical factors, except for one variable: medical follow-up in the department performing transplantation [odds ratio (OR): 1.67 (95%CI: 1.05-2.67)]. Registration before starting dialysis was not associated with medical factors but with age [OR of patients younger than 45 years vs those older than 65 years: 3.85 (95%CI: 1.05-24.92)] and medical follow-up in the department performing transplantation [OR: 3.56 (95%CI: 1.98-6.67)]. CONCLUSIONS In a French community-based network, patients followed by the nephrology department performing transplantation are more likely to be registered on the transplant waiting list early in the course of chronic kidney disease. Age over 55 per se is a considerable barrier to access to kidney transplantation. Medical guidelines should allow a standardization of criteria for registration.
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Affiliation(s)
- Sahar Bayat
- Service de néphrologie, Hôpitaux de Brabois, 54500 Vandoeuvre les Nancy, France
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