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Abstract
Confronted with the decision to initiate dialysis, patients and caregivers often seek information about how expected survival chances evolve, both initially and afterward, providing the patient survives beyond arbitrary periods of time. Large registry data, used to examine these issues, may be subject to early ascertainment bias, such as those accruing from nonregistration of with end-stage kidney disease who die shortly after dialysis initiation and inclusion of patients with acute kidney injury with slower than typical recovery rates. Despite these caveats, available studies have suggested that mortality hazards are much higher in the first 3 months of renal replacement therapy. Prominent modifiable associations of early mortality include late referral to nephrology services, initial dialysis with vascular catheters, and, most problematically, higher glomerular filtration rates at initiation of renal replacement therapy. Despite their imperfections, currently available information is relatively user-unfriendly and could be better leveraged to help patients and treatment teams make better decisions.
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Affiliation(s)
- Robert N Foley
- Department of Medicine, University of Minnesota, Minneapolis, MN.
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2
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Long B, Koyfman A, Lee CM. Emergency medicine evaluation and management of the end stage renal disease patient. Am J Emerg Med 2017; 35:1946-1955. [PMID: 28893450 DOI: 10.1016/j.ajem.2017.09.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Revised: 09/02/2017] [Accepted: 09/03/2017] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND End stage renal disease (ESRD) is increasing in the U.S., and these patients demonstrate greater all-cause mortality, cardiovascular events, and hospitalization rates when compared to those with normal renal function. These patients may experience significant complications associated with loss of renal function and dialysis. OBJECTIVE This review evaluates complications of ESRD including cardiopulmonary, neurologic, infectious disease, vascular, and access site complications, as well as medication use in this population. DISCUSSION ESRD incidence is rapidly increasing, and patients commonly require renal replacement therapy including hemodialysis (HDS) or peritoneal dialysis (PD), each type with specific features. These patients possess greater risk of neurologic complications, cardiopulmonary pathology, infection, and access site complications. Focused history and physical examination are essential. Neurologic issues include uremic encephalopathy, cerebrovascular pathology, and several others. Cardiopulmonary complications include pericarditis, pericardial effusion/tamponade, acute coronary syndrome, sudden cardiac death, electrolyte abnormalities, pulmonary edema, and air embolism. Infections are common, with patients more commonly presenting in atypical fashion. Access site infections and metastatic infections must be treated aggressively. Access site complications include bleeding, aneurysm/pseudoaneurysm, thrombosis/stenosis, and arterial steal syndrome. Specific medication considerations are required for analgesics, sedatives, neuromuscular blocking agents, antimicrobials, and anticoagulants. CONCLUSIONS Consideration of renal physiology with complications in ESRD can assist emergency providers in the evaluation and management of these patients. ESRD affects many organ systems, and specific pharmacologic considerations are required.
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Affiliation(s)
- Brit Long
- San Antonio Military Medical Center, Department of Emergency Medicine, 3841 Roger Brooke Dr, Fort Sam Houston, TX 78234, United States.
| | - Alex Koyfman
- The University of Texas Southwestern Medical Center, Department of Emergency Medicine, 5323 Harry Hines Boulevard, Dallas, TX 75390, United States
| | - Courtney M Lee
- Joint Base Elmendorf Richardson Medical Center, Department of Emergency Medicine, 5955 Zeamer Ave, JBER, AK, 99506, United States
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Tang W, Hu XH, Zhu L, Niu ZL, Su CY, Han QF, Wang T. Pre-dialysis renal clinic visits and patients' outcomes on peritoneal dialysis. Int Urol Nephrol 2016; 48:1911-1917. [PMID: 27587067 DOI: 10.1007/s11255-016-1400-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Accepted: 08/17/2016] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate the effect of pre-dialysis renal care on peritoneal dialysis (PD) patients' outcomes in China. METHODS In this retrospective cohort study, patients who started PD during January 1, 2006, to December 31, 2014, were included. Patients' medical charts were reviewed to extract the information. To explore the effect of pre-dialysis renal care on patients' outcomes, patient were divided into two groups according to whether or not they had frequent renal clinic visits: Group A (with frequent visits) and Group B (without frequent visits). RESULTS A total of 668 patients were included. Patients who admitted to emergency room before PD initiations were significantly higher in Group B than in Group A (42.7 vs. 33 %, p = 0.01). However, there was no significant difference in the proportion of patients requiring emergency hemodialysis prior to PD commencement (20.5 vs. 24.6 %, p = 0.21), acute heart failure (30.2 vs. 35.4 %, p = 0.16) and pulmonary infection (15.4 vs. 12.1 %, p = 0.23) between groups. Both the mortality and technical failure rate in Group A were significantly lower as compared to Group B (p = 0.003 and p < 0.01, respectively). Multivariable Cox regression analysis showed frequent pre-dialysis renal clinic visits were associated with both lower mortality rate (HR 0.62, 95 % CI 0.46-0.85, p = 0.003) and technical failure on PD (HR 0.58, 95 % CI 0.36-0.92, p = 0.022). CONCLUSION Pre-dialysis frequent clinic visits were associated with better PD outcomes. Pre-dialysis renal clinic management was suboptimal in the present cohort. More organized system to ensure people with established chronic kidney disease are well managed is necessary in China.
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Affiliation(s)
- Wen Tang
- Division of Nephrology, Peking University Third Hospital, 49 North Garden Rd, Haidian District, Beijing, 100191, China
| | - Xiu-Hong Hu
- Division of Nephrology, Peking University Third Hospital, 49 North Garden Rd, Haidian District, Beijing, 100191, China
- School of Chinese Integrative Medicine, Hebei Medical University, Shijiazhuang, China
- Division of Nephrology, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Lei Zhu
- Division of Nephrology, Peking University Third Hospital, 49 North Garden Rd, Haidian District, Beijing, 100191, China
- Division of Nephrology, The Second People's Hospital of Yibin, Yibin, China
| | - Zhe-Li Niu
- Division of Nephrology, Peking University Third Hospital, 49 North Garden Rd, Haidian District, Beijing, 100191, China
- School of Chinese Integrative Medicine, Hebei Medical University, Shijiazhuang, China
- Division of Nephrology, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Chu-Yan Su
- Division of Nephrology, Peking University Third Hospital, 49 North Garden Rd, Haidian District, Beijing, 100191, China
| | - Qing-Feng Han
- Division of Nephrology, Peking University Third Hospital, 49 North Garden Rd, Haidian District, Beijing, 100191, China.
| | - Tao Wang
- Division of Nephrology, Peking University Third Hospital, 49 North Garden Rd, Haidian District, Beijing, 100191, China
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Li Z, Abreu Z, Penner T, He L, Liu X, Bargman JM. Analysis of Hospitalization after Peritoneal Dialysis Catheter Implantation. Perit Dial Int 2015; 36:540-6. [PMID: 26475842 DOI: 10.3747/pdi.2014.00333] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Accepted: 07/06/2015] [Indexed: 02/05/2023] Open
Abstract
UNLABELLED ♦ BACKGROUND Implantation of the peritoneal dialysis catheter (PDC), usually an elective procedure, may necessitate unexpected hospitalization and even transfer to intensive care due to the multiple comorbidities and inherent instability of the end-stage renal disease patient. Information on hospitalization after PDC implantation is limited and details about the reason for hospitalization are lacking. ♦ METHODS We performed a cohort study in consecutive patients who underwent PDC implantation at a single institution from September 2007 to September 2013. Clinical characteristics of enrolled patients, technique of the implantation procedure, and all-cause unexpected hospitalization and morbidity within 14 days after implantation were analyzed. ♦ RESULTS Excluding the patients with pre-arranged admission, a total of 246 patients receiving 252 PDC implantations during the 6 years were studied. After 39 procedures (15.5%), patients had an unexpected hospital stay or re-admission due to operative complications (33.3%), worsening of disease (35.9%), or a single-night hospital stay for observation (30.8%). Compared with discharged patients, the patients with unexpected hospitalization were older (p = 0.001), experienced higher rates of previous episodes of heart failure (p = 0.006) and heart disease (p < 0.001), had more use of general anesthesia (GA) (p = 0.046), underwent more added procedures during the implantation (p = 0.02), and had more episodes of flow obstruction and peritonitis after implantation (p = 0.012 and p < 0.001, respectively). Using a multivariable logistic regression, we showed that age, cardiac morbidity, use of general anesthesia, PDC flow problems and peritonitis after implantation were independent predictors of all-cause unexpected hospitalization. ♦ CONCLUSIONS For the first time, our study analyzed the predictors of unplanned hospitalization after PDC implantation and identified the salient risk factors. Increased focus to identify patients at greatest risk for hospitalization, evaluation of processes of care, and implementation of preventive strategies may be helpful to reduce unplanned hospitalization after catheter insertion.
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Affiliation(s)
- Zi Li
- Department of Nephrology, West China Hospital of Sichuan University, Chengdu, China
| | - Zita Abreu
- Peritoneal Dialysis Program, University Health Network, Toronto, ON, Canada
| | - Todd Penner
- Peritoneal Dialysis Program, University Health Network, Toronto, ON, Canada
| | - Lian He
- Department of Nephrology, Peking University 3 Hospital, Beijing, China
| | - Xihui Liu
- Department of Nephrology, Linyi People's Hospital, Linyi, China
| | - Joanne M Bargman
- Peritoneal Dialysis Program, University Health Network, Toronto, ON, Canada
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Matheny ME, Peterson JF, Eden SK, Hung AM, Speroff T, Abdel-Kader K, Parr SK, Ikizler TA, Siew ED. Laboratory test surveillance following acute kidney injury. PLoS One 2014; 9:e103746. [PMID: 25117447 PMCID: PMC4130516 DOI: 10.1371/journal.pone.0103746] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Accepted: 07/01/2014] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Patients with hospitalized acute kidney injury (AKI) are at increased risk for accelerated loss of kidney function, morbidity, and mortality. We sought to inform efforts at improving post-AKI outcomes by describing the receipt of renal-specific laboratory test surveillance among a large high-risk cohort. METHODS We acquired clinical data from the Electronic health record (EHR) of 5 Veterans Affairs (VA) hospitals to identify patients hospitalized with AKI from January 1st, 2002 to December 31st, 2009, and followed these patients for 1 year or until death, enrollment in palliative care, or improvement in renal function to estimated GFR (eGFR) ≥ 60 L/min/1.73 m(2). Using demographic data, administrative codes, and laboratory test data, we evaluated the receipt and timing of outpatient testing for serum concentrations of creatinine and any as well as quantitative proteinuria recommended for CKD risk stratification. Additionally, we reported the rate of phosphorus and parathyroid hormone (PTH) monitoring recommended for chronic kidney disease (CKD) patients. RESULTS A total of 10,955 patients admitted with AKI were discharged with an eGFR<60 mL/min/1.73 m2. During outpatient follow-up at 90 and 365 days, respectively, creatinine was measured on 69% and 85% of patients, quantitative proteinuria was measured on 6% and 12% of patients, PTH or phosphorus was measured on 10% and 15% of patients. CONCLUSIONS Measurement of creatinine was common among all patients following AKI. However, patients with AKI were infrequently monitored with assessments of quantitative proteinuria or mineral metabolism disorder, even for patients with baseline kidney disease.
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Affiliation(s)
- Michael E. Matheny
- Geriatrics Research Education & Clinical Center (GRECC), Tennessee Valley Healthcare System (TVHS), Veteran's Health Administration, Nashville, TN, United States of America
- Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, TN, United States of America
- Division of General Internal Medicine, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, United States of America
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, United States of America
| | - Josh F. Peterson
- Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, TN, United States of America
- Division of General Internal Medicine, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, United States of America
| | - Svetlana K. Eden
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, United States of America
| | - Adriana M. Hung
- Geriatrics Research Education & Clinical Center (GRECC), Tennessee Valley Healthcare System (TVHS), Veteran's Health Administration, Nashville, TN, United States of America
- Division of Nephrology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, United States of America
| | - Theodore Speroff
- Geriatrics Research Education & Clinical Center (GRECC), Tennessee Valley Healthcare System (TVHS), Veteran's Health Administration, Nashville, TN, United States of America
- Division of General Internal Medicine, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, United States of America
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, United States of America
| | - Khaled Abdel-Kader
- Division of Nephrology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, United States of America
| | - Sharidan K. Parr
- Division of Nephrology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, United States of America
| | - T. Alp Ikizler
- Division of Nephrology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, United States of America
| | - Edward D. Siew
- Division of Nephrology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, United States of America
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Smart NA, Dieberg G, Ladhani M, Titus T. Early referral to specialist nephrology services for preventing the progression to end-stage kidney disease. Cochrane Database Syst Rev 2014:CD007333. [PMID: 24938824 DOI: 10.1002/14651858.cd007333.pub2] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Early referral of patients with chronic kidney disease (CKD) is believed to help with interventions to address risk factors to slow down the rate of progression of kidney failure to end-stage kidney disease (ESKD) and the need for dialysis, hospitalisation and mortality. OBJECTIVES We sought to evaluate the benefits (reduced hospitalisation and mortality; increased quality of life) and harms (increased hospitalisations and mortality, decreased quality of life) of early versus late referral to specialist nephrology services in CKD patients who are progressing to ESKD and RRT. In this review, referral is defined as the time period between first nephrology evaluation and initiation of dialysis; early referral is more than one to six months, whereas late referral is less than one to six months prior to starting dialysis. All-cause mortality and hospitalisation and quality of life were measured by the visual analogue scale and SF-36. SF-36 and KDQoL are validated measurement instruments for kidney diseases. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, 2012; Issue 1) which contains the Cochrane Renal Group's Specialised Register; MEDLINE (1966 to February 2012), EMBASE (1980 to February 2012). Search terms were approved by the Trial Search Co-ordinator. SELECTION CRITERIA Randomised controlled trials (RCTs), quasi-RCTs, prospective and retrospective longitudinal cohort studies were eligible for inclusion. DATA COLLECTION AND ANALYSIS Two authors independently assessed study quality and extracted data. Events relating to adverse effects were collected from the studies. MAIN RESULTS No RCTs or quasi-RCTs were identified. There were 40 longitudinal cohort studies providing data on 63,887 participants; 43,209 (68%) who were referred early and 20,678 (32%) referred late.Comparative mortality was higher in patients referred to specialist services late versus those referred early. Risk ratios (RR) for mortality reductions in patients referred early were evident at three months (RR 0.61, 95% CI 0.55 to 0.67; I² = 84%) and remained at five years (RR 0.66, 95% CI 0.60 to 0.71; I² = 87%). Initial hospitalisation was 9.12 days shorter with early referral (95% CI -10.92 to -7.32 days; I² = 82%) compared to late referral. Pooled analysis showed patients referred early were more likely than late referrals to initiate RRT with peritoneal dialysis (RR 1.74, 95% CI 1.64 to 1.84; I² = 92%).Patients referred early were less likely to receive temporary vascular access (RR 0.47, 95% CL 0.45 to 0.50; I² = 97%) than those referred late. Patients referred early were more likely to receive permanent vascular access (RR 3.22, 95% CI 2.92 to 3.55; I² = 97%). Systolic blood pressure (BP) was significantly lower in early versus late referrals (MD -3.09 mm Hg, 95% CI -5.23 to -0.95; I² = 85%); diastolic BP was significantly lower in early versus late referrals (MD -1.64 mm Hg, 95% CI -2.77 to -0.51; I² = 82%). EPO use was significantly higher in those referred early (RR 2.92, 95% CI 2.42 to 3.52; I² = 0%). eGFR was higher in early referrals (MD 0.42 mL/min/1.73 m², 95% CI 0.28 to 0.56; I² = 95%). Diabetes prevalence was similar in patients referred early and late (RR 1.05, 95% CI 0.96 to 1.15; I² = 87%) as was ischaemic heart disease (RR 1.05, 95% CI 0.97 to 1.13; I² = 74%), peripheral vascular disease (RR 0.99, 95% CI 0.84 to 1.17; I² = 90%), and congestive heart failure (RR 1.00, 95% CI 0.86 to 1.15; I² = 92%). Inability to walk was less prevalent in early referrals (RR 0.66, 95% CI 0.51 to 0.86). Prevalence of chronic obstructive pulmonary disease was similar in those referred early and late (RR 0.89, 95% CI 0.70 to 1.14; I² = 94%) as was cerebrovascular disease (RR 0.90, 95% CI 0.74 to 1.11; I² = 83%).The quality of the included studies was assessed as being low to moderate based on the Newcastle-Ottawa Scale. Slight differences in the definition of early versus late referral infer some risk of bias. Generally, heterogeneity in most of the analyses was high. AUTHORS' CONCLUSIONS Our analysis showed reduced mortality and mortality and hospitalisation, better uptake of peritoneal dialysis and earlier placement of arteriovenous fistulae for patients with chronic kidney disease who were referred early to a nephrologist. Differences in mortality and hospitalisation data between the two groups were not explained by differences in prevalence of comorbid disease or serum phosphate. However, early referral was associated with better preparation and placement of dialysis access.
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Affiliation(s)
- Neil A Smart
- Exercise Physiology Convenor, University of New England, University Drive, Armidale, Australia, NSW 2351
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Serafinceanu C, Neculaescu C, Cimponeriu D, Timar R, Covic AC. Impact of gender and dialysis modality on early mortality risk in diabetic ESRD patients: data from a large single center cohort. Int Urol Nephrol 2013; 46:607-14. [PMID: 24366761 DOI: 10.1007/s11255-013-0589-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Accepted: 10/14/2013] [Indexed: 01/08/2023]
Abstract
BACKGROUND Diabetes mellitus (DM)-associated chronic kidney disease (diabetic renal disease) became the predominant etiology of the end-stage renal disease (ESRD) in the western countries and shows the same trend in the developing countries. Early mortality (EM) after the dialysis initiation, defined as death of all causes within the first 3 months after initiation of renal replacement therapy (RRT), is of concern especially for the high-risk renal patients including diabetics. The goal of the present study was to identify demographic and clinical risk factors associated with EM in a retrospective cohort of Romanian DM patients initiated on dialysis. METHODS A retrospective case-control study was designed. Clinical recordings from all patients initiated on hemodialysis (HD) or peritoneal dialysis between January 1996 and December 2005 in the Dialysis Center of NIDNMD Paulescu, Bucharest, were collected and analyzed. Patients were classified accordingly in two groups: those who displayed EM formed the "cases" group, while the others were included in the "controls" group. Both univariate (subgroup analysis) and multivariate analyses (logistic regression, Cox regression) were used to analyze the impact of risk factors on EM outcome. RESULTS Data from 788 patients were included in the analysis. The factors significantly associated with EM in the univariate analysis were female gender, late initiation (LI) of dialysis, old age and HD used as the first/only method. Applying the multivariate analysis, only the use of HD (OR = 4.20, p < 0.0001) and the LI of dialysis (p < 0.0001; 95 % CI 1.36-2.30) were associated with EM, while female gender showed only a trend to a higher EM (OR = 1.29, p = 0.052). CONCLUSIONS Hemodialysis used as a first/single method for RRT and the LI of dialysis were independent predictors of EM in our ESRD diabetic patients. A possible explanation for the first factor could be our specific center procedure, which allows only the HD as rescue therapy method for the most severe cases, managed in the intensive care unit.
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Affiliation(s)
- C Serafinceanu
- National Institute of Nutrition, Diabetes and Metabolic Diseases "N. Paulescu", 5-7th, Ion Movila Str., 020475, Sector 2, Bucharest, Romania,
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Li PKT, Chow KM. Peritoneal Dialysis–First Policy Made Successful: Perspectives and Actions. Am J Kidney Dis 2013; 62:993-1005. [DOI: 10.1053/j.ajkd.2013.03.038] [Citation(s) in RCA: 92] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Accepted: 03/19/2013] [Indexed: 12/31/2022]
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Abdellatif AA. Role of Single-Pill Combination Therapy in Optimizing Blood Pressure Control in High-Risk Hypertension Patients and Management of Treatment-Related Adverse Events. J Clin Hypertens (Greenwich) 2012; 14:718-26. [DOI: 10.1111/j.1751-7176.2012.00696.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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10
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Siew ED, Peterson JF, Eden SK, Hung AM, Speroff T, Ikizler TA, Matheny ME. Outpatient nephrology referral rates after acute kidney injury. J Am Soc Nephrol 2012; 23:305-12. [PMID: 22158435 PMCID: PMC3269178 DOI: 10.1681/asn.2011030315] [Citation(s) in RCA: 144] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2011] [Accepted: 10/05/2011] [Indexed: 01/22/2023] Open
Abstract
AKI associates with an increased risk for the development and progression of CKD and mortality. Processes of care after an episode of AKI are not well described. Here, we examined the likelihood of nephrology referral among survivors of AKI at risk for subsequent decline in kidney function in a US Department of Veterans Affairs database. We identified 3929 survivors of AKI hospitalized between January 2003 and December 2008 who had an estimated GFR (eGFR) <60 ml/min per 1.73 m(2) 30 days after peak injury. We analyzed time to referral considering improvement in kidney function (eGFR ≥60 ml/min per 1.73 m(2)), dialysis initiation, and death as competing risks over a 12-month surveillance period. Median age was 73 years (interquartile range, 62-79 years) and the prevalence of preadmission kidney dysfunction (baseline eGFR <60 ml/min per 1.73 m(2)) was 60%. Overall mortality during the surveillance period was 22%. The cumulative incidence of nephrology referral before dying, initiating dialysis, or experiencing an improvement in kidney function was 8.5% (95% confidence interval, 7.6-9.4). Severity of AKI did not affect referral rates. These data demonstrate that a minority of at-risk survivors are referred for nephrology care after an episode of AKI. Determining how to best identify survivors of AKI who are at highest risk for complications and progression of CKD could facilitate early nephrology-based interventions.
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Affiliation(s)
| | - Josh F. Peterson
- Division of General Internal Medicine, Department of Medicine
- Department of Biomedical Informatics, and
- Geriatrics Research Education & Clinical Center, Tennessee Valley Healthcare System VA Medical Center, Veterans Health Administration, Nashville, Tennessee
| | - Svetlana K. Eden
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee; and
| | - Adriana M. Hung
- Division of Nephrology and
- Geriatrics Research Education & Clinical Center, Tennessee Valley Healthcare System VA Medical Center, Veterans Health Administration, Nashville, Tennessee
| | - Theodore Speroff
- Division of General Internal Medicine, Department of Medicine
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee; and
- Geriatrics Research Education & Clinical Center, Tennessee Valley Healthcare System VA Medical Center, Veterans Health Administration, Nashville, Tennessee
| | | | - Michael E. Matheny
- Division of General Internal Medicine, Department of Medicine
- Department of Biomedical Informatics, and
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee; and
- Geriatrics Research Education & Clinical Center, Tennessee Valley Healthcare System VA Medical Center, Veterans Health Administration, Nashville, Tennessee
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SZETO CHEUKCHUN, KWAN BONNIECHINGHA, CHOW KAIMING, PANG WINGFAI, KWONG VICKIEWAIKI, LEUNG CHIBON, LI PHILIPKAMTAO. Life expectancy of Chinese patients with chronic kidney disease without dialysis. Nephrology (Carlton) 2011; 16:715-9. [DOI: 10.1111/j.1440-1797.2011.01504.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Chow KM, Szeto CC, Kwan BCH, Pang WF, Leung CB, Li PKT. Characteristics and Outcomes of Chronic Kidney Disease Patients Who Default on Appointments at a Low Clearance Clinic. Int J Organ Transplant Med 2011. [DOI: 10.1016/s1561-5413(11)60005-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Villa G, Rodríguez-Carmona A, Fernández-Ortiz L, Cuervo J, Rebollo P, Otero A, Arrieta J. Cost analysis of the Spanish renal replacement therapy programme. Nephrol Dial Transplant 2011; 26:3709-14. [PMID: 21427072 DOI: 10.1093/ndt/gfr088] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND A cost analysis of the Spanish Renal Replacement Therapy (RRT) programme in the year 2010, for end-stage renal disease (ESRD) patients, was performed from the perspective of the Public Administration. METHODS The costs associated with each RRT modality [hemodialysis (HD), peritoneal dialysis (PD) and kidney transplantation (Tx)] were analysed. The Spanish ESRD incidence and prevalence figures in the year 2010 were forecasted in order to enable the calculation of an aggregate cost for each modality. Costs were mainly computed based on a review of the existing literature and of the Official Bulletins of the Spanish Autonomous Communities. Data from Oblikue Consulting eSalud health care costs database and from several Spanish public sources were also employed. RESULTS In the year 2010, the forecasted incidence figures for HD, PD and Tx were 5409, 822 and 2317 patients, respectively. The forecasted prevalence figures were 22,582, 2420 and 24,761 patients, respectively. The average annual per-patient costs (incidence and prevalence) were €2651 and €37,968 (HD), €1808 and €25,826 (PD) and €38,313 and €6283 (Tx). Indirect costs amounted to €8929 (HD), €7429 (PD) and €5483 (Tx). The economic impact of the Spanish RRT programme on the Public Administration budget was estimated at ~€1829 million (indirect costs included): €1327 (HD), €109 (PD) and €393 (Tx) million. CONCLUSIONS HD accounted for >70% of the aggregate costs of the Spanish RRT programme in 2010. From a costs minimization perspective, it would be preferable if the number of incident and prevalent patients in PD were increased.
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Affiliation(s)
- Guillermo Villa
- Department of Health Outcomes Research, BAP Health Outcomes Research, Oviedo, Spain.
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Li PKT, Chow KM. Peritoneal dialysis patient selection: characteristics for success. Adv Chronic Kidney Dis 2009; 16:160-8. [PMID: 19393965 DOI: 10.1053/j.ackd.2009.02.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This review focuses on the strategy of patient selection for peritoneal dialysis (PD) based on published epidemiology studies and observational data. With the success of the PD first model in Hong Kong, experience shows that there is no particular patient group that cannot be put on PD except those who have major problems in the abdomen. Incident patients should be offered the choice to receive PD at the start of dialysis in order to preserve better the residual renal function. Concern has also been expressed for a time-dependent negative impact of PD on survival, although PD in general provides survival advantage at least during the first few years after the start of dialysis. Regular patient review is essential to allow prompt adjustment of the dialysis regimen and modality when required. Accumulating research suggests that center size has a significant effect on the patient and technique survival of patients undergoing PD. Comorbid diabetes, large and small body size, peritoneal membrane transport status, elderly age group, and socioeconomic status are important patient factors to consider. Good clinical and psychosocial care of the PD patients are essential as well as the attention to their compliance. Enhanced training to medical and nursing personnel on PD is one of the key success factors for improving its utilization and outcome.
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Baer G, Lameire N, Van Biesen W. Late referral of patients with end-stage renal disease: an in-depth review and suggestions for further actions. NDT Plus 2009; 3:17-27. [PMID: 25949401 PMCID: PMC4421547 DOI: 10.1093/ndtplus/sfp050] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2009] [Accepted: 04/06/2009] [Indexed: 12/17/2022] Open
Abstract
Late referral of patients with chronic kidney disease (CKD) is a known problem and a major challenge for practising nephrologists since decades. In this review we report about the reasons for late referral, its epidemiology and socioeconomic impact and the medical particularities of late referred patients. We furthermore highlight on the efforts which have been undertaken so far to avoid late referral and should be undertaken in future to face the ever growing numbers of chronic kidney disease patients.
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Affiliation(s)
- Gernot Baer
- Department of Nephrology, Immunology, Rheumatology and Hypertension, Krankenhaus der Barmherzigen Brueder, Trier , Germany
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Tzamaloukas AH, Raj DS. Referral of Patients with Chronic Kidney Disease to the Nephrologist: Why and When. Perit Dial Int 2008. [DOI: 10.1177/089686080802800406] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Antonios H. Tzamaloukas
- Renal Section, Department of Medicine University of New Mexico School of Medicine Albuquerque, New Mexico, USA
- New Mexico Veterans Affairs Health Care System Division of Nephrology Department of Medicine University of New Mexico School of Medicine Albuquerque, New Mexico, USA
| | - Dominic S.C. Raj
- New Mexico Veterans Affairs Health Care System Division of Nephrology Department of Medicine University of New Mexico School of Medicine Albuquerque, New Mexico, USA
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