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Haarhaus M, Bratescu LO, Pana N, Gemene EM, Silva EM, Santos Araujo CAR, Macario F. Early referral to nephrological care improves long-term survival and hospitalization after dialysis initiation, independent of optimal dialysis start - a call for harmonization of reimbursement policies. Ren Fail 2024; 46:2313170. [PMID: 38357766 PMCID: PMC10877651 DOI: 10.1080/0886022x.2024.2313170] [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: 09/11/2023] [Accepted: 01/28/2024] [Indexed: 02/16/2024] Open
Abstract
Early treatment of kidney disease can slow disease progression and reduce the increased risk of mortality associated with end-stage kidney disease. However, uncertainty exists whether early referral (ER) to nephrological care per se or an optimal dialysis start impacts patient outcome after dialysis initiation. We determined the effect of ER and suboptimal dialysis start on the 3-year mortality and hospitalizations after dialysis initiation. Between January 2015 and July 2018, 349 patients with ≥1 month of follow-up started dialysis at nine Romanian dialysis clinics. After excluding patients with COVID-19 during follow-up, 254 patients (97 ER and 157 late referral) were included in this retrospective study. The observational period was truncated at 3 years, death, or loss to follow-up. Clinical and laboratory data were retrieved from the quality database of the nephrological care providers. Patients were followed for a median (25-75%) of 36 (16-36) months. At dialysis start, ER patients had higher hemoglobin, phosphate, and albumin levels and started dialysis less often via a central dialysis catheter (p < 0.001 for each). Logistic regression analysis demonstrated an independent lower risk for frequent hospitalizations for ER patients (odds ratio 0.22 (95% confidence interval 0.1-0.485), p < 0.001), and Cox regression analysis revealed an improved survival (hazard ratio 0.540 (95% confidence interval 0.325-0.899), p = 0.02), both independent of optimal dialysis start. In conclusion, early referral to nephrological care was associated with improved survival and lower hospitalization rates during the three years after dialysis initiation, independent of optimal dialysis start. These results strongly support the reimbursement of nephrological care before dialysis initiation.
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Affiliation(s)
- Mathias Haarhaus
- Diaverum, Malmö, Sweden
- Karolinska Institutet, Institutionen for klinisk vetenskap intervention och teknik, Stockholm, Sweden
| | | | - Nicolae Pana
- Diaverum Romania, Bucharest, Romania
- Universitatea de Medicina si Farmacie Carol Davila, Bucuresti, Romania
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2
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Wongpraphairot S, Choopun K, Sriphatphiriyakun T, Titawatanakul A, Chongsuvivatwong V, Phongphithakchai A. Comparison of immediate-start peritoneal dialysis without break-in period and conventional-start peritoneal dialysis: a two-center retrospective audit. Int Urol Nephrol 2024; 56:2403-2409. [PMID: 38441870 DOI: 10.1007/s11255-024-03967-0] [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: 11/14/2023] [Accepted: 01/29/2024] [Indexed: 06/21/2024]
Abstract
PURPOSE Immediate-start peritoneal dialysis (PD) has emerged as a strategy for patients in need of urgent dialysis. However, the ideal timing for initiating this procedure remains uncertain. In this study, we aimed to compare complications and outcomes between immediate-start PD and conventional-start PD. METHODS We performed a two-center retrospective cohort study between 1 January 2015 and 31 May 2020. Patients who underwent PD were divided into immediate-start PD (without break-in period) and conventional-start PD group (break-in period within at least 14 days). The primary outcomes were the incidence of the mechanical complications and infectious complication. The secondary outcomes were technique failure and patient survival. RESULTS A total of 209 patients (106 in the immediate-start PD group and 103 in the conventional-start PD group) were included. Immediate-start PD had significantly lower catheter malfunction or migration rate compare with conventional-start PD (2.8% vs. 15.5%, p = 0.003) but comparable rates of dialysate leaks, pleuroperitoneal leaks, and hemoperitoneum. Infectious complications (exit-site infection and peritonitis) were similar between groups. Technique survival was comparable (7.5% vs. 4.8%, p = 0.22), while immediate-start PD exhibited lower mortality rates (0.9% vs. 13.6%, p = 0.001). CONCLUSION Immediate-start PD appears to be a viable option for patients in need of urgent dialysis, with reduced catheter complications and comparable infectious complications and technique survival when compared to conventional-start PD.
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Affiliation(s)
- Suwikran Wongpraphairot
- Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, 15 Kanchanavanit Road, Hat Yai, 90110, Songkhla, Thailand
| | | | | | | | | | - Atthaphong Phongphithakchai
- Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, 15 Kanchanavanit Road, Hat Yai, 90110, Songkhla, Thailand.
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3
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Goldman S, Bargman JM, Lok CE, Gozdzik A, Perl J, Chan CT. The effect of implementing a dialysis start unit on modality decision among patients with unplanned start kidney replacement therapy. Hemodial Int 2024; 28:255-261. [PMID: 38937138 DOI: 10.1111/hdi.13165] [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: 09/09/2023] [Revised: 03/25/2024] [Accepted: 06/09/2024] [Indexed: 06/29/2024]
Abstract
INTRODUCTION Many individuals start dialysis in an acute setting with suboptimal pre-dialysis education. These individuals are often treated with central venous catheter insertion and initiation of in-center hemodialysis and only a minority will transfer to a home-based therapy. The dialysis start unit is a program performing in-center hemodialysis in a separate space while providing support and education on chronic kidney disease and treatment options in the initial weeks of kidney replacement therapy. We aimed to assess the uptake of home dialysis therapies between 2013 and 2021 among patients who started acute inpatient hemodialysis at University Health Network, Toronto and underwent dialysis at the dialysis start unit. METHODS This is a retrospective observational cohort study based on prospectively collected data. Patients' demographics were obtained from electronic charts. In the dialysis start unit, all patients received dialysis modality education by a nurse educator, dedicated home dialysis nurses, and the allied health care team. FINDINGS During 2013-2021, 122 patients were dialyzed in the dialysis start unit and included in the study. Among those patients, 68 patients ultimately chose home dialysis (57 peritoneal dialysis and 11 home hemodialysis). Fifty-four patients continued in-center hemodialysis. Patients adopting home dialysis were less likely to have diabetes and hypertension as the etiology of kidney failure and more likely to have glomerulonephritis or vasculitis. DISCUSSION Dialysis modality education is implementable in advanced chronic kidney disease. Individualized education and care after unplanned start dialysis can potentially enhance home dialysis choice and utilization.
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Affiliation(s)
- Shira Goldman
- Division of Nephrology, University Health Network, University of Toronto, Toronto, ON, Canada
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Nephrology and Hypertension, Rabin Medical Center, Petach Tikva, Israel
| | - Joanne M Bargman
- Division of Nephrology, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Charmaine E Lok
- Division of Nephrology, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Anna Gozdzik
- Division of Nephrology, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Jeffrey Perl
- Division of Nephrology and Keenan Research Center, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Christopher T Chan
- Division of Nephrology, University Health Network, University of Toronto, Toronto, ON, Canada
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4
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Kitamura M, Yamashita H, Sugiyama S, Kuroki R, Fukuda H, Sawase A, Tsuchiyama A, Takehara K, Watanabe J, Takazono T, Imamura R, Mukae H, Nishino T. Unplanned hemodialysis initiation: A retrospective analysis of patient characteristics and prognosis in an emergency hospital. Ther Apher Dial 2024. [PMID: 38946143 DOI: 10.1111/1744-9987.14181] [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: 03/21/2024] [Revised: 05/22/2024] [Accepted: 06/13/2024] [Indexed: 07/02/2024]
Abstract
INTRODUCTION Functional decline occurs during dialysis initiation, particularly in unplanned cases. To prevent unplanned hemodialysis, we aimed to identify associated factors from the first referral to the nephrology department to hemodialysis initiation and assess patient prognosis post-unplanned hemodialysis initiation. METHODS This retrospective study involved 257 Japanese patients initiating hemodialysis and compared patient characteristics based on whether hemodialysis was planned or unplanned at a single center. Patient outcomes were evaluated in collaboration with maintenance hemodialysis centers. RESULTS Unplanned hemodialysis initiation correlated with heart failure history (p < 0.05) and infections like pneumonia (p < 0.001). Patients with unplanned hemodialysis initiation had a worse prognosis than those with planned initiation (p < 0.001), and multivariable Cox regression showed it as an independent risk factor for death (p < 0.05). CONCLUSIONS Hygiene and careful attention to heart failure may reduce unplanned hemodialysis and improve patient well-being and healthcare efficiency. This retrospective analysis highlights crucial considerations for optimizing the initiation of hemodialysis.
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Affiliation(s)
- Mineaki Kitamura
- Department of Nephrology, Nagasaki Harbor Medical Center, Nagasaki, Japan
- Department of Nephrology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Hiroshi Yamashita
- Department of Nephrology, Nagasaki Harbor Medical Center, Nagasaki, Japan
- Department of Nephrology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Sayaka Sugiyama
- Department of Nephrology, Nagasaki Harbor Medical Center, Nagasaki, Japan
- Department of Nephrology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Ryoma Kuroki
- Department of Nephrology, Nagasaki Harbor Medical Center, Nagasaki, Japan
- Department of Nephrology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Haruka Fukuda
- Department of Nephrology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Atsushi Sawase
- Department of Nephrology, Nagasaki Harbor Medical Center, Nagasaki, Japan
- Department of Nephrology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Ayaka Tsuchiyama
- Department of Urology, Nagasaki Harbor Medical Center, Nagasaki, Japan
| | - Kosuke Takehara
- Department of Urology, Nagasaki Harbor Medical Center, Nagasaki, Japan
| | - Junichi Watanabe
- Department of Urology, Nagasaki Harbor Medical Center, Nagasaki, Japan
| | - Takahiro Takazono
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Ryoichi Imamura
- Department of Urology, 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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Klamrowski MM, Klein R, McCudden C, Green JR, Rashidi B, White CA, Oliver MJ, Molnar AO, Edwards C, Ramsay T, Akbari A, Hundemer GL. Derivation and Validation of a Machine Learning Model for the Prevention of Unplanned Dialysis. Clin J Am Soc Nephrol 2024:01277230-990000000-00393. [PMID: 38787617 DOI: 10.2215/cjn.0000000000000489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 05/21/2024] [Indexed: 05/26/2024]
Abstract
Key Points
Nearly half of all patients with CKD who progress to kidney failure initiate dialysis in an unplanned fashion, which is associated with poor outcomes.Machine learning models using routinely collected data can accurately predict 6- to 12-month kidney failure risk among the population with advanced CKD.These machine learning models retrospectively deliver advanced warning on a substantial proportion of unplanned dialysis events.
Background
Approximately half of all patients with advanced CKD who progress to kidney failure initiate dialysis in an unplanned fashion, which is associated with high morbidity, mortality, and health care costs. A novel prediction model designed to identify patients with advanced CKD who are at high risk for developing kidney failure over short time frames (6–12 months) may help reduce the rates of unplanned dialysis and improve the quality of transitions from CKD to kidney failure.
Methods
We performed a retrospective study using machine learning random forest algorithms incorporating routinely collected age and sex data along with time-varying trends in laboratory measurements to derive and validate 6- and 12-month kidney failure risk prediction models in the population with advanced CKD. The models were comprehensively characterized in three independent cohorts in Ontario, Canada—derived in a cohort of 1849 consecutive patients with advanced CKD (mean [SD] age 66 [15] years, eGFR 19 [7] ml/min per 1.73 m2) and validated in two external advanced CKD cohorts (n=1356; age 69 [14] years, eGFR 22 [7] ml/min per 1.73 m2).
Results
Across all cohorts, 55% of patients experienced kidney failure, of whom 35% involved unplanned dialysis. The 6- and 12-month models demonstrated excellent discrimination with area under the receiver operating characteristic curve of 0.88 (95% confidence interval [CI], 0.87 to 0.89) and 0.87 (95% CI, 0.86 to 0.87) along with high probabilistic accuracy with the Brier scores of 0.10 (95% CI, 0.09 to 0.10) and 0.14 (95% CI, 0.13 to 0.14), respectively. The models were also well calibrated and delivered timely alerts on a significant number of patients who ultimately initiated dialysis in an unplanned fashion. Similar results were found upon external validation testing.
Conclusions
These machine learning models using routinely collected patient data accurately predict near-future kidney failure risk among the population with advanced CKD and retrospectively deliver advanced warning on a substantial proportion of unplanned dialysis events. Optimal implementation strategies still need to be elucidated.
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Affiliation(s)
- Martin M Klamrowski
- Department of Systems and Computer Engineering, Carleton University, Ottawa, Ontario, Canada
| | - Ran Klein
- Department of Systems and Computer Engineering, Carleton University, Ottawa, Ontario, Canada
- Division of Nuclear Medicine, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Christopher McCudden
- Eastern Ontario Regional Laboratory Association, Ottawa, Ontario, Canada
- Division of Biochemistry, Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - James R Green
- Department of Systems and Computer Engineering, Carleton University, Ottawa, Ontario, Canada
| | - Babak Rashidi
- Division of General Internal Medicine, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Christine A White
- Division of Nephrology, Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Matthew J Oliver
- Division of Nephrology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Amber O Molnar
- Division of Nephrology, Department of Medicine, McMaster University, Hamilton Ontario, Canada
| | - Cedric Edwards
- Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Tim Ramsay
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Ayub Akbari
- Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Gregory L Hundemer
- Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
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6
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Virtanen J, Heiro M, Koivuviita N, Löyttyniemi E, Järvisalo MJ, Tertti R, Metsärinne K, Hellman T. Survival, cumulative hospital days and infectious complications in urgent-start PD compared with urgent-start HD. Perit Dial Int 2024:8968608241244939. [PMID: 38661183 DOI: 10.1177/08968608241244939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Urgent-start peritoneal dialysis (PD) carries a similar efficacy and safety profile compared to urgent-start haemodialysis (HD) but is only sparsely applied due to resource issues and concerns of complication risks. Furthermore, few data exist on adverse outcomes associated with central venous catheter (CVC) insertions in urgent-start HD patients. Thus, we sought to compare patient and dialysis-related outcomes in patients undergoing urgent-start PD or HD. METHODS All patients initiating urgent-start PD in a tertiary research hospital in 2005-2018 were included in this retrospective, single-centre, comparative study and matched with urgent-start HD patients of similar age and chronic kidney disease aetiology. All urgent-start PDs were initiated within 72 h after catheter insertion, and urgent-start HDs were performed via a CVC. All analyses were performed at 3 months and at 1 year of follow-up, respectively. RESULTS Thirty-three patients who commenced urgent-start PD and 58 matched urgent-start HD control patients were included. Altogether, 26 patients (29%; PD: 36%, HD 24%) died within the 1-year follow-up, and patient survival was similar at 3 months (hazard ratio (HR): 1.15, 95% confidence interval (CI): 0.35-3.81, p = 0.82) and at 1 year of follow-up (HR: 0.64, 95% CI: 0.30-1.39, p = 0.26) between the study groups. There were no differences in the total kidney replacement therapy (KRT)-related infection rate (p = 0.66) or cumulative first-year hospital care days (p = 0.43) between the treatment groups. Altogether, 139 CVCs were inserted during the 1-year follow-up. The number of CVCs per patient was associated with the emergence of blood culture-positive bacteraemia and increased cumulative first-year hospital care days. CONCLUSIONS Patient survival, cumulative first-year hospital care days and total KRT-related infection rate at 3 months and 1-year follow-up are similar between urgent-start PD and urgent-start HD patients. Furthermore, CVC insertion rate is associated with incident blood culture-positive bacteraemia and increased cumulative first-year hospital care days.
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Affiliation(s)
- Jonna Virtanen
- Kidney Center, Department of Internal Medicine, Turku University Hospital and University of Turku, Finland
| | - Maija Heiro
- Department of Internal Medicine, Vaasa Central Hospital and University of Turku, Vaasa, Finland
| | - Niina Koivuviita
- Kidney Center, Department of Internal Medicine, Turku University Hospital and University of Turku, Finland
| | - Eliisa Löyttyniemi
- Department of Biostatistics, University of Turku and Turku University Hospital, Finland
| | - Mikko J Järvisalo
- Kidney Center, Department of Internal Medicine, Turku University Hospital and University of Turku, Finland
- Department of Internal Medicine, Satakunta Central Hospital, Pori, Finland
| | - Risto Tertti
- Department of Internal Medicine, Vaasa Central Hospital and University of Turku, Vaasa, Finland
| | - Kaj Metsärinne
- Kidney Center, Department of Internal Medicine, Turku University Hospital and University of Turku, Finland
| | - Tapio Hellman
- Kidney Center, Department of Internal Medicine, Turku University Hospital and University of Turku, Finland
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Fritz BA. Virtual Care in Nephrology: An In-Depth Retrospective Analysis of Outcomes Using the Reset Kidney Health Model. J Clin Med 2023; 13:66. [PMID: 38202073 PMCID: PMC10779835 DOI: 10.3390/jcm13010066] [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: 10/16/2023] [Revised: 12/11/2023] [Accepted: 12/17/2023] [Indexed: 01/12/2024] Open
Abstract
The advent of virtual healthcare has reshaped patient management paradigms across various medical domains. This analysis examines the potential effectiveness of treating chronic kidney disease (CKD) using Reset Kidney Health's virtual, multidisciplinary, and integrated care approach. The pilot study concentrated on evaluating the impact of this care model on the estimated Glomerular Filtration Rate (eGFR) of CKD patients over an eight-month period. The analyses showed that a majority of patients managed with the Reset Kidney Health Model experienced stability or improvements in their kidney function, as measured by eGFR. While this pilot study has several limitations, these early results suggest the potential benefits of digital healthcare innovations in chronic disease management and provide an argument for the broader integration of virtual care strategies in healthcare systems. These initial findings could lay the groundwork for further research into effectively integrating digital healthcare in chronic disease management.
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8
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Zhou Y, Wang X, Yuan H, Wu L, Zhang B, Chen X, Zhang Y. Impact of recombinant human brain natriuretic peptide on emergency dialysis and prognosis in end-stage renal disease patients with type 4 cardiorenal syndrome. Sci Rep 2023; 13:20752. [PMID: 38007545 PMCID: PMC10676370 DOI: 10.1038/s41598-023-48125-1] [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: 06/07/2023] [Accepted: 11/22/2023] [Indexed: 11/27/2023] Open
Abstract
Recombinant human brain natriuretic peptide (rhBNP) effects on type 4 cardiorenal syndrome (CRS) and adverse events such as heart failure rehospitalization and all-cause mortality have not been assessed in large-scale research. This study evaluated the impact of rhBNP on emergency dialysis and prognosis in end-stage renal disease (ESRD) patients with type 4 CRS, and the risk factors of emergency dialysis. This retrospective cohort study included patients with type 4 CRS and ESRD admitted for decompensated heart failure between January 2016 and December 2021. Patients were divided into the rhBNP and non-rhBNP cohorts, according to whether they were prescribed rhBNP. The primary outcomes were emergency dialysis at first admission and cardiovascular events within a month after discharge. A total of 77 patients were included in the rhBNP cohort (49 males and 28 females, median age 67) and 79 in the non-rhBNP cohort (47 males and 32 females, median age 68). After adjusting for age, residual renal function, and primary diseases, Cox regression analysis showed that rhBNP was associated with emergency dialysis (HR = 0.633, 95% CI 0.420-0.953) and cardiovascular events (HR = 0.410, 95% CI 0.159-0.958). In addition, multivariate logistic regression analysis showed that estimated glomerular filtration rate (eGFR) (OR = 0.782, 95% CI 0.667-0.917, P = 0.002) and procalcitonin (PCT) levels (OR = 1.788, 95% CI 1.193-2.680, P = 0.005) at the first visit were independent risk factors for emergency dialysis while using rhBNP was a protective factor for emergency dialysis (OR = 0.195, 95% CI 0.084-0.451, P < 0.001). This study suggests that RhBNP can improve cardiac function and reduce the occurrence of emergency dialysis and cardiovascular events in ESRD patients with type 4 CRS.
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Affiliation(s)
- Yue Zhou
- Department of Nephrology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, China
| | - Xiaojian Wang
- Department of Nephrology, BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, 210019, China
| | - Hongbo Yuan
- Department of Nephrology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, China
| | - Linke Wu
- Department of Respiratory, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, China
| | - Bin Zhang
- Department of Cardiology, Nanjing Yuhua Hospital, Nanjing, 210039, China
| | - Xiaoxia Chen
- Department of Nephrology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, China.
| | - Yafeng Zhang
- Department of Public Health, Affiliated Hospital of Jiangsu University, Zhenjiang, 212003, China.
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9
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Molnar AO, Nash DM, Emblem J, Bota S, McArthur E, Luo B, Liu Y, Garg AX, Blake PG, Brimble KS. Patient Care Gaps Prior to Maintenance Dialysis Initiation: A Population-Based Retrospective Study. Can J Kidney Health Dis 2023; 10:20543581231212134. [PMID: 38020481 PMCID: PMC10657522 DOI: 10.1177/20543581231212134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 09/19/2023] [Indexed: 12/01/2023] Open
Abstract
Background Guidelines in Ontario, Canada, recommend timely referral for multidisciplinary kidney care to facilitate planned dialysis initiation. Many patients do not receive recommended multidisciplinary kidney care prior to dialysis. Objective To better understand why this gap in pre-dialysis care exists, we conducted a study to describe the pathways by which patients initiate maintenance dialysis. Design A retrospective cohort study. Setting Population-based, using health care administrative databases from Ontario, Canada. Patients Adults initiating maintenance dialysis from April 2016 to March 2019. Measurements and methods Patients were grouped based on whether they received recommended multidisciplinary kidney care prior to dialysis initiation (at least 1 year of care with at least 2 visits). For those who did not receive recommended care, we grouped patients as having no identified care gap or into the following groups: (1) lack of timely chronic kidney disease (CKD) screening, (2) late nephrology referral (<1 year), or (3) late or no referral for multidisciplinary kidney care among patients followed by a nephrologist for at least 1 year. Results A total of 9216 patients were included with a mean (standard deviation) age of 66 (15) years, and 61.5% were male. Of the total, 896 (9.7%) patients died, 7671 (83.2%) remained on dialysis at 90 days, and 649 (7.0%) had stopped dialysis due to kidney function recovery within 90 days. Of the 9216 patients, 5434 (59%) had not received recommended multidisciplinary kidney care. Among those without recommended care, there were 2251 (41.4%) patients with no identified care gaps, 1351 (24.9%) patients with a lack of timely CKD screening, 359 (6.6%) patients with late nephrology referral, and 1473 (27.1%) patients with late or no referral for multidisciplinary kidney care. Limitations We could not determine if patients were referred but declined multidisciplinary kidney care. Conclusions More than half of patients had not received recommended multidisciplinary kidney care. Many patients experienced an acute decline in kidney function, which may not be preventable, but in others, there were missed opportunities for CKD screening or early referral to nephrology, or at the level of nephrology practice for early referral for multidisciplinary care. This work could be used to inform policies aimed at improving increased uptake of multidisciplinary kidney care prior to dialysis.
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Affiliation(s)
- Amber O. Molnar
- Division of Nephrology, Department of Medicine, McMaster University, Hamilton, ON, Canada
- St. Joseph’s Hospital, Hamilton, ON, Canada
- ICES, ON, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Danielle M. Nash
- ICES, ON, Canada
- Lawson Health Research Institute, London Health Sciences Centre, ON, Canada
| | | | - Sarah Bota
- ICES, ON, Canada
- Lawson Health Research Institute, London Health Sciences Centre, ON, Canada
| | - Eric McArthur
- ICES, ON, Canada
- Lawson Health Research Institute, London Health Sciences Centre, ON, Canada
| | - Bin Luo
- ICES, ON, Canada
- Lawson Health Research Institute, London Health Sciences Centre, ON, Canada
| | - Yaqing Liu
- Ontario Renal Network, Ontario Health, Toronto, Canada
| | - Amit X. Garg
- ICES, ON, Canada
- Lawson Health Research Institute, London Health Sciences Centre, ON, Canada
- Division of Nephrology, Department of Medicine, Western University, London, ON, Canada
| | - Peter G. Blake
- Lawson Health Research Institute, London Health Sciences Centre, ON, Canada
- Ontario Renal Network, Ontario Health, Toronto, Canada
- Division of Nephrology, Department of Medicine, Western University, London, ON, Canada
| | - K. Scott Brimble
- Division of Nephrology, Department of Medicine, McMaster University, Hamilton, ON, Canada
- St. Joseph’s Hospital, Hamilton, ON, Canada
- Ontario Renal Network, Ontario Health, Toronto, Canada
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10
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Piveteau J, Raffray M, Couchoud C, Ayav C, Chatelet V, Vigneau C, Bayat S. Pre-dialysis care trajectory and post-dialysis survival and transplantation access in patients with end-stage kidney disease. J Nephrol 2023; 36:2057-2070. [PMID: 37505404 DOI: 10.1007/s40620-023-01711-y] [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: 12/12/2022] [Accepted: 06/18/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND The pre-dialysis care trajectory impact on post-dialysis outcomes is poorly known. This study assessed survival, access to kidney transplant waiting list and to transplantation after dialysis initiation by taking into account the patients' pre-dialysis care consumption (inpatient and outpatient) and the conditions of dialysis start: initiation context (emergency or planned) and vascular access type (catheter or fistula). METHODS Adults who started dialysis in France in 2015 were included. Clinical data came from the French REIN registry and data on the care trajectory from the French National Health Data system (SNDS). The Cox model was used to assess survival and access to kidney transplantation. RESULTS We included 8856 patients with a mean age of 68 years. Survival was shorter in patients with emergency or planned dialysis initiation with a catheter compared to patients with planned dialysis with a fistula. The risk of death was lower in patients who were seen by a nephrologist more than once in the 6 months before dialysis than in those who were seen only once. The rate of kidney transplant at 1 year post-dialysis was lower for patients with emergency or planned dialysis initiation with a catheter (respectively, HR = 0.5 [0.4; 0.8] and HR = 0.7 [0.5; 0.9]) compared to patients with planned dialysis start with a fistula. Patients who were seen by a nephrologist more than three times between 0 and 6 months before dialysis start were more likely to access the waiting list 1 and 3 years after dialysis start (respectively, HR = 1.3 [1.1; 1.5] and HR = 1.2 [1.1; 1.4]). CONCLUSIONS Nephrological follow-up in the year before dialysis initiation is associated with better survival and higher probability of access to kidney transplantation. These results emphasize the importance of early patient referral to nephrologists by general practitioners.
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Affiliation(s)
- Juliette Piveteau
- Univ Rennes, EHESP, CNRS, Inserm, Arènes - UMR 6051, RSMS - U1309, French School of Public Health, 15 Avenue du Professeur Léon Bernard, Rennes, France.
| | - Maxime Raffray
- Univ Rennes, EHESP, CNRS, Inserm, Arènes - UMR 6051, RSMS - U1309, French School of Public Health, 15 Avenue du Professeur Léon Bernard, Rennes, France
| | - Cécile Couchoud
- Renal Epidemiology and Information Network (REIN) Registry, Biomedecine Agency, Saint-Denis-La-Plaine, France
| | - Carole Ayav
- CHRU-Nancy, INSERM, Université de Lorraine, CIC, Epidémiologie Clinique, Nancy, France
| | - Valérie Chatelet
- Centre Universitaire des Maladies Rénales, CHU Caen, Caen, France
- U1086 Inserm, ANTICIPE, Centre de Lutte Contre le Cancer François Baclesse, Caen, France
| | - Cécile Vigneau
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, Rennes, France
| | - Sahar Bayat
- Univ Rennes, EHESP, CNRS, Inserm, Arènes - UMR 6051, RSMS - U1309, French School of Public Health, 15 Avenue du Professeur Léon Bernard, Rennes, France
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Tummalapalli SL, Struthers SA, White DL, Beckrich A, Brahmbhatt Y, Erickson KF, Garimella PS, Gould ER, Gupta N, Lentine KL, Lew SQ, Liu F, Mohan S, Somers M, Weiner DE, Bieber SD, Mendu ML. Optimal Care for Kidney Health: Development of a Merit-based Incentive Payment System (MIPS) Value Pathway. J Am Soc Nephrol 2023; 34:1315-1328. [PMID: 37400103 PMCID: PMC10400097 DOI: 10.1681/asn.0000000000000163] [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: 12/20/2022] [Accepted: 05/17/2023] [Indexed: 07/05/2023] Open
Abstract
The Merit-based Incentive Payment System (MIPS) is a mandatory pay-for-performance program through the Centers for Medicare & Medicaid Services (CMS) that aims to incentivize high-quality care, promote continuous improvement, facilitate electronic exchange of information, and lower health care costs. Previous research has highlighted several limitations of the MIPS program in assessing nephrology care delivery, including administrative complexity, limited relevance to nephrology care, and inability to compare performance across nephrology practices, emphasizing the need for a more valid and meaningful quality assessment program. This article details the iterative consensus-building process used by the American Society of Nephrology Quality Committee from May 2020 to July 2022 to develop the Optimal Care for Kidney Health MIPS Value Pathway (MVP). Two rounds of ranked-choice voting among Quality Committee members were used to select among nine quality metrics, 43 improvement activities, and three cost measures considered for inclusion in the MVP. Measure selection was iteratively refined in collaboration with the CMS MVP Development Team, and new MIPS measures were submitted through CMS's Measures Under Consideration process. The Optimal Care for Kidney Health MVP was published in the 2023 Medicare Physician Fee Schedule Final Rule and includes measures related to angiotensin-converting enzyme inhibitor and angiotensin receptor blocker use, hypertension control, readmissions, acute kidney injury requiring dialysis, and advance care planning. The nephrology MVP aims to streamline measure selection in MIPS and serves as a case study of collaborative policymaking between a subspecialty professional organization and national regulatory agencies.
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Affiliation(s)
- Sri Lekha Tummalapalli
- Division of Healthcare Delivery Science & Innovation and Division of Nephrology & Hypertension, Weill Cornell Medicine, New York, New York
- The Rogosin Institute, New York, New York
| | - Sarah A. Struthers
- Division of Nephrology, Department of Medicine, University of Washington, Seattle, Washington
| | | | - Amy Beckrich
- Renal Physicians Association, Rockville, Maryland
| | | | - Kevin F. Erickson
- Selzman Institute for Kidney Health, Section of Nephrology, Baylor College of Medicine, Houston, Texas
| | - Pranav S. Garimella
- Division of Nephrology-Hypertension, University of California San Diego, San Diego, California
| | - Edward R. Gould
- Division of Nephrology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Nupur Gupta
- Division of Nephrology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Krista L. Lentine
- Saint Louis University Transplant Center, SSM-Saint Louis University Hopstial, St. Louis, Missouri
| | - Susie Q. Lew
- Division of Renal Diseases and Hypertension, George Washington University, Washington, DC
| | - Frank Liu
- The Rogosin Institute, New York, New York
| | - Sumit Mohan
- Department of Medicine, Division of Nephrology, Vagelos College of Physicians & Surgeons, Columbia University, New York, New York
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Michael Somers
- Division of Nephrology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Daniel E. Weiner
- Division of Nephrology, Department of Medicine, Tufts Medical Center, Boston, Massachusetts
| | | | - Mallika L. Mendu
- Division of Renal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston Massachusetts
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12
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Goldman S, Chan CT, Einbinder Y, Rozen-Zvi B, Morduchowicz G, Perl J. Nephrologists' Perspectives on Home Dialysis Utilization: A National Survey From Israel. Kidney Med 2023; 5:100680. [PMID: 37576430 PMCID: PMC10421980 DOI: 10.1016/j.xkme.2023.100680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2023] Open
Affiliation(s)
- Shira Goldman
- Division of Nephrology, St. Michael’s Hospital, Toronto, Ontario, Canada
- Division of Nephrology, University Health Network, University of Toronto, Toronto, Ontario, Canada
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Nephrology and Hypertension, Rabin Medical Center, Petach-Tikva, Israel
| | - Christopher T. Chan
- Division of Nephrology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Yael Einbinder
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel
| | - Benaya Rozen-Zvi
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Nephrology and Hypertension, Rabin Medical Center, Petach-Tikva, Israel
| | - Gabriel Morduchowicz
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Nephrology and Hypertension, Rabin Medical Center, Petach-Tikva, Israel
| | - Jeffrey Perl
- Division of Nephrology and Keenan Research Center, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
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13
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Tachikart A, Vachey C, Vauchy C, Savet C, Ducloux D, Courivaud C. Determinants of urgent start dialysis in a chronic kidney disease cohort followed by nephrologists. BMC Nephrol 2023; 24:190. [PMID: 37370038 DOI: 10.1186/s12882-023-03222-1] [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: 10/25/2022] [Accepted: 05/30/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND The French Renal Epidemiology and Information Network (REIN) registry collect dialysis initiation context for each patient starting dialysis with a flawed definition of urgent start dialysis (USD). The main objective of this study was to identify factors associated with USD in patients regularly followed-up by a nephrologist using a classification of USD considering the preparation to renal replacement therapy. METHODS This retrospective cohort study included adult patients who started dialysis between 2012 and 2018 in the Franche-Comté region of France after a minimum of two nephrology consultations. We classified dialysis initiation context as follows: USD for patients with no dialysis access (DA) created or planned, unplanned non urgent start dialysis (UNUSD) for patients starting with a recent or non-functional DA and planned start dialysis (PSD) for those starting with a functional and mature DA. RESULTS Four hundred and sixty-five patients met inclusion criteria. According to REIN registry, 94 (20.3%) patients were urgent starters (US) whereas with our classification 80 (17.2%) and 73 (15.7%) where respectively US and unplanned non urgent starters (UNUS). The factors independently associated with USD in our classification were: stroke (odds ratio(OR) = 2.76, 95% confidence interval (95%CI)=[1.41-5.43]), cardiac failure (OR = 1.78, 95%CI=[1.07-2.96]) and the number of nephrology consultations prior dialysis onset (OR = 0.73, 95%CI=[0.64-0.83]). Thirty-one patients died during the first year after dialysis start. According to our classification, we observed significantly different survival probabilities: 95.7%, 89.5% and 83.4% respectively for planned starters, UNUS and US (p = 0.001). CONCLUSION The two factors independently associated with USD were cardiac failure and stroke.
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Affiliation(s)
- Amin Tachikart
- Department of Nephrology, Dialysis and Renal Transplantation, Univ Hospital of Besançon, Besançon, France.
| | - Clément Vachey
- Department of Nephrology, Dialysis and Renal Transplantation, Univ Hospital of Besançon, Besançon, France
| | - Charline Vauchy
- Department of Nephrology, Dialysis and Renal Transplantation, Univ Hospital of Besançon, Besançon, France
| | - Caroline Savet
- Agence de la Biomédecine, REIN Registry, Saint Denis La Plaine Cedex, Paris, France
| | - Didier Ducloux
- Department of Nephrology, Dialysis and Renal Transplantation, Univ Hospital of Besançon, Besançon, France
| | - Cécile Courivaud
- Department of Nephrology, Dialysis and Renal Transplantation, Univ Hospital of Besançon, Besançon, France
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14
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Yaxley J, Scott T. Urgent-start peritoneal dialysis. Nefrologia 2023; 43:293-301. [PMID: 36517362 DOI: 10.1016/j.nefroe.2022.05.010] [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: 01/13/2022] [Accepted: 05/12/2022] [Indexed: 06/17/2023] Open
Abstract
Peritoneal dialysis is an important form of kidney replacement therapy. Most patients presenting with an unplanned, urgent need for dialysis are prescribed haemodialysis, leading to peritoneal dialysis underutilisation. Urgent-start peritoneal dialysis refers to treatment that is commenced within 2 weeks of catheter placement. Urgent-start peritoneal dialysis represents an efficacious, cost-effective alternative to the conventional approach of commencing dialysis. There is a paucity of evidence to guide management, however experience with the technique is increasing. This article overviews the rationale and practical application of urgent-start peritoneal dialysis.
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Affiliation(s)
- Julian Yaxley
- Department of Nephrology, Cairns Hospital, Cairns, Queensland, Australia; Department of Nephrology, Gold Coast University Hospital, Southport, Queensland, Australia; Department of Intensive Care Medicine, Gold Coast University Hospital, Southport, Queensland, Australia.
| | - Tahira Scott
- Department of Nephrology, Cairns Hospital, Cairns, Queensland, Australia; Department of Nephrology, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
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15
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Fukuzaki H, Nakata J, Nojiri S, Shimizu Y, Shirotani Y, Maeda T, Kano T, Mishiro M, Nohara N, Io H, Suzuki Y. Outpatient clinic specific for end-stage renal disease improves patient survival rate after initiating dialysis. Sci Rep 2023; 13:5991. [PMID: 37045851 PMCID: PMC10097859 DOI: 10.1038/s41598-023-31636-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 03/15/2023] [Indexed: 04/14/2023] Open
Abstract
The importance of a shared decision-making (SDM) approach is widely recognized worldwide. In Japan, hospital accreditation involves the promotion of SDM for patients with end-stage renal disease (ESRD) when considering renal replacement therapy (RRT). This study aimed to clarify the effectiveness and long-term medical benefits of SDM in RRT. Patients with ESRD who underwent dialysis therapy were retrospectively divided into those who visited outpatient clinics specific for ESRD (ESRD clinic) supporting RRT selection with an SDM approach (visited group) and those who did not visit the ESRD clinic (non-visited group). Data of 250 patients (129 in the non-visited group and 121 in the visited group) were analyzed. Mortality was significantly higher in the non-visited group than in the visited group. Not seeing an ESRD specialist was associated with emergent initiation of dialysis and subsequent 1 year mortality. The number of patients who chose peritoneal dialysis as a modality of RRT was significantly larger in the visited group. These findings demonstrate the association between the ESRD clinic, 1 year survival in patients with ESRD after initiating dialysis, and the different RRT modalities. This specific approach in the ESRD clinic may improve the management of patients with ESRD.
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Affiliation(s)
- Haruna Fukuzaki
- Department of Nephrology, Faculty of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Junichiro Nakata
- Department of Nephrology, Faculty of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Shuko Nojiri
- Medical Technology Innovation Center, Juntendo University, Tokyo, Japan
| | - Yuki Shimizu
- Department of Nephrology, Faculty of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Yuka Shirotani
- Department of Nephrology, Faculty of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Takuya Maeda
- Department of Nephrology, Faculty of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Toshiki Kano
- Department of Nephrology, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Maiko Mishiro
- Department of Nephrology, Faculty of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Nao Nohara
- Department of Nephrology, Faculty of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Hiroaki Io
- Department of Nephrology, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Yusuke Suzuki
- Department of Nephrology, Faculty of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
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16
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Balkoca M, Turkmen E, Dilek M, Arik N, Sayarlioglu H. Evaluation of complications in urgent start peritoneal dialysis: Single-center experience. Ther Apher Dial 2023; 27:314-319. [PMID: 36127867 DOI: 10.1111/1744-9987.13916] [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: 07/20/2022] [Revised: 08/01/2022] [Accepted: 08/03/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Patients who were urgent start peritoneal dialysis (USPD) were evaluated in terms of complications. METHODS The data from 102 patients (43 males and 59 females, mean age 58.18 ± 15.3 years) who were on peritoneal dialysis with a placed catheter between January 2014 and June 2019 in our Nephrology clinic was evaluated. The patients were divided into three groups according to the starting time of peritoneal dialysis. The development of complications between the groups (peritonitis, leakage, hernia), hemodialysis return time and overall survival times were compared. RESULTS There was no difference between the groups in terms of survival and complications. Diabetes, advanced age, albumin values were found to be risk factors for mortality, while no differences were found between the groups in terms of complications and mortality. CONCLUSION USPD can be recommended for both because it provides a permanent dialysis option and because it leads to fewer complications than urgent start HD.
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Affiliation(s)
- Murat Balkoca
- Department of Internal Medicine, Ondokuz Mayıs Üniversitesi, Samsun, Turkey
| | - Ercan Turkmen
- Department of Nephrology, Ondokuz Mayıs Üniversitesi, Samsun, Turkey
| | - Melda Dilek
- Department of Nephrology, Ondokuz Mayıs Üniversitesi, Samsun, Turkey
| | - Nurol Arik
- Department of Nephrology, Ondokuz Mayıs Üniversitesi, Samsun, Turkey
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Walker CS, Gadegbeku CA. Addressing kidney health disparities with new national policy: the time is now. Cardiovasc Diagn Ther 2023; 13:115-121. [PMID: 36864968 PMCID: PMC9971295 DOI: 10.21037/cdt-22-566] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 02/06/2023] [Indexed: 02/15/2023]
Abstract
End-stage kidney disease (ESKD) affects over 780,000 Americans and is associated with excess morbidity and premature death. Kidney disease health disparities are well-recognized, manifesting as ESKD overburden among racial and ethnic minority populations. Specifically, Black and Hispanic individuals have a 3.4-fold and 1.3-fold greater life risk of developing ESKD than their white counterparts. There is compelling evidence that communities of color have less opportunity to benefit from kidney-specific care throughout the course of their disease, from pre-ESKD, to ESKD home therapies and kidney transplantation. These healthcare inequities have the combined devastating impact of worse outcomes and quality of life for patients and families at a significant financial cost on the healthcare system. In the last three years, across two presidential administrations, bold, broad initiatives have been outlined that, together could lead to significant transformation in kidney health. The Advancing American Kidney Health (AAKH) initiative was established as a national framework to revolutionize kidney care but did not address health equity. More recently, the Advancing Racial Equity executive order was announced, outlining initiatives to promote equity for historically underserved communities. Building from these presidential directives, we outline strategies to address the complex issue of kidney health disparities, focusing on patient awareness, care delivery, scientific advancement, and workforce initiatives. An equity-focused framework will guide policy advancements to reduce the kidney disease burden in susceptible populations and positively impact the health and well-being of all Americans.
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Affiliation(s)
| | - Crystal A. Gadegbeku
- Department of Kidney Medicine, Cleveland Clinic Health System, Cleveland, OH, USA
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18
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Elliott MJ, Ravani P, Quinn RR, Oliver MJ, Love S, MacRae J, Hiremath S, Friesen S, James MT, King-Shier KM. Patient and Clinician Perspectives on Shared Decision Making in Vascular Access Selection: A Qualitative Study. Am J Kidney Dis 2023; 81:48-58.e1. [PMID: 35870570 DOI: 10.1053/j.ajkd.2022.05.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 05/30/2022] [Indexed: 12/24/2022]
Abstract
RATIONALE & OBJECTIVE Collaborative approaches to vascular access selection are being increasingly encouraged to elicit patients' preferences and priorities where no unequivocally superior choice exists. We explored how patients, their caregivers, and clinicians integrate principles of shared decision making when engaging in vascular access discussions. STUDY DESIGN Qualitative description. SETTING & PARTICIPANTS Semistructured interviews with a purposive sample of patients, their caregivers, and clinicians from outpatient hemodialysis programs in Alberta, Canada. ANALYTICAL APPROACH We used a thematic analysis approach to inductively code transcripts and generate themes to capture key concepts related to vascular access shared decision making across participant roles. RESULTS 42 individuals (19 patients, 2 caregivers, 21 clinicians) participated in this study. Participants identified how access-related decisions follow a series of major decisions about kidney replacement therapy and care goals that influence vascular access preferences and choice. Vascular access shared decision making was strengthened through integration of vascular access selection with dialysis-related decisions and timely, tailored, and balanced exchange of information between patients and their care team. Participants described how opportunities to revisit the vascular access decision before and after dialysis initiation helped prepare patients for their access and encouraged ongoing alignment between patients' care priorities and treatment plans. Where shared decision making was undermined, hemodialysis via a catheter ensued as the most readily available vascular access option. LIMITATIONS Our study was limited to patients and clinicians from hemodialysis care settings and included few caregiver participants. CONCLUSIONS Findings suggest that earlier, or upstream, decisions about kidney replacement therapies influence how and when vascular access decisions are made. Repeated vascular access discussions that are integrated with other higher-level decisions are needed to promote vascular access shared decision making and preparedness.
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Affiliation(s)
- Meghan J Elliott
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
| | - Pietro Ravani
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Robert R Quinn
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Matthew J Oliver
- Division of Nephrology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Shannan Love
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jennifer MacRae
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Swapnil Hiremath
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Sarah Friesen
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Matthew T James
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Kathryn M King-Shier
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
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19
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Yaxley J, Scott T. Urgent-start peritoneal dialysis. Nefrologia 2022. [DOI: 10.1016/j.nefro.2022.05.002] [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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20
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Yoshida T, Aoyama T, Morioka Y, Takeuchi Y. Association of inadequate energy intake on admission with activities of daily living at discharge in patients undergoing unplanned hemodialysis initiation: a retrospective case-series study. RENAL REPLACEMENT THERAPY 2022. [DOI: 10.1186/s41100-022-00399-3] [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
In a previous study, patients who underwent unplanned hemodialysis initiation did not have improved nutritional status and activities of daily living (ADL) at discharge compared with patients whose initiation of hemodialysis was planned. Therefore, the aim of this study was to analyze the factors that delayed or made it difficult to improve nutritional status and ADL in patients undergoing unplanned hemodialysis initiation.
Methods
Participants were patients with end-stage kidney disease who experienced unplanned initiation of new maintenance hemodialysis between April 2017 and March 2020. Patients were divided into two groups: a group who required assistance with ADL at discharge (assistance group) and a group who did not require assistance (independence group). Patient characteristics, nutritional management, and blood tests data obtained from medical records were retrospectively analyzed using univariate and multivariate analyses.
Results
In total, 95 patients who experienced unplanned dialysis initiation were included in the analysis. Of these, 55 (58%) patients were in the assistance group and 40 (42%) were in the independence group. The assistance group was significantly older than the independence group and contained significantly fewer male patients. In the assistance group, energy intake on admission and serum albumin at discharge were significantly lower, and C-reactive protein was significantly higher, than in the independence group. The multivariate analysis showed that age, sex, and energy intake on admission were associated with requirement for assistance with ADL at discharge.
Conclusions
Inadequate energy intake on admission was associated with requirement for assistance with ADL at discharge for patients who experienced unplanned hemodialysis initiation. This suggests that active nutritional management from the time of admission could reduce the requirement for assistance with ADL and could increase independence.
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Kyte D, Anderson N, Bishop J, Bissell A, Brettell E, Calvert M, Chadburn M, Cockwell P, Dutton M, Eddington H, Forster E, Hadley G, Ives NJ, Jackson LJ, O'Brien S, Price G, Sharpe K, Stringer S, Verdi R, Waters J, Wilcockson A. Results of a pilot feasibility randomised controlled trial exploring the use of an electronic patient-reported outcome measure in the management of UK patients with advanced chronic kidney disease. BMJ Open 2022; 12:e050610. [PMID: 35304391 PMCID: PMC8935185 DOI: 10.1136/bmjopen-2021-050610] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES The use of routine remote follow-up of patients with chronic kidney disease (CKD) is increasing exponentially. It has been suggested that online electronic patient-reported outcome measures (ePROMs) could be used in parallel, to facilitate real-time symptom monitoring aimed at improving outcomes. We tested the feasibility of this approach in a pilot trial of ePROM symptom monitoring versus usual care in patients with advanced CKD not on dialysis. DESIGN A 12-month, parallel, pilot randomised controlled trial (RCT) and qualitative substudy. SETTING AND PARTICIPANTS Queen Elizabeth Hospital Birmingham, UK. Adult patients with advanced CKD (estimated glomerular filtration rate ≥6 and ≤15 mL/min/1.73 m2, or a projected risk of progression to kidney failure within 2 years ≥20%). INTERVENTION Monthly online ePROM symptom reporting, including automated feedback of tailored self-management advice and triggered clinical notifications in the advent of severe symptoms. Real-time ePROM data were made available to the clinical team via the electronic medical record. OUTCOMES Feasibility (recruitment and retention rates, and acceptability/adherence to the ePROM intervention). Health-related quality of life, clinical data (eg, measures of kidney function, kidney failure, hospitalisation, death) and healthcare utilisation. RESULTS 52 patients were randomised (31% of approached). Case report form returns were high (99.5%), as was retention (96%). Overall, 73% of expected ePROM questionnaires were received. Intervention adherence was high beyond 90 days (74%) and 180 days (65%); but dropped beyond 270 days (46%). Qualitative interviews supported proof of concept and intervention acceptability, but highlighted necessary changes aimed at enhancing overall functionality/scalability of the ePROM system. LIMITATIONS Small sample size. CONCLUSIONS This pilot trial demonstrates that patients are willing to be randomised to a trial assessing ePROM symptom monitoring. The intervention was considered acceptable; though measures to improve longer-term engagement are needed. A full-scale RCT is considered feasible. TRIAL REGISTRATION NUMBER ISRCTN12669006 and the UK NIHR Portfolio (CPMS ID: 36497).
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Affiliation(s)
- Derek Kyte
- School of Applied Health & Community, University of Worcester, Worcester, UK
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Nicola Anderson
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Jon Bishop
- Birmingham Clinical Trials Unit (BCTU), Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Andrew Bissell
- Patient Advisory Group, Centre for Patient-Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Elizabeth Brettell
- Birmingham Clinical Trials Unit (BCTU), Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Melanie Calvert
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
- National Institute for Health Research (NIHR) Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK
- National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) West Midlands, University of Birmingham, Birmingham, UK
- National Institute for Health Research (NIHR) Surgical Reconstruction and Microbiology Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
| | - Marie Chadburn
- Birmingham Clinical Trials Unit (BCTU), Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Paul Cockwell
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Mary Dutton
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Helen Eddington
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Elliot Forster
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Gabby Hadley
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Natalie J Ives
- Birmingham Clinical Trials Unit (BCTU), Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Louise J Jackson
- Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Sonia O'Brien
- Patient Advisory Group, Centre for Patient-Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Gary Price
- Patient Advisory Group, Centre for Patient-Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Keeley Sharpe
- Patient Advisory Group, Centre for Patient-Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Rav Verdi
- Patient Advisory Group, Centre for Patient-Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Judi Waters
- Patient Advisory Group, Centre for Patient-Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Adrian Wilcockson
- Birmingham Clinical Trials Unit (BCTU), Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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22
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Wen X, Yang L, Sun Z, Zhang X, Zhu X, Zhou W, Hu X, Liu S, Luo P, Cui W. Feasibility of a break-in period of less than 24 hours for urgent start peritoneal dialysis: a multicenter study. Ren Fail 2022; 44:450-460. [PMID: 35272577 PMCID: PMC8920377 DOI: 10.1080/0886022x.2022.2049306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Urgent start peritoneal dialysis (USPD) is an effective therapeutic method for end-stage renal disease (ESRD). However, whether it is safe to initiate peritoneal dialysis (PD) within 24 h unclear. We examined the short-term outcomes of a break-in period (BI) of 24 h for patients undergoing USPD. Methods This real-world, multicenter, retrospective cohort study evaluated USPD patients from five centers from January 2013 to August 2020. Patients were divided into BI ≤ 24 h or BI > 24 h groups. The Primary outcomes included incidence of mechanical and infectious complications. The secondary outcome was technique failure. Moreover, we presented a subgroup analysis for patients who did not receive temporary hemodialysis (HD). Results A total of 871 USPD patients were included: 470 in the BI ≤ 24 h and 401 in the BI > 24 h groups. Mechanical and infectious complications did not differ between the two groups across the follow-up timepoints (2 weeks, 1 month, 3 months, and 6 months) (p > 0.05). Multiple logistic regression analysis revealed that BI ≤ 24 h was not an independent risk factor for mechanical complications, catheter migration, or infectious complications (p > 0.05). A BI ≤ 24 h was not an independent significant risk factor for technique failure by multivariate Cox regression analysis (p > 0.05). The subgroup analysis of patients who did not receive temporary HD returned the same results. Conclusion Initiating PD within 24 h of catheter insertion was not associated with increased mechanical complications, infectious complications, or technique failures.
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Affiliation(s)
- Xi Wen
- Division of Nephrology, The Second Hospital of Jilin University, Changchun, China
| | - Liming Yang
- Division of Nephrology, The First Hospital of Jilin University-the Eastern Division, Changchun, China
| | - Zhanshan Sun
- Division of Nephrology, Xing'anmeng people's Hospital, Ulan Hot, China
| | - Xiaoxuan Zhang
- Division of Nephrology, Jilin FAW General Hospital, Changchun, China
| | - Xueyan Zhu
- Division of Nephrology, Jilin City Central Hospital, Jilin, China
| | - Wenhua Zhou
- Division of Nephrology, The Second Hospital of Jilin University, Changchun, China
| | - Xiaoqing Hu
- Division of Nephrology, The Second Hospital of Jilin University, Changchun, China
| | - Shichen Liu
- Division of Nephrology, The Second Hospital of Jilin University, Changchun, China
| | - Ping Luo
- Division of Nephrology, The Second Hospital of Jilin University, Changchun, China
| | - Wenpeng Cui
- Division of Nephrology, The Second Hospital of Jilin University, Changchun, China
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23
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Aloudah SA, Alanazi BA, Alrehaily MA, Alqessayer AN, Alanazi NS, Elhassan E. Chronic Kidney Disease Education Class Improves Rates of Early Access Creation and Peritoneal Dialysis Enrollment. Cureus 2022; 14:e21306. [PMID: 35070580 PMCID: PMC8765590 DOI: 10.7759/cureus.21306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2022] [Indexed: 11/18/2022] Open
Abstract
Background Most patients with end-stage kidney disease begin hemodialysis (HD) in an unplanned fashion at a late stage, necessitating the commencement of HD with a temporary venous catheter, the least favorable option. Alternative modalities of kidney replacement therapy (KRT), peritoneal dialysis (PD), and preemptive transplant offer similar or better outcomes than HD at a lower overall cost, and yet they remain underutilized in Saudi Arabia. Early education may help prepare patients with advanced chronic kidney disease (CKD IV and V) to accept their disease and choose a KRT modality that minimizes complications and matches their lifestyle. The aim of the study is to assess the impact of a pilot educational class on therapy choices and outcomes. Methodology In a cross-sectional study, we conducted phone interviews and reviewed medical records of 81 attendees of the multidisciplinary monthly educational class about KRT that was held at the King Abdulaziz Medical City (KAMC) from January 2017 to October 2021. The interview was conducted at least one year after the participants attended the class. The study proposal, consent, and questionnaire were approved by the King Abdulaziz International Medical Research Center. Patient data was retrieved from KAMC electronic medical record system. Results Volunteer participation in the survey was high (62/81). For the respondents, a preemptive kidney transplant was the most preferred (48/62, 77%) option for KRT. Among the preferred fallback options, HD was the most frequently chosen (29/62, 47%) compared to PD (26/62, 41.9%). At the time of the interview, a great majority of the patients (54/62, 87%) was already on KRT, including about half (26/54, 48%) on HD via a catheter, and the rest about equally divided between those on HD via an arteriovenous (AF) fistula (13/54, 24%) and those on PD (15/54, 28%). Thus, half of the respondents on KRT (28/54, 51%) avoided urgent HD catheter commencement. However, because of an unfortunate shortage of donors, only a small minority (2/62, 3%) of patients received preemptive transplantation. Conclusion The KAMC CKD education class helped boost the fraction of patients, significantly above the national average, who accepted the diagnosis of kidney failure and pursued preemptive native HD access or enrolled in PD.
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24
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Raffray M, Vigneau C, Couchoud C, Laude L, Campéon A, Schweyer FX, Bayat S. The dynamics of the general practitioner-nephrologist collaboration for the management of patients with chronic kidney disease before and after dialysis initiation: a mixed-methods study. Ther Adv Chronic Dis 2022; 13:20406223221108397. [PMID: 36199764 PMCID: PMC9527990 DOI: 10.1177/20406223221108397] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 06/01/2022] [Indexed: 11/22/2022] Open
Abstract
Background: Effective collaboration between general practitioners (GP) and nephrologists is crucial in CKD care. We aimed to analyse GPs’ and nephrologists’ presence and involvement in CKD care and assess how they intertwine to shape patients’ trajectories. Methods: We conducted a mixed-methods study that included all patients with CKD who started dialysis in France in 2015 (the REIN registry) and a sample of nephrologists and GPs. We quantified professionals’ presence through patients’ reimbursed healthcare from the French National Health Data System, 2 years before and 1 year after dialysis start. Involvement in CKD care was derived from the nephrologists’ and GPs’ interviews. Results: Among 8856 patients included, nephrologists’ presence progressively increased from 29% to 67% of patients with a contact during the 2 years before dialysis start. However, this was partly dependent on the GPs’ referral practices. Interviews revealed that GPs initially controlled the therapeutic strategy on their own. Although unease grew with CKD’s management complexity, reducing their involvement in favour of nephrologists, GPs’ presence remained frequent throughout the pre-dialysis period. Upon dialysis start, nephrologists’ presence and involvement became total, while GPs’ greatly decreased (48% of patients with a contact at month 12 after dialysis start). Collaboration was smooth when GPs maintained contact with patients and could contribute to their care through aspects of their specialty they valued. Conclusions: This mixed-methods study shows presences and forms of involvement of GPs and nephrologists in CKD care adjusting along the course of CKD and unveils the mechanisms at play in their collaboration.
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Affiliation(s)
- Maxime Raffray
- Univ Rennes, EHESP, CNRS, Inserm, Arènes – UMR 6051, RSMS (Recherche sur les Services et Management en Santé) – U 1309, F-35000 Rennes, France
| | - Cécile Vigneau
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) – UMR_S 1085, Rennes, France
| | - Cécile Couchoud
- Renal Epidemiology and Information Network (REIN) Registry, Biomedecine Agency, Saint-Denis, France
| | - Laetitia Laude
- Univ Rennes, EHESP, CNRS, Inserm, Arènes – UMR 6051, RSMS (Recherche sur les Services et Management en Santé) – U 1309, Rennes, France
| | | | | | - Sahar Bayat
- Univ Rennes, EHESP, CNRS, Inserm, Arènes – UMR 6051, RSMS (Recherche sur les Services et Management en Santé) – U 1309, Rennes, France
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25
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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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26
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Barrett TM, Davenport CA, Ephraim PL, Peskoe S, Mohottige D, DePasquale N, McElroy L, Boulware LE. Disparities in Discussions about Kidney Replacement Therapy in CKD Care. KIDNEY360 2021; 3:158-163. [PMID: 35368562 PMCID: PMC8967603 DOI: 10.34067/kid.0004752021] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 10/22/2021] [Indexed: 01/10/2023]
Abstract
Participants who identified as female and Black reported more thorough discussions of dialysis than transplant.Participants with low incomes and education reported more thorough discussions of dialysis than transplant.
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Affiliation(s)
- Tyler M. Barrett
- Division of General Internal Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Clemontina A. Davenport
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina
| | - Patti L. Ephraim
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland,Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Sarah Peskoe
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina
| | - Dinushika Mohottige
- Division of General Internal Medicine, Duke University School of Medicine, Durham, North Carolina,Division of Nephrology, Duke University School of Medicine, Durham, North Carolina
| | - Nicole DePasquale
- Division of General Internal Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Lisa McElroy
- Division of General Internal Medicine, Duke University School of Medicine, Durham, North Carolina,Division of Abdominal Transplant, Duke University School of Medicine, Durham, North Carolina
| | - L. Ebony Boulware
- Division of General Internal Medicine, Duke University School of Medicine, Durham, North Carolina
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27
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Fages V, de Pinho NA, Hamroun A, Lange C, Combe C, Fouque D, Frimat L, Jacquelinet C, Laville M, Ayav C, Liabeuf S, Pecoits-Filho R, Massy ZA, Boucquemont J, Stengel B. Urgent-start dialysis in patients referred early to a nephrologist-the CKD-REIN prospective cohort study. Nephrol Dial Transplant 2021; 36:1500-1510. [PMID: 33944928 DOI: 10.1093/ndt/gfab170] [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: 12/23/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The lack of a well-designed prospective study of the determinants of urgent dialysis start led us to investigate its individual- and provider-related factors in patients seeing nephrologists. METHODS The Chronic Kidney Disease Renal Epidemiology and Information Network (CKD-REIN) is a prospective cohort study that included 3033 patients with CKD [mean age 67 years, 65% men, mean estimated glomerular filtration rate (eGFR) 32 mL/min/1.73 m2] from 40 nationally representative nephrology clinics from 2013 to 2016 who were followed annually through 2020. Urgent-start dialysis was defined as that 'initiated imminently or <48 hours after presentation to correct life-threatening manifestations' according to the Kidney Disease: Improving Global Outcomes 2018 definition. RESULTS Over a 4-year (interquartile range 3.0-4.8) median follow-up, 541 patients initiated dialysis with a known start status and 86 (16%) were identified with urgent starts. The 5-year risks for the competing events of urgent and non-urgent dialysis start, pre-emptive transplantation and death were 4, 17, 3 and 15%, respectively. Fluid overload, electrolytic disorders, acute kidney injury and post-surgery kidney function worsening were the reasons most frequently reported for urgent-start dialysis. Adjusted odds ratios for urgent start were significantly higher in patients living alone {2.14 [95% confidence interval (CI) 1.08-4.25] or with low health literacy [2.22 (95% CI 1.28-3.84)], heart failure [2.60 (95% CI 1.47-4.57)] or hyperpolypharmacy [taking >10 drugs; 2.14 (95% CI 1.17-3.90)], but not with age or lower eGFR at initiation. They were lower in patients with planned dialysis modality [0.46 (95% CI 0.19-1.10)] and more nephrologist visits in the 12 months before dialysis [0.81 (95% CI 0.70-0.94)] for each visit. CONCLUSIONS This study highlights several patient- and provider-level factors that are important to address to reduce the burden of urgent-start dialysis.
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Affiliation(s)
- Victor Fages
- UVSQ, INSERM, Clinical Epidemiology Team, Centre de Recherche en Epidémiologie et Santé des Populations, Université Paris-Saclay, Villejuif, France.,Service de Néphrologie, Dialyse, Transplantation Rénale et Aphérèse, CHU de Lille, Lille, France
| | - Natalia Alencar de Pinho
- UVSQ, INSERM, Clinical Epidemiology Team, Centre de Recherche en Epidémiologie et Santé des Populations, Université Paris-Saclay, Villejuif, France
| | - Aghilès Hamroun
- UVSQ, INSERM, Clinical Epidemiology Team, Centre de Recherche en Epidémiologie et Santé des Populations, Université Paris-Saclay, Villejuif, France.,Service de Néphrologie, Dialyse, Transplantation Rénale et Aphérèse, CHU de Lille, Lille, France
| | - Céline Lange
- UVSQ, INSERM, Clinical Epidemiology Team, Centre de Recherche en Epidémiologie et Santé des Populations, Université Paris-Saclay, Villejuif, France.,Agence de Biomédecine, La Plaine Saint-Denis, France
| | - Christian Combe
- Service de Néphrologie, Transplantation, Dialyse, Aphérèses, CHU de Bordeaux, Bordeaux, France.,INSERM Unité 1026, Université de Bordeaux, Bordeaux, France
| | - Denis Fouque
- Université Claude Bernard Lyon1, CarMeN INSERM 1060, Lyon, France.,Service de Néphrologie, Lyon-Sud Hospital, Pierre-Bénite, France
| | - Luc Frimat
- Service de Néphrologie, Université de Lorraine, APEMAC, CHRU de Nancy - Hôpitaux de Brabois, Nancy, France
| | - Christian Jacquelinet
- UVSQ, INSERM, Clinical Epidemiology Team, Centre de Recherche en Epidémiologie et Santé des Populations, Université Paris-Saclay, Villejuif, France.,Agence de Biomédecine, La Plaine Saint-Denis, France
| | - Maurice Laville
- Université Claude Bernard Lyon1, CarMeN INSERM 1060, Lyon, France.,Association Utilisation Rein Artificiel Région Lyonnaise, Lyon, France
| | - Carole Ayav
- CHRU de Nancy, Université de Lorraine, INSERM, CIC Epidémiologie Clinique, Hôpitaux de Brabois, Nancy, France
| | - Sophie Liabeuf
- Département de Recherche Clinique, Service de Pharmacologie Clinique, CHU d'Amiens, Université de Picardie Jules Verne, INSERM U-1088, Amiens, France
| | - Roberto Pecoits-Filho
- Arbor Research Collaborative for Health, Ann Arbor, MI, USA.,Pontificia Universidade Catolica do Prana, Curitiba, Brazil
| | - Ziad A Massy
- UVSQ, INSERM, Clinical Epidemiology Team, Centre de Recherche en Epidémiologie et Santé des Populations, Université Paris-Saclay, Villejuif, France.,Service de Néphrologie-Dialyse, CHU Ambroise Paré, APHP, Boulogne-Billancourt, France
| | - Julie Boucquemont
- UVSQ, INSERM, Clinical Epidemiology Team, Centre de Recherche en Epidémiologie et Santé des Populations, Université Paris-Saclay, Villejuif, France
| | - Bénédicte Stengel
- UVSQ, INSERM, Clinical Epidemiology Team, Centre de Recherche en Epidémiologie et Santé des Populations, Université Paris-Saclay, Villejuif, France
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28
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Talbot B, Lin R, Li Q, Jun M, Kotwal S, Sen S, Gallagher M. The Impact of Clinical Presentation on Survival in Patients Requiring Hemodialysis Catheters for Acute and Unplanned Dialysis: A Prospective Observational Study. Can J Kidney Health Dis 2021; 8:20543581211009986. [PMID: 33996108 PMCID: PMC8082983 DOI: 10.1177/20543581211009986] [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: 11/27/2020] [Accepted: 03/11/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Most studies addressing hemodialysis initiation with a dialysis catheter focus on patients entering maintenance dialysis programs and exclude other patients, such as those with acute kidney injury (AKI), making interpretation and application of the results difficult for clinicians managing patients at the time of dialysis commencement. OBJECTIVE To compare the survival of all patients requiring a catheter for hemodialysis access according to the nature of clinical presentation. DESIGN Prospective observational. SETTING An Australian tertiary renal unit. PATIENTS All patients requiring a central venous catheter (CVC) for hemodialysis access between 2005 and 2015. MEASUREMENTS Baseline comorbidities, demographics, and nature of clinical presentation. Data regarding each episode of dialysis access insufficiency and each CVC were collected. The primary outcome was all-cause mortality. METHODS Patients were classified into 1 of 3 groups based on physician assessment at the time of presentation: patients believed to have AKI with expected renal recovery (AKI), patients considered to be entering the maintenance dialysis program without a functioning dialysis access (Maintenance Dialysis), patients unable to perform peritoneal dialysis, or use their existing hemodialysis access (Access Failure). Time-split multivariable Cox regression analyses were used to compare survival between groups. RESULTS A total of 557 eligible patients had complete prospective data regarding CVC use and were included in the analyses. The majority of patients were in the AKI (246/557, 44%) and Maintenance Dialysis groups (182/557, 33%) compared with the Access Failure group (129/557, 23%). During a median follow-up of 3 years, 302 (54%) of the 557 patients died. Following adjustment, risk of all-cause mortality was higher in the AKI group (hazard ratio [HR]: 2.01, 95% confidence interval [CI]: 1.31-3.60, P = .001) during the first 2 years after catheter insertion and lower in years 2 to 4 (HR: 0.42, 95% CI: 0.20-0.88, P = .02) than in the reference Maintenance Dialysis group. No difference in mortality risk between the Access Failure and reference group was found. LIMITATIONS Single-center study. Possible residual confounding owing to the observational study design. CONCLUSIONS Patients requiring acute or unplanned hemodialysis experience high mortality, and the nature of clinical presentation does influence outcomes. Most notable is the greater early mortality experienced by patients with AKI compared to other patient groups. Prospective definition of the nature of unplanned dialysis initiation is important to accurately measure and improve outcomes in this high-risk patient population. HUMAN RESEARCH ETHICS COMMITTEE APPROVAL NUMBER CH62/6/2017-042.
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Affiliation(s)
- Benjamin Talbot
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
- Concord Clinical School, The University of Sydney, NSW, Australia
| | - Ray Lin
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Qiang Li
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Min Jun
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Sradha Kotwal
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
- Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Shaundeep Sen
- Concord Clinical School, The University of Sydney, NSW, Australia
- Department of Renal Medicine, Concord Repatriation General Hospital, Sydney, NSW, Australia
| | - Martin Gallagher
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
- Concord Clinical School, The University of Sydney, NSW, Australia
- Department of Renal Medicine, Concord Repatriation General Hospital, Sydney, NSW, Australia
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29
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Naylor KL, Knoll GA, McArthur E, Garg AX, Lam NN, Field B, Getchell LE, Hahn E, Kim SJ. Outcomes of an Inpatient Dialysis Start in Patients With Kidney Graft Failure: A Population-Based Multicentre Cohort Study. Can J Kidney Health Dis 2021; 8:2054358120985376. [PMID: 33552528 PMCID: PMC7841655 DOI: 10.1177/2054358120985376] [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: 08/23/2020] [Accepted: 11/28/2020] [Indexed: 11/20/2022] Open
Abstract
Background: The frequency and outcomes of starting maintenance dialysis in the hospital as an inpatient in kidney transplant recipients with graft failure are poorly understood. Objective: To determine the frequency of inpatient dialysis starts in patients with kidney graft failure and examine whether dialysis start status (hospital inpatient vs outpatient setting) is associated with all-cause mortality and kidney re-transplantation. Design: Population-based cohort study. Setting: We used linked administrative healthcare databases from Ontario, Canada. Patients: We included 1164 patients with kidney graft failure from 1994 to 2016. Measurements: All-cause mortality and kidney re-transplantation. Methods: The cumulative incidence function was used to calculate the cumulative incidence of all-cause mortality and kidney re-transplantation, accounting for competing risks. Subdistribution hazard ratios from the Fine and Gray model were used to examine the relationship between inpatient dialysis starts (vs outpatient dialysis start [reference]) and the dependent variables (ie, mortality or re-transplant). Results: We included 1164 patients with kidney graft failure. More than half (55.8%) of patients with kidney graft failure, initiated dialysis as an inpatient. Compared with outpatient dialysis starters, inpatient dialysis starters had a significantly higher cumulative incidence of mortality and a significantly lower incidence of kidney re-transplantation (P < .001). The 10-year cumulative incidence of mortality was 51.9% (95% confidence interval [CI]: 47.4, 56.9%) (inpatient) and 35.3% (95% CI: 31.1, 40.1%) (outpatient). After adjusting for clinical characteristics, we found inpatient dialysis starters had a significantly increased hazard of mortality in the first year after graft failure (hazard ratio: 2.18 [95% CI: 1.43, 3.33]) but at 1+ years there was no significant difference between groups. Limitations: Possibility of residual confounding and unable to determine inpatient dialysis starts that were unavoidable. Conclusions: In this study we identified that most patients with kidney graft failure had inpatient dialysis starts, which was associated with an increased risk of mortality. Further research is needed to better understand the reasons for an inpatient dialysis start in this patient population.
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Affiliation(s)
- Kyla L Naylor
- ICES, ON, Canada.,Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
| | - Gregory A Knoll
- Department of Medicine (Nephrology), University of Ottawa and Ottawa Hospital Research Institute, ON, Canada
| | | | - Amit X Garg
- ICES, ON, Canada.,Department of Epidemiology and Biostatistics, Western University, London, ON, Canada.,Division of Nephrology, Western University, London, ON, Canada
| | - Ngan N Lam
- Division of Nephrology, University of Alberta, Edmonton, Canada
| | - Bonnie Field
- Renal Patient and Family Advisory Council, London Health Sciences Centre, ON, Canada
| | - Leah E Getchell
- Division of Nephrology, London Health Sciences Centre, ON, Canada
| | - Emma Hahn
- Division of Nephrology, London Health Sciences Centre, ON, Canada
| | - S Joseph Kim
- Division of Nephrology, Toronto General Hospital, University Health Network and University of Toronto, ON, Canada
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Chia JMX, Goh ZS, Seow PS, Seow TYY, Choo JCJ, Foo MWY, Newman S, Griva K. Psychosocial Factors, Intentions to Pursue Arteriovenous Dialysis Access, and Access Outcomes: A Cohort Study. Am J Kidney Dis 2020; 77:931-940. [PMID: 33279557 DOI: 10.1053/j.ajkd.2020.09.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 09/17/2020] [Indexed: 11/11/2022]
Abstract
RATIONALE & OBJECTIVE Suboptimal dialysis preparation of patients with chronic kidney disease (CKD) is common, but little is known about its relationship to psychosocial factors. This study aimed to assess patients' attitudes about access creation and to identify factors associated with patients' intentions regarding dialysis access creation and outcomes. STUDY DESIGN Prospective cohort study. SETTING & PARTICIPANTS 190 patients with stage 4/5 CKD not receiving dialysis treated at 2 hospitals in Singapore and 128 of their family members. PREDICTORS Self-reported measures of illness perception, health-related quality of life, and attitudes toward access creation. Sociodemographic and clinical measures were also obtained. OUTCOME Intention to create an arteriovenous fistula (AVF; ie, proceed with access vs wait and see) and time to creation of a functional AVF. ANALYTICAL APPROACH Exploratory factor analysis (EFA) was undertaken to construct internally consistent subscales for a newly developed questionnaire about attitudes toward access creation. Logistic regression and cause-specific hazards models were conducted to identify psychosocial factors associated with patients' access creation intentions and access outcomes, respectively. RESULTS EFA (explained 50.1% variance) revealed 4 domains: access and dialysis concerns, need for dialysis, worry about cost, and value of access. A high risk of intention to delay access creation (51.1%) was found among patients despite early referral and education. Multivariable analysis (R2=0.45) showed that the intention to proceed with access creation was associated with greater perceived value from access (odds ratio, 2.61; 95% CI, 1.46-4.65; P<0.001). LIMITATIONS Limited generalization, as only those already receiving nephrology care were studied. CONCLUSIONS Approximately half of the patients studied planned to delay access creation. The questionnaire developed to evaluate attitudes about access creation may help identify individuals for whom decision-support programs would be useful. These findings highlight the need to understand and address patients' concerns about access creation.
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Affiliation(s)
- Jace Ming Xuan Chia
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore
| | - Zhong Sheng Goh
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore
| | - Pei Shing Seow
- Department of General Medicine, Khoo Teck Puat Hospital, Singapore
| | | | | | | | - Stanton Newman
- School of Health Sciences, Division of Health Services Research and Management, City University of London, London, United Kingdom
| | - Konstadina Griva
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore.
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Raffray M, Vigneau C, Couchoud C, Bayat S. Predialysis Care Trajectories of Patients With ESKD Starting Dialysis in Emergency in France. Kidney Int Rep 2020; 6:156-167. [PMID: 33426395 PMCID: PMC7785414 DOI: 10.1016/j.ekir.2020.10.026] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 10/22/2020] [Accepted: 10/23/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction Emergency dialysis start (EDS) is frequent for patients with chronic kidney disease (CKD). To improve CKD management, new trajectory-based care policies are currently being introduced both in France and in the United States. This study describes the different types of predialysis care trajectories and factors associated with EDS. Methods Adults patients who started dialysis in France in 2015 were included. Individual clinical and health care consumption data were retrieved from the French national end-stage kidney disease (ESKD) registry (Renal Epidemiology and Information Network [REIN]) and the French National Health Data system (SNDS), respectively. Hierarchical Clustering on Principal Component was used to identify groups of patients with the same health care consumption profile during the 2 years before dialysis start. Logistic regression analysis was used to identify factors associated with EDS. Results Among the 8856 patients included in the analysis, 2681 (30.3%) had EDS. The Hierarchical Clustering on Principal Component identified six types of predialysis care trajectories in which EDS rate ranged from 13.8% to 61.8%. After adjustment for the patients’ characteristics, less frequent or lack of follow-up with a nephrologist was associated with higher risk of EDS (odds ratio [OR]: 1.32; 95% confidence interval [CI]: 1.17–1.50 and OR: 1.83; 95% CI: 1.58–2.12), but not follow-up with a general practitioner. Conclusions The care trajectories during the 2 years before dialysis start were heterogeneous and patients with a lesser or lack of follow-up with a nephrologist were more likely to start dialysis in emergency, regardless of the frequency of follow-up by a general practitioner (GP). New CKD policies should include actions to strengthen CKD screening and referral to nephrologists.
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Affiliation(s)
- Maxime Raffray
- University of Rennes, French School of Public Health (EHESP), Pharmaco-epidemiology and health Services Research, Rennes, France
- Correspondence: Maxime Raffray, French School of Public Health, 15 Avenue du Professeur Léon Bernard, 35043 Rennes, France.
| | - Cécile Vigneau
- University of Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail), Rennes, France
| | - Cécile Couchoud
- REIN Registry, Biomedecine Agency, Saint-Denis-La-Plaine, France
| | - Sahar Bayat
- University of Rennes, French School of Public Health (EHESP), Pharmaco-epidemiology and health Services Research, Rennes, France
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32
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Xieyi G, Xiaohong T, Xiaofang W, Zi L. Urgent-start peritoneal dialysis in chronic kidney disease patients: A systematic review and meta-analysis compared with planned peritoneal dialysis and with urgent-start hemodialysis. Perit Dial Int 2020; 41:179-193. [PMID: 32319854 DOI: 10.1177/0896860820918710] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
An increasing number of studies have focused on whether peritoneal dialysis (PD) can be used for the urgent initiation of dialysis in patients with chronic kidney disease (CKD). We performed this systematic review and meta-analysis to evaluate the feasibility and safety of urgent-start PD compared with those of planned PD and urgent-start hemodialysis (HD) in this population. PubMed, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), clinicaltrials.gov, and China National Knowledge Infrastructure (CNKI) were searched for relevant studies. Conference abstracts were also searched in relevant websites. The meta-analysis was performed using RevMan 5.3 software. A total of 15 trials involving 2426 participants were identified. The quality of the included studies was fair, but the quality of evidence was very low. Unadjusted meta-analysis showed that urgent-start PD had significantly higher mortality than planned PD, while adjusted meta-analysis did not show a significant difference. Higher incident of leakage and catheter mechanical dysfunction were observed in urgent-start PD. However, peritonitis, exit-site infection, or PD technique survival were comparable between urgent-start and planned PD. The all-cause mortality was comparable in urgent-start PD and urgent-start HD. Bacteremia was significantly lower in the urgent-start PD group than with urgent-start HD. Based on limited evidences, PD may be a viable alternative to HD for CKD patients requiring urgent-start dialysis. Because of the inconsistent results and the low quality of evidence, a definitive conclusion could not be drawn for whether urgent-start PD was comparable with planned PD. Therefore, high-quality and large-scale studies are needed in the future.
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Affiliation(s)
- Guo Xieyi
- Department of Nephrology, 34753West China Hospital of Sichuan University, Chengdu, China.,34753West China School of Medicine, Sichuan University, Chengdu, China
| | - Tang Xiaohong
- Department of Nephrology, 34753West China Hospital of Sichuan University, Chengdu, China
| | - Wu Xiaofang
- Department of Nephrology, 34753West China Hospital of Sichuan University, Chengdu, China.,34753West China School of Medicine, Sichuan University, Chengdu, China
| | - Li Zi
- Department of Nephrology, 34753West China Hospital of Sichuan University, Chengdu, China
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Heaf J, Heiro M, Petersons A, Vernere B, Povlsen JV, Sørensen AB, Clyne N, Bumblyte I, Zilinskiene A, Randers E, Løkkegaard N, Ots-Rosenberg M, Kjellevold S, Kampmann JD, Rogland B, Lagreid I, Heimburger O, Lindholm B. Suboptimal dialysis initiation is associated with comorbidities and uraemia progression rate but not with estimated glomerular filtration rate. Clin Kidney J 2020; 14:933-942. [PMID: 33777377 PMCID: PMC7986329 DOI: 10.1093/ckj/sfaa041] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 03/15/2020] [Indexed: 12/20/2022] Open
Abstract
Background Despite early referral of uraemic patients to nephrological care, suboptimal dialysis initiation (SDI) remains a common problem associated with increased morbimortality. We hypothesized that SDI is related to pre-dialysis care. Methods In the ‘Peridialysis’ study, time and reasons for dialysis initiation (DI), clinical and biochemical data and centre characteristics were registered during the pre- and peri-dialytic period for 1583 end-stage kidney disease patients starting dialysis over a 3-year period at 15 nephrology departments in the Nordic and Baltic countries to identify factors associated with SDI. Results SDI occurred in 42%. Risk factors for SDI were late referral, cachexia, comorbidity (particularly cardiovascular), hypoalbuminaemia and rapid uraemia progression. Patients with polycystic renal disease had a lower incidence of SDI. High urea and C-reactive protein levels, acidosis and other electrolyte disorders were markers of SDI, independently of estimated glomerular filtration rate (eGFR). SDI patients had higher eGFR than non-SDI patients during the pre-dialysis period, but lower eGFR at DI. eGFR as such did not predict SDI. Patients with comorbidities had higher eGFR at DI. Centre practice and policy did not associate with the incidence of SDI. Conclusions SDI occurred in 42% of all DIs. SDI was associated with hypoalbuminaemia, comorbidity and rate of eGFR loss, but not with the degree of renal failure as assessed by eGFR.
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Affiliation(s)
- James Heaf
- Department of Medicine, Zealand University Hospital, Roskilde, Denmark.,Department of Nephrology, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
| | | | | | | | - Johan V Povlsen
- Department of Nephrology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Naomi Clyne
- Department of Nephrology, Clinical Sciences Lund, Lund University and Skåne University Hospital, Lund, Sweden
| | - Inga Bumblyte
- Nephrological Clinic, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Alanta Zilinskiene
- Nephrological Clinic, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Else Randers
- Department of Medicine, Viborg Regional Hospital, Viborg, Denmark
| | | | | | | | | | - Björn Rogland
- Department of Medicine, Kristianstad Hospital, Kristianstad, Sweden
| | - Inger Lagreid
- Department of Medicine, St Olav University Hospital, Trondheim, Norway
| | - Olof Heimburger
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Bengt Lindholm
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
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