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Ethier I, Hayat A, Pei J, Hawley CM, Johnson DW, Francis RS, Wong G, Craig JC, Viecelli AK, Htay H, Ng S, Leibowitz S, Cho Y. Peritoneal dialysis versus haemodialysis for people commencing dialysis. Cochrane Database Syst Rev 2024; 6:CD013800. [PMID: 38899545 PMCID: PMC11187793 DOI: 10.1002/14651858.cd013800.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Abstract
BACKGROUND Peritoneal dialysis (PD) and haemodialysis (HD) are two possible modalities for people with kidney failure commencing dialysis. Only a few randomised controlled trials (RCTs) have evaluated PD versus HD. The benefits and harms of the two modalities remain uncertain. This review includes both RCTs and non-randomised studies of interventions (NRSIs). OBJECTIVES To evaluate the benefits and harms of PD, compared to HD, in people with kidney failure initiating dialysis. SEARCH METHODS We searched the Cochrane Kidney and Transplant Register of Studies from 2000 to June 2024 using search terms relevant to this review. Studies in the Register were identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Registry Platform (ICTRP) Search Portal, and ClinicalTrials.gov. MEDLINE and EMBASE were searched for NRSIs from 2000 until 28 March 2023. SELECTION CRITERIA RCTs and NRSIs evaluating PD compared to HD in people initiating dialysis were eligible. DATA COLLECTION AND ANALYSIS Two investigators independently assessed if the studies were eligible and then extracted data. Risk of bias was assessed using standard Cochrane methods, and relevant outcomes were extracted for each report. The primary outcome was residual kidney function (RKF). Secondary outcomes included all-cause, cardiovascular and infection-related death, infection, cardiovascular disease, hospitalisation, technique survival, life participation and fatigue. MAIN RESULTS A total of 153 reports of 84 studies (2 RCTs, 82 NRSIs) were included. Studies varied widely in design (small single-centre studies to international registry analyses) and in the included populations (broad inclusion criteria versus restricted to more specific participants). Additionally, treatment delivery (e.g. automated versus continuous ambulatory PD, HD with catheter versus arteriovenous fistula or graft, in-centre versus home HD) and duration of follow-up varied widely. The two included RCTs were deemed to be at high risk of bias in terms of blinding participants and personnel and blinding outcome assessment for outcomes pertaining to quality of life. However, most other criteria were assessed as low risk of bias for both studies. Although the risk of bias (Newcastle-Ottawa Scale) was generally low for most NRSIs, studies were at risk of selection bias and residual confounding due to the constraints of the observational study design. In children, there may be little or no difference between HD and PD on all-cause death (6 studies, 5752 participants: RR 0.81, 95% CI 0.62 to 1.07; I2 = 28%; low certainty) and cardiovascular death (3 studies, 7073 participants: RR 1.23, 95% CI 0.58 to 2.59; I2 = 29%; low certainty), and was unclear for infection-related death (4 studies, 7451 participants: RR 0.98, 95% CI 0.39 to 2.46; I2 = 56%; very low certainty). In adults, compared with HD, PD had an uncertain effect on RKF (mL/min/1.73 m2) at six months (2 studies, 146 participants: MD 0.90, 95% CI 0.23 to 3.60; I2 = 82%; very low certainty), 12 months (3 studies, 606 participants: MD 1.21, 95% CI -0.01 to 2.43; I2 = 81%; very low certainty) and 24 months (3 studies, 334 participants: MD 0.71, 95% CI -0.02 to 1.48; I2 = 72%; very low certainty). PD had uncertain effects on residual urine volume at 12 months (3 studies, 253 participants: MD 344.10 mL/day, 95% CI 168.70 to 519.49; I2 = 69%; very low certainty). PD may reduce the risk of RKF loss (3 studies, 2834 participants: RR 0.55, 95% CI 0.44 to 0.68; I2 = 17%; low certainty). Compared with HD, PD had uncertain effects on all-cause death (42 studies, 700,093 participants: RR 0.87, 95% CI 0.77 to 0.98; I2 = 99%; very low certainty). In an analysis restricted to RCTs, PD may reduce the risk of all-cause death (2 studies, 1120 participants: RR 0.53, 95% CI 0.32 to 0.86; I2 = 0%; moderate certainty). PD had uncertain effects on both cardiovascular (21 studies, 68,492 participants: RR 0.96, 95% CI 0.78 to 1.19; I2 = 92%) and infection-related death (17 studies, 116,333 participants: RR 0.90, 95% CI 0.57 to 1.42; I2 = 98%) (both very low certainty). Compared with HD, PD had uncertain effects on the number of patients experiencing bacteraemia/bloodstream infection (2 studies, 2582 participants: RR 0.34, 95% CI 0.10 to 1.18; I2 = 68%) and the number of patients experiencing infection episodes (3 studies, 277 participants: RR 1.23, 95% CI 0.93 to 1.62; I2 = 20%) (both very low certainty). PD may reduce the number of bacteraemia/bloodstream infection episodes (2 studies, 2637 participants: RR 0.44, 95% CI 0.27 to 0.71; I2 = 24%; low certainty). Compared with HD; It is uncertain whether PD reduces the risk of acute myocardial infarction (4 studies, 110,850 participants: RR 0.90, 95% CI 0.74 to 1.10; I2 = 55%), coronary artery disease (3 studies, 5826 participants: RR 0.95, 95% CI 0.46 to 1.97; I2 = 62%); ischaemic heart disease (2 studies, 58,374 participants: RR 0.86, 95% CI 0.57 to 1.28; I2 = 95%), congestive heart failure (3 studies, 49,511 participants: RR 1.10, 95% CI 0.54 to 2.21; I2 = 89%) and stroke (4 studies, 102,542 participants: RR 0.94, 95% CI 0.90 to 0.99; I2 = 0%) because of low to very low certainty evidence. Compared with HD, PD had uncertain effects on the number of patients experiencing hospitalisation (4 studies, 3282 participants: RR 0.90, 95% CI 0.62 to 1.30; I2 = 97%) and all-cause hospitalisation events (4 studies, 42,582 participants: RR 1.02, 95% CI 0.81 to 1.29; I2 = 91%) (very low certainty). None of the included studies reported specifically on life participation or fatigue. However, two studies evaluated employment. Compared with HD, PD had uncertain effects on employment at one year (2 studies, 593 participants: RR 0.83, 95% CI 0.20 to 3.43; I2 = 97%; very low certainty). AUTHORS' CONCLUSIONS The comparative effectiveness of PD and HD on the preservation of RKF, all-cause and cause-specific death risk, the incidence of bacteraemia, other vascular complications (e.g. stroke, cardiovascular events) and patient-reported outcomes (e.g. life participation and fatigue) are uncertain, based on data obtained mostly from NRSIs, as only two RCTs were included.
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Affiliation(s)
- Isabelle Ethier
- Department of Nephrology, Centre hospitalier de l'Université de Montréal, Montréal, Canada
- Health innovation and evaluation hub, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Canada
| | - Ashik Hayat
- Department of Nephrology, Princess Alexandra Hospital, Woolloongabba, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Juan Pei
- Department of Nephrology, Princess Alexandra Hospital, Woolloongabba, Australia
- Department of Nephrology, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Carmel M Hawley
- Department of Nephrology, Princess Alexandra Hospital, Woolloongabba, Australia
- Australasian Kidney Trials Network, The University of Queensland, Brisbane, Australia
- Translational Research Institute, Brisbane, Australia
| | - David W Johnson
- Department of Nephrology, Princess Alexandra Hospital, Woolloongabba, Australia
- Australasian Kidney Trials Network, The University of Queensland, Brisbane, Australia
- Translational Research Institute, Brisbane, Australia
| | - Ross S Francis
- Department of Nephrology, Princess Alexandra Hospital, Woolloongabba, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Germaine Wong
- School of Public Health, The University of Sydney, Sydney, Australia
| | - Jonathan C Craig
- Cochrane Kidney and Transplant, Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Andrea K Viecelli
- Department of Nephrology, Princess Alexandra Hospital, Woolloongabba, Australia
- Australasian Kidney Trials Network, The University of Queensland, Brisbane, Australia
- Translational Research Institute, Brisbane, Australia
| | - Htay Htay
- Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore
| | - Samantha Ng
- Department of Nephrology, Princess Alexandra Hospital, Woolloongabba, Australia
| | - Saskia Leibowitz
- Department of Nephrology, Logan Hospital, Meadowbrook, Australia
| | - Yeoungjee Cho
- Department of Nephrology, Princess Alexandra Hospital, Woolloongabba, Australia
- Australasian Kidney Trials Network, The University of Queensland, Brisbane, Australia
- Translational Research Institute, Brisbane, Australia
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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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Liu T, Wang Y. The influence of different peritoneal dialysis techniques on wound infection in patients with peritoneal dialysis tube. Int Wound J 2024; 21:e14352. [PMID: 37622537 PMCID: PMC10781592 DOI: 10.1111/iwj.14352] [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: 07/20/2023] [Accepted: 08/03/2023] [Indexed: 08/26/2023] Open
Abstract
More and more research has started to investigate the effect of peritoneal dialysis treatment on the incidence of pericatheter wound complications in chronic kidney disease (CKD). This meta-study evaluated the effect of emergency peritoneal dialysis (EPD) with conventional peritoneal dialysis (CPD) in patients with catheter-related complications. We looked up 4 databases: PubMed, EMBASE, Cochrane, and Web of Science, and analysed the data with RevMan 5. There were a total of 15 studies with 3034 participants. While the quality of the research included was fairly good, the evidence was mediocre. In the meta-analyses, the risk of leak in the conduit with PD was very high (OR, 2.48; 95% CI, 1.72, 3.59, p < 0.00001). However, for those treated with urgent medical method prior to initiation of PD, the risk for peritonitis, catheter dysfunction and bleeding was similar compared with CPD. Based on limited information, immediate initiation of PDs is advised in order to increase the quality of life for people in urgent need, except if there is no consideration for loss of fluid. The low quality of the evidence is holding up the evidence. This research, however, is also informative because of the large number of available data. Consequently, additional high quality, large, randomized controlled studies are required to establish.
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Affiliation(s)
- Ting Liu
- Department of General PracticeThe Second Hospital of Dalian Medical UniversityDalianChina
| | - Yuan Wang
- Department of NephrologyThe Second Hospital of Dalian Medical UniversityDalianChina
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Yin C, Zhang X, Zhu J, Yuan Z, Wang T, Wang X. Comparison of hospitalization cause and risk factors between patients undergoing hemodialysis and peritoneal dialysis. Medicine (Baltimore) 2022; 101:e31186. [PMID: 36482565 PMCID: PMC9726322 DOI: 10.1097/md.0000000000031186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
This retrospective study was designed to compare the cause of hospitalization and influencing factors between patients undergoing hemodialysis (HD) and peritoneal dialysis (PD). Baseline data and laboratory parameters of 192 dialysis patients (92 HD patients and 100 PD patients) were compared. Quantitative parameters with normal distribution were assessed using independent t-test or analysis of variance (ANOVA). Quantitative parameters with non-normal distribution were assessed by non-parametric test. Qualitative data were statistically compared using χ2 test. The number of patients with urban employee medical insurance (88 HD patients and 60 PD patients) and rural cooperative medical care (12 HD patients and 40 PD patients) significantly differed (P < .01). The hospitalization rate of PD patients was significantly higher than that of HD counterparts. The average length of hospital stay of PD patients was 10 days, remarkably longer than 8 days of HD patients (P < .01). The primary cause of hospitalization for HD patients was infection-related complications, followed by cardiovascular, cerebrovascular complications and dialysis access disorders. The primary cause of hospitalization for PD patients was infection-related complications, followed by dialysis access disorders, cardiovascular, and gastrointestinal complications. Compared with the HD group, the levels of hemoglobin, serum albumin, alkaline phosphatase, intact parathyroid hormone were significantly decreased, whereas serum urea nitrogen, serum creatinine, phosphorus levels and cardiothoracic ratio were remarkably increased in the PD group (all P < .01). The hospitalization rate of PD patients is relatively higher, and the length of hospital stay is longer. Extensive attention and efforts should be delivered to enhance the understanding of disease and lower the risk of complications for patients.
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Affiliation(s)
- Caixia Yin
- Department of Nephrology, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing Jiangning Hospital, Nanjing, Jiangsu, China
| | - Xiumei Zhang
- Department of Nephrology, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing Jiangning Hospital, Nanjing, Jiangsu, China
| | - Jiang Zhu
- Department of Nephrology, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing Jiangning Hospital, Nanjing, Jiangsu, China
| | - Zijing Yuan
- Department of Nephrology, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing Jiangning Hospital, Nanjing, Jiangsu, China
| | - Tao Wang
- Department of Nephrology, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing Jiangning Hospital, Nanjing, Jiangsu, China
| | - Xixi Wang
- Department of Nephrology, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing Jiangning Hospital, Nanjing, Jiangsu, China
- * Correspondence: Xixi Wang, Department of Nephrology, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing Jiangning Hospital, Nanjing, Jiangsu 211100, China (e-mail: )
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Behera MR, John EE, Thomas A, David VG, Alexander S, Mohapatra A, Valson AT, Jacob S, Kakde S, Koshy PM, Rajan G, Varughese S. Difficult cannulation of hemodialysis arteriovenous fistula - Role of imaging in access management (DICAF STUDY). J Vasc Access 2022; 23:877-884. [PMID: 33977819 PMCID: PMC7615862 DOI: 10.1177/11297298211015097] [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] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Difficulty in cannulation of arteriovenous fistula (AVF) can lead to inadequate dialysis, transient to permanent loss of access and increases dependency on bridging catheters. This study aimed to analyze the causes for difficult fistula cannulation, using various imaging modalities. METHODOLOGY This was a retrospective single-center observational study conducted between October 2017 and June 2018. Patients whose fistulae were difficult to cannulate were initially evaluated by physical examination followed by doppler ultrasonography or/and fistulogram as necessary. The patients were divided into two groups that is, primary difficult cannulation (within first three months of creation of fistula) or secondary difficult cannulation (after three months). RESULTS We encountered difficult cannulation in 43 patients. About 60% were primary difficult cannulations. Most common causes for difficulty in cannulation were cannulation zone (CZ) stenosis (23.3%), immature fistula (20.9%), outflow stenosis (18.6%), inflow stenosis (11.6%), anatomical abnormalities (11.6%), outflow plus CZ stenosis (9.3%) and inflow plus CZ stenosis (4.7%). Among patients with primary difficult cannulation, immature fistula (34.6%) was the most common cause, whereas CZ stenosis (47.1%) was the most common etiology for secondary difficult cannulation. Edema leading to difficult cannulation was found in 12 patients (27.9%), all of which was due to central vein stenosis. Cannulation resulted in hematoma, fistula thrombosis, failure of fistula and pseudoaneurysm in 83.7%, 27.9%, 16.3%, and 2.3% of cases respectively. Bridging temporary dialysis catheter placement was required in 67.4% patients. Ultrasound doppler had lower diagnostic value when compared to fistulogram (71.4% vs 93.9%, p = 0.014). CONCLUSION Difficulty in cannulating the arteriovenous fistula is a common problem in hemodialysis patients. We suggest that patients whose fistulae are difficult to cannulate should undergo early radiological evaluation to decrease catheter dependency and access failure.
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Affiliation(s)
| | | | - Athul Thomas
- Department of Nephrology, Christian Medical College, Vellore, TN, India
| | | | - Suceena Alexander
- Department of Nephrology, Christian Medical College, Vellore, TN, India
| | - Anjali Mohapatra
- Department of Nephrology, Christian Medical College, Vellore, TN, India
| | - Anna T Valson
- Department of Nephrology, Christian Medical College, Vellore, TN, India
| | - Shibu Jacob
- Department of Nephrology, Christian Medical College, Vellore, TN, India
| | - Shailesh Kakde
- Department of Nephrology, Christian Medical College, Vellore, TN, India
| | | | - Gautam Rajan
- Department of Nephrology, Christian Medical College, Vellore, TN, India
| | - Santosh Varughese
- Department of Nephrology, Christian Medical College, Vellore, TN, India
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Alam F, Al Salmi I, Al Zadjali M, Jha DK, Hannawi S. Demography and Outcomes of Arteriovenous Fistula: Challenges and Future Directions. SAUDI JOURNAL OF KIDNEY DISEASES AND TRANSPLANTATION 2022; 33:627-638. [PMID: 37955455 DOI: 10.4103/1319-2442.389423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2023] Open
Abstract
The incidence and prevalence rates of treated end-stage kidney disease (ESKD) patients are on the rise worldwide. Hemodialysis remains the main modality of providing renal replacement therapy for the ESKD patients, and the preferred vascular access is an arteriovenous fistula (AVF). The objective is to assess the patency rates and primary failures of the AVF. All patients who attended the Royal Hospital in Muscat, Oman, from January 2010 to December 2014 for AVF creation were included in this study. Data were extracted from the hospital's electronic medical record system where data are entered prospectively. During the period of study from 2010 to 2014, 465 primary fistulae were created in 427 patients. The mean age of the patient was 58 years. Only 6% needed general anesthesia, while the rest were done under regional or local anesthesia. Fifty-one percent of the patients were diabetic. Preemptive AVF was constructed in only 12% of patients. Most cases (47%) had left brachiocephalic (BC) fistulae. The left radiocephalic (RC) fistulae constituted 25.7% and the left brachiobasilic fistulae 9.9%. The remaining were constructed in the right upper limb. The total patency was achieved in 80% of fistulae and the failure rate was 20% at 6 months. Whereas, at 12 months, the total patency rate was 71% and the failure rate was 29%. Thus, we can conclude that more than 50% of patients, half of them being females, were diabetics. This resulted in more fistulae being constructed in the arm, namely left BC fistulae and left RC fistulae. Furthermore, it is important to note that only a very small percentage of patients had an established preemptive AVF. These factors may be responsible for a failure rate of 20% and 29% of the AVFs at 6 months and 12 months, respectively.
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Affiliation(s)
- Faisal Alam
- Department of Surgery, The Royal Hospital, Muscat, Oman
| | - Issa Al Salmi
- Department of Renal Medicine, The Royal Hospital, Muscat, Oman
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Abstract
The practice and clinical outcomes of peritoneal dialysis (PD) have demonstrated significant improvement over the past 20 years. The aim of this review is to increase awareness and update healthcare professionals on current PD practice, especially with respect to patient and technique survival, patient modality selection, pathways onto PD, understanding patient experience of care and use prior to kidney transplantation. These improvements have been impacted, at least in part, by greater emphasis on shared decision-making in dialysis modality selection, the use of advanced laparoscopic techniques for PD catheter implantation, developments in PD connecting systems, glucose-sparing strategies, and modernising technology in managing automated PD patients remotely. Evidence-based clinical guidelines such as those prepared by national and international societies such as the International Society of PD have contributed to improved PD practice underpinned by a recognition of the place of continuous quality improvement processes.
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Affiliation(s)
- Ayman Karkar
- Medical Affairs - Renal Care, Scientific Office, Baxter A.G., Dubai, United Arab Emirates
| | - Martin Wilkie
- Sheffield Teaching Hospitals NHS Foundation Trust, Herries Road, Sheffield, UK
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8
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Guzman-Ventura W, Caballero-Alvarado J. Survival of patients on chronic hemodialysis versus chronic peritoneal dialysis. Rev Peru Med Exp Salud Publica 2022; 39:161-169. [PMID: 36477316 PMCID: PMC11397744 DOI: 10.17843/rpmesp.2022.392.10853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 06/30/2022] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE. To compare the survival of patients with chronic kidney disease (CKD) on hemodialysis (HD) versus peritoneal dialysis (PD). MATERIALS AND METHODS. Survival analysis of a retrospective cohort of patients ≥ 18 years who started HD versus PD at the Victor Lazarte Echegaray Hospital from 2015 to 2019. We analyzed the following covariates: age, sex, diabetes mellitus as cause of CKD, temporary central venous catheter (CVC) as initial vascular access and glomerular filtration rate. Survival was calculated with Kaplan-Meier curves for the overall cohort and for age ≥ 60 years, diabetes mellitus as a cause of CKD and CVC. The risk of death was estimated by Hazard Ratio (HR) according to the Cox proportional hazards model for each covariate adjusted for dialysis type in a bivariate and multivariate analysis considering significant difference if the p-value < 0.05. RESULTS. We included 368 patients on HD of whom 129 (35.1%) died, and 172 patients on PD of whom 66 (38.4%) died (p=0.455). The cumulative probability of survival at 60 months for HD was 30% and for PD was 37% with similar survival curves (p=0.719). The median survival time for HD was 32 months (IQR: 20-53) and for PD was 32.5 months (IQR: 18-57) (p=0.999). The covariates associated with higher mortality adjusted for dialysis type were age ≥60 years (HR 1.77; p<0.001) and diabetes mellitus as a cause of CKD (HR 1.63; p=0.002). CONCLUSIONS. Survival of patients with CKD on HD and PD was similar.
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Affiliation(s)
- Wilmer Guzman-Ventura
- Hospital Víctor Lazarte Echegaray, Seguro Social de Salud, Trujillo, Perú
- Escuela de Medicina Humana, Universidad Privada Antenor Orrego, Trujillo, Perú
| | - José Caballero-Alvarado
- Hospital Regional Docente de Trujillo, Trujillo, Perú
- Escuela de Posgrado, Universidad Privada Antenor Orrego, Trujillo, Perú
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Hu X, Yang L, Sun Z, Zhang X, Zhu X, Zhou W, Wen X, Liu S, Cui W. Break-in Period ≤24 Hours as an Option for Urgent-start Peritoneal Dialysis in Patients With Diabetes. Front Endocrinol (Lausanne) 2022; 13:936573. [PMID: 35909563 PMCID: PMC9329536 DOI: 10.3389/fendo.2022.936573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 06/10/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The optimal break-in period (BI) of urgent-start peritoneal dialysis (USPD) initiation for patients with end-stage renal disease (ESRD) and diabetes is unclear. We aimed to explore the safety and applicability of a BI ≤24 h in patients with ESRD and diabetes. METHODS We used a retrospective cohort design wherein we recruited patients with ESRD and diabetes who underwent USPD at five institutions in China between January 2013 and August 2020. The enrolled patients were grouped according to BI. The primary outcomes were mechanical and infectious complication occurrences, whereas the secondary outcome was technique survival. RESULTS We enrolled 310 patients with diabetes, of whom 155 and 155 patients were in the BI ≤24 h and BI >24 h groups, respectively. The two groups showed a comparable incidence of infectious and mechanical complications within 6 months after catheter insertion (p>0.05). Logistic regression analysis revealed that a BI ≤24 h was not an independent risk factor for mechanical or infectious complications. Kaplan-Meier estimates showed no statistically significant between-group differences in technique survival rates (p>0.05). Cox multivariate regression analysis revealed that a BI ≤24 h was not an independent risk factor for technique failure. CONCLUSION USPD initiation with a BI ≤24 h may be safe and feasible for patients with ESRD and diabetes.
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Affiliation(s)
- Xiaoqing Hu
- 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, Inner Mongolia, 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
| | - Xi Wen
- Division of Nephrology, The Second Hospital of Jilin University, Changchun, China
| | - Shichen Liu
- Division of Nephrology, The Second Hospital of Jilin University, Changchun, China
| | - Wenpeng Cui
- Division of Nephrology, The Second Hospital of Jilin University, Changchun, China
- *Correspondence: Wenpeng Cui,
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Han G, Bohmart A, Shaaban H, Mages K, Jedlicka C, Zhang Y, Steel P. Emergency Department Utilization Among Maintenance Hemodialysis Patients: A Systematic Review. Kidney Med 2021; 4:100391. [PMID: 35243303 PMCID: PMC8861946 DOI: 10.1016/j.xkme.2021.09.007] [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: 11/30/2022] Open
Affiliation(s)
- Gregory Han
- Department of Emergency Medicine, Weill Cornell Medicine, New York, NY
- Address for Correspondence: Gregory Han, BA, Department of Emergency Medicine, Weill Cornell Medicine, 1300 York Avenue, New York, NY 10065.
| | - Andrew Bohmart
- The Rogosin Institute, Weill Cornell Medicine, New York, NY
| | - Heba Shaaban
- Department of Emergency Medicine, Weill Cornell Medicine, New York, NY
| | - Keith Mages
- Robert L. Brown History of Medicine Collection, University at Buffalo, Buffalo, NY
| | - Caroline Jedlicka
- Samuel J. Wood Library and C.V. Starr Biomedical Information Center, Weill Cornell Medicine, New York, NY
| | - Yiye Zhang
- Department of Emergency Medicine, Weill Cornell Medicine, New York, NY
| | - Peter Steel
- Department of Emergency Medicine, Weill Cornell Medicine, New York, NY
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11
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Ghosh NK, Bhattacharjee HK, Prajapati O, Krishna A, Kumar A, Mahajan S, Bansal VK. Impact of clinical parameters and vascular haemodynamics on arterio-venous fistula maturation in patients with end stage renal disease: A prospective study on Indian patients. J Vasc Access 2021; 23:508-514. [PMID: 33719712 DOI: 10.1177/11297298211001158] [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: 11/16/2022] Open
Abstract
BACKGROUND About 18%-65% of Arterio-Venous fistula (AVF) made to facilitate haemodialysis in end stage renal disease patient fail to mature. This study was designed to evaluate the impact of clinical parameters and vascular haemodynamics on maturation of AVF on Indian patients. MATERIAL AND METHODS This was a prospective observational study. Eligible patients' clinical profiles and vascular haemodynamics by Doppler ultrasonography were noted. All patients underwent radio-cephalic AVF on the non-dominant arm under local anaesthesia. Clinical definition was used to assess success rate of AVFs which is defined as successful six settings of satisfactory dialysis. Data were analysed using Stata/12.0 software. Independent t-test, chi-square test, logistic regression analysis and multivariate analysis were used. The p-value of <0.05 was considered significant. RESULTS A total of 205 patients were enrolled and analysed. Among clinical factors, age, sex, serum creatinine, hypertension had no significant association with failure (p = 0.5, 0.08, 0.76 and 0.74). Patient's BMI and presence of diabetes had significant impact on outcome (p < 0.001 and 0.02 respectively). Among vascular haemodynamics, radial vein diameter of >2.5 mm and radial artery flow rate >40 ml/min had no significant association with failure (p = 0.12 and 0.28). Diameter of radial artery (>2 mm) and intra-operatively immediate thrill were independent predictor of success (p = 0.002 and <0.001). CONCLUSION In the present study rate of fistula, maturation was 73.2% without any post-operative radiological intervention. Radial artery diameter >2 mm and presence of immediate thrill post-operatively were significantly associated with successful cannulation.
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Affiliation(s)
- Nalini Kanta Ghosh
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | | | - Omprakash Prajapati
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Asuri Krishna
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Atin Kumar
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Sandeep Mahajan
- Department of Nephrology, All India Institute of Medical Sciences, New Delhi, India
| | - Virinder Kumar Bansal
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
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12
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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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13
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Wang D, Calabro-Kailukaitis N, Mowafy M, Kerns ES, Suvarnasuddhi K, Licht J, Ahn SH, Hu SL. Urgent-start peritoneal dialysis results in fewer procedures than hemodialysis. Clin Kidney J 2020; 13:166-171. [PMID: 32296520 PMCID: PMC7147319 DOI: 10.1093/ckj/sfz053] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 04/08/2019] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Peritoneal dialysis (PD) is an underutilized modality for hospitalized patients with an urgent need to start renal replacement therapy in the USA. Most patients begin hemodialysis (HD) with a tunneled central venous catheter (CVC). METHODS We examined the long-term burden of dialysis modality-related access procedures with urgent-start PD and urgent-start HD in a retrospective cohort of 73 adults. The number of access-related (mechanical and infection-related) procedures for each modality was compared in the first 30 days and cumulatively through the duration of follow-up. RESULTS Fifty patients underwent CVC placement for HD and 23 patients underwent PD catheter placement for urgent-start dialysis. Patients were followed on average >1 year. The PD group was significantly younger, with less diabetes, with a higher pre-dialysis serum creatinine and more likely to have a planned dialysis access. The mean number of access-related procedures per patient in the two groups was not different at 30 days; however, when compared over the duration of follow-up, the number of access-related procedures was significantly higher in the HD group compared with the PD group (4.6 ± 3.9 versus 0.61 ± 0.84, P < 0.0001). This difference persisted when standardized to procedures per patient-month (0.37 ± 0.57 versus 0.081 ± 0.18, P = 0.019). Infection-related procedures were similar between groups. Findings were the same even after case-matching was performed for age and diabetes mellitus with 18 patients in each group. CONCLUSIONS Urgent-start PD results in fewer invasive access procedures compared with urgent-start HD long term, and should be considered for urgent-start dialysis.
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Affiliation(s)
- Delin Wang
- Division of Kidney Diseases and Hypertension, Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
- Department of Medicine, Aspirus Nephrology Clinic, Wausau, WI, USA
| | - Nathan Calabro-Kailukaitis
- Division of Kidney Diseases and Hypertension, Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Mahmoud Mowafy
- Division of Kidney Diseases and Hypertension, Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Eric S Kerns
- Division of Kidney Diseases and Hypertension, Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Khetisuda Suvarnasuddhi
- Division of Kidney Diseases and Hypertension, Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Jonah Licht
- Division of Kidney Diseases and Hypertension, Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
- Providence Access Care, Providence, RI, USA
| | - Sun H Ahn
- Division of Kidney Diseases and Hypertension, Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
- Department of Radiology, Rhode Island Hospital, Providence, RI, USA
| | - Susie L Hu
- Division of Kidney Diseases and Hypertension, Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
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14
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Marshall MR. The benefit of early survival on PD versus HD—Why this is (still) very important. Perit Dial Int 2020; 40:405-418. [DOI: 10.1177/0896860819895177] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
There are a number of misconceptions around the identified early survival benefit of peritoneal dialysis (PD) relative to hemodialysis (HD), including that such benefits “even out in the end” since the relative risk of death over time eventually encompasses 1.0 (or even an estimate that is unfavorable to PD); that the early benefit is, in fact, most likely due to unmeasured confounding; and such benefits are only due to the influence of central venous catheters and “crash starters” in the HD group. In fact, the early survival benefit results in a substantial gain of patient life years in PD cohorts relative to HD ones, even if it the benefit appears to “even out in the end,” is relatively insensitive to unmeasured confounding, and persists even when the effects of central venous catheters are accounted for. In this review, the calculations and arguments are made to support these tenets. Survival on dialysis is still one of the most important considerations for all stakeholders in the end-stage kidney disease community, including patients who rank it among their top priorities. Shared decision-making is a fundamental patient right and requires both balanced information and an iterative mechanism for a consensual decision based on shared understanding and purpose. A cornerstone of this process should be an explicit discussion of the early survival benefit of PD relative to HD.
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Affiliation(s)
- Mark R Marshall
- Department of Renal Medicine, Counties Manukau District Health Board, Auckland, New Zealand
- School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Medical Affairs, Baxter Healthcare (Asia) Pte Ltd, Singapore
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15
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Thiery A, Séverac F, Hannedouche T, Couchoud C, Do VH, Tiple A, Béchade C, Sauleau EA, Krummel T. Survival advantage of planned haemodialysis over peritoneal dialysis: a cohort study. Nephrol Dial Transplant 2019; 33:1411-1419. [PMID: 29447408 DOI: 10.1093/ndt/gfy007] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 12/22/2017] [Indexed: 11/14/2022] Open
Abstract
Background Previous studies comparing the outcomes in haemodialysis (HD) with those in peritoneal dialysis (PD) have yielded conflicting results. Methods The aim of the study was to compare the survival of planned HD versus PD patients in a cohort of adult incident patients who started renal replacement therapy (RRT) between 2006 and 2008 in the nationwide REIN registry (Réseau Epidémiologie et Information en Néphrologie). Patients who started RRT in emergency or stopped RRT within 2 months were excluded. Adjusted Cox models, propensity score matching and marginal structural models (MSMs) were used to compensate for the lack of randomization and provide causal inference from longitudinal data with time-dependent treatments and confounders including transplant censorship, modality change over time and time-varying covariates. Results Among a total of 13 767 dialysis patients, 13% were on PD at initiation of RRT and 87% were on HD. The median survival times were 53.5 months or 4.45 years and 38.6 months or 3.21 years for patients starting on HD and PD, respectively. Regardless of the model used, there was a consistent advantage in terms of survival for HD patients: hazard ratio (HR) 0.76 [95% confidence interval (95% CI) 0.69-0.84] with the Cox model using propensity score; HR 0.67 (95% CI 0.62-0.73) in the Cox model with censorship for each treatment change; and HR 0.82 (95% CI 0.69-0.97) with MSMs. However, MSMs tended to reduce the survival gap between PD and HD patients. Conclusion This large cohort study using various statistical methods to minimize the bias appears to demonstrate a better survival in planned HD than in PD.
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Affiliation(s)
- Alicia Thiery
- Department of Public Health, Centre Paul Strauss, Strasbourg, France
| | - François Séverac
- Department of Public Health, Strasbourg University Hospital, Strasbourg, France.,Biostatistical Laboratory, Laboratory ICube, University of Strasbourg, Strasbourg, France
| | - Thierry Hannedouche
- School of Medicine, University of Strasbourg, Strasbourg, France.,Department of Nephrology and Dialysis, Strasbourg University Hospital, Strasbourg, France
| | | | - Van Huyen Do
- Biostatistical Laboratory, Laboratory ICube, University of Strasbourg, Strasbourg, France
| | - Aurélien Tiple
- Department of Nephrology, Dialysis and Transplantation, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Clémence Béchade
- Department of Nephrology, Dialysis and Transplantation, Caen University Hospital, Caen, France
| | - Erik-Andre Sauleau
- Department of Public Health, Strasbourg University Hospital, Strasbourg, France.,Biostatistical Laboratory, Laboratory ICube, University of Strasbourg, Strasbourg, France.,School of Medicine, University of Strasbourg, Strasbourg, France
| | - Thierry Krummel
- Department of Nephrology and Dialysis, Strasbourg University Hospital, Strasbourg, France
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16
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Caro Martínez A, Olry de Labry Lima A, Muñoz Terol JM, Mendoza García ÓJ, Remón Rodríguez C, García Mochón L, Castro de la Nuez P, Aresté Fosalba N. Optimal start in dialysis shows increased survival in patients with chronic kidney disease. PLoS One 2019; 14:e0219037. [PMID: 31361758 PMCID: PMC6667140 DOI: 10.1371/journal.pone.0219037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 06/16/2019] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To compare the survival among patients with chronic kidney disease who had optimal starts of renal replacement therapy, dialysis or hemodialysis, with patients who had suboptimal starts. METHODS A retrospective cohort consisting of >18 year-old patients who started renal replacement therapy, using peritoneal dialysis or hemodialysis, in any public hospital or associated center of the Andalusian Public Health System, between the 1st of January of 2006 and the 15th of March of 2017. The optimal start was defined when all the following criteria were met: a planned dialysis start, a minimum of six-month follow-up by a nephrologist, and a first dialysis method coinciding with the one registered at 90 days. The information was obtained from the registry of the Information System of the Transplant Autonomic Coordination of Andalusia. RESULTS A total of 10,692 patients were studied. 4,377 (40.9%) of these patients died. A total of 4,937 patients (46.17%) achieved optimal starts of renal replacement therapy and showed higher survival rates (HR 0.669; 95% CI 0.628-0.712) in the multivariate analysis of Cox regression model. CONCLUSIONS Patients with an optimal start of renal replacement therapy have a greater survival than those who had a non-optimal start. Therefore, the necessary measures should be encouraged to increase the optimal start of the patient in dialysis.
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Affiliation(s)
- Araceli Caro Martínez
- Escuela Andaluza de Salud Pública (EASP), Campus Universitario de Cartuja, Granada, Spain
| | - Antonio Olry de Labry Lima
- Escuela Andaluza de Salud Pública (EASP), Campus Universitario de Cartuja, Granada, Spain
- CIBER en Epidemiología y Salud Pública (CIBERESP), Granada, Spain
- Instituto de Investigación Biosanitaria ibs, Granada, Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain
| | | | | | | | - Leticia García Mochón
- Escuela Andaluza de Salud Pública (EASP), Campus Universitario de Cartuja, Granada, Spain
- CIBER en Epidemiología y Salud Pública (CIBERESP), Granada, Spain
- Instituto de Investigación Biosanitaria ibs, Granada, Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain
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17
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Yeh LM, Chiu SYH, Lai PC. The Impact of Vascular Access Types on Hemodialysis Patient Long-term Survival. Sci Rep 2019; 9:10708. [PMID: 31341241 PMCID: PMC6656721 DOI: 10.1038/s41598-019-47065-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 07/10/2019] [Indexed: 02/07/2023] Open
Abstract
Vascular access (VA) is the cornerstone for carrying out hemodialysis, yet it may bring in complications and leads to hemodialysis quality decline. This study aimed to explore the impact of vascular access types, including arteriovenous shunts and central venous catheter on all-cause mortality after adjustment of other risk factors. Total 738 ESRD patients aged over 40 year old receiving regular hemodialysis therapies were recruited between January 2001 and December 2010 from a single hemodialysis center in northern Taiwan. We ascertained the causes and date of death by linking our hospital database with Nationwide Mortality Registry Database. VA types and biochemistry parameters were extracted from the electronic hospital records. Patients were categorized into three groups, including (1)arteriovenous shunts (AVF)/arteriovenous shunts with Gortex®(AVG); (2)AVF/AVG combined central venous catheter; (3)catheter only. The time-dependent influence of vascular types i.e. initiation and follow-up period was also assessed. The mean follow-up time was 4.5 years. In patients using central venous catheter for initiation of hemodialysis, the adjusted hazard ratio (HR) for all-cause mortality was 1.55(95%CI: 1.09, 2.21), when compared with AVF/AVG. In the follow-up period, after adjustment for other risk factors, the multivariable analysis showed that the adjusted HRs were 3.23(95%CI: 1.85, 5.64) and 1.45(95%CI: 1.11, 1.91) for catheter only and AVF/AVG plus catheter, respectively. Our results showed that vascular accesses used for hemodialysis had different and time-dependent impact on patients' long-term survival. Patients who started hemodialysis with central venous catheter had significantly higher all-cause mortality rate. Furthermore, in the follow-up period, patients both in the catheter only and AVF/AVG plus catheter groups also had the significant all-cause mortality rates. Our results support the early establishment of arteriovenous shunt for the chronic kidney disease patients.
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Affiliation(s)
- Li-Mei Yeh
- Hemodialysis unit, Department of Nephrology, Chang Gung Memorial Hospital, Taipei, Taiwan.,Department of Health Care Management and Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan
| | - Sherry Yueh-Hsia Chiu
- Department of Health Care Management and Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan.,Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Ping-Chin Lai
- Department of Nephrology, Chang Gung Memorial Hospital, Taoyuan, Taiwan. .,The Kidney Institute and Division of Nephrology, China Medical University Hospital, Taichung, Taiwan.
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18
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Javaid MM, Khan BA, Subramanian S. The modality of choice, manual or automated, for urgent start peritoneal dialysis. Clin Kidney J 2019; 12:443-446. [PMID: 31198547 PMCID: PMC6543972 DOI: 10.1093/ckj/sfz008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Indexed: 11/13/2022] Open
Abstract
Over the last decade, urgent start peritoneal dialysis (USPD), defined as initiation of peritoneal dialysis (PD) before the traditionally recommended break-in period of 2-4 weeks, has increasingly been seen as a viable option for late-presenting end-stage renal disease patients, obviating the need for haemodialysis via central venous catheter. Different prescriptions and protocols involving both manual and automated exchanges have been published, but there is no head-to-head comparison of the two modalities and no consensus on the most suitable modality exists. Evaluation of the available evidence suggests that PD can be initiated urgently using either or both options without much difference in the outcome. The two most critical aspects dictating the success of a USPD programme are using low dwell volumes and keeping patients in a strict supine position during the dialysis exchanges in the first couple of weeks of the therapy. These measures are crucial in keeping the intraperitoneal pressure to a minimum and reduce the risk of mechanical complications, including catheter leaks and malpositioning.
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Affiliation(s)
- Muhammad M Javaid
- School of Rural Health Mildura, Monash University, Mildura, VC, Australia.,Department of Medicine, Mildura Base Hospital, Mildura, VC, Australia
| | - Behram A Khan
- Division of Nephrology, National University Hospital, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Srinivas Subramanian
- Division of Nephrology, National University Hospital, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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19
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Scholz SS, Vukadinović D, Lauder L, Ewen S, Ukena C, Townsend RR, Wagenpfeil S, Böhm M, Mahfoud F. Effects of Arteriovenous Fistula on Blood Pressure in Patients With End-Stage Renal Disease: A Systematic Meta-Analysis. J Am Heart Assoc 2019; 8:e011183. [PMID: 30764686 PMCID: PMC6405662 DOI: 10.1161/jaha.118.011183] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 01/11/2019] [Indexed: 01/21/2023]
Abstract
Background Central arteriovenous fistula ( AVF ) creation is under investigation for treatment of severe hypertension. We evaluated the effects of AVF for initiation of hemodialysis on systolic, diastolic, and mean arterial blood pressure in patients with end-stage renal disease. Methods and Results Data search included PubMed, Web of Science, and the Cochrane Library. A systematic review and meta-analysis of peer-reviewed studies reporting the effects of the creation/ligation of an AVF on blood pressure in patients with end-stage renal disease was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis), PRISMA -P (PRISMA for systematic review protocols), and ROBINS-I (Risk of Bias in Non-Randomized Studies) criteria by the Cochrane Bias Methods Group. All studies in which the results could have been biased by hemodialysis were excluded. A total of 14 trials including 412 patients with end-stage renal disease ( AVF creation, n=185; AVF ligation, n=227) fulfilled the criteria and were subsequently analyzed. Average blood pressure in patients with no/closed AVF was 140.5/77.6 mm Hg with a mean arterial blood pressure of 96.1 mm Hg. Following creation of AVF , systolic blood pressure significantly decreased by 8.7 mm Hg ( P<0.001), diastolic blood pressure by 5.9 mm Hg ( P<0.001), and mean arterial blood pressure by 6.6 mm Hg ( P=0.02), whereas after ligation systolic blood pressure increased by 5.2 mm Hg ( P=0.07), diastolic blood pressure by 3.8 mm Hg ( P=0.02), and mean arterial blood pressure by 3.7 mm Hg ( P=0.07) during short- to long-term follow-up. Conclusions Creation of AVF significantly decreases blood pressure in patients with end-stage renal disease, whereas blood pressure tends to increase after ligation. These findings illustrate the hemodynamic consequences of AVF which are under investigation for severe hypertension.
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Affiliation(s)
- Sean S. Scholz
- Klinik für Innere Medizin IIIKardiologie, Angiologie und Internistische IntensivmedizinSaarland University HospitalHomburg/SaarGermany
| | - Davor Vukadinović
- Klinik für Innere Medizin IIIKardiologie, Angiologie und Internistische IntensivmedizinSaarland University HospitalHomburg/SaarGermany
| | - Lucas Lauder
- Klinik für Innere Medizin IIIKardiologie, Angiologie und Internistische IntensivmedizinSaarland University HospitalHomburg/SaarGermany
| | - Sebastian Ewen
- Klinik für Innere Medizin IIIKardiologie, Angiologie und Internistische IntensivmedizinSaarland University HospitalHomburg/SaarGermany
| | - Christian Ukena
- Klinik für Innere Medizin IIIKardiologie, Angiologie und Internistische IntensivmedizinSaarland University HospitalHomburg/SaarGermany
| | - Raymond R. Townsend
- Perelman School of MedicineUniversity of Pennsylvania Medical CenterPhiladelphiaPA
| | - Stefan Wagenpfeil
- Institut für Medizinische BiometrieEpidemiologie und Medizinische Informatik (IMBEI)Saarland UniversityCampus Homburg/SaarGermany
| | - Michael Böhm
- Klinik für Innere Medizin IIIKardiologie, Angiologie und Internistische IntensivmedizinSaarland University HospitalHomburg/SaarGermany
| | - Felix Mahfoud
- Klinik für Innere Medizin IIIKardiologie, Angiologie und Internistische IntensivmedizinSaarland University HospitalHomburg/SaarGermany
- Institute for Medical Engineering and ScienceMassachusetts Institute of TechnologyCambridgeMA
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20
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Javaid MM, Khan BA, Subramanian S. Is surgical PD catheter insertion safe for urgent-start peritoneal dialysis? Semin Dial 2019; 32:225-228. [PMID: 30734972 DOI: 10.1111/sdi.12774] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Urgent-start peritoneal dialysis (USPD) is increasingly seen as a viable alternative to hemodialysis through a central venous catheter for late-presenting end-stage renal disease patients. However, concerns remain about starting dialysis early following the surgical implantation of the peritoneal dialysis (PD) catheter; urgent PD is often thought to be a safe option only after minimally invasive percutaneous catheter insertions. Analysis of the cumulative data from published literature presented in this review appears to negate this general perception and shows that compared to the percutaneous catheter insertions, starting PD urgently following surgically placed catheter is not associated with more catheter leaks, dysfunctions, or other complications. The outcome of USPD is independent of the mode of catheter insertion. Instead, measures to minimize intra-peritoneal pressure including using the low initial dwell volume based on patient's weight and body habitus and keeping patients in strict supine posture during exchanges in the first 2 weeks of treatment are the two most important factors ensuring a minimization of the risk of catheter-related complications.
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Affiliation(s)
- Muhammad M Javaid
- School of Rural Health Mildura, Monash University, Melbourne, Australia.,Department of Medicine, Mildura Base Hospital, Mildura, VIC, Australia
| | - Behram A Khan
- Division of Nephrology, National University Hospital, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Srinivas Subramanian
- Division of Nephrology, National University Hospital, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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21
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Okamoto T, Sakurada T, Koitabashi K, Shibagaki Y. Changes to indications for tunneled cuffed catheter use in hemodialysis patients: A single-center experience. Hemodial Int 2018; 22:S3-S9. [PMID: 30365210 DOI: 10.1111/hdi.12697] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 09/04/2018] [Indexed: 11/30/2022]
Abstract
INTRODUCTION As the number of elderly end-stage renal disease patients lacking suitable vessels for arteriovenous fistula (AVF) is increasing, indications for tunnel cuffed catheters (TCCs) may be expanding. This study aimed to clarify changes over time in the number of patients with TCC and indications for TCCs. METHODS This single-center retrospective study analyzed 143 catheters for 95 patients who inserted TCCs between July 2005 and July 2017. Patients were divided into two groups (early- and late-phase groups) based on the median observational period. Demographic data and clinical information were then compared. FINDINGS Fifty TCCs were inserted in the early phase group, and 93 TCCs were inserted in the late-phase group. The late-phase group was older (77 vs. 70 years; P = 0.003) and showed a higher frequency of hypertensive nephropathy (29% vs. 14%; P < 0.05) and a lower frequency of a history of cardiovascular disease (52.7% vs. 70.0%; P = 0.045). In the late-phase group, indications for bridge vascular access (0% vs. 11.8%; P < 0.05) or severe cardiac dysfunction (8.0% vs. 20.5%; P < 0.05) were increased. In addition, the late-phase group showed increases in percentage of patients with the catheter inserted in the femoral vein (10.0% vs. 23.7%; P = 0.047), nephrologists performing catheter insertion (56.0% vs. 87.1%; P < 0.001), and the patients who underwent superficialization of the brachial artery (28.0% vs. 46.2%; P = 0.034). Significant differences in catheter survival, incidence of complications, reasons for catheter removal, or incidence of catheter-related infection were not observed between groups. DISCUSSION Patients with indications for TCC may be increasing due to an increase in elderly end-stage renal disease patients whose activities of daily living have decreased. In addition, indications for bridge vascular access were widely accepted in the late-phase group.
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Affiliation(s)
- Takeshi Okamoto
- Division of Nephrology and Hypertension, Department of Internal Medicine, St Marianna University School of Medicine, Kanagawa, Japan
| | - Tsutomu Sakurada
- Division of Nephrology and Hypertension, Department of Internal Medicine, St Marianna University School of Medicine, Kanagawa, Japan
| | - Kenichiro Koitabashi
- Division of Nephrology and Hypertension, Department of Internal Medicine, St Marianna University School of Medicine, Kanagawa, Japan
| | - Yugo Shibagaki
- Division of Nephrology and Hypertension, Department of Internal Medicine, St Marianna University School of Medicine, Kanagawa, Japan
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Javaid M, Khan B, Subramanian S. A Case to Swap Hemodialysis Catheters for Peritoneal Dialysis Catheters in Late-Presenting End-Stage Renal Disease. Perit Dial Int 2018; 38:233-234. [DOI: 10.3747/pdi.2017.00250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- M.M. Javaid
- Mildura Base Hospital, MilduraVictoria, Australia
| | - B.A. Khan
- Division of NephrologyUniversity Medicine Cluster National University Hospital Singapore
- Yong Loo Lin School of MedicineNational University of Singapore Singapore
| | - S. Subramanian
- Division of NephrologyUniversity Medicine Cluster National University Hospital Singapore
- Yong Loo Lin School of MedicineNational University of Singapore Singapore
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Javaid MM, Khan BA, Subramanian S. Peritoneal dialysis as initial dialysis modality: a viable option for late-presenting end-stage renal disease. J Nephrol 2018; 32:51-56. [PMID: 29616470 DOI: 10.1007/s40620-018-0485-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 03/12/2018] [Indexed: 12/22/2022]
Abstract
Late-presenting end-stage renal disease is a significant problem worldwide. Up to 70% of patients start dialysis in an unplanned manner without a definitive dialysis access in place. Haemodialysis via a central venous catheter is the default modality for the majority of such patients, and peritoneal dialysis is usually not considered as a feasible option. However, in the recent years, some reports on urgent-start peritoneal dialysis in the late-presenting end-stage renal disease have been published. The collective experience shows that PD can be a safe, efficient and cost-effective alternative to haemodialysis in late-presenting end-stage renal disease with comparable outcomes to the conventional peritoneal dialysis and urgent-start haemodialysis. More importantly, as compared to urgent-start haemodialysis via a central venous catheter, urgent-start peritoneal dialysis has significantly fewer incidences of catheter-related bloodstream infections, dialysis-related complications and need for dialysis catheter re-insertions during the initial phase of the therapy. This article examines the rationale and feasibility for starting peritoneal dialysis urgently in late-presenting end-stage renal disease patients and reviews the literature to compare the urgent-start peritoneal dialysis with conventional peritoneal dialysis and urgent-start haemodialysis.
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Affiliation(s)
| | - Behram Ali Khan
- Division of Nephrology, University Medicine Cluster, National University Hospital Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 10, Singapore, 119228, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Srinivas Subramanian
- Division of Nephrology, University Medicine Cluster, National University Hospital Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 10, Singapore, 119228, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Affiliation(s)
- Emilie Trinh
- Division of Nephrology; McGill University Health Center; Montreal QC Canada
| | | | - Jeffrey Perl
- Division of Nephrology; St. Michael's Hospital and the Keenan Research Center in the Li Ka Shing Knowledge Institute; St. Michael's Hospital; Toronto ON Canada
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Habib A, Durand AC, Brunet P, Duval-Sabatier A, Moranne O, Bataille S, Benhaim L, Bargas É, Gentile S. Facteurs influençant le choix de la dialyse péritonéale : le point de vue des patients et des néphrologues. Nephrol Ther 2017; 13:93-102. [DOI: 10.1016/j.nephro.2016.07.451] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 06/21/2016] [Accepted: 07/08/2016] [Indexed: 11/25/2022]
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[Comparison of peritoneal dialysis and hemodialysis survival in Provence-Alpes-Côte d'Azur]. Nephrol Ther 2016; 12:221-8. [PMID: 27320372 DOI: 10.1016/j.nephro.2016.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 01/05/2016] [Accepted: 01/05/2016] [Indexed: 11/20/2022]
Abstract
PURPOSE To analyze and compare survival of patients initially treated with peritoneal dialysis (PD) or hemodialysis (HD). METHODS We used data from the French REIN registry. We included all patients aged 18 years or more who started dialysis between 1st January 2004 and 12 December 2012 in Provence-Alpes-Côte d'Azur Region (PACA). These patients were followed up until 30 June 2014. Survival curves were generated using the Kaplan-Meier technique and tested using the log-rank test. Variables predictive of all-cause mortality were determined using Cox regression models. The propensity score was used. MAIN RESULTS Survival was similar between initial dialysis modalities: PD and HD, even after adjusting for the propensity score. But, when we exclude the patients who had switched from one technique of dialysis to another, survival was better in HD patients. According to the multivariate analysis, advanced age and the lack of walking autonomy appear to be associated with an increase in mortality in dialysis patients. But, the presence of hypertension improve the survival in this cohort. CONCLUSION The survival is similar between hemodialysis and peritoneal dialysis.
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Yilmaz M, Kircelli F, Artan AS, Oto O, Asci G, Gunestepe K, Basci A, Ok E, Sever MS. Naturally nonanemic dialysis patients: Who are they? Hemodial Int 2016; 20:522-529. [PMID: 27147461 DOI: 10.1111/hdi.12425] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Introduction Not only anemia, but also erythropoiesis stimulating agent (ESA)s for treating anemia may adversely affect prognosis of chronic hemodialysis patients. Various features of naturally (with no ESA usage) nonanemic patients may be useful for defining several factors in the pathogenesis of anemia. Methods Data, retrieved from the European Clinical Database (EuCliD)-Turkey on naturally nonanemic prevalent chronic hemodialysis patients (n: 201) were compared with their anemic (those who required ESA treatment) counterparts (n: 3948). Findings Mean hemoglobin values were 13.5 ± 0.8 and 11.5 ± 0.9 g/dL in nonanemic and anemic patients, respectively (P < 0.001). Nonanemia status was associated with younger age, male gender, longer dialysis vintage, nondiabetic status, more frequent hepatitis-C virus seropositivity and more frequent arteriovenous fistula usage. Serum ferritin and CRP levels and urea reduction ratio were higher in ESA-requiring patients. One (99%) and two (95.3%) years survival rates of the "naturally nonanemic" patients were superior as compared to anemics (91.0% and 82.6%, respectively), (P < 0.001). Discussion "Naturally nonanemic" status is associated with better survival in prevalent chronic hemodialysis patients; underlying mechanisms in this favorable outcome should be investigated by randomized controlled trials including large number of patients.
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Affiliation(s)
- Murvet Yilmaz
- Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Department of Nephrology, Istanbul, Turkey.
| | - Fatih Kircelli
- Fresenius Medical Care, Department of Nephrology, Turkey
| | - Ayse Serra Artan
- Istanbul Medical Faculty, Department of Nephrology, Istanbul, Turkey
| | - Ozgur Oto
- Istanbul Medical Faculty, Department of Nephrology, Istanbul, Turkey
| | - Gulay Asci
- Ege Medical Faculty, Department of Nephrology, Izmir, Turkey
| | | | - Ali Basci
- Ege Medical Faculty, Department of Nephrology, Izmir, Turkey
| | - Ercan Ok
- Ege Medical Faculty, Department of Nephrology, Izmir, Turkey
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Shahidi SH, Soheilipour M. Comparison of vascular access use in hemodialysis patients in Isfahan in 2003 and 2013. Indian J Nephrol 2015; 25:16-20. [PMID: 25684867 PMCID: PMC4323907 DOI: 10.4103/0971-4065.134656] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Vascular access (VA) complications are the leading cause of morbidity in the hemodialysis (HD) population and responsible for high health care costs. This study was designed to compare the profile of VA use for HD in Isfahan dialysis units in 2003 and 2013. A cross-sectional observational study was conducted between January and March 2013 on 536 HD patients in seven units. The patients data about VA type, number, survival, and demographic characteristics were collected and compared with the data collected in year 2003 on 320 patients in the same city units. The mean age of patients increased from 51 ± 17 to 58 ± 15 years (P < 0.001). The most common etiology of end-stage renal disease was diabetes mellitus, but the percentage increased in 2013 (P = 0.001).The use of an arteriovenous fistula (AVF) as a first dialysis access fell from 60.6% in 2003 to 35.4% in 2013 (P < 0.001). At the time of study, AVFs were used in 92.2% of patients in 2003 versus 56.5% in 2013 (P < 0.001). The 1, 2, 3 and 5 years AVF survival was 80%, 78%, 73%, and 69%, respectively in 2003 versus 79.4%, 61.2%, 47.3%, and 31.5% in 2013. The AVFs proportions decreased and the tunneled catheters proportions increased while the proportion of temporary catheters decreased in 2013 compared with 2003.
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Affiliation(s)
- S. H. Shahidi
- Department of Nephrology, Kidney Diseases Research Center, Isfahan, Iran
| | - M. Soheilipour
- Department of Internal Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Foran JP, Jain AK, Casserly IP, Kandzari DE, Rocha-Singh KJ, Witkowski A, Katzen BT, Deaton D, Balmforth P, Sobotka PA. The ROX coupler: Creation of a fixed iliac arteriovenous anastomosis for the treatment of uncontrolled systemic arterial hypertension, exploiting the physical properties of the arterial vasculature. Catheter Cardiovasc Interv 2014; 85:880-6. [DOI: 10.1002/ccd.25707] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Revised: 10/09/2014] [Accepted: 10/10/2014] [Indexed: 11/10/2022]
Affiliation(s)
- John P. Foran
- Royal Brompton Hospital; London United Kingdom
- St. Helier University Hospital; Surrey United Kingdom
| | - Ajay K. Jain
- London Chest Hospital; National Institute for Health Research (NIHR) Cardiovascular Biomedical Research Unit, Barts Health NHS Trust; London United Kingdom
| | | | | | | | | | - Barry T. Katzen
- Miami Cardiac & Vascular Institute, Baptist Hospital of Miami; Miami Florida
| | | | | | - Paul A. Sobotka
- The Ohio State University, Columbus, Ohio; and ROX Medical, Inc.; San Clemente California
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31
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Couchoud C, Bolignano D, Nistor I, Jager KJ, Heaf J, Heimburger O, Van Biesen W, Bilo H, Bolignano D, Coentrao L, Couchoud C, Covic A, Drechsler C, De Sutter J, Goldsmith D, Gnudi L, Heaf J, Heimburger O, Jager K, Nacak H, Nistor I, Soler M, Tomson C, Van Biesen W, Vanhuffel L, Van Laecke S, Weekers L, Wiecek A. Dialysis modality choice in diabetic patients with end-stage kidney disease: a systematic review of the available evidence. Nephrol Dial Transplant 2014; 30:310-20. [DOI: 10.1093/ndt/gfu293] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Ridão Curty NF, da Silva Martins LF, Sanches Ito CA, Schafranski M, Brites DA, Busato CR. Morbimortality study of infection in patients undergoing different types of dialysis in a renal replacement therapy center. Braz J Infect Dis 2014; 18:281-6. [PMID: 24389285 PMCID: PMC9427506 DOI: 10.1016/j.bjid.2013.08.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Accepted: 08/18/2013] [Indexed: 10/31/2022] Open
Abstract
INTRODUCTION Renal replacement therapy is the treatment of end-stage chronic kidney disease and can be performed through dialysis catheters, arteriovenous fistulas/grafts, and peritoneal dialysis. Patients are usually immunocompromised and exposed to invasive procedures, leading to high rates of infection and increased mortality. OBJECTIVES To compare the prevalence of infection and related deaths, as well as the sensitivity profile of the putative bacteria in patients treated with peritoneal dialysis, arteriovenous fistula hemodialysis and catheter hemodialysis. METHODS This is case-control study. Six hundred forty-four patients undergoing renal replacement therapy were selected. Patients were divided into three groups according to the modality of dialysis treatment: peritoneal dialysis (126 patients), arteriovenous fistula hemodialysis (326 patients), and catheter hemodialysis (192 patients). RESULTS One hundred sixteen patients (18.01%) developed infection. There was a higher incidence of infection in the peritoneal dialysis group (44 patients; 34.92%; OR: 3.32; CI 95%=2.13-5.17; p=0.0001). In the catheter hemodialysis group, 48 patients (25%) had infection (OR: 1.88; CI 95%: 1.24-2.85; p=0.0035). In the arteriovenous fistula hemodialysis group, 24 patients (7.36%) developed infection (OR: 0.19; CI 95%: 0.12-0.31; p=0.0001). Five patients (4.31%) died due to infection (four in the peritoneal dialysis group and one in the catheter hemodialysis group). There were no deaths due to infection in the arteriovenous fistula hemodialysis group. CONCLUSIONS Peritoneal dialysis is the treatment with greater risk of infection and mortality, followed by catheter hemodialysis. The lowest risk of infection and mortality was observed in arteriovenous fistula hemodialysis group.
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Affiliation(s)
- Natália Fabiane Ridão Curty
- Universidade Estadual de Ponta Grossa, Medicine Department, Avenida General Carlos Cavalcanti 4748, CEP: 84030900 Ponta Grossa, Paraná, Brazil.
| | - Lucilene Fagundes da Silva Martins
- Universidade Estadual de Ponta Grossa, Medicine Department, Avenida General Carlos Cavalcanti 4748, CEP: 84030900 Ponta Grossa, Paraná, Brazil
| | | | - Marcelo Schafranski
- Universidade Estadual de Ponta Grossa, Medicine Department, Avenida General Carlos Cavalcanti 4748, CEP: 84030900 Ponta Grossa, Paraná, Brazil
| | | | - César Roberto Busato
- Universidade Estadual de Ponta Grossa, Medicine Department, Avenida General Carlos Cavalcanti 4748, CEP: 84030900 Ponta Grossa, Paraná, Brazil
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Li PKT, Chow KM. Peritoneal Dialysis–First Policy Made Successful: Perspectives and Actions. Am J Kidney Dis 2013; 62:993-1005. [DOI: 10.1053/j.ajkd.2013.03.038] [Citation(s) in RCA: 92] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Accepted: 03/19/2013] [Indexed: 12/31/2022]
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Hill M, Mor MK, Travis L, Ward T, Palevsky PM, Ramkumar M, Weisbord SD. Renal function following fistulography in patients with advanced chronic kidney disease. Ren Fail 2013; 35:791-5. [DOI: 10.3109/0886022x.2013.794432] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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