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Takahashi R, Yabe H, Ishikawa H, Hibino T, Morishita S, Kono K, Moriyama Y, Yamada T. The impact of malnutrition on the effectiveness of intradialytic exercise in hemodialysis patients: amulticenter cohort study. Int Urol Nephrol 2024; 56:2093-2101. [PMID: 38334912 DOI: 10.1007/s11255-024-03952-7] [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: 09/06/2023] [Accepted: 01/06/2024] [Indexed: 02/10/2024]
Abstract
PURPOSE Low physical function can be effectively improved via intradialytic exercise. However, the association between the effects of intradialytic exercise on physical function and malnutrition severity has not been studied extensively. This study aimed to investigate the impact of nutritional status severity on physical function in patients undergoing hemodialysis with low physical function to whom intradialytic exercise was prescribed. METHODS The participants were patients with decreased mobility [walking speed < 1.0 m/s and/or Short Physical Performance Battery (SPPB) < 12] who had been undergoing hemodialysis thrice a week for 6 months and performing intradialytic exercise program. Patients were divided into groups based on the Geriatric Nutritional Risk Index (GNRI) [Non-malnutrition group (GNRI > 98), Gentle/slim malnutrition group (GNRI ≤ 98, GNRI ≥ 92), Mild malnutrition group (GNRI < 92, GNRI ≥ 82), Severe malnutrition group (GNRI < 82)]. The primary outcomes were Grip strength, isometric knee extension strength (IKES), SPPB, and 10-m walking speed measured at baseline and at 6 months. Statistical analyses were performed using a linear mixed-effects model with the intention-to-treat analysis, including within-group analysis and between-group comparison. RESULTS A total of 805 participants were included in the study. Within-group comparisons showed significantly improved IKES, 10-m walking speed, and SPPB improved, except in the Severe malnutrition group. Grip strength significantly improved in the Gentle/slim and mild malnutrition groups. Between-group comparison with controls showed that the improvement in Grip strength was significantly bigger in the Gentle/slim malnutrition group [0.98 (0.15 to 1.82) kg] than in the non-malnutrition group. However, IKES in the Severe malnutrition group [- 5.14 (- 9.18 to - 1.10) %] less significantly improve than that in the non-malnutrition group. No significant differences were found in the other indices. CONCLUSION In patients with severe malnutrition, the changes in IKES scores resulting from Intradialytic exercise were significantly smaller than those observed in non-malnourished patients. Therefore, it is necessary to initiate suitable nutritional and exercise therapy based on the severity of malnutrition.
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Affiliation(s)
- Ren Takahashi
- Department of Rehabilitation, Kaikoukai Josai Hospital, Nagoya, Aichi, Japan.
- Division of Rehabilitation Science, Seirei Christopher University Graduate School, Hamamatsu, Shizuoka, Japan.
| | - Hiroki Yabe
- Department of Physical Therapy, School of Rehabilitation Sciences, Seirei Christopher University, Hamamatsu, Shizuka, Japan
| | - Hideaki Ishikawa
- Department of Internal Medicine, Kaikoukai Josai Hospital, Nagoya, Aichi, Japan
| | - Takashi Hibino
- Department of Rehabilitation, Kaikoukai Josai Hospital, Nagoya, Aichi, Japan
| | - Sayumi Morishita
- Department of Rehabilitation, Kaikoukai Josai Hospital, Nagoya, Aichi, Japan
| | - Kenichi Kono
- Department of Physical Therapy, International University of Health and Welfare School of Health Science at Narita, Narita, Chiba, Japan
| | - Yoshifumi Moriyama
- Department of Wellness Center, Nagoya Kyoritsu Hospital, Nagoya, Aichi, Japan
| | - Tetsuya Yamada
- Dialysis Division, Kaikoukai Healthcare Group, Nagoya, Aichi, Japan
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Park JH, Park HC, Kim DH, Lee YK, Cho AJ. Mortality and Risk Factors in Very Elderly Patients Who Start Hemodialysis: Korean Renal Data System, 2016-2020. Am J Nephrol 2023; 54:175-183. [PMID: 37231807 DOI: 10.1159/000530933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 04/23/2023] [Indexed: 05/27/2023]
Abstract
INTRODUCTION The number of elderly patients with end-stage renal disease (ESRD) is increasing worldwide. However, decision-making about elderly patients with ESRD remains complex because of the lack of studies, especially in very elderly patients (≥75 years). We examined the characteristics of very elderly patients starting hemodialysis (HD) and the associated mortality and prognostic factors. METHODS Data were analyzed retrospectively using a nationwide cohort registry, the Korean Renal Data System. Patients who started HD between January 2016 and December 2020 were included and divided into three groups according to age at HD initiation (<65, 65-74, and ≥75 years). The primary outcome was all-cause mortality during the study period. Risk factors for mortality were analyzed using Cox proportional hazard models. RESULTS In total, 22,024 incident patients were included with 10,006, 5,668, and 6,350 in each group (<65, 65-74, and ≥75 years, respectively). Among the very elderly group, women had a higher cumulative survival rate than men. The survival rate was lower in patients with vascular access via a catheter than in those with an arteriovenous fistula or graft. Very elderly patients with more comorbid diseases had a significantly lower survival rate than those with fewer comorbidities. In the multivariate Cox models, old age, cancer presence, catheter use, low body mass index, low Kt/V, low albumin concentration, and capable status of partial self-care were associated with high risk of mortality. CONCLUSION Preparation of an arteriovenous fistula or graft when starting HD should be considered in very elderly patients with fewer comorbid diseases.
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Affiliation(s)
- Ji Hyeon Park
- Department of Internal Medicine, National Police Hospital, Seoul, Republic of Korea
| | - Hayne Cho Park
- Department of Internal Medicine, Kangnam Sacred Heart Hospital, Seoul, Republic of Korea
- Hallym University Kidney Research Institute, Seoul, Republic of Korea
| | - Do Hyoung Kim
- Department of Internal Medicine, Kangnam Sacred Heart Hospital, Seoul, Republic of Korea
- Hallym University Kidney Research Institute, Seoul, Republic of Korea
| | - Young Ki Lee
- Department of Internal Medicine, Kangnam Sacred Heart Hospital, Seoul, Republic of Korea
- Hallym University Kidney Research Institute, Seoul, Republic of Korea
| | - AJin Cho
- Department of Internal Medicine, Kangnam Sacred Heart Hospital, Seoul, Republic of Korea
- Hallym University Kidney Research Institute, Seoul, Republic of Korea
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Yeung EK, Brown L, Kairaitis L, Krishnasamy R, Light C, See E, Semple D, Polkinghorne KR, Toussaint ND, MacGinley R, Roberts MA. Impact of haemodialysis hours on outcomes in older patients. Nephrology (Carlton) 2023; 28:109-118. [PMID: 36401820 DOI: 10.1111/nep.14133] [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: 07/23/2022] [Revised: 11/02/2022] [Accepted: 11/10/2022] [Indexed: 11/20/2022]
Abstract
AIM Previous studies report an association between longer haemodialysis treatment sessions and improved survival. Worldwide, there is a trend to increasing age among prevalent patients receiving haemodialysis. This analysis aimed to determine whether the mortality benefit of longer haemodialysis treatment sessions diminishes with increasing age. METHODS This was a retrospective cohort study of people who first commenced thrice-weekly haemodialysis aged ≥65 years, reported to the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry from 2005 to 2015, included from 90 days after dialysis start. The primary outcome was all-cause mortality. Cox regression analysis was performed with haemodialysis session duration the exposure of interest. RESULTS Of 8224 people who commenced haemodialysis as their first treatment for kidney failure aged ≥65 years during this period, 4727 patients died. Longer dialysis hours per session was associated with a decreased risk of death in unadjusted analyses [hazard ratio, HR, for ≥5 h versus 4 to <4.5 h: 0.81 (0.75-0.88, p < .001)]. Patients having longer dialysis sessions were younger but had greater co-morbidity. In an adjusted model including age and other variables, the survival benefit of longer hours was only partially attenuated [HR for previous comparison: 0.75 (0.69-0.82, p < .001)], and no interaction between age and hours was demonstrated (p = .89). CONCLUSION The apparent survival benefit associated with longer haemodialysis session length appears to be preserved in patients 65 years or older. In practice, the benefit of longer dialysis hours should be carefully weighed against other factors in this patient group.
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Affiliation(s)
- Emily K Yeung
- Department of Nephrology, Monash Health, Clayton, Victoria, Australia
| | - Leanne Brown
- School of Nursing and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Lukas Kairaitis
- Department of Renal Medicine, Blacktown Hospital, Blacktown, New South Wales, Australia.,School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | - Rathika Krishnasamy
- Department of Nephrology, Sunshine Coast University Hospital, Birtinya, Queensland, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Casey Light
- Renal Service, Armadale Kalamunda Group, Mount Nasura, Western Australia, Australia
| | - Emily See
- School of Medicine, University of Melbourne, Melbourne, Victoria, Australia.,Centre for Integrated Critical Care, University of Melbourne, Melbourne, Victoria, Australia.,Department of Intensive Care, Austin Hospital, Heidelberg, Victoria, Australia
| | - David Semple
- Department of Renal Medicine, Auckland District Health Board, Auckland, New Zealand.,Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Kevan R Polkinghorne
- School of Medicine, Monash University, Melbourne, Victoria, Australia.,Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Victoria, Australia.,Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
| | - Nigel D Toussaint
- Department of Nephrology, The Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia
| | - Robert MacGinley
- Eastern Health Clinical School, Monash University, Victoria, Australia
| | - Matthew A Roberts
- Eastern Health Clinical School, Monash University, Victoria, Australia
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Elezi B, Rumano M, Abazaj E, Topi S. Health-related quality-of-life measures used in hemodialysis patients in Albania. THE EGYPTIAN JOURNAL OF INTERNAL MEDICINE 2023. [DOI: 10.1186/s43162-022-00172-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Abstract
Background
Chronic kidney disease is a growing worldwide public health concern. On the other hand, patients’ perception of health is an important outcome measure in the assessment of the influence of chronic disease and received treatment. Interest in measuring health-related quality of life has increased together with an awareness that such humanistic outcomes require valid and reliable measures. The aimed study was to evaluate the health-related quality of life (QoL) and to investigate the relationship between selected demographic and clinical characteristics and Health-related Quality of Life (HRQoL) scores in hemodialysis patients.
Methods
This survey study was conducted on hemodialysis patients (209 patients) during the periods 2017–2018. The QoL includes 25 questions classified into five dimensions, which are mobility, personal care, common activities, discomfort and pain, anxiety, and depression. P value < .05 was considered statistically significant.
Results
Overall 209 hemodialysis patients, the mean of the five domains varies from a minimum value of 1.75 ± 1.06 for personal care to a maximum value of 2.65 ± 1.44 for anxiety and/or depression. In our study, among hemodialysis patients is seen a significant association scored between the quality of life and demographic variables like age groups (p = 0.034), and gender (p = 0.01) as in the previous studies. The presence of comorbidities was significantly associated with the QOL (p = 0.001). About the questionnaire, “How good or bad your health is today” the average score resulted to be 47.08 ± 4.5.
Conclusion
As we saw from the results of this study, a considerable number of the patients live with low income. Age, sex, and comorbidities are dependent factors of HRQoL. Therefore, we suggest that future studies include other factors that will evaluate hemodialysis efficiency and find the association between these and QoL.
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Hirano Y, Fujikura T, Kono K, Ohashi N, Yamaguchi T, Hanajima W, Yasuda H, Yamauchi K. Decline in Walking Independence and Related Factors in Hospitalization for Dialysis Initiation: A Retrospective Cohort Study. J Clin Med 2022; 11:6589. [PMID: 36362821 PMCID: PMC9659087 DOI: 10.3390/jcm11216589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 10/29/2022] [Accepted: 11/04/2022] [Indexed: 10/29/2023] Open
Abstract
Patients with chronic kidney disease require intervention planning because their physical function declines with worsening disease. Providers can work closely with patients during the induction phase of dialysis. This single-center, retrospective observational study aimed to investigate the rate of decline in walking independence during the induction phase of dialysis and the factors that influence this decline, and to provide information on prevention and treatment during this period. Of the 354 patients who were newly initiated on hemodialysis between April 2018 and January 2022, 285 were included in the analysis. The functional independence measure-walking score was used to sort patients into decreased walking independence (DWI; n = 46) and maintained walking independence (no DWI; n = 239) groups, and patient characteristics were compared. After adjusting for various factors by logistic regression analysis, we observed that age, high Charlson comorbidity index (CCI), C-reactive protein, and emergency dialysis start (EDS) were significant predictors of DWI. Even during the very short period of dialysis induction, as many as 16.1% of patients had DWI, which was associated with older age, higher CCI, higher inflammation, and EDS. Therefore, we recommend the early identification of patients with these characteristics and early rehabilitation.
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Affiliation(s)
- Yuma Hirano
- Department of Rehabilitation Medicine, Hamamatsu University Hospital, 1-20-1 Handayama, Higashi-ku, Hamamatsu City 431-3192, Japan
| | - Tomoyuki Fujikura
- First Department of Medicine, Hamamatsu University Hospital, 1-20-1 Handayama, Higashi-ku, Hamamatsu City 431-3192, Japan
| | - Kenichi Kono
- Department of Physical Therapy, International University of Health and Welfare School of Health Science at Narita, 4-3, Kozunomori, Narita City 286-8686, Japan
| | - Naro Ohashi
- First Department of Medicine, Hamamatsu University Hospital, 1-20-1 Handayama, Higashi-ku, Hamamatsu City 431-3192, Japan
| | - Tomoya Yamaguchi
- Department of Rehabilitation Medicine, Hamamatsu University Hospital, 1-20-1 Handayama, Higashi-ku, Hamamatsu City 431-3192, Japan
| | - Wataru Hanajima
- Department of Rehabilitation Medicine, Hamamatsu University Hospital, 1-20-1 Handayama, Higashi-ku, Hamamatsu City 431-3192, Japan
| | - Hideo Yasuda
- First Department of Medicine, Hamamatsu University Hospital, 1-20-1 Handayama, Higashi-ku, Hamamatsu City 431-3192, Japan
| | - Katsuya Yamauchi
- Department of Rehabilitation Medicine, Hamamatsu University Hospital, 1-20-1 Handayama, Higashi-ku, Hamamatsu City 431-3192, Japan
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Sánchez-Tocino ML, Miranda-Serrano B, Villoria-González S, Pereira-García M, López-González A, González-Parra E. Clasificación funcional del paciente anciano en hemodiálisis y su influencia en la individualización del tratamiento. ENFERMERÍA NEFROLÓGICA 2022. [DOI: 10.37551/s2254-28842022003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Introducción: La edad de los pacientes en hemodiálisis está aumentando, presentando mayor deterioro. Objetivos: Conocer la situación del paciente anciano en hemodiálisis categorizando nuestra población. Analizar la relación entre las escalas de funcionalidad, desnutrición y comorbilidad. Material y Método: Estudio descriptivo transversal, pacientes 75-95 años. Se midieron: a) Comorbilidad-CHARLSON: alta (>6 puntos). b) Nutrición-MISS: extremadamente desnutrido (<10 puntos.); desnutrición muy severa (>7-10 puntos); moderada-severa (>5-7 puntos); leve-moderada (>2-5 puntos); normonutrido (<2 puntos); c) Dependencia-BARTHEL, independiente (100 puntos); dependencia leve (91-99 puntos); moderada (61-90 puntos.); severa (21-60 puntos.); total (<20 puntos). d) Fragilidad-FRAIL, no fragilidad (0 puntos); prefrágil (1-2 puntos); frágil (>3 puntos). Resultados: 60 pacientes, 68%(41) hombres, edad media 81,85±5,58 años y tiempo HD 49,88±40,29 meses. Etiología más prevalente, diabetes mellitus (28%). MIS: 6,01±3,80 puntos. clasificándose 8(13%) normonutridos, 24(40%) desnutrición leve-moderada, 10(17%) desnutrición moderada-severa, 13(22%) desnutrición muy severa y 5(8%) extremadamente desnutridos. BARTHEL: 88,16±18,59 puntos, clasificó 32(53%) independientes, 6(10%) dependencia leve, 17(28%) dependencia moderada, 4(7%) dependencia severa, 1(2%) dependencia total. FRAIL: 1,98±1,32 puntos, clasificó 10(17%) no frágiles, 31(51%) prefrágiles y 19(32%) frágiles. CHARLSON: 10,01±2,20 puntos. Presentando 60(100%) alta comorbilidad. CHARLSON presentó diferencias entre sexo, mayor en hombres (p=0,002). Se encontró alta correlación entre Barthel y Frail (r=0,647,p<0,001), moderada entre MIS y Barthel (r=0,556, p<0,001) y MIS y Frail (r=0,455,p<0,001). Charlson obtuvo peor correlación. Conclusiones: Se evidenció gran deterioro general del paciente añoso en diálisis, alertando sobre la necesidad de realizar tratamientos individualizados enfocados en su recuperación, incluida la propia diálisis.
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Yang CH, Wu CY, Low JTS, Chuang YS, Huang YW, Hwang SJ, Chen PJ. Exploring the Impact of Different Types of Do-Not-Resuscitate Consent on End-of-Life Treatments among Patients with Advanced Kidney Disease: An Observational Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:8194. [PMID: 34360487 PMCID: PMC8346049 DOI: 10.3390/ijerph18158194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 04/27/2021] [Accepted: 07/30/2021] [Indexed: 11/16/2022]
Abstract
Background: Patients with advanced kidney disease have a symptomatic and psychological burden which warrant renal supportive care or palliative care. However, the impact of do-not-resuscitate consent type (signed by patients or surrogates) on end-of-life treatments in these patients remains unclear. Objective: We aim to identify influential factors correlated with different do-not-resuscitate consent types in patients with advanced kidney disease and the impact of do-not-resuscitate consent types on various life-prolonging treatments. Methods: This was a retrospective observational study. We included patients aged 20 years and over, diagnosed with advanced kidney disease and receiving palliative and hospice care consultation services between January 2014 and December 2018 in a tertiary teaching hospital in Taiwan. We reviewed medical records and used logistic regression to identify factors associated with do-not-resuscitate consent types and end-of-life treatments. Results: A total of 275 patients were included, in which 21% signed their do-not-resuscitate consents. A total of 233 patients were followed until death, and 32% of the decedents continued hemodialysis, 75% underwent nasogastric (NG) tube placement, and 70% took antibiotics in their final seven days of life. Do-not-resuscitate consents signed by patients were associated with reduced life-prolonging treatments including feeding tube placement and antibiotic use in the last seven days (odd ratio and 95% confidence interval were 0.16, 0.07-0.34 and 0.33, 0.16-0.69, respectively) compared to do-not-resuscitate consents signed by surrogates. Conclusions: Do-not-resuscitate consent signed by patients and not by surrogates may reflect better patients' autonomy and reduced life-prolonging treatments in the final seven days of patients with advanced kidney disease.
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Affiliation(s)
- Chiu-Hsien Yang
- Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (C.-H.Y.); (C.-Y.W.); (Y.-S.C.)
| | - Chien-Yi Wu
- Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (C.-H.Y.); (C.-Y.W.); (Y.-S.C.)
| | - Joseph T. S. Low
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London W1T 7NF, UK;
| | - Yun-Shiuan Chuang
- Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (C.-H.Y.); (C.-Y.W.); (Y.-S.C.)
| | - Yu-Wen Huang
- Department of Nursing, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan;
| | - Shang-Jyh Hwang
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan;
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Ping-Jen Chen
- Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (C.-H.Y.); (C.-Y.W.); (Y.-S.C.)
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London W1T 7NF, UK;
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
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Wang SC, Hu KC, Chang WC, Hsu CY. Utilization of hospice and nonhospice care in patients with end-stage renal disease on dialysis. Tzu Chi Med J 2021; 34:232-238. [PMID: 35465279 PMCID: PMC9020240 DOI: 10.4103/tcmj.tcmj_207_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 08/30/2021] [Accepted: 09/15/2021] [Indexed: 11/09/2022] Open
Abstract
Objectives: The prevalence of end-stage renal disease (ESRD) and the number of patients undergoing dialysis in Taiwan are high. Since September 2009, the National Health Insurance has started to provide hospice care to patients with renal failure in Taiwan. Therefore, it is necessary to understand the use of hospice and nonhospice care in patients with ESRD on dialysis. We aim to understand trends in patients with ESRD receiving hospice and nonhospice care as well as medical care efforts during the last month of their lives (2009–2013). Materials and Methods: The cohort study was conducted using 1 million randomly selected samples from the Taiwan Health Insurance Research Database for millions of people in Taiwan in 2009–2013. Descriptive statistics were presented to summarize the characteristics of data. To compare differences between cohorts, Chi-square tests and Student's t-tests were used. Mann–Whitney U-tests were performed for nonnormally distributed data. Mantel–Haenszel test was test for trend. Results: We recruited 770 ESRD patients who underwent hemodialysis; among them, 154 patients received hospice care. Patients who received hospice care had a significantly longer survival time after removal of mechanical ventilator (20 vs. 0 days) and after discontinuation of dialysis (2 vs. 0 days) compared with those who did not receive hospice care. Patients who received hospice care had more pain control (61.04% vs. 17.37%, P < 0.0001) and other symptomatic control (55.84% vs. 43.18% with diuretics, P < 0.05; 64.29% and 48.21% with laxatives, P = 0.0004) medications than those who did not. Nevertheless, the overall medical cost in the hospice group was significantly lower (90 USD and 280 USD, P < 0.0001). Conclusion: Our results suggest that the addition of hospice care may permit patients a longer life-support-free survival time. In addition, despite a more frequent symptomatic controlling agent use, hospice care significantly reduced the overall medical expenditure.
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Erken E, Ulgen C, Sarisik FN, Erken N, Gungor O, Altunoren O. Hematological Parameters and Clinical Features in Patients with Advanced Chronic Kidney Disease. Yonago Acta Med 2020; 63:353-359. [PMID: 33253334 DOI: 10.33160/yam.2020.11.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 08/04/2020] [Indexed: 11/05/2022]
Abstract
Background Hematological parameters like red cell distribution width (RDW) and mean platelet volume (MPV) were reported to be associated with inflammation, atherosclerosis, and chronic kidney disease (CKD) progression. In this study, we evaluated RDW and MPV along with clinical features in patients with advanced CKD. We also aimed to detect clues for causative relations concerning these parameters, renal function and comorbidities. Methods Stage 3-5 CKD patients (627 total) were included (mean age 63.1 years, 48.3% male). Patients with malignancies, cirrhosis, infections, severe anemia, and systemic inflammation were excluded. Patients were evaluated for clinical features and grouped for comparison using median RDW and MPV. Linear regression models were generated to predict potential influences on RDW and MPV. Results Mean estimated glomerular filtration rate (eGFR) was 27.3 mL/min/1.73m2. Mean Charlson Comorbidity Index (CCI) score was 5.83 ± 2.06. Patients with high RDW (n = 303) were older with higher CRP and CCI, they also had lower eGFR, hemoglobin, and albumin (P < 0.001 for all). Patients with low MPV (n = 311) had lower eGFR, and platelet counts (P = 0.015 and 0.017). eGFR was negatively correlated with RDW after adjusting for age, gender and comorbidities. In a further adjusted model RDW was associated with CRP, CCI, hemoglobin and albumin (P < 0.05 for all), not with eGFR. MPV was positively correlated with eGFR in our adjusted, and fully adjusted regression models (P = 0.003). Conclusion In this study, we found that high RDW is associated with comorbidity burden, anemia, and inflammatory status in patients with advanced CKD. Meanwhile, low MPV seems to be associated with worse renal function.
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Affiliation(s)
- Ertugrul Erken
- Sutcu Imam University, Department of Nephrology, Kahramanmaras, Turkey
| | - Cansu Ulgen
- Sutcu Imam University, Department of Internal Medicine, Kahramanmaras, Turkey
| | - Feyza Nur Sarisik
- Sutcu Imam University, Department of Internal Medicine, Kahramanmaras, Turkey
| | - Neziha Erken
- Dokuz Eylul University Department of Geriatric Medicine, Izmir, Turkey
| | - Ozkan Gungor
- Sutcu Imam University, Department of Nephrology, Kahramanmaras, Turkey
| | - Orcun Altunoren
- Sutcu Imam University, Department of Nephrology, Kahramanmaras, Turkey
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Song YH, Cai GY, Xiao YF, Chen XM. Risk factors for mortality in elderly haemodialysis patients: a systematic review and meta-analysis. BMC Nephrol 2020; 21:377. [PMID: 32867718 PMCID: PMC7457491 DOI: 10.1186/s12882-020-02026-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Accepted: 08/18/2020] [Indexed: 12/16/2022] Open
Abstract
Background Older haemodialysis patients accompany a high burden of functional impairment, limited life expectancy, and healthcare utilization. This meta-analysis aimed to evaluate how various risk factors influenced the prognosis of haemodialysis patients in late life, which might contribute to decision making by patients and care providers. Methods PubMed, Embase, and Cochrane Central were searched systematically for studies evaluating the risk factors for mortality in elderly haemodialysis patients. Twenty-eight studies were included in the present systematic review. The factors included age, cardiovascular disease, diabetes mellitus, type of vascular access, dialysis initiation time, nutritional status and geriatric impairments. Geriatric impairments included frailty, cognitive or functional impairment and falls. Relative risks with 95% confidence intervals were derived. Results Functional impairment (OR = 1.45, 95% CI: 1.20–1.75), cognitive impairment (OR = 1.46, 95% CI: 1.32–1.62) and falls (OR = 1.14, 95% CI: 1.06–1.23) were significantly and independently associated with increased mortality in elderly haemodialysis patients. Low body mass index conferred a mortality risk (OR = 1.43, 95% CI: 1.31–1.56) paralleling that of frailty as a marker of early death. The results also confirmed that the older (OR = 1.43, 95% CI: 1.22–1.68) and sicker (in terms of Charlson comorbidity index) (OR = 1.41, 95% CI: 1.35–1.50) elderly haemodialysis patients were, the more likely they were to die. In addition, increased mortality was associated with early-start dialysis (OR = 1.18, 95% CI: 1.01–1.37) and with the use of a central venous catheter (OR = 1.53, 95% CI: 1.44–1.62). Conclusions Multiple factors influence the risk of mortality in elderly patients undergoing haemodialysis. Geriatric impairment is related to poor outcome. Functional/cognitive impairment and falls in elderly dialysis patients are strongly and independently associated with mortality.
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Affiliation(s)
- Yu-Huan Song
- Department of Nephrology, Aerospace Center Hospital, 15 Yuquan Road, Beijing, 100049, China.,Department of Nephrology, Chinese PLA Generl Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, 28 Fuxing Road, Beijing, 100853, China
| | - Guang-Yan Cai
- Department of Nephrology, Chinese PLA Generl Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, 28 Fuxing Road, Beijing, 100853, China.
| | - Yue-Fei Xiao
- Department of Nephrology, Aerospace Center Hospital, 15 Yuquan Road, Beijing, 100049, China.
| | - Xiang-Mei Chen
- Department of Nephrology, Chinese PLA Generl Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, 28 Fuxing Road, Beijing, 100853, China
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11
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Arhuidese IJ, Beaulieu RJ, Aridi HD, Locham S, Baldwin EK, Malas MB. Age-related outcomes of arteriovenous grafts for hemodialysis access. J Vasc Surg 2020; 72:643-650. [PMID: 32067881 DOI: 10.1016/j.jvs.2019.10.096] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 10/01/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND The prevalence of end-stage renal disease spans the spectrum of age. Arteriovenous grafts are viable alternatives for hemodialysis access in patients whose anatomy precludes placement of an arteriovenous fistula. This report describes the age-related outcomes after arteriovenous graft placement in a population-based cohort. METHODS A retrospective cohort study was conducted of all patients who initiated hemodialysis in the U.S. Renal Data System (2007-2014). The χ2 test, t-test, Kaplan-Meier analysis, log-rank test, and multivariable logistic and Cox regression analyses were employed to evaluate access maturation, interventions, patency, and mortality. RESULTS Of the 78,341 patients studied, 10,150 (13%) were younger than 50 years, 13,167 (16.8%) were 50 to 59 years, 19,975 (25.5%) were 60 to 69 years, 20,307 (25.9%) were 70 to 79 years, and 14,742 (18.8%) were 80+ years. There was no significant difference in access maturation time for patients in the older age categories compared to patients younger than 50 years. Primary patency at 5 years comparing <50 years vs 50 to 59 years vs 60 to 69 years vs 70 to 79 years vs 80+ years was 12% vs 12% vs 9% vs 9% vs 8% (P < .001). Primary assisted patency at 5 years was 20% vs 21% vs 18% vs 17% vs 14% (P < .001). Secondary patency at 5 years was 36% vs 39% vs 36% vs 30% vs 31% (P < .001). There was no significant difference in primary patency (adjusted hazard ratio [aHR], 1.00; 95% confidence interval [CI], 1.00-1.00; P < .001), primary assisted patency (aHR, 1.00; 95% CI, 1.00-1.00; P < .001), and secondary patency (aHR, 1.00; 95% CI, 1.00-1.00; P = .029) with increasing age. However, there was a decrease in severe prosthetic graft infection requiring graft excision (aHR, 0.99; 95% CI, 0.99-0.99; P < .001) and increase in mortality (aHR, 1.03; 95% CI, 1.03-1.03; P < .001) for the older age categories compared with the younger patients. CONCLUSIONS In this population-based cohort of hemodialysis patients, there was no significant association between older age and prosthetic graft maturation or patency. However, older age was associated with a decrease in severe graft infection and the expected increase in mortality.
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Affiliation(s)
- Isibor J Arhuidese
- Division of Vascular Surgery, University of South Florida, Tampa, Fla; Division of Vascular Surgery, Johns Hopkins Medical Institutions, Baltimore, Md
| | - Robert J Beaulieu
- Division of Vascular Surgery, Johns Hopkins Medical Institutions, Baltimore, Md; Division of Vascular Surgery, University of Michigan, Ann Arbor, Mich
| | - Hanaa Dakour Aridi
- Division of Vascular Surgery, Johns Hopkins Medical Institutions, Baltimore, Md; Division of Vascular Surgery, University of California San Diego, San Diego, Calif
| | - Satinderjit Locham
- Division of Vascular Surgery, Johns Hopkins Medical Institutions, Baltimore, Md; Division of Vascular Surgery, University of California San Diego, San Diego, Calif
| | - Erin K Baldwin
- Division of Vascular Surgery, University of South Florida, Tampa, Fla
| | - Mahmoud B Malas
- Division of Vascular Surgery, Johns Hopkins Medical Institutions, Baltimore, Md; Division of Vascular Surgery, University of California San Diego, San Diego, Calif.
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12
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Yao CA, Lin CH. Treatment with the herbal formulation Eefooton slows the progression of chronic kidney disease: A case report. Medicine (Baltimore) 2019; 98:e17573. [PMID: 31651859 PMCID: PMC6824663 DOI: 10.1097/md.0000000000017573] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
RATIONALE Patients with end-stage kidney disease (ESKD) receiving maintenance dialysis experience an overall burden of physical and emotional symptoms. However, there were limited alternative treatments to dialysis. PATIENT CONCERNS A 79-year-old woman with chronic kidney disease stage 5 (CKD5) and gout had refused to be on dialysis. She also had hypoglycemia, hypertension, and heart disease. DIAGNOSES The patient had received the ultrasonography, the renal biopsy and biochemical examinations, confirming the diagnosis of renal impairment, primary hypertension, and chronic nephritic syndrome with unspecified morphologic changes. INTERVENTIONS She was administered with 20 mL Eefooton (a liquid formula of herbal extracts: Astragalus membranaceus 3 g, Codonopsis pilosula 3 g, Ligustrum lucidum 3 g, Panax quinquefolius 1.3 g, and Rhodiola sacra 1.3 g) orally twice a day for 6 months in addition to her regular medications. OUTCOMES The patient was followed up for 3 months after the completion of the Eefooton adjuvant treatment. The patient's renal function was improved, and CKD progression was alleviated. After Eefooton treatment, the sizes of both kidneys in the patient increased by 8% while blood urea nitrogen (BUN) and serum creatinine concentrations were decreased. In addition, further reduction in BUN concentration was observed 2 months posttreatment. LESSONS This case demonstrated that Eefooton has potential therapeutic significance in patients with CKD5 who chose conservative treatment over dialysis.
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Affiliation(s)
- Chien-An Yao
- Department of Family Medicine, National Taiwan University Hospital, Taipei City
| | - Chih-Hui Lin
- Gerent Biotech R&D Center No. 20, Jen Yi St., Taichung City, Taiwan (R.O.C.)
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13
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Chiang JK, Chen JS, Kao YH. Comparison of medical outcomes and health care costs at the end of life between dialysis patients with and without cancer: a national population-based study. BMC Nephrol 2019; 20:265. [PMID: 31311518 PMCID: PMC6636130 DOI: 10.1186/s12882-019-1440-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 06/25/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Palliative care has improved the quality of end-of-life (EOL) care and lowered the health care cost of cancer, and these benefits should be extended to patients with other serious illnesses including end-stage kidney disease. We evaluated the quality of EOL care, survival probabilities, and health care costs for dialysis patients in their last month of life. METHODS We conducted a population-based study and analyzed data from Taiwan's Longitudinal Health Insurance Database, which contains claims information of patient medical records, health care costs, and insurance system exit dates (our proxy for death between 2006 and 2011). RESULTS Data of 1177 adult patients who died of chronic hemodialysis or peritoneal dialysis were investigated. The mean age of these patients was 69.7 ± 11.9 years, and 585 (49.7%) were women. Some patients with dialysis received cardiopulmonary resuscitation (66.9%), died in a hospital (65.0%), or were admitted to an intensive care unit (51.0%) in the last month of life. We further classified these patients into two groups, namely dialysis with cancer (DC) (n = 149) and dialysis without cancer (D) (n = 1028). Only 19 dialysis patients received palliative care, and the proportion of patients receiving palliative care was higher in the DC group than in the D group (11.4% vs. 0.2%). The mean health care costs per person during the final month of life was similar between the DC and D groups (USD 2755 ± 259 vs. USD 2827 ± 88). Multivariate logistic regression showed that the DC group had lower odds of receiving cardiopulmonary resuscitation (CPR) (OR: 0.39, CI = 0.26-0.56, p < 0.001) procedures, higher odds of longer hospital stays than the third quartile (> 25 days) (OR: 1.52, CI = 1.01-2.29, p = 0.0046), and higher odds of being hospitalized more than once (OR: 2.26, CI = 1.42-3.59, p = 0.001) than the D group in the last month of life after adjustments. CONCLUSIONS DC patients received hospice care more frequently, received CPR less frequently, and had similar health care costs. DC patients also had a higher risk of a hospital stay that lasted more than 25 days and more than one hospitalization compared with D patients in the final month of life.
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Affiliation(s)
- Jui-Kun Chiang
- Department of Family Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, 2, Minsheng Road, Dalin, 622, Chiayi, Taiwan
| | - Jean-Shi Chen
- Department of Nephrology, Tainan Municipal Hospital (Managed by Show Chwan Medical Care Corporation), 670 Chung-Te Road, Tainan, 701, Taiwan
| | - Yee-Hsin Kao
- Department of Family Medicine, Tainan Municipal Hospital (Managed by Show Chwan Medical Care Corporation), 670 Chung-Te Road, Tainan, 701, Taiwan.
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14
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Hwang D, Lee E, Park S, Yoo BC, Park S, Choi KJ, Oh S, Kim MJ, Kim H, Jeon JS, Noh H, Han DC, Kwon SH. Validation of risk prediction tools in elderly patients who initiate dialysis. Int Urol Nephrol 2019; 51:1231-1238. [PMID: 31134506 DOI: 10.1007/s11255-019-02160-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 04/23/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE The number of elderly patients with end-stage renal disease on maintenance dialysis therapy is gradually increasing. The elderly population has difficulties in making decisions regarding initiation of dialysis treatment because of their high morbidity and frailty. The purpose of this study was to determine the best prognostic tool in predicting short-term mortality in elderly patients undergoing dialysis. METHODS This study is a multicenter retrospective study. We enrolled patients, aged ≥ 75 years, who began hemodialysis at three university hospitals in Korea from January 2010 to December 2016. We applied two comorbidity-based score tools (Thamer and Wick, each consisting of seven variables) and the Clinical Frailty Scale (CFS, seven scales), which were validated for mortality prediction in elderly incident patients. Patient's information was obtained from electronic medical records in the participating center, and mortality data (up to December 2016) were obtained from the Korean National Statistical Office. Models were compared using the area under the receiver operating characteristic curve. RESULTS Among the 219 patients enrolled in this study, the 3- and 6-month mortality rates were 31 (14.4%) and 48 (22.4%), respectively. Receiver operating characteristic curve analysis revealed that both score systems and the CFS showed similar performance while predicting 3- and 6-month mortality. The scores from these indices correlated with survival time. CONCLUSION Predicting short-term mortality and long-term survival time for elderly patients is possible using the Thamer and Wick scores and the CFS.
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Affiliation(s)
- Dohui Hwang
- Division of Nephrology, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, 59 Daesagwan-ro, Yongsan-gu, Seoul, 04401, Republic of Korea
| | - Eunbin Lee
- Division of Nephrology, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, 59 Daesagwan-ro, Yongsan-gu, Seoul, 04401, Republic of Korea
| | - Samel Park
- Division of Nephrology, Soonchunhyang University Cheonan Hospital, Cheonan, Chungcheongnam-do, Korea
| | - Byung Chul Yoo
- Division of Nephrology, Soonchunhyang University Bucheon Hospital, Cheonan, Gyeonggi-do, Korea
| | - Suyeon Park
- Department of Biostatistics, Soonchunhyang University Hospital, Seoul, Korea
| | - Kyoung Jin Choi
- Division of Nephrology, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, 59 Daesagwan-ro, Yongsan-gu, Seoul, 04401, Republic of Korea
| | - Songhee Oh
- Division of Nephrology, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, 59 Daesagwan-ro, Yongsan-gu, Seoul, 04401, Republic of Korea
| | - Mi Jung Kim
- Division of Nephrology, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, 59 Daesagwan-ro, Yongsan-gu, Seoul, 04401, Republic of Korea
| | - Hyoungnae Kim
- Division of Nephrology, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, 59 Daesagwan-ro, Yongsan-gu, Seoul, 04401, Republic of Korea.,Hyonam Kidney Laboratory, Soonchunhyang University Hospital, Seoul, Korea
| | - Jin Seok Jeon
- Division of Nephrology, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, 59 Daesagwan-ro, Yongsan-gu, Seoul, 04401, Republic of Korea.,Hyonam Kidney Laboratory, Soonchunhyang University Hospital, Seoul, Korea
| | - Hyunjin Noh
- Division of Nephrology, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, 59 Daesagwan-ro, Yongsan-gu, Seoul, 04401, Republic of Korea.,Hyonam Kidney Laboratory, Soonchunhyang University Hospital, Seoul, Korea
| | - Dong Cheol Han
- Division of Nephrology, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, 59 Daesagwan-ro, Yongsan-gu, Seoul, 04401, Republic of Korea.,Hyonam Kidney Laboratory, Soonchunhyang University Hospital, Seoul, Korea
| | - Soon Hyo Kwon
- Division of Nephrology, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, 59 Daesagwan-ro, Yongsan-gu, Seoul, 04401, Republic of Korea. .,Hyonam Kidney Laboratory, Soonchunhyang University Hospital, Seoul, Korea.
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15
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Scheuch M, Freiin von Rheinbaben S, Kabisch A, Engeßer J, Ahrendt S, Dabers T, Kohler C, Holtfreter S, Bröker BM, Stracke S. Staphylococcus aureus colonization in hemodialysis patients: a prospective 25 months observational study. BMC Nephrol 2019; 20:153. [PMID: 31060511 PMCID: PMC6503363 DOI: 10.1186/s12882-019-1332-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 04/12/2019] [Indexed: 12/24/2022] Open
Abstract
Background Dialysis patients are frequently exposed to Staphylococcus aureus due to stays in dialysis centers, hospitals or rest homes. The hemodialysis vascular access is a potential entry site for S. aureus, in particular when using a central venous catheter (CVC) which increases the risk of sepsis compared to arteriovenous (AV) fistula. We prospectively followed a cohort of 86 hemodialysis patients from an outpatient dialysis center over 25 months analyzing S. aureus carrier status, S. aureus infection rates and mortality. Methods Demographic data and patients´ medical histories were collected and followed from all hemodialysis patients. Blood samples, nasal swabs and swabs from the hemodialysis vascular access site were taken every six months for a period of 25 months and tested for S. aureus. Strains were cultured and further characterized by spa PCR and microarray-based genotyping. Resulting data were compared with those from the general population. Results In cross-sectional analyses, an average of 40% of hemodialysis patients were S. aureus carriers compared to 27% in the general population. Longitudinally, a total of 65% were S. aureus carriers: 16% were persistent carriers, 43% were intermittently colonized. The most common S. aureus lineage in the dialysis patient cohort was the clonal complex (CC) 8 and the spa type t008, while in the general population, the clonal complex CC30 dominates. During the study period, we observed six S. aureus-associated blood stream infections with one S. aureus attributable death. S. aureus carriers with an AV fistula were more densely colonized in the nasal mucosa compared to patients with a CVC. Overall mortality was lower for hemodialysis patients with a positive S. aureus carrier status compared to non-carriers (hazard ratio of 0.19). Conclusions Compared to the general population, hemodialysis patients were more frequently colonized with S. aureus and displayed both different S. aureus colonization densities as well as lineages, possibly explained by more frequent exposure to health care environments. The lower overall mortality in carriers compared to non-carriers is intriguing and will be investigated in detail in the future. Trial registration ISRCTN 14385893, 2. October 2018, retrospectively registered. Electronic supplementary material The online version of this article (10.1186/s12882-019-1332-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Matthias Scheuch
- Department of Internal Medicine A, Division of Nephrology, University Medicine Greifswald, Greifswald, Germany
| | | | - Antje Kabisch
- Department of Internal Medicine A, Division of Nephrology, University Medicine Greifswald, Greifswald, Germany
| | - Jonas Engeßer
- Department of Internal Medicine A, Division of Nephrology, University Medicine Greifswald, Greifswald, Germany
| | - Susanne Ahrendt
- Kuratorium für Dialyse und Nierentransplantation e.V., KfH-Nierenzentrum Greifswald, Greifswald, Germany
| | - Thomas Dabers
- Department of Internal Medicine A, Division of Nephrology, University Medicine Greifswald, Greifswald, Germany.,Kuratorium für Dialyse und Nierentransplantation e.V., KfH-Nierenzentrum Greifswald, Greifswald, Germany
| | - Christian Kohler
- Institute of Medical Microbiology, University Medicine Greifswald, Greifswald, Germany
| | - Silva Holtfreter
- Institute of Immunology and Transfusion Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Barbara M Bröker
- Institute of Immunology and Transfusion Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Sylvia Stracke
- Department of Internal Medicine A, Division of Nephrology, University Medicine Greifswald, Greifswald, Germany. .,Kuratorium für Dialyse und Nierentransplantation e.V., KfH-Nierenzentrum Greifswald, Greifswald, Germany.
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16
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Doi K, Nishida O, Shigematsu T, Sadahiro T, Itami N, Iseki K, Yuzawa Y, Okada H, Koya D, Kiyomoto H, Shibagaki Y, Matsuda K, Kato A, Hayashi T, Ogawa T, Tsukamoto T, Noiri E, Negi S, Kamei K, Kitayama H, Kashihara N, Moriyama T, Terada Y. The Japanese clinical practice guideline for acute kidney injury 2016. Clin Exp Nephrol 2018; 22:985-1045. [PMID: 30039479 PMCID: PMC6154171 DOI: 10.1007/s10157-018-1600-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Acute kidney injury (AKI) is a syndrome which has a broad range of etiologic factors depending on different clinical settings. Because AKI has significant impacts on prognosis in any clinical settings, early detection and intervention is necessary to improve the outcomes of AKI patients. This clinical guideline for AKI was developed by a multidisciplinary approach with nephrology, intensive care medicine, blood purification, and pediatrics. Of note, clinical practice for AKI management which was widely performed in Japan was also evaluated with comprehensive literature search.
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Affiliation(s)
- Kent Doi
- Department of Acute Medicine, The University of Tokyo, Tokyo, Japan
| | - Osamu Nishida
- Department of Anesthesiology and Critical Care Medicine, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | | | - Tomohito Sadahiro
- Department of Emergency and Critical Care Medicine, Tokyo Women's Medical University Yachiyo Medical Center, Chiba, Japan
| | - Noritomo Itami
- Department of Surgery, Kidney Center, Nikko Memorial Hospital, Hokkaido, Japan
| | - Kunitoshi Iseki
- Clinical Research Support Center, Tomishiro Central Hospital, Okinawa, Japan
| | - Yukio Yuzawa
- Department of Nephrology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Hirokazu Okada
- Department of Nephrology and General Internal Medicine, Saitama Medical University, Saitama, Japan
| | - Daisuke Koya
- Division of Anticipatory Molecular Food Science and Technology, Department of Diabetology and Endocrinology, Kanazawa Medical University, Kanawaza, Ishikawa, Japan
| | - Hideyasu Kiyomoto
- Department of Community Medical Supports, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Yugo Shibagaki
- Division of Nephrology and Hypertension, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Kenichi Matsuda
- Department of Emergency and Critical Care Medicine, University of Yamanashi School of Medicine, Yamanashi, Japan
| | - Akihiko Kato
- Blood Purification Unit, Hamamatsu University Hospital, Hamamatsu, Japan
| | - Terumasa Hayashi
- Department of Kidney Disease and Hypertension, Osaka General Medical Center, Osaka, Japan
| | - Tomonari Ogawa
- Nephrology and Blood Purification, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Tatsuo Tsukamoto
- Department of Nephrology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Eisei Noiri
- Department of Nephrology and Endocrinology, The University of Tokyo, Tokyo, Japan
| | - Shigeo Negi
- Department of Nephrology, Wakayama Medical University, Wakayama, Japan
| | - Koichi Kamei
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | | | - Naoki Kashihara
- Department of Nephrology and Hypertension, Kawasaki Medical School, Okayama, Japan
| | - Toshiki Moriyama
- Health Care Division, Health and Counseling Center, Osaka University, Osaka, Japan
| | - Yoshio Terada
- Department of Endocrinology, Metabolism and Nephrology, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan.
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17
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Doi K, Nishida O, Shigematsu T, Sadahiro T, Itami N, Iseki K, Yuzawa Y, Okada H, Koya D, Kiyomoto H, Shibagaki Y, Matsuda K, Kato A, Hayashi T, Ogawa T, Tsukamoto T, Noiri E, Negi S, Kamei K, Kitayama H, Kashihara N, Moriyama T, Terada Y. The Japanese Clinical Practice Guideline for acute kidney injury 2016. RENAL REPLACEMENT THERAPY 2018. [DOI: 10.1186/s41100-018-0177-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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18
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Doi K, Nishida O, Shigematsu T, Sadahiro T, Itami N, Iseki K, Yuzawa Y, Okada H, Koya D, Kiyomoto H, Shibagaki Y, Matsuda K, Kato A, Hayashi T, Ogawa T, Tsukamoto T, Noiri E, Negi S, Kamei K, Kitayama H, Kashihara N, Moriyama T, Terada Y. The Japanese Clinical Practice Guideline for acute kidney injury 2016. J Intensive Care 2018; 6:48. [PMID: 30123509 PMCID: PMC6088399 DOI: 10.1186/s40560-018-0308-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 06/22/2018] [Indexed: 12/20/2022] Open
Abstract
Acute kidney injury (AKI) is a syndrome which has a broad range of etiologic factors depending on different clinical settings. Because AKI has significant impacts on prognosis in any clinical settings, early detection and intervention are necessary to improve the outcomes of AKI patients. This clinical guideline for AKI was developed by a multidisciplinary approach with nephrology, intensive care medicine, blood purification, and pediatrics. Of note, clinical practice for AKI management which was widely performed in Japan was also evaluated with comprehensive literature search.
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Affiliation(s)
- Kent Doi
- Department of Acute Medicine, The University of Tokyo, Tokyo, Japan
| | - Osamu Nishida
- Department of Anesthesiology and Critical Care Medicine, Fujita Health University School of Medicine, Toyoake, Aichi Japan
| | | | - Tomohito Sadahiro
- Department of Emergency and Critical Care Medicine, Tokyo Women’s Medical University Yachiyo Medical Center, Chiba, Japan
| | - Noritomo Itami
- Kidney Center, Department of Surgery, Nikko Memorial Hospital, Hokkaido, Japan
| | - Kunitoshi Iseki
- Clinical Research Support Center, Tomishiro Central Hospital, Okinawa, Japan
| | - Yukio Yuzawa
- Department of Nephrology, Fujita Health University School of Medicine, Toyoake, Aichi Japan
| | - Hirokazu Okada
- Department of Nephrology and General Internal Medicine, Saitama Medical University, Saitama, Japan
| | - Daisuke Koya
- Division of Anticipatory Molecular Food Science and Technology, Department of Diabetology and Endocrinology, Kanazawa Medical University, Kanawaza, Ishikawa Japan
| | - Hideyasu Kiyomoto
- Department of Community Medical Supports, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Yugo Shibagaki
- Division of Nephrology and Hypertension, St. Marianna University School of Medicine, Kawasaki, Kanagawa Japan
| | - Kenichi Matsuda
- Department of Emergency and Critical Care Medicine, University of Yamanashi School of Medicine, Yamanashi, Japan
| | - Akihiko Kato
- Blood Purification Unit, Hamamatsu University Hospital, Hamamatsu, Japan
| | - Terumasa Hayashi
- Department of Kidney Disease and Hypertension, Osaka General Medical Center, Osaka, Japan
| | - Tomonari Ogawa
- Nephrology and Blood Purification, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Tatsuo Tsukamoto
- Department of Nephrology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Eisei Noiri
- Department of Nephrology and Endocrinology, The University of Tokyo, Tokyo, Japan
| | - Shigeo Negi
- Department of Nephrology, Wakayama Medical University, Wakayama, Japan
| | - Koichi Kamei
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | | | - Naoki Kashihara
- Department of Nephrology and Hypertension, Kawasaki Medical School, Okayama, Japan
| | - Toshiki Moriyama
- Health Care Division, Health and Counseling Center, Osaka University, Osaka, Japan
| | - Yoshio Terada
- Department of Endocrinology, Metabolism and Nephrology, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, 783-8505 Japan
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Plehn G, Butz T, Maagh P, Meissner A. Effect of patient’s age on the profitability of inpatient cardiac catheterization: a contribution margin analysis of frequently performed procedures over a 5-year period. BMC Health Serv Res 2017; 17:49. [PMID: 28100220 PMCID: PMC5241940 DOI: 10.1186/s12913-017-1999-4] [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] [Received: 05/21/2016] [Accepted: 01/11/2017] [Indexed: 11/10/2022] Open
Abstract
Background Methods Results Conclusions Electronic supplementary material
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Piccoli GB, Sofronie AC, Coindre JP. The strange case of Mr. H. Starting dialysis at 90 years of age: clinical choices impact on ethical decisions. BMC Med Ethics 2017; 18:61. [PMID: 29121886 PMCID: PMC5680775 DOI: 10.1186/s12910-017-0219-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Accepted: 10/31/2017] [Indexed: 12/16/2022] Open
Abstract
Background Starting dialysis at an advanced age is a clinical challenge and an ethical dilemma. The advantages of starting dialysis at “extreme” ages are questionable as high dialysis-related morbidity induces a reflection on the cost- benefit ratio of this demanding and expensive treatment in a person that has a short life expectancy. Where clinical advantages are doubtful, ethical analysis can help us reach decisions and find adapted solutions. Case presentation Mr. H is a ninety-year-old patient with end-stage kidney disease that is no longer manageable with conservative care, in spite of optimal nutritional management, good blood pressure control and strict clinical and metabolic evaluations; dialysis is the next step, but its morbidity is challenging. The case is analysed according to principlism (beneficence, non-maleficence, justice and respect for autonomy). In the setting of care, dialysis is available without restriction; therefore the principle of justice only partially applied, in the absence of restraints on health-care expenditure. The final decision on whether or not to start dialysis rested with Mr. H (respect for autonomy). However, his choice depended on the balance between beneficence and non-maleficence. The advantages of dialysis in restoring metabolic equilibrium were clear, and the expected negative effects of dialysis were therefore decisive. Mr. H has a contraindication to peritoneal dialysis (severe arthritis impairing self-performance) and felt performing it with nursing help would be intrusive. Post dialysis fatigue, poor tolerance, hypotension and intrusiveness in daily life of haemodialysis patients are closely linked to the classic thrice-weekly, four-hour schedule. A personalized incremental dialysis approach, starting with one session per week, adapting the timing to the patient’s daily life, can limit side effects and “dialysis shock”. Conclusions An individualized approach to complex decisions such as dialysis start can alter the delicate benefit/side-effect balance, ultimately affecting the patient’s choice, and points to a narrative, tailor-made approach as an alternative to therapeutic nihilism, in very old and fragile patients.
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Affiliation(s)
- Giorgina Barbara Piccoli
- Department of Clinical and Biological Sciences, University of Torino, Torino, Italy. .,Nephrology, Centre Hospitalier Le Mans, Avenue Roubillard, 72000, Le Mans, France.
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Thorsteinsdottir B, Ramar P, Hickson LJ, Reinalda MS, Albright RC, Tilburt JC, Williams AW, Takahashi PY, Jeffery MM, Shah ND. Care of the dialysis patient: Primary provider involvement and resource utilization patterns - a cohort study. BMC Nephrol 2017; 18:322. [PMID: 29070040 PMCID: PMC5657054 DOI: 10.1186/s12882-017-0728-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 09/29/2017] [Indexed: 01/21/2023] Open
Abstract
Background Efficient and safe delivery of care to dialysis patients is essential. Concerns have been raised regarding the ability of accountable care organizations to adequately serve this high-risk population. Little is known about primary care involvement in the care of dialysis patients. This study sought to describe the extent of primary care provider (PCP) involvement in the care of hemodialysis patients and the outcomes associated with that involvement. Methods In a retrospective cohort study, patients accessing a Midwestern dialysis network from 2001 to 2010 linked to United States Renal Database System and with >90 days follow up were identified (n = 2985). Outpatient visits were identified using Current Procedural Terminology (CPT)-4 codes, provider specialty, and grouped into quartiles-based on proportion of PCP visits per person-year (ppy). Top and bottom quartiles represented patients with high primary care (HPC) or low primary care (LPC), respectively. Patient characteristics and health care utilization were measured and compared across patient groups. Results Dialysis patients had an overall average of 4.5 PCP visits ppy, ranging from 0.6 in the LPC group to 6.9 in the HPC group. HPC patients were more likely female (43.4% vs. 35.3%), older (64.0 yrs. vs. 60.0 yrs), and with more comorbidities (Charlson 7.0 vs 6.0). HPC patients had higher utilization (hospitalizations 2.2 vs. 1.8 ppy; emergency department visits 1.6 vs 1.2 ppy) and worse survival (3.9 vs 4.3 yrs) and transplant rates (16.3 vs. 31.5). Conclusions PCPs are significantly involved in the care of hemodialysis patients. Patients with HPC are older, sicker, and utilize more resources than those managed primarily by nephrologists. After adjusting for confounders, there is no difference in outcomes between the groups. Further studies are needed to better understand whether there is causal impact of primary care involvement on patient survival. Electronic supplementary material The online version of this article (10.1186/s12882-017-0728-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Bjorg Thorsteinsdottir
- Division of Primary Care Internal Medicine, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA. .,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, 55905, USA. .,Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN, 55905, USA.
| | - Priya Ramar
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, 55905, USA
| | - LaTonya J Hickson
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, 55905, USA.,Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, 55905, USA
| | - Megan S Reinalda
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, 55905, USA
| | - Robert C Albright
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, 55905, USA
| | - Jon C Tilburt
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN, 55905, USA.,Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, 55905, USA
| | - Amy W Williams
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, 55905, USA
| | - Paul Y Takahashi
- Division of Primary Care Internal Medicine, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Molly M Jeffery
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, 55905, USA
| | - Nilay D Shah
- Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, 55905, USA
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Rak A, Raina R, Suh TT, Krishnappa V, Darusz J, Sidoti CW, Gupta M. Palliative care for patients with end-stage renal disease: approach to treatment that aims to improve quality of life and relieve suffering for patients (and families) with chronic illnesses. Clin Kidney J 2016. [PMID: 28638606 PMCID: PMC5469574 DOI: 10.1093/ckj/sfw105] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Providing end-of-life care to patients suffering from chronic kidney disease (CKD) and/or end-stage renal disease often presents ethical challenges to families and health care providers. However, as the conditions these patients present with are multifaceted in nature, so should be the approach when determining prognosis and treatment strategies for this patient population. Having an interdisciplinary palliative team in place to address any concerns that may arise during conversations related to end-of-life care encourages effective communication between the patient, the family and the medical team. Through the use of a case study, the authors demonstrate how an interdisciplinary palliative team can be used to make decisions that satisfy the patient's and the medical team's desires for end-of-life care.
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Affiliation(s)
- Amy Rak
- Department of Internal Medicine and Research, Akron General Medical Center-Cleveland Clinic, Akron, OH, USA
| | - Rupesh Raina
- Department of Internal Medicine and Research, Akron General Medical Center-Cleveland Clinic, Akron, OH, USA.,Department of Nephrology, Akron General Medical Center-Cleveland Clinic, Akron, OH, USA
| | - Theodore T Suh
- Division of Geriatric and Palliative Medicine, University of Michigan Health System, Geriatric Research Education and Clinical Center, Ann Arbor VA Hospital, Ann Arbor, MI, USA
| | - Vinod Krishnappa
- Department of Internal Medicine and Research, Akron General Medical Center-Cleveland Clinic, Akron, OH, USA.,Department of Nephrology, Akron General Medical Center-Cleveland Clinic, Akron, OH, USA
| | - Jessica Darusz
- Department of Internal Medicine and Research, Akron General Medical Center-Cleveland Clinic, Akron, OH, USA.,Department of Nephrology, Akron General Medical Center-Cleveland Clinic, Akron, OH, USA
| | | | - Mona Gupta
- Section of Palliative Medicine, Taussig Cancer Institute, Cleveland, OH, USA.,Center for Geriatric Medicine, Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
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Measuring health-related quality of life in patients with conservatively managed stage 5 chronic kidney disease: limitations of the Medical Outcomes Study Short Form 36: SF-36. Qual Life Res 2016; 25:2799-2809. [PMID: 27522214 PMCID: PMC5065617 DOI: 10.1007/s11136-016-1313-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2016] [Indexed: 01/22/2023]
Abstract
PURPOSE Chronic kidney disease (CKD) negatively affects health-related quality of life (HRQoL), which is often measured using the Medical Outcomes Study Short Form 36 (SF-36) questionnaire. However, the adequacy of SF-36 in this population has not been reported. We aimed to determine floor and ceiling effects and responsiveness to change of SF-36 in patients with conservatively managed stage 5 CKD. METHODS SF-36 data were collected prospectively. Floor and ceiling effects were estimated for each SF-36 scale and summary measure based on raw scores. The minimal clinically important difference (MCID) was estimated using a combination of anchor-based and distribution-based methods. Responsiveness to change was assessed by comparing MCID for each scale and summary measure to its smallest detectable change. RESULTS SF-36 data were available for 73 of the 74 study participants. Using baseline data, floor and/or ceiling effects were detected for 3 of the 8 SF-36 scales. The anchor-based estimation of MCID based on differences in baseline functional status yielded the most reliable results. For the physical component summary, MCID was estimated at 5.7 points. Whilst the two SF-36 summary measures were responsive to change and free of floor and/or ceiling effects, six of the eight scales were not. CONCLUSIONS This small study of patients with conservatively managed stage 5 CKD found that only the summary measures of SF-36 and 2 of its 8 scales can be used to assess changes in HRQoL over time. These findings suggest that in this population, alternative HRQoL assessment tools should be considered for future studies.
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Wang SY, Zang XY, Fu SH, Bai J, Liu JD, Tian L, Feng YY, Zhao Y. Factors related to fatigue in Chinese patients with end-stage renal disease receiving maintenance hemodialysis: a multi-center cross-sectional study. Ren Fail 2016; 38:442-50. [DOI: 10.3109/0886022x.2016.1138819] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Gomez AT, Kiberd BA, Royston JP, Alfaadhel T, Soroka SD, Hemmelgarn BR, Tennankore KK. Comorbidity burden at dialysis initiation and mortality: A cohort study. Can J Kidney Health Dis 2015; 2:34. [PMID: 26351568 PMCID: PMC4562341 DOI: 10.1186/s40697-015-0068-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 07/24/2015] [Indexed: 11/14/2022] Open
Abstract
Background A high level of comorbidity at dialysis initiation is associated with an increased risk of death. However, contemporary assessments of the validity and prognostic value of comorbidity indices are lacking. Objectives To assess the validity of two comorbidity indices and to determine if a high degree of comorbidity is associated with mortality among dialysis patients. Design Cohort study. Setting QEII Health Sciences Centre (Halifax, Nova Scotia, Canada). Patients Incident, chronic dialysis patients between 01 Jan 2006 and 01 Jul 2013. Measurements Exposure: The Charlson Comorbidity Index (CCI) and End-Stage Renal Disease Comorbidity Index (ESRD-CI) were used to classify individual comorbid conditions into an overall score. Comorbidities were classified using patient charts and electronic records. Outcome: All-cause mortality. Confounders: Patient demographics, dialysis access, cause of ESRD and baseline laboratory data. Methods Regression coefficients were estimated on the CCI and ESRD-CI. Discrimination for death was assessed using Harrell’s c-index. Adjusted Cox proportional hazard models were used to calculate relative hazards and 95 % confidence intervals for each category of the CCI and ESRD-CI. Results The cohort consisted of 771 ESRD patients from 01 Jan 2006 to 01 Jul 2013. Most were male (62 %) and Caucasian (91 %). The cohort had a high proportion of diabetes (48 %), history of previous myocardial infarction (31 %) and heart failure (22 %). Regression coefficients on the CCI and ESRD-CI were 0.55 and 0.52, respectively. The c-index, for the prediction of death, was 0.61 for the CCI and 0.63 for the ESRD-CI. ESRD-CI scores of 4, 5 and ≥6 were associated with a similar mortality risk (adjusted relative hazard of 1.95, 1.89 and 1.99, respectively). There was a small increased mortality risk for CCI scores of 4, 5 and ≥6 (adjusted relative hazard of 1.86, 2.38 and 2.71, respectively). Limitations Classification of comorbidities for each patient was determined by clinical impression. Conclusions The CCI and ESRD-CI have a limited ability to discriminate mortality risk for incident dialysis patients. Acknowledging the frequency with which they are used, this study emphasizes the need to re-examine the usefulness of previously derived comorbidity indices in contemporary dialysis cohorts.
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Affiliation(s)
- Alwyn T Gomez
- Faculty of Medicine, Dalhousie University, Halifax, NS Canada
| | - Bryce A Kiberd
- Department of Medicine (Division of Nephrology), Dalhousie University, Halifax, NS Canada ; Nova Scotia Health Authority, 5820 University Avenue, Halifax, NS Canada B3H 1V8
| | | | - Talal Alfaadhel
- Department of Medicine (Division of Nephrology), Dalhousie University, Halifax, NS Canada
| | - Steven D Soroka
- Department of Medicine (Division of Nephrology), Dalhousie University, Halifax, NS Canada ; Nova Scotia Health Authority, 5820 University Avenue, Halifax, NS Canada B3H 1V8
| | - Brenda R Hemmelgarn
- Department of Medicine, University of Calgary, Calgary, AB Canada ; Department of Community Health Sciences, University of Calgary, Calgary, AB Canada
| | - Karthik K Tennankore
- Department of Medicine (Division of Nephrology), Dalhousie University, Halifax, NS Canada ; Nova Scotia Health Authority, 5820 University Avenue, Halifax, NS Canada B3H 1V8
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Shih CJ, Chen YT, Ou SM, Yang WC, Kuo SC, Tarng DC. The impact of dialysis therapy on older patients with advanced chronic kidney disease: a nationwide population-based study. BMC Med 2014; 12:169. [PMID: 25315422 PMCID: PMC4189680 DOI: 10.1186/s12916-014-0169-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Accepted: 09/01/2014] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Older patients with advanced chronic kidney disease (CKD) face the decision of whether to undergo dialysis. Currently available data on this issue are limited because they were generated by small, short-term studies with statistical drawbacks. Further research is urgently needed to provide objective information for dialysis decision making in older patients with advanced CKD. METHODS This nationwide population-based cohort study was conducted using Taiwan's National Health Insurance Research Database. Data from 2000 to 2010 were extracted. A total of 8,341 patients≥70 years old with advanced CKD and serum creatinine levels>6 mg/dl, who had been treated with erythropoiesis-stimulating agents were included. Cox proportional hazard models in which initiation of chronic dialysis was defined as the time-dependent covariate were used to calculate adjusted hazard ratios for mortality. The endpoint was all-cause mortality. RESULTS During a median follow-up period of 2.7 years, 6,292 (75.4%) older patients chose dialysis therapy and 2,049 (24.6%) received conservative care. Dialysis was initiated to treat kidney failure a median of 6.4 months after enrollment. Dialysis was associated with a 1.4-fold increased risk of mortality compared with conservative care (adjusted hazard ratio 1.39, 95% confidence interval 1.30 to 1.49). In subgroup analyses, the risk of mortality remained consistently increased, independent of age, sex and comorbidities. CONCLUSIONS In older patients, dialysis may be associated with increased mortality risk and healthcare cost compared with conservative care. For patients who are ≥70 years old with advanced CKD, decision making about whether to undergo dialysis should be weighted by consideration of risks and benefits.
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Affiliation(s)
- Chia-Jen Shih
- Department of Medicine, Taipei Veterans General Hospital, Yuanshan Branch, Yilan, Taiwan. .,School of Medicine, National Yang-Ming University, Taipei, Taiwan.
| | - Yung-Tai Chen
- School of Medicine, National Yang-Ming University, Taipei, Taiwan. .,Department of Medicine, Taipei City Hospital Heping Fuyou Branch, Taipei, Taiwan.
| | - Shuo-Ming Ou
- School of Medicine, National Yang-Ming University, Taipei, Taiwan. .,Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Section 2, Shih-Pai Road, Taipei, 11217, Taiwan. .,Institutes of Physiology and Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.
| | - Wu-Chang Yang
- School of Medicine, National Yang-Ming University, Taipei, Taiwan. .,Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Section 2, Shih-Pai Road, Taipei, 11217, Taiwan.
| | - Shu-Chen Kuo
- School of Medicine, National Yang-Ming University, Taipei, Taiwan. .,National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Miaoli County, Taiwan. .,Division of Infectious Diseases, Taipei Veterans General Hospital, Taipei, Taiwan.
| | - Der-Cherng Tarng
- School of Medicine, National Yang-Ming University, Taipei, Taiwan. .,Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Section 2, Shih-Pai Road, Taipei, 11217, Taiwan. .,Institutes of Physiology and Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.
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