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Yamamoto S, Bieber BA, Komaba H, Hanafusa N, Kitabayashi H, Nomura T, Cases A, Combe C, Pisoni RL, Robinson BM, Fukagawa M. Medical Director Practice of Advising Increased Dietary Protein Intake in Hemodialysis Patients With Hyperphosphatemia: Associations With Mortality in the Dialysis Outcomes and Practice Patterns Study. J Ren Nutr 2021; 32:243-250. [PMID: 33820694 DOI: 10.1053/j.jrn.2021.02.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 01/11/2021] [Accepted: 02/14/2021] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES Patients undergoing hemodialysis (HD) may have poor nutritional status and hyperphosphatemia. Nephrologists sometimes manage hyperphosphatemia by prescribing phosphate binders and/or recommending restriction of dietary phosphate including protein-rich foods; the later may, however, adversely affect nutritional status. DESIGN AND METHODS The analysis includes 8805 HD patients on dialysis ≥ 120 days in 12 countries in Dialysis Outcomes and Practice Patterns Study (DOPPS) phase 4 (2009-2011), from 248 facilities. The primary exposure variable was response to the following question: "For patients with serum albumin 3.0 g/dL and phosphate 6.0 mg/dL, do you recommend to (A) increase or (B) decrease/no change in dietary protein intake (DPI)?". The association between medical director's practice of recommending an increase in DPI and all-cause mortality was analyzed with Cox regression adjusted for potential confounders. Linear and logistic regressions were used to model the cross-sectional associations between DPI advice practice and intermediate markers of patient nutrition. RESULTS Median follow-up was 1.6 years. In the case scenario, 91% of medical directors in North America had a practice of recommending DPI increase compared to 58% in Europe (range = 36%-83% across 7 countries) and 56% in Japan. The practice of advising DPI increase was weakly associated with lower mortality [HR (95% CI): 0.88 (0.76-1.02)]. The association tended to be stronger in patients with age 70+ years [HR (95% CI): 0.82 (0.69-0.97), P = .12 for interaction]. The practice of advising DPI increase was associated with 0.276 mg/dL higher serum creatinine levels (95% CI: 0.033-0.520) after adjustment for case mix. CONCLUSIONS Medical director's practice of recommending an increase in DPI for HD patients with low albumin and high phosphate levels was associated with higher serum creatinine levels and potentially lower all-cause mortality. To recommend protein intake liberalization in parallel with phosphate management by physicians may be a critical practice for better nutritional status and outcomes in HD patients.
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Affiliation(s)
- Suguru Yamamoto
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
| | - Brian A Bieber
- Arbor Research Collaborative for Health, Ann Arbor, Michigan
| | - Hirotaka Komaba
- Division of Nephrology, Endocrinology and Metabolism, Tokai University School of Medicine, Isehara, Japan
| | - Norio Hanafusa
- Department of Blood Purification, Tokyo Women's Medical University, Tokyo, Japan
| | | | - Takanobu Nomura
- Medical Affairs Department, Kyowa Kirin Co. Ltd., Tokyo, Japan
| | - Aleix Cases
- Universitat de Barcelona, IDIBAPS, Barcelona, Spain
| | | | - Ronald L Pisoni
- Arbor Research Collaborative for Health, Ann Arbor, Michigan
| | | | - Masafumi Fukagawa
- Division of Nephrology, Endocrinology and Metabolism, Tokai University School of Medicine, Isehara, Japan
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Komaba H, Fuller DS, Taniguchi M, Yamamoto S, Nomura T, Zhao J, Bieber BA, Robinson BM, Pisoni RL, Fukagawa M. Fibroblast Growth Factor 23 and Mortality Among Prevalent Hemodialysis Patients in the Japan Dialysis Outcomes and Practice Patterns Study. Kidney Int Rep 2020; 5:1956-1964. [PMID: 33163716 PMCID: PMC7609896 DOI: 10.1016/j.ekir.2020.08.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 08/04/2020] [Accepted: 08/11/2020] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Elevated fibroblast growth factor 23 (FGF23) levels have been strongly associated with mortality in the predialysis and incident hemodialysis populations, but few studies have examined this relationship in a large cohort of prevalent hemodialysis patients and in particular among persons with high dialysis vintage. To address this, we analyzed data from the Japan Dialysis Outcomes and Practice Patterns Study (J-DOPPS). METHODS We included 1122 prevalent hemodialysis patients from the J-DOPPS phase 5 (2012-2015) who had FGF23 measurements. We evaluated the association of FGF23 levels with all-cause mortality and cardiovascular composite outcome using Cox regression adjusted for potential confounders. RESULTS At study enrollment, median dialysis vintage was 5.8 years (interquartile range, 2.7-12.4 years) and median FGF23 level was 2113 pg/ml (interquartile range, 583-6880 pg/ml). During 3-year follow-up, 154 of the 1122 participants died. In adjusted analyses, higher FGF23 was associated with a greater hazard of death (hazard ratio per doubling of FGF23, 1.12; 95% confidence interval, 1.03-1.21); however, the association became weaker as the dialysis vintage increased and finally disappeared in the highest tertile (>9.4 years). Similar patterns of effect modification by dialysis vintage were observed for cardiovascular composite outcome and in time-dependent models. CONCLUSION Elevated FGF23 was associated with mortality and cardiovascular events in prevalent hemodialysis patients, but the association was attenuated at longer dialysis vintages. This novel finding suggests that long-term hemodialysis patients may be less susceptible to the detrimental effects of FGF23 or correlated biological processes, and additional studies are needed to gain understanding of these possibilities.
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Affiliation(s)
- Hirotaka Komaba
- Division of Nephrology, Endocrinology, and Metabolism, Tokai University School of Medicine, Isehara, Japan
- The Institute of Medical Sciences, Tokai University, Isehara, Japan
| | | | | | - Suguru Yamamoto
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Takanobu Nomura
- Medical Affairs Department, Kyowa Kirin Co., Ltd., Tokyo, Japan
| | - Junhui Zhao
- Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA
| | - Brian A. Bieber
- Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA
| | | | - Ronald L. Pisoni
- Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA
| | - Masafumi Fukagawa
- Division of Nephrology, Endocrinology, and Metabolism, Tokai University School of Medicine, Isehara, Japan
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Boudville N, Johnson DW, Zhao J, Bieber BA, Pisoni RL, Piraino B, Bernardini J, Nessim SJ, Ito Y, Woodrow G, Brown F, Collins J, Kanjanabuch T, Szeto CC, Perl J. Regional variation in the treatment and prevention of peritoneal dialysis-related infections in the Peritoneal Dialysis Outcomes and Practice Patterns Study. Nephrol Dial Transplant 2020; 34:2118-2126. [PMID: 30053214 DOI: 10.1093/ndt/gfy204] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 05/29/2018] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Peritoneal dialysis (PD)-related infections lead to significant morbidity. The International Society for Peritoneal Dialysis (ISPD) guidelines for the prevention and treatment of PD-related infections are based on variable evidence. We describe practice patterns across facilities participating in the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS). METHODS PDOPPS, a prospective cohort study, enrolled nationally representative samples of PD patients in Australia/New Zealand (ANZ), Canada, Thailand, Japan, the UK and the USA. Data on PD-related infection prevention and treatment practices across facilities were obtained from a survey of medical directors'. RESULTS A total of 170 centers, caring for >11 000 patients, were included. The proportion of facilities reporting antibiotic administration at the time of PD catheter insertion was lowest in the USA (63%) and highest in Canada and the UK (100%). Exit-site antimicrobial prophylaxis was variably used across countries, with Japan (4%) and Thailand (28%) having the lowest proportions. Exit-site mupirocin was the predominant exit-site prophylactic strategy in ANZ (56%), Canada (50%) and the UK (47%), while exit-site aminoglycosides were more common in the USA (72%). Empiric Gram-positive peritonitis treatment with vancomycin was most common in the UK (88%) and USA (83%) compared with 10-45% elsewhere. Empiric Gram-negative peritonitis treatment with aminoglycoside therapy was highest in ANZ (72%) and the UK (77%) compared with 10-45% elsewhere. CONCLUSIONS Variation in PD-related infection prevention and treatment strategies exist across countries with limited uptake of ISPD guideline recommendations. Further work will aim to understand the impact these differences have on the wide variation in infection risk between facilities and other clinically relevant PD outcomes.
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Affiliation(s)
- Neil Boudville
- Medical School, University of Western Australia, Perth, Western Australia, Australia
| | - David W Johnson
- Department of Nephrology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Junhui Zhao
- Arbor Research Collaborative for Health, Ann Arbor, MI, USA
| | - Brian A Bieber
- Arbor Research Collaborative for Health, Ann Arbor, MI, USA
| | | | - Beth Piraino
- Department of Medicine, Renal Electrolyte Division, University of Pittsburgh, Pittsburgh, PA, USA
| | - Judith Bernardini
- Department of Medicine, Renal Electrolyte Division, University of Pittsburgh, Pittsburgh, PA, USA
| | - Sharon J Nessim
- Department of Nephrology, Division of Nephrology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Yasuhiko Ito
- Department of Nephrology and Rheumatology, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Graham Woodrow
- Department of Nephrology, St James's University Hospital, Leeds, UK
| | - Fiona Brown
- Department of Nephrology, Monash Medical Centre, Clayton, Victoria, Australia
| | - John Collins
- Department of Renal Medicine, Auckland City Hospital, Auckland, New Zealand
| | - Talerngsak Kanjanabuch
- Division of Nephrology, Department of Internal Medicine, and Kidney & Metabolic Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Cheuk-Chun Szeto
- Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Jeffrey Perl
- Department of Medicine, Division of Nephrology, St. Michael's Hospital and the Keenan Research Center in the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
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Jadoul M, Bieber BA, Martin P, Akiba T, Nwankwo C, Arduino JM, Goodkin DA, Pisoni RL. Prevalence, incidence, and risk factors for hepatitis C virus infection in hemodialysis patients. Kidney Int 2020; 95:939-947. [PMID: 30904068 DOI: 10.1016/j.kint.2018.11.038] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 11/19/2018] [Accepted: 11/21/2018] [Indexed: 02/06/2023]
Abstract
Hepatitis C virus (HCV) infection is common in dialysis patients and is associated with increased morbidity and mortality. We used the Dialysis Outcomes and Practice Patterns Study (DOPPS, 1996-2015) to assess trends in the prevalence, incidence, and risk factors for HCV infection as defined by a documented diagnosis or antibody positivity. Among prevalent hemodialysis patients, HCV prevalence was nearly 10% in 2012-2015. Prevalence ranged from 4% in Belgium to as high as 20% in the Middle East, with intermediate prevalence in China, Japan, Italy, Spain, and Russia. HCV prevalence decreased over time in most countries participating in more than one phase of DOPPS, and prevalence was around 5% among patients who had recently (<4 months) initiated dialysis. The incidence of HCV infection decreased from 2.9 to 1.2 per 100 patient-years in countries participating in the initial phase of DOPPS. Although most units reported no seroconversions, 10% of units experienced 3 or more cases over a median of 1.1 years. High HCV prevalence in the hemodialysis unit was a powerful facility-level risk factor for seroconversion, but the use of isolation stations for HCV-positive patients was not associated with significantly lower seroconversion rates. Overall, despite a trend toward lower HCV prevalence among hemodialysis patients, the prevalence of HCV infection remains higher than in the general population. Combined with a high prevalence of HCV infection among patients with Stage 5 CKD, high rates of HCV seroconversion in a subset of hemodialysis units may contribute to this disparity.
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Affiliation(s)
- Michel Jadoul
- Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.
| | - Brian A Bieber
- Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA
| | | | - Takashi Akiba
- Department of Blood Purification and Internal Medicine, Kidney Center, Tokyo Women's Medical University, Tokyo, Japan
| | | | | | - David A Goodkin
- Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA
| | - Ronald L Pisoni
- Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA
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Jadoul M, Bieber BA, Goodkin DA, Pisoni RL. The authors reply. Kidney Int 2020; 97:421-422. [PMID: 31980078 DOI: 10.1016/j.kint.2019.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 11/01/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Michel Jadoul
- Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.
| | - Brian A Bieber
- Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA
| | - David A Goodkin
- Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA
| | - Ronald L Pisoni
- Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA
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Karaboyas A, Morgenstern H, Li Y, Bieber BA, Hakim R, Hasegawa T, Jadoul M, Schaeffner E, Vanholder R, Pisoni RL, Port FK, Robinson BM. Estimating the Fraction of First-Year Hemodialysis Deaths Attributable to Potentially Modifiable Risk Factors: Results from the DOPPS. Clin Epidemiol 2020; 12:51-60. [PMID: 32021471 PMCID: PMC6974411 DOI: 10.2147/clep.s233197] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 12/12/2019] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Mortality among first-year hemodialysis (HD) patients remains unacceptably high. To address this problem, we estimate the proportions of early HD deaths that are potentially preventable by modifying known risk factors. METHODS We included 15,891 HD patients (within 60 days of starting HD) from 21 countries in the Dialysis Outcomes and Practice Patterns Study (1996-2015), a prospective cohort study. Using Cox regression adjusted for potential confounders, we estimated the fraction of first-year deaths attributable to one or more of twelve modifiable risk factors (the population attributable fraction, AF) identified from the published literature by comparing predicted survival based on risk factors observed vs counterfactually set to reference levels. RESULTS The highest AFs were for catheter use (22%), albumin <3.5 g/dL (19%), and creatinine <6 mg/dL (12%). AFs were 5%-9% for no pre-HD nephrology care, no residual urine volume, systolic blood pressure <130 or ≥160 mm Hg, phosphorus <3.5 or ≥5.5 mg/dL, hemoglobin <10 or ≥12 g/dL, and white blood cell count >10,000/μL. AFs for ferritin, calcium, and PTH were <3%. Overall, 65% (95% CI: 59%-71%) of deaths were attributable to these 12 risk factors. Additionally, the AF for C-reactive protein >10 mg/L was 21% in facilities where it was routinely measured. CONCLUSION A substantial proportion of first-year HD deaths could be prevented by successfully modifying a few risk factors. Highest priorities should be decreasing catheter use and limiting malnutrition/inflammation whenever possible.
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Affiliation(s)
| | - Hal Morgenstern
- Departments of Epidemiology and Environmental Health Sciences, School of Public Health, and Department of Urology, Medical School, University of Michigan, Ann Arbor, MI, USA
| | - Yun Li
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Brian A Bieber
- Arbor Research Collaborative for Health, Ann Arbor, MI, USA
| | - Raymond Hakim
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Takeshi Hasegawa
- Division of Nephrology, Department of Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan, and Showa University Research Administration Center (SURAC), Showa University, Tokyo, Japan
| | - Michel Jadoul
- Cliniques universitaires St Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Elke Schaeffner
- Institute of Public Health, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | | | | | - Friedrich K Port
- Department of Epidemiology, University of Michigan School of Public Health, and Department of Internal Medicine-Nephrology, University of Michigan Medical School, Ann Arbor, MI, USA
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Perl J, Fuller DS, Bieber BA, Boudville N, Kanjanabuch T, Ito Y, Nessim SJ, Piraino BM, Pisoni RL, Robinson BM, Schaubel DE, Schreiber MJ, Teitelbaum I, Woodrow G, Zhao J, Johnson DW. Peritoneal Dialysis-Related Infection Rates and Outcomes: Results From the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS). Am J Kidney Dis 2020; 76:42-53. [PMID: 31932094 DOI: 10.1053/j.ajkd.2019.09.016] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 09/24/2019] [Indexed: 01/29/2023]
Abstract
RATIONALE & OBJECTIVE Peritoneal dialysis (PD)-related peritonitis carries high morbidity for PD patients. Understanding the characteristics and risk factors for peritonitis can guide regional development of prevention strategies. We describe peritonitis rates and the associations of selected facility practices with peritonitis risk among countries participating in the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS). STUDY DESIGN Observational prospective cohort study. SETTING & PARTICIPANTS 7,051 adult PD patients in 209 facilities across 7 countries (Australia, New Zealand, Canada, Japan, Thailand, United Kingdom, United States). EXPOSURES Facility characteristics (census count, facility age, nurse to patient ratio) and selected facility practices (use of automated PD, use of icodextrin or biocompatible PD solutions, antibiotic prophylaxis strategies, duration of PD training). OUTCOMES Peritonitis rate (by country, overall and variation across facilities), microbiology patterns. ANALYTICAL APPROACH Poisson rate estimation, proportional rate models adjusted for selected patient case-mix variables. RESULTS 2,272 peritonitis episodes were identified in 7,051 patients (crude rate, 0.28 episodes/patient-year). Facility peritonitis rates were variable within each country and exceeded 0.50/patient-year in 10% of facilities. Overall peritonitis rates, in episodes per patient-year, were 0.40 (95% CI, 0.36-0.46) in Thailand, 0.38 (95% CI, 0.32-0.46) in the United Kingdom, 0.35 (95% CI, 0.30-0.40) in Australia/New Zealand, 0.29 (95% CI, 0.26-0.32) in Canada, 0.27 (95% CI, 0.25-0.30) in Japan, and 0.26 (95% CI, 0.24-0.27) in the United States. The microbiology of peritonitis was similar across countries, except in Thailand, where Gram-negative infections and culture-negative peritonitis were more common. Facility size was positively associated with risk for peritonitis in Japan (rate ratio [RR] per 10 patients, 1.07; 95% CI, 1.04-1.09). Lower peritonitis risk was observed in facilities that had higher automated PD use (RR per 10 percentage points greater, 0.95; 95% CI, 0.91-1.00), facilities that used antibiotics at catheter insertion (RR, 0.83; 95% CI, 0.69-0.99), and facilities with PD training duration of 6 or more (vs <6) days (RR, 0.81; 95% CI, 0.68-0.96). Lower peritonitis risk was seen in facilities that used topical exit-site mupirocin or aminoglycoside ointment, but this association did not achieve conventional levels of statistical significance (RR, 0.79; 95% CI, 0.62-1.01). LIMITATIONS Sampling variation, selection bias (rate estimates), and residual confounding (associations). CONCLUSIONS Important international differences exist in the risk for peritonitis that may result from varied and potentially modifiable treatment practices. These findings may inform future guidelines in potentially setting lower maximally acceptable peritonitis rates.
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Affiliation(s)
- Jeffrey Perl
- Arbor Research Collaborative for Health, Ann Arbor, MI; St Michael's Hospital, Toronto, Canada.
| | | | | | - Neil Boudville
- Medical School, University of Western Australia, Perth, Australia
| | - Talerngsak Kanjanabuch
- Center of Excellence in Kidney Metabolic Disorders and Division of Nephrology, Department of Medicine, Chulalongkorn University, Bangkok, Thailand
| | | | - Sharon J Nessim
- Division of Nephrology, Jewish General Hospital, McGill University, Montreal, Canada
| | | | | | | | | | | | | | - Graham Woodrow
- Renal Unit, St James's University Hospital, Leeds, United Kingdom
| | - Junhui Zhao
- Arbor Research Collaborative for Health, Ann Arbor, MI
| | - David W Johnson
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia; Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia; Translational Research Institute, Brisbane, Australia
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Wang J, Bieber BA, Hou FF, Port FK, Anand S. Mineral and bone disorder and management in the China Dialysis Outcomes and Practice Patterns Study. Chin Med J (Engl) 2019; 132:2775-2782. [PMID: 31856047 PMCID: PMC6940068 DOI: 10.1097/cm9.0000000000000533] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Despite a growing population of patients starting hemodialysis in China, little is known about markers of mineral bone disease (MBD) and their management. We present data on prevalence and correlates of hypocalcemia, hyperphosphatemia, and secondary hyperparathyroidism from the China Dialysis Outcomes and Practice Patterns Study (DOPPS), with evaluation of whether these laboratory markers triggered changes in management. METHODS We compared the frequency of measurement and prevalence of poor control of MBD markers in China DOPPS with other DOPPS regions. We also used generalized estimating equations to assess correlates of MBD markers, and separate models to assess predictors of vitamin D and phosphate binder prescriptions in the China DOPPS. RESULTS Severe hyperphosphatemia (>7 mg/dL) and secondary hyperparathyroidism (>600 pg/mL) were common (27% and 21% prevalence, respectively); both were measured infrequently (14.9% and 3.2% of patients received monthly measurements in China). Frequency of dialysis sessions was positively associated with hyperphosphatemia; presence of residual kidney function was negatively associated with both hyperphosphatemia and secondary hyperparathyroidism. Laboratory measures indicating poor control of MBD were not associated with subsequent prescription of active vitamin D or phosphate binder. CONCLUSIONS There are substantial opportunities for improvement and standardization of MBD management in China. Development of country-specific guidelines may yield realistic targets and standardization of medication use accounting for availability and cost.
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Affiliation(s)
- Jun Wang
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China
| | | | - Fan-Fan Hou
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China
| | | | - Shuchi Anand
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, CA, USA
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Sukul N, Speyer E, Tu C, Bieber BA, Li Y, Lopes AA, Asahi K, Mariani L, Laville M, Rayner HC, Stengel B, Robinson BM, Pisoni RL. Pruritus and Patient Reported Outcomes in Non-Dialysis CKD. Clin J Am Soc Nephrol 2019; 14:673-681. [PMID: 30975656 PMCID: PMC6500934 DOI: 10.2215/cjn.09600818] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 02/20/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND OBJECTIVES Among patients on hemodialysis, pruritus has been associated with poorer mental and physical quality of life, sleep quality, depression, and mortality. We evaluated patients with nondialysis CKD to describe the prevalence of pruritus, identify associated factors, and investigate associations with patient-reported outcomes. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Using cross-sectional data from patient questionnaires in the CKD Outcomes and Practice Patterns Study (CKDopps), we asked patients with CKD stages 3-5 (nondialysis) from the United States, Brazil, and France to identify how much they were bothered by pruritus. Response options ranged from "not at all" to "extremely." Log-Poisson regression, yielding prevalence ratios, was used to evaluate associations of moderate-to-extreme pruritus with patient characteristics, CKD stage, self-reported depression symptoms, and restless sleep. Mixed linear regression was used to examine associations between pruritus and physical and mental component summary scores, with lower scores indicating poorer quality of life. RESULTS Of the 5658 CKDopps patients enrolled in the United States, Brazil, and France, 3780 (67%) answered the pruritus question. The prevalence of moderate-to-extreme pruritus was 24%, and more likely in older patients, women, and those with stage 5 CKD, lung disease, diabetes, and physician-diagnosed depression. In adjusted models, patients with moderate pruritus had physical and mental component summary scores 3.5 (95% confidence interval [95% CI], -4.6 to -2.3) and 2.3 (95% CI, -3.2 to -1.5) points lower, respectively, than patients without pruritus, and they also had a higher adjusted prevalence of patient-reported depression (prevalence ratio, 1.83; 95% CI, 1.58 to 2.11) and restless sleep (prevalence ratio, 1.69; 95% CI, 1.49 to 1.91) compared with patients without pruritus. These patient-reported outcomes were progressively worse with increasing severity of pruritus. CONCLUSIONS Our findings demonstrate high prevalence of pruritus in nondialysis CKD, as well as strong associations of pruritus with poor health-related quality of life, self-reported depression symptoms, and self-reported poor sleep.
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Affiliation(s)
- Nidhi Sukul
- Department of Internal Medicine, Division of Nephrology and
| | - Elodie Speyer
- Centre for Research in Epidemiology and Population Health, Univ Paris-Saclay, Univ Paris Sud, Université Versailles Saint Quentin, UMRS 1018, Villejuif, France
| | - Charlotte Tu
- Arbor Research Collaborative for Health, Ann Arbor, Michigan
| | - Brian A Bieber
- Arbor Research Collaborative for Health, Ann Arbor, Michigan
| | - Yun Li
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
| | - Antonio A Lopes
- Department of Internal Medicine, Federal University of Bahia, Salvador, Brazil
| | - Koichi Asahi
- Division of Nephrology and Hypertension, Department of Internal Medicine, Iwate Medical University School of Medicine, Morioka, Japan
| | - Laura Mariani
- Department of Internal Medicine, Division of Nephrology and
| | - Maurice Laville
- Nephrology Department, Lyon Sud Hospital, Lyon University, Laboratoire de Recherche en Cardiovasculaire, Métabolisme, diabétologie et Nutrition INSERM U 1060, Pierre Benite, France; and
| | - Hugh C Rayner
- Department of Renal Medicine, Birmingham Heartlands Hospital, Birmingham, United Kingdom
| | - Bénédicte Stengel
- Centre for Research in Epidemiology and Population Health, Univ Paris-Saclay, Univ Paris Sud, Université Versailles Saint Quentin, UMRS 1018, Villejuif, France
| | | | - Ronald L Pisoni
- Arbor Research Collaborative for Health, Ann Arbor, Michigan
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Stirnadel-Farrant HA, Karaboyas A, Cizman B, Bieber BA, Kler L, Jones D, Cobitz AR, Robinson BM. Cardiovascular Event Rates Among Hemodialysis Patients Across Geographical Regions-A Snapshot From The Dialysis Outcomes and Practice Patterns Study (DOPPS). Kidney Int Rep 2019; 4:864-872. [PMID: 31194073 PMCID: PMC6551512 DOI: 10.1016/j.ekir.2019.03.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 02/20/2019] [Accepted: 03/18/2019] [Indexed: 12/19/2022] Open
Abstract
Introduction Cardiovascular (CV) morbidity and mortality are excessively high among hemodialysis (HD) patients. Anemia is a common complication of chronic kidney disease (CKD) and a known risk factor for CV events. To understand the impact of the recent regulatory and guideline changes in anemia management, we examined regional CV event rates in high-risk and erythropoiesis-stimulating agent (ESA)-hyporesponsive HD patients. Methods A prospective cohort study including 16,560 HD patients, 8660 CV high-risk, and 884 hyporesponsive to ESAs, from the Dialysis Outcomes and Practice Patterns Study (DOPPS) phase 4 (2009-2011) and phase 5 (2012-2015) was conducted to quantify all-cause mortality, major adverse cardiovascular events (MACE), and MACE plus heart failure and thromboembolic events (MACE+). Results The MACE+ rates (per 100 patient-years) were highest in North America (NA) (19.4; 95% CI = 18.2-20.7), followed by Europe (EU) (17.4; 95% CI = 16.6-18.1) and lowest in Japan (7.5; 95% CI = 6.9-8.1). When restricted to the high CV risk population, rates increased by 36% in NA, 45% in EU, and 72% in Japan. Mortality accounted for >74% of MACE+ events. MACE+ rates in ESA-hyporesponsive patients and high CV risk patients were similar in NA and EU cohorts. There were minimal differences in outcomes between the DOPPS phases 4 and 5. Conclusion Cardiovascular event rates are high in the HD population, vary by geographic region, and are substantially higher in high CV risk patients and ESA-hyporesponsive patients; however, the rates appear not to be affected by anemia guideline changes. The findings from this study will be essential to contextualize the design of future CV anemia-related outcome studies and clinical trials.
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Affiliation(s)
| | - Angelo Karaboyas
- Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA
| | - Borut Cizman
- GlaxoSmithKline, Collegeville, Pennsylvania, USA
| | - Brian A Bieber
- Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA
| | - Lata Kler
- GlaxoSmithKline, Stockley Park, Uxbridge, UK
| | | | | | - Bruce M Robinson
- Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA
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11
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Tennankore K, Zhao J, Karaboyas A, Bieber BA, Robinson BM, Morgenstern H, Jassal SV, Finkelstein FO, Kanjanabuch T, Cheawchanwattana A, Pisoni RL, Sloand JA, Perl J. The Association of Functional Status with Mortality and Dialysis Modality Change: Results from the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS). Perit Dial Int 2019; 39:103-111. [PMID: 30739094 DOI: 10.3747/pdi.2018.00094] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 11/14/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Little is known about the prevalence of functional impairment in peritoneal dialysis (PD) patients, its variation by country, and its association with mortality or transfer to hemodialysis. METHODS A prospective cohort study was conducted in PD patients from 7 countries in the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS) (2014 - 2017). Functional status (FS) was assessed by combining self-reports of 8 instrumental and 5 basic activities of daily living, using the Lawton-Brody and the Katz questionnaires. Summary FS scores, ranging from 1.25 (most dependent) to 13 (independent), were based on the patient's ability to perform each activity with or without assistance. Logistic regression was used to estimate the odds ratio (OR; 95% confidence interval [CI]) of a FS score < 11 comparing each country with the United States (US). Cox regression was used to estimate the hazard ratio (HR; 95% CI) for the effect of a low FS score on mortality and transfer to hemodialysis, adjusting for case mix. RESULTS Of 2,593 patients with complete data on FS, 48% were fully independent (FS = 13), 32% had a FS score 11 to < 13, 14% had a FS score 8 to < 11, and 6% had a FS score < 8. Relative to the US, low FS scores (< 11; more dependent) were more frequent in Thailand (OR = 10.48, 5.90 - 18.60) and the United Kingdom (UK) (OR = 3.29, 1.77 - 6.08), but similar in other PDOPPS countries. The FS score was inversely and monotonically associated with mortality but not with transfer to hemodialysis; the HR, comparing a FS score < 8 vs 13, was 4.01 (2.44 - 6.61) for mortality and 0.91 (0.58 - 1.43) for transfer to hemodialysis. CONCLUSION Regional differences in FS scores observed across PDOPPS countries may have been partly due to differences in regional patient selection for PD. Functional impairment was associated with mortality but not with permanent transfer to hemodialysis.
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Affiliation(s)
| | - Junhui Zhao
- Arbor Research Collaborative for Health, Ann Arbor, MI, USA
| | | | - Brian A Bieber
- Arbor Research Collaborative for Health, Ann Arbor, MI, USA
| | | | - Hal Morgenstern
- Departments of Epidemiology and Environmental Health Sciences, School of Public Health, and Department of Urology, Medical School, University of Michigan, Ann Arbor, MI, USA
| | - S Vanita Jassal
- Division of Nephrology, University Health Network, Toronto, ON, Canada
| | | | - Talerngsak Kanjanabuch
- Kidney and Metabolic Research Center, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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12
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Port FK, Morgenstern H, Bieber BA, Karaboyas A, McCullough KP, Tentori F, Pisoni RL, Robinson BM. Understanding associations of hemodialysis practices with clinical and patient-reported outcomes: examples from the DOPPS. Nephrol Dial Transplant 2018; 32:ii106-ii112. [PMID: 28201556 PMCID: PMC5837538 DOI: 10.1093/ndt/gfw287] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 06/18/2016] [Indexed: 11/14/2022] Open
Affiliation(s)
- Friedrich K Port
- Arbor Research Collaborative for Health, Ann Arbor, MI, USA.,Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Hal Morgenstern
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA.,Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, USA.,Department of Urology, Medical School, University of Michigan, Ann Arbor, MI, USA
| | - Brian A Bieber
- Arbor Research Collaborative for Health, Ann Arbor, MI, USA
| | | | | | - Francesca Tentori
- Arbor Research Collaborative for Health, Ann Arbor, MI, USA.,Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Bruce M Robinson
- Arbor Research Collaborative for Health, Ann Arbor, MI, USA.,Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
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13
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Yamamoto S, Karaboyas A, Komaba H, Taniguchi M, Nomura T, Bieber BA, De Sequera P, Christensson A, Pisoni RL, Robinson BM, Fukagawa M. Mineral and bone disorder management in hemodialysis patients: comparing PTH control practices in Japan with Europe and North America: the Dialysis Outcomes and Practice Patterns Study (DOPPS). BMC Nephrol 2018; 19:253. [PMID: 30290781 PMCID: PMC6173912 DOI: 10.1186/s12882-018-1056-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 09/24/2018] [Indexed: 12/26/2022] Open
Abstract
Background High-circulating level of parathyroid hormone (PTH) is associated with elevated mortality in dialysis patients. The Japanese Society for Dialysis Therapy guideline suggests a lower PTH target than other international guidelines; thus, PTH control may differ in Japan compared with other regions, and be associated with mortality. Methods We analyzed data from hemodialysis patients with ≥3 measurements of PTH during the first 9 months after enrollment in the Dialysis Outcomes and Practice Patterns Study (DOPPS) phases 4–5 (2009–2015). PTH control was assessed by the mean, slope, and mean squared error (MSE) of all PTH measurements over the 9-month run-in period. Distribution of each PTH control was assessed by regions (Europe/Australia/New Zealand [Eur/ANZ], Japan and North America) and dialysis vintage. Mortality rates were compared across PTH control categories using Cox regression models. Results Mean PTH was lower in Japan than in other regions across dialysis vintage categories. In patients with dialysis vintage < 90 days, PTH level was more likely to decline > 5% per month in Japan (48% of patients) versus Eur/ANZ (35%) and North America (35%). In patients with dialysis vintage > 1 year, Japanese patients maintained steady PTH, while patients in Eur/ANZ and North America were more likely to experience a PTH increase. Mean PTH was associated with mortality in the overall samples (highest mortality rate for PTH > 600 pg/mL, hazard ratio, 1.35; 95% confidence interval, 1.20 to 1.52 vs PTH 200–399 pg/mL), and the association was obvious in the prevalent patients (hazard ratio, 1.44; 95% confidence interval, 1.26 to 1.65). PTH slope and MSE did not show significant association with mortality in the overall sample as well as in subjects stratified both by region and dialysis vintage. Conclusion PTH control in hemodialysis patients, as measured by keeping a stable PTH level over 9 months, was observed in Japan contrasted with other regions. High PTH mean, but not increased PTH slope and MSE, was associated with mortality especially in prevalent patients.
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Affiliation(s)
- Suguru Yamamoto
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Niigata, 951-8510, Japan.
| | | | - Hirotaka Komaba
- Division of Nephrology, Endocrinology and Metabolism, Tokai University School of Medicine, Isehara, Japan
| | | | - Takanobu Nomura
- Medical Affairs Department, Kyowa Hakko Kirin Co. Ltd., Tokyo, Japan
| | - Brian A Bieber
- Arbor Research Collaborative for Health, Ann Arbor, MI, USA
| | | | | | | | | | - Masafumi Fukagawa
- Division of Nephrology, Endocrinology and Metabolism, Tokai University School of Medicine, Isehara, Japan
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14
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Pisoni RL, Bieber BA, Al Wakeel J, Al Arrayed S, Alkandari N, Hassan M, Karkar A, Al Lawati NM, Al Ali F, Albert JM, Robinson BM. The dialysis outcomes and practice patterns study phase 5 in the Gulf Cooperation Council countries: Design and study methods. Saudi J Kidney Dis Transpl 2018; 27:S1-11. [PMID: 27991474 DOI: 10.4103/1319-2442.194878] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The Dialysis Outcomes and Practice Patterns Study (DOPPS) is an international prospective cohort study of the relationships between hemodialysis (HD) care practices and HD patient outcomes. The DOPPS began in 1996, in the United States, and has since expanded to 21 countries, collecting detailed data from >75,000 HD patients, with >200 scientific publications, focused on describing HD practices associated with improved HD patient outcomes. The goal of DOPPS is to help HD patients "live better and live longer." Starting in 2012, the DOPPS was able to expand to all six of the Gulf Cooperation Council (GCC) countries, namely, Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates. The DOPPS study design consists of selecting HD facilities for study participation in each country to represent the different types of HD facilities and geographic regions within each GCC country. Within each study site, HD patients were randomly selected for detailed data collection to represent the HD practices within each participating HD facility. Altogether, 41 HD facilities have participated in the GCC-DOPPS Phase 5 study including 20 facilities from Saudi Arabia, nine from the United Arab Emirates, four each from Kuwait and Oman, two from Qatar, and one from Bahrain. Herein, we provide a detailed description of the study design and methods, data collection, study management, scientific investigator oversight and guidance, and study governance and support for the GCCDOPPS Phase 5 study.
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Affiliation(s)
| | - Brian A Bieber
- Arbor Research Collaborative for Health, Ann Arbor, MI, USA
| | | | | | | | - Mohamed Hassan
- Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | | | | | | | | | - Bruce M Robinson
- Arbor Research Collaborative for Health; Department of Internal Medicine, Division of Nephrology, University of Michigan, Ann Arbor, MI, USA
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- List of Study Group in Acknowledgment
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15
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Rayner HC, Larkina M, Wang M, Graham-Brown M, van der Veer SN, Ecder T, Hasegawa T, Kleophas W, Bieber BA, Tentori F, Robinson BM, Pisoni RL. International Comparisons of Prevalence, Awareness, and Treatment of Pruritus in People on Hemodialysis. Clin J Am Soc Nephrol 2017; 12:2000-2007. [PMID: 28923831 PMCID: PMC5718267 DOI: 10.2215/cjn.03280317] [Citation(s) in RCA: 132] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 08/17/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Uremic pruritus in patients on hemodialysis is associated with depression, lower quality of life, and mortality. We studied the prevalence, awareness, and treatment of pruritus to assess how well this important condition is currently managed internationally. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Data from 35,452 patients on hemodialysis in up to 17 countries from the Dialysis Outcomes and Practice Patterns Study were analyzed to describe pruritus prevalence from 1996 to 2015. Data from 6256 patients and 268 medical directors in 17 countries in 2012-2015 were analyzed to describe predictors, effects, medical directors' awareness, and treatment of pruritus. RESULTS Patients very much or extremely bothered by itching declined from 28% in 1996 to 18% in 2015. In 2012-2015, among patients nearly always or always bothered by itching, pruritus had a major effect on work and social life; 18% used no treatment for pruritus, and 17% did not report itching to health care staff. In total, 69% of medical directors underestimated the prevalence of pruritus in their unit. Managing high serum phosphorus and low Kt/V was ranked as the most important intervention, but no relationship was found between these factors and pruritus; 57% of medical directors used oral antihistamines for first-line chronic treatment of pruritus. Gabapentin was used by 45% as first-, second-, or third-line treatment. Nalfurafine was only used in Japan. CONCLUSIONS The prevalence of pruritus in people on hemodialysis is decreasing but remains underestimated. Large numbers of patients on hemodialysis with severe pruritus do not receive treatment. There is wide variation in the use of unlicensed medications for the treatment of pruritus. These data provide a benchmark for initiatives to improve the management of uremic pruritus. MULTIMEDIA This article contains multimedia at https://vimeo.com/49458473This article contains multimedia at vimeo.com/49455976.
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Affiliation(s)
- Hugh C Rayner
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
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16
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Hoshino J, Larkina M, Karaboyas A, Bieber BA, Ubara Y, Takaichi K, Akizawa T, Akiba T, Fukuhara S, Pisoni RL, Saito A, Robinson BM. Unique hemoglobin A1c level distribution and its relationship with mortality in diabetic hemodialysis patients. Kidney Int 2017; 92:497-503. [DOI: 10.1016/j.kint.2017.02.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 01/17/2017] [Accepted: 02/02/2017] [Indexed: 11/27/2022]
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17
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Wong MM, McCullough KP, Bieber BA, Bommer J, Hecking M, Levin NW, McClellan WM, Pisoni RL, Saran R, Tentori F, Tomo T, Port FK, Robinson BM. Interdialytic Weight Gain: Trends, Predictors, and Associated Outcomes in the International Dialysis Outcomes and Practice Patterns Study (DOPPS). Am J Kidney Dis 2017; 69:367-379. [DOI: 10.1053/j.ajkd.2016.08.030] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 08/13/2016] [Indexed: 11/11/2022]
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18
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Al-Ali FS, Bieber BA, Pisoni RL, Ezzat H, AlGhonaim M, AlHejaili F, AlGhareeb S, Saleh A, Al Maimani Y, Alyousef A, Ahmed HZ, Hamad A. Nutritional status and outcomes in hemodialysis patients from the Gulf Cooperation Council countries enrolled in the dialysis outcome and practice patterns study phase 5 (2012-2015). Saudi J Kidney Dis Transpl 2016; 27:S31-41. [PMID: 27991477 DOI: 10.4103/1319-2442.194888] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Nutrition is an important factor in maintaining good health of hemodialysis (HD) patients, affecting their morbidity and mortality. The Dialysis Outcomes and Practice Patterns Study (DOPPS) is an international observational study assessing differences in dialysis practices and outcomes across >20 countries. Here, we present the results for the Gulf Cooperation Council (GCC) countries regarding nutrition data and its relationship with outcomes as a part of the DOPPS Phase 5 study (2012-2015). Data were from Phase 5 of the DOPPS. Main analyses were based on 927 adult chronic HD patients enrolled at the start of the GCC-DOPPS Phase 5 study from each of the 40 randomly selected GCC HD facilities from Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates. Within each participating facility, 20-30 patients were randomly selected, depending on facility size. Analysis showed minor differences across GCC countries in age, albumin levels, nutrition supplement use, and being bothered by the lack of appetite. Elderly (>60 years old) and diabetic HD patients displayed poorer nutritional parameters than young and nondiabetic patients. A low albumin level (<3.2 g/dL) was associated with the highest risk of mortality with a hazard ratio (HR) of 2.47 (P <0.0001) followed by diabetes with HR 1.57 (P <0.04) and older age [HR= 1.27/10 years older (P <0.01)]. Quality of life measures physical component summary and mental component summary correlated negatively with albumin <3.2 g/dL (-2.18 and -5.5, respectively, P <0.05 for each), and with serum creatinine level <7.5 mg/dL (-2.29 and -2.1 respectively, P <0.05 for each. We are presenting the first study of the nutrition status and outcomes for HD patients in the GCC countries in DOPPS. Our results were mostly comparable to findings in previous trials in other countries. Although the data are observational, our study provides good insight into aspects of nutrition in the GCC countries and can be compared to the rest of the world to better understand trends and practice differences.
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Affiliation(s)
- Fadwa S Al-Ali
- Department of Nephrology, Hamad General Hospital, Doha, Qatar
| | - Brian A Bieber
- Arbor Research Collaborative for Health, Ann Arbor, MI, USA
| | | | - Hany Ezzat
- Department of Nephrology, Hamad General Hospital, Doha, Qatar
| | - Mohammed AlGhonaim
- Nephrology Division, Department of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Fayez AlHejaili
- Department of Nephrology, King Saud University for Health Sciences, Riyadh, Saudi Arabia
| | - Sumaya AlGhareeb
- Department of Nephrology, Salmaniya Medical Complex, Manama, Bahrain
| | - Abdulkarim Saleh
- Department of Nephrology, Shaikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | | | - Anas Alyousef
- Department of Nephrology, Farwaniya Hospital, Kuwait City, Kuwait
| | - Haroun Z Ahmed
- Saudi Center for Organ Transplantation, Riyadh, Saudi Arabia
| | - Abdullah Hamad
- Department of Nephrology, Hamad General Hospital, Doha, Qatar
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- List of Study Group in Acknowledgment
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AlSahow A, AlRukhaimi M, Al Wakeel J, Al-Ghamdi SMG, AlGhareeb S, AlAli F, Al Salmi I, AlHelal B, AlGhonaim M, Bieber BA, Pisoni RL. Demographics and key clinical characteristics of hemodialysis patients from the Gulf Cooperation Council countries enrolled in the dialysis outcomes and practice patterns study phase 5 (2012-2015). Saudi J Kidney Dis Transpl 2016; 27:S12-23. [PMID: 27991475 DOI: 10.4103/1319-2442.194885] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- Ali AlSahow
- Division of Nephrology, Jahra Hospital, Jahra, Kuwait
| | | | - Jamal Al Wakeel
- Nephrology Division, Department of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | | | | | | | | | | | - Mohammed AlGhonaim
- Nephrology Division, Department of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Brian A Bieber
- Arbor Research Collaborative for Health, Ann Arbor,MI, USA
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- List of Study Group in Acknowledgement
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20
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Abouchacra S, Obaidli A, Al-Ghamdi SMG, Al Wakeel J, Al Salmi I, Al Ghareeb S, Al Azmi M, Elsayed M, Bieber BA, Pisoni RL. Gulf Cooperation Council-dialysis outcomes and practice patterns study: An overview of anemia management trends at the regional and country specific levels in the Gulf Cooperation Council countries. Saudi J Kidney Dis Transpl 2016; 27:51-61. [PMID: 27991479 DOI: 10.4103/1319-2442.194895] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
The Gulf Cooperation Council-Dialysis Outcomes and Practice Patterns Study (GCC-DOPPS) marks the joining of the six Gulf region countries including Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates to the main DOPPS study in 2012. The current review is a descriptive reporting on results related to the management of anemia from these countries. Our data demonstrate consistent anemia management patterns across the GCC countries allowing the achievement of international treatment levels. Overall, the majority of hemodialysis patients were prescribed appropriate erythropoiesis-stimulating agents (ESAs) and supplemental iron, enabling the attainment of mean hemoglobin (Hb) level of 10.9 g/dL. Comparisons of the individual country profiles reveal individual differences in the choice and mode of ESA and iron administration. However, all countries displayed good compliance with guideline recommendations. The same challenges as elsewhere are faced in the GCC, with respect to optimizing Hb levels and judiciously using ESA and iron supplements. Some opportunities exist for focused efforts to fine tune inter-facility variability in anemia management based on continued data tracking. The latter is vital in enabling adopting new trends to further improve not only anemia management but also the wholesome care of dialysis patients.
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Affiliation(s)
- Samra Abouchacra
- Department of Medicine, Tawam Hospital, Al Ain, United Arab Emirates
| | - Ali Obaidli
- Department of Medicine, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - Saeed M G Al-Ghamdi
- Department of Medicine, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Jamal Al Wakeel
- Department of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Issa Al Salmi
- Department of Medicine, The Royal Hospital, Muscat, Oman
| | | | | | | | - Brian A Bieber
- Arbor Research Collaborative for Health, Ann Arbor, MI, USA
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- List of Study Group in Acknowledgment
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21
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Shaheen FAM, Al Wakeel J, Al-Ghamdi SMG, Alhelal B, AlGhareeb S, Al Obaidli AA, AlSalmi I, Abdulaziz HE, Bieber BA, Pisoni RL. Cardiovascular and cerebrovascular comorbidities in hemodialysis patients from the Gulf Cooperation Council countries enrolled in the dialysis outcome and practice pattern study phase 5 (2012-2015). Saudi J Kidney Dis Transpl 2016; 27:S24-30. [PMID: 27991476 DOI: 10.4103/1319-2442.194886] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
To determine the prevalence of cardiovascular comorbidities and their active risk factors in the selected hemodialysis centers in the Gulf Cooperation Council (GCC) countries, the Dialysis Outcome and Practice Pattern Study (DOPPS) was performed on 40 dialysis centers in the six GCC countries from June 2012 to May 2015. There were 21 dialysis centers from Saudi Arabia, nine from the United Arab Emirates (UAE), four from Kuwait, four from Oman, two from Qatar, and one from Bahrain. There were 922 patients participating in the study; 419 patients from Saudi Arabia, 144 from the UAE, 164 from Kuwait, 89 from Oman, 58 from Qatar, and 25 from Bahrain. Baseline data and laboratory investigations were obtained from every study patient, and the patients with any new events, change of dialysis prescription, or death were reported to the DOPPS main center during follow-up. The median age of the patients in the GCC centers was 55 years (range 32- 80 years), and the median percentage of males was 57%. The most common cause of chronic kidney disease among the study patients was diabetes mellitus (median: 43%) followed by hypertension (median: 29%) and glomerulonephritis (median: 9%). Hypertension (median 90%) and diabetes mellitus (median 52%) were the most common predisposing comorbidities to cardiovascular events in the study patients. The median ratios of patients with coronary artery disease, peripheral vascular disease, and congestive heart failure were 34%, 23%, and 24%, respectively. The median ratio for cerebrovascular comorbidities was 9%. The median prevalence of the factors that may predispose to the cardiovascular and cerebrovascular comorbidities such as gender of the patients, adequacy of dialysis, diabetes, hypertension, hypercholesterolemia, levels of anemia, parathormone levels, and calcium and phosphorus levels in the GCC countries were comparable with those in the previous DOPPS in other countries.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Brian A Bieber
- Arbor Research Collaborative for Health, Ann Arbor, MI, USA
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- List of Study Group in Acknowledgement
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Fuller DS, Zepel L, Bieber BA, Robinson BM, Pisoni RL. Hemodialysis Facility Variation in Hospitalization and Transfusions Using Medicare Claims: The DOPPS Practice Monitor for US Dialysis Care. Am J Kidney Dis 2016; 67:337-40. [DOI: 10.1053/j.ajkd.2015.10.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 10/07/2015] [Indexed: 11/11/2022]
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Jassal SV, Karaboyas A, Comment LA, Bieber BA, Morgenstern H, Sen A, Gillespie BW, De Sequera P, Marshall MR, Fukuhara S, Robinson BM, Pisoni RL, Tentori F. Functional Dependence and Mortality in the International Dialysis Outcomes and Practice Patterns Study (DOPPS). Am J Kidney Dis 2015; 67:283-92. [PMID: 26612280 DOI: 10.1053/j.ajkd.2015.09.024] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 09/21/2015] [Indexed: 11/11/2022]
Abstract
BACKGROUND Patients receiving long-term dialysis have among the highest mortality and hospitalization rates. In the nonrenal literature, functional dependence is recognized as a contributor to subsequent disability, recurrent hospitalization, and increased mortality. A higher burden of functional dependence with progressive worsening of kidney function has been observed in several studies, suggesting that functional dependence may contribute to both morbidity and mortality in dialysis patients. STUDY DESIGN Prospective cohort study. SETTING & PARTICIPANTS 7,226 hemodialysis patients from 12 countries in the DOPPS (Dialysis Outcomes and Practice Patterns Study) phase 4 (2009-2011) with self-reported data for functional status. PREDICTOR Patients' ability to perform 13 basic and instrumental activities of daily living was summarized to create an overall functional status score (range, 1.25 [most dependent] to 13 [functionally independent]). OUTCOME Cox regression was used to estimate the association between functional status and all-cause mortality, adjusting for several demographic and clinical risk factors for mortality. Median follow-up was 17.2 months. RESULTS The proportion of patients who could perform each activity of daily living task without assistance ranged from 97% (eating) to 47% (doing housework). 36% of patients could perform all 13 tasks without assistance (functional status = 13), and 14% of patients had high functional dependence (functional status < 8). Functionally independent patients were younger and had many indicators of better health status, including higher quality of life. Compared with functionally independent patients, the adjusted HR for mortality was 2.37 (95% CI, 1.92-2.94) for patients with functional status < 8. LIMITATIONS Possible nonresponse bias and residual confounding. CONCLUSIONS We found a high burden of functional dependence across all age groups and across all DOPPS countries. When adjusting for several known mortality risk factors, including age, access type, cachexia, and multimorbidity, functional dependence was a strong consistent predictor of mortality.
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Affiliation(s)
- S Vanita Jassal
- Division of Nephrology, University Health Network, Toronto, Canada
| | | | - Leah A Comment
- Arbor Research Collaborative for Health, Ann Arbor, MI; University of Michigan, Ann Arbor, MI
| | | | - Hal Morgenstern
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI; Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MI; Department of Urology, Medical School, University of Michigan, Ann Arbor, MI
| | | | - Brenda W Gillespie
- Arbor Research Collaborative for Health, Ann Arbor, MI; University of Michigan, Ann Arbor, MI
| | | | - Mark R Marshall
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; Department of Renal Medicine, Counties Manukau Health, Auckland, New Zealand; Baxter Healthcare (Asia Pacific), Shanghai, People's Republic of China
| | - Shunichi Fukuhara
- Kyoto University, Sakyo-ku, Kyoto, Japan; Center for Innovative Research in Community and Clinical Excellence, Fukushima Medical University, Fukushima, Japan
| | - Bruce M Robinson
- Arbor Research Collaborative for Health, Ann Arbor, MI; University of Michigan, Ann Arbor, MI
| | | | - Francesca Tentori
- Arbor Research Collaborative for Health, Ann Arbor, MI; Vanderbilt University Medical Center, Nashville, TN.
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Fuller DS, Bieber BA, Pisoni RL, Li Y, Morgenstern H, Akizawa T, Jacobson SH, Locatelli F, Port FK, Robinson BM. International Comparisons to Assess Effects of Payment and Regulatory Changes in the United States on Anemia Practice in Patients on Hemodialysis: The Dialysis Outcomes and Practice Patterns Study. J Am Soc Nephrol 2015; 27:2205-15. [PMID: 26582402 DOI: 10.1681/asn.2015060673] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 10/13/2015] [Indexed: 11/03/2022] Open
Abstract
For years, erythropoiesis-stimulating agent (ESA) use among patients on dialysis was much higher in the United States than in Europe or Japan. Sweeping changes to dialysis reimbursement and regulatory policies for ESA in the United States in 2011 were expected to reduce ESA use and hemoglobin levels. We used the Dialysis Outcomes and Practice Patterns Study (DOPPS) data from 7129 patients in 223 in-center hemodialysis facilities (average per month) to estimate and compare time trends in ESA dose and hemoglobin levels among patients on hemodialysis in the United States, Germany, Italy, Spain, the United Kingdom, and Japan. From 2010 to 2013, substantial declines in ESA use and hemoglobin levels occurred in the United States but not in other DOPPS countries. Between August of 2010 and April of 2013, mean weekly ESA dose in the United States decreased 40.4% for black patients and 38.0% for nonblack patients; mean hemoglobin decreased from 11.5 g/dl in black patients and 11.4 g/dl in nonblack patients to 10.6 g/dl in both groups. In 2010 and 2013, adjusted weekly ESA doses per kilogram were 41% and 11% lower, respectively, in patients in Europe and 60% and 18% lower, respectively, in patients in Japan than in nonblack patients in the United States. Adjusted hemoglobin levels in 2010 and 2013 were 0.07 g/dl lower and 0.56 g/dl higher, respectively, in patients in Europe and 0.93 and 0.01 g/dl lower, respectively, in patients in Japan than in nonblack patients in the United States. In conclusion, ESA dosing reductions in the United States likely reflect efforts in response to changes in reimbursement policy and regulatory guidance.
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Affiliation(s)
| | - Brian A Bieber
- Arbor Research Collaborative for Health, Ann Arbor, Michigan
| | - Ronald L Pisoni
- Arbor Research Collaborative for Health, Ann Arbor, Michigan
| | - Yun Li
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Hal Morgenstern
- Departments of Epidemiology and Environmental Health Sciences, School of Public Health, Department of Urology, Medical School, University of Michigan, Ann Arbor, Michigan
| | - Tadao Akizawa
- Department of Nephrology, Showa University School of Medicine, Shinagawa, Tokyo, Japan
| | - Stefan H Jacobson
- Department of Clinical Sciences, Division of Nephrology, Danderyd University Hospital, Stockholm, Sweden; and
| | | | | | - Bruce M Robinson
- Arbor Research Collaborative for Health, Ann Arbor, Michigan; Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
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25
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Tentori F, Zepel L, Fuller DS, Wang M, Bieber BA, Robinson BM, Pisoni RL. The DOPPS Practice Monitor for US Dialysis Care: PTH Levels and Management of Mineral and Bone Disorder in US Hemodialysis Patients. Am J Kidney Dis 2015; 66:536-9. [PMID: 26300197 DOI: 10.1053/j.ajkd.2015.07.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 07/14/2015] [Indexed: 11/11/2022]
Affiliation(s)
- Francesca Tentori
- Arbor Research Collaborative for Health, Ann Arbor, MI; Vanderbilt University Medical Center, Nashville, TN.
| | - Lindsay Zepel
- Arbor Research Collaborative for Health, Ann Arbor, MI
| | | | - Mia Wang
- Arbor Research Collaborative for Health, Ann Arbor, MI
| | | | - Bruce M Robinson
- Arbor Research Collaborative for Health, Ann Arbor, MI; University of Michigan, Ann Arbor, MI
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Kanda E, Bieber BA, Pisoni RL, Robinson BM, Fuller DS. Importance of simultaneous evaluation of multiple risk factors for hemodialysis patients' mortality and development of a novel index: dialysis outcomes and practice patterns study. PLoS One 2015; 10:e0128652. [PMID: 26030526 PMCID: PMC4451281 DOI: 10.1371/journal.pone.0128652] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 04/29/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND For hemodialysis (HD) patients, many risk factors for death are associated with each other intricately. However, they are often considered separately in clinical settings. We evaluated the maintenance HD patients' risk of death within one year from multiple risk factors simultaneously considering their interrelationships using a novel index (survival index, SI) for HD patients in the United States developed using data from the Dialysis Outcomes and Practice Patterns Study (DOPPS). METHODS We analyzed data from 3899 and 3765 patients to develop and validate SI, respectively. To predict death within one year, candidate models were developed using logistic regression models. The final model was determined by comparing the accuracy among the models for the prediction of deaths. RESULTS The model included age; body mass index; serum creatinine, albumin, total cholesterol and phosphorus levels; history of cardiovascular diseases; and arteriovenous fistula use. SI showed a higher accuracy in predicting death (c-statistic, 0.739) than geriatric nutritional risk index (0.647) and serum albumin level (0.637). The probability of death predicted on the basis of SI matched the observed number of deaths. Cox proportional hazard models for time-dependent SI showed that patients with low SI had a higher risk of death than patients with high SI [reference, Group 4 (26.1≤SI)]; Group 1 (SI<12.7), adjusted hazard ratio, 7.97 (95% CI, 5.02, 12.65); Group 2 (12.7≤SI<19.0), 3.18 (95% CI, 1.96, 5.16); Group 3 (19.0≤SI<26.1), 2.20 (95% CI, 1.33, 3.66). CONCLUSION Results of this study suggest that the simultaneous evaluation of multiple risk factors can more accurately assess patients' prognosis and identify patients at an increased risk of death than single factors.
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Affiliation(s)
- Eiichiro Kanda
- Department of Nephrology, Tokyo Kyosai Hospital, Meguro, Tokyo, Japan
- Life science and bioethics center, Tokyo Medical and Dental University, Bunkyo, Tokyo, Japan
- * E-mail:
| | - Brian A. Bieber
- Arbor Research Collaborative for Health, Ann Arbor, MI, United States of America
| | - Ronald L. Pisoni
- Arbor Research Collaborative for Health, Ann Arbor, MI, United States of America
| | - Bruce M. Robinson
- Arbor Research Collaborative for Health, Ann Arbor, MI, United States of America
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States of America
| | - Douglas S. Fuller
- Arbor Research Collaborative for Health, Ann Arbor, MI, United States of America
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Fissell RB, Karaboyas A, Bieber BA, Sen A, Li Y, Lopes AA, Akiba T, Bommer J, Ethier J, Jadoul M, Pisoni RL, Robinson BM, Tentori F. Phosphate binder pill burden, patient-reported non-adherence, and mineral bone disorder markers: Findings from the DOPPS. Hemodial Int 2015; 20:38-49. [PMID: 25975222 DOI: 10.1111/hdi.12315] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Because of multiple comorbidities, hemodialysis (HD) patients are prescribed many oral medications, including phosphate binders (PBs), often resulting in a high "pill burden." Using data from the international Dialysis Outcomes and Practice Patterns Study (DOPPS), we assessed associations between PB pill burden, patient-reported PB non-adherence, and levels of serum phosphorus (SPhos) and parathyroid hormone (PTH) using standard regression analyses. The study included data collected from 5262 HD patients from dialysis units participating in the DOPPS in 12 countries. PB prescription ranged from a mean of 7.4 pills per day in the United States to 3.9 pills per day in France. About half of the patients were prescribed at least 6 PB pills per day, and 13% were prescribed at least 12 PB pills per day. Overall, the proportion of patients who reported skipping PBs at least once in the past month was 45% overall, ranging from 33% in Belgium to 57% in the United States. There was a trend toward greater PB non-adherence and a higher number of prescribed PB pills per day. Non-adherence to PB prescription was associated with high SPhos (>5.5 mg/dL) and PTH (>600 pg/mL). Adherence to PB is a challenge for many HD patients and may be related to the number of PB pills prescribed. Prescription of a simplified PB regimen could improve patient adherence and perhaps improve SPhos and PTH levels.
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Affiliation(s)
| | - Angelo Karaboyas
- Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA
| | - Brian A Bieber
- Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA
| | - Ananda Sen
- University of Michigan, Ann Arbor, Michigan, USA
| | - Yun Li
- Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA.,University of Michigan, Ann Arbor, Michigan, USA
| | - Antonio A Lopes
- Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | | | | | - Jean Ethier
- Center Hospital de University of Montreal, Montreal, Quebec, Canada
| | - Michel Jadoul
- Cliniques St Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Ronald L Pisoni
- Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA
| | - Bruce M Robinson
- Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA.,University of Michigan, Ann Arbor, Michigan, USA
| | - Francesca Tentori
- Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA
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28
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Tentori F, Wang M, Bieber BA, Karaboyas A, Li Y, Jacobson SH, Andreucci VE, Fukagawa M, Frimat L, Mendelssohn DC, Port FK, Pisoni RL, Robinson BM. Recent changes in therapeutic approaches and association with outcomes among patients with secondary hyperparathyroidism on chronic hemodialysis: the DOPPS study. Clin J Am Soc Nephrol 2014; 10:98-109. [PMID: 25516917 DOI: 10.2215/cjn.12941213] [Citation(s) in RCA: 197] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND AND OBJECTIVES Elevated parathyroid hormone levels may be associated with adverse clinical outcomes in patients on dialysis. After the introduction of practice guidelines suggesting higher parathyroid hormone targets than those previously recommended, changes in parathyroid hormone levels and treatment regimens over time have not been well documented. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Using data from the international Dialysis Outcomes and Practice Patterns Study, trends in parathyroid hormone levels and secondary hyperparathyroidism therapies over the past 15 years and the associations between parathyroid hormone and clinical outcomes are reported; 35,655 participants from the Dialysis Outcomes and Practice Patterns Study phases 1-4 (1996-2011) were included. RESULTS Median parathyroid hormone increased from phase 1 to phase 4 in all regions except for Japan, where it remained stable. Prescriptions of intravenous vitamin D analogs and cinacalcet increased and parathyroidectomy rates decreased in all regions over time. Compared with 150-300 pg/ml, in adjusted models, all-cause mortality risk was higher for parathyroid hormone=301-450 (hazard ratio, 1.09; 95% confidence interval, 1.01 to 1.18) and >600 pg/ml (hazard ratio, 1.23; 95% confidence interval, 1.12 to 1.34). Parathyroid hormone >600 pg/ml was also associated with higher risk of cardiovascular mortality as well as all-cause and cardiovascular hospitalizations. In a subgroup analysis of 5387 patients not receiving vitamin D analogs or cinacalcet and with no prior parathyroidectomy, very low parathyroid hormone (<50 pg/ml) was associated with mortality (hazard ratio, 1.25; 95% confidence interval, 1.04 to 1.51). CONCLUSIONS In a large international sample of patients on hemodialysis, parathyroid hormone levels increased in most countries, and secondary hyperparathyroidism treatments changed over time. Very low and very high parathyroid hormone levels were associated with adverse outcomes. In the absence of definitive evidence in support of a specific parathyroid hormone target, there is an urgent need for additional research to inform clinical practice.
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Affiliation(s)
- Francesca Tentori
- Arbor Research Collaborative for Health, Ann Arbor, Michigan; Vanderbilt University Medical Center, Nashville, Tennessee
| | - Mia Wang
- Arbor Research Collaborative for Health, Ann Arbor, Michigan
| | - Brian A Bieber
- Arbor Research Collaborative for Health, Ann Arbor, Michigan
| | | | - Yun Li
- Arbor Research Collaborative for Health, Ann Arbor, Michigan; Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Stefan H Jacobson
- Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
| | | | - Masafumi Fukagawa
- Division of Nephrology, Endocrinology, and Metabolism, Tokai University School of Medicine, Isehara, Japan
| | - Luc Frimat
- Clinical Epidemiology, Inserm CIC-EC and Nephrology Department, Centre Hospitalier Universitaire de Nancy, Vandoeuvre-lès-Nancy, France
| | - David C Mendelssohn
- Department of Nephrology, Humber River Regional Hospital and University of Toronto, Weston, Ontario, Canada; and
| | | | - Ronald L Pisoni
- Arbor Research Collaborative for Health, Ann Arbor, Michigan
| | - Bruce M Robinson
- Arbor Research Collaborative for Health, Ann Arbor, Michigan; Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
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Lopes AA, Lantz B, Morgenstern H, Wang M, Bieber BA, Gillespie BW, Li Y, Painter P, Jacobson SH, Rayner HC, Mapes DL, Vanholder RC, Hasegawa T, Robinson BM, Pisoni RL. Associations of self-reported physical activity types and levels with quality of life, depression symptoms, and mortality in hemodialysis patients: the DOPPS. Clin J Am Soc Nephrol 2014; 9:1702-12. [PMID: 25278548 DOI: 10.2215/cjn.12371213] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND OBJECTIVES Physical activity has been associated with better health status in diverse populations, but the association in patients on maintenance hemodialysis is less established. Patient-reported physical activities and associations with mortality, health-related quality of life, and depression symptoms in patients on maintenance hemodialysis in 12 countries were examined. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS In total, 5763 patients enrolled in phase 4 of the Dialysis Outcomes and Practice Patterns Study (2009-2011) were classified into five aerobic physical activity categories (never/rarely active to very active) and by muscle strength/flexibility activity using the Rapid Assessment of Physical Activity questionnaire. The Kidney Disease Quality of Life scale was used for health-related quality of life. The Center for Epidemiologic Studies Depression scale was used for depression symptoms. Linear regression was used for associations of physical activity with health-related quality of life and depression symptoms scores. Cox regression was used for association of physical activity with mortality. RESULTS The median (interquartile range) of follow-up was 1.6 (0.9-2.5) years; 29% of patients were classified as never/rarely active, 20% of patients were classified as very active, and 20.5% of patients reported strength/flexibility activities. Percentages of very active patients were greater in clinics offering exercise programs. Aerobic activity, but not strength/flexibility activity, was associated positively with health-related quality of life and inversely with depression symptoms and mortality (adjusted hazard ratio of death for very active versus never/rarely active, 0.60; 95% confidence interval, 0.47 to 0.77). Similar associations with aerobic activity were observed in strata of age, sex, time on dialysis, and diabetes status. CONCLUSIONS The findings are consistent with the health benefits of aerobic physical activity for patients on maintenance hemodialysis. Greater physical activity was observed in facilities providing exercise programs, suggesting a possible opportunity for improving patient outcomes.
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Affiliation(s)
- Antonio Alberto Lopes
- Department of Internal Medicine, School of Medicine, Federal University of Bahia, Salvador, BA, Brazil
| | - Brett Lantz
- Arbor Research Collaborative for Health, Ann Arbor, Michigan; University of Michigan, Ann Arbor, Michigan
| | - Hal Morgenstern
- Arbor Research Collaborative for Health, Ann Arbor, Michigan; Departments of Epidemiology, Environmental Health Sciences, and Department of Urology, School of Medicine, University of Michigan, Ann Arbor, Michigan
| | - Mia Wang
- Arbor Research Collaborative for Health, Ann Arbor, Michigan
| | - Brian A Bieber
- Arbor Research Collaborative for Health, Ann Arbor, Michigan
| | - Brenda W Gillespie
- Arbor Research Collaborative for Health, Ann Arbor, Michigan; Biostatistics, School of Public Health and
| | - Yun Li
- Arbor Research Collaborative for Health, Ann Arbor, Michigan; Biostatistics, School of Public Health and
| | - Patricia Painter
- Department of Physical Therapy, University of Utah, Salt Lake City, Utah
| | - Stefan H Jacobson
- Division of Nephrology, Karolinska Institute, Danderyd Hospital, Stockholm, Sweden
| | - Hugh C Rayner
- Department of Renal Medicine, Birmingham Heartlands Hospital, Birmingham, United Kingdom
| | - Donna L Mapes
- Arbor Research Collaborative for Health, Ann Arbor, Michigan
| | | | - Takeshi Hasegawa
- Division of Nephrology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Tokyo, Japan
| | | | - Ronald L Pisoni
- Arbor Research Collaborative for Health, Ann Arbor, Michigan
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Tentori F, Fuller DS, Port FK, Bieber BA, Robinson BM, Pisoni RL. The DOPPS practice monitor for US dialysis care: potential impact of recent guidelines and regulatory changes on management of mineral and bone disorder among US hemodialysis patients. Am J Kidney Dis 2014; 63:851-4. [PMID: 24613057 DOI: 10.1053/j.ajkd.2014.02.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 02/04/2014] [Indexed: 11/11/2022]
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Kimata N, Karaboyas A, Bieber BA, Pisoni RL, Morgenstern H, Gillespie BW, Saito A, Akizawa T, Fukuhara S, Robinson BM, Port FK, Akiba T. Gender, low Kt/V, and mortality in Japanese hemodialysis patients: Opportunities for improvement through modifiable practices. Hemodial Int 2014; 18:596-606. [DOI: 10.1111/hdi.12142] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | | | - Brian A. Bieber
- Arbor Research Collaborative for Health; Ann Arbor Michigan USA
| | | | - Hal Morgenstern
- Arbor Research Collaborative for Health; Ann Arbor Michigan USA
- Departments of Epidemiology and Environmental Health Sciences; School of Public Health; University of Michigan; Ann Arbor Michigan USA
| | - Brenda W. Gillespie
- Arbor Research Collaborative for Health; Ann Arbor Michigan USA
- Department of Biostatistics; School of Public Health; University of Michigan; Ann Arbor Michigan USA
| | | | - Tadao Akizawa
- Division of Nephrology; Department of Medicine; Showa University School of Medicine; Tokyo Japan
| | - Shunichi Fukuhara
- Department of Epidemiology and Healthcare Research; Kyoto University Graduate School of Medicine and Public Health; Kyoto Japan
| | - Bruce M. Robinson
- Arbor Research Collaborative for Health; Ann Arbor Michigan USA
- Department of Internal Medicine-Nephrology; University of Michigan; Ann Arbor Michigan USA
| | - Friedrich K. Port
- Arbor Research Collaborative for Health; Ann Arbor Michigan USA
- Department of Internal Medicine-Nephrology; University of Michigan; Ann Arbor Michigan USA
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Fuller DS, Pisoni RL, Bieber BA, Port FK, Robinson BM. The DOPPS practice monitor for U.S. dialysis care: update on trends in anemia management 2 years into the bundle. Am J Kidney Dis 2013; 62:1213-6. [PMID: 24140369 DOI: 10.1053/j.ajkd.2013.09.006] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Accepted: 09/13/2013] [Indexed: 11/11/2022]
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Kawaguchi T, Karaboyas A, Robinson BM, Li Y, Fukuhara S, Bieber BA, Rayner HC, Andreucci VE, Pisoni RL, Port FK, Morgenstern H, Akizawa T, Saran R. Associations of frequency and duration of patient-doctor contact in hemodialysis facilities with mortality. J Am Soc Nephrol 2013; 24:1493-502. [PMID: 23886592 DOI: 10.1681/asn.2012080831] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
It is unknown whether regular patient-doctor contact (PDC) contributes to better outcomes for patients undergoing hemodialysis. Here, we analyzed the associations between frequency and duration of PDC during hemodialysis treatments with clinical outcomes among 24,498 patients from 778 facilities in the international Dialysis Outcomes and Practice Patterns Study (DOPPS). The typical facility PDC frequency, estimated by facility personnel, was high (more than once per week) for 55% of facilities, intermediate (once per week) for 24%, and low (less than once per week) for 21%. The mean ± SD estimated duration of a typical interaction between patient and physician was 7.7 ± 5.6 minutes. PDC frequency and duration varied across DOPPS phases and countries; the proportion of facilities with high PDC frequency was 17% in the United States and 73% across the other countries. Compared with high PDC frequency, the adjusted hazard ratio (HR) for all-cause mortality was 1.06 (95% confidence interval [CI], 0.96 to 1.17) for intermediate PDC frequency and 1.11 (95% CI, 1.01 to 1.23) for low PDC frequency (P=0.03 for trend). Furthermore, each 5-minutes-shorter duration of PDC was associated with a 5% higher risk for death, on average (HR, 1.05; 95% CI, 1.01 to 1.09), adjusted for PDC frequency and other covariates. Multivariable analyses also suggested modest inverse associations between both PDC frequency and duration with hospitalization but not with kidney transplantation. Taken together, these results suggest that policies supporting more frequent and longer duration of PDC may improve patient outcomes in hemodialysis.
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Affiliation(s)
- Takehiko Kawaguchi
- Division of Nephrology, Department of Internal Medicine, National Hospital Organization Chiba-East Hospital, Japan.
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Suri RS, Lindsay RM, Bieber BA, Pisoni RL, Garg AX, Austin PC, Moist LM, Robinson BM, Gillespie BW, Couchoud CG, Galland R, Lacson EK, Zimmerman DL, Li Y, Nesrallah GE. A multinational cohort study of in-center daily hemodialysis and patient survival. Kidney Int 2013; 83:300-7. [DOI: 10.1038/ki.2012.329] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Fuller DS, Pisoni RL, Bieber BA, Gillespie BW, Robinson BM. The DOPPS Practice Monitor for US Dialysis Care: Trends Through December 2011. Am J Kidney Dis 2013; 61:342-6. [DOI: 10.1053/j.ajkd.2012.10.002] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Accepted: 10/04/2012] [Indexed: 11/11/2022]
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Pisoni RL, Fuller DS, Bieber BA, Gillespie BW, Robinson BM. The DOPPS Practice Monitor for US dialysis care: trends through August 2011. Am J Kidney Dis 2012; 60:160-5. [PMID: 22560744 DOI: 10.1053/j.ajkd.2012.04.001] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Accepted: 04/03/2012] [Indexed: 11/11/2022]
Abstract
We have examined trends in hemodialysis practice from August 2010 to August 2011, a time frame spanning the implementation of the bundled PPS, a major ESA label change by the FDA, and announcements from CMS on the proposed and final rules for the first year of the Quality Incentive Program (QIP) plus the proposed rules for the second and third years of the QIP. Although many hemodialysis practices have remained stable during this 1-year time period, substantial changes have been seen. These include a decline in epoetin dose and hemoglobin levels, an increase in IV iron use and serum ferritin levels, and an increase in PTH levels. The rates of decline in hemoglobin and epoetin dosing levels were greatest in the 2 months after the ESA label change in June 2011. Trends in anemia care in ensuing months, with more follow-up time after the label change, will be of great interest. In view of declining hemoglobin levels, a mechanism for comprehensive monitoring of transfusion rates is warranted to understand this important aspect of care for hemodialysis patients. Regarding clinical outcomes, no trend in all-cause mortality has been evident during this 1-year time period. Additional follow-up is warranted to understand if findings reported here persist over time, and require confirmation with national data as these become available. Trends in clinical care may not necessarily affect patient outcomes, and careful evaluation is required to understand effects on patient outcomes.
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Affiliation(s)
- Ronald L Pisoni
- Arbor Research Collaborative for Health, Ann Arbor, MI, USA.
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Robinson BM, Fuller DS, Bieber BA, Turenne MN, Pisoni RL. The DOPPS Practice Monitor for US dialysis care: trends through April 2011. Am J Kidney Dis 2011; 59:309-12. [PMID: 22169621 DOI: 10.1053/j.ajkd.2011.11.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2011] [Accepted: 11/05/2011] [Indexed: 11/11/2022]
Affiliation(s)
- Bruce M Robinson
- Arbor Research Collaborative for Health, Ann Arbor, MI 48104, USA.
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