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Fitzgibbon JJ, Heindel P, Appah-Sampong A, Holden-Wingate C, Hentschel DM, Mamdani M, Ozaki CK, Hussain MA. Temporal trends in hemodialysis access creation during the fistula first era. J Vasc Surg 2024; 79:1483-1492.e3. [PMID: 38387816 DOI: 10.1016/j.jvs.2024.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 02/09/2024] [Accepted: 02/14/2024] [Indexed: 02/24/2024]
Abstract
OBJECTIVE Although forearm arteriovenous fistulas (AVFs) are the preferred initial vascular access for hemodialysis based on national guidelines, there are no population-level studies evaluating trends in creation of forearm vs upper arm AVFs and arteriovenous grafts (AVGs). The purpose of this study was to report temporal trends in first-time permanent hemodialysis access type, and to assess the effect of national initiatives on rates of AVF placement. METHODS Retrospective cross-sectional study (2012-2022) utilizing the Vascular Quality Initiative database. All patients older than 18 years with creation of first-time upper extremity surgical hemodialysis access were included. Anatomic location of the AVF or AVG (forearm vs upper arm) was defined based on inflow artery, outflow vein, and presumed cannulation zone. Primary analysis examined temporal trends in rates of forearm vs upper arm AVFs and AVGs using time series analyses (modified Mann-Kendall test). Subgroup analyses examined rates of access configuration stratified by age, sex, race, dialysis, and socioeconomic status. Interrupted time series analysis was performed to assess the effect of the 2015 Fistula First Catheter Last initiative on rates of AVFs. RESULTS Of the 52,170 accesses, 57.9% were upper arm AVFs, 25.2% were forearm AVFs, 15.4% were upper arm AVGs, and 1.5% were forearm AVGs. From 2012 to 2022, there was no significant change in overall rates of forearm or upper arm AVFs. There was a numerical increase in upper arm AVGs (13.9 to 18.2 per 100; P = .09), whereas forearm AVGs significantly declined (1.8 to 0.7 per 100; P = .02). In subgroup analyses, we observed a decrease in forearm AVFs among men (33.1 to 28.7 per 100; P = .04) and disadvantaged (Area Deprivation Index percentile ≥50) patients (29.0 to 20.7 per 100; P = .04), whereas female (17.2 to 23.1 per 100; P = .03), Black (15.6 to 24.5 per 100; P < .01), elderly (age ≥80 years) (18.7 to 32.5 per 100; P < .01), and disadvantaged (13.6 to 20.5 per 100; P < .01) patients had a significant increase in upper arm AVGs. The Fistula First Catheter Last initiative had no effect on the rate of AVF placement (83.2 to 83.7 per 100; P=.37). CONCLUSIONS Despite national initiatives to promote autogenous vascular access, the rates of first-time AVFs have remained relatively constant, with forearm AVFs only representing one-quarter of all permanent surgical accesses. Furthermore, elderly, Black, female, and disadvantaged patients saw an increase in upper arm AVGs. Further efforts to elucidate factors associated with forearm AVF placement, as well as potential physician, center, and regional variation is warranted.
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Affiliation(s)
- James J Fitzgibbon
- Department of Surgery, Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital/Harvard Medical School, Boston, MA; Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital/Harvard Medical School, Boston, MA
| | - Patrick Heindel
- Department of Surgery, Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital/Harvard Medical School, Boston, MA; Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital/Harvard Medical School, Boston, MA
| | - Abena Appah-Sampong
- Department of Surgery, Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital/Harvard Medical School, Boston, MA; Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital/Harvard Medical School, Boston, MA
| | - Christopher Holden-Wingate
- Department of Surgery, Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital/Harvard Medical School, Boston, MA
| | - Dirk M Hentschel
- Division of Renal Medicine, Brigham and Women's Hospital/Harvard Medical School, Boston, MA
| | - Muhammad Mamdani
- Data Science and Advanced Analytics, Unity Health Toronto, Toronto, Ontario, Canada; Temerty Centre for Artificial Intelligence Research and Education in Medicine, University of Toronto, Toronto, Ontario, Canada
| | - C Keith Ozaki
- Department of Surgery, Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital/Harvard Medical School, Boston, MA
| | - Mohamad A Hussain
- Department of Surgery, Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital/Harvard Medical School, Boston, MA; Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital/Harvard Medical School, Boston, MA.
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Nguyen KH, Thorsness R, Hayes S, Kim D, Mehrotra R, Swaminathan S, Baranwal N, Lee Y, Rivera-Hernandez M, Trivedi AN. Evaluation of Racial, Ethnic, and Socioeconomic Disparities in Initiation of Kidney Failure Treatment During the First 4 Months of the COVID-19 Pandemic. JAMA Netw Open 2021; 4:e2127369. [PMID: 34618039 PMCID: PMC8498850 DOI: 10.1001/jamanetworkopen.2021.27369] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 07/28/2021] [Indexed: 12/24/2022] Open
Abstract
Importance Persons with kidney failure require treatment (ie, dialysis or transplantation) for survival. The burden of the COVID-19 pandemic and pandemic-related disruptions in care have disproportionately affected racial and ethnic minority and socially disadvantaged populations, raising the importance of understanding disparities in treatment initiation for kidney failure during the pandemic. Objective To examine changes in the number and demographic characteristics of patients initiating treatment for incident kidney failure following the COVID-19 pandemic by race and ethnicity, county-level COVID-19 mortality rate, and neighborhood-level social disadvantage. Design, Setting, and Participants This cross-sectional time-trend study used data from US patients who developed kidney failure between January 1, 2018, and June 30, 2020. Data were analyzed between January and July 2021. Exposures COVID-19 pandemic. Main Outcomes and Measures Number of patients initiating treatment for incident kidney failure and mean estimated glomerular filtration rate (eGFR) at treatment initiation. Results The study population included 127 149 patients with incident kidney failure between January 1, 2018, and June 30, 2020 (mean [SD] age, 62.8 [15.3] years; 53 021 [41.7%] female, 32 932 [25.9%] non-Hispanic Black, and 19 835 [15.6%] Hispanic/Latino patients). Compared with the pre-COVID-19 period, in the first 4 months of the pandemic (ie, March 1 through June 30, 2020), there were significant decreases in the proportion of patients with incident kidney failure receiving preemptive transplantation (1805 [2.1%] pre-COVID-19 vs 551 [1.4%] during COVID-19; P < .001) and initiating hemodialysis treatment with an arteriovenous fistula (2430 [15.8%] pre-COVID-19 vs 914 [13.4%] during COVID-19; P < .001). The mean (SD) eGFR at initiation declined from 9.6 (5.0) mL/min/1.73 m2 to 9.5 (4.9) mL/min/1.73 m2 during the pandemic (P < .001). In stratified analyses by race/ethnicity, these declines were exclusively observed among non-Hispanic Black patients (mean [SD] eGFR: 8.4 [4.6] mL/min/1.73 m2 pre-COVID-19 vs 8.1 [4.5] mL/min/1.73 m2 during COVID-19; P < .001). There were significant declines in eGFR at initiation for patients residing in counties in the highest quintile of COVID-19 mortality rates (9.5 [5.0] mL/min/1.73 m2 pre-COVID-19 vs 9.2 [5.0] mL/min/1.73 m2 during COVID-19; P < .001), but not for patients residing in other counties. The number of patients initiating treatment for incident kidney failure was approximately 30% lower than projected in April 2020. Conclusions and Relevance In this cross-sectional study of US adults, the COVID-19 pandemic was associated with a substantially lower number of patients initiating treatment for incident kidney failure and treatment initiation at lower levels of kidney function during the first 4 months, particularly for Black patients and people living in counties with high COVID-19 mortality rates.
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Affiliation(s)
- Kevin H. Nguyen
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island
| | - Rebecca Thorsness
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island
| | - Susan Hayes
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island
| | - Daeho Kim
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island
| | - Rajnish Mehrotra
- Department of Medicine, University of Washington School of Medicine, Seattle
| | - Shailender Swaminathan
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island
- Sai University, Chennai, India
| | - Navya Baranwal
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Yoojin Lee
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island
| | - Maricruz Rivera-Hernandez
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island
| | - Amal N. Trivedi
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island
- Providence VA Medical Center, Providence, Rhode Island
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Lee YJ, Heo CM, Park S, Kim YW, Park JH, Kim IH, Ko J, Park BS. Top 100 cited articles on hemodialysis: A bibliometric analysis. Medicine (Baltimore) 2021; 100:e27237. [PMID: 34559120 PMCID: PMC10545359 DOI: 10.1097/md.0000000000027237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 07/23/2021] [Accepted: 08/24/2021] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION This study was conducted to better understand hemodialysis by reviewing the most-cited articles related to it. METHODS We searched articles on the Web of Science and selected the 100 most frequently cited articles. Subsequently, we reviewed these articles and identified their characteristics. RESULTS The 100 most frequently cited articles were published in 21 journals. The majority of these papers were published in the following journals: Kidney International (26 articles), New England Journal of Medicine (18 articles), Journal of the American Society of Nephrology (14 articles), and the American Journal of Kidney Disease (13 articles). The 100 most-cited articles were published in 25 countries. The United States of America was the country with the highest number of publications (65 articles). The University of Michigan was the institution with the highest number of articles (14 articles). FK Port was the author with the largest number of publications (13 articles). CONCLUSIONS This is the first study in the field of nephrology that provides a list of the 100 most-cited articles on hemodialysis. Through this study, clinicians will be able to recognize major academic interests and research trends in hemodialysis.
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Aono T, Shinya Y, Miyawaki S, Sugiyama T, Kumagai I, Takenobu A, Shin M, Saito N, Teraoka A. Changes in the Risk of Stroke in Dialysis Patients: A Retrospective Analysis over the Last 40 Years. Toxins (Basel) 2021; 13:350. [PMID: 34068165 PMCID: PMC8170903 DOI: 10.3390/toxins13050350] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 04/21/2021] [Revised: 05/06/2021] [Accepted: 05/11/2021] [Indexed: 11/17/2022] Open
Abstract
The stroke incidence in hemodialysis (HD) patients is high, but the associated factors remain largely unknown. This study aimed to analyze stroke incidence in HD patients and changes in risk factors. Data of 291 patients were retrospectively analyzed. The cumulative stroke incidences were 21.6% at 10 years and 31.5% at 20. Diabetic nephropathy (DN) significantly increased overall stroke (hazard ratio (HR), 2.24; 95% confidence interval (CI), 1.21-4.12; p = 0.001) and ischemic stroke (HR, 2.16; 95% CI, 1.00-4.64; p = 0.049). Patients treated with online HDF were less likely to have overall stroke (HR, 0.13; 95% CI, 0.03-0.56; p = 0.006) and ischemic stroke (HR, 0.08; 95% CI, 0.01-0.60; p = 0.014). DN (HR, 1.56; 95% CI, 1.08-2.27; p = 0.019) and age >80 years at HD initiation (20-49 years old; HR 0.13, 95% CI, 0.05-0.35, p < 0.001 and age 50-79 years; HR 0.42, 95% CI, 0.26-0.66, p < 0.001 (reference: age >80 years)) were significantly associated with stroke and/or death events. Over time, stroke risk increased in HD patients, due to the increasing number of DN. Although dialysis technology has advanced over time, these advances could not overcome other risk factors for stroke. Further increase in stroke and mortality due to aging remains a concern.
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Affiliation(s)
- Toshiya Aono
- Department of Neurosurgery, Teraoka Memorial Hospital, Hiroshima 729-3103, Japan; (T.A.); (A.T.); (A.T.)
| | - Yuki Shinya
- Department of Neurosurgery, Teraoka Memorial Hospital, Hiroshima 729-3103, Japan; (T.A.); (A.T.); (A.T.)
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo 113-8655, Japan; (S.M.); (M.S.); (N.S.)
| | - Satoru Miyawaki
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo 113-8655, Japan; (S.M.); (M.S.); (N.S.)
| | - Takehiro Sugiyama
- Diabetes and Metabolism Information Center, Research Institute, National Center for Global Health and Medicine, Tokyo 162-8655, Japan;
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Ibaraki 305-8575, Japan
| | - Isao Kumagai
- Department of Nephrology, Teraoka Memorial Hospital, Hiroshima 729-3103, Japan;
| | - Atsumi Takenobu
- Department of Neurosurgery, Teraoka Memorial Hospital, Hiroshima 729-3103, Japan; (T.A.); (A.T.); (A.T.)
| | - Masahiro Shin
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo 113-8655, Japan; (S.M.); (M.S.); (N.S.)
| | - Nobuhito Saito
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo 113-8655, Japan; (S.M.); (M.S.); (N.S.)
| | - Akira Teraoka
- Department of Neurosurgery, Teraoka Memorial Hospital, Hiroshima 729-3103, Japan; (T.A.); (A.T.); (A.T.)
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Sörgel F, Malin JJ, Hagmann H, Kinzig M, Bilal M, Eichenauer DA, Scherf-Clavel O, Simonis A, El Tabei L, Fuhr U, Rybniker J. Pharmacokinetics of remdesivir in a COVID-19 patient with end-stage renal disease on intermittent haemodialysis. J Antimicrob Chemother 2021; 76:825-827. [PMID: 33251541 PMCID: PMC7799013 DOI: 10.1093/jac/dkaa500] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 11/09/2020] [Indexed: 12/21/2022] Open
Affiliation(s)
- Fritz Sörgel
- IBMP – Institute for Biomedical and Pharmaceutical Research, Paul-Ehrlich-Straße 19, D-90562, Nürnberg-Heroldsberg, Germany
- Institute of Pharmacology, West German Heart and Vascular Centre, University of Duisburg-Essen, Essen, Germany
| | - Jakob J Malin
- Department I of Internal Medicine, Division of Infectious Diseases, University of Cologne, Cologne, Germany
- Faculty of Medicine, Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany
- German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - Henning Hagmann
- Faculty of Medicine, Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany
- Department II of Internal Medicine, University Hospital Cologne, Cologne, Germany
| | - Martina Kinzig
- IBMP – Institute for Biomedical and Pharmaceutical Research, Paul-Ehrlich-Straße 19, D-90562, Nürnberg-Heroldsberg, Germany
| | - Muhammad Bilal
- Faculty of Medicine and University Hospital Cologne, Center for Pharmacology, Department I of Pharmacology, University of Cologne, Cologne, Germany
| | - Dennis A Eichenauer
- University of Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, Intensive Care Program, Cologne, Germany
| | - Oliver Scherf-Clavel
- IBMP – Institute for Biomedical and Pharmaceutical Research, Paul-Ehrlich-Straße 19, D-90562, Nürnberg-Heroldsberg, Germany
- University of Wuerzburg, Institute for Pharmacy and Food Chemistry, Wuerzburg, Germany
| | - Alexander Simonis
- Department I of Internal Medicine, Division of Infectious Diseases, University of Cologne, Cologne, Germany
- Faculty of Medicine, Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany
| | - Lobna El Tabei
- Faculty of Medicine and University Hospital Cologne, Center for Pharmacology, Department I of Pharmacology, University of Cologne, Cologne, Germany
| | - Uwe Fuhr
- Faculty of Medicine and University Hospital Cologne, Center for Pharmacology, Department I of Pharmacology, University of Cologne, Cologne, Germany
| | - Jan Rybniker
- Department I of Internal Medicine, Division of Infectious Diseases, University of Cologne, Cologne, Germany
- Faculty of Medicine, Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany
- German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
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Sahay M, Jasuja S, Wai TSC, Alexander S, Jha V, Vachharajani T, Mostafi M, Pisharam JK, Jacob C, Gunawan A, Leong GB, Thwin KT, Agrawal RK, Vareesangthip K, Tanchanco R, Choong L, Herath C, Lin CC, Cuong NT, Haian HP, Akhtar SF, Alsahow A, Rana DS, Rajapurkar MM, Kher V, Verma S, Ramachandran R, Bhargava V, Puri S, Sagar G, Bahl A, Mandal S, Gupta A, Gallieni M. Aetiology, practice patterns and burden of end-stage kidney disease in South Asia and South-East Asia: A questionnaire-based survey. Nephrology (Carlton) 2021; 26:142-152. [PMID: 33169890 PMCID: PMC7615902 DOI: 10.1111/nep.13825] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 10/11/2020] [Accepted: 10/16/2020] [Indexed: 11/28/2022]
Abstract
AIM There is paucity of data on the epidemiology of end-stage kidney disease (ESKD) from South Asia and South-East Asia. The objective of this study was to assess the aetiology, practice patterns and disease burden and growth of ESKD in the region comparing the economies. METHODS The national nephrology societies of the region; responded to the questionnaire; based on latest registries, acceptable community-based studies and society perceptions. The countries in the region were classified into Group 1 (High|higher-middle-income) and Group 2 (lower|lowermiddle income). Student t-test, Mann-Whitney U test and Fisher's exact test were used for comparison. RESULTS Fifteen countries provided the data. The average incidence of ESKD was estimated at 226.7 per million population (pmp), (Group 1 vs. Group 2, 305.8 vs. 167.8 pmp) and average prevalence at 940.8 pmp (Group 1 vs. Group 2, 1306 vs. 321 pmp). Group 1 countries had a higher incidence and prevalence of ESKD. Diabetes, hypertension and chronic glomerulonephritis were most common causes. The mean age in Group 2 was lower by a decade (Group 1 vs. Group 2-59.45 vs 47.7 years). CONCLUSION Haemodialysis was the most common kidney replacement therapy in both groups and conservative management of ESKD was the second commonest available treatment option within Group 2. The disease burden was expected to grow >20% in 50% of Group 1 countries and 78% of Group 2 countries along with the parallel growth in haemodialysis and peritoneal dialysis.
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Affiliation(s)
- Manisha Sahay
- Department of Nephrology Osmania General Hospital, Hyderabad (+91) 9849097507
| | - Sanjiv Jasuja
- Department of Nephrology Indraprastha Apollo Hospital, Delhi (+91) 9711197981
| | - Tang Sydeny Chi Wai
- Department of Nephrology Queen Mary Hospital Hong Kong Society of Nephrology (+852) 92360037
| | | | - Vivekanand Jha
- Department of Nephrology George Institute of Global Health (+91) 85275 44733
| | - Tushar Vachharajani
- Department of Nephrology Cleveland Clinic, Ohio, United States (+1) 336 546 2713
| | - Mamun Mostafi
- Department of Nephrology Armed Forces Medical College, Bangladesh Representative from Bangladesh Renal Association (+880) 171 3035 346
| | - Jayakrishnan K Pisharam
- Department of Nephrology Ministry of Health, Brunei, Darussalam Medical Services, Brunei Representative from Brunei Society of Nephrology (+673) 817 8123
| | - Chakko Jacob
- Department of Nephrology Bangalore Baptist Hospital, India Representative from Indian Society of Nephrology (+91)9535236019
| | - Atma Gunawan
- Department of Nephrology Brawijaya University, Indonesia Representative from Society of Nephrology Indonesia (+62) 812 3300 543
| | - Goh Bak Leong
- Department of Nephrology Serdang Hospital, Malaysia Representative from Malaysian Nephrology Congress (+60) 1260 69119
| | - Khin Thida Thwin
- Department of Nephrology University Of Medicine, Myanmar Representative from Myanmar Nephro-Uro Society (+95) 95021764
| | - Rajendra Kumar Agrawal
- Department of Nephrology Bir Hospital, Nepal Nepal Society of Nephrology (+977)98 5102 3840
| | - Kriengsak Vareesangthip
- Department of Nephrology Siriraj Hospital, Mahidol University, Thailand Representative from Nephrology Society of Thailand (+66) 24198383
| | - Roberto Tanchanco
- Department of Nephrology The Medical City, Philippine Representative from Philippine Society of Nephrology (+63)9189173940
| | - Lina Choong
- Department of Nephrology Singapore General Hospital, Singapore Representative from Singapore Society of Nephrology (+65) 81253594
| | - Chula Herath
- Department of Nephrology Sri Jayewardenepura General Hospital, Srilanka Representative from Sri Lanka Society of Nephrology (+94) 773017025
| | - Chih-Ching Lin
- Department of Nephrology Taipei Veterans General Hospital, Taiwan Representative from Taiwan society of Nephrology (+886) 937024083
| | - Nguyen The Cuong
- Department of Nephrology Hochiminh City national University, Vietnam Representative from Society of Nephrology-Urology of Vietnam (+84) 912 323276
| | - Ha Phan Haian
- Department of Nephrology Viet Duc University Hospital, Vietnam Representative from- Society of Nephrology-Urology of Vietnam (+84) 913546992
| | - Syed Fazal Akhtar
- Department of Nephrology Sindh Institute of Urology and Transplantation, Pakistan Representative from Pakistan Society of Nephrology (+92)300 8249856
| | - Ali Alsahow
- Department of Nephrology Jahara Hospital, Kuwait Representative From Gulf Corporation Council (+96)599335599
| | - D S Rana
- Department of Nephrology Sir Gangaram Hospital, Delhi (+91)9811033984
| | - M M Rajapurkar
- Department of Nephrology Muljibhai Patel Urological Hospital, Gujrat (+91) 9824349500
| | - Vijay Kher
- Department of Nephrology Medanta Hospital Gurugram, Haryana (+91) 9811054118)
| | - Shalini Verma
- Clinical Research AVATAR foundation, New Delhi (+91)8586983027
| | | | - Vinant Bhargava
- Department of Nephrology Sir Ganga Ram Hospital, Delhi (+91) 9990610096
| | - Sonika Puri
- Department of Nephrology Rutgers Robert Wood Johnson Medical School, New Jersy United States +1 (732) 501 1737
| | - Gaurav Sagar
- Department of Nephrology Indraprastha Apollo Hospital, Delhi (+91) 9810995996
| | - Anupam Bahl
- Department of Nephrology Indraprastha Apollo Hospital, Delhi (+91) 9711311750
| | - Sandeep Mandal
- Department of Nephrology Columbia Asia Hospital, Gurugram (+91) 8130007368
| | - Ashwani Gupta
- Department of Nephrology Sir Ganga Ram Hospital, Delhi (+91) 9811049761
| | - Maurizio Gallieni
- Department of Nephrology ‘L. Sacco’ Department of Biomedical and Clinical Sciences University of Milano, Italy (+39) 347746 8832
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Pizarro-Sánchez MS, Avello A, Mas-Fontao S, Stock da Cunha T, Goma-Garcés E, Pereira M, Ortíz A, González-Parra E. Clinical Features of Asymptomatic SARS-CoV-2 Infection in Hemodialysis Patients. Kidney Blood Press Res 2021; 46:126-134. [PMID: 33503627 PMCID: PMC7900451 DOI: 10.1159/000512535] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 09/03/2020] [Accepted: 10/24/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND CKD is a risk factor for severe COVID-19. However, the clinical spectrum of COVID-19 in hemodialysis patients is still poorly characterized. OBJECTIVE To analyze the clinical spectrum of COVID-19 on hemodialysis patients. METHOD A retrospective observational study was conducted on 66 hemodialysis patients. Nasopharyngeal swab PCR and serology for SARS-CoV-2, blood analysis, chest radiography, treatment, and outcomes were assessed. RESULTS COVID-19 was diagnosed in 50 patients: 38 (76%) were PCR-positive and 12 (24%) were PCR-negative but developed anti-SARS-CoV-2 antibodies. By contrast, 17% of PCR-positive patients failed to develop detectable antibodies against SARS-CoV-2. Among PCR-positive patients, 5/38 (13%) were asymptomatic, while among PCR-negative patients 7/12 (58%) were asymptomatic (p = 0.005) for a total of 12/50 (24%) asymptomatic patients. No other differences were found between PCR-positive and PCR-negative patients. No differences in potential predisposing factors were found between asymptomatic and symptomatic patients except for a lower use of ACE inhibitors among asymptomatic patients. Asymptomatic patients had laboratory evidence of milder disease such as higher lymphocyte counts and oxygen saturation and lower troponin I and interleukin-6 levels than symptomatic patients. Overall mortality was 7/50 (14%) and occurred only in symptomatic PCR-positive patients in whom mortality was 7/33 (21%). CONCLUSIONS Asymptomatic SARS-CoV-2 infection is common in hemodialysis patients, especially among patients with initial negative PCR that later seroconvert. Thus COVID-19 mortality in hemodialysis patients may be lower than previously estimated based on PCR tests alone.
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Affiliation(s)
| | - Alejandro Avello
- Nephrology and Hypertension, UH-Fundacion Jimenez Diaz UAM, Madrid, Spain
| | | | | | - Elena Goma-Garcés
- Nephrology and Hypertension, UH-Fundacion Jimenez Diaz UAM, Madrid, Spain
| | - Mónica Pereira
- Iñígo Álvarez de Toledo Renal Foundation (FRIAT), Madrid, Spain
| | - Alberto Ortíz
- Nephrology and Hypertension, UH-Fundacion Jimenez Diaz UAM, Madrid, Spain
- Autónoma University of Madrid, Madrid, Spain
| | - Emilio González-Parra
- Nephrology and Hypertension, UH-Fundacion Jimenez Diaz UAM, Madrid, Spain,
- Autónoma University of Madrid, Madrid, Spain,
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8
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Xie J, Li X, Chen Y, Chen M, Mao N, Fan J. Efficacy and safety of evocalcet in treatment of secondary hyperparathyroidism in chronic kidney disease on hemodialysis patients: A protocol for a systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e22566. [PMID: 33181644 PMCID: PMC7668479 DOI: 10.1097/md.0000000000022566] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Secondary hyperparathyroidism (SHPT) have been associated with poor health outcomes in hemodialysis patients. The cinacalcet has popularized in clinic which has efficacy but more adverse events; the novel oral calcimimetic agents evocalcet has appeared in recent years. However, it is currently unknown whether evocalcet produces more beneficial effects and fewer adverse events in patients with SHPT. The aim of this systematic review is to estimate the safety and efficacy of evocacelt. METHODS Only randomized controlled trials (RCT) will be included in MEDLINE, EMBASE, the Cochrane Register of Controlled Trials, and PUBMED from July 2010 to July 2020. Two reviewers will screen, select studies, extract data, and assess quality independently. The methodological quality including the risk of bias of the included studies will be evaluated using a modified assessment form, which is based on Cochrane assessment tool. Review Manager 5.3 software will be used for heterogeneity assessment, generating funnel-plots, data synthesis, subgroup analysis, and sensitivity analysis. We will use GRADE system to evaluate the quality of our evidence. RESULTS We will provide some more practical and targeted results investigating the effect and safety of evocalcet for SHPT on hemodialysis in the current meta-analysis. CONCLUSION The stronger evidence about evocalcet effect and safety will be provided for clinicians and policymakers. ETHICS AND DISSEMINATION Ethical approval will be unnecessary because the data being included in this systematic review come from published literature and there will be no concerns regarding privacy. Findings of this research will be disseminated in a peer-reviewed journal or conference presentations. OSF REGISTRATION NUMBER DOI 10.17605/OSF.IO/N59RB.
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Affiliation(s)
- Jing Xie
- Hospital of Chengdu University of Traditional Chinese Medicine
| | - Xueying Li
- Hospital of Chengdu University of Traditional Chinese Medicine
| | - Yang Chen
- Hospital of Chengdu University of Traditional Chinese Medicine
| | - Ming Chen
- Hospital of Chengdu University of Traditional Chinese Medicine
| | - Nan Mao
- Department of Nephrology, The First Clinical Medical College
| | - Junming Fan
- Department of Nephrology, The First Clinical Medical College
- Chengdu Medical College, Chengdu, PR China
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9
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Zhu B, Shen J, Jiang R, Jin L, Zhan G, Liu J, Sha Q, Xu R, Miao L, Yang C. Abnormalities in gut microbiota and serum metabolites in hemodialysis patients with mild cognitive decline: a single-center observational study. Psychopharmacology (Berl) 2020; 237:2739-2752. [PMID: 32601991 DOI: 10.1007/s00213-020-05569-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 05/20/2020] [Indexed: 02/08/2023]
Abstract
RATIONALE Although a growing body of evidence indicates that the scores of cognitive function in hemodialysis patients are significantly lower than those of healthy individuals, underlying mechanisms have not been fully elucidated. OBJECTIVES To investigate the roles of gut microbiota and serum metabolites in hemodialysis patients with mild cognitive decline (MCD). METHODS A total of 30 healthy individuals and 77 hemodialysis patients were enrolled and were classified into healthy control (HC), normal cognitive function (NCF), and MCD groups by evaluation of Montreal Cognitive Assessment. Fecal samples were analyzed by 16S rRNA and serum samples were analyzed by gas chromatography-mass spectrometry from all subjects. RESULTS The 16S rRNA study demonstrated that the gut microbiota profiles, including α- and β-diversity, and a number of 16 gut bacteria were significantly altered in the MCD group compared with those in HC or those with NCF. A metabonomics study showed that a total of 29 serum metabolites were altered in the MCD group. Receiver operating characteristic curves showed that Genus Bilophila and serum putrescine might be sensitive biomarkers to indicate MCD in patients with hemodialysis. CONCLUSIONS These findings demonstrate gut microbiota and serum metabolites were probably involved in the pathogenesis of hemodialysis-related MCD. Therapeutic strategies targeting abnormalities in gut microbiota and serum metabolites may facilitate the beneficial effects for hemodialysis patients with MCD.
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Affiliation(s)
- Bin Zhu
- Department of Critical Care Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, 213003, China
| | - Jianqin Shen
- The Blood Purification Center, The Third Affiliated Hospital of Soochow University, Changzhou, 213003, China
| | - Riyue Jiang
- Department of Ultrasound Imaging, Renmin Hospital, Wuhan University, Wuhan, 430060, China
| | - Lina Jin
- The Blood Purification Center, The Third Affiliated Hospital of Soochow University, Changzhou, 213003, China
| | - Gaofeng Zhan
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Jinfeng Liu
- The Blood Purification Center, The Third Affiliated Hospital of Soochow University, Changzhou, 213003, China
| | - Qi Sha
- Department of Clinical Nutrition, The Third Affiliated Hospital of Soochow University, Changzhou, 213003, China
| | - Rongpeng Xu
- Department of Critical Care Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, 213003, China
| | - Liying Miao
- Department of Nephrology, The Third Affiliated Hospital of Soochow University, Changzhou, 213003, China.
| | - Chun Yang
- Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China.
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10
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Perna AF, Capolongo G, Trepiccione F, Simeoni M, Zacchia M, Ingrosso D. COVID-19, Low-Molecular-Weight Heparin, and Hemodialysis. Kidney Blood Press Res 2020; 45:357-362. [PMID: 32450560 PMCID: PMC7316655 DOI: 10.1159/000508460] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 04/30/2020] [Indexed: 11/19/2022] Open
Affiliation(s)
- Alessandra F Perna
- Department of Medical Translational Sciences, University of Campania Luigi Vanvitelli, Naples, Italy,
| | - Giovanna Capolongo
- Department of Medical Translational Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Francesco Trepiccione
- Department of Medical Translational Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Mariadelina Simeoni
- Department of Medical Translational Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Miriam Zacchia
- Department of Medical Translational Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Diego Ingrosso
- Department of Precision Medicine,University of Campania Luigi Vanvitelli, Naples, Italy
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11
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Dai L, Lu C, Liu J, Li S, Jin H, Chen F, Xue Z, Miao C. Impact of twice- or three-times-weekly maintenance hemodialysis on patient outcomes: A multicenter randomized trial. Medicine (Baltimore) 2020; 99:e20202. [PMID: 32443343 PMCID: PMC7253701 DOI: 10.1097/md.0000000000020202] [Citation(s) in RCA: 8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
AIM Maintenance hemodialysis (MHD) frequency is associated with survival and complication rates. Achieving the optimal balance between healthcare, quality of life (QOL), and medical costs is challenging. We compared complications, inflammatory status, nutritional status, and QOL between patients with different MHD frequencies. MATERIAL AND METHODS This was a multicenter randomized trial of patients treated between May 2011 and August 2017 at 3 tertiary hospitals in Wenzhou. Patients were grouped according to their treatment schedule over 1 year: twice-weekly or 3-times-weekly. Complications, biochemistry parameters, and QOL (KDQOL-SFTM 1.3 scale) were assessed. RESULTS One hundred forty patients were included aged 29 to 68 years (mean age, 50.9 ± 4.3 years). There were no significant differences in infection, heart failure, or cerebral hemorrhage complications between the 2 groups (P = .664). Pre-dialysis hemoglobin, high-sensitivity C-reactive protein, serum albumin, total cholesterol, triglyceride, calcium, phosphate, parathyroid hormone, and ejection fraction were similar in both groups (P > .05). After 1 year of MHD, both groups exhibited significant improvements in these parameters (all P < .05) with no significant differences between groups. Serum creatinine, blood urea nitrogen (BUN), and weekly standard hemodialysis treatment adequacy did not improve after treatment (all P > .05), although a difference in BUN was observed between the 2 groups (P < .001). QOL was superior in the twice-weekly group than in the 3-times-weekly group (all P < .05), except for social support, which was slightly better in the 3-times-weekly group than in the twice-weekly group. CONCLUSIONS Twice- and 3-times-weekly MHD resulted in comparable inflammatory and nutritional clinical outcomes and adverse events. QOL was better for the twice-weekly schedule. Even for patients with economic constraints, twice- or 3-times-weekly MHD should be selected with caution after consideration of BUN levels at baseline.
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Affiliation(s)
- Li Dai
- Department of Nephrology, Ruian People's Hospital, Ruian City, Wenzhou, Zhejiang, China
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12
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Janahi EM, Parkar SFD, Mustafa S, Eisa ZM. Implications of Hepatitis E Virus in Blood Transfusions, Hemodialysis, and Solid Organ Transplants. Medicina (Kaunas) 2020; 56:E206. [PMID: 32344807 PMCID: PMC7279256 DOI: 10.3390/medicina56050206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 04/19/2020] [Accepted: 04/21/2020] [Indexed: 01/05/2023]
Abstract
Hepatitis E Virus (HEV) is emerging as the primary cause of acute viral hepatitis in humans. The virus is commonly transmitted by the fecal-oral route via contaminated water in endemic regions or through the consumption of inadequately cooked swine products or game meats in industrialized regions. HEV genotypes 1 and 2 are predominantly associated with waterborne transmission in developing countries, whereas HEV3 and HEV4 are mainly zoonotically transmitted in industrialized countries. Seroprevalence in populations determined by detecting anti-HEV antibodies and serum HEV RNA is commonly used to analyze the presence of HEV. Although HEV RNA-based detection is now standardized, there is a lack of agreement between the assaying methods used for gathering seroprevalence data. Since 2004, HEV has been considered as a transmissible infectious agent through blood transfusion. Recent seroprevalence studies in European countries indicate an underestimated risk for blood transfusion and hence warrant testing the blood supply. HEV infection is usually self-limiting and spontaneously cleared. However, in about 60% of recipients of solid organ transplants, HEV progresses to chronic hepatitis. Immunosuppressive drugs such as tacrolimus are a major cause of chronic hepatitis and reducing its dosage results in viral clearance in about 30% of patients. In hemodialysis patients, the parenteral route is implicated as an important mechanism of transmission. In this review, we explore the clinical and epidemiological characteristics of various HEV genotypes in blood donors, hemodialysis patients, and transplant recipients.
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Affiliation(s)
- Essam M. Janahi
- Department of Biology, College of Science, University of Bahrain, Sakhir 32038, Bahrain; (S.F.D.P.); (S.M.)
| | - Saba F. D. Parkar
- Department of Biology, College of Science, University of Bahrain, Sakhir 32038, Bahrain; (S.F.D.P.); (S.M.)
| | - Sakina Mustafa
- Department of Biology, College of Science, University of Bahrain, Sakhir 32038, Bahrain; (S.F.D.P.); (S.M.)
| | - Zaki M. Eisa
- The National Center for Disease Prevention and Control, Jazan 82722-2476, Saudi Arabia;
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13
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Hoffman A, Sloan CE, Maciejewski ML, Wang V. Medicare Enrollment Among Patients With End-Stage Kidney Disease Receiving Dialysis in Outpatient Facilities Between 2005 and 2016. JAMA 2020; 323:1314-1316. [PMID: 32259222 PMCID: PMC7139269 DOI: 10.1001/jama.2020.0704] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
This study characterizes annual changes in enrollment of Medicare and non-Medicare patients treated at dialysis facilities before and after 2011 payment reforms and 2014 Affordable Care Act changes that influenced reimbursements.
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Affiliation(s)
- Abby Hoffman
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Caroline E. Sloan
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Matthew L. Maciejewski
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina
| | - Virginia Wang
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
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14
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Abstract
Microfluidic hemodialysis techniques have recently attracted great attention in the treatment of kidney disease due to their advantages of portability and wearability as well as their great potential for replacing clinical hospital-centered blood purification with continuous in-home hemodialysis. This Review summarizes the recent progress in microfluidic devices for hemodialysis. First, the history of kidney-inspired hemodialysis is introduced. Then, recent achievements in the preparation of microfluidic devices and hemodialysis nanoporous membrane materials are presented and categorized. Subsequently, attention is drawn to the recent progress of nanoporous membrane-based microfluidic devices for hemodialysis. Finally, the challenges and opportunities of hemodialysis microfluidic devices in the future are also discussed. This Review is expected to provide a comprehensive guide for the design of hemodialysis microfluidic devices that are closely related to clinical applications.
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Affiliation(s)
- Jing Luo
- CAS Key Laboratory of Bio-inspired Materials and Interfacial Science, CAS Center for Excellence in Nanoscience, Technical Institute of Physics and Chemistry, Chinese Academy of Sciences, Beijing, 100190, P. R. China
- University of Chinese Academy of Sciences, Beijing, 100049, P. R. China
| | - Jun-Bing Fan
- CAS Key Laboratory of Bio-inspired Materials and Interfacial Science, CAS Center for Excellence in Nanoscience, Technical Institute of Physics and Chemistry, Chinese Academy of Sciences, Beijing, 100190, P. R. China
| | - Shutao Wang
- CAS Key Laboratory of Bio-inspired Materials and Interfacial Science, CAS Center for Excellence in Nanoscience, Technical Institute of Physics and Chemistry, Chinese Academy of Sciences, Beijing, 100190, P. R. China
- University of Chinese Academy of Sciences, Beijing, 100049, P. R. China
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15
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Nafar M, Aghighi M, Dalili N, Alipour Abedi B. Perspective of 20 Years Hemodialysis Registry in Iran, on the Road to Progress. Iran J Kidney Dis 2020; 14:95-101. [PMID: 32165593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 02/29/2020] [Indexed: 06/10/2023]
Abstract
End-stage renal disease (ESRD) is a foremost health issue with major consequences in various parts of the world. In Iran, the prevalence/incidence of ESRD has increased during the past decades. The economic burden of ESRD treatment on patients, their families, and the whole healthcare system is huge as well. Hence ESRD is considered emerging public health problem in developing countries, including Iran, requiring short- and longterm changes in healthcare policies. Developing a national registry system for dialysis patients in Iran now enables us to summarize certain clinical characteristics of these patients and compares the present situation with the late 1990s when dialysis services just began to expand in the country. In this paper, the authors provide information regarding the process of establishing dialysis registry in Iran along with the report of the output of such a registry. Focusing on such an important measure in the whole country of around along with the data that it has produced is a gateway to further progress.
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Affiliation(s)
| | | | - Nooshin Dalili
- Department of Nephrology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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16
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Abstract
Hemodialysis (HD) is one of the resource hungry medical interventions. A huge volume of water (about 500 L) and significant amounts of energy (over 7 kW) are used for a hemodialysis session; over a kilogram of waste is produced during this procedure. Thus, HD contributes to global warming while saving patients' lives. In this paper, we showed these crucial points in HD treatment and possible ways (e.g. modifications in dialysate flow rate) to reduce environmental impact maintaining therapy standards.
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Affiliation(s)
- Monika Wieliczko
- Department of Nephrology, Dialysis and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | | | - Adrian Covic
- Grigore T. Popa' University of Medicine, Iasi, Romania
| | | | | | - Jolanta Małyszko
- Department of Nephrology, Dialysis and Internal Medicine, Medical University of Warsaw, Warsaw, Poland.
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17
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Santoro A. [Italian nephrology and the progress of dialysis from its dawn to the present day]. G Ital Nefrol 2020; 37:37-01-2020-1. [PMID: 32068355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
In Italy, over the last 50 years, dialysis has been the driving force of research in nephrology. The work of many Italian nephrologists has fueled progress in dialytic techniques worldwide, improving dramatically the quality of dialytic therapy. Our foreign colleagues unanimously agree that we have been the first to look into the complexities of dialysis, into the many differences between dialytic patients and how to best address this diversity. This has allowed us to adopt a holistic approach, deeply connected to technological innovation, with the aim of putting the patient center stage and creating a "precision dialysis".
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Affiliation(s)
- Antonio Santoro
- Scuola di Specializzazione in Nefrologia, Università degli Studi di Bologna, Policlinico S.Orsola-Malpighi
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18
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Esposito P, Battaglia Y, La Porta E, Grignano MA, Caramella E, Avella A, Peressini S, Sessa N, Albertini R, Di Natali G, Lisi C, Gregorini M, Rampino T. Significance of serum Myostatin in hemodialysis patients. BMC Nephrol 2019; 20:462. [PMID: 31829144 PMCID: PMC6907124 DOI: 10.1186/s12882-019-1647-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 07/26/2019] [Accepted: 11/28/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Malnutrition and muscle wasting are common in haemodialysis (HD) patients. Their pathogenesis is complex and involves many molecules including Myostatin (Mstn), which acts as a negative regulator of skeletal muscle. The characterisation of Mstn as a biomarker of malnutrition could be useful in the prevention and management of this condition. Previous studies have reported no conclusive results on the actual relationship between serum Mstn and wasting and malnutrition. So, in this study, we evaluated Mstn profile in a cohort of regular HD patients. METHODS We performed a cross-sectional study, enrolling 37 patients undergoing bicarbonate-HD (BHD) or haemodiafiltration (HDF) at least for six months. 20 sex-matched healthy subjects comprised the control group. Mstn serum levels were evaluated by ELISA before and after HD. We collected clinical and biochemical data, evaluated insulin resistance, body composition, malnutrition [by Malnutrition Inflammation Score (MIS)] and tested muscle function (by hand-grip strength, six-minute walking test and a questionnaire on fatigue). RESULTS Mstn levels were not significantly different between HD patients and controls (4.7 ± 2.8 vs 4.5 ± 1.3 ng/ml). In addition, while a decrease in Mstn was observed after HD treatment, there were no differences between BHD and HDF. In whole group of HD patients Mstn was positively correlated with muscle mass (r = 0.82, p < 0.001) and inversely correlated with age (r = - 0.63, p < 0.01) and MIS (r = - 0.39, p = 0.01). No correlations were found between Mstn and insulin resistance, such as between Mstn levels and parameters of muscle strength and fatigue. In multivariate analysis, Mstn resulted inversely correlated with fat body content (β = - 1.055, p = 0.002). CONCLUSIONS Circulating Mstn is related to muscle mass and nutritional status in HD patients, suggesting that it may have a role in the regulation of skeletal muscle and metabolic processes. However, also considering the lack of difference of serum Mstn between healthy controls and HD patients and the absence of correlations with muscle function tests, our findings do not support the use of circulating Mstn as a biomarker of muscle wasting and malnutrition in HD.
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Affiliation(s)
- Pasquale Esposito
- Unit of Nephrology, Dialysis and Transplantation, Fondazione IRCCS Policlinico San Matteo, and University of Pavia, Pavia, Italy
- Department of Internal Medicine, Division of Nephrology, Dialysis and Transplantation, University of Genoa and IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Yuri Battaglia
- Department of Specialized Medicine, Division of Nephrology and Dialysis, Hospital-University St. Anna, Ferrara, Italy.
| | - Edoardo La Porta
- Unit of Nephrology, Dialysis and Transplantation, Fondazione IRCCS Policlinico San Matteo, and University of Pavia, Pavia, Italy
| | - Maria Antonietta Grignano
- Unit of Nephrology, Dialysis and Transplantation, Fondazione IRCCS Policlinico San Matteo, and University of Pavia, Pavia, Italy
| | - Elena Caramella
- Unit of Nephrology, Dialysis and Transplantation, Fondazione IRCCS Policlinico San Matteo, and University of Pavia, Pavia, Italy
| | - Alessando Avella
- Unit of Nephrology, Dialysis and Transplantation, Fondazione IRCCS Policlinico San Matteo, and University of Pavia, Pavia, Italy
| | - Sabrina Peressini
- Clinical Chemistry Laboratory Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Nicodemo Sessa
- Clinical Chemistry Laboratory Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Riccardo Albertini
- Clinical Chemistry Laboratory Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Giuseppe Di Natali
- Physical Medicine and Rehabilitation Unit, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Claudio Lisi
- Physical Medicine and Rehabilitation Unit, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Marilena Gregorini
- Unit of Nephrology, Dialysis and Transplantation, Fondazione IRCCS Policlinico San Matteo, and University of Pavia, Pavia, Italy
| | - Teresa Rampino
- Unit of Nephrology, Dialysis and Transplantation, Fondazione IRCCS Policlinico San Matteo, and University of Pavia, Pavia, Italy
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19
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Chen Z, Lee BJ, McCulloch CE, Burrows NR, Heung M, Hsu RK, Pavkov ME, Powe NR, Saran R, Shahinian V, Hsu CY. The relation between dialysis-requiring acute kidney injury and recovery from end-stage renal disease: a national study. BMC Nephrol 2019; 20:342. [PMID: 31477040 PMCID: PMC6720077 DOI: 10.1186/s12882-019-1483-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 07/22/2019] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Approximately 4-6% of incident end stage renal disease (ESRD) patients in the U.S. recover enough kidney function to discontinue dialysis but there is considerable geographic variation. We undertook this study to investigate whether state-level variations in renal recovery among incident ESRD patients correlated with state-level variations in incidence of acute kidney injury requiring dialysis (AKI-D). METHODS We conducted a national cross-sectional ecological study at the state-level using data from State Inpatient Databases and U.S. Renal Data System. All hospital admissions and all ESRD patients in 18 US states (AZ, AR, CA, FL, IA, KY, MA, MD, MI, NJ, NM, NY, NV, OR, RI, SC, VT, and WA) were included. Correlation between AKI-D incidence and rate of renal recovery across states was determined using Pearson's r (overall and in subgroups). We also calculated partial correlations adjusted for sex and age. RESULTS AKI-D incidence ranged from 99.0 per million population (pmp) in Vermont to 490.4 pmp in Nevada. Rate of renal recovery among incident ESRD patients ranged from 8.8 pmp in Massachusetts to 29.3 pmp in Florida. A positive correlation between AKI-D incidence and rate of renal recovery among incident ESRD patients at state level was found overall (unadjusted r = 0.67; p = 0.002) and in age, sex, and race subgroups. The overall correlation persisted after adjusting for age (adjusted r = 0.62; p < 0.001) and sex (adjusted r = 0.65; p < 0.001). CONCLUSION Our findings suggest that AKI-D incidence is an important driver of renal recovery rates among incident ESRD patients.
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Affiliation(s)
- Zijin Chen
- Division of Nephrology, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
- Division of Nephrology, Department of Medicine, University of California, San Francisco, 533 Parnassus Ave, U404, Box 0532, San Francisco, CA, 94143-0532, USA
| | - Benjamin J Lee
- Division of Nephrology, Department of Medicine, University of California, San Francisco, 533 Parnassus Ave, U404, Box 0532, San Francisco, CA, 94143-0532, USA
- Houston Kidney Consultants, Houston, TX, USA
- Houston Methodist Institute for Academic Medicine, Houston, TX, USA
| | - Charles E McCulloch
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Nilka Ríos Burrows
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Michael Heung
- Division of Nephrology, Department of Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Raymond K Hsu
- Division of Nephrology, Department of Medicine, University of California, San Francisco, 533 Parnassus Ave, U404, Box 0532, San Francisco, CA, 94143-0532, USA
| | - Meda E Pavkov
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Neil R Powe
- UCSF Center for Vulnerable Populations, Department of Medicine, University of California, San Francisco, CA, USA
- Department of Medicine, San Francisco General Hospital, San Francisco, CA, USA
| | - Rajiv Saran
- Division of Nephrology, Department of Medicine, University of Michigan, Ann Arbor, MI, USA
- Kidney Epidemiology and Cost Center, University of Michigan, Ann Arbor, MI, USA
| | - Vahakn Shahinian
- Division of Nephrology, Department of Medicine, University of Michigan, Ann Arbor, MI, USA
- Kidney Epidemiology and Cost Center, University of Michigan, Ann Arbor, MI, USA
| | - Chi-Yuan Hsu
- Division of Nephrology, Department of Medicine, University of California, San Francisco, 533 Parnassus Ave, U404, Box 0532, San Francisco, CA, 94143-0532, USA.
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20
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Weinhandl ED, Ray D, Kubisiak KM, Collins AJ. Contemporary Trends in Clinical Outcomes among Dialysis Patients with Medicare Coverage. Am J Nephrol 2019; 50:63-71. [PMID: 31203279 DOI: 10.1159/000500943] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 04/30/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND The dialysis patient population in the United States continues to grow. Trends in rates of death and hospitalization among dialysis patients have important consequences for outpatient dialysis capacity and Medicare spending. OBJECTIVES To estimate contemporary trends in rates of death and hospitalization among dialysis patients in the United States, overall and within subgroups. METHODS We used Medicare Limited Data Sets (100% sample) in 2014-2017 to estimate trends in rates of death and hospitalization among dialysis patients with Medicare Parts A and B enrollment. We used seasonal autoregressive integrated moving average models to identify secular trends in the incidence of outcomes. RESULTS There were 631,075 unique patients; 222,924 deaths; and 1,876,779 hospital admissions. Weekly risks of both death and hospitalization exhibited strong seasonality. However, overall weekly risks of death were 34.9, 35.4, 35.2, and 35.7 deaths per 10,000 patients in 2014-2017, respectively (p = 0.47, from a likelihood ratio test of secular trend). The overall weekly risk of hospitalization was 3.08, 3.05, 3.11, and 3.11% in 2014, 2015, 2016, and 2017, respectively (p = 0.30). There were significant secular trends in risk of death in subgroups defined by black race and residency in South Atlantic states (p < 0.05). There were also secular trends in risk of hospitalization in subgroups defined by age 20-44 years, concurrent enrollment in Medicaid, and residency in South Central states. CONCLUSION For the first time since the beginning of this century, rates of both death and hospitalization among dialysis patients with Medicare fee-for-service coverage have stagnated. The reasons for this change are unknown and require detailed assessment. Persistent lack of change in clinical outcomes may alter the future expectations about dialysis patient population growth.
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Affiliation(s)
- Eric D Weinhandl
- NxStage Medical, Medical Affairs, Lawrence, Massachusetts, USA,
- Department of Pharmaceutical Care and Health Systems, University of Minnesota, Minneapolis, Minnesota, USA,
| | - Debabrata Ray
- NxStage Medical, Medical Affairs, Lawrence, Massachusetts, USA
| | | | - Allan J Collins
- NxStage Medical, Medical Affairs, Lawrence, Massachusetts, USA
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
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Taborelli M, Toffolutti F, Del Zotto S, Clagnan E, Furian L, Piselli P, Citterio F, Zanier L, Boscutti G, Serraino D. Increased cancer risk in patients undergoing dialysis: a population-based cohort study in North-Eastern Italy. BMC Nephrol 2019; 20:107. [PMID: 30922296 PMCID: PMC6437907 DOI: 10.1186/s12882-019-1283-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 03/07/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND In southern Europe, the risk of cancer in patients with end-stage kidney disease receiving dialysis has not been well quantified. The aim of this study was to assess the overall pattern of risk for de novo malignancies (DNMs) among dialysis patients in the Friuli Venezia Giulia region, north-eastern Italy. METHODS A population-based cohort study among 3407 dialysis patients was conducted through a record linkage between local healthcare databases and the cancer registry (1998-2013). Person-years (PYs) were calculated from 30 days after the date of first dialysis to the date of DNM diagnosis, kidney transplant, death, last follow-up or December 31, 2013, whichever came first. The risk of DNM, as compared to the general population, was estimated using standardized incidence ratios (SIRs) and 95% confidence intervals (CIs). RESULTS During 10,798 PYs, 357 DNMs were diagnosed in 330 dialysis patients. A higher than expected risk of 1.3-fold was found for all DNMs combined (95% CI: 1.15-1.43). The risk was particularly high in younger dialysis patients (SIR = 1.88, 95% CI: 1.42-2.45 for age 40-59 years), and it decreased with age. Moreover, significantly increased DNM risks emerged during the first 3 years since dialysis initiation, especially within the first year (SIR = 8.52, 95% CI: 6.89-10.41). Elevated excess risks were observed for kidney (SIR = 3.18; 95% CI: 2.06-4.69), skin non-melanoma (SIR = 1.81, 95% CI: 1.46-2.22), oral cavity (SIR = 2.42, 95% CI: 1.36-4.00), and Kaposi's sarcoma (SIR = 10.29, 95% CI: 1.25-37.16). CONCLUSIONS The elevated risk for DNM herein documented suggest the need to implement a targeted approach to cancer prevention and control in dialysis patients.
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Affiliation(s)
- Martina Taborelli
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, via Franco Gallini 2, 33081 Aviano, (PN) Italy
| | - Federica Toffolutti
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, via Franco Gallini 2, 33081 Aviano, (PN) Italy
| | - Stefania Del Zotto
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, via Franco Gallini 2, 33081 Aviano, (PN) Italy
| | - Elena Clagnan
- Azienda Regionale di Coordinamento per la Salute, Udine, Italy
| | - Lucrezia Furian
- Kidney and Pancreas Transplantation Unit, Padua University Hospital, Padua, Italy
| | - Pierluca Piselli
- Department of Epidemiology and Pre-Clinical Research, National Institute for Infectious Diseases “L. Spallanzani”, Rome, Italy
| | - Franco Citterio
- Renal Transplantation Unit, Department of Surgical Science, Università Cattolica Sacro Cuore, Rome, Italy
| | - Loris Zanier
- Azienda Regionale di Coordinamento per la Salute, Udine, Italy
| | - Giuliano Boscutti
- Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
| | - Diego Serraino
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, via Franco Gallini 2, 33081 Aviano, (PN) Italy
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22
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Omari AM, Omari LS, Dagash HH, Sweileh WM, Natour N, Zyoud SH. Assessment of nutritional status in the maintenance of haemodialysis patients: a cross-sectional study from Palestine. BMC Nephrol 2019; 20:92. [PMID: 30876391 PMCID: PMC6420767 DOI: 10.1186/s12882-019-1288-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 03/10/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Protein-energy wasting (PEW) is a relatively prevalent problem among adult haemodialysis patients (HDP). PEW is an important determinant of morbidity and mortality in HDP, therefore it is essential for dietitians to accurately assess malnutrition (MN) in these patients. HDP appear to be more susceptible to developing MN; however, this is not well documented. Therefore this study aimed to assess the nutritional status among HDP and to establish the factors associated with MN in these patients. METHODS A cross-sectional survey was carried out in Nablus, northern West Bank, in the main haemodialysis (HD) centre at the An-Najah National University Hospital. MN was detected using the malnutrition-inflammation scale (MIS), which involved four major elements: the patient's related medical history, their body mass index, a physical examination and laboratory parameters. RESULTS A total of 174 patients (91 male) were included in the study. Patients were aged 57.7 ± 12.8 years, and the median dialysis vintage was 3 years (interquartile range 1-5 years). HDP, especially the elderly (unstandardized coefficient β, 1.728; 95% CI, 0.700 to 2.756; P = 0.001), those with multiple comorbid diseases (unstandardized coefficient β, 1.673; 95% CI, 0.556 to 2.789; P = 0.004); those taking multiple chronic medications (unstandardized coefficient β, 1.259; 95% CI, 0.197 to 2.321; P = 0.020), or those with a long dialysis vintage (unstandardized coefficient β, 1.449; 95% CI, 0.410 to 2.487; P = 0.007), were positively associated with the MIS score in a multivariable linear regression model. Furthermore, HDP living with their family were negatively associated with the MIS score (unstandardized coefficient β, - 2.545; 95% CI, - 4.738 to - 0.352; P = 0.023). CONCLUSIONS The MIS score results indicate that MN is prevalent among HDP. These results demonstrate some correlations between nutritional status and patient characteristics (i.e. clinical and sociodemographic factors). Therefore these findings should help to increase the awareness of healthcare providers for interventions to enhance the nutritional status of HDP, especially those who are elderly, have multiple comorbid diseases, have multiple chronic medications, have experienced a long dialysis vintage or who live alone.
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Affiliation(s)
- Ali M. Omari
- 0000 0004 0631 5695grid.11942.3fDepartment of Medicine, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
| | - Leen S. Omari
- 0000 0004 0631 5695grid.11942.3fDepartment of Medicine, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
| | - Hazar H. Dagash
- 0000 0004 0631 5695grid.11942.3fDepartment of Medicine, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
| | - Waleed M. Sweileh
- 0000 0004 0631 5695grid.11942.3fDepartment of Physiology, Pharmacology, and Toxicology, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
| | - Nehal Natour
- 0000 0004 0631 5695grid.11942.3fPublic Health Department, College of Medicine and Health Sciences, An-Najah National University Hospital, An-Najah National University, Nablus, 44839 Palestine
| | - Sa’ed H. Zyoud
- 0000 0004 0631 5695grid.11942.3fPoison Control and Drug Information Center (PCDIC), College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
- 0000 0004 0631 5695grid.11942.3fDepartment of Clinical and Community Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
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Sinha SD, Bandi VK, Bheemareddy BR, Thakur P, Chary S, Mehta K, Pinnamareddy VR, Pandey R, Sreepada S, Durugkar S. Efficacy, tolerability and safety of darbepoetin alfa injection for the treatment of anemia associated with chronic kidney disease (CKD) undergoing dialysis: a randomized, phase-III trial. BMC Nephrol 2019; 20:90. [PMID: 30866856 PMCID: PMC6417108 DOI: 10.1186/s12882-019-1209-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 10/23/2018] [Accepted: 01/11/2019] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Darbepoetin alfa (DA-α) is a long-acting erythropoiesis-stimulating glycoprotein which has half-life three-fold longer than that of Erythropoietin alfa (EPO). The objective of this study was to compare the efficacy and safety of DA-α injection versus EPO for treating renal anemia amongst Indian patients with end-stage renal disease (ESRD) undergoing dialysis. METHODS Patients of either gender (aged 18-65 years) with ESRD undergoing dialysis who had hemoglobin (Hb) levels < 10 g/dL after receiving EPO were switched to DA-α (0.45 μg/kg) once weekly subcutaneously or EPO 50 IU/kg thrice weekly subcutaneously (centrally randomized 1:1) for 12-24 weeks (correction phase) followed by 12 weeks maintenance phase (for Hb levels ≥10 g/dL). The primary efficacy endpoint was mean change in Hb level from baseline to end of correction phase. RESULTS In the intention-to-treat population (n = 126), the between group difference in mean Hb change was - 0.01 g/dL (95% CI - 0.68 to - 0.66, p = 0.97). After adjusting for covariates, the difference was - 0.2878 g/dL (95% CI -0.936 to0.360). The lower limit of the two-sided 95% CI of primary endpoint was above the pre-specified non-inferiority margin of - 1.0 g/dL. Similar trend of non-inferiority was observed for per-protocol population. Safety profile of DA-α and EPO were observed to be similar. CONCLUSION Our study results demonstrated that for patients with ESRD undergoing dialysis, administering DA-α at lower dose frequency, is equally effective and well tolerated as EPO for treating renal anemia. TRIAL REGISTRATION CTRI/2012/07/002835 [Registered on: 27/07/2012]; Trial Registered Prospectively.
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Affiliation(s)
- Shubhadeep D. Sinha
- Clinical Development and Medical Affairs, Hetero Group, Hetero Corporate, 7-2-A2, Industrial Estates, Sanath Nagar, Hyderabad, Andhra Pradesh India
| | - Vamsi Krishna Bandi
- Clinical Development and Medical Affairs, Hetero Group, Hetero Corporate, 7-2-A2, Industrial Estates, Sanath Nagar, Hyderabad, Andhra Pradesh India
| | - Bala Reddy Bheemareddy
- Clinical Development and Medical Affairs, Hetero Group, Hetero Corporate, 7-2-A2, Industrial Estates, Sanath Nagar, Hyderabad, Andhra Pradesh India
| | - Pankaj Thakur
- Clinical Development and Medical Affairs, Hetero Group, Hetero Corporate, 7-2-A2, Industrial Estates, Sanath Nagar, Hyderabad, Andhra Pradesh India
| | - Sreenivasa Chary
- Clinical Development and Medical Affairs, Hetero Group, Hetero Corporate, 7-2-A2, Industrial Estates, Sanath Nagar, Hyderabad, Andhra Pradesh India
| | - Kalpana Mehta
- Department of Nephrology, B.L.Y Nair Hospital, A.L Nair Road, Mumbai, Maharashtra India
| | | | - Rajendra Pandey
- Department of Nephrology, Institute of Post Graduate Medical Education and Research Kolkata, 244 A.J.C Bose Road, Kolkata, West Bengal India
| | - Subhramanyam Sreepada
- Sri Raghavendra Hospital, 1-7-100, Opp. Round Building, Kamala Nagar, ECIL Cross Road, ECIL, Hyderabad, Andhra Pradesh 500062 India
| | - Santosh Durugkar
- Ashwini Hospital and Ramakanth Heart Care Center, Shivaji Nagar, Nanded, Maharashtra India
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Combe C, Mann J, Goldsmith D, Dellanna F, Zaoui P, London G, Denhaerynck K, Krendyukov A, Abraham I, MacDonald K. Potential life-years gained over a 5-year period by correcting DOPPS-identified modifiable practices in haemodialysis: results from the European MONITOR-CKD5 study. BMC Nephrol 2019; 20:81. [PMID: 30836953 PMCID: PMC6402099 DOI: 10.1186/s12882-019-1251-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 02/08/2019] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND DOPPS reported that thousands of life-years could be gained in the US and Europe over 5 years by correcting six modifiable haemodialysis practices. We estimated potential life-years gained across 10 European countries using MONITOR-CKD5 study data. METHODS The DOPPS-based target ranges were used, except for haemoglobin due to label changes, as well as DOPPS-derived relative mortality risks. Percentages of MONITOR-CKD5 patients outside targets were calculated. Consistent with the DOPPS-based analyses, we extrapolated life-years gained for the MONITOR-CKD5 population over 5 years if all patients were within targets. RESULTS Bringing the 10 MONITOR-CKD5 countries' dialysis populations into compliance on the six practices results in a 5-year gain of 97,428 patient-years. In descending order, survival impact was the highest for albumin levels, followed by phosphate levels, vascular access, haemoglobin, dialysis adequacy, and interdialytic weight gain. CONCLUSIONS Optimal management of the six modifiable haemodialysis practices may achieve 6.2% increase in 5-year survival. TRIAL REGISTRATION NCT01121237 . Clinicaltrials.gov registration May 12, 2010 (retrospectively registered).
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Affiliation(s)
- Christian Combe
- Centre Hospitalier Universitaire de Bordeaux and Unité INSERM 1026, University of Bordeaux, Bordeaux, France
| | - Johannes Mann
- Friedrich Alexander Universität Erlangen-Nürnberg, Erlangen, Germany
| | | | | | | | - Gérard London
- Centre Hospitalier F.H. Manhés, Fleury-Mérogis, France
| | - Kris Denhaerynck
- Matrix45, Tucson, AZ USA
- Department of Public Health, University of Basel, Basel, Switzerland
| | | | - Ivo Abraham
- Matrix45, Tucson, AZ USA
- University of Arizona College of Pharmacy and College of Medicine, Tucson, AZ USA
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25
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Cepeda Marte JL, Javier A, Ruiz-Matuk C, Paulino-Ramirez R. Quality of Life and Nutritional Status in diabetic patients on hemodialysis. Diabetes Metab Syndr 2019; 13:576-580. [PMID: 30641769 DOI: 10.1016/j.dsx.2018.11.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 11/02/2018] [Indexed: 11/20/2022]
Abstract
AIMS The quality of life (QoL) of patients with diabetes and in hemodialysis is affected by their nutritional status. We aimed to determine the correlation between QoL and nutritional status of patients in hemodialysis. METHODS We conducted a study with people with diabetes and in hemodialysis. We used Kidney Disease and Quality of Life-Short form (KDQOL-SFTM) scale to evaluate QoL and the Subjective Global Assessment (SGA) questionnaire for nutritional evaluation. RESULTS The studied patients, 71.43% were over 55 years old and 81% of participants were male. The domain of QoL must impaired were cognitive function (x¯=26.35, SD = 20.81) and interaction of social quality (x¯=19.32, SD = 17.24). The characteristics that most favorably impacted QoL were dialysis equipment support (x¯=83.93, SD = 20.59) and patient satisfaction (x¯=86.51, SD = 17.17). The undernourished patients were 56.6% (n = 14). There was a strong lineal relationship between the Physical and Mental Health Composite and nutritional status, Spearman rank (rho = 0.935, p = <0.001), (rho=0.926, p = <0.001) respectively. CONCLUSION There is a strong relationship between QoL and nutritional status, ensuring that a good nutritional status could positively influence QoL.
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Affiliation(s)
- Jenny L Cepeda Marte
- Instituto de Medicina Tropical & Salud Global, Universidad Iberoamericana, Calle Majoma 13, Los Rios, Santo Domingo, 22333, Dominican Republic.
| | - Adriana Javier
- Instituto Nacional de Diabetes, Endocrinología y Nutrición (INDEN), Hospital Escuela Jorge Abraham Hazoury Bahles, Paseo del Yaque los Ríos, Santo Domingo, 10604, Dominican Republic
| | - Carlos Ruiz-Matuk
- Instituto de Medicina Tropical & Salud Global, Universidad Iberoamericana, Calle Majoma 13, Los Rios, Santo Domingo, 22333, Dominican Republic
| | - Robert Paulino-Ramirez
- Instituto de Medicina Tropical & Salud Global, Universidad Iberoamericana, Calle Majoma 13, Los Rios, Santo Domingo, 22333, Dominican Republic
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Forghani MS, Jadidoleslami MS, Naleini SN, Rajabnia M. Measurement of the serum levels of serum troponins I and T, albumin and C-Reactive protein in chronic hemodialysis patients and their relationship with left ventricular hypertrophy and heart failure. Diabetes Metab Syndr 2019; 13:522-525. [PMID: 30641758 DOI: 10.1016/j.dsx.2018.11.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 11/02/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Hemodialysis patients are at high risk for cardiovascular diseases. The prognostic value of cardiac troponins, albumin and CRP in hemodialysis patients and their association with cardiac diseases has been proven. The aim of this study was to investigate the relationship between these factors and heart failure and left ventricular hypertrophy in hemodialysis patients in Sanandaj city. METHODS A total of 90 hemodialysis patients referred to hemodialysis ward of Tohid Medical Center of Sanandaj were enrolled in the study. After receiving the required information from patients and recording them in questionnaire, blood samples were taken from them and were sen to Lab for Measurement. Finally, the data were analyzed using SPSS software and Spearman correlation coefficient for independent variables and Chi square test and correlation coefficient of Choprovert's for independent qualitative variable. RESULTS In the case of LVH, 23.3% of patients were with normal thickness, 38.9% had mild LVH, 30% had moderate LVH and 7.8% had severe LVH. The mean serum albumin level in patients was 3.8 g/dl, CRP 9.4 mg/dL, and troponins I and T were 0.4 and 685.06 ng/dL, respectively. There was a statistically significant relationship between cardiac I and T troponins levels and CRP levels in patients with chronic hemodialysis (P < 0.05. There was a significant relationship between serum albumin level, troponins I, T and CRP with left ventricular hypertrophy in chronic hemodialysis patients (P < 0.05). CONCLUSION Serum levels of I and T troponins, albumin, as well as CRP, are related to heart failure and left ventricular hypertrophy in hemodialysis patients, and this can be used by physicians to determine the patient's ability and risk of disease Cardiovascular diseases.
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Affiliation(s)
- Mohammad Saad Forghani
- Department of Internal Medicine, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | | | - Seyyed Nima Naleini
- Student Research Committee, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Mohsen Rajabnia
- Student Research Committee, Kurdistan University of Medical Sciences, Sanandaj, Iran.
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Voorzaat BM, Janmaat CJ, Wilschut ED, Van Der Bogt KEA, Dekker FW, Rotmans JI. No consensus on physicians' preferences on vascular access management after kidney transplantation: Results of a multi-national survey. J Vasc Access 2019; 20:52-59. [PMID: 29843559 PMCID: PMC6305957 DOI: 10.1177/1129729818776905] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 02/14/2018] [Accepted: 03/26/2018] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE: Arteriovenous fistulas for hemodialysis vascular access are a burden for the cardiovascular system. After successful kidney transplantation, prophylactic arteriovenous fistula ligation may improve cardiac outcomes; however, evidence is scarce. This survey investigates physicians' preference for management of arteriovenous fistulas and identifies the factors associated with preference for either arteriovenous fistula ligation or maintenance. MATERIALS AND METHODS: A survey was sent to members of eight national and international Nephrology and Vascular Surgery societies. The survey comprised eight case vignettes of asymptomatic patients with a functioning arteriovenous fistula after kidney transplantation. Characteristics possibly associated with treatment preferences were arteriovenous fistula flow, left ventricular ejection fraction, and patient age. Respondents were asked to state preference to maintain or ligate the arteriovenous fistula. Linear mixed-effects models were used to investigate the association of treatment preference with case characteristics. RESULTS: A total of 585 surveys were returned. A reduced left ventricular ejection fraction of 30% (beta 0.60, 95% confidence interval 0.55; 0.65) and a high flow of 2500 mL/min (beta 0.46, 95% confidence interval 0.41; 0.51) were associated with a higher preference for arteriovenous fistula ligation. Disagreement among respondents was considerable, as in four out of eight cases less than 70% of respondents agreed on the arteriovenous fistula management strategy. CONCLUSION: Although respondents recognize a reduced left ventricular ejection fraction and a high flow as the risk factors, the high disagreement on management preferences suggests that evidence is inconclusive to recommend arteriovenous fistula ligation or maintenance after kidney transplantation. More research is needed to determine optimal arteriovenous fistula management after successful kidney transplantation.
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Affiliation(s)
- Bram M Voorzaat
- Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Cynthia J Janmaat
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Esther D Wilschut
- Department of Surgery, Haaglanden Medical Center, The Hague, The Netherlands
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Koen EA Van Der Bogt
- Department of Surgery, Haaglanden Medical Center, The Hague, The Netherlands
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Friedo W Dekker
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Joris I Rotmans
- Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
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Hamada S, Sano T, Nagatani Y, Tsukino M. Pleural effusion negatively impacts survival of patients undergoing maintenance hemodialysis. Pulmonology 2018; 25:58-60. [PMID: 30509856 DOI: 10.1016/j.pulmoe.2018.10.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 10/22/2018] [Accepted: 10/28/2018] [Indexed: 11/18/2022] Open
Affiliation(s)
- S Hamada
- Department of Respiratory Medicine, Hikone Municipal Hospital, 1882, Hassakacho, Hikone 522-8539, Japan.
| | - T Sano
- Department of Urology, Hikone Municipal Hospital, 1882, Hassakacho, Hikone 522-8539, Japan
| | - Y Nagatani
- Department of Urology, Hikone Municipal Hospital, 1882, Hassakacho, Hikone 522-8539, Japan
| | - M Tsukino
- Department of Respiratory Medicine, Hikone Municipal Hospital, 1882, Hassakacho, Hikone 522-8539, Japan
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29
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Pancras G, Shayo J, Anaeli A. Non-medical facilitators and barriers towards accessing haemodialysis services: an exploration of ethical challenges. BMC Nephrol 2018; 19:342. [PMID: 30509208 PMCID: PMC6276249 DOI: 10.1186/s12882-018-1140-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 11/15/2018] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Like most of the sub-Saharan countries, Tanzania faces significant increase in the number of patients diagnosed with an end-stage renal disease (ESRD) among which only a few manage to receive chronic haemodialysis services (CHD). Yet little is known about the non-medical facilitators and barriers towards accessing these services and the associated ethical challenges. METHODS A phenomenological study design which employed a qualitative approach was used. The study was conducted at the dialysis unit harboured within Muhimbili National Hospital. Data were collected from purposively sampled health care providers and ESRD patients by using in-depth interviews. Text data obtained were analysed based on inductive and deductive content analysis methods to formulate major themes. RESULTS Fourteen key informants were interviewed including nephrologists, renal nurses, social workers, nutritionists and ESRD patients. Three major themes were formulated: a) non-medical facilitators towards accessing CHD services which enshrines two sub-themes (membership to health insurance scheme and family support), (b) non-medical barriers towards accessing CHD services which enshrines four sub-themes (affordability of treatment costs, geographical accessibility, availability of CHD resources and acceptability of treatment procedures) and lastly (c) ethical challenges associated with accessing CHD services which also enshrines three sub-themes (dual role of health care providers, patients autonomy in decision making, and treatment disparity). CONCLUSION Non-medical facilitators to access CHD benefits few patients whereas non-medical barriers leave many ESRD patients untreated or partially treated. On the other hand, ethical challenges like treatment inequality are quickly gaining momentum. There is a need for guideline highlighting importance, position, and limitation of non-medical factors in the delivery of CHD services in Tanzania and other developing countries.
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Affiliation(s)
- Godwin Pancras
- Department of Bioethics and Health Professionalism, Muhimbili University of Health and Allied Sciences, P.O Box 65001, United Nations Rd, Dar es Salaam, Tanzania
| | - Judith Shayo
- Department of Clinical Nursing, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Amani Anaeli
- Department of Development Studies, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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Muscat DM, Kanagaratnam R, Shepherd HL, Sud K, McCaffery K, Webster A. Beyond dialysis decisions: a qualitative exploration of decision-making among culturally and linguistically diverse adults with chronic kidney disease on haemodialysis. BMC Nephrol 2018; 19:339. [PMID: 30482170 PMCID: PMC6258454 DOI: 10.1186/s12882-018-1131-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 11/05/2018] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND To date, limited research has been dedicated to exploring the experience of decision-making for chronic kidney disease (CKD) patients who have initiated dialysis and have to make decisions in the context of managing multiple illnesses. Evidence about the experience of decision-making for minority or disadvantaged groups living with CKD (e.g. culturally and linguistically diverse adults; those with lower health literacy or cognitive impairment) is also lacking. This study aimed to explore the experience of healthcare decision-making among culturally and linguistically diverse adults receiving in-centre haemodialysis for advanced CKD. METHODS Semi-structured interviews with English or Arabic-speaking adults recruited from four large haemodialysis units in Greater Western Sydney, Australia using stratified, purposive sampling. Interviews were audio-recorded, transcribed verbatim, and analysed using the Framework method. RESULTS Interviews were conducted with 35 participants from a range of cultural backgrounds (26 English-language; 9 Arabic-language). One quarter had limited health literacy as assessed by the Single Item Literacy Screener. Four major themes were identified from the data, highlighting that participants had limited awareness of decision-points throughout the CKD trajectory (other than the decision to initiate dialysis), expressed passivity regarding their involvement in healthcare decisions, and reported inconsistent information provision within and across dialysis units. There was diversity within cultural and linguistic groups in terms of preferences and beliefs regarding religiosity, decision-making and internalised prototypical cultural values. CONCLUSION Without sustained effort, adults living with CKD may be uninformed about decision points throughout the CKD trajectory and/or unengaged in the process of making decisions. While culture may be an important component of people's lives, cultural assumptions may oversimplify the diverse individual differences that exist within cultural groups.
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Affiliation(s)
- Danielle Marie Muscat
- The University of Sydney, Faculty of Medicine and Health, School of Public Health, Sydney Health Literacy Lab, Sydney, NSW Australia
| | - Roshana Kanagaratnam
- The University of Sydney, Faculty of Medicine and Health, School of Public Health, Sydney, NSW Australia
| | - Heather L. Shepherd
- The University of Sydney, Faculty of Science, School of Psychology, Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), Sydney, NSW Australia
| | - Kamal Sud
- The University of Sydney, Faculty of Medicine and Health, Nepean Clinical School, Sydney, NSW Australia
- Department of Renal Medicine, Nepean Hospital, Nepean Blue Mountains Local Health District, Sydney, NSW Australia
- Department of Renal Medicine and Transplantation, Westmead Hospital, Western Sydney Local Health District, Sydney, NSW Australia
| | - Kirsten McCaffery
- The University of Sydney, Faculty of Medicine and Health, School of Public Health, Sydney Health Literacy Lab, Sydney, NSW Australia
- The University of Sydney, Faculty of Science, School of Psychology, Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), Sydney, NSW Australia
- The University of Sydney, Faculty of Medicine and Health, School of Public Health, Wiser Healthcare, Sydney, NSW Australia
| | - Angela Webster
- The University of Sydney, Faculty of Medicine and Health, School of Public Health, Sydney, NSW Australia
- Department of Renal Medicine and Transplantation, Westmead Hospital, Western Sydney Local Health District, Sydney, NSW Australia
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Chen HC, Wang WT, Hsi CN, Chou CY, Lin HJ, Huang CC, Chang CT. Abdominal aortic calcification score can predict future coronary artery disease in hemodialysis patients: a 5-year prospective cohort study. BMC Nephrol 2018; 19:313. [PMID: 30409161 PMCID: PMC6225627 DOI: 10.1186/s12882-018-1124-x] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 10/26/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Abdominal aortic calcification (AAC) has been known to be associated with cardiovascular mortality in hemodialysis. However, the association between AAC and future coronary artery disease (CAD) occurrence is not clear. We aimed to clarify the association of AAC severity and the occurrence of future CAD events in hemodialysis patients. METHODS Hemodialysis (HD) patients were recruited in this prospective cohort study. AAC severity was quantified by AAC score, which was measured by lateral lumbar radiography. We used receiver operation curve (ROC) analysis to find the cutoff AAC value for CAD prediction. CAD-free survival was analyzed by Kaplan-Meier study. RESULTS There were 303 patients recruited for study with a median (interquartile range) follow-up of 95 (65-146) months. The AAC score in patients with occurrence of new CAD [9 (3-15.25), n = 114] was higher than in patients without new CAD occurrence [5 (1-9) n = 189], p < 0.001. Multivariate hazard ratio of AAC score for CAD was 1.039 (p = 0.016). ROC study showed that an AAC score of 5.5 had a sensitivity of 0.658 and a specificity of 0.587 in the prediction of new CAD occurrence. Patients with AAC score above 5.5 had significantly higher cumulative incidence of CAD than patients with AAC score below 5.5. Age, diabetes, prior history of CAD, and longer dialysis vintage were major factors associated with higher AAC score. CONCLUSIONS AAC score can predict the occurrence of future CAD events in HD patients. The best cut-off value of AAC score is 5.5. AAC score greater than 5.5 is a reliable abdominal aortic calcification marker, and can predict future CAD in ESRD patients. Major contributive factors for higher AAC score were age, presence of diabetes, prior history of CAD, and longer dialysis vintage.
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Affiliation(s)
- Hung-Chih Chen
- Division of Nephrology, Asia University Hospital, Taichung, Taiwan
| | - Wei-Ting Wang
- College of Medicine, China Medical University, Taichung, Taiwan
| | - Chieh-Ning Hsi
- College of Medicine, China Medical University, Taichung, Taiwan
| | - Che-Yi Chou
- Division of Nephrology, Asia University Hospital, Taichung, Taiwan
| | - Hsuan-Jen Lin
- Division of Nephrology, Asia University Hospital, Taichung, Taiwan
| | - Chiu-Ching Huang
- College of Medicine, China Medical University, Taichung, Taiwan
- Division of Nephrology, China Medical University Hospital, Taichung, 40447 Taiwan
| | - Chiz-Tzung Chang
- College of Medicine, China Medical University, Taichung, Taiwan
- Division of Nephrology, China Medical University Hospital, Taichung, 40447 Taiwan
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Bae E, Lee H, Kim DK, Oh KH, Kim YS, Ahn C, Han JS, Min SI, Min SK, Kim HC, Joo KW. Autologous arteriovenous fistula is associated with superior outcomes in elderly hemodialysis patients. BMC Nephrol 2018; 19:306. [PMID: 30400882 PMCID: PMC6218981 DOI: 10.1186/s12882-018-1109-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [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: 08/27/2018] [Accepted: 10/19/2018] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND The number of elderly patients with end-stage renal disease is increasing rapidly. The higher prevalence of comorbidities and shorter life expectancy in these patients make it difficult to decide on the type of vascular access (VA). We explored the optimal choice for VA in elderly hemodialysis patients. METHODS We included elderly patients (> 65 years) visiting our VA clinic and divided them into three groups as follows: radiocephalic arteriovenous fistula (AVF), brachiocephalic AVF, and prosthetic arteriovenous graft (AVG). The primary outcomes were VA abandonment and all-cause mortality. The secondary outcome was maturation failure (MF). RESULTS Of 529 patients, 61.2% were men. The mean age was 73.6 ± 6.0 years. The VA types were as follows: 49.9% radiocephalic AVF, 31.8% brachiocephalic AVF, and 18.3% AVG. Patients with an AVG tended to be older, female, and have a lower body mass index. More than half of patients (n = 302, 57.1%) started dialysis with central catheters, but the proportion of predialysis central catheter placement was not different among the VA types. Radiocephalic AVF was significantly superior to AVG in terms of VA abandonment (P = 0.005) and all-cause mortality (P < 0.001) in spite of a higher probability of MF. Brachiocephalic AVF was associated with a shorter time to the first needling and fewer interventions before maturation than radiocephalic AVF. CONCLUSIONS Autologous AVF was suggested as the preferred VA choice in terms of long-term outcomes in elderly patients.
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Affiliation(s)
- Eunjin Bae
- Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Changwon, South Korea
| | - Hajeong Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
- Kidney Reasearch Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - Dong Ki Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
- Kidney Reasearch Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - Kook-Hwan Oh
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Yon Su Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
- Kidney Reasearch Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - Curie Ahn
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
- Kidney Reasearch Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - Jin Suk Han
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
- Kidney Reasearch Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - Sang-Il Min
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Seung-Kee Min
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Hyo-Cheol Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea
| | - Kwon Wook Joo
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
- Kidney Reasearch Institute, Seoul National University College of Medicine, Seoul, South Korea
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080 Republic of Korea
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Jakupi X, Mlakar J, Lunar MM, Seme K, Rudhani I, Raka L, Vince A, Poljak M. A very high prevalence of hepatitis C virus infection among patients undergoing hemodialysis in Kosovo: a nationwide study. BMC Nephrol 2018; 19:304. [PMID: 30390638 PMCID: PMC6215601 DOI: 10.1186/s12882-018-1100-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 10/12/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Patients on hemodialysis are at high risk for hepatitis C virus (HCV) infection if measures for effective control of HCV infection in the hemodialysis environment are not implemented. Whereas in developed countries isolated small-scale outbreaks of HCV in hemodialysis units are occasionally reported, HCV transmission in the hemodialysis environment still represents a substantial problem in low-resource countries. This study systematically assessed the prevalence of HCV infection among all patients at all hemodialysis centers in Kosovo, determined the HCV genotype distribution, and reviewed the main risk factors associated with HCV infection in this group of patients. METHODS From January to March 2013, blood samples from all patients undergoing hemodialysis at all seven hemodialysis centers in Kosovo were collected. The samples were screened for the presence of anti-HCV antibodies, and seropositive samples were also tested for HCV RNA. Genotyping was performed by sequencing the core region of the HCV genome. Subsequently, face-to-face interviews were conducted with consented patients attending hemodialysis in December 2015 and with the management of all hemodialysis centers in Kosovo. RESULTS The overall seroprevalence of HCV infection among hemodialysis patients in Kosovo was 53.0% (354/668), ranging from 22.3 to 91.1% at different centers. HCV RNA was detected in 323/354 (91.2%) seropositive patients. The most frequent HCV genotype was genotype 1a (62.2%), followed by genotypes 4d (33.1%), 1b (4.0%), and 2c (0.7%). The duration of hemodialysis and receiving dialysis at more than one center were identified as independent significant predictors of anti-HCV positivity. Shortage of staff, lack of resources, and inconsistent use of hygienic precautions and/or isolation strategies were observed. CONCLUSIONS The prevalence of HCV infection among hemodialysis patients in Kosovo is extremely high. The relatively low prevalence of HCV infection in the general population, predominance of two otherwise rare HCV genotypes among hemodialysis patients, and longer history of hemodialysis as a predictor of HCV infection all indicate nosocomial transmission due to inappropriate infection control practices as the main transmission route.
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Affiliation(s)
- Xhevat Jakupi
- Department of Microbiology, Kosovo National Institute of Public Health, Rrethi i Spitalit, p.n, 10000 Prishtina, Kosovo
| | - Jana Mlakar
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Zaloška 4, 1000 Ljubljana, Slovenia
| | - Maja M. Lunar
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Zaloška 4, 1000 Ljubljana, Slovenia
| | - Katja Seme
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Zaloška 4, 1000 Ljubljana, Slovenia
| | - Ibrahim Rudhani
- Clinic for Nephrology, University Medical Center of Kosovo, Bulevardi i Dëshmorëve, p.n, 10000 Prishtina, Kosovo
| | - Lul Raka
- Faculty of Medicine, Hasan Prishtina University of Prishtina, Bulevardi i Dëshmorëve, p.n, 10000 Prishtina, Kosovo
| | - Adriana Vince
- Dr Fran Mihaljević University Hospital for Infectious Diseases, Mirogojska 8, 10000 Zagreb, Croatia
| | - Mario Poljak
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Zaloška 4, 1000 Ljubljana, Slovenia
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Viršilas E, Čerkauskienė R, Masalskienė J, Rudaitis Š, Dobilienė D, Jankauskienė A. Renal Replacement Therapy in Children in Lithuania: Challenges, Trends, and Outcomes. Medicina (Kaunas) 2018; 54:E78. [PMID: 30400223 PMCID: PMC6262335 DOI: 10.3390/medicina54050078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 10/19/2018] [Accepted: 10/30/2018] [Indexed: 11/17/2022]
Abstract
Background and Objectives: Pediatric renal replacement therapy (RRT) in Lithuania resumed in 1994 after a 12-year pause in renal transplantation. Management of end stage renal disease (ESRD) has changed, and outcomes have improved over decades. Our aim was to evaluate the dynamics of RRT in Lithuania in the period 1994⁻2015, describe its distinctive features, and compare our results with other countries. Materials and Methods: Data between 1994 and 2015 were collected from patients under the age of 18 years with ESRD receiving RRT. The data included: Hemodialysis (HD), peritoneal dialysis (PD), transplantation incidence and prevalence, transplant waiting time, dialysis modalities before transplantation, causes of ESRD and gender distribution in transplanted patients, and patient and graft survival. Results: RRT incidence and prevalence maintained an increase up until 2009. Sixty-four transplantations were performed. Juvenile nephronophthisis (25.9%) was the primary cause of ESRD in transplanted children. The transplant waiting time median was 8.0 months. The male to female ratio post-transplantation was 1.02. Patient survival after transplantation at 10 years was 90.0%, while graft survival for living (related) was 77.0% and 51.1% for deceased. Twelve patients died while on RRT. Conclusions: RRT numbers are increasing in Lithuania. HD is the primary treatment of choice before transplantation, with continued low numbers of preemptive transplantation. Patient survival post-transplantation is favorable, though graft survival is less satisfactory.
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Affiliation(s)
- Ernestas Viršilas
- Institute of Clinical Medicine, Vilnius University, LT-08406 Vilnius, Lithuania.
| | - Rimantė Čerkauskienė
- Institute of Clinical Medicine, Vilnius University, LT-08406 Vilnius, Lithuania.
| | - Jūratė Masalskienė
- Department of Pediatrics, Medical Academy, Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania.
| | - Šarūnas Rudaitis
- Department of Pediatrics, Medical Academy, Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania.
| | - Diana Dobilienė
- Department of Pediatrics, Medical Academy, Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania.
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Lee HS, Ju YS, Song YR, Kim JK, Choi SR, Joo N, Kim HJ, Park P, Kim SG. Current treatment status and medical costs for hemodialysis vascular access based on analysis of the Korean Health Insurance Database. Korean J Intern Med 2018; 33:1160-1168. [PMID: 30396254 PMCID: PMC6234403 DOI: 10.3904/kjim.2018.170] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Accepted: 07/24/2018] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS The Republic of Korea is a country where the hemodialysis population is growing rapidly. It is believed that the numbers of treatments related to vascular access-related complications are also increasing. This study investigated the current status of treatment and medical expenses for vascular access in Korean patients on hemodialysis. METHODS This was a descriptive observational study. We inspected the insurance claims of patients with chronic kidney disease who underwent hemodialysis between January 2008 and December 2016. We calculated descriptive statistics of the frequencies and medical expenses of procedures for vascular access. RESULTS The national medical expenses for access-related treatment were 7.12 billion KRW (equivalent to 6.36 million USD) in 2008, and these expenses increased to 42.12 billion KRW (equivalent to 37.67 million USD) in 2016. The population of hemodialysis patients, the annual frequency of access-related procedures, and the total medical cost for access-related procedures increased by 1.6-, 2.6-, and 5.9-fold, respectively, over the past 9 years. The frequency and costs of access care increased as the number of patients on hemodialysis increased. The increase in vascular access-related costs has largely been driven by increased numbers of percutaneous angioplasty. CONCLUSION The increasing proportion of medical costs for percutaneous angioplasty represents a challenge in the management of end-stage renal disease in Korea. It is essential to identify the clinical and physiological aspects as well as anatomical abnormalities before planning angioplasty. A timely surgical correction could be a viable option to control the rapid growth of access-related medical expenses.
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Affiliation(s)
- Hyung Seok Lee
- Department of Internal Medicine, Kidney Research Institute, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Young-Su Ju
- Department of Occupational and Environmental Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Young Rim Song
- Department of Internal Medicine, Kidney Research Institute, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Jwa Kyung Kim
- Department of Internal Medicine, Kidney Research Institute, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Sun Ryoung Choi
- Department of Internal Medicine, Kidney Research Institute, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Narae Joo
- Department of Internal Medicine, Kidney Research Institute, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Hyung Jik Kim
- Department of Internal Medicine, Kidney Research Institute, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Pyoungju Park
- Department of Internal Medicine, Kidney Research Institute, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Sung Gyun Kim
- Department of Internal Medicine, Kidney Research Institute, Hallym University Sacred Heart Hospital, Anyang, Korea
- Correspondence to Sung Gyun Kim, M.D. Department of Internal Medicine, Kidney Research Institute, Hallym University Sacred Heart Hospital, 22 Gwanpyeong-ro 170beon-gil, Dongan-gu, Anyang 14068, Korea Tel: +82-31-380-1942 Fax: +82-31-386-2269 E-mail:
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Hofman JMG, Eisenga MF, Diepenbroek A, Nolte IM, van Dam B, Westerhuis R, Bakker SJL, Franssen CFM, Gaillard CAJM. Switching iron sucrose to ferric carboxymaltose associates to better control of iron status in hemodialysis patients. BMC Nephrol 2018; 19:242. [PMID: 30236065 PMCID: PMC6149056 DOI: 10.1186/s12882-018-1045-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 09/12/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Although the efficacy of iron sucrose (IS) and ferric carboxymaltose (FCM) in treating anemia in hemodialysis (HD) patients has been studied individually, a comparison of these two intravenous iron formulations has not yet been performed in HD patients. METHODS We performed a retrospective audit on records of 221 stable HD patients from different HD centers in the Netherlands, who were switched from IS to FCM on a 1:1 ratio. To assess the effect of the switch on iron status parameters, data from 3 time points before and 3 time points after the switch were analyzed using linear mixed effects models. Subanalyses were done in 2 subgroups of patients anemic or iron deficient at baseline. RESULTS Hemoglobin increased in all groups (anemic [1.4 g/dL, P < 0.001] iron deficient [0.6 g/dL, P < 0.001]), while the weekly iron dose was significantly lower when patients received FCM compared to IS (48 vs 55 mg/week, P = 0.04). Furthermore, serum ferritin and transferrin saturation increased in all groups (anemic [64 μg/L, 5.0%, P < 0.001] iron deficient [76 μg/L, 3.6%, P < 0.001]). Finally, the darbepoetin α dose decreased significantly in all groups (anemic [- 16 μg/wk., P = 0.01] iron deficient [- 11 μg/wk., P < 0.001]). CONCLUSIONS In this real-life study in HD patients, a switch from IS to FCM resulted in an improvement of iron status parameters despite a lower weekly dose of FCM. Furthermore, the ESA dose was reduced during FCM, while hemoglobin levels increased.
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Affiliation(s)
- Jesse M. G. Hofman
- Department of Nephrology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, Groningen, 9713GZ The Netherlands
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, Hanzeplein 1, 9713GZ Groningen, The Netherlands
| | - Michele F. Eisenga
- Department of Nephrology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, Groningen, 9713GZ The Netherlands
| | - Adry Diepenbroek
- Department of Nephrology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, Groningen, 9713GZ The Netherlands
| | - Ilja M. Nolte
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, Groningen, 9713GZ The Netherlands
| | - Bastiaan van Dam
- Department of Internal Medicine, Medical Center Alkmaar, Wilhelminalaan 12, 1815JD Alkmaar, The Netherlands
| | - Ralf Westerhuis
- Dialysis Center Groningen, Hanzeplein 1, Groningen, 9713GZ The Netherlands
| | - Stephan J. L. Bakker
- Department of Nephrology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, Groningen, 9713GZ The Netherlands
| | - Casper F. M. Franssen
- Department of Nephrology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, Groningen, 9713GZ The Netherlands
| | - Carlo A. J. M. Gaillard
- Department of Internal Medicine and Dermatology, University Medical Center Utrecht, University of Utrecht, Heidelberglaan 100, 3584CX Utrecht, The Netherlands
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Duong TV, Wong TC, Chen HH, Chen TW, Chen TH, Hsu YH, Peng SJ, Kuo KL, Liu HC, Lin ET, Wang CS, Tseng IH, Feng YW, Chang TY, Su CT, Yang SH. Inadequate dietary energy intake associates with higher prevalence of metabolic syndrome in different groups of hemodialysis patients: a clinical observational study in multiple dialysis centers. BMC Nephrol 2018; 19:236. [PMID: 30231860 PMCID: PMC6145210 DOI: 10.1186/s12882-018-1041-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 09/10/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Metabolic syndrome (MetS) has been established as a risk for cardiovascular diseases and mortality in hemodialysis patients. Energy intake (EI) is an important nutritional therapy for preventing MetS. We examined the association of self-reported dietary EI with metabolic abnormalities and MetS among hemodialysis patients. METHODS A cross-sectional study design was carried out from September 2013 to April 2017 in seven hemodialysis centers. Data were collected from 228 hemodialysis patients with acceptable EI report, 20 years old and above, underwent three hemodialysis sessions a week for at least past 3 months. Dietary EI was evaluated by a three-day dietary record, and confirmed by 24-h dietary recall. Body compositions were measured by bioelectrical impedance analysis. Biochemical data were analyzed using standard laboratory tests. The cut-off values of daily EI were 30 kcal/kg, and 35 kcal/kg for age ≥ 60 years and < 60 years, respectively. MetS was defined by the American Association of Clinical Endocrinologists (AACE-MetS), and Harmonizing Metabolic Syndrome (HMetS). Logistic regression models were utilized for examining the association between EI and MetS. Age, gender, physical activity, hemodialysis vintage, Charlson comorbidity index, high sensitive C-reactive protein, and interdialytic weight gains were adjusted in the multivariate analysis. RESULTS The prevalence of inadequate EI, AACE-MetS, and HMetS were 60.5%, 63.2%, and 53.9%, respectively. Inadequate EI was related to higher proportion of metabolic abnormalities and MetS (p < 0.05). Results of the multivariate analysis shows that inadequate EI was significantly linked with higher prevalence of impaired fasting glucose (OR = 2.42, p < 0.01), overweight/obese (OR = 6.70, p < 0.001), elevated waist circumference (OR = 8.17, p < 0.001), AACE-MetS (OR = 2.26, p < 0.01), and HMetS (OR = 3.52, p < 0.01). In subgroup anslysis, inadequate EI strongly associated with AACE-MetS in groups of non-hypertension (OR = 4.09, p = 0.004), and non-cardiovascular diseases (OR = 2.59, p = 0.012), and with HMetS in all sub-groups of hypertension (OR = 2.59~ 5.33, p < 0.05), diabetic group (OR = 8.33, p = 0.003), and non-cardiovascular diseases (OR = 3.79, p < 0.001). CONCLUSIONS Inadequate EI and MetS prevalence was high. Energy intake strongly determined MetS in different groups of hemodialysis patients.
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Affiliation(s)
- Tuyen Van Duong
- School of Nutrition and Health Sciences, Taipei Medical University, No. 250 Wuxing Street, Taipei, 110, Taiwan
| | - Te-Chih Wong
- Department of Nutrition and Health Sciences, Chinese Culture University, Taipei, Taiwan
| | - Hsi-Hsien Chen
- Department of Nephrology, Taipei Medical University Hospital, Taipei, Taiwan
- School of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Tzen-Wen Chen
- School of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Tso-Hsiao Chen
- School of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Nephrology, Taipei Medical University- Wan Fang Hospital, Taipei, Taiwan
| | - Yung-Ho Hsu
- School of Medicine, Taipei Medical University, Taipei, Taiwan
- Division of Nephrology, Department of Internal Medicine, Taipei Medical University- Shuang Ho Hospital, Taipei, Taiwan
| | - Sheng-Jeng Peng
- Division of Nephrology, Cathay General Hospital, Taipei, Taiwan
| | - Ko-Lin Kuo
- Division of Nephrology, Taipei Tzu-Chi Hospital, Taipei, Taiwan
| | - Hsiang-Chung Liu
- Department of Nephrology, Wei Gong Memorial Hospital, Miaoli, Taiwan
| | - En-Tzu Lin
- Department of Nephrology, Lotung Poh-Ai Hospital, Yilan, Taiwan
| | - Chi-Sin Wang
- School of Nutrition and Health Sciences, Taipei Medical University, No. 250 Wuxing Street, Taipei, 110, Taiwan
| | - I-Hsin Tseng
- School of Nutrition and Health Sciences, Taipei Medical University, No. 250 Wuxing Street, Taipei, 110, Taiwan
| | - Yi-Wei Feng
- School of Nutrition and Health Sciences, Taipei Medical University, No. 250 Wuxing Street, Taipei, 110, Taiwan
| | - Tai-Yue Chang
- School of Nutrition and Health Sciences, Taipei Medical University, No. 250 Wuxing Street, Taipei, 110, Taiwan
| | - Chien-Tien Su
- School of Public Health, Taipei Medical University, Taipei, Taiwan
- Department of Family Medicine, Taipei Medical University Hospital, Taipei, Taiwan
| | - Shwu-Huey Yang
- School of Nutrition and Health Sciences, Taipei Medical University, No. 250 Wuxing Street, Taipei, 110, Taiwan.
- Research Center of Geriatric Nutrition, Taipei Medical University, Taipei, Taiwan.
- Nutrition Research Center, Taipei Medical University Hospital, Taipei, Taiwan.
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Jagannathan R, Ziolkowski SL, Weber MB, Cobb J, Pham N, Long J, Anand S, Lobelo F. Physical activity promotion for patients transitioning to dialysis using the "Exercise is Medicine" framework: a multi-center randomized pragmatic trial (EIM-CKD trial) protocol. BMC Nephrol 2018; 19:230. [PMID: 30208854 PMCID: PMC6136167 DOI: 10.1186/s12882-018-1032-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 09/02/2018] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Patients on dialysis are physically inactive, with most reporting activity levels below the fifth percentile of healthy age-matched groups. Several small studies have reported efficacy of diverse exercise interventions among persons with CKD and those on dialysis. However, no single intervention has been widely adopted in real-world practice, despite a clear need in this vulnerable population with high rates of mortality, frailty, and skilled nursing hospitalizations. METHODS/DESIGN We describe a pragmatic clinical trial for an exercise intervention among patients transitioning to dialysis. We will use an existing framework - Exercise is Medicine (EIM) - developed by the American College of Sports Medicine. After undertaking formative qualitative research to tailor the EIM framework to the advanced CKD population (eGFR < 30 ml/min/1.73m2), we will randomize 96 patients from two regions-Atlanta and Bay Area-in two intervention arms with incremental levels of clinical-community integration: physical activity assessment during Nephrology clinical visit, brief counseling at pre-dialysis education, and physical activity wearable (group 1) versus group 1 intervention components plus a referral to a free, EIM practitioner-led group exercise program over 16 weeks (group 2; 8 week core intervention; 8-week follow up). We will assess efficacy by comparing between group differences in minutes/week of objectively measured moderate intensity physical activity. To evaluate implementation, we will use questionnaires for assessing barriers to referral, participation and retention along the path of the intervention. Further we will have a plan for dissemination of the intervention by partnering with relevant stakeholders. DISCUSSION The overall goal is to inform the development of a practical, cost-conscious intervention "package" that addresses barriers and challenges to physical activity commonly faced by patients with advanced CKD and can be disseminated amongst interested practices. TRIAL REGISTRATION ClinicalTrials.gov identifier (Dated:10/17/2017): NCT03311763 .
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Affiliation(s)
- Ram Jagannathan
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, CNR 7051, Atlanta, GA, 30322, USA
| | | | - Mary Beth Weber
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, CNR 7051, Atlanta, GA, 30322, USA
| | - Jason Cobb
- Renal Division, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Nhat Pham
- Division of Nephrology, Santa Clara Valley Medical Center, San Jose, CA, USA
| | - Jin Long
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Shuchi Anand
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Felipe Lobelo
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, CNR 7051, Atlanta, GA, 30322, USA.
- Exercise is Medicine Global Research and Collaboration Center, 1518 Clifton Road NE, CNR 7051, Atlanta, GA, 30322, USA.
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Sharma AK, Toussaint ND, Elder GJ, Masterson R, Holt SG, Robertson PL, Ebeling PR, Baldock P, Miller RC, Rajapakse CS. Magnetic resonance imaging based assessment of bone microstructure as a non-invasive alternative to histomorphometry in patients with chronic kidney disease. Bone 2018; 114:14-21. [PMID: 29860153 DOI: 10.1016/j.bone.2018.05.029] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 05/22/2018] [Accepted: 05/29/2018] [Indexed: 01/16/2023]
Abstract
BACKGROUND Chronic kidney disease (CKD) adversely affects bone microarchitecture and increases fracture risk. Historically, bone biopsy has been the 'gold standard' for evaluating renal bone disease but is invasive and infrequently performed. High-resolution magnetic resonance imaging (MRI) quantifies bone microarchitecture noninvasively. In patients with CKD, it has not been compared with results derived from bone biopsy or with imaging using dual energy X-ray absorptiometry (DXA). METHODS Fourteen patients with end-stage kidney disease (ESKD) underwent MRI at the distal tibia, bone mineral density (BMD) by dual energy X-ray absorptiometry (DXA; hip and spine) and transiliac bone biopsies with histomorphometry and microcomputed tomography (micro-CT). All patients had biomarkers of mineral metabolism. Associations were determined by Spearman's or Pearson's rank correlation coefficients. RESULTS MRI indices of trabecular network integrity, surface to curve ratio (S/C) and erosion index (EI), correlated to histomorphometric trabecular bone volume (S/C r = 0.85, p = 0.0003; EI r = -0.82, p = 0.001), separation (S/C r = -0.58, p = 0.039; EI r = 0.79, p = 0.0012) and thickness (S/C, r = 0.65, p = 0.017). MRI EI and trabecular thickness (TbTh) also correlated to micro-CT trabecular separation (EI r = 0.63, p = 0.02; TbTh r = -0.60, p = 0.02). Significant correlations were observed between histomorphometric mineralization and turnover indices and various MRI parameters. MRI-derived trabecular parameters were also significantly related to femoral neck BMD. CONCLUSIONS This study highlights the heterogeneity of bone microarchitecture at differing skeletal sites. MRI demonstrates significant, relevant associations to important bone biopsy and DXA indices and warrants further investigation to assess its potential to non-invasively evaluate changes in bone structure and quality over time.
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Affiliation(s)
- Ashish K Sharma
- Department of Nephrology, The Royal Melbourne Hospital, Parkville, Australia; Department of Medicine (RMH), University of Melbourne, Parkville, Australia.
| | - Nigel D Toussaint
- Department of Nephrology, The Royal Melbourne Hospital, Parkville, Australia; Department of Medicine (RMH), University of Melbourne, Parkville, Australia
| | - Grahame J Elder
- Department of Renal Medicine, Westmead Hospital, Westmead, Australia; Osteoporosis and Bone Biology Division, Garvan Institute of Medical Research, Darlinghurst, Australia
| | - Rosemary Masterson
- Department of Nephrology, The Royal Melbourne Hospital, Parkville, Australia; Department of Medicine (RMH), University of Melbourne, Parkville, Australia
| | - Stephen G Holt
- Department of Nephrology, The Royal Melbourne Hospital, Parkville, Australia; Department of Medicine (RMH), University of Melbourne, Parkville, Australia
| | - Patricia L Robertson
- Department of Medicine (RMH), University of Melbourne, Parkville, Australia; Department of Radiology, The Royal Melbourne Hospital, Parkville, Australia
| | | | - Paul Baldock
- Osteoporosis and Bone Biology Division, Garvan Institute of Medical Research, Darlinghurst, Australia
| | - Rhiannon C Miller
- Departments of Radiology and Orthopaedic Surgery, University of Pennsylvania, PA, USA
| | - Chamith S Rajapakse
- Departments of Radiology and Orthopaedic Surgery, University of Pennsylvania, PA, USA
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Martin N, Smith AC, Dungey MR, Young HML, Burton JO, Bishop NC. Exercise during hemodialysis does not affect the phenotype or prothrombotic nature of microparticles but alters their proinflammatory function. Physiol Rep 2018; 6:e13825. [PMID: 30294974 PMCID: PMC6174123 DOI: 10.14814/phy2.13825] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 07/19/2018] [Indexed: 12/13/2022] Open
Abstract
Hemodialysis patients have dysfunctional immune systems, chronic inflammation and comorbidity-associated risks of cardiovascular disease (CVD) and infection. Microparticles are biologically active nanovesicles shed from activated endothelial cells, immune cells, and platelets; they are elevated in hemodialysis patients and are associated with chronic inflammation and predictive of CVD mortality in this group. Exercise is advocated in hemodialysis to improve cardiovascular health yet acute exercise induces an increase in circulating microparticles in healthy populations. Therefore, this study aimed to assess acute effect of intradialytic exercise (IDE) on microparticle number and phenotype, and their ability to induce endothelial cell reactive oxygen species (ROS) in vitro. Eleven patients were studied during a routine hemodialysis session and one where they exercised in a randomized cross-over design. Microparticle number increased during hemodialysis (2064-7071 microparticles/μL, P < 0.001) as did phosphatidylserine+ (P < 0.05), platelet-derived (P < 0.01) and percentage procoagulant neutrophil-derived microparticles (P < 0.05), but this was not affected by IDE. However, microparticles collected immediately and 60 min after IDE (but not later) induced greater ROS generation from cultured endothelial cells (P < 0.05), suggesting a transient proinflammatory event. In summary IDE does not further increase prothrombotic microparticle numbers that occurs during hemodialysis. However, given acute proinflammatory responses to exercise stimulate an adaptation toward a circulating anti-inflammatory environment, microparticle-induced transient increases of endothelial cell ROS in vitro with IDE may indicate the potential for a longer-term anti-inflammatory adaptive effect. These findings provide a crucial evidence base for future studies of microparticles responses to IDE in view of the exceptionally high risk of CVD in these patients.
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Affiliation(s)
- Naomi Martin
- National Centre for Sport and Exercise MedicineSchool of Sport, Exercise and Health SciencesLoughborough UniversityLeicestershireUnited Kingdom
- Leicester Kidney Lifestyle TeamDepartment of Infection, Immunity & InflammationUniversity of Leicester and John Walls Renal UnitUniversity Hospitals of Leicester NHS TrustLeicestershireUnited Kingdom
| | - Alice C. Smith
- Leicester Kidney Lifestyle TeamDepartment of Infection, Immunity & InflammationUniversity of Leicester and John Walls Renal UnitUniversity Hospitals of Leicester NHS TrustLeicestershireUnited Kingdom
| | - Maurice R. Dungey
- National Centre for Sport and Exercise MedicineSchool of Sport, Exercise and Health SciencesLoughborough UniversityLeicestershireUnited Kingdom
- Leicester Kidney Lifestyle TeamDepartment of Infection, Immunity & InflammationUniversity of Leicester and John Walls Renal UnitUniversity Hospitals of Leicester NHS TrustLeicestershireUnited Kingdom
| | - Hannah M. L. Young
- Leicester Kidney Lifestyle TeamDepartment of Infection, Immunity & InflammationUniversity of Leicester and John Walls Renal UnitUniversity Hospitals of Leicester NHS TrustLeicestershireUnited Kingdom
| | - James O. Burton
- Leicester Kidney Lifestyle TeamDepartment of Infection, Immunity & InflammationUniversity of Leicester and John Walls Renal UnitUniversity Hospitals of Leicester NHS TrustLeicestershireUnited Kingdom
| | - Nicolette C. Bishop
- National Centre for Sport and Exercise MedicineSchool of Sport, Exercise and Health SciencesLoughborough UniversityLeicestershireUnited Kingdom
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Assimon MM, Brookhart MA, Fine JP, Heiss G, Layton JB, Flythe JE. A Comparative Study of Carvedilol Versus Metoprolol Initiation and 1-Year Mortality Among Individuals Receiving Maintenance Hemodialysis. Am J Kidney Dis 2018; 72:337-348. [PMID: 29653770 PMCID: PMC6477681 DOI: 10.1053/j.ajkd.2018.02.350] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [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: 09/22/2017] [Accepted: 02/04/2018] [Indexed: 11/11/2022]
Abstract
BACKGROUND Carvedilol and metoprolol are the β-blockers most commonly prescribed to US hemodialysis patients, accounting for ∼80% of β-blocker prescriptions. Despite well-established pharmacologic and pharmacokinetic differences between the 2 medications, little is known about their relative safety and efficacy in the hemodialysis population. STUDY DESIGN A retrospective cohort study using a new-user design. SETTING & PARTICIPANTS Medicare-enrolled hemodialysis patients treated at a large US dialysis organization who initiated carvedilol or metoprolol therapy from January 1, 2007, through December 30, 2012. PREDICTOR Carvedilol versus metoprolol initiation. OUTCOMES All-cause mortality, cardiovascular mortality, and intradialytic hypotension (systolic blood pressure decrease ≥ 20mmHg during hemodialysis plus intradialytic saline solution administration) during a 1-year follow-up period. MEASUREMENTS Survival models were used to estimate HRs and 95% CIs in mortality analyses. Poisson regression was used to estimate incidence rate ratios (IRRs) and 95% CIs in intradialytic hypotension analyses. Inverse probability of treatment weighting was used to adjust for several demographic, clinical, laboratory, and dialysis treatment covariates in all analyses. RESULTS 27,064 individuals receiving maintenance hemodialysis were included: 9,558 (35.3%) carvedilol initiators and 17,506 (64.7%) metoprolol initiators. Carvedilol (vs metoprolol) initiation was associated with greater all-cause (adjusted HR, 1.08; 95% CI, 1.02-1.16) and cardiovascular mortality (adjusted HR, 1.18; 95% CI, 1.08-1.29). In subgroup analyses, similar associations were observed among patients with hypertension, atrial fibrillation, heart failure, and a recent myocardial infarction, the main cardiovascular indications for β-blocker therapy. During follow-up, carvedilol (vs metoprolol) initiators had a higher rate of intradialytic hypotension (adjusted IRR, 1.10; 95% CI, 1.09-1.11). LIMITATIONS Residual confounding may exist. CONCLUSIONS Relative to metoprolol initiation, carvedilol initiation was associated with higher 1-year all-cause and cardiovascular mortality. One potential mechanism for these findings may be the increased occurrence of intradialytic hypotension after carvedilol (vs metoprolol) initiation.
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Affiliation(s)
- Magdalene M Assimon
- University of North Carolina Kidney Center, Division of Nephrology and Hypertension, Department of Medicine, UNC School of Medicine, Chapel Hill, NC; Department of Epidemiology, UNC Gillings School of Global Public Health, Chapel Hill, NC.
| | - M Alan Brookhart
- Department of Epidemiology, UNC Gillings School of Global Public Health, Chapel Hill, NC
| | - Jason P Fine
- Department of Biostatistics, UNC Gillings School of Global Public Health, Chapel Hill, NC
| | - Gerardo Heiss
- Department of Epidemiology, UNC Gillings School of Global Public Health, Chapel Hill, NC
| | - J Bradley Layton
- Department of Epidemiology, UNC Gillings School of Global Public Health, Chapel Hill, NC; RTI Health Solutions, Research Triangle Park, Chapel Hill, NC
| | - Jennifer E Flythe
- University of North Carolina Kidney Center, Division of Nephrology and Hypertension, Department of Medicine, UNC School of Medicine, Chapel Hill, NC; Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC
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42
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Song MK, Paul S, Ward SE, Gilet CA, Hladik GA. One-Year Linear Trajectories of Symptoms, Physical Functioning, Cognitive Functioning, Emotional Well-being, and Spiritual Well-being Among Patients Receiving Dialysis. Am J Kidney Dis 2018; 72:198-204. [PMID: 29395483 PMCID: PMC6057855 DOI: 10.1053/j.ajkd.2017.11.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [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: 07/10/2017] [Accepted: 11/11/2017] [Indexed: 11/11/2022]
Abstract
BACKGROUND This study evaluated 1-year linear trajectories of patient-reported dimensions of quality of life among patients receiving dialysis. STUDY DESIGN Longitudinal observational study. SETTING & PARTICIPANTS 227 patients recruited from 12 dialysis centers. FACTORS Sociodemographic and clinical characteristics. MEASUREMENTS/OUTCOMES Participants completed an hour-long interview monthly for 12 months. Each interview included patient-reported outcome measures of overall symptoms (Edmonton Symptom Assessment System), physical functioning (Activities of Daily Living/Instrumental Activities of Daily Living), cognitive functioning (Patient's Assessment of Own Functioning Inventory), emotional well-being (Center for Epidemiologic Studies Depression Scale, State Anxiety Inventory, and Positive and Negative Affect Schedule), and spiritual well-being (Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale). For each dimension, linear and generalized linear mixed-effects models were used. Linear trajectories of the 5 dimensions were jointly modeled as a multivariate outcome over time. RESULTS Although dimension scores fluctuated greatly from month to month, overall symptoms, cognitive functioning, emotional well-being, and spiritual well-being improved over time. Older compared with younger participants reported higher scores across all dimensions (all P<0.05). Higher comorbidity scores were associated with worse scores in most dimensions (all P<0.01). Nonwhite participants reported better spiritual well-being compared with their white counterparts (P<0.01). Clustering analysis of dimension scores revealed 2 distinctive clusters. Cluster 1 was characterized by better scores than those of cluster 2 in nearly all dimensions at baseline and by gradual improvement over time. LIMITATIONS Study was conducted in a single region of the United States and included mostly patients with high levels of function across the dimensions of quality of life studied. CONCLUSIONS Multidimensional patient-reported quality of life varies widely from month to month regardless of whether overall trajectories improve or worsen over time. Additional research is needed to identify the best approaches to incorporate patient-reported outcome measures into dialysis care.
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Affiliation(s)
- Mi-Kyung Song
- Center for Nursing Excellence in Palliative Care, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA.
| | - Sudeshna Paul
- Center for Nursing Excellence in Palliative Care, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA
| | - Sandra E Ward
- University of Wisconsin-Madison, School of Nursing, Madison, WI
| | - Constance A Gilet
- UNC Kidney Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Gerald A Hladik
- UNC Kidney Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Cataldo E, Columbano V, Nielsen L, Gendrot L, Covella B, Piccoli GB. Phosphate binders as a cause of hypothyroidism in dialysis patients: practical indications from a review of the literature. BMC Nephrol 2018; 19:155. [PMID: 29966512 PMCID: PMC6027573 DOI: 10.1186/s12882-018-0947-9] [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] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 06/14/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Although fatigue is common in dialysis patients, polypharmacy is seldom listed among its causes. In this report, we describe a dialysis patient who developed severe fatigue due to pharmacological interaction between two commonly prescribed drugs, phosphate binders and levothyroxine. CASE PRESENTATION A 65-year old woman, on dialysis for 17 years, complained of fatigue (weight 54 Kg, height 1.55 m, BMI: 23 Kg/m2; malnutrition inflammation index: 10; Charlson index 9). She had been treated with lithium for about 20 years. A heavy smoker, she was obese and diabetic when young, but stopped treatment after weight loss. She had undergone thyroidectomy for papillary carcinoma, left hemicolectomy for colon adenocarcinoma, left quadrantectomy followed by radiotherapy for ductal mammary adenocarcinoma, subtotal parathyroidectomy for tertiary hyperparathyroidism. At the time of this report, she was on thrice-weekly hemodiafiltration (Daugirdas 2 Kt/V: 1.6-1.8). Her recent treatment included spironolactone, amlodipine, perindopril, valproate, lamotrigine, levothyroxine, vitamin D, calcium carbonate, sodium polystyrene and sevelamer. After she questioned her doctor about whether her fatigue might be the result of a drug interaction, levothyroxine interference was identified (TSH, previously normal, increased to 13.07 mU/L, after increasing sevelamer dose, and normalized after change of drug schedule). LITERATURE REVIEW only 5 relevant papers on levothyroxine and phosphate binders on dialysis were found on Pubmed and EMBASE (out of 351 titles retrieved). Information was therefore inferred from studies in normal volunteers or in other diseases. DISCUSSION AND CONCLUSIONS Our case differs from other reports on lower TSH at diagnosis, underlining the need for awareness of the importance of early diagnosis. Integrating the scant literature on dialysis patients with data available in the general population, some working conclusions can be reached: while all phosphate binders potentially interfere with levothyroxine absorption, interference seems to be highest for sevelamer; interference is limited but not excluded by increasing the intervals between drugs; morning fast is usually indicated but, when clashing with the timing of other drugs, a bedtime dose and liquid preparations may be indicated. In the absence of an agreed control schedule, our case supports close monitoring of TSH (1-3 months if unstable, twice-yearly in stable patients).
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Affiliation(s)
- Emanuela Cataldo
- Néphrologie Centre Hospitalier le Mans, Avenue Roubillard, 72000, Le Mans, France
- Nefrologia, Università degli Studi di Bari "Aldo Moro", Bari, Italy
| | - Valeria Columbano
- Néphrologie Centre Hospitalier le Mans, Avenue Roubillard, 72000, Le Mans, France
- Nefrologia, Università della Campania "Luigi Valvitelli", Naples, Italy
| | - Louise Nielsen
- Néphrologie Centre Hospitalier le Mans, Avenue Roubillard, 72000, Le Mans, France
| | - Lurlynis Gendrot
- Néphrologie Centre Hospitalier le Mans, Avenue Roubillard, 72000, Le Mans, France
| | - Bianca Covella
- Néphrologie Centre Hospitalier le Mans, Avenue Roubillard, 72000, Le Mans, France
- Nefrologia, Università degli Studi di Bari "Aldo Moro", Bari, Italy
| | - Giorgina Barbara Piccoli
- Néphrologie Centre Hospitalier le Mans, Avenue Roubillard, 72000, Le Mans, France.
- Dipartimento di Scienze Cliniche e Biologiche, Università di Torino, Turin, Italy.
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Vigneau C, Guebre-Egziabher F. [The future of kidney failure treatments]. Soins 2018; 63:49-51. [PMID: 29958584 DOI: 10.1016/j.soin.2018.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The future of nephrology lies in the miniaturisation of renal replacement techniques, the development of the use of stem cells and xenotransplants. Moreover, medicine must be personalised, from screening and throughout the care pathway of the patient with chronic kidney failure. Thereby, the risk of morbidity can be reduced and the quality of life improved, with the help of connected tools. The role of the patients themselves and all healthcare professionals is essential.
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Affiliation(s)
- Cécile Vigneau
- Service de néphrologie, CHU Pontchaillou, 2, rue Henri-Le Guilloux, 35033 Rennes, France.
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Durand AC, Jouve E, Delarozière JC, Boucekine M, Izaaryene G, Crémades A, Mazoué F, Devictor B, Kakar A, Sambuc R, Brunet P, Gentile S. End-stage renal disease treated in Provence-Alpes Côte d'Azur: 12-years follow-up and forecast to the year 2030. BMC Nephrol 2018; 19:141. [PMID: 29907091 PMCID: PMC6003073 DOI: 10.1186/s12882-018-0929-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 05/24/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study describes the time trend of renal replacement therapy for end-stage renal disease (ESRD) in the Provence-Alpes Côte d'Azur region (PACA) between 2004 and 2015, and forecasts up to 2030. METHODS A longitudinal study was conducted on all ESRD patients treated in PACA and recorded in the French Renal Epidemiology and Information Network (REIN) during this period. Time trends and forecasts to 2030 were analyzed using Poisson regression models. RESULTS Since 2004, the number of new patients has steadily increased by 3.4% per year (95% CI, 2.8-3.9, p < 0.001) and the number of patients receiving RRT has increased by 3.7% per year (RR 1.037, 95% CI: 1.034-1.039, p < 0.001). If these trends continue, the PACA region will be face with 7371 patients on dialysis and 3891 with a functional renal transplant who will need to be managed in 2030. The two most significant growth rates were the percentage of obese people (RR 1.140, 95% CI: 1.131-1.149, p < 0.001) and those with diabetes (RR 1.070, 95% CI; 1.064-1.075, p < 0.001). CONCLUSION This study highlights the increase in the number of ESRD patients over 12 years, with no prospect of stabilization. These findings allow us to anticipate the quality and quantity of care offered and to propose more preventive measures to combat obesity and diabetes.
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Affiliation(s)
- Anne-Claire Durand
- Aix-Marseille University, EA 3279, Public Health, Chronic Diseases and Quality of Life research Unit, 27 Boulevard Jean Moulin, 13385 Marseille cedex 5, France
- Cellule d’appui épidémiologique, registre REIN Provence-Alpes Côtes d’Azur, Hôpital de La Conception, Assistance Publique - Hôpitaux de Marseille, Marseille, France
| | - Elisabeth Jouve
- Service d’Evaluation Médicale, Hôpital de La Conception, Assistance Publique - Hôpitaux de Marseille, Marseille, France
| | - Jean-Christophe Delarozière
- Aix-Marseille University, EA 3279, Public Health, Chronic Diseases and Quality of Life research Unit, 27 Boulevard Jean Moulin, 13385 Marseille cedex 5, France
- Cellule d’appui épidémiologique, registre REIN Provence-Alpes Côtes d’Azur, Hôpital de La Conception, Assistance Publique - Hôpitaux de Marseille, Marseille, France
| | - Mohamed Boucekine
- Aix-Marseille University, EA 3279, Public Health, Chronic Diseases and Quality of Life research Unit, 27 Boulevard Jean Moulin, 13385 Marseille cedex 5, France
| | - Ghizlane Izaaryene
- Aix-Marseille University, EA 3279, Public Health, Chronic Diseases and Quality of Life research Unit, 27 Boulevard Jean Moulin, 13385 Marseille cedex 5, France
- Cellule d’appui épidémiologique, registre REIN Provence-Alpes Côtes d’Azur, Hôpital de La Conception, Assistance Publique - Hôpitaux de Marseille, Marseille, France
| | - Adeline Crémades
- Aix-Marseille University, EA 3279, Public Health, Chronic Diseases and Quality of Life research Unit, 27 Boulevard Jean Moulin, 13385 Marseille cedex 5, France
- Cellule d’appui épidémiologique, registre REIN Provence-Alpes Côtes d’Azur, Hôpital de La Conception, Assistance Publique - Hôpitaux de Marseille, Marseille, France
| | - Franck Mazoué
- Aix-Marseille University, EA 3279, Public Health, Chronic Diseases and Quality of Life research Unit, 27 Boulevard Jean Moulin, 13385 Marseille cedex 5, France
- Cellule d’appui épidémiologique, registre REIN Provence-Alpes Côtes d’Azur, Hôpital de La Conception, Assistance Publique - Hôpitaux de Marseille, Marseille, France
| | - Bénédicte Devictor
- Aix-Marseille University, EA 3279, Public Health, Chronic Diseases and Quality of Life research Unit, 27 Boulevard Jean Moulin, 13385 Marseille cedex 5, France
| | - Asmatullah Kakar
- Aix-Marseille University, EA 3279, Public Health, Chronic Diseases and Quality of Life research Unit, 27 Boulevard Jean Moulin, 13385 Marseille cedex 5, France
| | - Roland Sambuc
- Aix-Marseille University, EA 3279, Public Health, Chronic Diseases and Quality of Life research Unit, 27 Boulevard Jean Moulin, 13385 Marseille cedex 5, France
- Cellule d’appui épidémiologique, registre REIN Provence-Alpes Côtes d’Azur, Hôpital de La Conception, Assistance Publique - Hôpitaux de Marseille, Marseille, France
| | - Philippe Brunet
- Cellule d’appui épidémiologique, registre REIN Provence-Alpes Côtes d’Azur, Hôpital de La Conception, Assistance Publique - Hôpitaux de Marseille, Marseille, France
- Department of nephrology and renal transplantation, Hôpital de La Conception, Assistance Publique - Hôpitaux de Marseille, Marseille, France
| | - Stéphanie Gentile
- Aix-Marseille University, EA 3279, Public Health, Chronic Diseases and Quality of Life research Unit, 27 Boulevard Jean Moulin, 13385 Marseille cedex 5, France
- Cellule d’appui épidémiologique, registre REIN Provence-Alpes Côtes d’Azur, Hôpital de La Conception, Assistance Publique - Hôpitaux de Marseille, Marseille, France
- Service d’Evaluation Médicale, Hôpital de La Conception, Assistance Publique - Hôpitaux de Marseille, Marseille, France
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Bonenkamp AA, van Gelder MK, Abrahams AC, Boereboom FTJ, Cornelis T, Luik AJ, Özyilmaz A, van der Sande FM, van Eck van der Sluijs A, Gerritsen KGF, van Jaarsveld BC. Home haemodialysis in the Netherlands: State of the art. Neth J Med 2018; 76:144-157. [PMID: 29845936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Home haemodialysis (HHD) has gained popularity in recent years, due to improved clinical outcomes associated with frequent or prolonged haemodialysis sessions, best achievable at home. However, several barriers to HHD are perceived by the physician and patient, among which lack of experience and education, logistic difficulties and reimbursement issues seem to be the most important ones. HHD, in particular when performed with intensified frequency or duration, is associated with improved quality of life, blood pressure control and survival. Serious adverse events are rare; however, more vascular access complications arise due to frequent needling. This emphasises the importance of comprehensive education and training. This review aims to provide the physician with a detailed state of the art overview on HHD in the Netherlands, discussing potential barriers and benefits, and offering practical advice.
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Affiliation(s)
- A A Bonenkamp
- Department of Nephrology, University Medical Centre, Amsterdam, the Netherlands
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Angioi A, Cabiddu G, Conti M, Pili G, Atzeni A, Matta V, Cao R, Floris M, Songini M, Mulas MF, Rosner M, Pani A. Metformin associated lactic acidosis: a case series of 28 patients treated with sustained low-efficiency dialysis (SLED) and long-term follow-up. BMC Nephrol 2018; 19:77. [PMID: 29609531 PMCID: PMC5879547 DOI: 10.1186/s12882-018-0875-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [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: 04/13/2017] [Accepted: 03/15/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Metformin associated lactic acidosis (MALA) is a well-known serious side effect of biguanides. However, the best treatment strategy remains a matter of debate. In the last 14 years, we observed a significant increase in hospitalizations for MALA to our Center. We report the outcomes of our clinical and therapeutic approach. METHODS This is a single-center case series. Twenty-eight patients affected with MALA and acute kidney failure admitted between January 2000 and September 2014 were included. We analyzed comorbidities, laboratory tests and clinical parameters at admission, at 36 h and at discharge. All patients were treated with sustained low-efficiency dialysis (SLED) until normalization of serum lactate (≤ 3 mmol/L), bicarbonate (between 20 and 25 mmol/L) and potassium (between 4.0 and 5.1 mmol/L). RESULTS The mortality rate was 21.4%, with all of the events occurring within 24 h from admission, and before or during the first hemodialysis treatment. Precipitating causes included; acute dehydration (86.4%), systemic inflammatory response syndrome (SIRS) (57.1%), sepsis (10.7%), nephrolithiasis (14.6%) and exposure to iodinated contrast (7.1%). No further episodes of lactic acidosis were described after discontinuing the drug over a mean follow-up of 27.2 months. Furthermore, while in 2010, we had a peak incidence of MALA of 76.8 cases per 100,000 patients on metformin, this rate fell after an education campaign conducted by specialists on the proper usage of metformin in patients at risk of MALA. Although the fall in incidence after the educational program was not necessarily causal, in 2014 the incidence was 32.9/100,000. CONCLUSIONS We report an improved mortality rate in patients affected with MALA and acute kidney injury treated with SLED compared with other series published in literature. Rapid introduction of effective hemodialysis is critical in improving outcomes.
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Affiliation(s)
- Andrea Angioi
- Division of Nephrology and Dialysis, Azienda Ospedaliera G. Brotzu, Piazzale Ricchi n°1, 09134 Cagliari, Italy
| | - Gianfranca Cabiddu
- Division of Nephrology and Dialysis, Azienda Ospedaliera G. Brotzu, Piazzale Ricchi n°1, 09134 Cagliari, Italy
| | - Maura Conti
- Division of Nephrology and Dialysis, Azienda Ospedaliera G. Brotzu, Piazzale Ricchi n°1, 09134 Cagliari, Italy
| | - Gianfranco Pili
- Division of Nephrology and Dialysis, Azienda Ospedaliera G. Brotzu, Piazzale Ricchi n°1, 09134 Cagliari, Italy
| | - Alice Atzeni
- Division of Nephrology and Dialysis, Azienda Ospedaliera G. Brotzu, Piazzale Ricchi n°1, 09134 Cagliari, Italy
| | - Valeria Matta
- Division of Nephrology and Dialysis, Azienda Ospedaliera G. Brotzu, Piazzale Ricchi n°1, 09134 Cagliari, Italy
| | - Riccardo Cao
- Division of Nephrology and Dialysis, Azienda Ospedaliera G. Brotzu, Piazzale Ricchi n°1, 09134 Cagliari, Italy
| | - Matteo Floris
- Division of Nephrology and Dialysis, Azienda Ospedaliera G. Brotzu, Piazzale Ricchi n°1, 09134 Cagliari, Italy
| | - Marco Songini
- Diabetology Unit, Azienda Ospedaliera G. Brotzu, Cagliari, Italy
| | | | - Mitchell Rosner
- Division of Nephrology, University of Virginia Health System, Charlottesville, Virginia USA
| | - Antonello Pani
- Division of Nephrology and Dialysis, Azienda Ospedaliera G. Brotzu, Piazzale Ricchi n°1, 09134 Cagliari, Italy
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Allawi AAD. Malnutrition, inflamation and atherosclerosis (MIA syndrome) in patients with end stage renal disease on maintenance hemodialysis (a single centre experience). Diabetes Metab Syndr 2018; 12:91-97. [PMID: 28964721 DOI: 10.1016/j.dsx.2017.09.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 09/20/2017] [Indexed: 01/09/2023]
Abstract
BACKGROUND Inflammation and malnutrition play an important role in endothelial dysfunction, atherosclerosis and excessive cardiovascular morbidity and mortality in ESRD patients AIM OF THE STUDY: The primary objective is to determine the prevalence of inflammation, malnutrition and atherosclerosis in patients on maintenance haemodialysis. Secondary objective was to determine the association for atherosclerosis with inflammation and malnutrition. PATIENT AND METHODS One hundred and one adult patients with end stage renal disease on maintenance haemodialysis who are met with the exclusion criteria were enrolled in this cross sectional study from haemodialysis unit of Baghdad teaching hospital over the period of July/2015 - June 2016. All patients were thoroughly examined and many variables were evaluated (age, gender, blood pressure, diabetes mellitus, serum lipid profile, smoking habits, serum albumin, CRP, calcium, Phosphate, Parathyroid hormone and haemoglobin measurements). All patients underwent a carotid Doppler ultrasound study. RESULTS Atherosclerosis was present in 65.3%: 58.4% of patients had malnutrition and 43.6% had inflammation. The association for atherosclerosis and high CRP and low serum albumin is strong and independent of other atherosclerosis risk factors. There is significant inverse and independent correlation between CRP and albumin. CONCLUSION Inflammation (high serum CRP) and malnutrition (low serum albumin) in patients on haemodialysis are significantly associated with carotid atherosclerosis. Inflammation was more prevalent in the malnourished patients than in those with normal nutritional status.
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Affiliation(s)
- Ali Abdulmajid Dyab Allawi
- FRCP London, Assistant Professor Baghdad College of Medicine, University of Baghdad, Consultant Nephrologist and Transplant Physcian, Baghdad, Iraq.
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Khatib ST, Hemadneh MK, Hasan SA, Khazneh E, Zyoud SH. Quality of life in hemodialysis diabetic patients: a multicenter cross-sectional study from Palestine. BMC Nephrol 2018; 19:49. [PMID: 29490623 PMCID: PMC5831192 DOI: 10.1186/s12882-018-0849-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [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: 09/27/2017] [Accepted: 02/20/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Both diabetes and hemodialysis can seriously impair patients' health related quality of life (HRQOL). This study seeks to obtain data which will help to address the factors associated with impaired HRQOL in hemodialysis patients with diabetes in Palestine. METHODS A cross-sectional study was performed in multiple centers in the period from November 2016 to June 2017. We utilized the Arabic version of EuroQoL 5 Dimensions 5 Levels (EQ-5D-5L) scale and EuroQol-visual analogue scale (EQ-VAS) to measure patients' HRQOL. The study was conducted in six dialysis centers in the North of West Bank, Palestine. Descriptive and comparative statistics were used to describe clinical and socio-demographic features of patients. Multiple linear regression analysis was used to determine the association between clinical and socio-demographic factors and HRQOL score. RESULTS One hundred and forty one diabetic patients undergoing hemodialysis were enrolled in our study. Overall, 52.5% of them (74 patients) were males; the patients had a mean age of 60.32 with 52.5% of them aged below 60. The mean ± standard deviation of EQ-5D-5L index and EQ-VAS score was 0.314 ± 0.4 and 50.85±22.43, respectively. The findings of this study suggest that female patients, uneducated patients, unemployed patients, unmarried patients, and patients with more chronic diseases and comorbidities had a significant poor HRQOL scores (p values <0.05). Variables such as marital status and occupational status were significantly (p < 0.05) associated with the QOL score. More specifically, married status and employed patients positively associated with QOL score (β = 0.22; p = 0.016 and β = 0.27; p = 0.013, respectively). CONCLUSIONS Among diabetic patients undergoing hemodialysis, married status and being employed were associated with modestly higher scores of QOL. We recommend that healthcare providers give more attention to diabetic dialysis patients who are unemployed and unmarried, as they are at a higher risk of having impaired HRQOL.
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Affiliation(s)
- Sohaib T. Khatib
- 0000 0004 0631 5695grid.11942.3fDepartment of Medicine, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
| | - Mohammad K. Hemadneh
- 0000 0004 0631 5695grid.11942.3fDepartment of Medicine, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
| | - Samer A. Hasan
- 0000 0004 0631 5695grid.11942.3fDepartment of Medicine, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
| | - Emad Khazneh
- 0000 0004 0631 5695grid.11942.3fNephrology Unit, Internal Medicine Department, An-Najah National University Hospital, An-Najah National University, Nablus, 44839 Palestine
| | - Sa’ed H. Zyoud
- 0000 0004 0631 5695grid.11942.3fPoison Control and Drug Information Center (PCDIC), College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
- 0000 0004 0631 5695grid.11942.3fDepartment of Clinical and Community Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
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Erickson KF, Zhao B, Ho V, Winkelmayer WC. Employment among Patients Starting Dialysis in the United States. Clin J Am Soc Nephrol 2018; 13:265-273. [PMID: 29348264 PMCID: PMC5967428 DOI: 10.2215/cjn.06470617] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [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: 06/20/2017] [Accepted: 10/19/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Patients with ESRD face significant challenges to remaining employed. It is unknown when in the course of kidney disease patients stop working. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We examined employment trends over time among patients ages 18-54 years old who initiated dialysis in the United States between 1996 and 2013 from a national ESRD registry. We compared unadjusted trends in employment at the start of dialysis and 6 months before ESRD and used linear probability models to estimate changes in employment over time after adjusting for patient characteristics and local unemployment rates in the general population. We also examined employment among selected vulnerable patient populations and changes in employment in the 6 months preceding dialysis initiation. RESULTS Employment was low among patients starting dialysis throughout the study period at 23%-24%, and 38% of patients who were employed 6 months before ESRD stopped working by dialysis initiation. However, after adjusting for observed characteristics, the probability of employment increased over time; patients starting dialysis between 2008 and 2013 had a 4.7% (95% confidence interval, 4.3% to 5.1%) increase in the absolute probability of employment at the start of dialysis compared with patients starting dialysis between 1996 and 2001. Black and Hispanic patients were less likely to be employed than other patients starting dialysis, but this gap narrowed during the study period. CONCLUSIONS Although working-aged patients in the United States starting dialysis have experienced increases in the adjusted probability of employment over time, employment at the start of dialysis has remained low.
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Affiliation(s)
- Kevin F. Erickson
- Section of Nephrology and Selzman Institute for Kidney Health, Baylor College of Medicine, Houston, Texas; and
- Baker Institute for Public Policy and Department of Economics, Rice University, Houston, Texas
| | - Bo Zhao
- Section of Nephrology and Selzman Institute for Kidney Health, Baylor College of Medicine, Houston, Texas; and
| | - Vivian Ho
- Baker Institute for Public Policy and Department of Economics, Rice University, Houston, Texas
| | - Wolfgang C. Winkelmayer
- Section of Nephrology and Selzman Institute for Kidney Health, Baylor College of Medicine, Houston, Texas; and
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