1
|
Roetker NS, Guo H, Decker-Palmer MR, Peng Y, Wetmore JB. Changes in hemodialysis catheter management after introduction of the end-stage renal disease prospective payment system. BMC Nephrol 2021; 22:8. [PMID: 33407237 PMCID: PMC7788942 DOI: 10.1186/s12882-020-02222-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 12/23/2020] [Indexed: 11/10/2022] Open
Abstract
Background We investigated whether implementation of the end-stage renal disease prospective payment system (ESRD PPS) was associated with changes in thrombolytic therapy use and other aspects of catheter management in hemodialysis (HD) patients. Methods Using quarterly, period prevalent cohorts of patients undergoing maintenance HD with a catheter in the US Renal Data System (2008–2015), we studied rates of claims for within- and outside-HD-unit thrombolytic use, and thrombus/fibrin sheath removal, and rates of delayed HD treatment after ESRD PPS implementation, January 1, 2011. Associations between PPS implementation and change in trend of rates of each outcome were assessed using covariate-adjusted Poisson regression, using a piecewise linear function for quarter-time (with breakpoint at PPS implementation). Results Among an average of 69,428 quarterly catheter users, rates of claims for within-HD-unit thrombolytic use declined from 236.6 (Q1–2008) to 81.4 (Q4–2012) per 100 person-years (P < 0.0001, PPS association with change in trend); rates of claims for thrombus/fibrin sheath removal procedures increased from 3.9 (Q1–2008) to 8.8 (Q3–2015) per 100 person-years (P = 0.0001, PPS association with change in trend). Rates of delayed HD treatment increased from 1.6 (Q2–2008) to 2.3 (Q3–2015) per patient-quarter, although PPS implementation was associated with a decrease in this rising trend (1.6% increase per quarter pre-PPS, 1.2% post-PPS; P < 0.0001, change in trend). Conclusions After PPS implementation, thrombolytic use decreased and thrombus/fibrin sheath removal increased. The increasing trend in delayed HD treatment appeared to slow after PPS implementation, but delayed sessions continued to increase year over year for unclear reasons. Supplementary Information The online version contains supplementary material available at 10.1186/s12882-020-02222-9.
Collapse
Affiliation(s)
- Nicholas S Roetker
- Chronic Disease Research Group, Hennepin Healthcare Research Institute, 701 Park Ave., Suite S2.100, Minneapolis, MN, 55415, USA.
| | - Haifeng Guo
- Chronic Disease Research Group, Hennepin Healthcare Research Institute, 701 Park Ave., Suite S2.100, Minneapolis, MN, 55415, USA
| | | | - Yi Peng
- Chronic Disease Research Group, Hennepin Healthcare Research Institute, 701 Park Ave., Suite S2.100, Minneapolis, MN, 55415, USA
| | - James B Wetmore
- Chronic Disease Research Group, Hennepin Healthcare Research Institute, 701 Park Ave., Suite S2.100, Minneapolis, MN, 55415, USA.,Division of Nephrology, Hennepin County Medical Center and Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| |
Collapse
|
2
|
Utilisation de la régression de Poisson en néphrologie. Nephrol Ther 2020; 16:184-190. [DOI: 10.1016/j.nephro.2019.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 09/30/2019] [Indexed: 11/17/2022]
|
3
|
Al Ismaili F, Al Salmi I, Al Maimani Y, Metry AM, Al Marhoobi H, Hola A, Pisoni RL. Epidemiological Transition of End-Stage Kidney Disease in Oman. Kidney Int Rep 2017; 2:27-35. [PMID: 29142938 PMCID: PMC5678924 DOI: 10.1016/j.ekir.2016.09.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Revised: 08/17/2016] [Accepted: 09/01/2016] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION The number of persons receiving renal replacement therapy (RRT) is estimated at more than 2.5 million worldwide, and is growing by 8% annually. Registries in the developing world are not up to standards compared to the United States Renal Data System (USRDS). Herein we examine the causes, progression, and magnitude of end-stage kidney disease (ESKD) over 3 decades in Oman. METHODS We examined ESKD data from 1983 to 2013. Data from 1998 to 2013 were obtained through an Information Management System. Data before 2008 were collected from patients' files. A questionnaire based on USRDS form 2728 was completed by nephrologists once a citizen reached ESKD. RESULTS A total of 4066 forms were completed, with a response rate of 90% (52% male). The mean (SD) age was 50.1 (14.0) years. By 31 December 2013, there were 2386 patients alive on RRT, of whom 1206 were on hemodialysis (50.5%), 1080 were living with a functioning kidney transplant (45.3%), and 100 were receiving peritoneal dialysis (4.2%). The incidence of ESKD on RRT was 21, 75, and 120 per million population in 1983, 2001, and 2013, respectively. Similarly, the prevalence of ESKD was 49, 916, and 2386 in 1983, 2001, and 2013 respectively. Among patients with ESKD on RRT, a progressive rise was seen in diabetic nephropathy, with 5.8%, 32.1%, and 46% in 1983, 2001, and 2013 respectively. DISCUSSION The incidence and prevalence of ESKD has increased progressively over last 30 years. This is anticipated to continue at an even higher rate in view of the progressive rise in noncommunicable diseases. Continuous improvement in registries is required to improve capturing of ESKD patients for providing accurate data to health authorities, and enhancing public awareness of the magnitude, future trends, treatments, and outcomes regarding ESKD.
Collapse
Affiliation(s)
| | - Issa Al Salmi
- The Renal Medicine Department, The Royal Hospital, Muscat, Oman
- Correspondence: Issa Al Salmi; The Royal Hospital, P O Box 1331, code 111, The Royal Hospital, Muscat, Oman.The Royal Hospital, P O Box 1331, code 111The Royal HospitalMuscatOman
| | | | | | | | - Alan Hola
- The Renal Medicine Department, The Royal Hospital, Muscat, Oman
| | - Ronald L. Pisoni
- Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA
| |
Collapse
|
4
|
Shroff GR, Li S, Herzog CA. Trends in Mortality Following Acute Myocardial Infarction Among Dialysis Patients in the United States Over 15 Years. J Am Heart Assoc 2015; 4:e002460. [PMID: 26459933 PMCID: PMC4845120 DOI: 10.1161/jaha.115.002460] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 08/13/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND We sought to determine 15-year trends in mortality rates among dialysis patients with acute myocardial infarction (AMI) in the contemporary era. METHODS AND RESULTS Using the US Renal Data System database, we assembled 4 study cohorts of period-prevalent dialysis patients in 1993, 1998, 2003, and 2008 who were hospitalized for an index AMI in that calendar year. ST-segment elevation myocardial infarction (STEMI) and non-STEMI were identified, and in-hospital mortality was calculated. Cumulative probability of death during 2-year follow-up after AMI admission was estimated by the Kaplan-Meier method and adjusted for patient characteristics. A total of 42 933 dialysis patients with AMI were included. Between 1993 (n=4494) and 2008 (n=16 361), proportional increases occurred in patient groups aged ≥75 years (23% and 31%, respectively; P<0.001), of black race (25% and 31%, respectively; P<0.001), with end-stage renal disease due to diabetes (42% and 55%, respectively; P<0.001), and with non-STEMI (42.2% and 80.7%, respectively; P<0.001). For all patients with AMI, in-hospital mortality rates decreased (31.9% in 1993, 18.8% in 2008; P<0.001), as did unadjusted 2-year cumulative probability of death after AMI admission (76.5% in 1993, 71.5% in 2008; P<0.001). Between 1993 and 2008, among STEMI patients, in-hospital mortality (38.2% and 25.9%, P<0.001) and unadjusted 2-year cumulative probability of mortality (77.3% and 71.2%, P<0.001) decreased, but decreases did not occur among NSTEMI patients (14.2% and 14.9%, P=0.47, and 70.9% and 70.1%, P=0.52 respectively). CONCLUSIONS In-hospital mortality and 2-year cumulative probability of death following AMI among dialysis patients decreased between 1993 and 2008 but only among STEMI patients, coincident with increased in-hospital percutaneous coronary intervention rates. Period-prevalent cases of non-STEMI markedly increased without interval change in survival.
Collapse
Affiliation(s)
- Gautam R Shroff
- Division of Cardiology, Department of Medicine, Hennepin County Medical Center and University of Minnesota, Minneapolis, MN (G.R.S., C.A.H.)
| | - Shuling Li
- Chronic Disease Research Group, Minneapolis Medical Research Foundation, Minneapolis, MN (S.L., C.A.H.)
| | - Charles A Herzog
- Division of Cardiology, Department of Medicine, Hennepin County Medical Center and University of Minnesota, Minneapolis, MN (G.R.S., C.A.H.) Chronic Disease Research Group, Minneapolis Medical Research Foundation, Minneapolis, MN (S.L., C.A.H.)
| |
Collapse
|
5
|
Scialla JJ, Liu J, Crews DC, Guo H, Bandeen-Roche K, Ephraim PL, Tangri N, Sozio SM, Shafi T, Miskulin DC, Michels WM, Jaar BG, Wu AW, Powe NR, Boulware LE. An instrumental variable approach finds no associated harm or benefit with early dialysis initiation in the United States. Kidney Int 2014; 86:798-809. [PMID: 24786707 PMCID: PMC4182128 DOI: 10.1038/ki.2014.110] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Revised: 02/07/2014] [Accepted: 02/20/2014] [Indexed: 01/24/2023]
Abstract
The estimated glomerular filtration rate (eGFR) at dialysis initiation has been rising. Observational studies suggest harm, but may be confounded by unmeasured factors. As instrumental variable methods may be less biased we performed a retrospective cohort study of 310,932 patients starting dialysis between 2006 to 2008 and registered in the United States Renal Data System in order to describe geographic variation in eGFR at dialysis initiation and determine its association with mortality. Patients were grouped into 804 health service areas by zip code. Individual eGFR at dialysis initiation averaged 10.8 ml/min/1.73m2 but varied geographically. Only 11% of the variation in mean health service areas-level eGFR at dialysis initiation was accounted for by patient characteristics. We calculated demographic-adjusted mean eGFR at dialysis initiation in the health service areas using the 2006 and 2007 incident cohort as our instrument and estimated the association between individual eGFR at dialysis initiation and mortality in the 2008 incident cohort using the 2 stage residual inclusion method. Among 89,547 patients starting dialysis in 2008 with eGFR 5 to 20 ml/min/1.73m2, eGFR at initiation was not associated with mortality over a median of 15.5 months [hazard ratio 1.025 per 1 ml/min/1.73m2 for eGFR 5 to 14 ml/min/1.73m2; and 0.973 per 1 ml/min/1.73m2 for eGFR 14 to 20 ml/min/1.73m2]. Thus, there was no associated harm or benefit from early dialysis initiation in the United States.
Collapse
Affiliation(s)
- Julia J Scialla
- Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Jiannong Liu
- Chronic Disease Research Group, Minneapolis, Minnesota, USA
| | - Deidra C Crews
- 1] Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA [2] Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Haifeng Guo
- Chronic Disease Research Group, Minneapolis, Minnesota, USA
| | - Karen Bandeen-Roche
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Patti L Ephraim
- 1] Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA [2] Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Navdeep Tangri
- Department of Medicine, Seven Oaks General Hospital, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Stephen M Sozio
- 1] Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA [2] Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Tariq Shafi
- 1] Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA [2] Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Dana C Miskulin
- Division of Nephrology, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Wieneke M Michels
- 1] Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA [2] Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA [3] Department of Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Bernard G Jaar
- 1] Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA [2] Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA [3] Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA [4] Nephrology Center of Maryland, Baltimore, Maryland, USA
| | - Albert W Wu
- 1] Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA [2] Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA [3] Department of Health, Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA [4] Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA [5] Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Neil R Powe
- San Francisco General Hospital and University of California San Francisco, San Francisco, California, USA
| | - L Ebony Boulware
- 1] Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA [2] Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA [3] Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA [4] Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | | |
Collapse
|
6
|
Arneson TJ, Li S, Liu J, Kilpatrick RD, Newsome BB, St Peter WL. Trends in hip fracture rates in US hemodialysis patients, 1993-2010. Am J Kidney Dis 2013; 62:747-54. [PMID: 23631997 DOI: 10.1053/j.ajkd.2013.02.368] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Accepted: 02/25/2013] [Indexed: 11/11/2022]
Abstract
BACKGROUND Changes in mineral and bone disorder treatment patterns and demographic changes in the dialysis population may have influenced hip fracture rates in US dialysis patients in 1993-2010. STUDY DESIGN Retrospective follow-up study analyzing trends over time in hospitalized hip fracture rates. SETTING & PARTICIPANTS Using Medicare data, we created 2 point-prevalent study cohorts for each study year. Hemodialysis cohorts included patients with Medicare as primary payer receiving hemodialysis in the United States on January 1 of each year; non-end-stage renal disease (ESRD) cohorts included Medicare beneficiaries 66 years or older on January 1 of each year. FACTORS Age, sex, race, primary cause of ESRD, dual Medicare/Medicaid enrollment status, comorbid conditions. OUTCOMES Hip fracture rates. MEASUREMENTS Unadjusted hip fracture rates measured using number of events per 1,000 person-years in each year, then adjusted for patient characteristics. Poisson models estimated strata-specific event rates. RESULTS The observed number of first hospitalized hip fracture events and the adjusted hip fracture rate increased steadily from 1993 (831 events; 11.9/1,000 person-years), peaked in 2004 (3,256 events; 21.9/1,000 person-years), and decreased through 2010 (2,912 events; 16.6/1,000 person-years). The trend for the subset of hemodialysis patients 66 years or older was similar to the trend for the full hemodialysis cohort; however, it differed markedly in magnitude and pattern from the non-ESRD Medicare cohort, for which rates were substantially lower and slowly decreasing since 1996. LIMITATIONS Unable to provide causal explanations for observed changes; hip fractures identified through inpatient episodes; results do not describe hemodialysis patients without Medicare Parts A and B; laboratory values unavailable in the Medicare data set. CONCLUSIONS Temporal trends in hip fracture rates among Medicare hemodialysis patients differ markedly from the steadily decreasing trend in non-ESRD Medicare beneficiaries, showing a relatively rapid increase until 2004 and relatively rapid decrease thereafter. Further research is needed to define associated factors.
Collapse
Affiliation(s)
- Thomas J Arneson
- Chronic Disease Research Group, Minneapolis Medical Research Foundation, Minneapolis, MN.
| | | | | | | | | | | |
Collapse
|
7
|
[Hypoglycemia: each patient's individual risk has to be evaluated]. MMW Fortschr Med 2012; 154:62-6; quiz 67-8. [PMID: 22693761 DOI: 10.1007/s15006-012-0524-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
8
|
Bonnet F, Gauthier E, Gin H, Hadjadj S, Halimi JM, Hannedouche T, Rigalleau V, Romand D, Roussel R, Zaoui P. Expert consensus on management of diabetic patients with impairment of renal function. DIABETES & METABOLISM 2011; 37 Suppl 2:S1-25. [DOI: 10.1016/s1262-3636(11)70961-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
|