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Pieper D, Mathes T, Marshall MR. A systematic review of the impact of center volume in dialysis. BMC Res Notes 2015; 8:812. [PMID: 26695620 PMCID: PMC4688925 DOI: 10.1186/s13104-015-1785-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 12/01/2015] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND A significant relationship exists between the volume of surgical procedures that a given center performs and subsequent outcomes. It seems plausible that such a volume-outcome relationship is also present in dialysis. METHODS MEDLINE and EMBASE were searched in November 2014 for non-experimental studies evaluating the association between center volume and patient outcomes [mortality, morbidity, peritonitis, switch to hemodialysis (HD) or any other treatment], without language restrictions or other limits. Selection of relevant studies, data extraction and critical appraisal were performed by two independent reviewers. We did not perform meta-analysis due to clinical and methodological heterogeneity (e.g. different volume categories). RESULTS 16 studies met out inclusion criteria. Most studies were performed in the US. The study quality ranged from fair to good. Only few items were judged to have a high risk of bias, while many items were judged to have an unclear risk of bias due to insufficient reporting. All 10 studies that analyzed peritoneal dialysis (PD) technique survival by modeling switch to HD or any other treatment as an outcome showed a statistical significant effect. The relative effect measures ranged from 0.25 to 0.94 (median 0.73) in favor of high volume centers. All nine studies indicated a lower mortality for PD in high volume centers, but only study was statistical significant. CONCLUSIONS This systematic review supports a volume-outcome relationship in peritoneal dialysis with respect to switch to HD or any other treatment. An effect on mortality is probably present in HD. Further research is needed to identify and understand the associations of center volume that are causally related to patient benefit.
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Affiliation(s)
- Dawid Pieper
- Institute for Research in Operative Medicine, Witten/Herdecke University, Ostmerheimer Str. 200, Building 38, 51109, Cologne, Germany.
| | - Tim Mathes
- Institute for Research in Operative Medicine, Witten/Herdecke University, Ostmerheimer Str. 200, Building 38, 51109, Cologne, Germany.
| | - Mark Roger Marshall
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand. .,Department of Renal Medicine, Counties Manukau, Health, Auckland, New Zealand. .,Baxter Healthcare (Asia Pacific), Shanghai, People's Republic of China.
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Abd-El-Gawad WM, Abou-Hashem RM, El Maraghy MO, Amin GE. The validity of Geriatric Nutrition Risk Index: simple tool for prediction of nutritional-related complication of hospitalized elderly patients. Comparison with Mini Nutritional Assessment. Clin Nutr 2013; 33:1108-16. [PMID: 24418116 DOI: 10.1016/j.clnu.2013.12.005] [Citation(s) in RCA: 100] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Revised: 12/14/2013] [Accepted: 12/18/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND & AIMS The Geriatric Nutritional Risk Index (GNRI) is a promising tool initially proposed to predict nutrition-related complications in sub-acute care setting. So, the main aim of this study was to validate the use of GNRI in hospitalized elderly patients by testing its ability to predict patients' outcome through the comparison with Mini Nutritional Assessment (MNA). METHODS A prospective cohort study was conducted on 131 patients aged 60 and over admitted consecutively from October 2011 to September 2012 to the acute geriatrics medical ward in Ain Shams University hospitals, Cairo, Egypt. All patients were subjected to nutritional screening using GNRI and MNA and measurement of weight, body mass index (BMI), mid arm circumference (MAC), and calf circumference (CC), serum levels of total protein, albumin and prealbumin. Patients were followed for 6 months for the occurrence of major health complications as prolonged length of stay, infectious complications and mortality. RESULTS Mean age was 69.32 ± 8.17 years. Lower GNRI scores were statically significantly associated with worse MNA scores, lower weight, BMI, MAC, CC and albumin (P value < 0.001 for all). Only with GNRI, increasing odds ratio (OR) was seen with increasing risk of nutrition-related complication (from mild to moderate to severe). ORs (95%CI) for three month mortality were 1.63(0.0.27-10.00), 5.03(1.36-18.52), and 11.24(3.03-41.67), and OR (95%CI) for six month mortality were 1.64(0.403-6.62), 4.29 (1.45-12.66), and 5.71(1.87-17.54) respectively compared to patients with no risk and. By regression, both severe and moderate grade of GNRI were independent predictors of three and six month mortality (P value for three month: 0.002, 0.015; for six month: 0.002, 0.008 respectively) after adjustment of age, sex, and cancer rather than MNA. CONCLUSIONS GNRI showed a higher prognostic value for describing and classification of nutritional status and nutritional-related complications in hospitalized elderly patients in addition to its simplicity.
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Affiliation(s)
- Wafaa Mostafa Abd-El-Gawad
- Geriatrics and Gerontology Department, Faculty of Medicine, Ain Shams University, Abbassia, Cairo, Egypt.
| | - Rania Mohammed Abou-Hashem
- Geriatrics and Gerontology Department, Faculty of Medicine, Ain Shams University, Abbassia, Cairo, Egypt.
| | | | - Ghada Essam Amin
- Environmental and Occupational Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
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Bennett PN, Miller MD, Woodman RJ, Hill K, Murray S, Gleadle JM. Nutrition screening by nurses in dialysis. J Clin Nurs 2012; 22:723-32. [PMID: 23039313 DOI: 10.1111/j.1365-2702.2012.04286.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2012] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To determine whether a nurse-completed dialysis nutritional screening tool improves referral rates for nutritional support and compare nutrition sensitive biochemical indices, mortality rates and patient-centred quality of life outcomes between referred and non-referred dialysis patients. BACKGROUND People with chronic kidney disease requiring dialysis are nutritionally at risk. Nutrition screening has been shown to identify dialysis patients who are nutritionally at risk to refer to dietitian expertise. DESIGN Prospective cluster-randomised control trial. METHODS Monthly nurse-completed nutrition screening was completed for six consecutive months using a validated four-item instrument measuring weight change, serum phosphate, serum potassium and appetite. Participants (n = 81) were haemodialysis patients from four satellite haemodialysis centres in one Australian metropolitan health service. Primary outcome measure was rate of referral to dietetic services for nutrition support for intervention vs. control groups at six months. Secondary outcome measures were blood pressure, biochemical indices and mortality for referred vs. non-referred patients at six and nine months, and generic and dialysis-specific quality of life for referred vs. non-referred at nine months was examined. RESULTS There were three times as many dietetic referrals in the intervention group than in the control group (26·3 vs. 9·3%). Serum phosphate increased significantly more in the referred patients than the non-referred patients. There were no clinically significant changes between groups in quality of life, blood pressure, mortality rates or other biochemical indices at either six or nine months. CONCLUSION Nurse-completed nutritional screening can lead to appropriate dietetic referrals for nutritional support by nutritional expert clinicians. RELEVANCE TO CLINICAL PRACTICE This study is the first to demonstrate that monthly systematic nurse-completed nutritional screening can facilitate appropriate dietetic referrals that may lead to increased nutritional care for people in satellite dialysis centres.
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Affiliation(s)
- Paul N Bennett
- Department of Nursing, Deakin University and Southern Health Nursing Research Centre, Melbourne, Vic., Australia.
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Castledine CI, Caskey FJ, Tomson CRV, Ansell D. Trends in renal replacement therapy and changes in peritoneal dialysis utilization in the United kingdom. Perit Dial Int 2011; 31 Suppl 2:S53-7. [PMID: 21364209 DOI: 10.3747/pdi.2009.00194] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Clare I Castledine
- UK Renal Registry, Southmead Hospital, Southmead Road, Bristol, United Kingdom.
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Bonfante GMS, Gomes IC, Andrade EIG, Lima EM, Acurcio FA, Cherchiglia ML. Duration of temporary catheter use for hemodialysis: an observational, prospective evaluation of renal units in Brazil. BMC Nephrol 2011; 12:63. [PMID: 22093280 PMCID: PMC3227575 DOI: 10.1186/1471-2369-12-63] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2011] [Accepted: 11/17/2011] [Indexed: 11/14/2022] Open
Abstract
Background For chronic hemodialysis, the ideal permanent vascular access is the arteriovenous fistula (AVF). Temporary catheters should be reserved for acute dialysis needs. The AVF is associated with lower infection rates, better clinical results, and a higher quality of life and survival when compared to temporary catheters. In Brazil, the proportion of patients with temporary catheters for more than 3 months from the beginning of therapy is used as an evaluation of the quality of renal units. The aim of this study is to evaluate factors associated with the time between the beginning of hemodialysis with temporary catheters and the placement of the first arteriovenous fistula in Brazil. Methods This is an observational, prospective non-concurrent study using national administrative registries of all patients financed by the public health system who began renal replacement therapy (RRT) between 2000 and 2004 in Brazil. Incident patients were eligible who had hemodialysis for the first time. Patients were excluded who: had hemodialysis reportedly started after the date of death (inconsistent database); were younger than 18 years old; had HIV; had no record of the first dialysis unit; and were dialyzed in units with less than twenty patients. To evaluate individual and renal unit factors associated with the event of interest, the frailty model was used (N = 55,589). Results Among the 23,824 patients (42.9%) who underwent fistula placement in the period of the study, 18.2% maintained the temporary catheter for more than three months until the fistula creation. The analysis identified five statistically significant factors associated with longer time until first fistula: higher age (Hazard-risk - HR 0.99, 95% CI 0.99-1.00); having hypertension and cardiovascular diseases (HR 0.94, 95% CI 0.9-0.98) as the cause of chronic renal disease; residing in capitals cities (HR 0.92, 95% CI 0.9-0.95) and certain regions in Brazil - South (HR 0.83, 95% CI 0.8-0.87), Midwest (HR 0.88, 95% CI 0.83-0.94), Northeast (HR 0.91, 95% CI 0.88-0.94), or North (HR 0.88, 95% CI 0.83-0.94) and the type of renal unit (public or private). Conclusion Monitoring the provision of arteriovenous fistulas in renal units could improve the care given to patients with end stage renal disease.
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Mactier R, Hoenich N, Breen C. Renal Association Clinical Practice Guideline on haemodialysis. Nephron Clin Pract 2011; 118 Suppl 1:c241-86. [PMID: 21555899 DOI: 10.1159/000328072] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2009] [Accepted: 12/01/2009] [Indexed: 11/19/2022] Open
Affiliation(s)
- Robert Mactier
- Renal Services, NHS Greater Glasgow and Clyde and NHS Forth Valley.
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Silva GMD, Gomes IC, Andrade EIG, Lima EM, Acurcio FDA, Cherchiglia ML. Permanent vascular access in patients with end-stage renal disease, Brazil. Rev Saude Publica 2011; 45:241-8. [PMID: 21344129 DOI: 10.1590/s0034-89102011005000005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2009] [Accepted: 08/25/2010] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To assess factors associated with the establishment of permanent vascular access for patients with end-stage renal disease. METHODS Cross-sectional study conducted in a nationally representative sample of Brazilian end-stage renal disease patients in dialysis and transplant centers during 2007. The sample comprised only patients who received hemodialysis as a primary therapy modality and reported the type of vascular access for their primary hemodialysis treatment (N=2,276). Data were from the TRS Project--"Economic and Epidemiologic Evaluation of Modalities of Renal Replacement Therapy in Brazil". Multiple logistic regression analysis was used to assess factors associated with the establishment of permanent vascular access in these patients. RESULTS About 30% of the patients studied had an arteriovenous vascular access. The following factors were associated with a lower likelihood of having an arteriovenous vascular access as a primary type of access: time of hemodialysis start since the diagnosis of chronic renal failure < 1 year; shorter dialysis therapy; having no private health insurance; living in the central-western, northeastern and southeastern regions of Brazil; and living in the northern region plus having no private health insurance. In the final model there was found a positive association between the outcome and pre-dialysis care and no were association with socioeconomic and comorbidity variables. CONCLUSIONS The study results showed that the focus should on pre-dialysis care to increase the establishment of an arteriovenous vascular access before starting hemodialysis in Brazil.
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Affiliation(s)
- Gisele Macedo da Silva
- Departamento de Medicina Preventiva e Social, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
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Abstract
Demand for renal replacement therapy (dialysis and transplantation) is projected to rise by approximately 5% every year until at least 2030. Therefore, particular attention should be paid to areas in which significant increases in demand are likely to lead to further pressure on services. There is evidence to support higher patient survival rates in home haemodialysis compared with those that receive hospital- or satellite-based haemodialysis (i.e. a smaller renal unit based in a community hospital closer to the patient's home). Furthermore, studies suggest that home haemodialysis is at least as effective as and less costly than hospital or satellite unit haemodialysis. Therefore, there is a greater requirement for expanding the provision of home haemodialysis, and to make this treatment option available to a wider range of patients.
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Castledine C, Gilg J, Rogers C, Ben-Shlomo Y, Caskey F. Chapter 15: UK Renal Centre Survey Results 2010: RRT Incidence and Use of Home Dialysis Modalities. ACTA ACUST UNITED AC 2011; 119 Suppl 2:c255-67. [DOI: 10.1159/000331783] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Hommel K, Rasmussen S, Kamper AL, Madsen M. Regional and social inequalities in chronic renal replacement therapy in Denmark. Nephrol Dial Transplant 2010; 25:2624-32. [PMID: 20207710 DOI: 10.1093/ndt/gfq110] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The incidence of chronic renal replacement therapy (RRT) varies markedly between Danish nephrology centres. The aim of the present study was to establish if there is regional and social variation in the incidence of chronic RRT in Denmark when analysed according to patient residence. The importance of diabetic nephropathy and patients aged 70 years or older was also studied. METHODS Incident patients on chronic RRT in the period 1995-2006 were identified in the Danish National Registry on Regular Dialysis and Transplantation. Information on residence, income, educational status and ethnic origin was obtained from Statistics Denmark. Rates of incident RRT patients were standardized for regional differences of sex and age as well as income, educational status and ethnic origin. Poisson regression was used when comparing rates. RESULTS Age- and sex-standardized incident chronic RRT rates among individuals with low income or short educational level were higher (P < 0.0001) compared to other groups. Also, standardized rates of patients in total and patients aged 70 years or older were higher in the catchment areas of the nephrology centres located in the two largest cities than for patients with residence in other areas of the country (P < 0.0001). Standardizing for regional differences of ethnic origin did not change the rates. The incident chronic RRT rate caused by diabetic nephropathy was higher for patients with residence in the catchment area of the nephrology centre in the largest city [49 per million people (p.m.p.) (95% CI = 40-57 p.m.p.)] compared to the catchment area of the nephrology centre located in the second largest city [31 (95% CI = 26-37 p.m.p.)] and other areas [29 p.m.p. (95% CI = 26-31 p.m.p.)] in 2001-06. When standardizing for differences in income among the 30-69-year-old persons, the rate of patients with residence in the catchment area of the nephrology centre located in the largest city decreased but was still higher than in other regions (P = 0.0003). CONCLUSIONS There are marked socio-economic and regional differences in rates of incident RRT patients. The rates of incident RRT patients are highest in the catchment areas of the two largest nephrology centres and this may be partly explained by a higher frequency of end-stage diabetic nephropathy and a new treatment programme targeting frail, mainly elderly, patients.
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Affiliation(s)
- Kristine Hommel
- Department of Nephrology, Rigshospitalet, Copenhagen, Denmark.
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Yamada K, Furuya R, Takita T, Maruyama Y, Yamaguchi Y, Ohkawa S, Kumagai H. Simplified nutritional screening tools for patients on maintenance hemodialysis. Am J Clin Nutr 2008; 87:106-13. [PMID: 18175743 DOI: 10.1093/ajcn/87.1.106] [Citation(s) in RCA: 365] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Malnutrition is a prevalent complication in patients on maintenance hemodialysis. Nutritional screening tools may be useful to identify those patients at nutritional risk from among hundreds of hemodialysis patients in a large facility. OBJECTIVE We tested several simplified nutritional screening tools on hemodialysis patients to validate the potential application of the tools. DESIGN The simplified nutritional screening tools were chosen from references published between 1985 and 2005. Nutritional assessments, including history taking, and anthropometric and biochemical measurements were performed on 422 hemodialysis patients. These results were applied to obtain the score of each nutritional screening tool and the malnutrition-inflammation score (MIS), a comprehensive nutritional assessment tool, as the reference standard. The usefulness of each nutritional screening tool for identifying nutritional risk was assessed by comparison with the MIS value and various individual nutritional measures. RESULTS Five reliable nutritional screening tools were found by the literature search. Among them, the geriatric nutritional risk index (GNRI) was considered to be the most accurate in identifying hemodialysis patients at nutritional risk, because the area under the receiver operating characteristic curve generated with the MIS value was the largest. The GNRI showed a significantly negative correlation with the MIS (r=-0.67, P<0.0001), and the most accurate GNRI cutoff to identify a malnourished patient according to the MIS was <91.2. The GNRI's sensitivity, specificity, and accuracy of <91.2 in predicting malnutrition according to the MIS were 0.730, 0.819, and 0.787, respectively. CONCLUSION The GNRI was the simplest and most accurate risk index for identifying hemodialysis patients at nutritional risk according to the MIS.
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Affiliation(s)
- Kohsuke Yamada
- Department of Clinical Nutrition, School of Food and Nutritional Sciences and the COE Program in the 21st Century, University of Shizuoka, Shizuoka, Japan
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