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Liao CT, Lai JH, Chen YW, Hsu YH, Wu MY, Zheng CM, Hsu CC, Wu MS, Chuang SY. Transitions of dialysis status and outcomes after the unplanned first dialysis: a nationwide population-based cohort study. Sci Rep 2023; 13:12867. [PMID: 37553351 PMCID: PMC10409749 DOI: 10.1038/s41598-023-39913-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 08/02/2023] [Indexed: 08/10/2023] Open
Abstract
In Taiwan, most first-time dialysis was started without the creation of an arteriovenous shunt. Here, we aimed to elucidate the transitions of dialysis status in the unplanned first dialysis patients and determine factors associated with their outcomes. A total of 50,315 unplanned first dialysis patients aged more than 18 years were identified from the National Health Insurance Dataset in Taiwan between 2001 and 2012. All patients were followed for 5 years for the transitions in dialysis status, including robust (dialysis-free), sporadic dialysis, continued dialysis, and death. Furthermore, factors associated with the development of continued dialysis and death were examined by the Cox proportional hazard models. After 5 years after the first dialysis occurrence, there were 5.39% with robust status, 1.67% with sporadic dialysis, 8.45% with continued dialysis, and 84.48% with death. Notably, we have identified common risk factors for developing maintenance dialysis and deaths, including male gender, older age, diabetes, coronary heart disease, stroke, heart failure, sepsis, and surgery. There was an extremely high mortality rate among the first unplanned dialysis patients in Taiwan. Less than 10% of these patients underwent continued dialysis during the 5-year follow-up period. This study highlighted the urgent need for interventions to improve patient outcomes.
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Affiliation(s)
- Chia-Te Liao
- Division of Nephrology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- TMU-Research Center of Urology and Kidney (TMU-RCUK), Taipei Medical University, Taipei, Taiwan
| | - Jia-Hong Lai
- Institute of Population Health Sciences, National Health Research Institutes, No. 35, Keyan Road, Zhunan, Miaoli County, 35053, Taiwan
| | - Yu-Wei Chen
- Division of Nephrology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- TMU-Research Center of Urology and Kidney (TMU-RCUK), Taipei Medical University, Taipei, Taiwan
| | - Yung-Ho Hsu
- Division of Nephrology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- TMU-Research Center of Urology and Kidney (TMU-RCUK), Taipei Medical University, Taipei, Taiwan
- Division of Nephrology, Department of Internal Medicine, Hsin Kuo Min Hospital, Taipei Medical University, Taoyuan City, Taiwan
| | - Mei-Yi Wu
- Division of Nephrology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- TMU-Research Center of Urology and Kidney (TMU-RCUK), Taipei Medical University, Taipei, Taiwan
| | - Cai-Mei Zheng
- Division of Nephrology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- TMU-Research Center of Urology and Kidney (TMU-RCUK), Taipei Medical University, Taipei, Taiwan
| | - Chih-Cheng Hsu
- Institute of Population Health Sciences, National Health Research Institutes, No. 35, Keyan Road, Zhunan, Miaoli County, 35053, Taiwan
- National Center for Geriatrics and Welfare Research, National Health Research Institutes, Yunlin, Taiwan
| | - Mai-Szu Wu
- Division of Nephrology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- TMU-Research Center of Urology and Kidney (TMU-RCUK), Taipei Medical University, Taipei, Taiwan
| | - Shao-Yuan Chuang
- Institute of Population Health Sciences, National Health Research Institutes, No. 35, Keyan Road, Zhunan, Miaoli County, 35053, Taiwan.
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2
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Thurlow JS, Joshi M, Yan G, Norris KC, Agodoa LY, Yuan CM, Nee R. Global Epidemiology of End-Stage Kidney Disease and Disparities in Kidney Replacement Therapy. Am J Nephrol 2021; 52:98-107. [PMID: 33752206 PMCID: PMC8057343 DOI: 10.1159/000514550] [Citation(s) in RCA: 242] [Impact Index Per Article: 80.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 01/17/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND The global epidemiology of end-stage kidney disease (ESKD) reflects each nation's unique genetic, environmental, lifestyle, and sociodemographic characteristics. The response to ESKD, particularly regarding kidney replacement therapy (KRT), depends on local disease burden, culture, and socioeconomics. Here, we explore geographic variation and global trends in ESKD incidence and prevalence and examine variations in KRT modality, practice patterns, and mortality. We conclude with a discussion on disparities in access to KRT and strategies to reduce ESKD global burden and to improve access to treatment in low- and middle-income countries (LMICs). SUMMARY From 2003 to 2016, incidence rates of treated ESKD were relatively stable in many higher income countries but rose substantially predominantly in East and Southeast Asia. The prevalence of treated ESKD has increased worldwide, likely due to improving ESKD survival, population demographic shifts, higher prevalence of ESKD risk factors, and increasing KRT access in countries with growing economies. Unadjusted 5-year survival of ESKD patients on KRT was 41% in the USA, 48% in Europe, and 60% in Japan. Dialysis is the predominant KRT in most countries, with hemodialysis being the most common modality. Variations in dialysis practice patterns account for some of the differences in survival outcomes globally. Worldwide, there is a greater prevalence of KRT at higher income levels, and the number of people who die prematurely because of lack of KRT access is estimated at up to 3 times higher than the number who receive treatment. Key Messages: Many people worldwide in need of KRT as a life-sustaining treatment do not receive it, mostly in LMICs where health care resources are severely limited. This large treatment gap demands a focus on population-based prevention strategies and development of affordable and cost-effective KRT. Achieving global equity in KRT access will require concerted efforts in advocating effective public policy, health care delivery, workforce capacity, education, research, and support from the government, private sector, nongovernmental, and professional organizations.
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Affiliation(s)
- John S Thurlow
- Nephrology Service, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
- Department of Medicine, Uniformed Services University, Bethesda, Maryland, USA
| | - Megha Joshi
- Nephrology Service, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
- Department of Medicine, Uniformed Services University, Bethesda, Maryland, USA
| | - Guofen Yan
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Keith C Norris
- Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, USA
| | - Lawrence Y Agodoa
- Office of the Director, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Christina M Yuan
- Nephrology Service, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
- Department of Medicine, Uniformed Services University, Bethesda, Maryland, USA
| | - Robert Nee
- Nephrology Service, Walter Reed National Military Medical Center, Bethesda, Maryland, USA,
- Department of Medicine, Uniformed Services University, Bethesda, Maryland, USA,
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3
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Elsayed ME, Morris AD, Li X, Browne LD, Stack AG. Propensity score matched mortality comparisons of peritoneal and in-centre haemodialysis: systematic review and meta-analysis. Nephrol Dial Transplant 2021; 35:2172-2182. [PMID: 31981353 PMCID: PMC7716812 DOI: 10.1093/ndt/gfz278] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 11/26/2019] [Indexed: 01/25/2023] Open
Abstract
Background Accurate comparisons of haemodialysis (HD) and peritoneal dialysis (PD) survival based on observational studies are difficult due to substantial residual confounding that arises from imbalances between treatments. Propensity score matching (PSM) comparisons confer additional advantages over conventional methods of adjustment by further reducing selection bias between treatments. We conducted a systematic review of studies that compared mortality between in-centre HD with PD using a PSM-based approach. Methods A sensitive search strategy identified all citations in the PubMed, Cochrane and EMBASE databases from inception through November 2018. Pooled PD versus HD mortality hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated through random-effects meta-analysis. A subsequent meta-regression explored factors to account for between-study variation. Results The systematic review yielded 214 citations with 17 cohort studies and 113 578 PSM incident dialysis patients. Cohort periods spanned the period 1993–2014. The pooled HR for PD versus HD was 1.06 (95% CI 0.99–1.14). There was considerable variation by country, however, mortality risks for PD versus HD remained virtually unchanged when stratified by geographical region with HRs of 1.04 (95% CI 0.94–1.15), 1.14 (95% CI 0.99–1.32) and 0.98 (0.87–1.10) for European, Asian and American cohorts, respectively. Subgroup meta-analyses revealed similar risks for patients with diabetes [HR 1.09 (95% CI 0.98–1.21)] and without diabetes [HR 0.99 (95% CI 0.90–1.09)]. Heterogeneity was substantial (I2 = 87%) and was largely accounted for by differences in cohort period, study type and country of origin. Together these factors explained a substantial degree of between-studies variance (R2 = 90.6%). Conclusions This meta-analysis suggests that PD and in-centre HD carry equivalent survival benefits. Reported differences in survival between treatments largely reflect a combination of factors that are unrelated to clinical efficacy.
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Affiliation(s)
- Mohamed E Elsayed
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland.,Department of Nephrology, Royal Preston Hospital, Preston, UK
| | - Adam D Morris
- Department of Nephrology, Royal Preston Hospital, Preston, UK
| | - Xia Li
- Departments of Mathematics and Statistics, La Trobe University, Melbourne, Victoria, Australia
| | - Leonard D Browne
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - Austin G Stack
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland.,Department of Nephrology, University Hospital Limerick, Limerick, Ireland.,Health Research Institute, University of Limerick, Limerick, Ireland
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Abstract
Dialysis adequacy is conventionally quantified as net urea clearance. Single pool (sp) Kt/Vurea remains the best studied measure of dialysis adequacy globally. Other measures such as fluid status control, anemia correction, and mineral metabolism are monitored variably. Increasing use of hemodiafiltration across Europe and many parts of Japan and Australia is predicated on studies showing better patient survival with middle molecule clearance. Apart from local clinical practice guidelines, the income level and public health policy of a country determine quality of dialysis services. Among developed nations, small solute clearance adequacy targets are achieved with high frequency. In the United States, dialysis adequacy target is met by focussing on high blood flow rates and large dialyzer size, sometimes at the cost of session time. In Japan, Australia, and Germany, session length is given importance. Dialysis adequacy reporting is restricted and inconsistent in developing nations. The Gulf Cooperation Council countries, Russia and Malaysia, respectively, are close to achieving dialysis adequacy target (spKt/Vurea ≥1.2) universally in their dialysis populations. Patient-reported outcomes are typically measured only in developed countries. Patient survival on dialysis, partly linked to dialysis adequacy, varies greatly around the world, with Japan having the best survival rates. Until the development of better markers of dialysis adequacy, universal consistency in reporting of conventional parameters with a focus on patient-reported measures should be endeavored.
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Affiliation(s)
- Joyita Bharati
- Department of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vivekanand Jha
- George Institute for Global Health, UNSW, New Delhi, India.,School of Public Health, Imperial College, London, UK.,Manipal Academy of Higher Education, Manipal, India
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5
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Potluri VS, Sawinski D, Tam V, Shults J, Cohen JB, Wiebe DJ, Shah SP, Berns JS, Reese PP. Effect of Neighborhood Food Environment and Socioeconomic Status on Serum Phosphorus Level for Patients on Chronic Dialysis. J Am Soc Nephrol 2020; 31:2622-2630. [PMID: 32917783 DOI: 10.1681/asn.2020030290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 07/20/2020] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Elevated blood phosphorus levels are common and associated with a greater risk of death for patients receiving chronic dialysis. Phosphorus-rich foods are prevalent in the American diet, and low-phosphorus foods, including fruits and vegetables, are often less available in areas with more poverty. The relative contributions of neighborhood food availability and socioeconomic status to phosphorus control in patients receiving dialysis are unknown. METHODS Using longitudinal data from a national dialysis provider, we constructed hierarchical, linear mixed-effects models to evaluate the relationships between neighborhood food environment or socioeconomic status and serum phosphorus level among patients receiving incident dialysis. RESULTS Our cohort included 258,510 patients receiving chronic hemodialysis in 2005-2013. Median age at dialysis initiation was 64 years, 45% were female, 32% were Black, and 15% were Hispanic. Within their residential zip code, patients had a median of 25 "less-healthy" food outlets (interquartile range, 11-40) available to them compared with a median of four "healthy" food outlets (interquartile range, 2-6). Living in a neighborhood with better availability of healthy food was not associated with a lower phosphorus level. Neighborhood income also was not associated with differences in phosphorus. Patient age, race, cause of ESKD, and mean monthly dialysis duration were most closely associated with phosphorus level. CONCLUSIONS Neither neighborhood availability of healthy food options nor neighborhood income was associated with phosphorus levels in patients receiving chronic dialysis. Modifying factors, such as nutrition literacy, individual-level financial resources, and adherence to diet restrictions and medications, may be more powerful contributors than food environment to elevated phosphorus.
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Affiliation(s)
- Vishnu S Potluri
- Renal-Electrolyte and Hypertension Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.,Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Deirdre Sawinski
- Renal-Electrolyte and Hypertension Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Vicky Tam
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Justine Shults
- Department of Biostatistics, Epidemiology and Bioinformatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jordana B Cohen
- Renal-Electrolyte and Hypertension Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.,Department of Biostatistics, Epidemiology and Bioinformatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Douglas J Wiebe
- Department of Biostatistics, Epidemiology and Bioinformatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Siddharth P Shah
- Renal-Electrolyte and Hypertension Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jeffrey S Berns
- Renal-Electrolyte and Hypertension Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Peter P Reese
- Renal-Electrolyte and Hypertension Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania .,Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania.,Department of Biostatistics, Epidemiology and Bioinformatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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6
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Ng ESY, Wong PY, Kamaruddin ATH, Lim CTS, Chan YM. Poor Sleep Quality, Depression and Social Support Are Determinants of Serum Phosphate Level among Hemodialysis Patients in Malaysia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E5144. [PMID: 32708766 PMCID: PMC7400380 DOI: 10.3390/ijerph17145144] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 05/29/2020] [Accepted: 05/29/2020] [Indexed: 12/30/2022]
Abstract
Despite optimal control of serum phosphate level being imperative to avoid undesirable health outcomes, hyperphosphataemia is a highly prevalent mineral abnormality among the dialysis population. This study aimed to determine factors associated with hyperphosphatemia among hemodialysis patients in Malaysia. Multiple linear regression analysis was used to ascertain the possible factors that influence serum phosphate levels. A total of 217 hemodialysis patients were recruited. Hyperphosphatemia was prevalent. Only approximately 25% of the patients were aware that optimal control of hyperphosphatemia requires the combined effort of phosphate binder medication therapy, dietary restriction, and dialysis prescription. The presence of diabetes mellitus may affect serum phosphate levels, complicating dietary phosphorus management. Patients who were less depressive portrayed higher serum phosphate levels, implying intentional non-compliance. Better compliance on phosphate binder, longer sleep duration, and higher social support was associated with a lower level of serum phosphate. Despite sleep disturbance being one of the most prevalent and intense symptom burdens identified by hemodialysis patients, relatively few studies have addressed this issue. It is time to formulate sleep therapeutic interventions besides the encouragement of strong social support, hoping which many clinical outcomes including hyperphosphatemia can be better controlled among hemodialysis patients.
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Affiliation(s)
- Eileen Suk Ying Ng
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia (UPM), Serdang 43400, Malaysia; (E.S.Y.N.); (P.Y.W.); (A.T.H.K.)
| | - Poh Yoong Wong
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia (UPM), Serdang 43400, Malaysia; (E.S.Y.N.); (P.Y.W.); (A.T.H.K.)
| | - Ahmad Teguh Hakiki Kamaruddin
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia (UPM), Serdang 43400, Malaysia; (E.S.Y.N.); (P.Y.W.); (A.T.H.K.)
| | - Christopher Thiam Seong Lim
- Department of Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia (UPM), Serdang 43400, Malaysia;
| | - Yoke Mun Chan
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia (UPM), Serdang 43400, Malaysia; (E.S.Y.N.); (P.Y.W.); (A.T.H.K.)
- Research Center of Excellence, Nutrition and Non Communicable Diseases, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia (UPM), Serdang 43400, Malaysia
- Malaysian Research Institute on Ageing, Universiti Putra Malaysia, Serdang 43400, Malaysia
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Sampson M, Faria N, Powell JJ. Efficacy and safety of PT20, an iron-based phosphate binder, for the treatment of hyperphosphataemia: a randomized, double-blind, placebo-controlled, dose-ranging, Phase IIb study in patients with haemodialysis-dependent chronic kidney disease. Nephrol Dial Transplant 2020; 36:1399-1407. [PMID: 32651955 PMCID: PMC8311578 DOI: 10.1093/ndt/gfaa116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Indexed: 11/26/2022] Open
Abstract
Background Hyperphosphataemia is a common complication of chronic kidney disease (CKD). PT20 (ferric iron oxide adipate) is an investigational molecule engineered to offer enhanced phosphate-binding properties relative to other phosphate binders. Methods In this double-blind, parallel-group, placebo-controlled, dose-ranging study (ClinicalTrials.gov identifier NCT02151643), the efficacy and safety of 28 days of oral PT20 treatment were evaluated in patients with dialysis-dependent CKD. Participants were randomly assigned in an 8:8:8:13:13 ratio to receive PT20 (400, 800, 1600 or 3200 mg) or placebo three times daily. Results Among 153 participants, 129 completed treatment [7 discontinued because of adverse events (AEs), 2 because of hyperphosphataemia and 15 for other reasons]. PT20 treatment for 28 days resulted in a statistically significant and dose-dependent reduction in serum phosphate concentration. There were no statistically significant effects of PT20 treatment on changes in haemoglobin or ferritin concentrations or transferrin saturation between Days 1 and 29. The incidence of treatment-emergent AEs was broadly similar across the PT20 and placebo groups (42–59% versus 44%). The most common PT20 treatment-related AEs were gastrointestinal, primarily diarrhoea (13–18%) and discoloured faeces (3–23%). No serious AEs were considered to be related to study treatment. There were no clinically significant changes in laboratory results reflecting acid/base status or increases in ferritin that could indicate the absorption of components of PT20. Conclusions In this first study investigating the efficacy and safety of PT20 in patients with hyperphosphataemia and dialysis-dependent CKD, PT20 significantly lowered serum phosphate concentrations and was generally well tolerated.
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Affiliation(s)
| | - Nuno Faria
- Department of Veterinary Medicine, University of Cambridge, Cambridge, UK.,Medical Research Council Elsie Widdowson Laboratory, Cambridge, UK
| | - Jonathan J Powell
- Department of Veterinary Medicine, University of Cambridge, Cambridge, UK.,Medical Research Council Elsie Widdowson Laboratory, Cambridge, UK
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Wang M, Obi Y, Streja E, Rhee CM, Chen J, Hao C, Kovesdy CP, Kalantar-Zadeh K. Impact of residual kidney function on hemodialysis adequacy and patient survival. Nephrol Dial Transplant 2019; 33:1823-1831. [PMID: 29688442 DOI: 10.1093/ndt/gfy060] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 02/21/2018] [Indexed: 11/14/2022] Open
Abstract
Background Both dialysis dose and residual kidney function (RKF) contribute to solute clearance and are associated with outcomes in hemodialysis patients. We hypothesized that the association between dialysis dose and mortality is attenuated with greater RKF. Methods Among 32 251 incident hemodialysis patients in a large US dialysis organization (2007-11), we examined the interaction between single-pool Kt/V (spKt/V) and renal urea clearance (rCLurea) levels in survival analyses using multivariable Cox proportional hazards regression model. Results The median rCLurea and mean baseline spKt/V were 3.06 [interquartile range (IQR) 1.74-4.85] mL/min/1.73 m2 and 1.32 ± 0.28, respectively. A total of 7444 (23%) patients died during the median follow-up of 1.2 years (IQR 0.5-2.2 years) with an incidence of 15.4 deaths per 100 patient-years. The Cox model with adjustment for case-mix and laboratory variables showed that rCLurea modified the association between spKt/V and mortality (Pinteraction = 0.03); lower spKt/V was associated with higher mortality among patients with low rCLurea (i.e. <3 mL/min/1.73 m2) but not among those with higher rCLurea. The adjusted mortality hazard ratios (aHRs) and 95% confidence intervals of the low (<1.2) versus high (≥1.2) spKt/V were 1.40 (1.12-1.74), 1.21 (1.10-1.33), 1.06 (0.98-1.14), and 1.00 (0.93-1.08) for patients with rCLurea of 0.0, 1.0, 3.0 and 6.0 mL/min/1.73 m2, respectively. Conclusions Incident hemodialysis patients with substantial RKF do not exhibit the expected better survival at higher hemodialysis doses. RKF levels should be taken into account when deciding on the dose of dialysis treatment among incident hemodialysis patients.
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Affiliation(s)
- Mengjing Wang
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, Department of Medicine, University of California Irvine Medical Center, Orange, CA, USA.,Division of Nephrology, Department of Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Yoshitsugu Obi
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, Department of Medicine, University of California Irvine Medical Center, Orange, CA, USA
| | - Elani Streja
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, Department of Medicine, University of California Irvine Medical Center, Orange, CA, USA.,Nephrology Section, Tibor Rubin Veterans Affairs Medical Center, Long Beach, CA, USA
| | - Connie M Rhee
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, Department of Medicine, University of California Irvine Medical Center, Orange, CA, USA.,Nephrology Section, Tibor Rubin Veterans Affairs Medical Center, Long Beach, CA, USA
| | - Jing Chen
- Division of Nephrology, Department of Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Chuanming Hao
- Division of Nephrology, Department of Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Csaba P Kovesdy
- Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA.,Nephrology Section, Memphis VA Medical Center, Memphis, TN, USA
| | - Kamyar Kalantar-Zadeh
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, Department of Medicine, University of California Irvine Medical Center, Orange, CA, USA.,Nephrology Section, Tibor Rubin Veterans Affairs Medical Center, Long Beach, CA, USA.,Fielding School of Public Health at UCLA, Los Angeles, CA, USA
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9
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King AJ, Siegel M, He Y, Nie B, Wang J, Koo-McCoy S, Minassian NA, Jafri Q, Pan D, Kohler J, Kumaraswamy P, Kozuka K, Lewis JG, Dragoli D, Rosenbaum DP, O'Neill D, Plain A, Greasley PJ, Jönsson-Rylander AC, Karlsson D, Behrendt M, Strömstedt M, Ryden-Bergsten T, Knöpfel T, Pastor Arroyo EM, Hernando N, Marks J, Donowitz M, Wagner CA, Alexander RT, Caldwell JS. Inhibition of sodium/hydrogen exchanger 3 in the gastrointestinal tract by tenapanor reduces paracellular phosphate permeability. Sci Transl Med 2019; 10:10/456/eaam6474. [PMID: 30158152 DOI: 10.1126/scitranslmed.aam6474] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 10/31/2017] [Accepted: 03/06/2018] [Indexed: 12/16/2022]
Abstract
Hyperphosphatemia is common in patients with chronic kidney disease and is increasingly associated with poor clinical outcomes. Current management of hyperphosphatemia with dietary restriction and oral phosphate binders often proves inadequate. Tenapanor, a minimally absorbed, small-molecule inhibitor of the sodium/hydrogen exchanger isoform 3 (NHE3), acts locally in the gastrointestinal tract to inhibit sodium absorption. Because tenapanor also reduces intestinal phosphate absorption, it may have potential as a therapy for hyperphosphatemia. We investigated the mechanism by which tenapanor reduces gastrointestinal phosphate uptake, using in vivo studies in rodents and translational experiments on human small intestinal stem cell-derived enteroid monolayers to model ion transport physiology. We found that tenapanor produces its effect by modulating tight junctions, which increases transepithelial electrical resistance (TEER) and reduces permeability to phosphate, reducing paracellular phosphate absorption. NHE3-deficient monolayers mimicked the phosphate phenotype of tenapanor treatment, and tenapanor did not affect TEER or phosphate flux in the absence of NHE3. Tenapanor also prevents active transcellular phosphate absorption compensation by decreasing the expression of NaPi2b, the major active intestinal phosphate transporter. In healthy human volunteers, tenapanor (15 mg, given twice daily for 4 days) increased stool phosphorus and decreased urinary phosphorus excretion. We determined that tenapanor reduces intestinal phosphate absorption predominantly through reduction of passive paracellular phosphate flux, an effect mediated exclusively via on-target NHE3 inhibition.
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Affiliation(s)
| | | | - Ying He
- Ardelyx Inc., Fremont, CA 94555, USA
| | | | - Ji Wang
- Ardelyx Inc., Fremont, CA 94555, USA
| | | | | | | | - Deng Pan
- Ardelyx Inc., Fremont, CA 94555, USA
| | | | | | | | | | | | | | - Debbie O'Neill
- University of Alberta, Edmonton, Alberta T6G 1C9, Canada
| | - Allein Plain
- University of Alberta, Edmonton, Alberta T6G 1C9, Canada
| | - Peter J Greasley
- Cardiovascular and Metabolic Disease (CVMD) Translational Medicine Unit, Early Clinical Development, Innovative Medicines and Early Development (IMED) Biotech Unit, AstraZeneca Gothenburg, 431 50 Mölndal, Sweden
| | | | - Daniel Karlsson
- Bioscience, CVMD, IMED Biotech Unit, AstraZeneca Gothenburg, 431 50 Mölndal, Sweden
| | - Margareta Behrendt
- Bioscience, CVMD, IMED Biotech Unit, AstraZeneca Gothenburg, 431 50 Mölndal, Sweden
| | - Maria Strömstedt
- Bioscience, CVMD, IMED Biotech Unit, AstraZeneca Gothenburg, 431 50 Mölndal, Sweden
| | | | - Thomas Knöpfel
- Institute of Physiology, University of Zurich and National Center of Competence in Research Kidney Control of Homeostasis, CH-8057 Zurich, Switzerland
| | - Eva M Pastor Arroyo
- Institute of Physiology, University of Zurich and National Center of Competence in Research Kidney Control of Homeostasis, CH-8057 Zurich, Switzerland
| | - Nati Hernando
- Institute of Physiology, University of Zurich and National Center of Competence in Research Kidney Control of Homeostasis, CH-8057 Zurich, Switzerland
| | - Joanne Marks
- Department of Neuroscience, Physiology and Pharmacology, University College London, Royal Free Campus, London NW3 2PF, UK
| | - Mark Donowitz
- Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Carsten A Wagner
- Institute of Physiology, University of Zurich and National Center of Competence in Research Kidney Control of Homeostasis, CH-8057 Zurich, Switzerland
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10
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Verberne WR, Das-Gupta Z, Allegretti AS, Bart HAJ, van Biesen W, García-García G, Gibbons E, Parra E, Hemmelder MH, Jager KJ, Ketteler M, Roberts C, Al Rohani M, Salt MJ, Stopper A, Terkivatan T, Tuttle KR, Yang CW, Wheeler DC, Bos WJW. Development of an International Standard Set of Value-Based Outcome Measures for Patients With Chronic Kidney Disease: A Report of the International Consortium for Health Outcomes Measurement (ICHOM) CKD Working Group. Am J Kidney Dis 2018; 73:372-384. [PMID: 30579710 DOI: 10.1053/j.ajkd.2018.10.007] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 10/14/2018] [Indexed: 12/14/2022]
Abstract
Value-based health care is increasingly promoted as a strategy for improving care quality by benchmarking outcomes that matter to patients relative to the cost of obtaining those outcomes. To support the shift toward value-based health care in chronic kidney disease (CKD), the International Consortium for Health Outcomes Measurement (ICHOM) assembled an international working group of health professionals and patient representatives to develop a standardized minimum set of patient-centered outcomes targeted for clinical use. The considered outcomes and patient-reported outcome measures were generated from systematic literature reviews. Feedback was sought from patients and health professionals. Patients with very high-risk CKD (stages G3a/A3 and G3b/A2-G5, including dialysis, kidney transplantation, and conservative care) were selected as the target population. Using an online modified Delphi process, outcomes important to all patients were selected, such as survival and hospitalization, and to treatment-specific subgroups, such as vascular access survival and kidney allograft survival. Patient-reported outcome measures were included to capture domains of health-related quality of life, which were rated as the most important outcomes by patients. Demographic and clinical variables were identified to be used as case-mix adjusters. Use of these consensus recommendations could enable institutions to monitor, compare, and improve the quality of their CKD care.
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Affiliation(s)
| | - Zofia Das-Gupta
- International Consortium for Health Outcomes Measurement, London, United Kingdom
| | | | - Hans A J Bart
- patient representative, Dutch Kidney Patients Association (NVN), Bussum, the Netherlands
| | - Wim van Biesen
- Renal Division, Ghent University Hospital, Ghent, Belgium
| | - Guillermo García-García
- University of Guadalajara Health Sciences Center, Hospital Civil de Guadalajara "Fray Antonio Alcalde," Guadalajara, Jalisco, Mexico
| | - Elizabeth Gibbons
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom (EG)
| | - Eduardo Parra
- Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Marc H Hemmelder
- Dutch Renal Registry (Renine), Nefrovisie, Utrecht; Medical Center Leeuwarden, Leeuwarden
| | - Kitty J Jager
- ERA-EDTA Registry, Amsterdam UMC, University of Amsterdam, Department of Medical Informatics, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Markus Ketteler
- Klinikum Coburg, Coburg, Germany; University of Split School of Medicine, Split, Croatia
| | - Charlotte Roberts
- International Consortium for Health Outcomes Measurement, London, United Kingdom
| | | | - Matthew J Salt
- International Consortium for Health Outcomes Measurement, London, United Kingdom
| | - Andrea Stopper
- European Renal Care Providers Association, Brussels, Belgium
| | | | - Katherine R Tuttle
- Providence Medical Research Center, Providence Health Care Kidney Research Institute, Nephrology Division and Institute for Translational Health Sciences, University of Washington, Spokane, WA
| | - Chih-Wei Yang
- Chang Gung Memorial Hospital, Linkou; Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - David C Wheeler
- Centre for Nephrology, University College London, London, United Kingdom
| | - Willem Jan W Bos
- St Antonius Hospital, Nieuwegein; Leiden University Medical Center, Leiden, the Netherlands
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11
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Jones CB, Chan CT. Boundaries of frequency and treatment time in conventional hemodialysis: Balancing convenience, economics, and health outcomes. Semin Dial 2018; 31:537-543. [PMID: 30094871 DOI: 10.1111/sdi.12742] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Since the inception of hemodialysis (HD) for patients with chronic kidney disease, the "perfect" dialysis prescription has remained elusive. Part of this may relate to the heterogeneity among populations, individual patients, and differences in access to health provision. The optimal balance between dialysis frequency and duration to achieve reductions in patient morbidity and mortality continues to be debated. The concept of dialysis adequacy originated from a post hoc mathematical analysis of the National Cooperative Study and has evolved to become a way of calculating dialysis dose and standardizing the dialysis prescription. In contrast, in its originally conceived sense, dialysis adequacy referred to the effective clearance of small solutes. Given the evolution of dialysis practice, we now aim to consider dialysis adequacy in a broader and more holistic manner particularly in view of our aging population and focus toward important patient-centered outcomes. While the traditional thrice weekly, HD regimen remains the default renal replacement modality, alternative strategies including short daily HD, long conventional HD, and long nocturnal HD are being widely implemented. We aim for optimal solute clearance, effective ultrafiltration to achieve normotension (while avoiding intradialytic symptoms) and maintenance of nutritional parameters all within the caveat that quality of life and autonomy are preserved.
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Affiliation(s)
- Clare B Jones
- Division of Nephrology, University Health Network, Toronto, ON, Canada
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12
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Jones CB, Bargman JM. Should we look beyond Kt/V urea in assessing dialysis adequacy? Semin Dial 2018; 31:420-429. [PMID: 29573025 DOI: 10.1111/sdi.12684] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Since the advent of maintenance dialysis therapy, our interpretation of what adequate dialysis really is has broadened and become more controversial. This is not only due to our changing and aging dialysis population but also to our evolving knowledge base. As nephrologists, we strive to achieve both quality and (often) quantity of life for our patients and we feel reassured when we have a quantifiable marker to show for our efforts. However, we suggest that adequate dialysis reaches far beyond the realms of attaining a particular biochemical result. Dialysis adequacy should encompass a more comprehensive assessment of patient well-being. This metric could comprise quality of life and patient-specified goals, sufficient small solute and middle molecule clearance, optimal blood pressure control, and effective bone-mineral balance, all in the context of minimizing mortality and morbidity, and a livable dialysis regimen for the patient.
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Affiliation(s)
- Clare B Jones
- Division of Nephrology, University Health Network, Toronto, Canada
| | - Joanne M Bargman
- Division of Nephrology, University Health Network, Toronto, Canada
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13
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Wakamoto K, Doi S, Nakashima A, Kawai T, Kyuden Y, Naito T, Asai M, Takahashi S, Murakami M, Masaki T. Comparing the 12-month patency of low- versus high-pressure dilation in failing arteriovenous fistulae: A prospective multicenter trial (YOROI study). J Vasc Access 2018; 19:477-483. [PMID: 29552951 DOI: 10.1177/1129729818760976] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE This study was performed to investigate the effect of the balloon dilation pressure on the 12-month patency rate in patients with failed arteriovenous fistulas undergoing hemodialysis. MATERIALS AND METHODS In this multicenter, prospective, randomized trial, the 4-mm-diameter YOROI balloon was used for dilation of stenotic lesions. The balloons were inflated to a pressure of 8 atm (low-pressure group) or 30 atm to achieve complete expansion (high-pressure group). The 12-month patency rate after balloon angioplasty was analyzed by the Kaplan-Meier method and log-rank test and/or a Cox proportional hazard model. We also investigated the dilation pressure required to achieve complete expansion in the high-pressure group. RESULTS In total, 71 patients were enrolled and allocated to either the low-pressure group (n = 34) or the high-pressure group (n = 37). The 12-month patency rates showed no significant difference between the low- and high-pressure groups (47% and 49%, respectively; p = 0.87). In the low-pressure group, the patency rate was not different between patients with complete dilation and residual stenosis (44% and 50%, respectively; p = 0.87). The Cox proportional hazard model revealed that the 12-month patency rate was associated with the stenosis diameter (hazard ratio 0.36; p = 0.001) and the presence of diabetes (hazard ratio 0.33; p = 0.018). Finally, the pressure required to achieve complete dilation was ≤20 atm in 76% of patients and ≤30 atm in 97% of patients. One patient required a dilation pressure of >30 atm. CONCLUSION The patency rate does not differ between low-pressure dilation and high-pressure dilation.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Takao Masaki
- 1 Hiroshima University Hospital, Hiroshima, Japan
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14
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Affiliation(s)
- Emilie Trinh
- Division of Nephrology; McGill University Health Center; Montreal QC Canada
| | | | - Jeffrey Perl
- Division of Nephrology; St. Michael's Hospital and the Keenan Research Center in the Li Ka Shing Knowledge Institute; St. Michael's Hospital; Toronto ON Canada
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15
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Torina P, Westheimer E, Schanzer H. Brachial Vein Transposition Arteriovenous Fistula: Is it an Acceptable Option for Chronic Dialysis Vascular Access? J Vasc Access 2018. [DOI: 10.1177/112972980800900107] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Purpose The aim of this study was to evaluate the midterm performance of brachial vein arteriovenous fistulas (AVFs) and to compare this performance with arteriovenous grafts (AVGs) and basilic vein transposition AVFs. Methods A retrospective analysis was performed. Between December 2002 and October 2006, 149 AV access procedures consisting of brachial vein transposition AVFs (11 one-stage and 2 two-stage procedures), basilic vein transposition AVFs (n=42), and AVGs (n=94) were performed in 141 patients. Results 73% of one-stage brachial vein AVF patients experienced at least one complication during follow-up vs. 52% of the basilic vein transposition AVF group and 55% of the AVG group. The primary patency rates at 12 months for one-stage brachial vein AVFs, basilic vein AVFs, and AVGs were 24, 45 and 50%, respectively. The assisted primary patency rates were 45, 74 and 63%, and the secondary patency rates were 45, 74 and 78%, respectively. A significant difference in the overall secondary patency rates between one-stage brachial vein AVF and AVGs (p=0.015) was detected. Significance was approached between one-stage brachial vein AVFs and basilic vein AVFs overall assisted primary patency (p=0.055) and secondary patency (p=0.055) rates. Conclusion The brachial vein transposition, when done as a one-stage procedure, is associated with inferior patency rates when compared to the basilic vein transposition AVF and AVG. Therefore, in the setting of inadequate cephalic and basilic vein, a prosthetic graft is superior to a brachial vein transposition. A two-stage procedure, as suggested by others, may improve the results of this technique.
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Affiliation(s)
- P.J. Torina
- Department of Surgery, Mount Sinai School of Medicine, New York, New York - USA
| | - E.F. Westheimer
- Department of Surgery, Mount Sinai School of Medicine, New York, New York - USA
| | - H.R. Schanzer
- Department of Surgery, Mount Sinai School of Medicine, New York, New York - USA
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16
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Rizk R, Hiligsmann M, Karavetian M, Evers SMAA. Cost-effectiveness of dedicated dietitians for hyperphosphatemia management among hemodialysis patients in Lebanon: results from the Nutrition Education for Management of Osteodystrophy trial. J Med Econ 2017; 20:1024-1038. [PMID: 28657451 DOI: 10.1080/13696998.2017.1347877] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
AIM To assess the cost-effectiveness of nutrition education by dedicated dietitians (DD) for hyperphosphatemia management among hemodialysis patients. MATERIALS AND METHODS This was a trial-based economic evaluation in 12 Lebanese hospital-based units. In total, 545 prevalent patients were cluster randomized to DD, trained hospital dietitian (THD), and existing practice (EP) groups. During Phase I (6 months), DD (n = 116) received intensive education by DD trained on renal nutrition, THD (n = 299) received care from trained hospital dietitians, and EP (n = 130) received usual care from untrained hospital dietitians. Patients were followed-up during Phase II (6 months). RESULTS At baseline, EP had the lowest weekly hemodialysis time, and DD had the highest serum phosphorus and malnutrition-inflammation score. The additional costs of the intervention were low compared with the societal costs (DD: $76.7, $21,007.7; EP: $4.6, $18,675.4; THD: $17.4, $20,078.6, respectively). Between Phases I and II, DD showed the greatest decline in services use and societal costs (DD: -$2,364.0; EP: -$1,727.7; THD: -$1,105.7). At endline, DD experienced the highest decrease in adjusted serum phosphorus (DD: -0.32; EP: +0.16; THD: +0.04 mg/dL), no difference in quality-adjusted life-years (QALY), and the highest societal costs. DD had a cost-effectiveness ratio of $7,853.6 per 1 mg decrease in phosphorus, compared with EP; and was dominated by THD. Regarding QALY, DD was dominated by EP and THD. The results were sensitive to changes in key parameters. LIMITATIONS The analysis depended on numerous assumptions. Interpreting the results is limited by the significant baseline differences in key parameters, suggestive of higher baseline societal costs in DD. CONCLUSIONS DD yielded the greatest effectiveness and decrease in societal costs, but did not affect QALY. Regarding serum phosphorus, DD was likely to be cost-effective compared with EP, but had a low cost-effectiveness probability compared with THD. Regarding QALY, DD was not likely to be cost-effective. Assessing the long-term cost-effectiveness of DD, on similar groups, is recommended.
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Affiliation(s)
- Rana Rizk
- a Department of Health Services Research , CAPHRI, Care and Public Health Research Institute, Maastricht University , Maastricht , The Netherlands
| | - Mickaël Hiligsmann
- a Department of Health Services Research , CAPHRI, Care and Public Health Research Institute, Maastricht University , Maastricht , The Netherlands
| | - Mirey Karavetian
- b Department of Health Sciences, College of Natural and Health Sciences , Zayed University , Dubai , United Arab Emirates
| | - Silvia M A A Evers
- a Department of Health Services Research , CAPHRI, Care and Public Health Research Institute, Maastricht University , Maastricht , The Netherlands
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17
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Song KK, Zhao DL, Wang YD, Wang Y, Sun XF, Miao LN, Ni ZH, Lin HL, Liu FY, Li Y, He YN, Wang NS, Wang CL, Zhang AH, Chen MH, Yang XP, Deng YY, Shao FM, Fu SX, Fang JA, Cai GY, Chen XM. Analysis of Factors Associated with Death in Maintenance Hemodialysis Patients: A Multicenter Study in China. Chin Med J (Engl) 2017; 130:885-891. [PMID: 28397716 PMCID: PMC5407033 DOI: 10.4103/0366-6999.204103] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: Patients on hemodialysis have a high-mortality risk. This study analyzed factors associated with death in patients on maintenance hemodialysis (MHD). While some studies used baseline data of MHD patients, this study used the most recent data obtained from patients just prior to either a primary endpoint or the end of the study period to find the characteristics of patients preceding death. Methods: Participants were selected from 16 blood purification centers in China from January 2012 to December 2014. Patients’ data were collected retrospectively. Based on survival status, the participants were divided into two groups: survival group and the death group. Logistic regression analysis was performed to determine factors associated with all-cause mortality. Results: In total, 4104 patients (57.58% male, median age 59 years) were included. Compared with the survival group, the death group had more men and more patients with diabetic nephropathy (DN) and hypertensive nephropathy. The patients preceding death also had lower levels of diastolic blood pressure, hemoglobin, serum albumin, serum calcium, serum phosphate, Kt/V, and higher age. Multivariate analysis revealed that male sex (odd ratio [OR]: 1.437, 95% confidence interval [CI]: 1.094–1.886), age (OR: 1.046, 95% CI: 1.036–1.057), and presence of DN (OR: 1.837, 95% CI: 1.322–2.552) were the risk factors associated with mortality. High serum calcium (OR: 0.585, 95% CI: 0.346–0.989), hemoglobin (OR: 0.974, 95% CI: 0.967–0.981), albumin (OR: 0.939, 95% CI: 0.915–0.963) levels, and dialysis with noncuffed catheter (OR: 0.165, 95% CI: 0.070–0.386) were protective factors based on a multivariate analysis. Conclusions: Hemodialysis patients preceding death had lower hemoglobin, albumin, and serum calcium levels. Multivariate analysis showed that male sex, age, DN, low hemoglobin, low albumin, and low serum calcium were associated with death in hemodialysis patients.
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Affiliation(s)
- Kang-Kang Song
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing 100853, China
| | - De-Long Zhao
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing 100853, China
| | - Yuan-Da Wang
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing 100853, China
| | - Yong Wang
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing 100853, China
| | - Xue-Feng Sun
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing 100853, China
| | - Li-Ning Miao
- Department of Nephrology, The Second Hospital of Jilin University, Changchun, Jilin 130041, China
| | - Zhao-Hui Ni
- Department of Nephrology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Peritoneal Dialysis Research Center, Shanghai 200127, China
| | - Hong-Li Lin
- Department of Nephrology, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116011, China
| | - Fu-You Liu
- Department of Nephrology, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, China
| | - Ying Li
- Department of Nephrology, Third Hospital of Hebei Medical University, Kidney Disease Research Center of Hebei Province, Shijiazhuang, Hebei 050081, China
| | - Ya-Ni He
- Department of Nephrology, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing 400042, China
| | - Nian-Song Wang
- Department of Nephrology, Shanghai Jiao Tong University, Affiliated The Sixth People's Hospital, Shanghai 200233, China
| | - Cai-Li Wang
- Department of Nephrology, First Affiliated Hospital of Baotou Medical College, Baotou, Inner Mongolia 014040, China
| | - Ai-Hua Zhang
- Department of Nephrology, Peking University Third Hospital, Beijing 100191, China
| | - Meng-Hua Chen
- Department of Nephrology, General Hospital of Ningxia Medical University, Yinchuan, Ningxia 750004, China
| | - Xiao-Ping Yang
- Department of Nephrology, The First Affiliated Hospital of Shihezi University School of Medicine, Shihezi, Xinjiang 832008, China
| | - Yue-Yi Deng
- Department of Nephrology, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
| | - Feng-Min Shao
- Department of Nephrology, Henan Provincial People's Hospital, Zhengzhou, Henan 450003, China
| | - Shu-Xia Fu
- Department of Nephrology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei 050000, China
| | - Jing-Ai Fang
- Department of Nephrology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi 030001, China
| | - Guang-Yan Cai
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing 100853, China
| | - Xiang-Mei Chen
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing 100853, China
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18
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Thompson S, Manns B, Lloyd A, Hemmelgarn B, MacRae J, Klarenbach S, Unsworth L, Courtney M, Tonelli M. Impact of using two dialyzers in parallel on phosphate clearance in hemodialysis patients: a randomized trial. Nephrol Dial Transplant 2017; 32:855-861. [PMID: 27190374 DOI: 10.1093/ndt/gfw085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 03/20/2016] [Indexed: 11/14/2022] Open
Abstract
Background Dietary restriction and phosphate binders are the main interventions used to manage hyperphosphatemia in people on hemodialysis, but have limited efficacy. Modifying conventional dialysis regimens to enhance phosphate clearance as an alternative approach remains relatively unstudied. Methods This was a 10-week, 2-arm, randomized crossover study. Participants were prevalent dialysis patients ( n = 32) with consecutive serum phosphate levels >1.6 mmol/L and on stable doses of a phosphate binder. Following a 2-week run-in period, participants were randomized to initiate dialysis using two high flux dialyzers in parallel (blood flow ≥350 mL/min, dialysate flow 800 mL/min) or standard dialysis using one high flux dialyzer (blood flow ≥350 mL/min, dialysate flow of 800 mL/min). Each regimen was 3 weeks in duration. After a 2-week washout period, participants received the alternate regimen. The primary outcome was the mean difference in phosphate clearance by dialyzer strategy. Secondary outcomes were phosphate removal and pre-dialysis serum phosphate. Results Phosphate clearance for the double dialyzer strategy did not differ significantly from the single dialyzer strategy [mean difference 7.5 mL/min (95% confidence interval, 95% CI, -6.1, 21.0), P = 0.28]. There was no difference in total phosphate removal and pre-dialysis phosphate between the double and single dialyzer strategies [total phosphate removal mean difference -0.2 mmol (95% CI -4.1, 3.7), P = 0.93; pre-dialysis mean difference 0.01 mmol/L (95% CI -0.18, 0.21), P = 0.88]. There was no difference in the proportion of participants who experienced at least one episode of intradialytic hypotension (32 versus 47%, P = 0.13). A limitation of the study was frequent protocol deviations in the dialysis prescription. Conclusions In this study, the use of two dialyzers in parallel did not increase phosphate clearance, phosphate removal or pre-dialysis serum phosphorus when compared with a standard dialysis treatment strategy. Future studies should continue to evaluate novel methods of phosphate removal using conventional hemodialysis.
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Affiliation(s)
| | - Braden Manns
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Canada
| | - Anita Lloyd
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - Brenda Hemmelgarn
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Canada
| | - Jennifer MacRae
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Larry Unsworth
- Department of Chemical and Materials Engineering, University of Alberta, Edmonton, Canada
| | - Mark Courtney
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - Marcello Tonelli
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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19
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Rizk R, Karavetian M, Hiligsmann M, Evers SMAA. Effect of stage-based education provided by dedicated dietitians on hyperphosphataemic haemodialysis patients: results from the Nutrition Education for Management of Osteodystrophy randomised controlled trial. J Hum Nutr Diet 2017; 30:554-562. [DOI: 10.1111/jhn.12472] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- R. Rizk
- Department of Health Services Research; CAPHRI School of Public Health and Primary Care; Maastricht University; Maastricht The Netherlands
| | - M. Karavetian
- Department of Natural Sciences in Public Health; College of Natural and Health Sciences; Zayed University; Dubai United Arab Emirates
| | - M. Hiligsmann
- Department of Health Services Research; CAPHRI School of Public Health and Primary Care; Maastricht University; Maastricht The Netherlands
| | - S. M. A. A. Evers
- Department of Health Services Research; CAPHRI School of Public Health and Primary Care; Maastricht University; Maastricht The Netherlands
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20
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Speyer E, Morgenstern H, Hayashino Y, Kerr PG, Rayner H, Robinson BM, Pisoni RL. Reliability and validity of the coping strategy inventory-short form applied to hemodialysis patients in 13 countries: Results from the Dialysis Outcomes and Practice Patterns Study (DOPPS). J Psychosom Res 2016; 91:12-19. [PMID: 27894457 DOI: 10.1016/j.jpsychores.2016.08.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 08/25/2016] [Accepted: 08/27/2016] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The Coping Strategies Inventory-Short Form (CSI-SF) measures four coping strategies based on 16 items: 4 items each indicating problem- vs. emotion-focused engagement or disengagement. Here we provide the first assessment of reliability and construct validity of the CSI-SF among hemodialysis patients across 13 countries. METHODS The CSI-SF was completed by patients in 9 languages in phase 4 of the Dialysis Outcomes and Practice Patterns Study (2009-11). Cronbach's alpha was used to assess internal consistency. Exploratory and confirmatory factor analyses were applied to assess the factor structure of the CSI-SF by country and language. CSI-SF data were analyzed from 7201 patients (60% male; median age 62.5 [range 18-96] years). RESULTS Good internal consistency (α=0.56-0.80) was seen for three scales in English (US, UK, Canada, Australia, New Zealand), German, and Swedish versions. The fourth scale was internally consistent if two items were dropped. In these countries, both exploratory and confirmatory factor analyses indicated a factor structure consistent with the four CSI-SF scales. Other language versions showed a factor structure inconsistent with these four scales. CONCLUSION The slightly modified English, German, and Swedish versions of the CSI-SF are reliable and valid instruments for measuring coping strategies in hemodialysis patients.
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Affiliation(s)
- Elodie Speyer
- Arbor Research Collaborative for Health, Ann Arbor, MI, United States.
| | - Hal Morgenstern
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, United States; Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, United States; Department of Urology, Medical School, University of Michigan, Ann Arbor, MI, United States
| | - Yasuaki Hayashino
- Department of Endocrinology, Admission Coordination Center Tenri Hospital, Japan
| | - Peter G Kerr
- Monash Health & Monash University, Clayton, Australia
| | - Hugh Rayner
- Birmingham Heartlands Hospital, Birmingham, United Kingdom
| | - Bruce M Robinson
- Arbor Research Collaborative for Health, Ann Arbor, MI, United States
| | - Ronald L Pisoni
- Arbor Research Collaborative for Health, Ann Arbor, MI, United States
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Chen JB, Chou FF, Yang CH, Hua MS. Association between clinical variables and mortality after parathyroidectomy in maintenance hemodialysis patients. Am J Surg 2016; 213:140-145. [PMID: 27469221 DOI: 10.1016/j.amjsurg.2016.03.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 03/08/2016] [Accepted: 03/10/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND We investigated factors associated with all-cause mortality and cardiovascular disease (CVD)-associated mortality after parathyroidectomy (PTX) in patients on maintenance hemodialysis (HD). METHODS Our study population consisted of 161 consecutive HD patients who underwent PTX before 2009 and 354 consecutive HD patients without PTX as controls from those visiting the Kaohsiung Chang Gung Memorial Hospital, Taiwan between 2009 and 2013. All-cause and CVD mortality with clinical variables were compared in PTX and non-PTX HD patients. RESULTS PTX patients had significantly lower all-cause and CVD mortality than controls. Multivariate logistic regression analyses showed PTX patients had a lower odds ratio for all-cause mortality than those without (odds ratio = .35, 95% confidence interval = .16 to .74). Association analysis based on clinical variables revealed patients with higher hemoglobin, albumin, creatinine, and HD adequacy index-Kt/V levels had significantly decreased risk of all-cause mortality. CONCLUSIONS PTX in HD patients reduces the risk of death.
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Affiliation(s)
- Jin-Bor Chen
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Fong-Fu Chou
- Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta Pei Road, Niao Song District, Kaohsiung, Taiwan.
| | - Cheng-Hong Yang
- Department of Electronic Engineering, National Kaohsiung University of Applied Sciences, Kaohsiung, Taiwan
| | - Moi-Sin Hua
- Department of Electronic Engineering, National Kaohsiung University of Applied Sciences, Kaohsiung, Taiwan
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Sugisawa H, Shimizu Y, Kumagai T, Sugisaki H, Ohira S, Shinoda T. Effects of socioeconomic status on physical and mental health of hemodialysis patients in Japan: differences by age, period, and cohort. Int J Nephrol Renovasc Dis 2016; 9:171-82. [PMID: 27471405 PMCID: PMC4948840 DOI: 10.2147/ijnrd.s107031] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Study purpose Whether or not socioeconomic status (SES)-related differences in the health of hemodialysis patients differ by age, period, and birth cohort remains unclear. We examined whether SES-related gaps in physical and mental health change with age, period, and birth cohort for hemodialysis patients. Methods Data were obtained from repeated cross-sectional surveys conducted in 1996, 2001, 2006, and 2011, with members of a national patients’ association as participants. We used raking adjustment to create a database which had similar characteristics to the total sample of dialysis patients in Japan. SES was assessed using family size-adjusted income levels. We divided patients into three groups based on their income levels: below the first quartile, over the second quartile and under the third quartile, and over the fourth quartile. We used the number of dialysis complications as a physical health indicator and depressive symptoms as a mental health indicator. We used a cross-classified random-effects model that estimated fixed effects of age categories and period as level-1 factors, and random effects of birth cohort as level-2 factors. Results Relative risk of dialysis complications in respondents below the first quartile compared with ones over the fourth quartile was reduced in age categories >60 years. Mean differences in depressive symptoms between respondents below the first quartile and ones over the fourth quartile peaked in the 50- to 59-year-old age group, and were reduced in age groups >60 years. In addition, mean differences varied across periods, widening from 1996 to 2006. There were no significant birth cohort effects on income differences for dialysis complications or depressive symptoms. Conclusion The number of dialysis complications and depressive symptoms in dialysis patients were affected by income differences, and the degree of these differences changed with age category and period.
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Affiliation(s)
| | - Yumiko Shimizu
- Faculty of Nursing, The Jikei University School of Medicine, Chofu
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Joson CG, Henry SL, Kim S, Cheung MY, Parab P, Abcar AC, Jacobsen SJ, Morisky DE, Sim JJ. Patient-Reported Factors Associated With Poor Phosphorus Control in a Maintenance Hemodialysis Population. J Ren Nutr 2015; 26:141-8. [PMID: 26614738 DOI: 10.1053/j.jrn.2015.09.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Revised: 09/21/2015] [Accepted: 09/27/2015] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE The purpose of this study was to determine the influence of patient-reported medication adherence and phosphorus-related knowledge on phosphorus control and pharmacy-reported adherence to phosphorus binding medication among patients on maintenance hemodialysis. DESIGN Retrospective, cross-sectional cohort study. SUBJECTS Seventy-nine hemodialysis patients (mean age 64.2 years, SD = 14 years; 46.8% female) in a stand-alone hemodialysis unit within an integrated learning healthcare system. Ten percent (10%) of subjects were Caucasian, 42% Latino, 19% African American, and 29% Asian. Forty-eight percent had diabetes; 72% had BMI ≥ 30. Inclusion criteria included the provision of survey data and having medication refill data available in the pharmacy system. 77.2% had mean phosphorus levels ≤ 5.5 mg/dL; 22.8% had mean phosphorus levels > 5.5 mg/dL. INTERVENTION Subjects were administered the 8-item Morisky Medication Adherence Scale (MMAS-8) and also reported on their phosphorus-related knowledge. MAIN OUTCOME MEASURE Phosphorus levels within an adequate range. RESULTS The mean serum phosphorus level was 4.96 mg/dL (SD = 1.21). In the well-controlled group, mean phosphorus was 4.44 mg/dL (SD = 0.76). In the poorly controlled group, mean phosphorus was 6.69 mg/dL (SD = 0.74). A total of 61% of patients reported at least some unintentional medication nonadherence, and 48% reported intentional medication nonadherence. Phosphorus-specific knowledge was low, with just under half of patients reporting that they could not name two high-phosphorus foods or identify a phosphorus-related health risk. Phosphorus binder-related nonadherence was substantially higher in the uncontrolled than the controlled group. Adjusting for age, individuals with poorer self-reported binder adherence were less likely to have controlled phosphorus levels (odds ratio = 0.71, P = .06). CONCLUSION Phosphorus-related non-adherence, but not low phosphorus-specific knowledge, was associated with poorer phosphorus control. Such findings provide important information for the development of evidence-based strategies for improving phosphorus control among patients on dialysis.
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Affiliation(s)
- Cherriday G Joson
- Division of Nephrology & Hypertension, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California
| | - Shayna L Henry
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California.
| | - Sue Kim
- Kaiser Permanente Los Angeles Medical Center, Los Angeles, California
| | - Mandy Y Cheung
- Renal Business Group, Kaiser Permanente Southern California, Pasadena, California
| | - Prajakta Parab
- Kaiser Permanente Los Angeles Medical Center, Los Angeles, California
| | - Antoine C Abcar
- Division of Nephrology & Hypertension, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California
| | - Steven J Jacobsen
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - Donald E Morisky
- Department of Community Health Sciences, University of California Los Angeles Fielding School of Public Health, Los Angeles, California
| | - John J Sim
- Division of Nephrology & Hypertension, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California
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Djukanović L, Dimković N, Marinković J, Andrić B, Bogdanović J, Budošan I, Cvetičanin A, Djordjev K, Djordjević V, Djurić Ž, Lilić BH, Jovanović N, Jelačić R, Knežević V, Kostić S, Lazarević T, Ljubenović S, Marić I, Marković R, Milenković S, Milićević O, Mitić I, Mićunović V, Mišković M, Pilipović D, Plješa S, Radaković M, Stanojević MS, Janković BT, Vojinović G, Šefer K. Compliance with guidelines and predictors of mortality in hemodialysis. Learning from Serbia patients. Nefrologia 2015; 35:287-95. [PMID: 26299172 DOI: 10.1016/j.nefro.2015.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 02/22/2015] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES The aims of the study were to determine the percentage of patients on regular hemodialysis (HD) in Serbia failing to meet KDOQI guidelines targets and find out factors associated with the risk of time to death and the association between guidelines adherence and patient outcome. METHODS A cohort of 2153 patients on regular HD in 24 centers (55.7% of overall HD population) in Serbia were followed from January 2010 to December 2012. The percentage of patients failing to meet KDOQI guidelines targets of dialysis dose (Kt/V>1.2), hemoglobin (>110g/L), serum phosphorus (1.1-1.8mmol/L), calcium (2.1-2.4mmol/L) and iPTH (150-300pg/mL) was determined. Cox proportional hazards analysis was used to select variables significantly associated with the risk of time to death. RESULTS The patients were on regular HD for 5.3±5.3 years, dialyzed 11.8±1.9h/week. Kt/V<1.2 had 42.4% of patients, hemoglobin <110g/L had 66.1%, s-phosphorus <1.1mmol/L had 21.7% and >1.8mmol/L 28.6%, s-calcium <2.1mmol/L had 11.7% and >2.4mmol/L 25.3%, iPTH <150pg/mL had 40% and >300pg/mL 39.7% of patients. Using Cox model (adjustment for patient age, gender, duration of HD treatment) age, duration of HD treatment, hemoglobin, iPTH and diabetic nephropathy were selected as significant independent predictors of time to death. When targets of five examined parameters were included in Cox model, target for KtV, hemoglobin and iPTH were found to be significant independent predictors of time to death. CONCLUSION Substantial proportion of patients examined failed to meet KDOQI guidelines targets. The relative risk of time to death was associated with being outside the targets for Kt/V, hemoglobin and iPTH.
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Affiliation(s)
| | - Nada Dimković
- School of Medicine, University of Belgrade, Belgrade, Serbia
| | | | | | | | - Ivana Budošan
- Department of Nephrology, Clinical Center of Vojvodina, Novi Sad, Serbia
| | - Anica Cvetičanin
- Nephrology Ward, Health Center Srem, Mitrovica, Srem Mitrovica, Serbia
| | | | | | - Živka Djurić
- Department of Nephrology, Clinical Centre Zvezdara, Belgrade, Serbia
| | | | | | - Rosa Jelačić
- Department of Nephrology, General Hospital Zrenjanin, Zrenjanin, Serbia
| | - Violeta Knežević
- Department of Nephrology, Clincal Center of Vojvodina, Novi Sad, Serbia
| | | | - Tatjana Lazarević
- Department of Nephrology, Clinical Center of Kragujevac, Kragujevac, Serbia
| | | | - Ivko Marić
- Department of Nephrology, Lazarevac, Serbia
| | | | | | | | - Igor Mitić
- Department of Nephrology, Clincal Center of Vojvodina, Novi Sad, Serbia
| | | | - Milena Mišković
- Hemodialysis Ward, Health Center Obrenovac, Obrenovac, Serbia
| | - Dragana Pilipović
- Hemodialysis Ward, Health Center Bačka Palanka, Bačka Palanka, Serbia
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Dimković N, Djukanović L, Marinković J, Djurić Ž, Knežević V, Lazarević T, Ljubenović S, Marković R, Rabrenović V. Achievement of guideline targets in elderly patients on hemodialysis: a multicenter study. Int Urol Nephrol 2015. [PMID: 26223198 DOI: 10.1007/s11255-015-1055-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Advanced age is associated with shorter survival on dialysis. The aim of the present study was to compare the adherence with KDOQI guideline targets and the association between mortality and satisfying the guidelines targets between hemodialysis patients aged 65 years and over and those younger than 65 years. METHODS Data were collected using a questionnaire sent to all 46 HD centers in Serbia with totally 3868 HD patients. The 24 centers responded and sent the data on all patients aged 18 years or older that were on regular HD for more than 3 months (2153 patients, 1320 males, aged 18-90 years). Data are presented in two groups: a group of patients younger than 65 years (1438, 66.8 %) and a group of patients aged 65 years and over (715, 33.2 %). The percentage of patients whose values failed to meet the targets recommended by KDOQI Clinical Practice Guidelines was calculated for dialysis dose (spKt/V), hemoglobin, serum phosphorus, serum calcium and plasma iPTH (150-300 pg/mL). Patients were followed from enrollment until their death, kidney transplantation, departure from the center or the end of the study. RESULTS Elderly patients were more likely to have hypertension, significantly lower systolic and diastolic blood pressure and smaller dialysis vintage than younger patients. They were less frequently treated with high-flux membranes and hemodiafiltration and they had significantly lower number of dialysis hours per week and significantly lower interdialytic weight gain. They used ESA and phosphate binders less frequently than younger patients (p < 0.001 and p = 0.002). Older patients had similar Kt/V as younger ones but they had significantly more frequent Hb level outside the target range than younger patients. During the year follow-up period, by using a Cox proportional hazards model it has been confirmed that age, dialysis vintage, weekly dialysis time and target values for Kt/V were significant independent predictors of time to death for younger patients and gender, dialysis vintage and iPTH were independent predictor of time to death for older patients. CONCLUSION Despite less favorable dialysis prescription, older patients had similar Kt/V and less frequent deviations from the target values proposed by KDOQI for serum phosphorus and iPTH but more frequent deviation for Hb value as compared with younger patients. Risk factors for mortality differ between older and younger patients; out of five KDOQI targets, only Kt/V proved to be a significant risk factor for mortality for younger and iPTH for older patients.
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Affiliation(s)
- Nada Dimković
- School of Medicine, University of Belgrade, Belgrade, Serbia,
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Hanafusa N, Nomura T, Hasegawa T, Nangaku M. Age and anemia management: relationship of hemoglobin levels with mortality might differ between elderly and nonelderly hemodialysis patients. Nephrol Dial Transplant 2014; 29:2316-26. [PMID: 25150218 PMCID: PMC4240181 DOI: 10.1093/ndt/gfu272] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Accepted: 07/21/2014] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The elderly hemodialyzed population is growing. However, little is known about the relationship between hemoglobin level and survival according to age. We investigated the effect of age on the relationship between hemoglobin and survival within the Japan Dialysis Outcomes and Practice Patterns Study (DOPPS) cohort. METHODS We enrolled the entire Japan DOPPS phases 3 and 4 population. Patients were divided by the age of 75 years into two groups. Cox's proportional hazard model was used with hemoglobin at every 4 months treated as a time-dependent variable. The interaction of age and hemoglobin was analyzed. RESULTS We included 3341 patients in the analyses. The primary outcome occurred in 567 patients during the median follow-up of 2.64 years. Hemoglobin of entire population was 10.3 ± 1.3 g/dL. The median of epoetin dose was 3000 IU/week. Interaction was found between ages stratified by the age of 75 years and hemoglobin values (P = 0.045) with use of Cox's proportional hazard model. The nonelderly population had poorer prognosis with hemoglobin <10 g/dL, while elderly population only with hemoglobin <9 g/dL. For both hemoglobin strata <9, ≥9 and <10 g/dL, interactions between age and hemoglobin were significant. Subgroup analysis indicated that interaction between age and Hb levels was observed only in the nondiabetic nephropathy group. Several sensitivity analyses demonstrated a similar trend with the original analyses and reinforced the robustness. CONCLUSIONS The elderly population might tolerate low hemoglobin levels. Our findings open the way for further investigation of individualized anemia management.
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Affiliation(s)
- Norio Hanafusa
- Department of Hemodialysis and Apheresis, The University of Tokyo Hospital, Tokyo, Japan
- Division of Total Renal Care Medicine, The University of Tokyo Hospital, Tokyo, Japan
- Japanese Dialysis Outcomes and Practice Patterns Study (J-DOPPS) for Anemia Working Group, Tokyo, Japan
| | | | - Takeshi Hasegawa
- Japanese Dialysis Outcomes and Practice Patterns Study (J-DOPPS) for Anemia Working Group, Tokyo, Japan
- Division of Nephrology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan
- Department of Healthcare Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
- Division of Nephrology, Department of Medicine, Showa University School of Medicine, Yokohama, Japan
- Center for Innovative Research for Communities and Clinical Excellence, Fukushima Medical University, Fukushima, Japan
| | - Masaomi Nangaku
- Department of Hemodialysis and Apheresis, The University of Tokyo Hospital, Tokyo, Japan
- Japanese Dialysis Outcomes and Practice Patterns Study (J-DOPPS) for Anemia Working Group, Tokyo, Japan
- Division of Nephrology and Endocrinology, The University of Tokyo School of Medicine, Tokyo, Japan
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The economic impact of improving phosphate binder therapy adherence and attainment of guideline phosphorus goals in hemodialysis patients: a Medicare cost-offset model. Adv Ther 2014; 31:1272-86. [PMID: 25479935 DOI: 10.1007/s12325-014-0170-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Hyperphosphatemia (serum phosphorus >5.5 mg/dL) in hemodialysis patients is a key factor in mineral and bone disorders and is associated with increased hospitalization and mortality risks. Treatment with oral phosphate binders offers limited benefit in achieving target serum phosphorus concentrations due to high daily pill burden (7-10 pills/day) and associated poor medication adherence. The economic value of improving phosphate binder adherence and increasing percent time in range (PTR) for target phosphorus concentrations has not been previously assessed in dialysis patients. The current retrospective analysis was conducted to summarize health care cost savings to United States (US) payers associated with improved phosphate binder adherence and increased PTR for target phosphorus concentrations in adult end-stage renal disease (ESRD) patients receiving hemodialysis therapy. METHODS Phosphate binder adherence and PTR were derived from hemodialysis patients who were treated at a large dialysis organization between January 2007 and December 2011. Cost model inputs were derived from US Renal Data System data between July 2007 and December 2009. A cost-offset model was constructed to estimate monthly and annual incremental health care costs (total Medicare; inpatient, outpatient, and Medicare Part B) associated with different levels of phosphate binder adherence and PTR. Model inputs included number of ESRD patients, population adherence to phosphate binders, PTR associated with adherence to phosphate binders, and per-patient per-month cost associated with PTR. A base case model estimated monthly and annual costs of phosphate binder therapy in the population using estimated model inputs. The estimated adherence rate was used to determine number of patients in compliant and noncompliant groups. Monthly costs were calculated as the sum of per-patient per-month cost times the number of patients in adherent and nonadherent groups. Annual costs were monthly costs times 12 and assumed the same level of adherence, PTR, and per-patient per-month costs over time. To study the impact of improving phosphate binder adherence and PTR on cost outcomes, we hypothetically and simultaneously increased both base phosphate binders adherence and PTR for adherent patients (adherence/PTR: 10/20%, 20/40%, 30/60%). Monthly and annual costs were derived for each scenario and compared against the results of the base case model. One-way sensitivity analysis was performed to test model robustness. RESULTS The base case model estimated total Medicare and inpatient costs of $5,152,342 and $1,435,644, respectively (N = 1,000). When base case model costs were compared to results of each extended model scenario, overall Medicare cost savings (range 0.3-1.9%) and inpatient cost savings (range 1.2-5.7%) were observed. The one-way sensitivity analysis indicated that results were sensitive to PTR for adherent and nonadherent patients and the factor used to increase adherence rate and PTR associated with adherence in the hypothetical scenarios. However, cost savings in overall Medicare costs and inpatient costs were still noted. CONCLUSION Increasing phosphate binder adherence and improving phosphorus control were associated with increased cost savings in total Medicare costs and inpatient costs.
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Wang S, Alfieri T, Ramakrishnan K, Braunhofer P, Newsome BA. Serum phosphorus levels and pill burden are inversely associated with adherence in patients on hemodialysis. Nephrol Dial Transplant 2014; 29:2092-9. [PMID: 24009281 PMCID: PMC4209875 DOI: 10.1093/ndt/gft280] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 05/11/2013] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Phosphate binders (PBs) account for about one half of the daily pill burden for US hemodialysis (HD) patients, which may reduce adherence. Adherence can be estimated by the medication possession ratio (MPR), which is defined as the proportion of time a patient had sufficient medication to have taken it as prescribed. Gaps of time between prescription fills lower the patient's MPR. We assessed the association of PB pill burden and adherence (MPR) with phosphorus goal attainment. METHODS Using pharmacy management program data, HD patients on PB monotherapy were tracked from first PB fill during 1 January 2007-30 June 2011 for 1 year, or until PB change or censoring. Data were assessed with generalized linear models. RESULTS We analyzed 8616 patients. Higher pill burden was associated with lower adherence. Lower adherence tended to be associated with higher mean phosphorus levels and lower percentage of patients with serum phosphorus ≤5.5 mg/dL (P < 0.001). The association between adherence and these clinical outcomes was most pronounced in the lowest and highest pill burden strata (<3, >3-6, >12-15, >15). CONCLUSIONS Adherence, as measured by the MPR, was negatively related to higher pill burden and phosphorus levels and positively related to patients in the phosphorus target range. Within pill burden strata, phosphorus increased and patients in the target range generally decreased with decreasing adherence, suggesting that patients prescribed fewer PB pills are less likely to have treatment gaps, and may be more likely to achieve phosphorus targets.
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Affiliation(s)
- Steven Wang
- DaVita Clinical Research, Minneapolis, MN, USA
| | | | | | - Peter Braunhofer
- Vifor Fresenius Medical Care Renal Pharma, Glattbrugg, Switzerland
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Kõlvald K, Pechter U, Luman M, Ilmoja M, Ots-Rosenberg M. Improvements in renal replacement therapy practice patterns in estonia. NEPHRON EXTRA 2014; 4:108-18. [PMID: 25177339 PMCID: PMC4130824 DOI: 10.1159/000363349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background The clinical performance indicators (CPI) are important tools to assess and improve the quality of renal replacement therapy (RRT). The aim of the current study was to compare the results of a longitudinal set of CPI in RRT patients and to determine the extent to which the guidelines for anaemia, calcium phosphate management and other CPI are met in Estonian renal centres. Methods A long-term retrospective, observational, cross-sectional CPI analysis was undertaken in RRT patients from 2007 to 2011. The following CPI set of well-designed measures based on good evidence was analysed: anaemia management variables, laboratory analyses of mineral metabolism, nutritional status variables and dialysis adequacy variables. Results Relatively small changes in the analysed mean CPI values were noticed during the study period. In the course of the study, we noticed an improvement in anaemia control, but not all centres achieved the standard of >80% of the dialysis patients with a haemoglobin (Hb) level >100 g/l. There was a trend of decreasing Hb concentrations below 125 g/l in both haemodialysis (HD) and peritoneal dialysis (PD) patients. In 2011, hyperphosphataemia was present in 58% of the HD and 47% of the PD patients, whereas centre differences varied between 50 and 60% of both the HD and PD patients. HD adequacy was achieved in 77% of the HD patients. Conclusion An improvement in the data collection was noticed, and the analysis of CPI allows renal centres to assess and compare their practices with others. The collection and evaluation of CPI of RRT patients is an important improvement and significantly increases the awareness of nephrologists.
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Affiliation(s)
- Külli Kõlvald
- Department of Internal Medicine, Tartu University, Tartu, Tallinn, Estonia
| | - Ulle Pechter
- Department of Internal Medicine, Tartu University, Tartu, Tallinn, Estonia
| | - Merike Luman
- Department of Nephrology, North Estonian Regional Hospital, Tallinn, Estonia
| | - Madis Ilmoja
- Department of Nephrology, West Tallinn Central Hospital, Tallinn, Estonia
| | - Mai Ots-Rosenberg
- Department of Internal Medicine, Tartu University, Tartu, Tallinn, Estonia
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Kolesnyk I, Noordzij M, Kolesnyk M, Kulyzky M, Jager KJ. Renal replacement therapy in Ukraine: epidemiology and international comparisons. Clin Kidney J 2014; 7:330-5. [PMID: 25852905 PMCID: PMC4377756 DOI: 10.1093/ckj/sfu037] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 03/27/2014] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Little is known about the status of renal replacement therapy (RRT) in the post-Soviet countries. We therefore investigated the epidemiology and treatment outcomes of RRT in Ukrainian patients and put the results into an international perspective. METHODS Data from the Ukrainian National Renal Registry for patients on RRT between 1 January 2010 and 31 December 2012 were selected. We calculated the incidence and prevalence of RRT per million population (pmp) and the 3-, 12- and 24-month patient survival using the Kaplan-Meier method and Cox regression. RESULTS There were 5985 prevalent patients on RRT on 31 December 2012 (131.2 pmp). Mean age was 46.5 ± 13.8 years, 56% men and 74% received haemodialysis (HD), while peritoneal dialysis and kidney transplantation both represented 13%. The most common cause of end-stage renal disease was glomerulonephritis (51%), while only 12% had diabetes. In 2012, 1129 patients started dialysis (incidence 24.8 pmp), with 80% on HD. Mean age was 48 ± 14 years, 58% men and 20% had diabetes. Three, 12- and 24-month patient survival on dialysis was 95.1%, 86.0% and 76.4%, respectively. The transplant rate in 2012 was 2.1 pmp. CONCLUSIONS The incidence and prevalence of RRT and the transplantation rate in Ukraine are among the lowest in Europe, suggesting that the need for RRT is not being met. Strategies to reduce the RRT deficit include the development and improvement of transplantation and home-based dialysis programmes. Further evaluation of the quality of Ukrainian RRT care is needed.
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Affiliation(s)
- Inna Kolesnyk
- Ukrainian Renal Registry , Institute of Nephrology , Kiev , Ukraine
| | - Marlies Noordzij
- ERA-EDTA Registry, Department of Medical Informatics , Academic Medical Center, University of Amsterdam , Amsterdam , The Netherlands
| | - Mykola Kolesnyk
- Ukrainian Renal Registry , Institute of Nephrology , Kiev , Ukraine
| | - Mykola Kulyzky
- Ukrainian Renal Registry , Institute of Nephrology , Kiev , Ukraine
| | - Kitty J Jager
- ERA-EDTA Registry, Department of Medical Informatics , Academic Medical Center, University of Amsterdam , Amsterdam , The Netherlands
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Heaf JG, Wehberg S. Relative survival of peritoneal dialysis and haemodialysis patients: effect of cohort and mode of dialysis initiation. PLoS One 2014; 9:e90119. [PMID: 24614569 PMCID: PMC3948631 DOI: 10.1371/journal.pone.0090119] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Accepted: 01/27/2014] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Epidemiological studies consistently show an initial survival advantage for PD patients compared to HD. It has recently been suggested that this is due to the fact that many HD patients are referred late, and start dialysis on an acute, in-patient basis. The present study was performed to investigate (1) whether, and if so, how, PD and HD prognosis had changed in recent years, (2) whether a potential survival advantage of PD versus HD is constant over dialysis duration, and (3) whether differences in prognosis could be explained by patient age, renal diagnosis of diabetic nephropathy, or mode of dialysis initiation. PATIENTS AND METHODS 12095 patients starting dialysis therapy between 1990 and 2010 in Denmark were studied. Prognosis was assessed according to initial dialysis modality on an intention-to-treat basis, censored for transplantation. Results were adjusted for age, sex, renal diagnosis, Charlson Comorbidity Index (CCI), and mode of dialysis initiation. RESULTS Overall adjusted prognosis improved by 34% (HD 30%, PD 42%). PD prognosis relative to HD improved, and was 16% better at the end of the period. Final PD prognosis improved consistently from 1990-99 to 2000-10 in all subgroups. PD was associated with a significant initial survival advantage, both overall and for all subgroups For the latter cohort, overall PD prognosis was better than HD for the first 4 years, after which it was insignificantly worse. The initial survival advantage was also present in a subgroup analysis of patients with early & routine ESRD initiation. CONCLUSIONS Dialysis survival has increased during the past 20 years. PD survival since 2000 has been better than HD, overall and for all subgroups. The difference in survival is not explained by mode of dialysis initiation.
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Affiliation(s)
- James G. Heaf
- Department of Nephrology B, Copenhagen University Hospital at Herlev, Herlev, Denmark
| | - Sonja Wehberg
- Department of Epidemiology, Odense University Hospital, Odense, Denmark
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Kimata N, Karaboyas A, Bieber BA, Pisoni RL, Morgenstern H, Gillespie BW, Saito A, Akizawa T, Fukuhara S, Robinson BM, Port FK, Akiba T. Gender, low Kt/V, and mortality in Japanese hemodialysis patients: Opportunities for improvement through modifiable practices. Hemodial Int 2014; 18:596-606. [DOI: 10.1111/hdi.12142] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | | | - Brian A. Bieber
- Arbor Research Collaborative for Health; Ann Arbor Michigan USA
| | | | - Hal Morgenstern
- Arbor Research Collaborative for Health; Ann Arbor Michigan USA
- Departments of Epidemiology and Environmental Health Sciences; School of Public Health; University of Michigan; Ann Arbor Michigan USA
| | - Brenda W. Gillespie
- Arbor Research Collaborative for Health; Ann Arbor Michigan USA
- Department of Biostatistics; School of Public Health; University of Michigan; Ann Arbor Michigan USA
| | | | - Tadao Akizawa
- Division of Nephrology; Department of Medicine; Showa University School of Medicine; Tokyo Japan
| | - Shunichi Fukuhara
- Department of Epidemiology and Healthcare Research; Kyoto University Graduate School of Medicine and Public Health; Kyoto Japan
| | - Bruce M. Robinson
- Arbor Research Collaborative for Health; Ann Arbor Michigan USA
- Department of Internal Medicine-Nephrology; University of Michigan; Ann Arbor Michigan USA
| | - Friedrich K. Port
- Arbor Research Collaborative for Health; Ann Arbor Michigan USA
- Department of Internal Medicine-Nephrology; University of Michigan; Ann Arbor Michigan USA
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Lloret M, Ruiz-García C, DaSilva I, Furlano M, Barreiro Y, Ballarín J, Bover J. Lanthanum carbonate for the control of hyperphosphatemia in chronic renal failure patients: a new oral powder formulation - safety, efficacy, and patient adherence. Patient Prefer Adherence 2013; 7:1147-56. [PMID: 24235818 PMCID: PMC3826937 DOI: 10.2147/ppa.s31694] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Chronic kidney disease (CKD) is associated with very high mortality rates, mainly of cardiovascular origin. The retention of phosphate (P) and increased fibroblast growth factor-23 levels are common, even at early stages of CKD, due to disturbances in normal P homeostasis. Later, hyperphosphatemia appears, which has also been strongly associated with high mortality rates linked to P-mediated cardiovascular and procalcifying effects. Treatment guidelines for these patients continue to be poorly implemented, at least partially due to the lack of adherence to a P-restricted diet and P-binder therapy. Calcium-free P binders, such as lanthanum carbonate, have been associated with a decreased progression of vascular calcification, rendering them an important therapeutic alternative for these high cardiovascular risk CKD patients. Lanthanum carbonate has typically been available as chewable tablets, and the new presentation as an oral powder may provide a useful alternative in the therapeutic armamentarium. This powder is a tasteless, odorless, and colorless semisolid compound miscible with food. In a recent study in healthy individuals, the safety and efficacy of this novel form were evaluated, and it was concluded that it is well tolerated and pharmacodynamically equivalent to the chewable form. In the long run, individualization of preferences and treatments seems an achievable goal prior to final demonstration of improvements in hard outcomes in wide clinical trials in CKD patients.
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Affiliation(s)
- MªJesús Lloret
- Nephrology Department, Fundació Puigvert, IIB Sant Pau, Barcelona, Spain; REDinREN, Instituto de Investigación Carlos III, Madrid, Spain
| | - César Ruiz-García
- Nephrology Department, Fundació Puigvert, IIB Sant Pau, Barcelona, Spain; REDinREN, Instituto de Investigación Carlos III, Madrid, Spain
| | - Iara DaSilva
- Nephrology Department, Fundació Puigvert, IIB Sant Pau, Barcelona, Spain; REDinREN, Instituto de Investigación Carlos III, Madrid, Spain
| | - Mónica Furlano
- Nephrology Department, Fundació Puigvert, IIB Sant Pau, Barcelona, Spain; REDinREN, Instituto de Investigación Carlos III, Madrid, Spain
| | - Yaima Barreiro
- Nephrology Department, Fundació Puigvert, IIB Sant Pau, Barcelona, Spain; REDinREN, Instituto de Investigación Carlos III, Madrid, Spain
| | - José Ballarín
- Nephrology Department, Fundació Puigvert, IIB Sant Pau, Barcelona, Spain; REDinREN, Instituto de Investigación Carlos III, Madrid, Spain
| | - Jordi Bover
- Nephrology Department, Fundació Puigvert, IIB Sant Pau, Barcelona, Spain; REDinREN, Instituto de Investigación Carlos III, Madrid, Spain
- Correspondence: Jordi Bover, Nephrology Department, Fundació Puigvert, C Cartagena 340-350, 08025 Barcelona, Spain, Tel +34 93 416 97 00, Fax +34 93 416 97 30, Email
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Gesualdo L, London G, Turner M, Lee C, Macdonald K, Goldsmith D, Covic A, Zaoui P, Combe C, Mann J, Dellanna F, Muenzberg M, Abraham I. A pharmacoepidemiological study of the multi-level determinants, predictors, and clinical outcomes of biosimilar epoetin alfa for renal anaemia in haemodialysis patients: background and methodology of the MONITOR-CKD5 study. Intern Emerg Med 2013; 8:389-99. [PMID: 21590439 DOI: 10.1007/s11739-011-0622-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2011] [Accepted: 04/29/2011] [Indexed: 11/24/2022]
Abstract
Prior longitudinal observational studies have examined the practice patterns and outcomes of anaemia management, including the use of erythropoiesis-stimulating agents (ESAs). Several dimensions of effectiveness remain unaddressed; especially considering the revised ESA label (target Hb levels between 10 and 12 g/dL), the recently published TREAT study, and the European approval of the first ESA biosimilar (HX575). Anecdotal evidence suggests that patient outcomes are influenced by physician-related variables and whether anaemia management is congruent with practice guidelines, but this has not been studied systematically. MONITOR-CKD5 is an international, prospective, observational, pharmacoepidemiological study evaluating the multi-level factors and outcomes of treatment with HX575 for renal anaemia in haemodialysis patients. Driven by a novel, integrated, multi-focal framework for post-approval observational studies, it examines determinants of response at both the patient and the physician level; integrates an advocated statistical methodology here to fore used mainly in the social and behavioural sciences; assesses factors potentially predictive of a poor treatment response; and evaluates the extent to which treatment is congruent with evidence-based guidelines, good practice evidence, and the revised ESA label. This pan-European study will recruit at least 1,000 patients from a minimum of 75 centres, and follow them for up to 24 months following initiation of anaemia management with biosimilar epoetin alfa. MONITOR-CKD5 will not only study the core issues addressed by prior observational studies but also aims to take knowledge discovery a step further by assessing outcomes across varying cohorts of patients, and examining the impact of evidence-based practice on clinical outcomes, differentiating, in the process, between physician-level and patient-level determinants.
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Affiliation(s)
- Loreto Gesualdo
- Department of Nephrology, Università degli Studi di Bari, Bari, Italy.
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Covic A, Rastogi A. Hyperphosphatemia in patients with ESRD: assessing the current evidence linking outcomes with treatment adherence. BMC Nephrol 2013; 14:153. [PMID: 23865421 PMCID: PMC3728082 DOI: 10.1186/1471-2369-14-153] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Accepted: 07/12/2013] [Indexed: 01/29/2023] Open
Abstract
In recent years, the imbalance in phosphate homeostasis in patients with end-stage renal disease (ESRD) has been the subject of much research. It appears that, while hyperphosphatemia may be a tangible indicator of deteriorating kidney function, lack of phosphate homeostasis may also be associated with the increased risk of cardiovascular events and mortality that has become a hallmark of ESRD. The need to maintain phosphorus concentrations within a recommended range is reflected in evidence-based guidelines. However, these do not reflect serum phosphorus concentrations achieved by most patients in clinical practice. Given this discrepancy, it is important to consider ways in which dietary restriction of phosphorus intake and, in particular, use of phosphate binders in patients with ESRD can be made more effective. Poor adherence is common in patients with ESRD and has been associated with inadequate control of serum phosphorus concentrations. Studies indicate that, among other factors, major reasons for poor adherence to phosphate binder therapy include high pill burden and patients’ lack of understanding of their condition and its treatment. This review examines available evidence, seeking to understand fully the reasons underlying poor adherence in patients with ESRD and consider possible strategies for improving adherence in clinical practice.
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Affiliation(s)
- Adrian Covic
- Gr.T. Popa University of Medicine and Pharmacy, Iasi, Romania.
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Shibiru T, Gudina EK, Habte B, Derbew A, Agonafer T. Survival patterns of patients on maintenance hemodialysis for end stage renal disease in Ethiopia: summary of 91 cases. BMC Nephrol 2013; 14:127. [PMID: 23782468 PMCID: PMC3693969 DOI: 10.1186/1471-2369-14-127] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Accepted: 06/12/2013] [Indexed: 11/16/2022] Open
Abstract
Background The increasing incidence and prevalence of chronic kidney disease is an important challenge for health systems around the world. Access for care of the disease in Ethiopia is extremely limited. The main purpose of the study was to investigate survival pattern and assess risk factors for poor outcome of patients on maintenance hemodialysis for end stage renal disease in Ethiopia. Methods Medical records of patients on maintenance hemodialysis for end stage renal disease at Saint Gabriel General Hospital between 2002 and 2010 were reviewed. The data was collected by complete review of patient’s clinical data. Descriptive statistics was used for most variables and Chi-square test, where necessary, was used to test the association among various variables. Kaplan-Meier survival analysis was done to assess both short and long term survival. P-values of < 0.05 were considered as statistically significant. Results A total of 190 patients were registered for hemodialysis at the hospital 91 of which were included in the final assessment. Mean age at dialysis initiation was 58 ± 15 years. Fifty-five (60.4%) of the patients had prior history of diabetes. Almost all of them had serum creatinine of > 5mg/dl and some degree of anemia at dialysis initiation. Forty-one (45.1%) deaths occurred during dialysis treatment and 21 (23.1%) of patients died within the first 90 days of starting dialysis. Only 42.1% of them survived longer than a year. The frequently registered causes of death were septicemia (34.1%) and cardiovascular diseases (29.3%). Use of catheter as vascular access was associated with decreased short term and long term survival. Conclusion Dialysis as treatment modality is extremely scarce in Ethiopia and affordable to only the rich. Survival pattern in those on the treatment is less satisfactory and short of usual standards in the developed world and needs further investigation. We thus recommend a large scale analysis of national dialysis registry at all dialysis centers in the country.
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Abstract
The Beijing Hemodialysis Quality Control and Improvement Center started patient data collection from 2007. We report here the trends in incidence, prevalence, and mortality of end-stage renal disease (ESRD) patients on maintenance hemodialysis (MHD). The incidence increased from 94 per million population in 2007 to 147.3 per million population in 2010. The leading cause of ESRD changed from chronic glomerulonephritis (32.1%) to diabetes (40.1%). The point prevalence of MHD at the end of 2006 was 269 per million population, and gradually increased to 509 per million population in the end of 2010. The leading cause of ESRD in 2010 prevalent patients was chronic nephritis (33.9%), followed by diabetes (29.5%). The annual mortality varied from 7.4 to 9.0%. Old or diabetic patients suffered a higher mortality. The 2010 prevalent MHD patients achieved KDOQI hemoglobin, calcium, phosphate, and intact parathyroid hormone guidelines, which was comparable to other DOPPS (Dialysis Outcome and Practice Pattern Study) countries; Beijing MHD patients had a relatively higher albumin level.
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Affiliation(s)
- Li Zuo
- Department of Medicine, Renal Division, Peking University First Hospital , Beijing, China ; Institute of Nephrology, Peking University , Beijing, China ; Key Laboratory of Renal Disease, Ministry of Health of China , Beijing, China
| | - Mei Wang
- Department of Nephrology, Peking University People's Hospital , Beijing, China
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Paniagua R, Ventura MDJ, Ávila-Díaz M, Hinojosa-Heredia H, Méndez-Duran A, Cisneros A, Gómez AM, Cueto-Manzano A, Trinidad P, Obrador GT, García-López E, Lindholm B. Reaching Targets for Mineral Metabolism Clinical Practice Guidelines and Its Impact on Outcomes Among Mexican Chronic Dialysis Patients. Arch Med Res 2013; 44:229-34. [DOI: 10.1016/j.arcmed.2013.01.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Accepted: 01/23/2013] [Indexed: 11/30/2022]
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Abstract
Anaemia is a common finding in people with diabetes and chronic kidney disease and failure of the kidney to produce erythro-poietin in response to a falling haemoglobin concentration is a key component, correlating with the degree of albuminuria, renal dysfunction and iron deficiency. Anaemia in diabetes is associated with a number of adverse outcomes, including increased risk of all cause and cardiovascular mortality. Whether or not anaemia is a marker or mediator of adverse outcome still remains to be completely resolved. Treatment of anaemia in diabetes has quality of life benefits and reduces transfusion requirements. Correction of anaemia to normal haemoglobin concentrations is associated with significant adverse cardiovascular outcomes and is not recommended, escalating doses of erythropoiesis-stimulating agents should be avoided. The treatment of anaemia in people with diabetes and chronic kidney disease should begin with optimisation of iron stores. An aspirational haemoglobin concentration range of 10-12 g/dl with anaemia management, balances proven benefits of anaemia treatment with potential cardiovascular risk.
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Affiliation(s)
- P E Stevens
- Kent and Canterbury Hospital, Canterbury, Kent, UK.
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41
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Cheng X, Nayyar S, Wang M, Li X, Sun Y, Huang W, Zhang L, Wu H, Jia Q, Liu W, Sun X, Li J, Lun L, Zhou C, Cui T, Zhang A, Wang K, Wang S, Sun W, Zuo L. Mortality rates among prevalent hemodialysis patients in Beijing: a comparison with USRDS data. Nephrol Dial Transplant 2013; 28:724-32. [PMID: 22907953 DOI: 10.1093/ndt/gfs326] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The raw annual mortality rate reported in Chinese patients on maintenance hemodialysis (MHD) was around 10% between 2005 to 2010, and it was around 20% in the US as reported by the United States Renal Data System (USRDS). Our hypothesis was that the large survival difference was caused by differences in race and practice pattern between nations in addition to differences in patient characteristics. METHODS Annual mortality in Beijing prevalent MHD patients per year in 2007, 2008, 2009 and 2010 was reported and relative risks of death were compared with the corresponding mortality of USRDS prevalent MHD patients (in whites, African-Americans and Asian-Americans) after age, gender and primary cause of end-stage renal disease (ESRD) were adjusted. A total of 11 675 MHD patients from 104 dialysis facilities under control of Beijing Blood Purification Quality Control and Improvement Center (BJBPQCIC) from 31 December 2006 to 31 December 2010 were included. A total of 1 937 819 MHD patients (only white, African-American and Asian-American were eligible for inclusion) were subtracted from the USRDS No-60-Day prevalent dataset from the year 2004 to 2009, using the RenDER system. Raw annual mortality for each race was reported as a number per 1000 MHD patients at risk for each year. Age, gender and primary cause of ESRD, adjusted annual mortality and relative risk race of death were reported comparing the Beijing patients and each race of the USRDS. RESULTS The raw annual mortality for the Beijing cohort increased gradually from 47.8 per 1000 patient-years in 2007 to 76.8 in 2010. The raw annual mortality for the white cohort in 2007 was 250.7 per 1000 patient-years, and gradually decreased to 236.3 in 2009. The raw annual mortality for African-Americans (167.8 and 156.7 per 1000 patient-years in 2007 and 2009, respectively) was much lower than that for whites. The annual mortality for Asian-Americans was slightly lower than that for African-Americans. After adjustment, Beijing MHD still had a survival benefit compared with each of the examined USRDS race. The annual mortality rates were 99.4, 80.6 and 94.3 per 1000 patient-years when adjusted to whites, African-Americans and Asian-Americans, respectively, in cohort 2009. CONCLUSIONS The annual mortality for the Beijing MHD patients was lower than that for their USRDS counterparts, and this difference existed after baseline demographics were adjusted. This survival difference between the Beijing and the USRDS MHD cohorts could be attributed to differences in race or practice pattern. More studies are needed to validate our hypothesis.
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Affiliation(s)
- Xuyang Cheng
- Institute of Nephrology, Peking University First Hospital, Beijing,China
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Analisi costo-efficacia di cinacalcet più terapia standard versus terapia standard nel trattamento dei pazienti in dialisi con iperparatiroidismo secondario. ACTA ACUST UNITED AC 2013. [DOI: 10.1007/bf03320637] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Ketteler M, Wüthrich RP, Floege J. Management of hyperphosphataemia in chronic kidney disease-challenges and solutions. Clin Kidney J 2013; 6:128-36. [PMID: 26019840 PMCID: PMC4432434 DOI: 10.1093/ckj/sfs173] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Accepted: 11/13/2012] [Indexed: 12/11/2022] Open
Abstract
Hyperphosphataemia is a clinical consequence of the advanced stages of chronic kidney disease (CKD). Considerable evidence points to a role of hyperphosphataemia in the pathogenesis of CKD-associated cardiovascular (CV) complications, including vascular calcification, and with increased all-cause and CV mortality. These observations place management of hyperphosphataemia at the centre of CKD treatment. Although our increased understanding of the physiological role of FGF-23 may provide a long-term alternative biomarker of phosphate load and underlying disease progression, regular determination of serum phosphate is currently the most frequently used parameter to evaluate phosphate load in clinical practice. This review considers the challenges physicians and patients face in trying to control hyperphosphataemia. Amongst these are the limitations of dietary phosphate restriction, giving rise to the need for phosphate binder therapy to maintain serum phosphate control. Once the decision to use phosphate binders has been made, considerations include the relative efficacy, different potential side effects and pill burden associated with various phosphate binders. Although a number of phosphate binders are available, adherence poses a major obstacle to effective treatment. This emphasizes that further improvements to phosphate binder therapy can be made. Evaluation of novel agents and their potential role in the clinic should continue.
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Affiliation(s)
- Markus Ketteler
- Division of Nephrology , Coburg Clinic and KfH-Dialysis Center , Coburg , Germany
| | | | - Jürgen Floege
- Division of Nephrology and Clinical Immunology , RWTH University Hospital Aachen , Aachen , Germany
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Robinson BM, Bieber B, Pisoni RL, Port FK. Dialysis Outcomes and Practice Patterns Study (DOPPS): its strengths, limitations, and role in informing practices and policies. Clin J Am Soc Nephrol 2012; 7:1897-905. [PMID: 23099654 DOI: 10.2215/cjn.04940512] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Bruce M Robinson
- Arbor Research Collaborative for Health, Ann Arbor, Michigan 48104, USA.
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Alashek WA, McIntyre CW, Taal MW. Determinants of survival in patients receiving dialysis in Libya. Hemodial Int 2012; 17:249-55. [PMID: 22882674 DOI: 10.1111/j.1542-4758.2012.00728.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Maintenance dialysis is associated with reduced survival when compared with the general population. In Libya, information about outcomes on dialysis is scarce. This study, therefore, aimed to provide the first comprehensive analysis of survival in Libyan dialysis patients. This prospective multicenter study included all patients in Libya who had been receiving dialysis for >90 days in June 2009. Sociodemographic and clinical data were collected upon enrollment and survival status after 1 year was determined. Two thousand two hundred seventy-three patients in 38 dialysis centers were followed up for 1 year. The majority were receiving hemodialysis (98.8%). Sixty-seven patients were censored due to renal transplantation, and 46 patients were lost to follow-up. Thus, 2159 patients were followed up for 1 year. Four hundred fifty-eight deaths occurred, (crude annual mortality rate of 21.2%). Of these, 31% were due to ischemic heart disease, 16% cerebrovascular accidents, and 16% due to infection. Annual mortality rate was 0% to 70% in different dialysis centers. Best survival was in age group 25 to 34 years. Binary logistic regression analysis identified age at onset of dialysis, physical dependency, diabetes, and predialysis urea as independent determinants of increased mortality. Patients receiving dialysis in Libya have a crude 1-year mortality rate similar to most developed countries, but the mean age of the dialysis population is much lower, and this outcome is thus relatively poor. As in most countries, cardiovascular disease and infection were the most common causes of death. Variation in mortality rates between different centers suggests that survival could be improved by promoting standardization of best practice.
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Affiliation(s)
- Wiam A Alashek
- School of Graduate Entry Medicine, University of Nottingham, Nottingham, UK.
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Weinreich T, Leistikow F, Hartmann HG, Vollgraf G, Dellanna F. Monthly continuous erythropoietin receptor activator treatment maintains stable hemoglobin levels in routine clinical management of hemodialysis patients. Hemodial Int 2012; 16:11-9. [PMID: 22098689 DOI: 10.1111/j.1542-4758.2011.00608.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Once-monthly administration of CERA, a continuous erythropoietin receptor activator, has shown equivalent efficacy to shorter-acting erythropoiesis-stimulating agents (ESAs) that require more frequent dosing, but data on routine use of once-monthly CERA in hemodialysis patients are lacking. Study on Efficacy, Safety and Applicability of Mircera (SESAM) was a prospective, multicenter, noninterventional trial with a duration of up to 9 months (month 0-5 "titration phase"; month 6-8 "evaluation phase") to test the stability of Hb control in hemodialysis patients under routine conditions. Patient selection, Hb targets and CERA dosing were at the discretion of the local nephrologist. 918 patients from 92 German nephrology centers were included. Ninety-three percent were on ESA treatment prior to study entry. The mean number of CERA dose changes during the study was 1.9 ± 1.9 per patient. Mean Hb level was 11.4 ± 1.2 g/dL at baseline and 11.7 ± 1.4 g/dL at the end of the 8-month study. During the evaluation phase (months 6-8), 15.6%, 40.3%, and 66.0% of patients had stable Hb (i.e., at least two values) in the ranges 11-12, 10-12, and 10-13 g/dL, respectively. The mean intra-individual fluctuation in Hb was 1.4 ± 0.7 g/dL during the study (0.5 ± 0.4 g/dL during the 3-month evaluation phase). More than 90% of patients, and > 80% of physicians, rated CERA therapy as "very good" or "good" throughout the study. Four patients (0.4%) discontinued prematurely due to adverse drug reactions. Once-monthly CERA therapy maintains stable Hb values with low intra-individual variability and few dose adaptations in hemodialysis patients when administered entirely according to local practice, and the regimen was well-tolerated.
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Abstract
The need to improve haemodialysis (HD) therapies and to reduce cardiovascular and all-cause mortality frequently encountered by dialysis patients has been recognized and addressed for many years. A number of approaches, including increasing the frequency versus duration of treatment, have been proposed and debated in terms of their clinical efficacy and economic feasibility. Future prescription of dialysis to an expanding end-stage chronic kidney disease (CKD-5D) population needs a re-evaluation of existing practices while maintaining the emphasis on patient well-being both in the short and in the long term. Efficient cleansing of the blood of all relevant uraemic toxins, including fluid and salt overload, remains the fundamental objective of all dialysis therapies. Simultaneously, metabolic disorders (e.g. anaemia, mineral bone disease, oxidative stress) that accompany renal failure need to be corrected also as part of the delivery of dialysis therapy itself. Usage of high-flux membranes that enable small and large uraemic toxins to be eliminated from the blood is the first prerequisite towards the aforementioned goals. Application of convective therapies [(online-haemodiafiltration (OL-HDF)] further enhances the detoxification effects of high-flux haemodialysis (HF-HD). However, despite an extended clinical experience with both HF-HD and OL-HDF spanning more than two decades, a more widespread prescription of convective treatment modalities awaits more conclusive evidence from large-scale prospective randomized controlled trials. In this review, we present a European perspective on the need to implement optimal dialysis and to improve it by adopting high convective therapies and to discuss whether inertia to implement these practice patterns may deprive patients of significantly improved well-being and survival.
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Wilson SM, Robertson JA, Chen G, Goel P, Benner DA, Krishnan M, Mayne TJ, Nissenson AR. The IMPACT (Incident Management of Patients, Actions Centered on Treatment) program: a quality improvement approach for caring for patients initiating long-term hemodialysis. Am J Kidney Dis 2012; 60:435-43. [PMID: 22607688 DOI: 10.1053/j.ajkd.2012.04.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2011] [Accepted: 04/11/2012] [Indexed: 12/18/2022]
Abstract
BACKGROUND Patients beginning dialysis therapy are at risk of death and illness. The IMPACT (Incident Management of Patients, Actions Centered on Treatment) quality improvement program was developed to improve incident hemodialysis patient outcomes through standardized care. STUDY DESIGN Quality improvement report. SETTING & PARTICIPANTS Patients who started hemodialysis therapy between September 2007 and December 2008 at DaVita facilities using the IMPACT program (n = 1,212) constituted the intervention group. Propensity score-matched patients who initiated hemodialysis therapy in the same interval at DaVita facilities not using the IMPACT program (n = 2,424) made up the control group. QUALITY IMPROVEMENT PLAN IMPACT intervention included a structured intake process and monitoring reports; patient enrollment in a 90-day patient education program and 90-day patient management pathway. OUTCOMES Mean dialysis adequacy (Kt/V), hemoglobin and albumin levels, percentage of patients using preferred vascular access (arteriovenous fistula or graft), and mortality at each quarter. RESULTS Compared with the non-IMPACT group, the IMPACT group was associated with a higher proportion of patients dialyzing with a preferred access at 90 days (0.50 [95% CI, 0.47-0.53] vs 0.47 [95% CI, 0.45-0.49]; P = 0.1) and 360 days (0.63 [95% CI, 0.61-0.66] vs 0.48 [95% CI, 0.46-0.50]; P < 0.001) and a lower mortality rate at 90 days (24.8 [95% CI, 19.0-30.7] vs 31.9 [95% CI, 27.1-36.6] deaths/100 patient-years; P = 0.08) and 360 days (17.8 [95% CI, 15.2-20.4] vs 25.1 [95% CI, 20.7-25.2] deaths/100 patient-years; P = 0.01). LIMITATIONS The study does not determine the care processes responsible for the improved outcomes. CONCLUSIONS Intense management of incident dialysis patients with the IMPACT quality improvement program was associated with significantly decreased first-year mortality. Focused attention to the care of incident patients is an important part of a dialysis program.
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Al Saran K, Sabry A, Hassan AH, Al Halawany Z. Evaluation of quality of care in a large Saudi Hemodialysis Center (Prince Salman Center for Kidney Diseases, Riyadh, KSA). Ren Fail 2011; 33:555-61. [PMID: 21663385 DOI: 10.3109/0886022x.2011.581402] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION The quality of care provided to dialysis patients is under increasing scrutiny and systematic measurements of clinical performance, relying on indicators such as levels of Kt/V, hemoglobin, and serum albumin, have been implemented. METHODS In this retrospective study we revised clinical and laboratory data of 146 chronic hemodialysis (HD) patients who met our inclusion criteria in the dialysis unit at Prince Salman Center for Kidney Diseases for a whole year - 2009. This study looked at the extent of adherence to the kidney diseases outcome quality initiative kidney diseases outcome quality initiative (K/DOQI), Centers for Disease Control and Prevention guidelines for prevention of transmission of infections among HD patients, and American Association of Medical Instrumentation standards for dialysis water quality. RESULTS A total of 146 HD patients (54.8% males and 45.2% females) were included in this study with mean age 51.21 ± 15.33 years. About 97.94% of cases had thrice-weekly sessions. An arteriovenous fistula was the vascular access in 78.1% of cases, and a permanent catheter was used in 21.9%. The mean predialysis blood pressure was ≤140/90 in 91.8% of cases. The mean hemoglobin level was 11.44 ± 1.46 g/dL in prevalent HD patients; 79.45% of cases had a hemoglobin level ≥11 g/dL. The mean serum albumin level was 33.53 ± 4.02 g/L; only 31.33% of cases had serum albumin ≥35 g/L. The mean parathormone level was 34.35 ± 28.70 pmol/L; 43.0% of patients had the target range (16.5-33 pmol/L), and the mean calcium level was 2.17 mmol/L; 89.73% of cases had the target range (2.12-2.52 mmol/L) while the mean serum phosphorus level was 1.46 mmol/L; 83.56% of patients had the target range (0.81-1.78 mmol/L). The Ca × Pi product was ≤4.5 in 83.56% of cases. The mean Kt/V value was 1.45 ± 0.18 in prevalent HD patients (98.63% and 60.96% of cases had Kt/V ≥1.2 and ≥ 1.4, respectively). All patients were negative for HIV serology test while the prevalence of hepatitis C virus-positive and hepatitis B virus-positive patients was 24.7% and 4.1%, respectively. All patients (except hepatitis B virus positive) were vaccinated against hepatitis B virus. The annual mortality rate was 5.67%. CONCLUSION Our study revealed an excellent quality of care for HD patients in the field of vascular access care, hemoglobin level, blood pressure control, and dialysis adequacy. On the other hand, this study showed the need for improving the nutritional status of patients through more dietary counseling, nutritional education, and early management for nutritional problems.
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Affiliation(s)
- Khalid Al Saran
- Department of Nephrology, Prince Salman Center for Kidney Diseases, Riyadh, KSA
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Süleymanlar G, Serdengeçti K, Altiparmak MR, Jager K, Seyahi N, Erek E. Trends in renal replacement therapy in Turkey, 1996-2008. Am J Kidney Dis 2011; 57:456-65. [PMID: 21335249 DOI: 10.1053/j.ajkd.2010.12.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2010] [Accepted: 12/08/2010] [Indexed: 11/11/2022]
Abstract
BACKGROUND National renal registry studies providing data for incidence, prevalence, and characteristics of end-stage renal disease and renal replacement therapy (RRT) serve as a basis to determine national strategies for the prevention and treatment of these diseases and identify new areas for special studies. STUDY DESIGN Since 1990, the Turkish Society of Nephrology has been coordinating a national renal registry that collects data on patients receiving RRT. This report focuses on data collected from 1996-2008. SETTING & PARTICIPANTS Data were collected in dialysis centers for patients on RRT. PREDICTOR Year. OUTCOMES Point prevalence and incidence of RRT, RRT modalities, demographic and clinical characteristics of patients on RRT. RESULTS From 1996 to 2008, the number of centers (199 and 760) and response rates to the registry (76% and 99.4%) increased. In 2008, the point prevalence of RRT was 756 per million population (pmp) and incidence was 188 pmp, including pediatric patients. In prevalent patients, the most common RRT modality was hemodialysis (77.0% of patients), followed by peritoneal dialysis (10.1%) and transplant (12.9%). The age of hemodialysis and transplant patients increased, with a predominance of male patients. Percentages of diabetes mellitus and hypertension as causes of ESRD increased, whereas those of chronic glomerulonephritis and urologic disease decreased. Infection and crude death rates decreased in all treatment modalities. LIMITATIONS The main study limitations were registry design and low number of kidney transplants. CONCLUSION With increasing numbers of dialysis centers and RRT patients during the last 12 years, the need for RRT in Turkey has been better met. The quality of RRT care has improved, especially regarding prevention and treatment of infections.
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Affiliation(s)
- Gültekin Süleymanlar
- Department of Medicine, Nephrology Division, Akdeniz University Medical School, Antalya, Turkey.
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