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  1. [Peritonitis in pediatric patients receiving peritoneal dialysis].

    PubMed

    Jellouli, Manel; Ferjani, Meriem; Abidi, Kamel; Hammi, Yosra; Boutiba, Ilhem; Naija, Ouns; Zarrouk, Chokri; Ben Abdallah, Taieb; Gargah, Tahar

    2015-12-01

    Peritonitis on catheter of dialysis represents the most frequent complication of the peritoneal dialysis (PD) in the pediatric population. It remains a significant cause of morbidity and mortality. In this study, we investigated the risk factors for peritonitis in children. In this study, we retrospectively collected the records of 85 patients who were treated with PD within the past ten years in the service of pediatrics of the University Hospital Charles-Nicolle of Tunis. Peritonitis rate was 0.75 episode per patient-year. Notably, peritonitis caused by Gram-positive organisms were more common. Analysis of infection risk revealed three significant independent factors: the poor weight (P=0.0045), the non-automated PD (P=0.02) and the short delay from catheter insertion to starting PD (P=0.02). The early onset peritonitis was significantly associated with frequent peritonitis episodes (P=0.0008). The mean duration between the first and second episode of peritonitis was significantly shorter than between PD commencement and the first episode of peritonitis. We revealed a significant association between Gram-negative peritonitis and the presence of ureterostomy (0.018) and between Gram-positive peritonitis and the presence of exit-site and tunnel infections (0.02). Transition to permanent hemodialysis was needed in many children but no death occurred in patients with peritonitis. Considering the important incidence of peritonitis in our patients, it is imperative to establish a targeted primary prevention. Nutritional care must be provided to children to avoid poor weight. The automated dialysis has to be the modality of choice. Copyright © 2015 Association Société de néphrologie. Published by Elsevier SAS. All rights reserved.

  2. Determinants of survival in patients receiving dialysis in Libya.

    PubMed

    Alashek, Wiam A; McIntyre, Christopher W; Taal, Maarten W

    2013-04-01

    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. © 2012 The Authors. Hemodialysis International © 2012 International Society for Hemodialysis.

  3. Fatigue experienced by patients receiving maintenance dialysis in hemodialysis units.

    PubMed

    Letchmi, Santhna; Das, Srijit; Halim, Hasliza; Zakariah, Farid Azizul; Hassan, Hamidah; Mat, Samsiah; Packiavathy, Ruth

    2011-03-01

    The fatigue that is observed in patients who are undergoing dialysis is usually associated with an impaired quality of life. The present cross-sectional study was conducted from January to April 2009 in three hemodialysis units in Kuala Lumpur, Malaysia. In this study, the Multidimensional Fatigue Inventory and Depression Anxiety and Stress Score 21 were used to determine the level of fatigue, depression, anxiety, and stress of patients who were undergoing dialysis. The data were obtained from a calculated sample of 116 and a total of 103 respondents participated in the study. A total of 56 (54.4%) and 47 (45.6%) respondents experienced a high level and a low level of fatigue, respectively. There was a significant relationship between the duration of treatment and the level of fatigue. The respondents who had been receiving treatment for > 2 years experienced more fatigue, compared to the respondents who had been undergoing hemodialysis for > 2 years. There was a significant difference in relation to the age of the participants regarding the level of fatigue. No significant relationship between the sex of the participants, anemia, depression, anxiety, stress, and the level of fatigue was observed. Special attention needs to be paid to both the younger and older adults who are receiving treatment. In addition, proper planning is needed for the patients regarding their daily activities in order to reduce fatigue. Nurses who work in hemodialysis units are recommended to provide exercise classes or group therapy in order to boost the energy levels among patients who are undergoing dialysis. Health professionals should provide appropriate treatment for patients who are experiencing fatigue in order to prevent any other complications that could arise.

  4. Peritoneal mucormycosis in a patient receiving continuous ambulatory peritoneal dialysis.

    PubMed

    Polo, J R; Luño, J; Menarguez, C; Gallego, E; Robles, R; Hernandez, P

    1989-03-01

    A 48-year-old man receiving maintenance hemodialysis for 3 years and continuous ambulatory peritoneal dialysis for 1 year developed a clinical picture compatible with peritonitis. Three successive fluid cultures were negative, and only after filtration of a large volume of peritoneal fluid a fungus identified as a Rhizopus sp was isolated in cultures of the filtering devices. The same fungus was also isolated from the peritoneal catheter cuff. Intravenous amphotericin B was administered and both the abdominal and general conditions of the patient improved transiently. Twenty days after initiation of antifungal treatment, a clinical suspicion of intestinal perforation arose and an exploratory laparotomy was scheduled, but the patient died during the anesthetic induction. The patient never received deferoxamine; any conditions predisposing to mucormycosis, such as diabetes or immunosuppression, were also absent.

  5. Vitamin D Deficiency and Mortality in Patients Receiving Dialysis: The Comprehensive Dialysis Study

    PubMed Central

    Anand, Shuchi; Chertow, Glenn M.; Johansen, Kirsten L.; Grimes, Barbara; Dalrymple, Lorien S.; Kaysen, George A.; Tamura, Manjula Kurella

    2014-01-01

    Objective Although several studies have shown poorer survival among individuals with 25-hydroxy (OH) vitamin D deficiency, data on patients receiving dialysis are limited. Using data from the Comprehensive Dialysis Study (CDS), we tested the hypothesis that patients new to dialysis with low serum concentrations of 25-OH vitamin D would experience higher mortality and hospitalizations. Design The CDS is a prospective cohort study. We recruited participants from 56 dialysis units located throughout the United States. Subjects and Intervention We obtained data on demographics, comorbidites, and laboratory values from the CDS Patient Questionnaire as well as the Medical Evidence Form (CMS form 2728). Participants provided baseline serum samples for 25-OH vitamin D measurements. Main Outcome Measure We ascertained time to death and first hospitalization as well as number of first-year hospitalizations via the U.S. Renal Data System standard analysis files. We used Cox proportional hazards to determine the association between 25-OH vitamin D tertiles and survival and hospitalization. For number of hospitalizations in the first year, we used negative binomial regression. Results The analytic cohort was composed of 256 patients with Patient Questionnaire data and 25-OH vitamin D concentrations. The mean age of participants was 62 (±14.0) years, and mean follow-up was 3.8 years. Patients with 25-OH vitamin D concentrations in the lowest tertile (<10.6 ng/mL) at the start of dialysis experienced higher mortality (adjusted hazard ratio 1.75, 95% confidence interval [CI] 1.03–2.97) as well as hospitalization (adjusted hazard ratio 1.76, 95% CI 1.24–2.49). Patients in the lower 2 tertiles (<15.5 ng/mL) experienced a higher rate of hospitalizations in the first year (incidence rate ratio 1.70 [95% CI 1.06–2.72] for middle tertile, 1.66 [95% CI 1.10–2.51] for lowest tertile). Conclusion We found a sizeable increase in mortality and hospitalization for patients on

  6. Outbreak of bloodstream infection with the mold Phialemonium among patients receiving dialysis at a hemodialysis unit.

    PubMed

    Clark, Thomas; Huhn, Gregory D; Conover, Craig; Cali, Salvatore; Arduino, Matthew J; Hajjeh, Rana; Brandt, Mary E; Fridkin, Scott K

    2006-11-01

    Molds are a rare cause of disseminated infection among dialysis patients. We evaluated a cluster of intravascular infections with the mold Phialemonium among patients receiving hemodialysis at the same facility in order to identify possible environmental sources and prevent further infection. Environmental assessment and case-control study. A hemodialysis center affiliated with a tertiary care hospital. We reviewed surveillance and clinical microbiology records and performed a blood culture survey for all patients. The following data for case patients were compared with those for control patients: underlying illness, dialysis characteristics, medications, and other possible exposure for 120 days prior to infection. Environmental assessment of water treatment, dialysis facilities, and heating, ventilation, and air-conditioning (HVAC) systems of the current and previous locations of the dialysis center was performed. Samples were cultured for fungus; Phialemonium isolates were confirmed by sequencing of DNA. Investigators observed dialysis access site disinfection technique. Four patients were confirmed as case patients, defined as a patient having intravascular infection with Phialemonium species; 3 presented with fungemia, and 1 presented with an intravascular graft infection. All case patients used a fistula or graft for dialysis access, as did 12 (75%) of 16 of control patients (P=.54). Case and control patients did not differ in other dialysis characteristics, medications received, physiologic findings, or demographic factors. Phialemonium species were not recovered from samples of water or dialysis machines, but were recovered from the condensation drip pans under the blowers of the HVAC system that supplied air to the dialysis center. Observational study of 21 patients detected suboptimal contact time with antiseptic agents used to prepare dialysis access sites. The report of this outbreak adds to previous published reports of Phialemonium infection occurring

  7. Patient-Reported Outcome Instruments for Physical Symptoms Among Patients Receiving Maintenance Dialysis: A Systematic Review

    PubMed Central

    Flythe, Jennifer E.; Powell, Jill D.; Poulton, Caroline J.; Westreich, Katherine D.; Handler, Lara; Reeve, Bryce B.; Carey, Timothy S.

    2015-01-01

    Background Patients with end-stage renal disease (ESRD) receiving dialysis have poor health-related quality of life (HRQoL). Physical symptoms are highly prevalent among dialysis-dependent patients and play important roles in HRQoL. A range of symptom assessment tools have been used in dialysis-dependent patients, but there has been no previous systematic assessment of the existing symptom measures’ content, validity, and reliability. Study Design systematic review of the literature Settings & Population ESRD patients on maintenance dialysis Selection Criteria for Studies instruments with ≥3 physical symptoms previously used in dialysis-dependent patients and evidence of validity or reliability testing Intervention patient-reported physical symptom assessment instrument Outcomes instrument symptom-related content, validity, and reliability Results From 3,148 screened abstracts, 89 full-text articles were eligible for review. After article exclusion and further article identification via reference reviews, 58 articles on 23 symptom assessment instruments with documented reliability or validity testing were identified. Of the assessment instruments, 43.5% were generic and 56.5% were ESRD-specific. Symptoms most frequently assessed were fatigue, shortness of breath, insomnia, nausea and vomiting, and appetite. The instruments varied widely in respondent time burden, recall period, and symptom attributes. Few instruments considered recall periods less than 2 weeks and few assessed a range of symptom attributes. Psychometric testing was completed for congruent validity (70%), known group validity (25%), responsiveness (30%), internal consistency (78%), and test-retest reliability (65%). Content validity was assessed in dialysis populations in 57% of the 23 instruments. Limitations Consideration of physical symptoms only and exclusion of single symptom-focused instruments Conclusions The number of available instruments focused exclusively on physical symptoms in

  8. Patient-Reported Outcome Instruments for Physical Symptoms Among Patients Receiving Maintenance Dialysis: A Systematic Review.

    PubMed

    Flythe, Jennifer E; Powell, Jill D; Poulton, Caroline J; Westreich, Katherine D; Handler, Lara; Reeve, Bryce B; Carey, Timothy S

    2015-12-01

    Patients with end-stage renal disease (ESRD) receiving dialysis have poor health-related quality of life. Physical symptoms are highly prevalent among dialysis-dependent patients and play important roles in health-related quality of life. A range of symptom assessment tools have been used in dialysis-dependent patients, but there has been no previous systematic assessment of the existing symptom measures' content, validity, and reliability. Systematic review of the literature. Patients with ESRD on maintenance dialysis therapy. Instruments with 3 or more physical symptoms previously used in dialysis-dependent patients and evidence of validity or reliability testing. Patient-reported physical symptom assessment instrument. Instrument symptom-related content, validity, and reliability. From 3,148 screened abstracts, 89 full-text articles were eligible for review. After article exclusion and further article identification by reference reviews, 58 articles on 23 symptom assessment instruments with documented reliability or validity testing were identified. Of the assessment instruments, 43.5% were generic and 56.5% were ESRD specific. Symptoms most frequently assessed were fatigue, shortness of breath, insomnia, nausea and vomiting, and appetite. Instruments varied widely in respondent time burden, recall period, and symptom attributes. Few instruments considered recall periods less than 2 weeks and few assessed a range of symptom attributes. Psychometric testing was completed for congruent validity (70%), known-group validity (25%), responsiveness (30%), internal consistency (78%), and test-retest reliability (65%). Content validity was assessed in dialysis populations in 57% of the 23 instruments. Consideration of physical symptoms only and exclusion of single symptom-focused instruments. The number of available instruments focused exclusively on physical symptoms in dialysis patients is limited. Few symptom-containing instruments have short recall periods, assess

  9. Assessment of caregiver burden of patients receiving dialysis treatment in Rawalpindi.

    PubMed

    Usman Shah, Hassan Bin; Atif, Iffat; Rashid, Farah; Babar, Muhammad Waleed; Arshad, Faizan; Qamar, Waqar; Khan, Owais Ahmed; Qadir, Muhammad Luqman

    2017-10-01

    To determine the burden on the caregivers of patients receiving dialysis treatment. This cross-sectional study was carried out in four different dialysis centres of Rawalpindi, Pakistan, from June 1 to December1, 2015, and comprised attendants of patients receiving dialysis. The data was collected from the attendants of patients receiving dialysis, and caregiver burden was measured using the Zarit Burden Interview questionnaire. SPSS 22 was used for data analysis. Of the 164 subjects, 97(59%) were females. The majority of caregivers reported stress for caring (2.28±1.31), patients asking for more help than needed (2.14±1.13), health problems (1.03±1.11), financial constraints (1.70±1.15) and little time for self-care (2.15±1.21). Besides, 107(65%) caregivers perceived the burden of their patients as mild to moderate. A positive correlation was found between the duration of a person on dialysis, daily hours of care-giving and the total burden score of his/her caregiver (p<0.05 each). Care-giving can create enormous burdens on caregivers, affecting their physical and psychological health.

  10. Dialysis disequilibrium syndrome induced by neoplastic meningitis in a patient receiving maintenance hemodialysis.

    PubMed

    Tsuchida, Yohei; Takata, Takuma; Ikarashi, Toshihiko; Iino, Noriaki; Kazama, Junichiro J; Narita, Ichiei

    2013-11-18

    Dialysis disequilibrium syndrome is characterized by neurological symptoms resulting from cerebral edema, which occurs as a consequence of hemodialysis. Dialysis disequilibrium syndrome most often occurs in patients who have just started hemodialysis, during hemodialysis, or soon after hemodialysis; although it may also occur in patients who are under maintenance hemodialysis with pre-existing neurological disease. A 70-year-old woman, who had been receiving maintenance hemodialysis for one year, was diagnosed with ovarian cancer by ascites cytological examination. Two years later, she reported severe headache and nausea during hemodialysis and was diagnosed with dialysis disequilibrium syndrome. Although brain images revealed mild hydrocephalus without any mass lesions, poorly differentiated adenocarcinoma cells were detected in her cerebrospinal fluid. These findings indicated that DDS was induced by neoplastic meningitis due to ovarian cancer metastasis. Neoplastic meningitis should be considered and excluded in hemodialysis patients with dialysis disequilibrium syndrome and malignancy by cytological examination of the cerebrospinal fluid even if cerebral imaging shows no obvious lesions. This is the first reported case of dialysis disequilibrium syndrome induced by neoplastic meningitis in a patient receiving maintenance hemodialysis.

  11. Amyloid and non-amyloid carpal tunnel syndrome in patients receiving chronic renal dialysis.

    PubMed

    Chary-Valckenaere, I; Kessler, M; Mainard, D; Schertz, L; Chanliau, J; Champigneulle, J; Pourel, J; Gaucher, A; Netter, P

    1998-06-01

    To determine the prevalence of amyloid deposits among patients with carpal tunnel syndrome (CTS) receiving dialysis, and to investigate the factors associated with amyloid and non-amyloid CTS. Subjects for this prospective study were dialysis patients who underwent surgery for CTS in the same surgical unit between 1989 and 1997. CTS was diagnosed from clinical and electromyographic (EMG) findings. Systematic standard radiographs and laboratory data were also obtained. Surgical investigations included systematic macroscopic examination and biopsy of the epineurium, flexor retinaculum, synovium, and flexor tendon sheaths. Samples were stained for amyloid and examined by plain and polarized light microscopy, immunohistochemistry, and electron microscopy. Forty-one samples from 30 patients (11 bilateral cases) were examined. Amyloid deposits were found in 26 samples from 18 patients (7 M, 11 F). Fifteen samples from 12 patients (3 M, 9 F) showed no amyloid deposits. Amyloid CTS was statistically significantly associated with arthralgia and longterm dialysis [mean 13.3 (range 5.5-23) vs 7.5 yrs (range 3 mo-14 yrs)] in non-amyloid CTS. Flexor tenosynovitis and carpal bone erosion occurred more frequently in amyloid CTS. There were no statistically significant differences between the 2 groups in clinical, laboratory or EMG findings, type of dialysis membrane, or frequency of ipsilateral fistula. Only amyloid CTS was recurrent. Amyloid deposits were confirmed microscopically in 63.4% of patients. The relatively large number of cases of non-amyloid CTS without signs of dialysis associated arthropathy suggests that CTS is not a satisfactory criterion for diagnosis of dialysis arthropathy or beta2-microglobulin amyloidosis unless the presence of amyloid has been confirmed or duration of dialysis treatment has been at least 15 years.

  12. Colon Cancer Screening among Patients Receiving Dialysis in the United States: Are We Choosing Wisely?

    PubMed

    Carlos, Christopher A; McCulloch, Charles E; Hsu, Chi-Yuan; Grimes, Barbara; Pavkov, Meda E; Burrows, Nilka R; Shahinian, Vahakn B; Saran, Rajiv; Powe, Neil R; Johansen, Kirsten L

    2017-08-01

    The American Society of Nephrology recommends against routine cancer screening among asymptomatic patients receiving maintenance dialysis on the basis of limited survival benefit. To determine the frequency of colorectal cancer screening among patients on dialysis and the extent to which screening tests were targeted toward patients at lower risk of death and higher likelihood of receiving a kidney transplant, we performed a cohort study of 469,574 Medicare beneficiaries ages ≥50 years old who received dialysis between January 1, 2007 and September 30, 2012. We examined colorectal cancer screening tests according to quartiles of risk of mortality and kidney transplant on the basis of multivariable Cox modeling. Over a median follow-up of 1.5 years, 11.6% of patients received a colon cancer screening test (57.9 tests per 1000 person-years). Incidence rates of colonoscopy, flexible sigmoidoscopy, and fecal occult blood test were 27.9, 0.6, and 29.5 per 1000 person-years, respectively. Patients in the lowest quartile of mortality risk were more likely to be screened than those in the highest quartile (hazard ratio, 1.53; 95% confidence interval, 1.49 to 1.57; 65.1 versus 46.4 tests per 1000 person-years, respectively), amounting to a 33% higher rate of testing. Additionally, compared with patients least likely to receive a transplant, patients most likely to receive a transplant were more likely to be screened (hazard ratio, 1.68; 95% confidence interval, 1.64 to 1.73). Colon cancer screening is being targeted toward patients on dialysis at lowest risk of mortality and highest likelihood of transplantation, but absolute rates are high, suggesting overscreening. Copyright © 2017 by the American Society of Nephrology.

  13. A Comparison of Uremic Pruritus in Patients Receiving Peritoneal Dialysis and Hemodialysis

    PubMed Central

    Wu, Hon-Yen; Peng, Yu-Sen; Chen, Hung-Yuan; Tsai, Wan-Chuan; Yang, Ju-Yeh; Hsu, Shih-Ping; Pai, Mei-Fen; Lu, Hui-Min; Chiang, Ju-Fen; Ko, Mei-Ju; Wen, Su-Ying; Chiu, Hsien-Ching

    2016-01-01

    Abstract Uremic pruritus is common and bothersome in patients receiving either peritoneal dialysis (PD) or hemodialysis (HD). To date, the preferred dialysis modality regarding the alleviation of uremic pruritus remains controversial. We conducted this cross-sectional study to compare the prevalence, intensity, and characteristics of uremic pruritus between PD and HD patients. Patients receiving maintenance dialysis at a referral medical center in Taiwan were recruited. Dialysis modality, patient demographic, clinical characteristics, and laboratory data were recorded. The intensity of uremic pruritus was measured using visual analogue scale (VAS) scores. Multivariate linear regression analysis was conducted to compare the severity of uremic pruritus between PD and HD patients. Generalized additive models were applied to detect nonlinear effects between pruritus intensity and continuous covariates. A total of 380 patients completed this study, with a mean age of 60.3 years and 49.2% being female. Uremic pruritus was presented in 24 (28.6%) of the 84 PD patients and 113 (38.2%) of the 296 HD patients (P = .12). The VAS score of pruritus intensity was significantly lower among the PD patients than the HD patients (1.32 ± 2.46 vs 2.26 ± 3.30, P = .04). Multivariate linear regression analysis showed that PD was an independent predictor for lower VAS scores of pruritus intensity compared with HD (β-value −0.88, 95% confidence interval −1.62 to −0.13). The use of active vitamin D was also an independent predictor for a lower intensity of uremic pruritus, whereas hyperphosphatemia and higher serum levels of triglyceride and aspartate transaminase were significantly associated with higher pruritus intensity. There was a trend toward a less affected body surface area of uremic pruritus in the PD patients than in the HD patients, but the difference did not reach statistical significance (P = .13). In conclusion, the severity of uremic pruritus

  14. Renal cell carcinoma co-existent with other renal disease: clinico-pathological features in pre-dialysis patients and those receiving dialysis or renal transplantation.

    PubMed

    Peces, Ramón; Martínez-Ara, Jorge; Miguel, José Luis; Arrieta, Javier; Costero, Olga; Górriz, José Luis; Picazo, Mari-Luz; Fresno, Manuel

    2004-11-01

    Patients on chronic dialysis are prone to developing acquired cystic kidney disease (ACKD), which may lead to the development of renal cell carcinoma (RCC). The risk factors for the development of RCC so far have not been determined in pre-dialysis patients with co-existent renal disease. The aim of this study was to evaluate the clinico-pathological features of RCC in pre-dialysis patients with associated renal diseases or in those undergoing chronic dialysis and renal transplantation. We studied 32 kidneys from 31 patients with RCC and associated renal diseases. Of those, 18 kidneys were from 17 patients not on renal replacement therapy (RRT) when diagnosed with RCC; 14 patients received dialysis or dialysis followed by renal transplantation. Several clinico-pathological features were analysed and compared between the two groups. Overall, there was a preponderance of males (75%); nephrosclerosis was the predominant co-existent disease (31%). The median intervals from renal disease to RCC in the dialysis and transplanted groups were significantly longer than in the pre-dialysis group (15.8+/-1.1 vs 2.4+/-0.7 years, P<0.0001). In contrast to pre-dialysis RCC, the dialysis and transplant RCC groups had greater frequency of ACKD (100 vs 28%, P<0.0001), papillary type RCC (43 vs 11%, P<0.05) and multifocal tumours (43 vs 5%, P<0.05). At the end of the study, 71% of dialysis and transplanted patients and 72% of pre-dialysis patients were alive. ACKD develops in dialysis patients, as it does in those with renal disease prior to RRT. The duration of renal disease, rather than the dialysis procedure itself, appears to be the main determinant of ACKD and RCC. The RCC occurring in patients with ACKD and prolonged RRT is more frequently of the papillary type and multifocal than the RCC occurring in patients with no or few acquired cysts and a short history of renal disease. Long-term outcomes did not differ between the two groups.

  15. Health numeracy: perspectives about using numbers in health management from African American patients receiving dialysis.

    PubMed

    Wright Nunes, Julie A; Osborn, Chandra Y; Ikizler, T Alp; Cavanaugh, Kerri L

    2015-04-01

    Health numeracy is linked to important clinical outcomes. Kidney disease management relies heavily on patient numeracy skills across the continuum of kidney disease care. Little data are available eliciting stakeholder perspectives from patients receiving dialysis about the construct of health numeracy. Using focus groups, we asked patients receiving hemodialysis open-ended questions to identify facilitators and barriers to their understanding, interpretation, and application of numeric information in kidney care. Transcripts were analyzed using content analysis. Twelve patients participated with a mean (standard deviation) age of 56 (12) years. All were African American, 50% were women, and 83% had an annual income <$20,000/year. Although patients felt numbers were critical to every aspect in life, they noted several barriers to understanding, interpreting and applying quantitative information specifically to manage their health. Low patient self-efficacy related to health numeracy and limited patient-provider communication about quantitatively based feedback, were emphasized as key barriers. Through focus groups of key patient stakeholders we identified important modifiable barriers to effective kidney care. Additional research is needed to develop tools that support numeracy-sensitive education and communication interventions in dialysis.

  16. APPETITE PREDICTS INTAKE AND NUTRITIONAL STATUS IN PATIENTS RECEIVING PERITONEAL DIALYSIS.

    PubMed

    Young, Valerie; Balaam, Sarah; Orazio, Linda; Bates, Annerley; Badve, Sunil V; Johnson, David W; Campbell, Katrina L

    2016-06-01

    Sub-optimal nutrition status is common amongst patients receiving peritoneal dialysis (PD) and leads to poor clinical outcome. This population experiences multi-factorial challenges to achieving optimal nutritional status, particularly driven by inadequate intake. The aim of this investigation was to identify factors associated with inadequate protein intake and sub-optimal nutritional status in patients undergoing PD. This was a cross-sectional study of 67 adult patients receiving PD (mean age 59 ± 14 years; 57% male) within a single centre. Participants were consecutively recruited and interviewed by renal dietitians, collecting: Subjective Global Assessment (SGA); quality of life (using EQ-5D); dietary intake (via dietary interview); and appetite (using Appetite and Diet Assessment Tool). Participant demographics were obtained via survey or medical charts. Main outcome measures were inadequate dietary protein intake (<1.1 g/kg adjusted body weight/day) and malnutrition (as defined by SGA rating B or C). Overall, 15 (22%) patients were malnourished and 29 (43%) had inadequate protein intake. Poor appetite (anorexia) was reported in 62% (18/29) of participants with inadequate protein malnourished patients reported anorexia versus 12 (23%) of the well-nourished patients (p = 0.0001). Anorexia was a key risk factor for inadequate protein intake and malnutrition in patients undergoing PD. These findings highlight a need to closely monitor patients with appetite disturbances. © 2016 European Dialysis and Transplant Nurses Association/European Renal Care Association.

  17. Associations of health literacy with dialysis adherence and health resource utilization in patients receiving maintenance hemodialysis.

    PubMed

    Green, Jamie A; Mor, Maria K; Shields, Anne Marie; Sevick, Mary Ann; Arnold, Robert M; Palevsky, Paul M; Fine, Michael J; Weisbord, Steven D

    2013-07-01

    Although limited health literacy is common in hemodialysis patients, its effects on clinical outcomes are not well understood. Observational study. 260 maintenance hemodialysis patients enrolled in a randomized clinical trial of symptom management strategies from January 2009 through April 2011. Limited health literacy. Dialysis adherence (missed and abbreviated treatments) and health resource utilization (emergency department visits and end-stage renal disease [ESRD]-related hospitalizations). We assessed health literacy using the Rapid Estimate of Adult Literacy in Medicine (REALM) and used negative binomial regression to analyze the independent associations of limited health literacy with dialysis adherence and health resource utilization over 12-24 months. 41 of 260 (16%) patients showed limited health literacy (REALM score, ≤60). There were 1,152 missed treatments, 5,127 abbreviated treatments, 552 emergency department visits, and 463 ESRD-related hospitalizations. Limited health literacy was associated independently with an increased incidence of missed dialysis treatments (missed, 0.6% vs 0.3%; adjusted incidence rate ratio [IRR], 2.14; 95% CI, 1.10-4.17), emergency department visits (annual visits, 1.7 vs 1.0; adjusted IRR, 1.37; 95% CI, 1.01-1.86), and hospitalizations related to ESRD (annual hospitalizations, 0.9 vs 0.5; adjusted IRR, 1.55; 95% CI, 1.03-2.34). Generalizability and potential for residual confounding. Patients receiving maintenance hemodialysis who have limited health literacy are more likely to miss dialysis treatments, use emergency care, and be hospitalized related to their kidney disease. These findings have important clinical practice and cost implications. Copyright © 2013 National Kidney Foundation, Inc. All rights reserved.

  18. Effectiveness of Cinacalcet in Patients with Chronic Kidney Disease and Secondary Hyperparathyroidism Not Receiving Dialysis

    PubMed Central

    Galicia-Basart, Maria; Alcalde-Rodrigo, Maria; Segarra-Medrano, Alfons; Suñé-Negre, Josep-Maria; Montoro-Ronsano, José-Bruno

    2016-01-01

    Background Secondary hyperparathyroidism (SHPT) is a common complication in chronic kidney disease (CKD) patients. Cinacalcet could be a therapeutic option although its use is controversial in patients not receiving dialysis. Thus, the aim of this study is to assess the effectiveness and safety of cinacalcet in patients with CKD and SHPT without renal replacement treatment (RRT) and without renal transplantation (RT). Methods A retrospective observational study was conducted. Patients were included if they had collected cinacalcet, under off-label use, during 2010 and 2011. Patients selected were followed from the beginning of cinacalcet therapy for one year of treatment. Results A total of 37 patients were included with CKD stage 3 (38%), 4 (51%) and 5 (11%). Baseline mean PTH value was 400.86 ± 168.60 mg/dl. At 12 months, a 67% of patients achieved at least a 30% reduction in their PTH value (p<0.001; CI 49.7–83.6), and the overall mean reduction of PTH values was 38% (p< 0.001; IC -49.1, -27.5). A 28% of the patients achieved KDOQI PTH goals (p = 0.003, CI 12%-50%). At 12 months, mean serum calcium values decreased by 6% and mean serum phosphorus values increased by 13%. A 19% of patients experienced hypocalcemia episodes while an increase of 24% in hyperphosphatemia episodes was observed. A 25% of patients finished cinacalcet before a year of treatment. Main withdrawal reasons were: gastrointestinal and other discomfort (8%), hypocalcaemia (8%), non-compliance (3%), interactions (3%) and excess of efficacy (3%). Conclusions Cinacalcet was effective in patients with CKD and SHPT not receiving dialysis. Electrolytic imbalances could be managed with administration of vitamin D and analogues or phosphate binders. PMID:27588942

  19. Comparison of survival in patients with end-stage renal disease receiving hemodialysis versus peritoneal dialysis.

    PubMed

    Beladi Mousavi, Seyed Seifollah; Hayati, Fatemeh; Valavi, Ehsan; Rekabi, Fazlollah; Mousavi, Marzieh Beladi

    2015-03-01

    Although the life expectancy of patients with end-stage renal disease (ESRD) has improved in recent years, it is still far below that of the general population. In this retrospective study, we compared the survival of patients with ESRD receiving hemodialysis (HD) versus those on peritoneal dialysis (PD). The study was conducted on patients referred to the HD and PD centers of the Emam Khomini Hospital and the Aboozar Children's Hospital from January 2007 to May 2012 in Ahvaz, Iran. All ESRD patients on maintenance HD or PD for more than two months were included in the study. The survival was estimated by the Kaplan-Meier method and the differences between HD and PD patients were tested by the log-rank test. Overall, 239 patients, 148 patients on HD (61.92%) and 91 patients on continuous ambulatory PD (CAPD) (38.55%) with mean age of 54.1 ± 17 years were enrolled in the study. Regardless of the causes of ESRD and type of renal replacement therapy (RRT), one-, two- and three-year survival of patients was 65%, 51% and 35%, respectively. There was no significant difference between type of RRT in one- (P-value = 0.737), two- (P-value = 0.534) and three- (P-value = 0.867) year survival. There was also no significant difference between diabetic and non-diabetic patients under HD and CAPD in the one-, two- and three-year survival. Although the three-year survival of diabetic patients under CAPD was lower than that of non-diabetic patients (13% vs. 34%), it was not statistically significant (P-value = 0.50). According to the results of the current study, there is no survival advantage of PD during the first years of initiation of dialysis, and the one-, two- and three-year survival of HD and PD patients is also similar.

  20. [Chronic dialysis patients' expectations towards dialysis nurses].

    PubMed

    Niedźwiecka, Agnieszka; Nowicki, Michał; Tkaczyk, Marcin

    2009-04-01

    As a result of changes in the Polish healthcare system, healthcare institutions--including dialysis units--are expected to provide their patients with broad-spectrum and high-quality services. Nurses are the members of the therapeutic team who spend most time with the patient undergoing renal replacement therapy, and thus the image of the whole dialysis unit depends on their work. The aim of the study was to assess the dialysis patients' expectations towards their nurses. The study group consisted of 150 adult dialysis patients treated with hemodialysis in dialysis units in Lodz region. The participants were asked to fill out an anonymous questionnaire specially tailored for the study. We showed that dialysis patients were generally satisfied with the level of care provided by nurses and described them as reliable, professional and well-qualified. Patients especially valued kind attitude, smile and friendliness of the nurses. Fully professional care was noticed by 25.7% of patients. Patients dialyzed for a longer period of time (over 10 years) described nurses' knowledge, practical skills and independence with more criticism. A quarter of them stated that nurses always relied on the doctor's decision. The study revealed that dialysis nurses' work, practical skills and attitude were assessed very well by patients. Their level of satisfaction would be higher if nurses spent more time and initiated more discussion with the patients. The high merit that nurses received should be considered as a stimulus that ought to increase the professional independence and quality of dialysis nurses performance.

  1. Frequency and severity of pain and symptom distress among patients with chronic kidney disease receiving dialysis.

    PubMed

    Gamondi, Claudia; Galli, Nadia; Schönholzer, Carlo; Marone, Claudio; Zwahlen, Hugo; Gabutti, Luca; Bianchi, Giorgia; Ferrier, Claudia; Cereghetti, Claudio; Giannini, Olivier

    2013-02-22

    Data on pain management in haemodialysis patients with end-stage renal disease are scanty. Our study aimed to collect information on the frequency and severity of pain and symptom distress among long-term dialysis patients in southern Switzerland. Patients with chronic kidney disease stage 5, on dialysis, treated in five nephrology units in southern Switzerland, who had given informed consent and were able to complete the survey, were interviewed to assess pain and correlated symptoms using a Visual Analogue Scale (VAS), the Brief Pain Inventory and the Edmonton Symptom Assessment System. To evaluate the impact of symptoms, the Instrumental Activities of Daily Living questionnaire was used. One hundred and twenty-three patients, aged 36-90 years and with a mean time on dialysis of 3.5 years, were interviewed. Pain was experienced by 81 patients during the 4 weeks before the interview: 68 had chronic pain; 66 reported pain intensity higher than 5 on the VAS; 35 identified musculoskeletal pain as the most disturbing pain. Five patients used drugs to cope with pain during the night. Asthenia and fatigue were prevalent concomitant symptoms. Asthenia, fatigue, sleep disturbances, dyspnoea, loss of appetite, nausea/vomiting and anxiety were correlated with pain. The majority of the patients reported that their pain limited their daily life activities. Pain severity and symptom distress in dialysis patients are important, but underestimated and undertreated. They interfere with sleep quality and daily living. Routine assessment of pain burden, pain management similar to that used in palliative care, and adequate analgesic use to treat specific dialysis-associated pain syndromes should be considered in guidelines.

  2. Phosphodiesterase type 5 inhibitor treatment for erectile dysfunction in patients with end-stage renal disease receiving dialysis or after renal transplantation.

    PubMed

    Lasaponara, Fedele; Sedigh, Omid; Pasquale, Giovanni; Bosio, Andrea; Rolle, Luigi; Ceruti, Carlo; Timpano, Massimiliano; Negro, Carlo Luigi Augusto; Paradiso, Matteo; Abbona, Annamaria; Segoloni, Giuseppe Paolo; Fontana, Dario

    2013-11-01

    The phosphodiesterase type 5 (PDE5) inhibitors are generally well tolerated and effective for treating erectile dysfunction (ED), including in patients with significant comorbidity. Because of this benign safety profile, investigators have used PDE5 inhibitors to treat patients with ED and severe renal disease or those who have received renal transplants. To assess safety and efficacy of PDE5 inhibitors in patients receiving dialysis or renal transplants. Erectile function as assessed by the International Index of Erectile Function (IIEF) and Global Assessment Questions; adverse events (AEs). We reviewed published studies of PDE5 inhibitors in patients receiving dialysis or renal transplants. In double-blind, placebo-controlled studies in patients receiving dialysis or renal transplants, sildenafil significantly improved erectile function as assessed by the IIEF, and 75-85% of patients reported improved erectile function on Global Assessment Questions; efficacy was more variable in less well-controlled studies. In >260 patients undergoing dialysis who received sildenafil in clinical studies, there were only six reported discontinuations because of AEs (headache [N=3], headache and nausea [N=1], gastrointestinal [N=1], and symptomatic blood pressure decrease [N=1]). In approximately 400 patients with renal transplants who received sildenafil, only three patients discontinued because of AEs. Vardenafil improved IIEF scores of up to 82% of renal transplant recipients in randomized, controlled studies (N=59, total), with no reported discontinuations because of AEs. Limited data also suggest benefit with tadalafil. ED is common in patients undergoing renal dialysis or postrenal transplant and substantially affects patient quality of life. Sildenafil and vardenafil appear to be efficacious and well tolerated in patients receiving renal dialysis or transplant. © 2013 International Society for Sexual Medicine.

  3. Factors affecting survival in advanced chronic kidney disease patients who choose not to receive dialysis.

    PubMed

    Wong, C F; McCarthy, M; Howse, M L P; Williams, P S

    2007-01-01

    for the other NDT patients was 10 days. The median overall survival (life expectancy) was 1.95 years. The one-year overall survival was 65%. SCG was an independent prognostic factor in predicting survival in NDT patients studied (p = 0.005), the hazard ratio being 2.53, for each incremental increase in the SCG. At one year, the survival for comorbidity grade 0, 1 and 2 were 83%, 70% and 56% respectively. Of the 28 patients who died, 20 did so at home (71%). The NDT of ESRD has become an important alternative modality in renal replacement therapy. With the emergence of epidemic proportions of CKD, more elderly patients with progressive renal disease will need to make informed decisions regarding renal replacement therapy. There is likely to be increasing number of elderly patients that will tolerate dialysis badly and who will be very dependent on others. We believe that there should be a multidisciplinary approach to assist the ESRD patients in choosing their modality of renal replacement therapy, and with an agreed care plan to support these patients in managing their chosen modality to achieve the best possible quality of life. There should be integrated services with primary care, community nurses, and palliative care teams to enable the majority of the patient's treatment to be carried out at home and to allow a dignified death. However. there was a statistically significant trend for shorter survival among those with greater comorbidities, as determined by the SCG. This is the first report of the potential importance of SCG as an independent prognostic factor in NDT patients. This will help us to counsel our patients in the future about their prognosis if they choose NDT as their modality of renal replacement therapy. Our prospective study is the first and currently the largest observational study of a multidisciplinary approach in the management of NDT patients. SCG was an independent prognostic factor in predicting survival. In those patients who chose not to

  4. Nutrition in dialysis patients.

    PubMed

    Sen, D; Prakash, J

    2000-07-01

    Malnutrition is a common clinical problem in dialysis patients, which is multifactorial in origin. It is most often found in a patient of chronic renal failure (CRF) during the period when the glomerular filtration rate (GFR) falls below 10 ml/min, but dialysis is yet to be started. The loss of proteins, aminoacids and other essential nutrients during the procedure of dialysis may further aggravate the malnutrition. Poor nutrition in dialysis patients is associated with increased morbidity and mortality in the form of delayed wound healing, malaise, fatigue, increased susceptibility to infection and poor rehabilitation. In view of the above consequences, all patients on dialysis must undergo nutritional assessment. It is very vital to maintain good nutritional status in-patients on dialysis by adequate protein and calories intake, appropriate supplementation of iron, calcium, minerals and water-soluble vitamins and, of course, the supplementation should be individualised. Nutritional needs are enhanced in presence of stresses like infection or surgery to limit excessive tissue catabolism and therefore, these are the situations, which demand intensive nutrition therapy. Total parenteral nutrition (TPN) may be required for patients on dialysis in intensive care unit, using a central venous catheter. However, enteral route is always preferred to parenteral ones, whenever possible. Even after adequate dialysis has been given, dietary counselling is often required for both hemodialysis and peritoneal dialysis patients to ensure that they ingest the recommended amount of protein, calories and essential micronutrients.

  5. Asaia bogorensis peritonitis identified by 16S ribosomal RNA sequence analysis in a patient receiving peritoneal dialysis.

    PubMed

    Snyder, Richard W; Ruhe, Jorg; Kobrin, Sidney; Wasserstein, Alan; Doline, Christa; Nachamkin, Irving; Lipschutz, Joshua H

    2004-08-01

    Here the authors report a case of refractory peritonitis leading to multiple hospitalizations and the loss of peritoneal dialysis access in a patient on automated peritoneal dialysis, caused by Asaia bogorensis, a bacterium not previously described as a human pathogen. This organism was identified by sequence analysis of the 16S ribosomal RNA gene. Unusual microbial agents may cause peritonitis, and molecular microbiological techniques are important tools for identifying these agents.

  6. [Anemia in peritoneal dialysis patients].

    PubMed

    Lausević, Mirjana; Nesić, Vidosava; Jovanović, Natasa; Stojimirović, Biljana

    2006-01-01

    A normocytic normochromic anemia is one of the first signs of renal failure. Since anemia increases morbidity and mortality, its elimination is one of the essential objectives of the treatment. Human recombinant erythropoietin (rHuEPO) has changed the therapeutical approach to anemia. The aim of the present study was to compare efficacy of anemia correction in peritoneal dialysis patients depending on treatment and dialysis modality. The study is the retrospective analysis of 64 patients who presented to our Clinic in 2003. Eighteen (28.13%) patients were treated with rHuEPO, 14 (28%) underwent continuous ambulatory peritoneal dialysis (CAPD), 2 (100%)--automated peritoneal dialysis (APD) and 2 (33.3%)--intermittent peritoneal dialysis (IPD). Mean hemoglobin level was 98.6 +/- 17.82 g/l in patients treated with rHuEPO versus 98.81 +/- 15.14 g/l in patients without rHuEPO treatment. Erythropoietin requirements were 3392.85 +/- 1211.77 IU/week All patients received iron supplementation during rHuEPO therapy. Mean serum ferritin levels were 463.41 +/- 360 ug/l. Transferrin saturation (TSAT) was 0.35 +/- 0.16%. No difference of serum iron and TSAT levels was found between CAPD and IPD patients. The degree of anemia significantly differed between CAPD and IPD patients. A total of 17.11% of PD patients were given blood transfusions, most frequently during the first three months after the onset of dialysis. Our conclusion is that the number of patients receiving rHuEPO should be increased, as 50% of our patients should be substituted, while only 28% are being treated. As 50% of patients receiving rHuEPO failed to reach target Hgb levels, higher EPO doses should be considered. Iron stores should be continuously monitored, particularly in patients receiving rHuEPO, since iron deficiency is an important problem for patients undergoing peritoneal dialysis, especially during erythropoietin therapy. Oral iron supplementation is satisfactory in the majority of patients, and iron

  7. Administration of chemotherapy in patients on dialysis.

    PubMed

    Kuo, James C; Craft, Paul S

    2015-08-01

    The prevalence of patients on dialysis has increased and these patients present a challenge for chemotherapy administration when diagnosed with cancer. A consensus on the dosage and timing of different chemotherapeutic agents in relation to dialysis has not been established. We describe the pattern of care and treatment outcome for cancer patients on dialysis in our institution. The dataset from the Australia and New Zealand Dialysis and Transplant Registry of patients on dialysis who had a diagnosis of cancer was obtained and matched to the pharmacy records in our institution to identify patients who had received chemotherapy while on dialysis. Relevant clinical information including details of the dialysis regimen, chemotherapy administration and adverse events was extracted for analysis. Between July 1999 and July 2014, 21 patients on dialysis were included for analysis. Five (23.8%) received chemotherapy, most of which was administered before dialysis sessions. As a result of adverse events, one patient discontinued treatment; two other patients required dose reduction or treatment delay. Chemotherapy administration was feasible in cancer patients on dialysis, but chemotherapy usage was low. Better understanding of the altered pharmacokinetics in patients on dialysis may improve chemotherapy access and practice.

  8. [Peritoneal dialysis in obstetric patients].

    PubMed

    Briones-Garduño, Jesús Carlos; Díaz de León-Ponce, Manuel Antonio; Rodríguez-Roldán, Martín; Briones-Vega, Carlos Gabriel; Torres-Pérez, Juan

    2006-01-01

    The prevalence of acute renal failure (ARF) in obstetric patients in our country is estimated to be between 3 and 42.8%. The most important causes are preeclampsia, especially when associated with thrombotic microangiopathy and hemolysis and less frequently to hemorrhagic shock. Early peritoneal dialysis (EPD) is the temporary treatment. For these patients, 100 % recovery in renal function was observed. When ARF is associated with multiple organ failure (MOF), the reported mortality ranges between 0 and 20 %. To describe clinical features and medical outcomes of patients treated with early peritoneal dialysis in pregnancy complicated by ARF. A case series was conducted at the Research Unit of the Instituto Materno Infantil del Estado de México. We reviewed the cases of patients admitted to the ICU matching the criteria for ARF. They were divided into two groups: those who received EPD vs. those who did not require EPD. The most important national series were included describing the association with preeclampsia and thrombotic microangiopathy with hemolysis. In a 5-year period, 1272 patients were admitted to the ICU; in 38 patients ARF was documented requiring peritoneal dialysis. In nine cases ARF was associated with thrombotic microangiopathy with hemolysis, two cases of stillbirth, and one case of mortality with MOF. A 100% recovery in renal function was observed in all cases, using 1.5% solution with an average of 34 dialysis treatments. The early use of peritoneal dialysis in obstetric patients with ARF has a good prognosis.

  9. Pharmacokinetics of Colistin Methanesulfonate and Formed Colistin in End-Stage Renal Disease Patients Receiving Continuous Ambulatory Peritoneal Dialysis

    PubMed Central

    Koomanachai, Pornpan; Landersdorfer, Cornelia B.; Chen, Gong; Lee, Hee Ji; Jitmuang, Anupop; Wasuwattakul, Somkiat; Sritippayawan, Suchai; Li, Jian

    2014-01-01

    Colistin, administered intravenously as its inactive prodrug colistin methanesulfonate (CMS), is increasingly used as last-line therapy to combat multidrug-resistant Gram-negative bacteria. CMS dosing needs to be adjusted for renal function. The impact of continuous ambulatory peritoneal dialysis (CAPD) on the pharmacokinetics of both CMS and colistin has not been studied. No CMS dosing recommendations are available for patients receiving CAPD. Eight CAPD patients received a single intravenous CMS dose (150 mg colistin base activity [CBA]) over 30 min. Serial blood and dialysate samples, and cumulative urine where applicable, were collected over 25 h. CMS and colistin concentrations were determined by high-performance liquid chromatography. Population pharmacokinetic modeling and Monte Carlo simulations were conducted. The total body clearance of CMS (excluding CAPD clearance) was 1.77 liters/h (44%) [population mean (between-subject variability)], while CAPD clearance was 0.088 liter/h (64%). The population mean terminal half-life of CMS was 8.4 h. For colistin, the total clearance/fraction of CMS metabolized to colistin (fm) (excluding CAPD clearance) was 2.74 liters/h (50%), the CAPD clearance was 0.101 liter/h (34%), and the mean terminal half-life was 13.2 h. Monte Carlo simulations suggested a loading dose of 300 mg CBA on day 1 and a maintenance dose of either 150 mg or 200 mg CBA daily to achieve a target average steady-state plasma colistin concentration of 2.5 mg/liter. Clearance by CAPD was low for both CMS and formed colistin. Therefore, CMS doses should not be increased during CAPD. Modeling and simulation enabled us to propose the first evidence-based CMS dosage regimen for CAPD patients. PMID:24189256

  10. [Ocular changes in dialysis patients].

    PubMed

    Popa, M; Nicoară, S

    2000-01-01

    The study analyzes the ocular aspects in patients receiving hemodialysis, in order to define the importance of the ophthalmological exam as prognosis and follow-up parameter. The prospective study includes 84 patients with renal insufficiency who received hemodialysis between 1994-1998. The ocular aspects and their connection with the dialysis and the basic disease are described and analyzed. The most important were the retinal vascular complications: hypertensive retinopathy, anterior optic ischaemic neuropathy, central retinal artery occlusion, diabetic retinopathy.

  11. Case report: The first case of Achromobacter xylosoxidans-related tunnel infection in a patient receiving peritoneal dialysis.

    PubMed

    Tsai, Jun-Li; Tsai, Shang-Feng

    2017-04-01

    Achromobacter xylosoxidans infection is mostly reported in immunocompromised patients. Until now, it is still rarely reported in patients undergoing peritoneal dialysis. This is the 1st case of A xylosoxidans infection due to tunnel infection of a Tenckhoff catheter. The diagnosis was confirmed by the report of culture. Risk factors for this infection in peritoneal dialysis include uremia with an immunocompromised state, contamination due to inexperienced skills, and aqueous environment of the dialysate. We believe that finding the source of A xylosoxidans contamination is the most important aspect of the overall treatment of the infection. Environmental investigation of suspected source contamination is warranted in those with A xylosoxidans infection. Once the diagnosis is made, removal of the Tenckhoff catheter should not be delayed.

  12. Demography and survival of patients receiving treatment for chronic renal failure in Australia and New Zealand: report on dialysis and renal transplantation treatment from the Australia and New Zealand Dialysis and Transplant Registry.

    PubMed

    Disney, A P

    1995-01-01

    There were 7,059 (403 per million) Australian patients and 1,341 (388 per million) New Zealand patients receiving renal replacement treatment at the end of 1992. Fifty-three percent and 50%, respectively, were dependent on a functioning transplant, 87% and 80%, respectively, from a cadaver donor. In Australia the majority of dialysis patients depended on hemodialysis (68%) and continuous ambulatory peritoneal dialysis (CAPD) (31%); 68% of patients were dialysing at home or in a satellite (free-standing) facility. The majority (62%) of home dialysis patients used CAPD treatment. In New Zealand there were 44% of patients on hemodialysis; 83% dialyzed at home and the majority (65%) used CAPD treatment. Few dialysis units (five of 71) in Australia were "for-profit" facilities; there was none in New Zealand. Universal health care has been available for renal replacement treatment for 20 years. The annual incidence of new patients increased steadily during the past 10 years, to 61 per million (Australia) and 69 per million (New Zealand) in 1992. There were disproportionate numbers of indigenous Australian Aboriginals (51%), New Zealand Maoris (30%), and Polynesian Pacific Islanders (11%) compared with their distribution in the general population. There was a considerable increase in elderly and diabetic patients during the period from 1983 to 1992: in Australia, 25% of patients were over 65 years of age and 14% of patients were diabetic, and in New Zealand, 16% of patients were over 65 years of age and 25% of patients were diabetic. The renal transplantation rate has remained unchanged since 1983 at 27 per million in Australia, but has increased markedly from 20 to 33 per million in New Zealand. The annual transplantation rate was 20% to 30% of those patients aged 15 to 64 years who were likely to be transplanted. The multifactorial analysis of risk factors for survival of dialysis patients showed age, male gender, CAPD treatment, Aboriginal race, and diabetic or

  13. Progression of coronary artery calcification and cardiac events in patients with chronic renal disease not receiving dialysis

    PubMed Central

    Russo, Domenico; Corrao, Salvatore; Battaglia, Yuri; Andreucci, Michele; Caiazza, Antonella; Carlomagno, Angelo; Lamberti, Monica; Pezone, Nicoletta; Pota, Andrea; Russo, Luigi; Sacco, Maurizio; Scognamiglio, Bernadette

    2011-01-01

    We tested for the presence of coronary calcifications in patients with chronic renal disease not on dialysis and studied its progression in 181 consecutive non-dialyzed patients who were followed for a median of 745 days. Coronary calcifications (calcium score) were tallied in Agatston units by computed tomography, and the patients were stratified into two groups by their baseline calcium score (100 U or less and over 100 U). Survival was measured by baseline calcium score and its progression. Cardiac death and myocardial infarction occurred in 29 patients and were significantly more frequent in those patients with calcium scores over 100 U (hazard ratio of 4.11). With a calcium score of 100 U or less, the hazard ratio for cardiac events was 0.41 and 3.26 in patients with absent and accelerated progression, respectively. Thus, in non-dialyzed patients, the extent of coronary calcifications was associated to cardiac events, and progression was an independent predictive factor of cardiac events mainly in less calcified patients. Hence, assessment of coronary calcifications and progression might be useful for earlier management of risk factors and guiding decisions for prevention of cardiac events in this patient population. PMID:21451461

  14. Progression of coronary artery calcification and cardiac events in patients with chronic renal disease not receiving dialysis.

    PubMed

    Russo, Domenico; Corrao, Salvatore; Battaglia, Yuri; Andreucci, Michele; Caiazza, Antonella; Carlomagno, Angelo; Lamberti, Monica; Pezone, Nicoletta; Pota, Andrea; Russo, Luigi; Sacco, Maurizio; Scognamiglio, Bernadette

    2011-07-01

    We tested for the presence of coronary calcifications in patients with chronic renal disease not on dialysis and studied its progression in 181 consecutive non-dialyzed patients who were followed for a median of 745 days. Coronary calcifications (calcium score) were tallied in Agatston units by computed tomography, and the patients were stratified into two groups by their baseline calcium score (100 U or less and over 100 U). Survival was measured by baseline calcium score and its progression. Cardiac death and myocardial infarction occurred in 29 patients and were significantly more frequent in those patients with calcium scores over 100 U (hazard ratio of 4.11). With a calcium score of 100 U or less, the hazard ratio for cardiac events was 0.41 and 3.26 in patients with absent and accelerated progression, respectively. Thus, in non-dialyzed patients, the extent of coronary calcifications was associated to cardiac events, and progression was an independent predictive factor of cardiac events mainly in less calcified patients. Hence, assessment of coronary calcifications and progression might be useful for earlier management of risk factors and guiding decisions for prevention of cardiac events in this patient population.

  15. A study to describe the health trajectory of patients with advanced renal disease who choose not to receive dialysis

    PubMed Central

    Kilshaw, Lindsey; Sammut, Hannah; Asher, Rebecca; Williams, Peter; Saxena, Rema; Howse, Matthew

    2016-01-01

    Background Some patients with end-stage renal failure (ESRF) are unlikely to benefit from dialysis and conservative management (CM) is offered as a positive alternative. Understanding the trajectory of illness by health care professionals may improve end-of-life care. Methods We aimed to describe the trajectory of functional status within our CM population through a prospective, observational study using the objective Timed Up and Go (TUG) test and subjective Barthel Index (BI) and health-related quality of life (HRQoL) [EuroQol 5D-5L (EQ-5D-5L)] measurements and correlating them with demographic and laboratory data and with sentinel events. Results There was a significant increase in TUG scores over the 6 months prior to death {2.24 [95% confidence interval (CI) 1.16–4.32], P = 0.017} and a significant decrease in EQ-5D-5L [−0.19 (95% CI −0.33 to −0.06), P = 0.006]. The only significant associations with mortality were serum albumin [hazard ratio (HR) 0.81 (95% CI 0.67–0.97), P = 0.024] and male gender [HR 5.94 (95% CI 1.50–23.5), P = 0.011]. Conclusions We have shown there is a significant decline in functional status in the last 6 months before death in the CM population. Of interest, there was a significant relationship of lower serum albumin with functional decline and risk of death. We hope that with improved insight into disease trajectories we can improve our ability to identify and respond to the changes in needs of these patients, facilitate complex and sensitive end-of-life discussions and improve end-of-life care. PMID:27274835

  16. Dialysis: Hypokalaemia and cardiac risk in peritoneal dialysis patients.

    PubMed

    Kwan, Bonnie Ching-Ha; Szeto, Cheuk-Chun

    2012-09-01

    Dialysis, particularly haemodialysis, is associated with an increased risk of cardiovascular disease. A new study confirms that hypokalaemia confers an excess cardiovascular risk and contributes disproportionately to the high risk of death in patients on peritoneal dialysis, which may partially account for the fact that observed cardiac risk is similar for patients on peritoneal dialysis and haemodialysis.

  17. Many Dialysis Patients Get Unnecessary Colonoscopies

    MedlinePlus

    ... transplant. Therefore, dialysis patients who have a limited life expectancy and no signs or symptoms of colon cancer ... weren't on dialysis but had similarly limited life expectancies, the dialysis patients had an 8 times higher ...

  18. Outcomes in patients with chronic kidney disease not on dialysis receiving extended dosing regimens of darbepoetin alfa: long-term results of the EXTEND observational cohort study

    PubMed Central

    Galle, Jan-Christoph; Addison, Janet; Suranyi, Michael G.; Claes, Kathleen; Di Giulio, Salvatore; Guerin, Alain; Herlitz, Hans; Kiss, István; Farouk, Mourad; Manamley, Nick; Wirnsberger, Gerhard; Winearls, Christopher

    2016-01-01

    Background Extended dosing of the erythropoiesis-stimulating agent (ESA) darbepoetin alfa (DA) once biweekly or monthly reduces anaemia treatment burden. This observational study assessed outcomes and dosing patterns in patients with chronic kidney disease not on dialysis (CKD-NoD) commencing extended dosing of DA. Methods Adult CKD-NoD patients starting extended dosing of DA in Europe or Australia in June 2006 or later were followed up until December 2012. Outcomes included haemoglobin (Hb) concentration, ESA dosing, mortality rates and receipt of dialysis and renal transplantation. Subgroup analyses were conducted for selected outcomes. Results Of 6035 enrolled subjects, 5723 (94.8%) met analysis criteria; 1795 (29.7%) received dialysis and 238 (3.9%) underwent renal transplantation. Mean (standard deviation) Hb concentration at commencement of extended dosing was 11.0 (1.5) g/dL. Mean [95% confidence interval (CI)] Hb 12 months after commencement of extended dosing (primary outcome) was 11.6 g/dL (11.5, 11.6) overall and was similar across countries, with no differences between subjects previously treated with an ESA versus ESA-naïve subjects, subjects with versus without prior renal transplant or diabetics versus non-diabetics. Weekly ESA dose gradually decreased following commencement of extended DA dosing and was similar across subgroups. The decrease in weekly DA dose was accompanied by an increase in the proportion of patients receiving iron therapy. Hb concentrations declined following changes in ESA labels and treatment guidelines. The mortality rate (95% CI) was 7.06 (6.68, 7.46) deaths per 100 years of follow-up. Subjects alive at study end had stable Hb concentrations in the preceding year, while those who died had lower and declining Hb concentrations in their last year. Conclusions Long-term, extended dosing of DA maintained Hb concentrations in patients already treated with an ESA and corrected and maintained Hb in ESA-naïve patients. PMID

  19. Psychometric properties of the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-Fatigue) in Chinese patients receiving maintenance dialysis.

    PubMed

    Wang, Si-Yuan; Zang, Xiao-Ying; Liu, Jun-Duo; Gao, Min; Cheng, Mei; Zhao, Yue

    2015-01-01

    Fatigue is a common symptom reported by patients with end-stage renal disease, and it can significantly decrease patients' quality of life. A brief and convenient fatigue assessment tool is needed for Chinese patients on maintenance dialysis. To determine the psychometric characteristics of the Chinese version of the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-Fatigue) in patients receiving maintenance dialysis. The Chinese version of the FACIT-Fatigue was obtained from the FACIT system. Test-retest reliability of this scale was examined using intraclass correlation coefficients, and the internal consistency was calculated by Cronbach's alpha. Content validity was examined using the content validity index (CVI), scale-level CVI/universal agreement, and scale-level CVI/average agreement. Construct validity was tested using Pearson product-moment correlations of the FACIT-Fatigue scores with the Revised Piper Fatigue Scale, Hospital Anxiety and Depression Scale, Pittsburgh Sleep Quality Index, and disease characteristics during the same period. A total of 172 patients (111 males and 61 females, mean age 52.6 ± 12.5 years) completed this study, with a median FACIT-Fatigue score of 41 (first and third quartiles 34.3-46). The Chinese version of the FACIT-Fatigue had excellent test-retest reliability (intraclass correlation coefficient = 0.98) and internal consistency (Cronbach's alpha = 0.92); the validity of the scale was supported by CVI, scale-level CVI/universal agreement, and scale-level CVI/average agreement values of at 0.67-1, 0.85, and 0.96, respectively. The standard error of measurement of the FACIT-Fatigue was 1.2. The significant correlations between the FACIT-Fatigue score and the Revised Piper Fatigue Scale (r = -0.658), Hospital Anxiety and Depression Scale (-0.566), and Pittsburgh Sleep Quality Index (-0.489) were supported by the FACIT-Fatigue, with good construct validity (all P < 0.01). The FACIT-Fatigue had acceptable

  20. Managing diabetes in dialysis patients.

    PubMed

    O'Toole, Sam M; Fan, Stanley L; Yaqoob, M Magdi; Chowdhury, Tahseen A

    2012-03-01

    Burgeoning levels of diabetes are a major concern for dialysis services, as diabetes is now the most common cause of end-stage renal disease in most developed nations. With the rapid rise in diabetes prevalence in developing countries, the burden of end stage renal failure due to diabetes is also expected to rise in such countries. Diabetic patients on dialysis have a high burden of morbidity and mortality, particularly from cardiovascular disease, and a higher societal and economic cost compared to non-diabetic subjects on dialysis. Tight glycaemic and blood pressure control in diabetic patients has an important impact in reducing risk of progression to end stage renal disease. The evidence for improving glycaemic control in patients on dialysis having an impact on mortality or morbidity is sparse. Indeed, many factors make improving glycaemic control in patients on dialysis very challenging, including therapeutic difficulties with hypoglycaemic agents, monitoring difficulties, dialysis strategies that exacerbate hyperglycaemia or hypoglycaemia, and possibly a degree of therapeutic nihilism or inertia on the part of clinical diabetologists and nephrologists. Standard drug therapy for hyperglycaemia (eg, metformin) is clearly not possible in patients on dialysis. Thus, sulphonylureas and insulin have been the mainstay of treatment. Newer therapies for hyperglycaemia, such as gliptins and glucagon-like peptide-1 analogues have become available, but until recently, renal failure has precluded their use. Newer gliptins, however, are now licensed for use in 'severe renal failure', although they have yet to be trialled in dialysis patients. Diabetic patients on dialysis have special needs, as they have a much greater burden of complications (cardiac, retinal and foot). They may be best managed in a multidisciplinary diabetic-renal clinic setting, using the skills of diabetologists, nephrologists, clinical nurse specialists in nephrology and diabetes, along with

  1. Dialysis modality selection: physician guided or patient led?*

    PubMed Central

    Winterbottom, Anna; Bekker, Hilary

    2016-01-01

    The process of choosing dialysis modality for patients is complex and requires input from the expert renal team. Although it is commonplace for nephrologists to recommend dialysis modalities to patients, this might not always lead to the patient receiving treatment which they regard as most suitable. Nephrologists should consider whether it is appropriate for pre-dialysis education to be directive, or whether the choice between treatment options should be led by the patient. PMID:27994862

  2. Depression Often Untreated in Dialysis Patients

    MedlinePlus

    ... finds. Many patients refuse to start or modify depression treatment. And in some cases kidney specialists don't ... bleak, said the authors of an accompanying commentary. "Depression in people receiving dialysis treatment is associated with lower quality of life, increased ...

  3. Peritoneal dialysis: update on patient survival

    PubMed Central

    Teixeira, J. Pedro; Combs, Sara A.; Teitelbaum, Isaac

    2015-01-01

    Due to ongoing limitations in the availability and timeliness of kidney transplantation, most patients with end-stage renal disease (ESRD) require some form of dialysis during their lifetime. Worldwide, ESRD patients most commonly receive hemodialysis (HD) or one of two forms of peritoneal dialysis (PD), continuous ambulatory PD (CAPD) or automated PD (APD). In this review, we analyze the data available from the last several decades on overall survival associated with HD as compared to PD as well as with CAPD compared to APD. Because of the inherent difficulty in randomly assigning patients to different dialysis modalities, the survival data available are virtually all observational and fraught with many confounding factors and limitations. However, over the last 10 – 15 years as overall survival of dialysis patients has steadily improved and statistical methods to analyze observational data have evolved, a pattern of virtual equivalence in survival among patients on HD vs. PD and on CAPD vs. APD has emerged. As such, impact upon lifestyle and upon quality of life likely should remain the predominant factors in guiding nephrologists and their patients in their choice of dialysis modality. PMID:25345384

  4. Nutritional evaluation of patients receiving dialysis for the management of protein-energy wasting: what is old and what is new?

    PubMed

    Riella, Miguel C

    2013-05-01

    Advances in the nutritional support of hospitalized patients in the early 1970s led to the recognition that tools were needed to evaluate the nutritional status of patients. The observation that malnutrition in patients receiving dialysis was associated with increased morbidity and mortality prompted many expert groups to develop nutritional scoring systems to be applied in these patients. Given the diverse and confusing terminologies that emerged from these publications, the International Society of Renal Nutritional and Metabolism convened an expert panel to recommend a new nomenclature and preferred methods to evaluate the nutritional status of patients with chronic kidney disease (CKD). The new and inclusive term protein-energy wasting (PEW) refers to a systematically defined condition based on certain criteria and reflects malnutrition and wasting caused not only by inadequate nutrient intake but also by depletion resulting from the inflammatory and noninflammatory conditions that prevail in this population. Serial assessment of nutritional status for detection and management of PEW is recommended using old and new scoring tools, including the Subjective Global Assessment (SGA), malnutrition inflammation score (MIS), Geriatric Nutritional Risk Index (GNRI), and PEW definition criteria. These tools, which are reliable methods and predictors of outcomes, are reviewed in this article.

  5. Prescribing for patients on dialysis

    PubMed Central

    Smyth, Brendan; Jones, Ceridwen; Saunders, John

    2016-01-01

    SUMMARY The pharmacokinetics of a drug may be altered in patients with renal impairment who require dialysis. Some drugs are contraindicated. The drug’s clearance and therapeutic index determine if a dose adjustment is needed. A lower dose or less frequent dosing may be required. Consult a reference source or the patient’s nephrologist before prescribing. Start at a low dose and increase gradually. If possible give once-daily drugs after dialysis. PMID:27041803

  6. Advance Directives and End-of-Life Care among Nursing Home Residents Receiving Maintenance Dialysis.

    PubMed

    Kurella Tamura, Manjula; Montez-Rath, Maria E; Hall, Yoshio N; Katz, Ronit; O'Hare, Ann M

    2017-03-07

    Little is known about the relation between the content of advance directives and downstream treatment decisions among patients receiving maintenance dialysis. In this study, we determined the prevalence of advance directives specifying treatment limitations and/or surrogate decision-makers in the last year of life and their association with end-of-life care among nursing home residents. Using national data from 2006 to 2007, we compared the content of advance directives among 30,716 nursing home residents receiving dialysis to 30,825 nursing home residents with other serious illnesses during the year before death. Among patients receiving dialysis, we linked the content of advance directives to Medicare claims to ascertain site of death and treatment intensity in the last month of life. In the last year of life, 36% of nursing home residents receiving dialysis had a treatment-limiting directive, 22% had a surrogate decision-maker, and 13% had both in adjusted analyses. These estimates were 13%-27%, 5%-11%, and 6%-13% lower, respectively, than for decedents with other serious illnesses. For patients receiving dialysis who had both a treatment-limiting directive and surrogate decision-maker, the adjusted frequency of hospitalization, intensive care unit admission, intensive procedures, and inpatient death were lower by 13%, 17%, 13%, and 14%, respectively, and hospice use and dialysis discontinuation were 5% and 7% higher compared with patients receiving dialysis lacking both components. Among nursing home residents receiving dialysis, treatment-limiting directives and surrogates were associated with fewer intensive interventions and inpatient deaths, but were in place much less often than for nursing home residents with other serious illnesses. Copyright © 2017 by the American Society of Nephrology.

  7. UK Renal Registry 17th Annual Report: Chapter 12 Epidemiology of Reported Infections amongst Patients Receiving Dialysis for Established Renal Failure in England in 2012 to 2013: a Joint Report from Public Health England and the UK Renal Registry.

    PubMed

    Pitcher, David; Rao, Anirudh; Caskey, Fergus; Davies, John; Crowley, Lisa; Fluck, Richard; Farrington, Ken

    2015-01-01

    Infection remains one of the leading causes of mortality in established renal failure patients receiving renal replacement therapy (RRT). Data were submitted to Public Health England (PHE) by NHS acute Trusts via Health Care Associated Infection Data Capture System (HCAI-DCS) including whether the patients were receiving dialysis. Individual renal units then confirmed the record either directly via the database or after being contacted. Data were collected for the period 1st May 2012 to the 30th April 2013. There were 31 episodes of MRSA bacteraemia, an overall rate of 0.13 per 100 dialysis patient years, representing a further year-on-year fall in MRSA rate. There were a higher number of MSSA episodes, 372 in total,with an overall rate of 1.59 per 100 dialysis patient years. The number of episodes of E. coli and C. difficile were 308 (1.32 per 100 dialysis patient years) and 123 (0.55 per 100 dialysis patient years) respectively. The presence of a central venous catheter was associated with an elevated risk of MRSA and MSSA bacteraemia. We present data relating to infections in renal dialysis patients reported to PHE in one year. The rate of MRSA bacteraemia episodes in England continues to fall. There is a higher rate of MSSA infections.We also report the results of the second year of E. coli and C. difficile data collection. Future cycles will give further ideas of the trend in incidences of these infections. Further work to refine the definitions and data collection is necessary to ensure consistency of reporting across centres.

  8. Peritoneal dialysis patient selection: characteristics for success.

    PubMed

    Li, Philip Kam-Tao; Chow, Kai Ming

    2009-05-01

    This review focuses on the strategy of patient selection for peritoneal dialysis (PD) based on published epidemiology studies and observational data. With the success of the PD first model in Hong Kong, experience shows that there is no particular patient group that cannot be put on PD except those who have major problems in the abdomen. Incident patients should be offered the choice to receive PD at the start of dialysis in order to preserve better the residual renal function. Concern has also been expressed for a time-dependent negative impact of PD on survival, although PD in general provides survival advantage at least during the first few years after the start of dialysis. Regular patient review is essential to allow prompt adjustment of the dialysis regimen and modality when required. Accumulating research suggests that center size has a significant effect on the patient and technique survival of patients undergoing PD. Comorbid diabetes, large and small body size, peritoneal membrane transport status, elderly age group, and socioeconomic status are important patient factors to consider. Good clinical and psychosocial care of the PD patients are essential as well as the attention to their compliance. Enhanced training to medical and nursing personnel on PD is one of the key success factors for improving its utilization and outcome.

  9. Hyponatremia in peritoneal dialysis patients.

    PubMed

    Uribarri, J; Prabhakar, S; Kahn, T

    2004-01-01

    Low serum sodium is uncommon in peritoneal dialysis (PD), which is surprising in view of the important role of normal kidney function to regulate water and sodium balance. We report 2 cases of persistent hyponatremia with balance studies in Case 1. We performed measurements of dialysate sodium and volume output over 24 hours in a group of chronic PD patients. The low serum sodium concentration did not vary too much with overall fluid removal via dialysis in patient 1, mainly because large quantities of sodium were removed in the dialysate. In the 24-hour studies, a significant relationship was found between net daily PD sodium removal and net daily dialysate volume removed (r = 0.65). There was no relationship between net daily PD sodium removal and serum sodium concentration. There was a linear direct correlation between serum and dialysate sodium concentration (r = 0.8) as shown by others previously. These results suggest that the main determinant of PD sodium loss is net dialysate ultrafiltration volume. Water loss via dialysis is necessarily associated with sodium loss. In order to maintain a normal serum sodium concentration salt intake must be proportional to the water loss induced by dialysis. The stimuli that allow dialysis patients to maintain this delicate balance between water and salt intake are of considerable interest but remain undetermined.

  10. The effect of increasing age on the prognosis of non-dialysis patients with chronic kidney disease receiving stable nephrology care.

    PubMed

    De Nicola, Luca; Minutolo, Roberto; Chiodini, Paolo; Borrelli, Silvio; Zoccali, Carmine; Postorino, Maurizio; Iodice, Carmela; Nappi, Felice; Fuiano, Giorgio; Gallo, Ciro; Conte, Giuseppe

    2012-08-01

    To define whether age modifies the prognosis of patients with chronic kidney disease (CKD) on nephrology care, we prospectively followed patients with CKD who have been receiving nephrology care in a clinic for 1 year or more. The incidence of end-stage renal disease (ESRD), defined by the occurrence of dialysis or transplant, or death without ESRD was estimated by a competing-risk approach, and interactions between age and risk factors tested in Cox models over a median follow-up period of 62.4 months. Of 1248 patients with stage III–V CKD, 481 were younger than 65, 410 were between 65 and 75, and 357 were over 75 years old. Within each age class, the mean estimated glomerular filtration rate(eGFR) was 31, 32, and 29 ml/min per 1.73 m2, respectively. There were 394 ESRD events and 353 deaths. The risk of ESRD was higher than the risk of death without ESRD for ages <60 years, and independent of eGFR. The ESRD risk diminished with aging but still prevailed for eGFRs of 25–35 in patients between 65 and 75 years and with an eGFR below 15 in those up to 85 years old. Proteinuria significantly increased the risk of ESRD with advancing age. Surprisingly, the unfavorable effects of cardiovascular disease on ESRD and of diabetes on survival significantly decreased with increasing age. Male gender, higher phosphate, lower body mass index, and hemoglobin were age-independent predictors for ESRD, while cardiovascular disease, lower hemoglobin, higher proteinuria and uric acid, and ESRD also predicted death. Thus, in older patients on nephrology care, the risk of ESRD prevailed overmortality even when eGFR was not severely impaired. Proteinuria increases ESRD risk, while the predictive role of other modifiable risk factors was unchanged compared with younger patients.

  11. A Nodular Foreign Body Reaction in a Dialysis Patient Receiving Long-term Treatment With Lanthanum Carbonate.

    PubMed

    Valika, Aziz K; Jain, Dhanpat; Jaffe, Phillip E; Moeckel, Gilbert; Brewster, Ursula C

    2016-01-01

    A 63-year-old man with HIV (human immunodeficiency virus) infection and end-stage renal disease, treated with lanthanum carbonate phosphate binder for 4 years, presented with anemia and an upper gastrointestinal bleed. Upper endoscopy revealed a nodular hyperplastic epithelium, with an endoscopic ultrasound confirming hyperechoic material within the nodules. Light microscopy showed collections of histiocytes and multinucleated giant cells containing brown granular cytoplasmic material and extracellular crystalline material, a finding confirmed by electron microscopy. Similar pathologic findings associated with lanthanum exposure have been described recently. In our patient, lanthanum carbonate treatment was withdrawn and gastrointestinal bleeding has since ceased. The patient was exposed to a high amount of lanthanum over a long period, which may explain his adverse reaction. However, other contributing factors, such as competing medications or comorbid conditions, also may have increased his sensitivity to the drug.

  12. Kidney Dialysis Patients Discover New Hope through ABE Program.

    ERIC Educational Resources Information Center

    Amonette, Linda; And Others

    A program was developed to provide adult basic education (ABE) to kidney patients while they are receiving dialysis treatment. The program, which relies on an individualized learning approach, involved the coordinated efforts of the following parties: West Virginia Dialysis Facilities, Inc.; the Charleston Renal Group; and the Kanawha County Adult…

  13. Kidney Dialysis Patients Discover New Hope through ABE Program.

    ERIC Educational Resources Information Center

    Amonette, Linda; And Others

    A program was developed to provide adult basic education (ABE) to kidney patients while they are receiving dialysis treatment. The program, which relies on an individualized learning approach, involved the coordinated efforts of the following parties: West Virginia Dialysis Facilities, Inc.; the Charleston Renal Group; and the Kanawha County Adult…

  14. Septic shock in chronic dialysis patients: clinical characteristics, antimicrobial therapy and mortality.

    PubMed

    Clark, Edward; Kumar, Anand; Langote, Amit; Lapinsky, Stephen; Dodek, Peter; Kramer, Andreas; Wood, Gordon; Bagshaw, Sean M; Wood, Ken; Gurka, Dave; Sood, Manish M

    2016-02-01

    To describe the clinical characteristics and in-hospital mortality of chronic dialysis-dependent end-stage kidney disease patients with septic shock in comparison to septic shock patients not receiving chronic dialysis. Using an international, multicenter database, we conducted a retrospective analysis of data collected from 10,414 patients admitted to the intensive care unit (ICU) with septic shock from 1989 to 2013, of which 800 (7.7 %) were chronic dialysis patients. Data on demographic characteristics, sites of infection, microbial pathogens, antimicrobial usage patterns, and in-hospital mortality were aggregated and compared for chronic dialysis and non-dialysis patients. Multivariate time-varying Cox models with and without propensity score matching were constructed to determine the association between dialysis and in-hospital death. Septic shock secondary to central venous catheter infection, peritonitis, ischemic bowel, and cellulitis was more frequent in chronic dialysis patients. The isolation of resistant organisms (10.7 vs. 7.1 %; p = 0.005) and delays in receiving antimicrobials (6.0 vs. 5.0 h) were more common in chronic dialysis patients than in non-dialysis patients. Delayed appropriate antimicrobial therapy was associated with an increased risk of death in chronic dialysis patients (p < 0.0001). In-hospital death occurred in 54.8 and 49.0 % of chronic dialysis and non-dialysis patients, respectively. After propensity score matching, there was no difference in overall survival between chronic dialysis and non-dialysis patients, but survival in chronic dialysis patients decreased over time compared to non-dialysis patients. The demographic and clinical characteristics of chronic dialysis patients with septic shock differ from those of similar non-dialysis patients. However, there was no significant difference in mortality between the chronic dialysis and non-dialysis patients with septic shock enrolled in this analysis.

  15. Testosterone deficiency in dialysis patients: Difference between dialysis techniques.

    PubMed

    Cigarrán, Secundino; Coronel, Francisco; Florit, Enrique; Calviño, Jesús; Villa, Juan; Gonzalez Tabares, Lourdes; Herrero, José Antonio; Carrero, Juan Jesús

    Testosterone deficiency is a prevalent condition in male patients with chronic kidney disease. However, it is not known whether the type of renal replacement therapy has an impact on testosterone deficiency that accompanies loss of renal function. The cross-sectional study enrolled 79 prevalent male patients on dialysis; 43 on haemodialysis (HD) and 36 on peritoneal dialysis (PD). The median age was 69 years and 31.6% were diabetics. Endogenous testosterone levels were measured by immunoluminescence assay (normal range 3-10.5ng/ml), while nutritional/inflammatory markers, bone and mineral metabolism markers, anaemia, type of dialysis technique and time on dialysis were also assessed. Body composition was evaluated by bioimpedance vector analysis and bioimpedance spectroscopy. Testosterone deficiency was defined as levels below 3ng/ml. Mean testosterone levels were 8.81±6.61ng/ml. Testosterone deficiency affected 39.5% of HD patients and only 5.6% of PD patients. In the univariate analysis, testosterone levels were directly correlated with type of dialysis technique (HD) (Rho Spearman 0.366; P<.001) and time on dialysis (Rho -0.412; P=.036) and only with the HD technique in the multivariate analysis. No other significant correlations were found. Circulating testosterone levels in men on dialysis were independently associated with HD technique. It can be concluded that a new factor -namely the dialysis technique- may be associated with falling testosterone levels and the associated loss of muscle mass and inflammation. Further studies are needed to establish whether the dialysis technique itself triggers testosterone elimination. Copyright © 2017 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.

  16. Chapter 12 Epidemiology of Staphylococcus aureus bacteraemia amongst patients receiving dialysis for established renal failure in England in 2009 to 2011: a joint report from the Health Protection Agency and the UK Renal Registry.

    PubMed

    Crowley, Lisa; Wilson, Jennie; Guy, Rebecca; Pitcher, David; Fluck, Richard

    2012-01-01

    Infection remains one of the leading causes of death in patients with end-stage renal failure (ESRF) receiving dialysis. Since April 2007, all centres providing renal replacement therapy in England have been required to provide additional data on patients with Methicillin Resistant Staphylococcus Aureus (MRSA) infection. From January 2011 this has also been required for patients with Methicillin Sensitive Staphylococcus Aureus (MSSA). MRSA data for 2009-2011 and the first 6 months of MSSA data are reported. Potential bacteraemia were identified by the Health Protection Agency based on clinical details provided and the clinical setting. The records were 'shared' with the parent renal centre who then complete the additional data on the HCAI-DCS website. Centres were also contacted by phone and email as a further validation step. From April 2009-2010 there were 77 confirmed episodes of MRSA bacteraemia at a median rate of 0.25 per 100 prevalent dialysis patients. This number decreased to 61 episodes between April 2010-2011 at a median rate of 0 per 100 prevalent dialysis patients. Overall there has been an 82% reduction in absolute episodes since the first year of mandatory reporting in 2007. The incidence of bacteraemia in patients with a central venous catheter was approximately six fold higher than in those with an AV fistula. From 1st January to 30th June 2011 there were 160 episodes of MSSA bacteraemia with a rate of 1.06 episodes per 100 dialysis patients, again the risk was six fold higher in patients with a CVC. Overall rates of MRSA bacteraemia in dialysis patients continued to fall although there remained variation between renal centres. Initial data from the early days of MSSA reporting suggested high rates of infection and an even greater variation between renal centres. This requires confirmation from future data collection. Copyright © 2012 S. Karger AG, Basel.

  17. Pulmonary hypertension in dialysis patients.

    PubMed

    Kosmadakis, George; Aguilera, Didier; Carceles, Odette; Da Costa Correia, Enrique; Boletis, Ioannis

    2013-01-01

    Pulmonary hypertension in end-stage renal disease patients is associated with significantly increased morbidity and mortality. The prevalence of pulmonary hypertension in dialysis patients is relatively high and varies in different studies from 17% to 49.53% depending on the mode of dialysis and other selection factors, such as the presence of other cardiovascular comorbidities. The etiopathogenic mechanisms that have been studied in relatively small studies mainly include arteriovenous fistula-induced increased cardiac output, which cannot be accomodated by, the spacious under normal conditions pulmonary circulation. Additionally, pulmonary vessels show signs of endothelial dysfunction, dysregulation of vascular tone due to an imbalance in vasoactive substances, and local as well as systemic inflammation. It is also believed that microbubbles escaping from the dialysis circuit can trigger vasoconstriction and vascular sclerosis. The non-specific therapeutic options that proved to be beneficial in pulmonary artery pressure reduction are endothelin inhibitors, phosphodiesterase inhibitor sildenafil, and vasodilatory prostaglandins in various forms. The specific modes of treatment are renal transplantation, size reduction or closure of high-flow arteriovenous fistulas, and transfer from hemodialysis to peritoneal dialysis-a modality that is associated with a lesser prevalence of pulmonary hypertension.

  18. A Rare Case of Aeromonas Hydrophila Catheter Related Sepsis in a Patient with Chronic Kidney Disease Receiving Steroids and Dialysis: A Case Report and Review of Aeromonas Infections in Chronic Kidney Disease Patients

    PubMed Central

    Khalil, Muhammad Abdul Mabood; Rehman, Abdur; Kashif, Waqar Uddin; Rangasami, Manickam; Tan, Jackson

    2013-01-01

    Aeromonas hydrophila (AH) is an aquatic bacterium. We present a case of fifty-five-year-old gentleman with chronic kidney disease (CKD) due to crescentic IgA nephropathy who presented to us with fever. He was recently pulsed with methyl prednisolone followed by oral prednisolone and discharged on maintenance dialysis through a double lumen dialysis catheter. Blood culture from peripheral vein and double lumen dialysis catheter grew AH. We speculate low immunity due to steroids and uremia along with touch contamination of dialysis catheter by the patient or dialysis nurse could have led to this rare infection. Dialysis catheter related infection by AH is rare. We present our case here and take the opportunity to give a brief review of AH infections in CKD patients. PMID:24558624

  19. Enabling self-management: selecting patients for home dialysis?

    PubMed

    Hutchison, Alastair J; Courthold, Jonathan J

    2011-12-01

    Pre-emptive living donor transplantation should always be promoted as the first-line treatment for kidney failure. Where that is not possible, patients must receive timely information and advice regarding all dialysis options available, including home-based peritoneal dialysis and haemodialysis. Where a dialysis unit enables and actively encourages self-management, patients will tend to select themselves, and if well motivated may overcome significant difficulties to exceed the expectations or predictions of dialysis staff. Patients then become advocates themselves and can provide other patients with the necessary motivation to consider a home treatment, such that they approach staff, rather than vice versa. For staff to be able to talk to patients with confidence requires direct experience of home dialysis, but in units which do not have a full range of home therapies, this may initially be difficult. Visiting patients in their home environment is an essential part of training for both medical and nursing staff. Before a patient is able to begin to engage in discussion about any dialysis therapy, they must have reached a point of acceptance that dialysis is necessary. If they are not at this point, then any attempt at 'education' will be largely futile. Once a patient has arrived at the point of choosing a home therapy, the pathway to their first dialysis at home must be as smooth and problem-free as possible.

  20. Efficacy and tolerability of lanthanum carbonate in treatment of hyperphosphatemia patients receiving dialysis--a systematic review and meta-analysis of randomized controlled trials.

    PubMed

    Huang, Wenhui; Liu, Jing; Tang, Yu; Gao, Xiaoling; Di, Baoshan; Zhang, Fengwa

    2014-01-01

    To evaluate the efficacy and tolerability of lanthanum carbonate (LC) in the treatment of hyperphosphatemia in dialysis patients. Multiple databases were used to recruit the published clinical randomized controlled trials (RCTs) comparing LC with placebo for hyperphosphatemia in dialysis patients from inception to March 2013. Results were expressed using standardized mean difference (SMD) for continuous variables and pooled odd ratios (OR) for dichotomous outcomes. Study quality was assessed according to Cochrane Handbook 5.1 guidelines and statistical analysis was performed using RevMan 5.2 software. A total of 950 patients in seven placebo-controlled RCTs were included. Results showed that LC could effectively controlled hyperphosphatemia compared with placebo (SMD -1.06, 95% CI -1.27- -0.86, P < 0.00001). The proportion of subjects reaching the target in the LC group was higher than that in the placebo group (OR 6.88, 95% CI 4.39-10.78, P < 0.00001). LC-treated patients showed less change in serum PTH and Ca × Pi product from baseline compared to the placebo group (SMD -0.21, 95% CI -0.48-0.06, P = 0.007; SMD -0.90, 95% CI -1.13- -0.66, P < 0.00001, respectively). LC-treated patients experienced more side-effects, like vomiting and nausea, than controls (OR 3.10, 95% CI 1.35-7.08, P = 0.007; OR 2.74, 95% CI 1.22-6.19, P = 0.02, respectively). But overall, the incidence of drug-related adverse events was similar between placebo- and LC-treated patients (OR 1.21, 95% CI 0.66-2.22, P = 0.54). In the treatment of hyperphosphatemia in dialysis patients, LC is well tolerated and more effective than placebo during short-term trials. Furthermore, it helps to maintain PTH and Ca × Pi product levels within recommended ranges. LC is an ideal choice for second-line treatment of hyperphosphatemia after therapy failure or other contraindication for calcium agents. Its long-term security still needs further research.

  1. Management of Anemia in Children Receiving Chronic Peritoneal Dialysis

    PubMed Central

    Borzych-Duzalka, Dagmara; Bilginer, Yelda; Ha, Il Soo; Bak, Mustafa; Rees, Lesley; Cano, Francisco; Munarriz, Reyner Loza; Chua, Annabelle; Pesle, Silvia; Emre, Sevinc; Urzykowska, Agnieszka; Quiroz, Lily; Ruscasso, Javier Darío; White, Colin; Pape, Lars; Ramela, Virginia; Printza, Nikoleta; Vogel, Andrea; Kuzmanovska, Dafina; Simkova, Eva; Müller-Wiefel, Dirk E.; Sander, Anja; Warady, Bradley A.

    2013-01-01

    Little information exists regarding the efficacy, modifiers, and outcomes of anemia management in children with CKD or ESRD. We assessed practices, effectors, and outcomes of anemia management in 1394 pediatric patients undergoing peritoneal dialysis (PD) who were prospectively followed in 30 countries. We noted that 25% of patients had hemoglobin levels below target (<10 g/dl or <9.5 g/dl in children older or younger than 2 years, respectively), with significant regional variation; levels were highest in North America and Europe and lowest in Asia and Turkey. Low hemoglobin levels were associated with low urine output, low serum albumin, high parathyroid hormone, high ferritin, and the use of bioincompatible PD fluid. Erythropoiesis-stimulating agents (ESAs) were prescribed to 92% of patients, and neither the type of ESA nor the dosing interval appeared to affect efficacy. The weekly ESA dose inversely correlated with age when scaled to weight but did not correlate with age when normalized to body surface area. ESA sensitivity was positively associated with residual diuresis and serum albumin and inversely associated with serum parathyroid hormone and ferritin. The prevalence of hypertension and left ventricular hypertrophy increased with the degree of anemia. Patient survival was positively associated with achieved hemoglobin and serum albumin and was inversely associated with ESA dose. In conclusion, control of anemia in children receiving long-term PD varies by region. ESA requirements are independent of age when dose is scaled to body surface area, and ESA resistance is associated with inflammation, fluid retention, and hyperparathyroidism. Anemia and high ESA dose requirements independently predict mortality. PMID:23471197

  2. Growth rates in pediatric dialysis patients and renal transplant recipients.

    PubMed

    Turenne, M N; Port, F K; Strawderman, R L; Ettenger, R B; Alexander, S R; Lewy, J E; Jones, C A; Agodoa, L Y; Held, P J

    1997-08-01

    We compared growth rates by modality over a 6- to 14-month period in 1,302 US pediatric end-stage renal disese (ESRD) patients treated during 1990. Modality comparisons were adjusted for age, sex, race, ethnicity, and ESRD duration using linear regression models by age group (0.5 to 4 years, 5 to 9 years, 10 to 14 years, and 15 to 18 years). Growth rates were higher in young children receiving a transplant compared with those receiving dialysis (ages 0.5 to 4 years, delta = 3.1 cm/yr v continuous cycling peritoneal dialysis [CCPD], P < 0.01; ages 5 to 9 years, delta = 2.0 to 2.6 cm/yr v CCPD, chronic ambulatory peritoneal dialysis (CAPD), and hemodialysis, P < 0.01). In contrast, growth rates in older children were not statistically different when comparing transplantation with each dialysis modality. For most age groups of transplant recipients, we observed faster growth with alternate-day versus daily steroids that was not fully explained by differences in allograft function. Younger patients (<15 years) grew at comparable rates with each dialysis modality, while older CAPD patients grew faster compared with hemodialysis or CCPD patients (P < 0.02). There was no substantial pubertal growth spurt in transplant or dialysis patients. This national US study of pediatric growth rates with dialysis and transplantation shows differences in growth by modality that vary by age group.

  3. Impact of sevelamer versus calcium-based binders on hospitalizations and missed in-center dialysis treatments among CKD patients on dialysis: a modeled analysis.

    PubMed

    Grima, Daniel T; Dunn, Elizabeth S; Bernard, Lisa M; Mendelssohn, David C

    2013-02-01

    The avoidance of hospitalizations and the maintenance of in-center dialysis sessions in patients receiving dialysis for end-stage renal disease (ESRD) have obvious benefits to patients, dialysis providers and payers. Benefits include better continuity of care, better patient outcomes, improved quality of life, and reduced healthcare expenditures. The objective of this study was to quantify, from the perspective of a dialysis provider in the US, the potential impact of sevelamer versus calcium-based binders (CBBs) on hospitalization days and maintenance of in-center dialysis sessions among hyperphosphatemic dialysis patients. A Microsoft Excel-based model was developed to simulate the number of missed dialysis sessions among three hypothetical cohorts of hyperphosphatemic patients treated with either sevelamer or CBBs. The cohorts were characterized by their size to represent a small, mid-size, or large dialysis organization (75, 30,000, and 120,000 patients, respectively). In any given month, a patient in the model could receive dialysis treatments within the center, experience a hospitalization, or die. Treatment-specific monthly survival rates, hospitalization rates, length of stay, and binder dosages were derived from the Dialysis Clinical Outcomes Revisited (DCOR) study. A dialysis schedule of three treatments per week was assumed. Analyses were conducted for a 1-year time horizon. For a small dialysis center, CBBs were associated with an increased number of missed in-center dialysis treatments (447) compared to sevelamer (395). Thus, sevelamer use avoided 52 missed in-center dialysis sessions during 1 year of treatment compared to CBBs. The magnitude of sevelamer's impact on maintaining in-center dialysis treatments increased with the size of the dialysis organization; for a mid-size dialysis organization sevelamer use avoided 20,571 missed in-center dialysis sessions and for a large dialysis organization sevelamer use avoided 82,286 missed in-center dialysis

  4. Cost-effectiveness analysis of therapies for chronic kidney disease patients on dialysis: a case for excluding dialysis costs.

    PubMed

    Grima, Daniel T; Bernard, Lisa M; Dunn, Elizabeth S; McFarlane, Philip A; Mendelssohn, David C

    2012-11-01

    paper presents a case for excluding dialysis costs in CEAs of therapies that extend the lives of patients receiving dialysis but do not impact the need for dialysis. The argument is founded on the following: (i) health economic guidelines imply that dialysis costs are unrelated to such therapies and therefore should not be included in CEAs of such therapies; (ii) the high cost and cost-effectiveness ratio associated with dialysis place an unreasonable and insurmountable barrier to demonstrating the cost effectiveness of such therapies, particularly since the decision to fund dialysis has already been made; and (iii) current clinical and reimbursement practices include the use of such therapies for patients with CKD receiving dialysis. We conclude that the exclusion of dialysis costs in such cases is methodologically correct given current health economic guidelines and is consistent with current practices regarding the treatment of dialysis patients.

  5. Dialysis adequacy in Chinese anuric peritoneal dialysis patients.

    PubMed

    Shao, Yeqing; Ma, Sha; Tian, Xiangyin; Wang, Tao; Xu, Jiayun

    2013-10-01

    We aimed in this study to explore how lower-protein diet would affect dialysis adequacy in anuric peritoneal dialysis (PD) patients. Patients' demographic features were collected, namely age, gender, weight, height, underlying renal disease, and time on PD. Urea kinetic model was used to assess solute clearance. A consecutive 3-day dietary record was collected to evaluate dietary protein intake (DPI), and normalized protein nitrogen appearance (nPNA) was also calculated to reflect protein intake. Blood samples were collected to measure hemoglobin and biochemistry. Patient's nutritional status was assessed by biochemistry, handgrip strength, and subjective global assessment (SGA). Body fluid distribution was measured by body composition monitor. Patients were 60.8 ± 14.92 years old, and the time on PD was 40.15 ± 22.90 months. Daily prescribed dialysis dose was 7,178 ± 1,326 mL. Kt/V was 1.6 ± 0.32. DPI was 0.8 ± 0.25 g/kg/day. nPNA was 0.9 ± 0.21 g/kg/day. Serum albumin was 39.42 ± 4.83 g/L. Prevalence of malnutrition (assessed by SGA) was 20.2 %. Serum phosphate and serum bicarbonate were 1.68 ± 0.47 and 27.16 ± 3.49 mmol/L, respectively. Systolic blood pressure and diastolic blood pressure were 123.4 ± 20.0 and 74.2 ± 12.6 mmHg, respectively. Patients with nPNA less than 0.6 had significantly lower serum albumin concentrations than the average, and patients with nPNA more than 1.2 g/kg/day had significantly higher levels of serum phosphate and serum urea than the average. Our study suggested that anuric PD patients could achieve adequate dialysis even under lower solute clearance. And lower-protein diet contributed largely to adequate dialysis in these patients.

  6. Dialysis headache in patients undergoing peritoneal dialysis and hemodialysis.

    PubMed

    Stojimirovic, Biljana; Milinkovic, Marija; Zidverc-Trajkovic, Jasna; Trbojevic-Stankovic, Jasna; Maric, Ivko; Milic, Miodrag; Andric, Branislav; Nikic, Petar

    2015-03-01

    Headache is among most frequently encountered neurological symptom during hemodialysis (HD), but still under investigated in peritoneal dialysis (PD) patients. The aim of this study was to assess the incidence and clinical characteristics of dialysis headache (DH) in HD and PD patients. A total of 409 patients (91 on PD and 318 on HD) were interviewed using a structured questionnaire, designed according to the diagnostic criteria of the International Headache Classification of Headache Disorders from 2004. Patients with DH underwent a thorough neurological examination. DH was reported by 21 (6.6%) HD patients and 0 PD patients. PD patients had significantly lower serum sodium, potassium, calcium, phosphate, urea and creatinine, calcium-phosphate product, and diastolic blood pressure than HD patients. HD patients had significantly lower hemoglobin compared to PD patients. Primary renal disease was mostly parenchymal in HD patients, and vascular in PD patients. DH appeared more frequently in men, mostly during the third hour of HD. It lasted less than four hours, was bilateral, non-pulsating and without associated symptoms. Biochemical alterations may be implicated in the pathophysiology of DH. Specific features of DH might contribute to better understanding of this secondary headache disorder.

  7. Bacteremia in hemodialysis and peritoneal dialysis patients.

    PubMed

    Wang, I-Kuan; Chang, Yi-Chih; Liang, Chih-Chia; Chuang, Feng-Rong; Chang, Chiz-Tzung; Lin, Hsin-Hung; Lin, Chung-Chih; Yen, Tzung-Hai; Lin, Po-Chang; Chou, Che-Yi; Huang, Chiu-Ching; Tsai, Wen-Chen; Chen, Jin-Hua

    2012-01-01

    To analyze the incidence rates and risk factors for bacteremia in patients undergoing hemodialysis (HD) and peritoneal dialysis (PD). The records of 898 consecutive patients undergoing dialysis from January 2003 to December 2008 were reviewed retrospectively. Episodes of bacteremia were recorded. China Medical University (Taichung, Taiwan). The overall incidence rate of bacteremia was 7.63 per 100 patient-years in HD patients and 3.56 per 100 patient-years in PD patients and it was higher in HD patients each year from 2003 to 2008. S. aureus (27.53%) was the most common pathogen in HD patients, whereas Coagulase-negative Staphylococcus (21.3%) was the most common pathogen in PD patients. Vascular access infection was the most common etiology in HD patients, whereas peritonitis was the most common etiology in PD patients. Older age, shorter dialysis vintage, use of HD rather than PD, current smoker, use of a venous dialysis catheter, presence of diabetes mellitus, higher comorbidity score, and lower serum albumin were significant risk factors for bacteremia. Diabetes mellitus and lower serum albumin were significant risk factors for bacteremia-associated mortality. Placement of a permanent access (fistula, graft, or PD catheter) prior to initiation of dialysis, smoking cessation, and better nutritional status (i.e. higher serum albumin) were associated with a reduced risk of bacteremia in dialysis patients. Higher serum albumin was also associated with a reduced bacteremia-associated mortality.

  8. UK Renal Registry 18th Annual Report: Chapter 12 Epidemiology of Reported Infections amongst Patients Receiving Dialysis for Established Renal Failure in England 2013 to 2014: a Joint Report from Public Health England and the UK Renal Registry.

    PubMed

    Evans, Rebecca; Caskey, Fergus; Fluck, Richard; Crowley, Lisa; Davies, John; Nsonwu, Olisaeloka; Farrington, Ken

    2016-01-01

    From 1st May 2013 to 30th April 2014 there were 35 episodes of Methicillin resistant Staphylococcus aureus (MRSA) bacteraemia in established renal failure patients on dialysis. This is now fairly stable year-on-year equating to a rate of 0.15 episodes per 100 dialysis patient years, following an initial decline in rates from 4.0 episodes per 100 dialysis patient years in 2005 when reporting began. Methicillin sensitive Staphylococcus aureus (MSSA) bacteraemia rates were slightly higher this year at 2.23 per 100 dialysis patient years (compared with 1.59 episodes per 100 dialysis patient years last year) with 526 episodes of blood stream infection reported. In 2005, the first year this was reported, there were 1,114 MSSA bacteraemias in 54 centres. There were 247 Clostridium difficile infection episodes with a rate of 1.05 per 100 dialysis patient years, slightly higher than last year at 0.55 episodes per 100 dialysis patient years. Escherichia coli infections occurred at a rate of 1.49 per 100 dialysis patient years, very similar to the rate reported last year (1.32 episodes per 100 dialysis patient years). This report has utilised a new methodology to identify cases, linking all established renal failure cases known to the UK Renal Registry (UKRR) with all infections reported to Public Health England and avoids the need for the local microbiology team to flag the patient as a renal patient. This may have increased the reliability of diagnosis at the UKRR level. In each infection for which access data were collected, the presence of a central venous catheter appeared to correlate with increased risk.

  9. Effects of disinfectants in renal dialysis patients

    SciTech Connect

    Klein, E.

    1986-11-01

    Patients receiving hemodialysis therapy risk exposure to both disinfectants and sterilants. Dialysis equipment is disinfected periodically with strong solutions of hypochlorite or formaldehyde. Gross hemolysis resulting from accidental hypochlorite infusion has led to cardiac arrest, probably as a result of hyperkalemia. Formaldehyde is commonly used in 4% solutions to sterilize the fluid paths of dialysis controllers and to sterilize dialyzers before reuse. It can react with red cell antigenic surfaces leading to the formation of anti-N antibodies. The major exposure risk is the low concentration of disinfectant found in municipal water used to prepare 450 L dialysate weekly. With thrice-weekly treatment schedules, the quality requirements for water used to make this solution must be met rigorously. Standards for water used in the preparation of dialysate have recently been proposed but not all patients are treated with dialysate meeting such standards. The introduction of sterilants via tap water is insidious and has let to more pervasive consequences. Both chlorine and chloramines, at concentrations found in potable water, are strong oxidants that cause extensive protein denaturation and hemolysis. Oxidation of the Fe/sup 2 +/ in hemoglobin to Fe/sup 3 +/ forms methemoglobin, which is incapable of carrying either O/sub 2/ or CO/sub 2/. Chloramine can form not only methemoglobin, but can also denature proteins within the red cell, thus forming aggregates (Heinz bodies). Chloramines also inhibit hexose monophosphate shunt activity, a mechanism that makes the red cell even more susceptible to oxidant damage.

  10. A new paradigm: home therapy for patients who start dialysis in an unplanned way.

    PubMed

    Lecouf, Angelique; Ryckelynck, Jean-Philippe; Ficheux, Maxence; Henri, Patrick; Lobbedez, Thierry

    2013-01-01

    Starting dialysis in a non-planned manner or in a 'suboptimal' manner is a frequent situation in dialysis centres, even for patients with a regular nephrology follow-up. Unplanned dialysis initiation can be defined as a patient beginning dialysis with no functional vascular access or peritoneal dialysis catheter. These patients start haemodialysis with a temporary catheter, frequently converted to a tunnelled catheter pending native fistula creation or whilst waiting for fistula maturation. In this case, conventional in-centre haemodialysis (ICH) is more frequently used than peritoneal dialysis (PD) or home haemodialysis (HHD). This review found that patients who start dialysis in an unplanned way are significantly older and have more heart and peripheral vascular diseases. Home-based dialysis therapies showed better outcomes than ICH (PD for the first two to three years and HHD for the long-term). This review proposes a paradigm shift in the initial form of dialysis offered to new patients starting dialysis in an unplanned way. Even if they require a temporary catheter, it is possible for them to receive a pre-dialysis education programme (PDEP). The PDEP should be based on both individualised information session(s) given by an experienced nurse to the patient and family and therapeutic education (educative diagnosis, individualised and group session(s)) in order to relieve anxiety and promote home modalities. © 2013 European Dialysis and Transplant Nurses Association/European Renal Care Association.

  11. Pica: an important and unrecognized problem in pediatric dialysis patients.

    PubMed

    Katsoufis, Chryso Pefkaros; Kertis, Myerly; McCullough, Judith; Pereira, Tanya; Seeherunvong, Wacharee; Chandar, Jayanthi; Zilleruelo, Gaston; Abitbol, Carolyn

    2012-11-01

    Pica is the compulsive consumption of non-nutritive substances, and this disorder may occur more frequently in dialysis patients. The purpose of our study was to determine the prevalence of pica and the associated demographic and metabolic characteristics. Retrospective, cross-sectional analysis. Hospital-based, outpatient, pediatric hemodialysis unit. Eighty-seven pediatric patients on chronic dialysis therapy were interviewed. Sixty-seven patients were receiving hemodialysis, whereas the remaining 20 were maintained on peritoneal dialysis. The predominantly nonwhite (93%) patient population had a mean age of 17.2 ± 7.2 years. Dialysis efficiency, estimated by urea clearance per patient volume (Kt/V), averaged 1.5 ± 0.5. Standard patient interview and documentation of laboratory and dialytic parameters. Prevalence of pica and associated comorbid conditions. The survey indicated that 46% of patients experienced pica, further divided into simple "ice" pica (34.5%) versus "hard" pica (12.6%). Hard pica included the consumption of chalk, starch, sugar, soap, sand, clay, Ajax cleanser, sponge, wood, and potting soil. Patients on hemodialysis were 8.3 times more likely to have hard pica compared with those on peritoneal dialysis. Greater than 5 years on dialysis was associated with a 3.2 odds ratio of having pica (P = .02). Anemia was the most significant morbid association, occurring at an odds ratio of 4.4 (P = .001) for all pica and 10.6 (P = .004) for hard pica. Pica, therefore, is prevalent and potentially harmful, requiring further attention in the nutritional management of pediatric dialysis patients. Copyright © 2012 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

  12. 42 CFR 414.316 - Payment for physician services to patients in training for self-dialysis and home dialysis.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... training for self-dialysis and home dialysis. 414.316 Section 414.316 Public Health CENTERS FOR MEDICARE... Payment for physician services to patients in training for self-dialysis and home dialysis. (a) For each... for self-dialysis and home dialysis. (b) CMS determines the amount on the basis of program experience...

  13. 42 CFR 414.316 - Payment for physician services to patients in training for self-dialysis and home dialysis.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... training for self-dialysis and home dialysis. 414.316 Section 414.316 Public Health CENTERS FOR MEDICARE... Payment for physician services to patients in training for self-dialysis and home dialysis. (a) For each... for self-dialysis and home dialysis. (b) CMS determines the amount on the basis of program experience...

  14. An Open, Randomized, Single-Center, Crossover Pharmacokinetic Study of Meropenem after Intraperitoneal and Intravenous Administration in Patients Receiving Automated Peritoneal Dialysis

    PubMed Central

    Pichler, Petra; Reznicek, Gottfried; Wimmer, Michaela; Kussmann, Manuel; Balcke, Peter; Burgmann, Heinz; Poeppl, Wolfgang

    2016-01-01

    The objective of this study was to determine the pharmacokinetic profile of meropenem in automated peritoneal dialysis (APD) patients. In 6 patients without peritonitis, a single dose of 0.5 g of meropenem was applied intraperitoneally (i.p.) or intravenously (i.v.) and concentrations in serum and dialysate were measured at specified intervals over 24 h with high-performance liquid chromatography-mass spectrometry. The mean maximum concentrations of meropenem in serum (Cmax) were 27.2 mg/liter (standard deviation [SD], ±6.9) and 10.1 mg/liter (SD, ±2.5) and in dialysate were 3.6 mg/liter (SD, ±2.3) and 185.8 mg/liter (SD, ±18.7) after i.v. and i.p. administrations, respectively. The mean areas under the curve from 0 to 24 (AUC0–24) of meropenem in serum were 173.5 mg · h/liter (SD, ±29.7) and 141.4 mg · h/liter (SD, ±37.5) (P = 0.046) and in dialysate were 42.6 mg · h/liter (SD, ±20.0) and 623.4 mg · h/liter (SD, ±84.1) (P = 0.028) after i.v. and i.p. administrations, respectively. The ratios for dialysate exposure over plasma exposure after i.v. and i.p. treatments were 0.2 (SD, ±0.1) and 4.6 (SD, ±0.9), respectively (P = 0.031). A mean target value of 40% T>MIC (time for which the free meropenem concentration exceeds the MIC) for clinically relevant pathogens with EUCAST susceptibility breakpoints of 2 mg/liter was reached in serum after i.p. and i.v. administrations and in dialysate after i.p. but not after i.v. administration. The present data indicate that low i.p. exposure limits the i.v. use of meropenem for PD-associated peritonitis. In contrast, i.p. administration not only results in superior concentrations in dialysate but also might be used to treat systemic infections. PMID:26902765

  15. Readmission within 30 days of hospital discharge among children receiving chronic dialysis.

    PubMed

    Springel, Tamar; Laskin, Benjamin; Furth, Susan

    2014-03-01

    The hospital admission rate for children receiving chronic dialysis has been increasing over the last decade. Approximately one third of patients with ESRD age 0-19 years are readmitted to the hospital within 30 days of discharge. The objective of this study was to examine hospital readmissions among a cohort of children receiving chronic dialysis to identify factors associated with higher rates of 30-day readmission. A retrospective cohort of index admissions was developed among chronic dialysis patients age 3 months to 17 years at free-standing children's hospitals reporting information to the Pediatric Hospital Information System between January 2006 and November 30, 2010, and followed until December 31, 2010. The primary outcome was any-cause 30-day readmission, and the secondary outcome was 30-day readmission for a cause similar to that of the index hospitalization. In this cohort, 25% of hospital admissions were followed by a readmission within 30 days. Children older than 2 years of age had a lower odds of readmission (odds ratio [OR], 0.6; 95% confidence interval [95% CI], 0.5 to 0.8). Those receiving hemodialysis had a higher risk of readmission (OR, 1.2; 95% CI, 1.0 to 1.4), and admissions >14 days were also more likely to be followed by a readmission (OR, 1.5; 95% CI, 1.1 to 2.0). Approximately 50% of the readmissions were for a similar diagnosis as the index admission; however, the specific admitting diagnosis was not associated with readmission. A significant number of admissions among children receiving long-term dialysis are followed by readmission within 30 days. Further investigation is required to reduce the high rate of readmissions in these children.

  16. Effects of exercise therapy during dialysis for elderly patients undergoing maintenance dialysis

    PubMed Central

    Chigira, Yusuke; Oda, Takahiro; Izumi, Masataka; Yoshimura, Tukasa

    2017-01-01

    [Purpose] Exercise therapy during dialysis is currently being recommended since it is easy for patients to follow and results in high participation rates. In this study, this therapy was performed for elderly patients undergoing maintenance dialysis, and its effects were examined. [Subjects and Methods] Seven elderly patients (age: 70.6 ± 4.4) with chronic renal failure, who were able to perform exercises during maintenance dialysis, received the exercise therapy 2 or 3 times weekly for 3 months. Lower-limb muscle strength as well as the standardized dialysis dose (Kt/V) was measured before and after intervention. The patients were also evaluated using the 30-sec chair stand test (CS-30), the World Health Organization QOL Assessment 26 (WHO-QOL26), and a questionnaire. [Results] The lower-limb muscle strength and circumference, CS-30 score, and Kt/V values improved after intervention, but the difference was not significant. Significant differences were observed only in the WHO-QOL26 score. [Conclusion] The outcome was particularly favorable in terms of the quality of life (QOL). Based on the results from the questionnaire, the higher QOL may be due to the patients’ development of a positive attitude toward these activities. Although there were no significant differences, the values for the other criteria also improved, thereby supporting the effectiveness of exercise therapy to maintain or improve the patients’ motor functions and activity daily living (ADL) ability. PMID:28210031

  17. Arthritis associated with calcium oxalate crystals in an anephric patient treated with peritoneal dialysis

    SciTech Connect

    Rosenthal, A.; Ryan, L.M.; McCarty, D.J.

    1988-09-02

    The authors report a case of calcium oxalate arthropathy in a woman undergoing intermittent peritoneal dialysis who was not receiving pharmacologic doses of ascorbic acid. She developed acute arthritis, with calcium oxalate crystals in Heberden's and Bouchard's nodes, a phenomenon previously described in gout. Intermittent peritoneal dialysis may be less efficient than hemodialysis in clearing oxalate, and physicians should now consider calcium oxalate-associated arthritis in patients undergoing peritoneal dialysis who are not receiving large doses of ascorbic acid.

  18. [Clinical characteristics and indicators of care of dialysis patients].

    PubMed

    Kolko, A; Hannedouche, T; Couchoud, C

    2013-09-01

    This chapter provides a set of indicators on patients treated by dialysis at December the 31th 2011. Even if ESRD is found in all classes of age, elders account for the great majority of the patients undergoing dialysis (median age: 70.4 years). These patients present a high rate of comorbidity especially diabetes (37% of patients) and cardiovascular comorbidities (59% of patients) that increases with the patient's age. Considering indicators of care, the main dialysis technique was hemodialysis (93.3% of patients). Even if an important inter-region variability remains considering the choices of treatment, more than 50% of the patients are undergoing hemodialysis in a hospital-based in-center unit, and we noticed an increase in hemodialysis in a medical satellite unit with time whereas the rate of self-care hemodialysis decreases. The rate of peritoneal dialysis remains stable. When comparing guidelines to real-life treatments, 77.5% of patients receive adequate dose of treatment (12H/week, KT/V>1.2), the rate of patients with a hemoglobin blood-level lower than 10 g/dl and without erythropoietin treatment is 1.3%, which confirmed a good management of anemia. On the contrary, 34% of patients have a BMI lower than 23 kg/m(2) and only 23% have an albumin blood-level over 40 g/l, which underlines that nutritional management of ESRD patients can be improved. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  19. Effects of disinfectants in renal dialysis patients.

    PubMed Central

    Klein, E

    1986-01-01

    Patients receiving hemodialysis therapy risk exposure to both disinfectants and sterilants. Dialysis equipment is disinfected periodically with strong solutions of hypochlorite or formaldehyde. More recently, reuse of dialyzers has introduced the use of additional sterilants, such as hydrogen peroxide and peracetic acid. The use of these sterilants is recognized by the center staffs and the home patient as a potential risk, and residue tests are carried out for the presence of these sterilants at the ppm level. Gross hemolysis resulting from accidental hypochlorite infusion has led to cardiac arrest, probably as a result of hyperkalemia. Formaldehyde is commonly used in 4% solutions to sterilize the fluid paths of dialysis controllers and to sterilize dialyzers before reuse. It can react with red cell antigenic surfaces leading to the formation of anti-N antibodies. Such reactions probably do not occur with hypochlorite or chloramines. The major exposure risk is the low concentration of disinfectant found in municipal water used to prepare 450 L dialysate weekly. With thrice-weekly treatment schedules, the quality requirements for water used to make this solution must be met rigorously. Standards for water used in the preparation of dialysate have recently been proposed but not all patients are treated with dialysate meeting such standards. The introduction of sterilants via tap water is insidious and has led to more pervasive consequences. Both chlorine and chloramines, at concentrations found in potable water, are strong oxidants that cause extensive protein denaturation and hemolysis. Oxidation of the Fe2+ in hemoglobin to Fe3+ forms methemoglobin, which is incapable of carrying either O2 or CO2.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:3816735

  20. Restless legs syndrome in patients on dialysis.

    PubMed

    Al-Jahdali, Hamdan H; Al-Qadhi, Waleed A; Khogeer, Haithm A; Al-Hejaili, Fayez F; Al-Ghamdi, Saeed M; Al Sayyari, Abdullah A

    2009-05-01

    Restless legs syndrome (RLS) is an extremely distressing problem experienced by patients on dialysis; the prevalence appears to be greater than in the general population, with a wide variation from 6.6% to 80%. The diagnosis of RLS is a clinical one, and its definition has been clarified and standardized by internationally recognized diagnostic criteria, published in 1995 by the International Restless Legs Syndrome Study Group (IRLSSG). This study was designed to find out the prevalence of RLS in Saudi patients with end-stage renal disease (ESRD) on maintenance dialysis. This is a cross sectional study carried out between May and Sept 2007 at two centers, King Abdulaziz Medical City-King Fahad National Guard Hospital (KAMC-KFNGH), Riyadh and King Faisal Specialist Hospital and Research Centre (KFHRC), Jeddah, Saudi Arabia. Data were gathered on 227 Saudi patients on chronic maintenance hemodialysis or chronic peritoneal dialysis. The prevalence of RLS was measured using IRLSSG's RLS Questionnaire (RLSQ). Potential risk factors for RLS including other sleep disorders, underlying cause of chronic renal failure, duration on dialysis, dialysis shift, biochemical tests and demographic data were also evaluated. The overall prevalence of RLS was 50.22% including 53.7% males and 46.3% females. Their mean age was 55.7 +/- 17.2 years and mean duration on dialysis 40.4 +/- 37.8 months. Significant predictors of RLS were history of diabetes mellitus (DM), coffee intake, afternoon dialysis, gender and type of dialysis (P= 0.03, 0.01, < 0.001, 0.05 and 0.009 respectively). Patients with RLS were found to be at increased risk of having insomnia and excessive daytime sleepiness (EDS) (P= < 0.001 and 0.001, respectively). Our study suggests that RLS is a very common problem in dialysis population and was significantly associated with other sleep disorders, particularly insomnia, and EDS. Optimal care of dialysis patient should include particular attention to the diagnosis and

  1. Optimal use of peritoneal dialysis in patients with diabetes.

    PubMed

    Chung, Sung Hee; Noh, Hyunjin; Ha, Hunjoo; Lee, Hi Bahl

    2009-02-01

    The survival of patients with end-stage renal disease (ESRD) resulting from diabetes continues to improve, but the survival rate among diabetic ESRD patients remains the lowest among all primary diagnoses probably because of the higher prevalence of cardiovascular comorbidity associated with diabetes. Diabetes, age, and comorbidity all significantly modify the effect of treatment modality on patient survival. As compared with hemodialysis (HD), peritoneal dialysis (PD) offers an equal or lower risk of death across all subgroups during the first 1-2 years of dialysis. The association of PD with better outcomes than are seen with HD is probably a result of a lower prevalence of infections and congestive heart failure and better preservation of residual renal function (RRF) in PD patients. Use of angiotensin converting-enzyme inhibitor (ACEI) or angiotensin II receptor blocker (ARB) helps to preserve RRF in ESRD patients and to maintain peritoneal membrane integrity longer in PD patients. Antioxidants can also support preservation of peritoneal membrane function. Peritoneal dialysis should be the initial modality of dialysis in all ESRD patients. Older patients (age > or = 45 years) with diabetes and patients without diabetes may switch to HD or receive a kidney graft in 1-2 years' time; younger patients (age < 45 years) with diabetes may stay on PD longer. Use of ACEI and ARB or antioxidants can help to maintain peritoneal membrane function longer.

  2. Trends in in-hospital cardiopulmonary resuscitation in adults receiving maintenance dialysis

    PubMed Central

    Wong, Susan P. Y.; Kreuter, William; Curtis, J. Randall; Hall, Yoshio N.; O’Hare, Ann M.

    2015-01-01

    Importance Understanding cardiopulmonary resuscitation (CPR) practices and outcomes can help to support advance care planning in patients receiving maintenance dialysis. Objective To characterize patterns and outcomes of in-hospital CPR in US adults receiving maintenance dialysis. Design A national retrospective cohort study. Setting A comprehensive national registry for end-stage renal disease. Participants 663,734 Medicare beneficiaries aged 18 years who initiated maintenance dialysis between January 1, 2000 and December 31, 2010. Exposure Receipt of in-hospital CPR from 91 days after dialysis initiation through the time of death, first kidney transplant or end of follow-up on December 31, 2011. Main outcomes and measures Incidence of CPR and survival after the first episode of CPR recorded in Medicare claims during follow-up. Results The annual incidence of CPR for the overall cohort was 1.4 events/1,000 in-hospital days (95% confidence interval [CI] 1.3–1.4). Approximately one in five (21.9%, 95% CI 21.4–22.3) CPR recipients survived to hospital discharge, with a median post-discharge survival of 5.0 months (interquartile range 0.7–16.8). Among patients who died in the hospital, 14.9% (95% CI 14.8–15.1) received CPR during their terminal admission. From 2000–2011, there was an increase in the incidence of CPR (1.0 events/1,000 in-hospital days [95% CI 0.9–1.1] to 1.6 events/1,000 in-hospital days [95% CI 1.6–1.7]; trend p<0.001), the proportion of CPR recipients who survived to discharge (15.2% [95% CI 11.1–20.5] to 28% [95% CI 26.7–29.4]; trend p<0.001) and the proportion of in-hospital deaths preceded by CPR (9.5% [95% CI 8.4–10.8] to 19.8% [95% CI 19.2–20.4]; trend p<0.001), with no substantial change in duration of post-discharge survival. Conclusions and relevance Among a national cohort of patients receiving maintenance dialysis, the incidence of CPR was higher and long-term survival worse than reported for other populations. PMID

  3. Hospitalization rates among dialysis patients during Hurricane Katrina.

    PubMed

    Howard, David; Zhang, Rebecca; Huang, Yijian; Kutner, Nancy

    2012-08-01

    Dialysis centers struggled to maintain continuity of care for dialysis patients during and immediately following Hurricane Katrina's landfall on the US Gulf Coast in August 2005. However, the impact on patient health and service use is unclear. The impact of Hurricane Katrina on hospitalization rates among dialysis patients was estimated. Data from the United States Renal Data System were used to identify patients receiving dialysis from January 1, 2001 through August 29, 2005 at clinics that experienced service disruptions during Hurricane Katrina. A repeated events duration model was used with a time-varying Hurricane Katrina indicator to estimate trends in hospitalization rates. Trends were estimated separately by cause: surgical hospitalizations, medical, non-renal-related hospitalizations, and renal-related hospitalizations. The rate ratio for all-cause hospitalization associated with the time-varying Hurricane Katrina indicator was 1.16 (95% CI, 1.05-1.29; P = .004). The ratios for cause-specific hospitalization were: surgery, 0.84 (95% CI, 0.68-1.04; P = .11); renal-related admissions, 2.53 (95% CI, 2.09-3.06); P < .001), and medical non-renal related, 1.04 (95% CI, 0.89-1.20; P = .63). The estimated number of excess renal-related hospital admissions attributable to Katrina was 140, representing approximately three percent of dialysis patients at the affected clinics. Hospitalization rates among dialysis patients increased in the month following the Hurricane Katrina landfall, suggesting that providers and patients were not adequately prepared for large-scale disasters.

  4. UK Renal Registry 12th Annual Report (December 2009): chapter 12: epidemiology of methicillin resistant Staphylococcus aureus bacteraemia amongst patients receiving dialysis for established renal failure in England in 2008: a joint report from the UK Renal Registry and the Health Protection Agency.

    PubMed

    Fluck, Richard; Wilson, Jennie; Tomson, Charles R V

    2010-01-01

    From April 2007, all centres providing renal replacement therapy in England were asked to provide additional data on patients with Methicillin Resistant Staphylococcus aureus (MRSA) bacteraemia using a secure web based system established to capture data for the mandatory surveillance of MRSA bacteremia. From April 2008 until March 2009 171 discrete episodes of MRSA bacteraemia were identified from the Health Protection Agency database as being potentially associated with patients in established renal failure (ERF) requiring dialysis. Of 171 records, 18 records were rejected by renal centres as not being associated with patients on dialysis or as being duplicates of other records. Following data validation by centres, 139 patients had vascular access documented (no episodes of bacteraemia were recorded amongst patients receiving peritoneal dialysis). Of these patients, 30.2% were utilising an arteriovenous fistula or graft and 69.8% were dialysing on a nontunnelled or tunnelled venous catheter. Two of the patients on arteriovenous fistulae had used venous catheters in the prior 28 days. Eleven patients had more than one episode in the year and accounted for 30 (20%) of the episodes of MRSA bacteraemia. Overall there was a reduction of 22% in episodes from the previous year. The median centre-specific rate of MRSA bacteraemia was 0.64 (range 0-3.49) episodes per 100 haemodialysis patients per year, and 0.55 (range 0-2.89) episodes per 100 dialysis (haemodialysis and peritoneal dialysis combined) patients per year. The rate of MRSA bacteraemia in patients requiring long term dialysis continues to fall within the prevalent dialysis population in England, but there is still marked variation in centrespecific rates. (c) 2010 S. Karger AG, Basel.

  5. Consolidation in the Dialysis Industry, Patient Choice, and Local Market Competition.

    PubMed

    Erickson, Kevin F; Zheng, Yuanchao; Winkelmayer, Wolfgang C; Ho, Vivian; Bhattacharya, Jay; Chertow, Glenn M

    2016-11-09

    The Medicare program insures >80% of patients with ESRD in the United States. An emphasis on reducing outpatient dialysis costs has motivated consolidation among dialysis providers, with two for-profit corporations now providing dialysis for >70% of patients. It is unknown whether industry consolidation has affected patients' ability to choose among competing dialysis providers. We identified patients receiving in-center hemodialysis at the start of 2001 and 2011 from the national ESRD registry and ascertained dialysis facility ownership. For each hospital service area, we determined the maximum distance within which 90% of patients traveled to receive dialysis in 2001. We compared the numbers of competing dialysis providers within that same distance between 2001 and 2011. Additionally, we examined the Herfindahl-Hirschman Index, a metric of market concentration ranging from near zero (perfect competition) to one (monopoly) for each hospital service area. Between 2001 and 2011, the number of different uniquely owned competing providers decreased 8%. However, increased facility entry into markets to meet rising demand for care offset the effect of provider consolidation on the number of choices available to patients. The number of dialysis facilities in the United States increased by 54%, and patients experienced an average 10% increase in the number of competing proximate facilities from which they could choose to receive dialysis (P<0.001). Local markets were highly concentrated in both 2001 and 2011 (mean Herfindahl-Hirschman Index =0.46; SD=0.2 for both years), but overall market concentration did not materially change. In summary, a decade of consolidation in the United States dialysis industry did not (on average) limit patient choice or result in more concentrated local markets. However, because dialysis markets remained highly concentrated, it will be important to understand whether market competition affects prices paid by private insurers, access to

  6. Venous and arterial thrombosis in dialysis patients.

    PubMed

    Ocak, Gurbey; Vossen, Carla Y; Rotmans, Joris I; Lijfering, Willem M; Rosendaal, Frits R; Parlevliet, Karien J; Krediet, Ray T; Boeschoten, Els W; Dekker, Friedo W; Verduijn, Marion

    2011-12-01

    Whether the risk of both venous and arterial thrombosis is increased in dialysis patients as compared to the general population is unknown. In addition, it is unknown which subgroups are at highest risk. Furthermore, it is unknown whether having a history of venous thrombosis or arterial thrombosis prior to dialysis treatment increases mortality risk. A total of 455 dialysis patients were followed for objectively verified symptomatic thrombotic events between January 1997 and June 2009. The incidence rates in dialysis patients as compared to the general population was 5.6-fold (95% CI 3.1-8.9) increased for venous thrombosis, 11.9-fold (95% CI 9.3-14.9) increased for myocardial infarction, and 8.4-fold (95% CI 5.7-11.5) increased for ischaemic stroke. The combination of haemodialysis, lowest tertile of albumin, history of venous thrombosis, and malignancy was associated with subsequent venous thrombosis. Increased age, renal vascular disease, diabetes, high cholesterol levels, history of venous thrombosis, and history of arterial thrombosis were associated with subsequent arterial thrombosis. The all-cause mortality risk was 1.9-fold (95% CI 1.1-3.3) increased for patients with a history of venous thrombosis and 1.9-fold (95% CI 1.4-2.6) increased for patients with a history of arterial thrombosis. A potential limitation of this study was that in some risk categories associations with venous thrombosis did not reach statistical significance due to small numbers. In conclusion, dialysis patients have clearly elevated risks of venous thrombosis and arterial thrombosis and occurrence of venous thrombosis or arterial thrombosis prior to the start of dialysis is associated with an increased mortality risk.

  7. Avoiding harm in peritoneal dialysis patients.

    PubMed

    Bender, Filitsa H

    2012-05-01

    This review is focused on minimizing complications and avoiding harm in peritoneal dialysis (PD) patients. Issues related to planning for PD are covered first, with emphasis on PD versus hemodialysis outcomes. Catheter types and insertion techniques are described next, including relevant recommendations by the International Society for Peritoneal Dialysis. A brief review of both noninfectious and infectious complications follows, with emphasis on cardiovascular and metabolic complications. Finally, recommendations for preventing PD-related infections are provided. In conclusion, with proper catheter insertion technique, good training, and attention to detail during the tenure in PD, excellent outcomes can be obtained in a well-informed motivated patient.

  8. Wearable impedance monitoring system for dialysis patients.

    PubMed

    Bonnet, S; Bourgerette, A; Gharbi, S; Rubeck, C; Arkouche, W; Massot, B; McAdams, E; Montalibet, A; Jallon, P

    2016-08-01

    This paper describes the development and the validation of a prototype wearable miniaturized impedance monitoring system for remote monitoring in home-based dialysis patients. This device is intended to assess the hydration status of dialysis patients using calf impedance measurements. The system is based on the low-power AD8302 component. The impedance calibration procedure is described together with the Cole parameter estimation and the hydric volume estimation. Results are given on a test cell to validate the design and on preliminary calf measurements showing Cole parameter variations during hemodialysis.

  9. Barriers to exercise participation among dialysis patients

    PubMed Central

    Johansen, Kirsten L.

    2012-01-01

    Background. Physical inactivity is a strong predictor of mortality in patients with end-stage renal disease and is associated with poor physical functioning. Patients with end-stage renal disease are inactive even compared to sedentary individuals without kidney disease. We sought to identify patient barriers to physical activity. Methods. Adult patients on hemodialysis in the San Francisco Bay Area were recruited and asked to complete a study survey composed of questions about self-reported level of physical functioning, physical activity participation, patient physical activity preference and barriers to physical activity. Univariate and multivariable linear regression analyses were performed to study the association between barriers to physical activity and participation in physical activity. Results. A total of 100 patients participated in the study, the majority of whom were male (73%), with a mean age of 60 ± 15 years. Twenty-seven percent identified themselves as white, 30% black and 21% Hispanic. The majority of participants strongly agreed that a sedentary lifestyle was a health risk (98%) and that increasing exercise was a benefit (98%). However, 92% of participants reported at least one barrier to physical activity. The most commonly reported barriers were fatigue on dialysis days and non-dialysis days (67 and 40%, respectively) and shortness of breath (48%). In multivariate analysis, a greater number of reported barriers was associated with lower levels of physical activity (P < 0.02). Post-dialysis fatigue was not associated with differences in activity level in multivariate analysis. Lack of motivation was associated with less physical activity. Endorsement of too many medical problems and not having enough time on dialysis days were also associated with less activity in adjusted analysis. Conclusion. We have identified a number of barriers to physical activity that can be addressed in studies aimed at increasing levels of physical activity

  10. [Educational scheme for patients on home peritoneal dialysis in Spain].

    PubMed

    Cirera Segura, F; Martín Espejo, J L; Reina Neyra, M

    2008-01-01

    The objective of the present study is to obtain information about the training programme for patients undergoing Domiciliary Peritoneal Dialysis (DPD) in Spain. For the purposes of the study we designed a questionnaire comprising 50 closed-ended items and one open response item. The questionnaire was sent to 104 hospitals and was completed by 78.84% of them (n > or = 82). The average of patients undergoing peritoneal dialysis (PD) in the hospitals under study was 27.6: 15.8 of them receiving Chronic Ambulatory Peritoneal Dialysis (CAPD) and 11.8 Automatic Peritoneal Dialysis (APD). The questionnaire also served to investigate into the training methodology used in the different units, the involvement of the family in the programme, the basic knowledge patients received about Chronic Renal Insufficiency, the procedures associated with the therapy and the preparation they obtained to solve small-scale contingencies and emergency situations as well as the improvement of their quality of life. We also evaluated the training programme of autonomous patients on DPD and at the end of the questionnaire a blank space was left for facilities to add any comments or suggestions they considered relevant. From the results obtained we may conclude that most Spanish hospitals have devised a training planning for patients undergoing PD which helps them or caregivers to perform domiciliary treatment safely, provides them with basic knowledge about the disease and the routine procedures associated with the treatment, enables them to cope with contingencies and emergency situations and improves their quality of life during the dialysis period.

  11. UK Renal Registry 16th annual report: chapter 15 epidemiology of reported infections amongst patients receiving dialysis for established renal Failure in England from May 2011 to April 2012: a joint report from Public Health England and the UK renal registry.

    PubMed

    Crowley, Lisa; Pitcher, David; Wilson, Jennie; Guy, Rebecca; Fluck, Richard

    2013-01-01

    Infection remains one of the leading causes of mortality in established renal failure patients receiving renal replacement therapy (RRT). Since 2007, centres providing RRT in England have been asked to provide additional data on patients with methicillin resistant Staphylococcus aureus (MRSA) bacteraemia. Since 2011, the option to provide data on methicillin sensitive Stapylococcus aureus (MSSA) and Escherichia coli bacteraemia, as well as Clostridium difficile infection has also been available. Data were submitted to Public Health England by laboratories via HCAI-DCS including whether the patients were receiving dialysis. Individual renal centres then confirmed the record either directly via the database or after being contacted. Data were collected for the period of the 1st May 2011 to the 30th April 2012. There were 49 episodes of MRSA bacteraemia, an overall rate of 0.22 per 100 dialysis patients per year, representing a further year on year fall in MRSA rate. There were a higher number of MSSA episodes, 322 in total, with an overall rate of 1.15 per 100 dialysis patients per year. The number of episodes and overall rate of E. coli and C. difficile were 284 and 0.92 per 100 prevalent dialysis patients per year and 172 and 0.61 per 100 prevalent dialysis patients per year respectively. In each infection type the presence of a central venous catheter appeared to correlate with an elevated risk. Data are presented from one year of infections reported to PHE. The rate of MRSA bacteraemia episodes in England continues to fall. There was a higher rate of MSSA infections amongst renal dialysis patients. Findings from the first year of E. coli and C. difficile data collection are also reported. Future cycles will give us a further idea of the trend in incidences of these infections. © 2014 S. Karger AG, Basel.

  12. Estimating residual kidney function in dialysis patients without urine collection.

    PubMed

    Shafi, Tariq; Michels, Wieneke M; Levey, Andrew S; Inker, Lesley A; Dekker, Friedo W; Krediet, Raymond T; Hoekstra, Tiny; Schwartz, George J; Eckfeldt, John H; Coresh, Josef

    2016-05-01

    Residual kidney function contributes substantially to solute clearance in dialysis patients but cannot be assessed without urine collection. We used serum filtration markers to develop dialysis-specific equations to estimate urinary urea clearance without the need for urine collection. In our development cohort, we measured 24-hour urine clearances under close supervision in 44 patients and validated these equations in 826 patients from the Netherlands Cooperative Study on the Adequacy of Dialysis. For the development and validation cohorts, median urinary urea clearance was 2.6 and 2.4 ml/min, respectively. During the 24-hour visit in the development cohort, serum β-trace protein concentrations remained in steady state but concentrations of all other markers increased. In the validation cohort, bias (median measured minus estimated clearance) was low for all equations. Precision was significantly better for β-trace protein and β2-microglobulin equations and the accuracy was significantly greater for β-trace protein, β2-microglobulin, and cystatin C equations, compared with the urea plus creatinine equation. Area under the receiver operator characteristic curve for detecting measured urinary urea clearance by equation-estimated urinary urea clearance (both 2 ml/min or more) were 0.821, 0.850, and 0.796 for β-trace protein, β2-microglobulin, and cystatin C equations, respectively; significantly greater than the 0.663 for the urea plus creatinine equation. Thus, residual renal function can be estimated in dialysis patients without urine collections.

  13. Pharmacotherapy of Hypertension in Chronic Dialysis Patients.

    PubMed

    Georgianos, Panagiotis I; Agarwal, Rajiv

    2016-11-07

    Among patients on dialysis, hypertension is highly prevalent and contributes to the high burden of cardiovascular morbidity and mortality. Strict volume control via sodium restriction and probing of dry weight are first-line approaches for the treatment of hypertension in this population; however, antihypertensive drug therapy is often needed to control BP. Few trials compare head-to-head the superiority of one antihypertensive drug class over another with respect to improving BP control or altering cardiovascular outcomes; accordingly, selection of the appropriate antihypertensive regimen should be individualized. To individualize therapy, consideration should be given to intra- and interdialytic pharmacokinetics, effect on cardiovascular reflexes, ability to treat comorbid illnesses, and adverse effect profile. β-Blockers followed by dihydropyridine calcium-channel blockers are our first- and second-line choices for antihypertensive drug use. Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers seem to be reasonable third-line choices, because the evidence base to support their use in patients on dialysis is sparse. Add-on therapy with mineralocorticoid receptor antagonists in specific subgroups of patients on dialysis (i.e., those with severe congestive heart failure) seems to be another promising option in anticipation of the ongoing trials evaluating their efficacy and safety. Adequately powered, multicenter, randomized trials evaluating hard cardiovascular end points are urgently warranted to elucidate the comparative effectiveness of antihypertensive drug classes in patients on dialysis. In this review, we provide an overview of the randomized evidence on pharmacotherapy of hypertension in patients on dialysis, and we conclude with suggestions for future research to address critical gaps in this important area.

  14. Pharmacokinetics of cefepime in patients undergoing continuous ambulatory peritoneal dialysis.

    PubMed Central

    Barbhaiya, R H; Knupp, C A; Pfeffer, M; Zaccardelli, D; Dukes, G M; Mattern, W; Pittman, K A; Hak, L J

    1992-01-01

    The pharmacokinetics of cefepime were studied in 10 male patients receiving continuous ambulatory peritoneal dialysis therapy. Five patients received a single 1,000-mg dose and the other five received a single 2,000-mg dose; all doses were given as 30-min intravenous infusions. Serial plasma, urine, and peritoneal dialysate samples were collected; and the concentrations of cefepime in these fluids were measured over 72 h by using a high-performance liquid chromatographic assay with UV detection. Pharmacokinetic parameters were calculated by noncompartmental methods. The peak concentrations in plasma and the areas under the plasma concentration-versus-time curve for the 2,000-mg dose group were twice as high as those observed for the 1,000-mg dose group. The elimination half-life of cefepime was about 18 h and was independent of the dose. The steady-state volume of distribution was about 22 liters, and values for the 1,000- and 2,000-mg doses were not significantly different. The values for total body clearance and peritoneal dialysis clearance were about 15 and 4 ml/min, respectively. No dose dependency was observed for the clearance estimates. Over the 72-h sampling period, about 26% of the dose was excreted intact into the peritoneal dialysis fluid. For 48 h postdose, mean concentrations of cefepime in dialysate at the end of each dialysis interval exceeded the reported MICs for 90% of the isolates (MIC90s) for bacteria which commonly cause peritonitis resulting from continuous peritoneal dialysis. A parenteral dose of 1,000 or 2,000 mg of cefepime every 48 h would maintain the antibiotic levels in plasma and peritoneal fluid above the MIC90s for the most susceptible bacteria for the treatment of systemic and intraperitoneal infections [corrected]. PMID:1510432

  15. Exploring Dynamic Risk Prediction for Dialysis Patients

    PubMed Central

    Ganssauge, Malte; Padman, Rema; Teredesai, Pradip; Karambelkar, Ameet

    2016-01-01

    Despite substantial advances in the treatment of end-stage renal disease, mortality of hemodialysis patients remains high. Several models exist that predict mortality for this population and identify patients at risk. However, they mostly focus on patients at a particular stage of dialysis treatment, such as start of dialysis, and only use the most recent patient data. Generalization of such models for predictions in later periods can be challenging since disease characteristics change over time and the evolution of biomarkers is not adequately incorporated. In this research, we explore dynamic methods which allow updates of initial predictions when patients progress in time and new data is observed. We compare a Dynamic Bayesian Network (DBN) to regularized logistic regression models and a Cox model with landmarking. Our preliminary results indicate that the DBN achieves satisfactory performance for short term prediction horizons, but needs further refinement and parameter tuning for longer horizons. PMID:28269937

  16. Factors influencing access to education, decision making, and receipt of preferred dialysis modality in unplanned dialysis start patients

    PubMed Central

    Machowska, Anna; Alscher, Mark Dominik; Reddy Vanga, Satyanarayana; Koch, Michael; Aarup, Michael; Qureshi, Abdul Rashid; Lindholm, Bengt; Rutherford, Peter A

    2016-01-01

    Objectives Unplanned dialysis start (UPS) leads to worse clinical outcomes than planned start, and only a minority of patients ever receive education on this topic and are able to make a modality choice, particularly for home dialysis. This study aimed to determine the predictive factors for patients receiving education, making a decision, and receiving their preferred modality choice in UPS patients following a UPS educational program (UPS-EP). Methods The Offering Patients Therapy Options in Unplanned Start (OPTiONS) study examined the impact of the implementation of a specific UPS-EP, including decision support tools and pathway improvement on dialysis modality choice. Linear regression models were used to examine the factors predicting three key steps: referral and receipt of UPS-EP, modality decision making, and actual delivery of preferred modality choice. A simple economic assessment was performed to examine the potential benefit of implementing UPS-EP in terms of dialysis costs. Results The majority of UPS patients could receive UPS-EP (214/270 patients) and were able to make a decision (177/214), although not all patients received their preferred choice (159/177). Regression analysis demonstrated that the initial dialysis modality was a predictive factor for referral and receipt of UPS-EP and modality decision making. In contrast, age was a predictor for referral and receipt of UPS-EP only, and comorbidity was not a predictor for any step, except for myocardial infarction, which was a weak predictor for lower likelihood of receiving preferred modality. Country practices predicted UPS-EP receipt and decision making. Economic analysis demonstrated the potential benefit of UPS-EP implementation because dialysis modality costs were associated with modality distribution driven by patient preference. Conclusion Education and decision support can allow UPS patients to understand their options and choose dialysis modality, and attention needs to be focused on

  17. Factors influencing access to education, decision making, and receipt of preferred dialysis modality in unplanned dialysis start patients.

    PubMed

    Machowska, Anna; Alscher, Mark Dominik; Reddy Vanga, Satyanarayana; Koch, Michael; Aarup, Michael; Qureshi, Abdul Rashid; Lindholm, Bengt; Rutherford, Peter A

    2016-01-01

    Unplanned dialysis start (UPS) leads to worse clinical outcomes than planned start, and only a minority of patients ever receive education on this topic and are able to make a modality choice, particularly for home dialysis. This study aimed to determine the predictive factors for patients receiving education, making a decision, and receiving their preferred modality choice in UPS patients following a UPS educational program (UPS-EP). The Offering Patients Therapy Options in Unplanned Start (OPTiONS) study examined the impact of the implementation of a specific UPS-EP, including decision support tools and pathway improvement on dialysis modality choice. Linear regression models were used to examine the factors predicting three key steps: referral and receipt of UPS-EP, modality decision making, and actual delivery of preferred modality choice. A simple economic assessment was performed to examine the potential benefit of implementing UPS-EP in terms of dialysis costs. The majority of UPS patients could receive UPS-EP (214/270 patients) and were able to make a decision (177/214), although not all patients received their preferred choice (159/177). Regression analysis demonstrated that the initial dialysis modality was a predictive factor for referral and receipt of UPS-EP and modality decision making. In contrast, age was a predictor for referral and receipt of UPS-EP only, and comorbidity was not a predictor for any step, except for myocardial infarction, which was a weak predictor for lower likelihood of receiving preferred modality. Country practices predicted UPS-EP receipt and decision making. Economic analysis demonstrated the potential benefit of UPS-EP implementation because dialysis modality costs were associated with modality distribution driven by patient preference. Education and decision support can allow UPS patients to understand their options and choose dialysis modality, and attention needs to be focused on ensuring equity of access to educational

  18. Serum irisin levels correlated to peritoneal dialysis adequacy in nondiabetic peritoneal dialysis patients.

    PubMed

    Tan, Zhijun; Ye, Zengchun; Zhang, Jun; Chen, Yanru; Cheng, Cailian; Wang, Cheng; Liu, Xun; Lou, Tanqi; Peng, Hui

    2017-01-01

    Irisin is a recently discovered myokine thought to be involved in multiple metabolism abnormalities in most dialysis patients. However, the myokine has not been thoroughly studied in peritoneal dialysis. This study aimed to evaluate serum irisin levels and establish their relation to dialysis adequacy, insulin resistance, and bone metabolism status in patients on peritoneal dialysis. A total of 59 nondiabetic prevalent peritoneal dialysis patients and 52 age- and sex-matched healthy controls were enrolled in this cross-sectional study. Serum irisin concentration was assessed by enzyme-linked immunosorbent assay. The correlations between serum irisin and dialysis adequacy, clinical, and metabolic variables were investigated. Serum irisin levels were lower in nondiabetic peritoneal dialysis patients (17.02ng/ml) compared with healthy controls (22.17ng/ml, P<0.001). Multivariate regression analysis revealed that fasting glucose levels were correlated inversely with serum irisin levels in peritoneal dialysis patients. Serum irisin levels were associated with neither insulin resistance nor bone metabolism in our patients. Serum irisin levels were positively associated with peritoneal Kt/Vurea (β = 4.933, 95% confidence interval [CI] = 0.536-9.331, P = 0.029) and peritoneal CCr (β = 0.259, 95% CI = 0.053-0.465, P = 0.015) among peritoneal dialysis patients. The study demonstrated that non-diabetic peritoneal dialysis patients have lower serum irisin levels, and the levels were correlated with peritoneal dialysis adequacy, indicating adequate dialysis may improve irisin secretion. Additional studies are needed to provide a confirmation.

  19. Serum irisin levels correlated to peritoneal dialysis adequacy in nondiabetic peritoneal dialysis patients

    PubMed Central

    Zhang, Jun; Chen, Yanru; Cheng, Cailian; Wang, Cheng; Liu, Xun; Lou, Tanqi; Peng, Hui

    2017-01-01

    Background Irisin is a recently discovered myokine thought to be involved in multiple metabolism abnormalities in most dialysis patients. However, the myokine has not been thoroughly studied in peritoneal dialysis. This study aimed to evaluate serum irisin levels and establish their relation to dialysis adequacy, insulin resistance, and bone metabolism status in patients on peritoneal dialysis. Methods A total of 59 nondiabetic prevalent peritoneal dialysis patients and 52 age- and sex-matched healthy controls were enrolled in this cross-sectional study. Serum irisin concentration was assessed by enzyme-linked immunosorbent assay. The correlations between serum irisin and dialysis adequacy, clinical, and metabolic variables were investigated. Results Serum irisin levels were lower in nondiabetic peritoneal dialysis patients (17.02ng/ml) compared with healthy controls (22.17ng/ml, P<0.001). Multivariate regression analysis revealed that fasting glucose levels were correlated inversely with serum irisin levels in peritoneal dialysis patients. Serum irisin levels were associated with neither insulin resistance nor bone metabolism in our patients. Serum irisin levels were positively associated with peritoneal Kt/Vurea (β = 4.933, 95% confidence interval [CI] = 0.536–9.331, P = 0.029) and peritoneal CCr (β = 0.259, 95% CI = 0.053–0.465, P = 0.015) among peritoneal dialysis patients. Conclusions The study demonstrated that non-diabetic peritoneal dialysis patients have lower serum irisin levels, and the levels were correlated with peritoneal dialysis adequacy, indicating adequate dialysis may improve irisin secretion. Additional studies are needed to provide a confirmation. PMID:28445520

  20. Satisfaction with care in peritoneal dialysis patients.

    PubMed

    Kirchgessner, J; Perera-Chang, M; Klinkner, G; Soley, I; Marcelli, D; Arkossy, O; Stopper, A; Kimmel, P L

    2006-10-01

    Patient satisfaction is an important aspect of dialysis care, only recently evaluated in clinical studies. We developed a tool to assess peritoneal dialysis (PD) customer satisfaction, and sought to evaluate and validate the Customer Satisfaction Questionnaire (CSQ), quantifying PD patient satisfaction. The CSQ included questions regarding administrative issues, Delivery Service, PD Training, Handling Requests, and transportation. The study was performed using interviews in all Hungarian Fresenius Medical Care dialysis centers offering PD. CSQ results were compared with psychosocial measures to identify if patient satisfaction was associated with perception of social support and illness burden, or depression. We assessed CSQ internal consistency and validity. Factor analysis explored potential underlying dimensions of the CSQ. One hundred and thirty-three patients treated with PD for end-stage renal disease for more than 3 months were interviewed. The CSQ had high internal consistency. There was high patient satisfaction with customer service. PD patient satisfaction scores correlated with quality of life (QOL) and social support measures, but not with medical or demographic factors, or depressive affect. The CSQ is a reliable tool to assess PD customer satisfaction. PD patient satisfaction is associated with perception of QOL. Efforts to improve customer satisfaction may improve PD patients' quantity as well as QOL.

  1. Setting Research Priorities for Patients on or Nearing Dialysis

    PubMed Central

    Hemmelgarn, Brenda; Lillie, Erin; Dip, Sally Crowe P.G.; Cyr, Annette; Gladish, Michael; Large, Claire; Silverman, Howard; Toth, Brenda; Wolfs, Wim; Laupacis, Andreas

    2014-01-01

    With increasing emphasis among health care providers and funders on patient-centered care, it follows that patients and their caregivers should be included when priorities for research are being established. This study sought to identify the most important unanswered questions about the management of kidney failure from the perspective of adult patients on or nearing dialysis, their caregivers, and the health care professionals who care for these patients. Research uncertainties were identified through a national Canadian survey of adult patients on or nearing dialysis, their caregivers, and health care professionals. Uncertainties were refined by a steering committee that included patients, caregivers, researchers, and clinicians to assemble a short-list of the top 30 uncertainties. Thirty-four people (11 patients; five caregivers; eight physicians; six nurses; and one social worker, pharmacist, physiotherapist, and dietitian each) from across Canada subsequently participated in a workshop to determine the top 10 research questions. In total, 1570 usable research uncertainties were received from 317 respondents to the survey. Among these, 259 unique uncertainties were identified; after ranking, these were reduced to a short-list of 30 uncertainties. During the in-person workshop, the top 10 research uncertainties were identified, which included questions about enhanced communication among patients and providers, dialysis modality options, itching, access to kidney transplantation, heart health, dietary restrictions, depression, and vascular access. These can be used alongside the results of other research priority–setting exercises to guide researchers in designing future studies and inform health care funders. PMID:24832095

  2. 42 CFR 414.316 - Payment for physician services to patients in training for self-dialysis and home dialysis.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... training for self-dialysis and home dialysis. 414.316 Section 414.316 Public Health CENTERS FOR MEDICARE... Program § 414.316 Payment for physician services to patients in training for self-dialysis and home dialysis. (a) For each patient, the carrier pays a flat amount that covers all physician services required...

  3. 42 CFR 414.316 - Payment for physician services to patients in training for self-dialysis and home dialysis.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... training for self-dialysis and home dialysis. 414.316 Section 414.316 Public Health CENTERS FOR MEDICARE... Program § 414.316 Payment for physician services to patients in training for self-dialysis and home dialysis. (a) For each patient, the carrier pays a flat amount that covers all physician services required...

  4. 42 CFR 414.316 - Payment for physician services to patients in training for self-dialysis and home dialysis.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... training for self-dialysis and home dialysis. 414.316 Section 414.316 Public Health CENTERS FOR MEDICARE... Program § 414.316 Payment for physician services to patients in training for self-dialysis and home dialysis. (a) For each patient, the carrier pays a flat amount that covers all physician services required...

  5. Healing of fracturing-bone disease occurring in patients on dialysis. A prospective study.

    PubMed

    Milne, F J; Hudson, G A; Meyers, A M; Baily, P; Barmeir, E; Dubowitz, B; Reis, P

    1982-06-19

    Ten patients developed fracturing-bone disease (osteomalacia) while on dialysis against water with high levels of aluminium. Eight patients remained on dialysis, using de-ionized or reverse-osmosis water, and 2 received a renal transplant. Clinical improvement as regards bone pain and proximal muscle weakness occurred in 6 months and radiographic evidence of healing of the pseudofractures was seen at approximately 12 months. Associated osteopenia and hyperparathyroidism were found in most patients, but no significant change in either was noted during the study period. The serum parathyroid hormone levels rose significantly in the patients who remained on dialysis. The chest and pelvic deformities typical of healed osteomalacia were seen. This dramatic improvement can only be attributed to the removal of some water-borne element, either by changing the water used in the dialysis or by successful renal transplantation. Aluminium-containing phosphate binders were used throughout the study in the patients on dialysis, and hypophosphataemia was never a feature.

  6. [Nutritional status of patients undergoing peritoneal dialysis].

    PubMed

    Bober, Joanna; Mazur, Olech; Gołembiewska, Edyta; Bogacka, Anna; Sznabel, Karina; Stańkowska-Walczak, Dobrosława; Kabat-Koperska, Joanna; Stachowska, Ewa

    2015-01-01

    The main causes of death in patients undergoing dialysis are cardiovascular diseases. Their presence is related to the nutritional status of patients treated with peritoneal dialysis, and has a predicted value in this kind of patient. Long-term therapy entails unfavourable changes, from which a clinically significant complication is protein-energy malnutrition and intensification of inflammatory processes. The aim of the study was to assess the nutritional status of patients with chronic kidney disease treated with peritoneal dialysis based on anthropometric, biochemical parameters analysis, a survey, as well as the determination of changes in measured parameters occurring over time. The study involved 40 people undergoing peritoneal dialysis (PD) and 30 healthy people. For dialyzed patients testing material was collected twice, every 6 months. Proteins, albumins, prealbumins, C-reactive protein and glucose levels were measured. Anthropometric measurements included body height, body weight, triceps skinfold and subscapular skinfold thickness. Body mass index (BMI) value and exponent of tissue protein source were calculated. The examined patients completed the questionnaire, which included, among other factors, the daily intake of nutrients, and lifestyle information. During the 6 month observation of the PD group a stastically significant increase in the energy value of intake food and amount of calories intake from carbohydrates was found. Analysis of nutritional status dependent on the BMI showed that overweight and obese patients are characterized by higher concentrations of the C-reactive protein and glucose, as well as lower concentrations of prealbumin compared to patients with normal body weight. At the same time, the energy value of food and the amount of protein in the group with BMI > 25 were smaller than in the other groups. During the 6 month observation a decrease the concentration of prealbumin and an increase in C-reactive protein in BMI > 25 group

  7. What is the best setting for receiving dialysis vascular access repair and maintenance services?

    PubMed

    El-Gamil, Audrey M; Dobson, Al; Manolov, Nikolay; DaVanzo, Joan E; Beathard, Gerald A; Foust Litchfield, Terry; Cowin, Brook

    2017-09-02

    Advances in dialysis vascular access (DVA) management have changed where beneficiaries receive this care. The effectiveness, safety, quality, and economy of different care settings have been questioned. This study compares patient outcomes of receiving DVA services in the freestanding office-based center (FOC) to those of the hospital outpatient department (HOPD). It also examines whether outcomes differ for a centrally managed system of FOCs (CMFOC) compared to all other FOCs (AOFOC). Retrospective cohort study of clinically and demographically similar patients within Medicare claims available through United States Renal Data System (USRDS) (2010-2013) who received at least 80% of DVA services in an FOC (n = 80,831) or HOPD (n = 133,965). Separately, FOC population is divided into CMFOC (n = 20,802) and AOFOC (n = 80,267). Propensity matching was used to control for clinical, demographic, and functional characteristics across populations. FOC patients experienced significantly better outcomes, including lower annual mortality (14.6% vs. 17.2%, p<0.001) and DVA-related infections (0.16 vs. 0.20, p<0.001), fewer hospitalizations (1.65 vs. 1.91, p<0.001), and lower total per-member-per-month (PMPM) payments ($5042 vs. $5361, p<0.001) than HOPD patients. CMFOC patients had lower annual mortality (12.5% vs. 13.8%, p<0.001), PMPM payments (DVA services) ($1486 vs. $1533, p<0.001) and hospitalizations ($1752 vs. $1816, p<0.001) than AOFOC patients. Where nephrologists send patients for DVA services can impact patient clinical and economic outcomes. This research confirmed that patients who received DVA care in the FOC had better outcomes than those treated in the HOPD. The organizational culture and clinical oversight of the CMFOC may result in more favorable outcomes than receiving care in AOFOC.

  8. Dialysis Facility and Patient Characteristics Associated with Utilization of Home Dialysis

    PubMed Central

    Walker, David R.; Inglese, Gary W.; Sloand, James A.

    2010-01-01

    Background and objectives: Nonmedical factors influencing utilization of home dialysis at the facility level are poorly quantified. Home dialysis is comparably effective and safe but less expensive to society and Medicare than in-center hemodialysis. Elimination of modifiable practice variation unrelated to medical factors could contribute to improvements in patient outcomes and use of scarce resources. Design, setting, participants, & measurements: Prevalent dialysis patient data by facility were collected from the 2007 ESRD Network’s annual reports. Facility characteristic data were collected from Medicare’s Dialysis Facility Compare file. A multivariate regression model was used to evaluate associations between the use of home dialysis and facility characteristics. Results: The utilization of home dialysis was positively associated with facility size, percent patients employed full- or part-time, younger population, and years a facility was Medicare certified. Variables negatively associated include an increased number of hemodialysis patients per hemodialysis station, chain association, rural location, more densely populated zip code, a late dialysis work shift, and greater percent of black patients within a zip code. Conclusions: Improved understanding of factors affecting the frequency of use of home dialysis may help explain practice variations across the United States that result in an imbalanced use of medical resources within the ESRD population. In turn, this may improve the delivery of healthcare and extend the ability of an increasingly overburdened medical financing system to survive. PMID:20634324

  9. Coronary artery calcification in Korean patients with incident dialysis.

    PubMed

    Bae, Eunjin; Seong, Eun Yong; Han, Byoung-Geun; Kim, Dong Ki; Lim, Chun Soo; Kang, Shin-Wook; Park, Cheol Whee; Kim, Chan-Duck; Shin, Byung Chul; Kim, Sung Gyun; Chung, Wookyung; Park, Jae Yoon; Lee, Joo Yeon; Kim, Yon Su

    2017-07-01

    Patients with chronic kidney disease have an extremely high risk of developing cardiovascular disease (CVD). In patients with end-stage renal disease (ESRD), coronary artery calcification (CAC) is associated with increased mortality from CVD. The present study aimed to investigate the risk factors for CAC in Korean patients with incident dialysis. Data on 423 patients with ESRD who started dialysis therapy between December 2012 and March 2014 were obtained from 10 university-affiliated hospitals. CAC was identified by using noncontrast-enhanced cardiac multidetector computed tomography. The CAC score was calculated according to the Agatston score, with CAC-positive subjects defined by an Agatston score >0. Patients' mean age was 55.6 ± 14.6 years, and 64.1% were men. The CAC-positive rate was 63.8% (270 of 423). Results of univariate analyses showed significant differences in age, sex, etiology of ESRD and comorbid conditions according to the CAC score. However, results of multiple regression analysis showed that only a higher age was significantly associated with the CAC score. Receiver operating characteristic curves showed that the sensitivity and specificity of L-spine radiography for diagnosing CAC were 56% and 91%, respectively, for diagnosing CAC (area under the curve, 0.735). CAC was frequent in patients with incident dialysis, and multiple regression analysis showed that only age was significantly associated with the CAC score. In addition, L-spine radiography could be a helpful modality for diagnosing CAC in patients with incident dialysis. © 2016 International Society for Hemodialysis.

  10. Disaster preparedness of dialysis patients for Hurricanes Gustav and Ike 2008.

    PubMed

    Kleinpeter, Myra A

    2009-01-01

    Hurricanes Katrina and Rita resulted in massive devastation of the Gulf Coast at Mississippi, Louisiana, and Texas during 2005. Because of those disasters, dialysis providers, nephrologists, and dialysis patients used disaster planning activities to work to mitigate the morbidity and mortality associated with the 2005 hurricane season for future events affecting dialysis patients. As Hurricane Gustav approached, anniversary events for Hurricane Katrina were postponed because of evacuation orders for nearly the entire Louisiana Gulf Coast. As part of the hurricane preparation, dialysis units reviewed the disaster plans of patients, and patients made preparation for evacuation. Upon evacuation, many patients returned to the dialysis units that had provided services during their exile from Hurricane Katrina; other patients went to other locations as part of their evacuation plan. Patients uniformly reported positive experiences with dialysis providers in their temporary evacuation communities, provided that those communities did not experience the effects of Hurricane Gustav. With the exception of evacuees to Baton Rouge, patients continued to receive their treatments uninterrupted. Because of extensive damage in the Baton Rouge area, resulting in widespread power losses and delayed restoration of power to hospitals and other health care facilities, some patients missed one treatment. However, as a result of compliance with disaster fluid and dietary recommendations, no adverse outcomes occurred. In most instances, patients were able to return to their home dialysis unit or a nearby unit to continue dialysis treatments within 4 - 5 days of Hurricane Gustav. Hurricane Ike struck the Texas Gulf Coast near Galveston, resulting in devastation of that area similar to the devastation seen in New Orleans after Katrina. The storm surge along the Louisiana Gulf Coast resulted in flooding that temporarily closed coastal dialysis units. Patients were prepared and experienced

  11. The impact of patient preference on dialysis modality and hemodialysis vascular access.

    PubMed

    Keating, Patrick T; Walsh, Michael; Ribic, Christine M; Brimble, Kenneth Scott

    2014-02-22

    Home-based dialysis, including peritoneal dialysis (PD) and home hemodialysis (HHD), is associated with improved health related quality of life and reduced health resource costs. It is uncertain to what extent initial preferences for dialysis modality influence the first dialysis therapy actually utilized. We examined the relationship between initial dialysis modality choice and first dialysis therapy used. Patients with chronic kidney disease (CKD) from a single centre who started dialysis after receiving modality education were included in this study. Multivariable logistic regression models were constructed to assess the independent association of patient characteristics and initial dialysis modality choice with actual dialysis therapy used and starting hemodialysis (HD) with a central venous catheter (CVC). Of 299 eligible patients, 175 (58.5%) initially chose a home-based therapy and 102 (58.3%) of these patients' first actual dialysis was a home-based therapy. Of the 89 patients that initially chose facility-based HD, 84 (94.4%) first actual dialysis was facility-based HD. The adjusted odds ratio (OR) for first actual dialysis as a home-based therapy was 29.0 for patients intending to perform PD (95% confidence interval [CI] 10.7-78.8; p < 0.001) and 12.4 for patients intending to perform HHD (95% CI 3.29-46.6; p < 0.001). Amongst patients whose first actual dialysis was HD, an initial choice of PD or not choosing a modality was associated with an increased risk of starting dialysis with a CVC (adjusted OR 3.73, 95% CI 1.51-9.21; p = 0.004 and 4.58, 95% CI 1.53-13.7; p = 0.007, respectively). Although initially choosing a home-based therapy substantially increases the probability of the first actual dialysis being home-based, many patients who initially prefer a home-based therapy start with facility-based HD. Programs that continually re-evaluate patient preferences and reinforce the values of home based therapies that led to the initial preference may

  12. [Patient education in pre-dialysis -- patient-led forums].

    PubMed

    Heatley, S A

    2006-01-01

    In order for patients to make an informed choice about renal replacement therapies, it is important that they are given sufficient and appropriate information, which must include explanations about their condition and likely outcomes with or without treatment. Furthermore information regarding the reality of living with dialysis, its strict regimes and patient's commitment to self care are imperative to enable patients to adapt to a life changing, ongoing, often relentless treatment. Encouraging patients to take control of their chronic illness through the provision of education support and choice is fundamental to the successful outcomes of the patient's journey through the pre-dialysis phase of their illness. This paper describes the implementation of Patient-led Forums designed to offer an education programme for pre-dialysis patients and the benefits gained by those who have attended.

  13. First year survival of patients on maintenance dialysis treatment in Poland

    PubMed Central

    Brodowska-Kania, Dorota; Rymarz, Aleksandra; Gibin´ski, Krzysztof; Kiełczewska, Julia; Smoszna, Jerzy; Saracyn, Marek; Szamotulska, Katarzyna; Niemczyk, Stanisław

    2015-01-01

    ABSTRACT Retrospective analysis of demographic and clinical data of all patients starting dialysis over two years in our Department (n = 105) has been conducted. Factors such as type of dialysis treatment, reason of end-stage renal disease, Body Mass Index (BMI), laboratory tests results, number and cause of death during first year of dialysis were taken under consideration. Five patients have been excluded from the analysis of mortality (four received renal transplantation, one changed dialysis center). Twenty tree deaths have been noted during first year of dialysis treatment. Nine of them occurred during the first three months of therapy. The leading cause of death was cardio-vascular events (n = 14, 60.9%), the second was malignancy (8, 34,8%), one patient died due to catheter associated infection. Malignancy as a cause of end-stage renal disease, lack of outpatient nephrology care, acute mode of beginning renal replacement therapy and lack of erythropoiesis stimulating agents therapy were associated with higher risk of all-cause mortality during first year of dialysis. Being under the outpatient nephrology care, etiology of ESRD other than malignancy and erythropoiesis stimulating agents therapy were independently associated with better survival during this period of time. Other independent variables did not reach statistical significance. To conclude, in order to improve one year survival of dialysis patients, outpatient nephrology care with adequate amount of visits and associated dialysis therapy should be employed. PMID:26663941

  14. Recent advances in the management of peritoneal dialysis patients

    PubMed Central

    2015-01-01

    Peritoneal dialysis is a form of kidney dialysis that is used to remove accumulated metabolic waste products and water in patients with end stage kidney disease. Long-term exposure to high concentrations of glucose and its by-products, both found in peritoneal dialysis fluid, has been implicated in contributing to peritoneal damage over time, in turn limiting long-term use of the technique. Newer peritoneal dialysis solutions have been developed in the hope of reducing the unfavorable effects of peritoneal dialysis solutions. In vitro and in vivo studies have suggested that newer peritoneal dialysis fluids have salutary effects on the peritoneal membrane. Short-term clinical studies have also found some metabolic benefits of glucose-sparing regimens in chronic peritoneal dialysis. Mixed results have been found in studies examining whether newer peritoneal dialysis fluids reduce peritonitis rates. Long-term studies are needed to investigate whether newer peritoneal dialysis fluids provide better peritoneal dialysis technique and/or patient survival, compared to standard glucose-based peritoneal dialysis fluids. PMID:26097730

  15. Relationship of aluminum to neurocognitive dysfunction in chronic dialysis patients

    SciTech Connect

    Sprague, S.M.; Corwin, H.L.; Tanner, C.M.; Wilson, R.S.; Green, B.J.; Goetz, C.G.

    1988-10-01

    Aluminum has been proposed as the causative agent in dialysis encephalopathy syndrome. We prospectively assessed whether other, less severe, neuropsychologic abnormalities were also associated with aluminum. A total of 16 patients receiving chronic dialytic therapy were studied. The deferoxamine infusion test (DIT) was used to assess total body aluminum burden. Neurologic function was evaluated by quantitative measures of asterixis, myoclonus, motor strength, and sensation. Cognitive function was assessed by measures of dementia, memory, language, and depression. There were four patients with a positive DIT (greater than 125 micrograms/L increment in serum aluminum) that was associated with an increase in the number of neurologic abnormalities observed, as well as an increase in severity of myoclonus, asterixis, and lower extremity weakness. Patients with a positive DIT also showed significant impairment in memory; however, no differences were noted on tests of dementia, depression, or language. There was no significant correlation between sex, age, presence of diabetes, mode of dialysis, years of chronic renal failure, years of dialysis or years of aluminum ingestion and any neurologic or neurobehavioral measurement, serum aluminum level, or DIT. These changes may represent early aluminum-associated neurologic dysfunction.

  16. Relationship of aluminum to neurocognitive dysfunction in chronic dialysis patients.

    PubMed

    Sprague, S M; Corwin, H L; Tanner, C M; Wilson, R S; Green, B J; Goetz, C G

    1988-10-01

    Aluminum has been proposed as the causative agent in dialysis encephalopathy syndrome. We prospectively assessed whether other, less severe, neuropsychologic abnormalities were also associated with aluminum. A total of 16 patients receiving chronic dialytic therapy were studied. The deferoxamine infusion test (DIT) was used to assess total body aluminum burden. Neurologic function was evaluated by quantitative measures of asterixis, myoclonus, motor strength, and sensation. Cognitive function was assessed by measures of dementia, memory, language, and depression. There were four patients with a positive DIT (greater than 125 micrograms/L increment in serum aluminum) that was associated with an increase in the number of neurologic abnormalities observed, as well as an increase in severity of myoclonus, asterixis, and lower extremity weakness. Patients with a positive DIT also showed significant impairment in memory; however, no differences were noted on tests of dementia, depression, or language. There was no significant correlation between sex, age, presence of diabetes, mode of dialysis, years of chronic renal failure, years of dialysis or years of aluminum ingestion and any neurologic or neurobehavioral measurement, serum aluminum level, or DIT. These changes may represent early aluminum-associated neurologic dysfunction.

  17. Roxadustat (FG-4592): Correction of Anemia in Incident Dialysis Patients.

    PubMed

    Besarab, Anatole; Chernyavskaya, Elena; Motylev, Igor; Shutov, Evgeny; Kumbar, Lalathaksha M; Gurevich, Konstantin; Chan, Daniel Tak Mao; Leong, Robert; Poole, Lona; Zhong, Ming; Saikali, Khalil G; Franco, Marietta; Hemmerich, Stefan; Yu, Kin-Hung Peony; Neff, Thomas B

    2016-04-01

    Safety concerns with erythropoietin analogues and intravenous (IV) iron for treatment of anemia in CKD necessitate development of safer therapies. Roxadustat (FG-4592) is an orally bioavailable hypoxia-inducible factor (HIF) prolyl hydroxylase inhibitor that promotes coordinated erythropoiesis through HIF-mediated transcription. We performed an open-label, randomized hemoglobin (Hb) correction study in anemic (Hb≤10.0 g/dl) patients incident to hemodialysis (HD) or peritoneal dialysis (PD). Sixty patients received no iron, oral iron, or IV iron while treated with roxadustat for 12 weeks. Mean±SD baseline Hb was 8.3±1.0 g/dl in enrolled patients. Roxadustat at titrated doses increased mean Hb by ≥2.0 g/dl within 7 weeks regardless of baseline iron repletion status, C-reactive protein level, iron regimen, or dialysis modality. Mean±SEM maximal change in Hb from baseline (ΔHb(max)), the primary endpoint, was 3.1±0.2 g/dl over 12 weeks in efficacy-evaluable patients (n=55). In groups receiving oral or IV iron, ΔHb(max) was similar and larger than in the no-iron group. Hb response (increase in Hb of ≥1.0 g/dl from baseline) was achieved in 96% of efficacy-evaluable patients. Mean serum hepcidin decreased significantly 4 weeks into study: by 80% in HD patients receiving no iron (n=22), 52% in HD and PD patients receiving oral iron (n=21), and 41% in HD patients receiving IV iron (n=9). In summary, roxadustat was well tolerated and corrected anemia in incident HD and PD patients, regardless of baseline iron repletion status or C-reactive protein level and with oral or IV iron supplementation; it also reduced serum hepcidin levels.

  18. Pazopanib in Renal Cell Carcinoma Dialysis Patients: A Mini-Review and a Case Report.

    PubMed

    Bersanelli, Melissa; Facchinetti, Francesco; Tiseo, Marcello; Maiorana, Mariarosa; Buti, Sebastiano

    2016-01-01

    Sporadic data are available about pazopanib use in patients with metastatic renal cell carcinoma (mRCC) undergoing dialysis and no systematic review has been previously performed about this issue. The objective of the present mini-review is to provide an overview of clinical outcomes of pazopanib in this population, in order to support the clinical oncologist for the treatment choice and management. All the literature ever published about mRCC dialysis patients receiving pazopanib, until August 2015, was evaluated: only two case series emerged from our search and one more patient from our department was also included, with a total of 11 mRCC dialysis patients overall. Moreover, we described our case of intrapatient dose titration of pazopanib during dialysis. The continued treatment schedule, the short half-life, the predominantly hepatic metabolism, the wide possibility of dose modulation, the favorable tolerability profile and the similar efficacy respect to sunitinib represent factors in favor of pazopanib as first line mRCC treatment in dialysis patients. The knowledge and the good management of toxicity during pazopanib treatment can lead, also in dialysis patients, to the best and longest application of the drug, taking into account the concept of a dose escalation guided by toxicity as a marker of efficacy. The review, together with our single case report, confirmed the efficacy, the good tolerability and the maneuverability of pazopanib treatment in mRCC patients undergoing dialysis.

  19. Shewanella algae Peritonitis in Patients on Peritoneal Dialysis.

    PubMed

    Shanmuganathan, Malini; Goh, Bak Leong; Lim, Christopher; NorFadhlina, Zakaria; Fairol, Ibrahim

    Patients with peritonitis present with abdominal pain, diarrhea, fever, and turbid peritoneal dialysis (PD) fluid. Shewanella algae peritonitis has not yet been reported in PD patients in the literature. We present the first 2 cases of Shewanella algae peritonitis in PD patients. Mupirocin cream is applied on the exit site as prophylactic antibiotic therapy. Copyright © 2016 International Society for Peritoneal Dialysis.

  20. Understanding by older patients of dialysis and conservative management for chronic kidney failure.

    PubMed

    Tonkin-Crine, Sarah; Okamoto, Ikumi; Leydon, Geraldine M; Murtagh, Fliss E M; Farrington, Ken; Caskey, Fergus; Rayner, Hugh; Roderick, Paul

    2015-03-01

    Older adults with chronic kidney disease stage 5 may be offered a choice between dialysis and conservative management. Few studies have explored patients' reasons for choosing conservative management and none have compared the views of those who have chosen different treatments across renal units. Qualitative study with semistructured interviews. Patients 75 years or older recruited from 9 renal units. Units were chosen to reflect variation in the scale of delivery of conservative management. Semistructured interviews audiorecorded and transcribed verbatim. Data were analyzed using thematic analysis. 42 interviews were completed, 4 to 6 per renal unit. Patients were sampled from those receiving dialysis, those preparing for dialysis, and those choosing conservative management. 14 patients in each group were interviewed. Patients who had chosen different treatments held varying beliefs about what dialysis could offer. The information that patients reported receiving from clinical staff differed between units. Patients from units with a more established conservative management pathway were more aware of conservative management, less often believed that dialysis would guarantee longevity, and more often had discussed the future with staff. Some patients receiving conservative management reported that they would have dialysis if they became unwell in the future, indicating the conditional nature of their decision. Recruitment of older adults with frailty and comorbid conditions was difficult and therefore transferability of findings to this population is limited. Older adults with chronic kidney disease stage 5 who have chosen different treatment options have contrasting beliefs about the likely outcomes of dialysis for those who are influenced by information provided by renal units. Supporting renal staff in discussing conservative management as a valid alternative to dialysis for a subset of patients will aid informed decision making. There is a need for better

  1. Prevalence of Cognitive Impairment Among Peritoneal Dialysis Patients, Impact on Peritonitis and Role of Assisted Dialysis.

    PubMed

    Shea, Yat Fung; Lam, Man Fai; Lee, Mi Suen Connie; Mok, Ming Yee Maggie; Lui, Sing-Leung; Yip, Terence P S; Lo, Wai Kei; Chu, Leung Wing; Chan, Tak-Mao

    2016-01-01

    ♦ Chronic renal failure and aging are suggested as risk factors for cognitive impairment (CI). We studied the prevalence of CI among peritoneal dialysis (PD) patients using Montreal Cognitive Assessment (MoCA), its impact on PD-related peritonitis in the first year, and the potential role of assisted PD. ♦ One hundred fourteen patients were newly started on PD between February 2011 and July 2013. Montreal Cognitive Assessment was performed in the absence of acute illness. Data on patient characteristics including demographics, comorbidities, blood parameters, dialysis adequacy, presence of helpers, medications, and the number PD-related infections were collected. ♦ The age of studied patients was 59±15.0 years, and 47% were female. The prevalence of CI was 28.9%. Patients older than 65 years old (odds ratio [OR] 4.88, confidence interval [CI] 1.79 - 13.28 p = 0.002) and with an education of primary level or below (OR 4.08, CI 1.30 - 12.81, p = 0.016) were independent risk factors for CI in multivariate analysis. Patients with PD-related peritonitis were significantly older (p < 0.001) and more likely to have CI as defined by MoCA (p = 0.035). After adjustment for age, however, CI was not a significant independent risk factor for PD-related peritonitis among self-care PD patients (OR 2.20, CI 0.65 - 7.44, p = 0.20). When we compared patients with MoCA-defined CI receiving self-care and assisted PD, there were no statistically significant differences between the 2 groups in terms of age, MoCA scores, or comorbidities. There were also no statistically significant differences in 1-year outcome of PD-related peritonitis rates or exit-site infections. ♦ Cognitive impairment is common among local PD patients. Even with CI, peritonitis rate in self-care PD with adequate training is similar to CI patients on assisted PD. Copyright © 2016 International Society for Peritoneal Dialysis.

  2. Patient perspectives on informed decision-making surrounding dialysis initiation

    PubMed Central

    Song, Mi-Kyung; Lin, Feng-Chang; Gilet, Constance A.; Arnold, Robert M.; Bridgman, Jessica C.; Ward, Sandra E.

    2013-01-01

    Background Careful patient–clinician shared decision-making about dialysis initiation has been promoted, but few studies have addressed patient perspectives on the extent of information provided and how decisions to start dialysis are made. Methods Ninety-nine maintenance dialysis patients recruited from 15 outpatient dialysis centers in North Carolina completed semistructured interviews on information provision and communication about the initiation of dialysis. These data were examined with content analysis. In addition, informed decision-making (IDM) scores were created by summing patient responses (yes/no) to 10 questions about the decision-making. Results The mean IDM score was 4.4 (of 10; SD = 2.0); 67% scored 5 or lower. Age at the time of decision-making (r = −0.27, P = 0.006), years of education (r = 0.24, P = 0.02) and presence of a warning about progressing to end-stage kidney disease (t = 2.9, P = 0.005) were significantly associated with IDM scores. Nearly 70% said that the risks and burdens of dialysis were not mentioned at all, and only one patient recalled that the doctor offered the option of not starting dialysis. While a majority (67%) said that they felt they had no choice about starting dialysis (because the alternative would be death) or about dialysis modality, only 21.2% said that they had felt rushed to make a decision. About one-third of the patients perceived that the decision to start dialysis and modality was already made by the doctor. Conclusions A majority of patients felt unprepared and ill-informed about the initiation of dialysis. Improving the extent of IDM about dialysis may optimize patient preparation prior to starting treatment and their perceptions about the decision-making process. PMID:23901048

  3. Evaluation of dialysis adequacy in hemodialysis patients: A systematic review.

    PubMed

    Barzegar, Hengameh; Moosazadeh, Mahmoud; Jafari, Hedayat; Esmaeili, Ravanbakhsh

    2016-08-25

    Hemodialysis is the common kidney replacement therapy in Iran. Doing an adequate and effective dialysis can improve patients' quality of life and reduce kidney failure complications. Additionally, dialysis quality is an important factor in reducing mortality in patients with chronic kidney failure. This systematic review has investigated the adequacy of dialysis in studies done on hemodialysis patients of Iran. All articles related to the dialysis adequacy in hemodialysis patients in English and Farsi (contemporary Persian) were identified by searching the related keywords in various electronic databases. According to the inclusion criteria 21 studies were identified. The results were analyzed using Stata software version 11. A number of 6677 patients had been enrolled in 21 studies that were chosen for this systematic review. Based on the random effects model, the overall dialysis adequacy (KT/V) (K: clearance of urea, T: duration of dialysis, V: distribution of urea) more than 1.2 and confidence interval were 36.3% and 46.2-26.4, respectively. Also, based on random effects model more than 65% urea reduction ratio in all studies was 28.8% and the confidence interval was 43.3-14.4. KT/V and urea reduction ratio were much less desirable in hemodialysis patients and the dialysis quality was also undesirable. It seems that inadequate dialysis prescription, use of inappropriate filters, low pump speed (blood flow speed), and the short duration and few times of dialysis are the major causes of this inadequacy. .

  4. Longitudinal measures of serum albumin and prealbumin concentrations in incident dialysis patients: the comprehensive dialysis study.

    PubMed

    Dalrymple, Lorien S; Johansen, Kirsten L; Chertow, Glenn M; Grimes, Barbara; Anand, Shuchi; McCulloch, Charles E; Kaysen, George A

    2013-03-01

    Serum albumin and prealbumin concentrations are strongly associated with the risk of death in dialysis patients. Our study examined the association among demographic characteristics, body composition, comorbidities, dialysis modality and access, inflammation, and longitudinal measures of albumin and prealbumin concentrations in incident dialysis patients. DESIGN, SETTING, SUBJECTS, AND OUTCOME MEASURES: The Comprehensive Dialysis Study is a prospective cohort study of incident dialysis patients; in this report, we examined the data from 266 Nutrition substudy participants who donated serum. The independent variables of interest were baseline age, sex, race, Quetélet's (body mass) index, dialysis modality and access, diabetes, heart failure, atherosclerotic vascular disease, serum creatinine level, and longitudinal measures of C-reactive protein. The outcomes of interest (dependent variables) were longitudinal measures of albumin and prealbumin concentrations, recorded at study entry and thereafter every 3 months for 1 year. In multivariable mixed linear models, female sex, peritoneal dialysis, hemodialysis with a catheter, and higher C-reactive protein concentrations were associated with lower serum albumin concentrations, and serum albumin concentrations increased slightly over the year. In comparison, prealbumin concentrations did not significantly change over time; female sex, lower body mass index, diabetes, atherosclerotic vascular disease, and higher C-reactive protein concentrations were associated with lower prealbumin concentrations. Serum creatinine had a curvilinear relation with serum albumin and prealbumin. Serum albumin level increases early in the course of dialysis, whereas prealbumin level does not, and the predictors of serum concentrations differ at any given time. Further understanding of the mechanisms underlying differences between albumin and prealbumin kinetics in dialysis patients may lead to an improved approach to the management of

  5. Understanding by Older Patients of Dialysis and Conservative Management for Chronic Kidney Failure

    PubMed Central

    Tonkin-Crine, Sarah; Okamoto, Ikumi; Leydon, Geraldine M.; Murtagh, Fliss E.M.; Farrington, Ken; Caskey, Fergus; Rayner, Hugh; Roderick, Paul

    2015-01-01

    Background Older adults with chronic kidney disease stage 5 may be offered a choice between dialysis and conservative management. Few studies have explored patients’ reasons for choosing conservative management and none have compared the views of those who have chosen different treatments across renal units. Study Design Qualitative study with semistructured interviews. Settings & Participants Patients 75 years or older recruited from 9 renal units. Units were chosen to reflect variation in the scale of delivery of conservative management. Methodology Semistructured interviews audiorecorded and transcribed verbatim. Analytical Approach Data were analyzed using thematic analysis. Results 42 interviews were completed, 4 to 6 per renal unit. Patients were sampled from those receiving dialysis, those preparing for dialysis, and those choosing conservative management. 14 patients in each group were interviewed. Patients who had chosen different treatments held varying beliefs about what dialysis could offer. The information that patients reported receiving from clinical staff differed between units. Patients from units with a more established conservative management pathway were more aware of conservative management, less often believed that dialysis would guarantee longevity, and more often had discussed the future with staff. Some patients receiving conservative management reported that they would have dialysis if they became unwell in the future, indicating the conditional nature of their decision. Limitations Recruitment of older adults with frailty and comorbid conditions was difficult and therefore transferability of findings to this population is limited. Conclusions Older adults with chronic kidney disease stage 5 who have chosen different treatment options have contrasting beliefs about the likely outcomes of dialysis for those who are influenced by information provided by renal units. Supporting renal staff in discussing conservative management as a valid

  6. Views of Japanese patients on the advantages and disadvantages of hemodialysis and peritoneal dialysis.

    PubMed

    Nakamura-Taira, Nanako; Muranaka, Yoshimi; Miwa, Masako; Kin, Seikon; Hirai, Kei

    2013-08-01

    The preference for dialysis modalities is not well understood in Japan. This study explored the subjective views of Japanese patients undergoing dialysis regarding their treatments. The participants were receiving in-center hemodialysis (CHD) or continuous ambulatory peritoneal dialysis (CAPD). In Study 1, 34 participants (17 CHD and 17 CAPD) were interviewed about the advantages and disadvantages of dialysis modalities. In Study 2, 454 dialysis patients (437 CHD and 17 CAPD) rated the advantages and disadvantages of CHD and CAPD in a cross-sectional survey. Interviews showed that professional care and dialysis-free days were considered as advantages of CHD, while independence, less hospital visits, and flexibility were considered as advantages of CAPD. Disadvantages of CHD included restriction of food and fluids and unpleasant symptoms after each dialysis session. Catheter care was an additional disadvantage of CAPD. Survey showed that the highly ranked advantages were professional care in CHD and less frequent hospital visits in CAPD, while the highly ranked disadvantages were concerns about emergency and time restrictions in CHD, and catheter care and difficulty in soaking in a bath in CAPD. The total scores of advantages and disadvantages showed that CHD patients subjectively rated their own modality better CHD over CAPD, while CAPD patients had the opposite opinion. The results of this study indicate that the factors affecting the decision-making process of Japanese patients are unique to Japanese culture, namely considering the trouble caused to the people around patients (e.g., families, spouses, and/or caregivers).

  7. Torque teno virus among dialysis and renal-transplant patients.

    PubMed

    Takemoto, Angélica Yukari; Okubo, Patrícia; Saito, Patricia Keiko; Yamakawa, Roger Haruki; Watanabe, Maria Angélica Ehara; Veríssimo da Silva Junior, Waldir; Borelli, Sueli Donizete; Bedendo, João

    2015-03-01

    Patients who undergo dialysis treatment or a renal transplant have a high risk of blood-borne viral infections, including the Torque teno virus (TTV). This study identified the presence of TTV and its genome groups in blood samples from 118 patients in dialysis and 50 renal-transplant recipients. The research was conducted in a hospital in the city of Maringá, state of Paraná. The viral DNA, obtained from whole blood, was identified by using two nested Polymerase Chain Reactions (PCR). The frequencies of TTV were 17% and 36% in dialysis patients using the methodology proposed by Nishizawa et al . (1997) and Devalle and Niel (2004) , respectively, and 10% and 54% among renal-transplant patients. There was no statistically significant association between the frequency of the pathogen and the variables: gender, time in dialysis, time since transplant, blood transfusions, and the concomitant presence of hepatitis B, for either the dialysis patients or the renal-transplant recipients. Among dialysis patients and renal-transplant recipients, genogroup 5 was predominant (48% and 66% respectively), followed by genogroup 4 (37% and 48%) and genogroup 1 (23% and 25%). Genogroup 2 was present in both groups of patients. Some patients had several genogroups, but 46% of the dialysis patients and 51% of the renal-transplant recipients had only a single genogroup. This study showed a high prevalence of TTV in dialysis patients and renal-transplant recipients.

  8. Are Non-cardiac Surgeries Safe for Dialysis Patients? – A Population-Based Retrospective Cohort Study

    PubMed Central

    Cherng, Yih-Giun; Liao, Chien-Chang; Chen, Tso-Hsiao; Xiao, Duan

    2013-01-01

    Background End-stage renal disease represents a risk complex that complicates surgical results. The surgical outcomes of dialysis patients have been studied in specific fields, but the global features of postoperative adverse outcomes in dialysis patients receiving non-cardiac surgeries have not been examined. Methods Taiwan’s National Health Insurance Research Database was used to study 8,937 patients under regular dialysis with 8,937 propensity-score matched-pair controls receiving non-cardiac surgery between 2004 and 2007. We investigated the influence of hemodialysis and peritoneal dialysis, effects of hypertension and diabetes, and impact of additional comorbidities on postoperative adverse outcomes. Results Postoperative mortality in dialysis patients was higher than in controls (odds ratio [OR] 3.33, 95% confidence interval [CI] 2.56 to 4.33) when receiving non-cardiac surgeries. Complications such as acute myocardial infarction, pneumonia, bleeding, and septicemia were significantly increased. Postoperative mortality was significantly increased among peritoneal dialysis patients (OR 2.71, 95% CI 1.70 to 4.31) and hemodialysis patients (OR 3.42, 95% CI 2.62 to 4.47) than in controls. Dialysis patients with both hypertension and diabetes had the highest risk of postoperative complications; these risks increased with number of preoperative medical conditions. Patients under dialysis also showed significantly increased length of hospitalization, more ICU stays and higher medical expenditures. Conclusion Surgical patients under dialysis encountered significantly higher postoperative complications and mortality than controls when receiving non-cardiac surgeries. Different dialysis techniques, pre-existing hypertension/diabetes, and various comorbidities had complication-specific impacts on surgical adverse outcomes. These findings can help surgical teams provide better risk assessment and postoperative care for dialysis patients. PMID:23516581

  9. Setting research priorities for patients on or nearing dialysis.

    PubMed

    Manns, Braden; Hemmelgarn, Brenda; Lillie, Erin; Dip, Sally Crowe P G; Cyr, Annette; Gladish, Michael; Large, Claire; Silverman, Howard; Toth, Brenda; Wolfs, Wim; Laupacis, Andreas

    2014-10-07

    With increasing emphasis among health care providers and funders on patient-centered care, it follows that patients and their caregivers should be included when priorities for research are being established. This study sought to identify the most important unanswered questions about the management of kidney failure from the perspective of adult patients on or nearing dialysis, their caregivers, and the health care professionals who care for these patients. Research uncertainties were identified through a national Canadian survey of adult patients on or nearing dialysis, their caregivers, and health care professionals. Uncertainties were refined by a steering committee that included patients, caregivers, researchers, and clinicians to assemble a short-list of the top 30 uncertainties. Thirty-four people (11 patients; five caregivers; eight physicians; six nurses; and one social worker, pharmacist, physiotherapist, and dietitian each) from across Canada subsequently participated in a workshop to determine the top 10 research questions. In total, 1570 usable research uncertainties were received from 317 respondents to the survey. Among these, 259 unique uncertainties were identified; after ranking, these were reduced to a short-list of 30 uncertainties. During the in-person workshop, the top 10 research uncertainties were identified, which included questions about enhanced communication among patients and providers, dialysis modality options, itching, access to kidney transplantation, heart health, dietary restrictions, depression, and vascular access. These can be used alongside the results of other research priority-setting exercises to guide researchers in designing future studies and inform health care funders. Copyright © 2014 by the American Society of Nephrology.

  10. Quality of life in chronic haemodialysis and peritoneal dialysis patients in Turkey and related factors.

    PubMed

    Oren, Besey; Enç, Nuray

    2013-12-01

    Turkey is the fifth country in Europe with regard to the number of patients receiving haemodialysis (HD). However, only a limited number of studies have comparatively investigated the factors that affect quality of life in haemodialysis and peritoneal dialysis (PD) patients in Turkey. The purpose of the study was to investigate the factors that affect quality of life in haemodialysis and peritoneal dialysis patients, as well as providing a comparison of quality of life between these groups. In this cross-sectional study, Quality of Life Scale and a data form was completed by 300 dialysis patients who received treatment at five hospital-based dialysis units in Istanbul, Turkey. The data were evaluated using arithmetic mean values, standard deviations, minimums, maximums, percentages, independent groups t-tests, Spearman correlation analyses and one-way variance analyses. The quality of life values in peritoneal dialysis patients were found to be higher than those of haemodialysis patients (P < 0.05). It was concluded that the quality of life in chronic dialysis patients was affected by various factors.

  11. Management of hypertension in patients during percutaneous dialysis access interventions.

    PubMed

    Gandhi, Bhavika V; Patel, Tejas B; Costanzo, Eric J; Masud, Avais; Mehandru, Sushil; Salman, Loay

    2017-09-11

    Not infrequently, interventionalists are faced with a patient with increased blood pressure who is about to undergo a dialysis access intervention such as tunneled hemodialysis catheter, percutaneous balloon angioplasty, or declotting procedure for a clotted arteriovenous access. This can frequently create a dilemma as functional dialysis access is needed to provide dialysis therapy and delaying treatment could result in a life-threatening situation, particularly in the presence of hyperkalemia. This article investigates hypertension in patients undergoing percutaneous dialysis access interventions and provides guidance to their management.

  12. Longitudinal Measures of Serum Albumin and Prealbumin Concentrations in Incident Dialysis Patients: the Comprehensive Dialysis Study

    PubMed Central

    Dalrymple, Lorien S.; Johansen, Kirsten L.; Chertow, Glenn M.; Grimes, Barbara; Anand, Shuchi; McCulloch, Charles E.; Kaysen, George A.

    2012-01-01

    Objective Serum albumin and prealbumin concentrations are strongly associated with the risk of death in patients on dialysis. Our study examined the association among demographic characteristics, body composition, co-morbidities, dialysis modality and access, inflammation and longitudinal measures of albumin and prealbumin in incident dialysis patients. Design, Setting, Subjects and Outcome Measures The Comprehensive Dialysis Study (CDS) is a prospective cohort study of incident dialysis patients; in this report we examined data from 266 Nutrition sub-study participants who donated serum. The independent variables of interest were baseline age, sex, race, Quetélet's (body mass) index, dialysis modality and access, diabetes, heart failure, atherosclerotic vascular disease, serum creatinine, and longitudinal measures of C-reactive protein. The outcomes of interest (dependent variables) were longitudinal measures of albumin and prealbumin concentrations, measured at study entry and every 3 months for one year. Results In multivariable mixed linear models, female sex, peritoneal dialysis, hemodialysis with a catheter, and higher C-reactive protein concentrations were associated with lower serum albumin concentrations, and serum albumin concentrations increased slightly over the year. In comparison, prealbumin concentrations did not significantly change over time; female sex, lower body mass index, diabetes, atherosclerotic vascular disease, and higher C-reactive protein concentrations were associated with lower prealbumin concentrations. Serum creatinine had a curvilinear relation with serum albumin and prealbumin. Conclusions Serum albumin increases early in the course of dialysis whereas prealbumin does not, and the predictors of serum concentrations differ at any given time. Further understanding of mechanisms underlying differences between albumin and prealbumin kinetics in persons on dialysis may lead to an improved approach to the management of protein energy

  13. Renal replacement therapy in elderly patients: peritoneal dialysis.

    PubMed

    Catizone, Luigi; Malacarne, Franco; Bortot, Alessia; Annaloro, Mariangela; Russo, Giorgia; Barillà, Antonio; Storari, Alda

    2010-01-01

    Management of chronic uremia in elderly patients presents several clinic and organizational difficulties. Hemodialysis (HD) and chronic peritoneal dialysis (CPD) are both available for the elderly, and the choice depends on the individual, clinical and familial conditions. Several reports have compared the outcomes for older patients treated by HD or peritoneal dialysis, with those for younger or older patients undergoing peritoneal dialysis. CPD is a successful dialysis option for elderly patients, in both patient and technique survival terms. All nutritional parameters are of pivotal importance. Several barriers, such as medical and social factors, physician bias, late referral and education irrespective of the needs of older patients, influence the choice of CPD. The development of assisted peritoneal dialysis, using community-based nurses or health care assistants, can overcome some of the barriers and enable frail older patients to have home-based dialysis treatment. Increasing age is associated with higher peritonitis rates among patients who started CPD in the 1990s, while age is not associated with peritonitis in more recent CPD cohorts, and no greater frequency of adverse outcomes of peritonitis has been seen among those who began CPD after the year 2000. In elderly dialysis patients, the management of quality of life (QOL) is important as well as adequacy of dialysis, nutritional status and survival rate. To obtain a good standard of QOL, it is essential to select carers who are properly educated and who can access an adequate support system, both physical and psychological, to help them cope with their burden.

  14. Hypothyroidism and Mortality among Dialysis Patients

    PubMed Central

    Rhee, Connie M.; Alexander, Erik K.; Bhan, Ishir

    2013-01-01

    Summary Background and objectives Hypothyroidism is highly prevalent among ESRD patients, but its clinical significance and the benefits of thyroid hormone replacement in this context remain unclear. Design, setting, participants, & measurements This study examined the association between hypothyroidism and all-cause mortality among 2715 adult dialysis patients with baseline thyrotropin levels measured between April of 2005 and April of 2011. Mortality was ascertained from Social Security Death Master Index and local registration systems. The association between hypothyroidism (thyrotropin greater than assay upper limit normal) and mortality was estimated using Cox proportional hazards models. To reduce the risk of observing reverse-causal associations, models included a 30-day lag between thyrotropin measurement and at-risk time. Results Among 350 (12.9%) hypothyroid and 2365 (87.1%) euthyroid (assay within referent range) patients, 917 deaths were observed during 5352 patient-years of at-risk time. Hypothyroidism was associated with higher mortality. Compared with thyrotropin in the low-normal range (0.4–2.9 mIU/L), subclinical hypothyroidism (thyrotropin >upper limit normal and ≤10.0 mIU/L) was associated with higher mortality; high-normal thyrotropin (≥3.0 mIU/L and ≤upper limit normal) and overt hypothyroidism (thyrotropin >10.0 mIU/L) were associated with numerically greater risk, but estimates were not statistically significant. Compared with spontaneously euthyroid controls, patients who were euthyroid while on exogenous thyroid replacement were not at higher mortality risk, whereas patients who were hypothyroid were at higher mortality risk. Sensitivity analyses indicated that effects on cardiovascular risk factors may mediate the observed association between hypothyroidism and death. Conclusions These data suggest that hypothyroidism is associated with higher mortality in dialysis patients, which may be ameliorated by thyroid hormone replacement

  15. Hypothyroidism and mortality among dialysis patients.

    PubMed

    Rhee, Connie M; Alexander, Erik K; Bhan, Ishir; Brunelli, Steven M

    2013-04-01

    Hypothyroidism is highly prevalent among ESRD patients, but its clinical significance and the benefits of thyroid hormone replacement in this context remain unclear. This study examined the association between hypothyroidism and all-cause mortality among 2715 adult dialysis patients with baseline thyrotropin levels measured between April of 2005 and April of 2011. Mortality was ascertained from Social Security Death Master Index and local registration systems. The association between hypothyroidism (thyrotropin greater than assay upper limit normal) and mortality was estimated using Cox proportional hazards models. To reduce the risk of observing reverse-causal associations, models included a 30-day lag between thyrotropin measurement and at-risk time. Among 350 (12.9%) hypothyroid and 2365 (87.1%) euthyroid (assay within referent range) patients, 917 deaths were observed during 5352 patient-years of at-risk time. Hypothyroidism was associated with higher mortality. Compared with thyrotropin in the low-normal range (0.4-2.9 mIU/L), subclinical hypothyroidism (thyrotropin >upper limit normal and ≤10.0 mIU/L) was associated with higher mortality; high-normal thyrotropin (≥3.0 mIU/L and ≤upper limit normal) and overt hypothyroidism (thyrotropin >10.0 mIU/L) were associated with numerically greater risk, but estimates were not statistically significant. Compared with spontaneously euthyroid controls, patients who were euthyroid while on exogenous thyroid replacement were not at higher mortality risk, whereas patients who were hypothyroid were at higher mortality risk. Sensitivity analyses indicated that effects on cardiovascular risk factors may mediate the observed association between hypothyroidism and death. These data suggest that hypothyroidism is associated with higher mortality in dialysis patients, which may be ameliorated by thyroid hormone replacement therapy.

  16. The impact of high-flux dialysis on mortality rates in incident and prevalent hemodialysis patients

    PubMed Central

    Kim, Hyung Wook; Kim, Su-Hyun; Kim, Young Ok; Jin, Dong Chan; Song, Ho Chul; Choi, Euy Jin; Kim, Yong-Lim; Kim, Yon-Su; Kang, Shin-Wook; Kim, Nam-Ho; Yang, Chul Woo

    2014-01-01

    Background/Aims The effect of high-flux (HF) dialysis on mortality rates could vary with the duration of dialysis. We evaluated the effects of HF dialysis on mortality rates in incident and prevalent hemodialysis (HD) patients. Methods Incident and prevalent HD patients were selected from the Clinical Research Center registry for end-stage renal disease (ESRD), a Korean prospective observational cohort study. Incident HD patients were defined as newly diagnosed ESRD patients initiating HD. Prevalent HD patients were defined as patients who had been receiving HD for > 3 months. The primary outcome measure was all-cause mortality. Results This study included 1,165 incident and 1,641 prevalent HD patients. Following a median 24 months of follow-up, the mortality rates of the HF and low-flux (LF) groups did not significantly differ in the incident patients (hazard ratio [HR], 1.046; 95% confidence interval [CI], 0.592 to 1.847; p = 0.878). In the prevalent patients, HF dialysis was associated with decreased mortality compared with LF dialysis (HR, 0.606; 95% CI, 0.416 to 0.885; p = 0.009). Conclusions HF dialysis was associated with a decreased mortality rate in prevalent HD patients, but not in incident HD patients. PMID:25378976

  17. The impact of high-flux dialysis on mortality rates in incident and prevalent hemodialysis patients.

    PubMed

    Kim, Hyung Wook; Kim, Su-Hyun; Kim, Young Ok; Jin, Dong Chan; Song, Ho Chul; Choi, Euy Jin; Kim, Yong-Lim; Kim, Yon-Su; Kang, Shin-Wook; Kim, Nam-Ho; Yang, Chul Woo; Kim, Yong Kyun

    2014-11-01

    The effect of high-flux (HF) dialysis on mortality rates could vary with the duration of dialysis. We evaluated the effects of HF dialysis on mortality rates in incident and prevalent hemodialysis (HD) patients. Incident and prevalent HD patients were selected from the Clinical Research Center registry for end-stage renal disease (ESRD), a Korean prospective observational cohort study. Incident HD patients were defined as newly diagnosed ESRD patients initiating HD. Prevalent HD patients were defined as patients who had been receiving HD for > 3 months. The primary outcome measure was all-cause mortality. This study included 1,165 incident and 1,641 prevalent HD patients. Following a median 24 months of follow-up, the mortality rates of the HF and low-flux (LF) groups did not significantly differ in the incident patients (hazard ratio [HR], 1.046; 95% confidence interval [CI], 0.592 to 1.847; p = 0.878). In the prevalent patients, HF dialysis was associated with decreased mortality compared with LF dialysis (HR, 0.606; 95% CI, 0.416 to 0.885; p = 0.009). HF dialysis was associated with a decreased mortality rate in prevalent HD patients, but not in incident HD patients.

  18. Microcystin exposure and biochemical outcomes among dialysis patients

    EPA Science Inventory

    Background and aims Dialysis patients appear to be at special risk for exposure to cyanobacteria toxins; episodes of microcystin (MCYST) exposure via dialysate during 1996 and 2001 have been previously reported. During 2001, as many as 44 dialysis patients were exposed to contam...

  19. Microcystin exposure and biochemical outcomes among dialysis patients

    EPA Science Inventory

    Background and aims Dialysis patients appear to be at special risk for exposure to cyanobacteria toxins; episodes of microcystin (MCYST) exposure via dialysate during 1996 and 2001 have been previously reported. During 2001, as many as 44 dialysis patients were exposed to contam...

  20. An opportunistic pathogen in a peritoneal dialysis patient: Ochrobactrum anthropi.

    PubMed

    Alparslan, Caner; Yavascan, Onder; Kose, Engin; Sanlioglu, Pinar; Aksu, Nejat

    2013-01-01

    The authors report a case of chronic peritoneal dialysis-related peritonitis from Ochrobactrum anthropi. O. anthropi is an emerging pathogen in immunocompromised patients. O. anthropi-related peritonitis in peritoneal dialysis patients has rarely been reported. To the authors' knowledge, no pediatric case of O. anthropi peritonitis has been reported to date in the literature.

  1. Mycobacterium fortuitum Peritonitis in a Patient on Continuous Ambulatory Peritoneal Dialysis (CAPD): A Case Report.

    PubMed

    Sangwan, Jyoti; Lathwal, Sumit; Kumar, Satish; Juyal, Deepak

    2013-12-01

    Mycobacterium fortuitum, an environmental organism, is capable of producing a variety of clinical infections such as cutaneous infections, abscesses and nosocomial infections. Rarely, it has been a documented as a cause of peritonitis in patients receiving continuous ambulatory peritoneal dialysis (CAPD). Continuous Ambulatory Peritoneal dialysis (CAPD) is one of the treatment options which are used for patients with end-stage renal disease (ESRD). Although peritonitis rates have declined in parallel with advances in peritoneal dialysis (PD) technology, peritonitis remains a leading complication of CAPD and it is the major cause for transfer to other methods of dialysis. We are reporting a case of M. fortuitum peritonitis in a patient who was undergoing CAPD, which was successfully treated. This case emphasizes the importance of mycobacterial cultures in patients with CAPD-associated peritonitis, whose routine cultures may yield no organisms.

  2. Cardiac Geometry in Children Receiving Chronic Peritoneal Dialysis: Findings from the International Pediatric Peritoneal Dialysis Network (IPPN) Registry

    PubMed Central

    Borzych, Dagmara; Soo Ha, Il; Serdaroglu, Erkin; Büscher, Rainer; Salas, Paulina; Patel, Hiren; Drozdz, Dorota; Vondrak, Karel; Watanabe, Andreia; Villagra, Jorge; Yavascan, Onder; Valenzuela, Maria; Gipson, Deborah; Ng, K.H.; Warady, Bradley A.; Schaefer, Franz

    2011-01-01

    Summary Background and objectives Left ventricular hypertrophy (LVH) is an independent risk factor and an intermediate end point of dialysis-associated cardiovascular comorbidity. We utilized a global pediatric registry to assess the prevalence, incidence, and predictors of LVH as well as its evolution in the longitudinal follow-up in dialyzed children. Design, setting, participants, & measurements Cross-sectional echocardiographic, clinical, and biochemical data were evaluated in 507 children on peritoneal dialysis (PD), and longitudinal data were evaluated in 128 patients. The 95th percentile of LV mass index relative to height age was used to define LVH. Results The overall LVH prevalence was 48.1%. In the prospective analysis, the incidence of LVH developing de novo in patients with normal baseline LV mass was 29%, and the incidence of regression from LVH to normal LV mass 40% per year on PD. Transformation to and regression from concentric LV geometry occurred in 36% and 28% of the patients, respectively. Hypertension, high body mass index, use of continuous ambulatory peritoneal dialysis, renal disease other than hypo/dysplasia, and hyperparathyroidism were identified as independent predictors of LVH. The use of renin-angiotensin system (RAS) antagonists and high total fluid output (sum of urine and ultrafiltration) were protective from concentric geometry. The risk of LVH at 1 year was increased by higher systolic BP standard deviation score and reduced in children with renal hypo/dysplasia. Conclusions Using height-adjusted left ventricular mass index reference data, LVH is highly prevalent but less common than previously diagnosed in children on PD. Renal hypo/dysplasia is protective from LVH, likely because of lower BP and polyuria. Hypertension, fluid overload, and hyperparathyroidism are modifiable determinants of LVH. PMID:21737855

  3. Cardiac geometry in children receiving chronic peritoneal dialysis: findings from the International Pediatric Peritoneal Dialysis Network (IPPN) registry.

    PubMed

    Bakkaloglu, Sevcan A; Borzych, Dagmara; Soo Ha, Il; Serdaroglu, Erkin; Büscher, Rainer; Salas, Paulina; Patel, Hiren; Drozdz, Dorota; Vondrak, Karel; Watanabe, Andreia; Villagra, Jorge; Yavascan, Onder; Valenzuela, Maria; Gipson, Deborah; Ng, K H; Warady, Bradley A; Schaefer, Franz

    2011-08-01

    Left ventricular hypertrophy (LVH) is an independent risk factor and an intermediate end point of dialysis-associated cardiovascular comorbidity. We utilized a global pediatric registry to assess the prevalence, incidence, and predictors of LVH as well as its evolution in the longitudinal follow-up in dialyzed children. Cross-sectional echocardiographic, clinical, and biochemical data were evaluated in 507 children on peritoneal dialysis (PD), and longitudinal data were evaluated in 128 patients. The 95(th) percentile of LV mass index relative to height age was used to define LVH. The overall LVH prevalence was 48.1%. In the prospective analysis, the incidence of LVH developing de novo in patients with normal baseline LV mass was 29%, and the incidence of regression from LVH to normal LV mass 40% per year on PD. Transformation to and regression from concentric LV geometry occurred in 36% and 28% of the patients, respectively. Hypertension, high body mass index, use of continuous ambulatory peritoneal dialysis, renal disease other than hypo/dysplasia, and hyperparathyroidism were identified as independent predictors of LVH. The use of renin-angiotensin system (RAS) antagonists and high total fluid output (sum of urine and ultrafiltration) were protective from concentric geometry. The risk of LVH at 1 year was increased by higher systolic BP standard deviation score and reduced in children with renal hypo/dysplasia. Using height-adjusted left ventricular mass index reference data, LVH is highly prevalent but less common than previously diagnosed in children on PD. Renal hypo/dysplasia is protective from LVH, likely because of lower BP and polyuria. Hypertension, fluid overload, and hyperparathyroidism are modifiable determinants of LVH.

  4. A prime determinant in selecting dialysis modality: peritoneal dialysis patient survival.

    PubMed

    Kim, Hyunwook; Ryu, Dong-Ryeol

    2017-03-01

    The number of patients with end-stage renal disease (ESRD) has rapidly increased, as has the cost of dialysis. Peritoneal dialysis (PD) is an established treatment for ESRD patients worldwide; it has a variety of advantages, including autonomy and flexibility, as well as economic benefits in many countries compared to hemodialysis (HD). However, the long-term survival rate of PD remains poor. Although direct comparison of survival rate between the dialysis modalities by randomized controlled trials is difficult due to the ethical issues, it has always been a crucial point when deciding which dialysis modality should be recommended to patients. Recently, in many countries, including the United States, Brazil, Spain, Australia, and New Zealand, the survival rate in PD patients has significantly improved. PD patient survival in Korea has also improved, but Korean PD patients are known to have higher risk of mortality and major adverse cardiovascular, cerebrovascular events than HD patients. Herein, we further evaluate why Korean PD patients had worse outcomes; we suggest that special attention should be paid to patients with diabetes, coronary artery disease, or congestive heart failure when they choose PD as the first dialysis modality in order to reduce mortality risk.

  5. Tuberculous peritonitis in a case receiving continuous ambulatory peritoneal dialysis(CAPD) treatment

    PubMed Central

    Sahin, Garip; Kiraz, Nuri; Sahin, Ilknur; Soydan, Mehmet; Akgün, Yurdanur

    2004-01-01

    Background Tuberculosis continues to be an important health problem in the world. Besides pulmonary involvement extrapulmonary involvement becomes an affair in developing countries, even in developed countries. Case presentation A thirty-six year old male patient was admitted with abdominal pain, diarrhea, nausea, vomiting and fever which had started one week before. The patient had been followed up with predialisis Chronic Renal Failure(CRF) diagnosis for 4 years and receiving continuous ambulatory peritoneal dialysis (CAPD) treatment for 4 months. In peritoneal fluid, 1600/mm3 cells were detected and 70% of them were polymorphonuclear leukocytosis. The patient begun nonspesific antibiotherapy but no benefit was obtained after 12 days and peritoneal fluid bacterial cultures remained negative. Peritoneal smear was positive for Asid-fast basilli (AFB), and antituberculosis therapy was started with isoniazid, rifampicine, ethambutol and pyrazinamide. After 15 days his peritoneal fluid cell count was decreased and his symptoms were relieved. Peritoneal fluid tuberculosis culture was found positive. Conclusion Considering this case, we think that in patients with CAPD catheter and peritonitis; when peritoneal fluid leukocytes are high and PMNL are dominant, AFB and tuberculosis culture must be investigated besides bacterial culture routinely. PMID:15461815

  6. Feasibility and Safety of Intra-Dialysis Yoga and Education in Maintenance Hemodialysis Patients

    PubMed Central

    Birdee, Gurjeet S.; Rothman, Russell L.; Sohl, Stephanie J.; Wertenbaker, Dolphi; Wheeler, Amy; Bossart, Chase; Balasire, Oluwaseyi; Ikizler, T. Alp

    2016-01-01

    Objective Patients with end-stage renal disease on maintenance hemodialysis are much more sedentary than healthy individuals. The purpose of this study was to assess the feasibility and safety of a 12-week intra-dialysis yoga intervention versus a kidney education intervention on the promotion of physical activity. Design and Methods We randomized participants by dialysis shift to either 12-week intra-dialysis yoga or an educational intervention. Intra-dialysis yoga was provided by yoga teachers to participants while receiving hemodialysis. Participants receiving the 12-week educational intervention received a modification of a previously developed comprehensive educational program for patients with kidney disease (“Kidney School”). The primary outcome for this study was feasibility based on recruitment and adherence to the interventions, and safety of intra-dialysis yoga. Secondary outcomes were to determine the feasibility of administering questionnaires at baseline and 12-weeks including the Kidney Disease-Related Quality of Life-36. Results Among 56 eligible patients approached for the study, 55% (n=31) were interested and consented to participation with 18 assigned to intra-dialysis yoga and 13 to the educational program. A total of 5 participants withdrew from the pilot study, all from the intra-dialysis yoga group. Two of these participants reported no further interest in participation. Three withdrawn participants switched dialysis times and therefore could no longer receive intra-dialysis yoga. As a result, 72% (13 of 18) and 100% (13 of 13) of participants completed 12-week intra-dialysis yoga and educational programs, respectively. There were no adverse events related to intra-dialysis yoga. Intervention participants practiced yoga a median of 21 sessions (70% participation frequency), with 60% of participants practicing at least 2 times a week. Participants in the educational program completed a median of 30 sessions (83% participation frequency

  7. Should dialysis be offered to all elderly patients?

    PubMed

    Germain, Michael J

    2015-01-01

    Nephrologist are often faced with the question of the appropriate initiation and withdrawal from dialysis. Many clinicians feel that patient should be offered dialysis when they have ESRD regardless of the potential risks vs. benefits. My position in this debate is that nephrologists have the obligation to order treatments that are indicated and effective for their patients and will provide more benefit that harm. They should not order dialysis in patient that are not likely to benefit from the treatment. Patients have the right to refuse treatments but not the right to demand that a clinician order an ineffective treatment. Shared decision making is the key principle in deciding on the initiation and withdrawal from dialysis. The national guideline; Shared Decision Making: The Appropriate Initiation and Withdrawal from Dialysis supports this approach. © 2015 S. Karger AG, Basel.

  8. Naturally nonanemic dialysis patients: Who are they?

    PubMed

    Yilmaz, Murvet; Kircelli, Fatih; Artan, Ayse Serra; Oto, Ozgur; Asci, Gulay; Gunestepe, Kutay; Basci, Ali; Ok, Ercan; Sever, Mehmet Sukru

    2016-10-01

    Introduction Not only anemia, but also erythropoiesis stimulating agent (ESA)s for treating anemia may adversely affect prognosis of chronic hemodialysis patients. Various features of naturally (with no ESA usage) nonanemic patients may be useful for defining several factors in the pathogenesis of anemia. Methods Data, retrieved from the European Clinical Database (EuCliD)-Turkey on naturally nonanemic prevalent chronic hemodialysis patients (n: 201) were compared with their anemic (those who required ESA treatment) counterparts (n: 3948). Findings Mean hemoglobin values were 13.5 ± 0.8 and 11.5 ± 0.9 g/dL in nonanemic and anemic patients, respectively (P < 0.001). Nonanemia status was associated with younger age, male gender, longer dialysis vintage, nondiabetic status, more frequent hepatitis-C virus seropositivity and more frequent arteriovenous fistula usage. Serum ferritin and CRP levels and urea reduction ratio were higher in ESA-requiring patients. One (99%) and two (95.3%) years survival rates of the "naturally nonanemic" patients were superior as compared to anemics (91.0% and 82.6%, respectively), (P < 0.001). Discussion "Naturally nonanemic" status is associated with better survival in prevalent chronic hemodialysis patients; underlying mechanisms in this favorable outcome should be investigated by randomized controlled trials including large number of patients. © 2016 International Society for Hemodialysis.

  9. Optimal choice of dialysis access for chronic kidney disease patients: developing a life plan for dialysis access.

    PubMed

    Lok, Charmaine E; Davidson, Ingemar

    2012-11-01

    Patient-focused dialysis modality and access selection requires a coordinated teamwork approach that emphasizes chronic kidney disease care to be a continuum of care. Individualized and detailed patient history and examination are the mainstays of dialysis modality and access selection. Preoperative vessel mapping by duplex Doppler ultrasonography can be a useful supplementary investigation to the history and physical examination to determine the optimal dialysis access type and site. Dialysis access modality and choice considers many patient factors that can be aided by a clinical risk score, asking key clinical questions, surgical expert opinion, and a multidisciplinary approach to individualized patient care. In many situations, a lifelong access utilization strategy prioritizes peritoneal dialysis as the first dialysis modality followed by appropriately planned hemodialysis. The goal of an integrated patient-focused approach is to achieve complication-free access to help patients achieve their life goals on and off dialysis. Copyright © 2012. Published by Elsevier Inc.

  10. PATIENTS EXPERIENCES OF INVOLVEMENT IN CHOICE OF DIALYSIS MODE.

    PubMed

    Erlang, Anne S; Nielsen, Ida H; Hansen, Helle O B; Finderup, Jeanette

    2015-12-01

    International guidelines recommend that patients choose dialysis mode based on their own values and preferences; thus, involvement is needed in dialysis choice. A literature review indicated a lack of knowledge concerning patient involvement in decision-making, especially concerning patients' experiences of the decision-making process just after making the decision and before starting dialysis. To gather information about how patients experienced involvement in the decision-making process of renal substation therapy just after they have made the decision and before starting dialysis. A qualitative method with a phenomenological and hermeneutic approach. The study was based on individual semi-structured interviews with nine adult patients with chronic kidney disease. A data-driven analysis based on systematic text condensation was used. Patients are a significant part of the decision. Health care professionals contribute to the experience of being involved. Patients keep putting off the final choice. The patients found themselves involved in the choice of dialysis mode and have different views on what is needed to feel being involved. Information, interaction, and advice from health care professionals affect this experience. However, the experience of not having any symptoms caused patients to put off the final choice of dialysis mode. © 2015 European Dialysis and Transplant Nurses Association/European Renal Care Association.

  11. Measures of blood pressure and cognition in dialysis patients

    USDA-ARS?s Scientific Manuscript database

    There are few reports on the relationship of blood pressure with cognitive function in maintenance dialysis patients. The Cognition and Dialysis Study is an ongoing investigation of cognitive function and its risk factors in six Boston area hemodialysis units. In this analysis, we evaluated the rela...

  12. Acute hepatitis C in patients receiving hemodialysis.

    PubMed

    Griveas, I; Germanidis, G; Visvardis, G; Morice, Y; Perelson, A S; Pawlotsky, J M; Papadopoulou, D

    2007-01-01

    Hepatitis C virus (HCV) infection is frequent in patients with end-stage renal disease treated by chronic dialysis, with a prevalence varying from 10-65% according to the geographical data. The prevalence is significantly associated with the duration of dialysis and the number of transfused blood products[1,2] and has dramatically declined with efficient blood screening.[3] We studied patients with acute HCV infection in a dialysis unit. The diagnosis was based on both anti-HCV detection and HCV-RNA detection. Other virological tools including HCV genotype determination was also used to tailor treatment to the individual patient and determine its efficacy for a one-year follow-up period. Seventeen patients (7 male and 10 female, mean age: 63.7 +/- 11.6 SD) with acute hepatitis C were enrolled to our study. All of them were followed up for a period of one year after the diagnosis was established. Phylogenetic analysis distinguished two separate HCV subtypes 1b, which were both responsible for this acute infection (see Figure 1). These types did not differ in their behavior on the clinical situation of our patients, as confirmed by the fact that in both groups of patients, there was only one patient who presented with acute illness. Six patients of our study group, three months after the acute infection, received pegylated interferon (Peg-IFNa2a) 135 mug for a six-month period. Four of them responded very well to therapy and at the first determination HCV RNA was below the cutoff point. One of our patients with very high HCV levels (HCV RNA > 50,000,000 IU/mL), despite receiving the same therapy, did not respond well and developed cirrhosis. In conclusion, it is clear from our experience that better information is needed about the current incidence, prevalence, and risk factors for HCV infection in dialysis patients. Algorithms for the diagnosis and management of hepatitis C should be developed by academic societies. Routine screening for hepatitis C also would allow

  13. Evaluating Infection Prevention Strategies in Out-Patient Dialysis Units Using Agent-Based Modeling.

    PubMed

    Wares, Joanna R; Lawson, Barry; Shemin, Douglas; D'Agata, Erika M C

    2016-01-01

    Patients receiving chronic hemodialysis (CHD) are among the most vulnerable to infections caused by multidrug-resistant organisms (MDRO), which are associated with high rates of morbidity and mortality. Current guidelines to reduce transmission of MDRO in the out-patient dialysis unit are targeted at patients considered to be high-risk for transmitting these organisms: those with infected skin wounds not contained by a dressing, or those with fecal incontinence or uncontrolled diarrhea. Here, we hypothesize that targeting patients receiving antimicrobial treatment would more effectively reduce transmission and acquisition of MDRO. We also hypothesize that environmental contamination plays a role in the dissemination of MDRO in the dialysis unit. To address our hypotheses, we built an agent-based model to simulate different treatment strategies in a dialysis unit. Our results suggest that reducing antimicrobial treatment, either by reducing the number of patients receiving treatment or by reducing the duration of the treatment, markedly reduces overall colonization rates and also the levels of environmental contamination in the dialysis unit. Our results also suggest that improving the environmental decontamination efficacy between patient dialysis treatments is an effective method for reducing colonization and contamination rates. These findings have important implications for the development and implementation of future infection prevention strategies.

  14. Patients receiving frequent hemodialysis have better health-related quality of life compared to patients receiving conventional hemodialysis.

    PubMed

    Garg, Amit X; Suri, Rita S; Eggers, Paul; Finkelstein, Fredric O; Greene, Tom; Kimmel, Paul L; Kliger, Alan S; Larive, Brett; Lindsay, Robert M; Pierratos, Andreas; Unruh, Mark; Chertow, Glenn M

    2017-03-01

    Most patients with end-stage kidney disease value their health-related quality of life (HRQoL) and want to know how it will be affected by their dialysis modality. We extended the findings of two prior clinical trial reports to estimate the effects of frequent compared to conventional hemodialysis on additional measures of HRQoL. The Daily Trial randomly assigned 245 patients to receive frequent (six times per week) or conventional (three times per week) in-center hemodialysis. The Nocturnal Trial randomly assigned 87 patients to receive frequent nocturnal (six times per week) or conventional (three times per week) home hemodialysis. All patients were on conventional hemodialysis prior to randomization, with an average feeling thermometer score of 70 to 75 (a visual analog scale from 0 to 100 where 100 is perfect health), an average general health scale score of 40 to 47 (a score from 0 to 100 where 100 is perfect health), and an average dialysis session recovery time of 2 to 3 hours. Outcomes are reported as the between-treatment group differences in one-year change in HRQoL measures and analyzed using linear mixed effects models. After one year in the Daily Trial, patients assigned to frequent in-center hemodialysis reported a higher feeling thermometer score, better general health, and a shorter recovery time after a dialysis session compared to standard thrice-weekly dialysis. After one year in the Nocturnal Trial, patients assigned to frequent home hemodialysis also reported a shorter recovery time after a dialysis session, but no statistical difference in their feeling thermometer or general health scores compared to standard home dialysis schedules. Thus, patients receiving day or nocturnal hemodialysis on average recovered approximately one hour earlier from a frequent compared to conventional hemodialysis session. Patients treated in an in-center dialysis facility reported better HRQoL with frequent compared to conventional hemodialysis.

  15. Hyperphosphatemia in children receiving peritoneal dialysis--an educational program.

    PubMed

    Blaszak, Richard T; Mitsnefes, Mark M; Ilyas, Mohammad; Salman, Scarlett D; Belcher, Sue M; Brady, Debbie R

    2005-07-01

    Hyperphosphatemia has been associated with the development of secondary hyperparathyroidism, renal osteodystrophy, cardiovascular calcification and increased risk of death. Using a one group, pretest-posttest study design, we sought to evaluate changes in serum phosphorus, calcium, parathyroid hormone and subject knowledge in response to a 3-month educational intervention. Mean serum phosphorus levels did not differ significantly between the three evaluation periods: pretreatment (5.69 mg/dl), treatment (5.84 mg/dl) and posttreatment (6.17 mg/dl). Mean serum calcium, calcium-phosphorus product and PTH values also did not differ significantly between the treatment periods. We observed no difference between the subject test scores between the two testing periods. Calcium-phosphorus product, serum phosphorus and PTH values on average, despite the education program, remained outside the K/DOQI target guidelines 44, 56 and 81% of the time, respectively. The results of this study suggest that an aggressive 3-month patient education program targeting dietary phosphorus knowledge, phosphate binder name and dosing, and knowledge of medical consequences associated with non-compliance had no effect on the serum phosphorus, calcium, PTH or phosphate binder need.

  16. New directions in peritoneal dialysis patient training.

    PubMed

    Hall, Gayle; Bogan, Amy; Dreis, Sandra; Duffy, AnnMarie; Greene, Suzanne; Kelley, Karen; Lizak, Holly; Nabut, Jose; Schinker, Vicky; Schwartz, Netta

    2004-01-01

    To study the effect of training methods on selected patient outcomes in peritoneal dialysis patients. Multi-center, longitudinal prospective quasi-experimental design study conducted over a 2-year period. Thirty-two Gambro Healthcare peritoneal dialysis (PD) home training programs in the United States. New patients starting PD were trained on PD technique and diet using either an adult learning theory-based curriculum in the experimental group (PG) or non-standardized conventional training programs in the control group (CG). Excluded were patients who were non-English speaking, legally blind without sighted caregiver, nursing home residents, and those with previous exposure to PD training. Information was collected by means of manual data collection tools and though the use of Gambro Healthcare computer system and was analyzed for statistical significance by Gambro Healthcare biostatistician. Compared with the CG, initial training took longer in the PG (PG = 29 hrs; CG = 22.6 hrs; p < .0001), and time required for retraining was less but not statistically significant (PG = 8.7 hrs; CG = 12.5 hrs; p = .1324). The peritonitis rate was less in the PG (28.2 per 1000 patient months) than in the CG (36.7 per 1000 patient months), but did not achieve statistical significance (p = .09783). Exit site infections (ESIs) were less in the PG than the CG (PG = 18.5; CG = 31.8; p = .00349). Dropout from PD to hemodialysis secondary to infection was less in the PG (1.6%) than in the CG (5.6%) (p = .0069). Measured on a scale with 4 being the best score, mean fluid balance scores in the PG were 3.41 compared to 3.25 in the CG (p < .0001), and mean compliance scores for the PG versus the CG were 3.62 and 3.52, respectively (p < .0001). Laboratory parameters between the two groups were significantly different only for Kt/V (PG = 2.4; CG = 2.3; p = 0.0107). Use of the adult learning theory-based training method curriculum was positively associated with improved patient outcomes in the

  17. Survival of patients ≥70 years with advanced chronic kidney disease: Dialysis vs. conservative care.

    PubMed

    Martínez Echevers, Yeleine; Toapanta Gaibor, Néstor Gabriel; Nava Pérez, Nathasha; Barbosa Martin, Francisco; Montes Delgado, Rafael; Guerrero Riscos, María Ángeles

    2016-01-01

    The number of elderly patients with advanced chronic kidney disease (ACKD) has increased in recent years, and the best therapeutic approach has not been determined due to a lack of evidence. To observe the progression of elderly patients with ACKD (stages 4 and 5) and to compare the survival of stage 5 CKD patients with and without dialysis treatment. All patients ≥70 years who began ACKD follow-up from 01/01/2007 to 31/12/2008 were included, and their progression was observed until 31/12/2013. Demographic data, the Charlson comorbidity index, history of ischaemic heart disease (IHD) and diabetes mellitus (DM) were assessed. A total of 314 patients ≥70 years with stages 4 and 5 CKD were studied. Of these patients, 162 patients had stage 5 CKD at the beginning of follow-up or progressed to stage 5 during the study, and 69 of these patients were treated with dialysis. In the stage 5 group: median age was 77 years (74-81); 48% had IHD; 50% had DM, Charlson 7 (6-9). Kaplan-Meier survival analysis: ≥70 years (93 vs. 69 patients with dialysis, log rank: 15 P<.001); patients ≥75 years (74 vs. 46 patients with dialysis, log rank: 8.9 P=.003); patients ≥80 (40 vs. 15 patients with dialysis) and p=0,2. Patients receiving dialysis were younger, with a lower Charlson comorbidity index and shorter follow-up time. Our study shows that dialysis treatment improves survival, although this benefit is lost in patients ≥80 years. Copyright © 2016 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.

  18. Association of dialysis adequacy with nutritional and inflammatory status in patients with chronic kidney failure.

    PubMed

    Hemayati, Roya; Lesanpezeshki, Mahboub; Seifi, Sepideh

    2015-11-01

    The number of patients with dialysis-dependent renal failure has increased in the past years worldwide. Several parameters have been introduced for the quantitative assessment of dialysis adequacy. The National Cooperative Dialysis Study results indicated that Kt/V and time-averaged concentration of urea (TAC) are predictors of mortality in patients who receive maintenance hemodialysis (HD). Also, the protein catabolic ratio (PCR), which is an indicator of nutritional status, can predict patients' mortality. Our aim was to assess the impact of parameters that show dialysis adequacy on indices of nutrition or inflammation. A total of 46 patients were included in the study; eight patients were excluded during the course of the study and 38 patients were enrolled in the final analysis. All patients were receiving HD for at least for three months. HD was administered three times per week and the study lasted for two months. Kt/V, TAC and PCR were assessed at the beginning of the study based on patients' urea and blood urea nitrogen in the first week of our study; these calculations were repeated at the end of the first and second months using the mean of the mentioned values in the month. Both adequacy indices significantly and positively correlated with changes in PCR (P <0.001). However, no significant correlation was detectable between Kt/V and TAC with either body mass index and albumin or C-reactive protein. Based on the Kt/V values, patients with adequate dialysis had slower decrease in the PCR (P <0.001). Our results indicate that adequacy of dialysis is correlated with patients' nutritional status. No correlation was observed between dialysis adequacy and inflammatory status.

  19. Strategies for preserving residual renal function in peritoneal dialysis patients

    PubMed Central

    Nongnuch, Arkom; Assanatham, Montira; Panorchan, Kwanpeemai; Davenport, Andrew

    2015-01-01

    Although there have been many advancements in the treatment of patients with chronic kidney disease (CKD) over the last 50 years, in terms of reducing cardiovascular risk, mortality remains unacceptably high, particularly for those patients who progress to stage 5 CKD and initiate dialysis (CKD5d). As mortality risk increases exponentially with progressive CKD stage, the question arises as to whether preservation of residual renal function once dialysis has been initiated can reduce mortality risk. Observational studies to date have reported an association between even small amounts of residual renal function and improved patient survival and quality of life. Dialysis therapies predominantly provide clearance for small water-soluble solutes, volume and acid-base control, but cannot reproduce the metabolic functions of the kidney. As such, protein-bound solutes, advanced glycosylation end-products, middle molecules and other azotaemic toxins accumulate over time in the anuric CKD5d patient. Apart from avoiding potential nephrotoxic insults, observational and interventional trials have suggested that a number of interventions and treatments may potentially reduce the progression of earlier stages of CKD, including targeted blood pressure control, reducing proteinuria and dietary intervention using combinations of protein restriction with keto acid supplementation. However, many interventions which have been proven to be effective in the general population have not been equally effective in the CKD5d patient, and so the question arises as to whether these treatment options are equally applicable to CKD5d patients. As strategies to help preserve residual renal function in CKD5d patients are not well established, we have reviewed the evidence for preserving or losing residual renal function in peritoneal dialysis patients, as urine collections are routinely collected, whereas few centres regularly collect urine from haemodialysis patients, and haemodialysis dialysis

  20. A Comparison of the Regional Circulation in the Feet between Dialysis and Non-Dialysis Patients using Indocyanine Green Angiography.

    PubMed

    Nishizawa, M; Igari, K; Kudo, T; Toyofuku, T; Inoue, Y; Uetake, H

    2017-09-01

    Peripheral artery disease in dialysis cases is more prone to critical limb ischemia compared to non-dialysis cases, with a significantly high rate of major amputation of the lower limbs. Lesions are distributed on the more distal side in dialysis critical limb ischemia cases. The aim of this study was to investigate the usefulness of indocyanine green angiography to determine differences in the regional circulation in the foot between dialysis and non-dialysis patients. The subjects included 62 cases, among which 20 were dialysis patients and 42 were non-dialysis patients. We compared the indocyanine green angiography parameters for regions of interest in the dialysis and non-dialysis groups, which included the magnitude of intensity from indocyanine green onset to maximum intensity (Imax), the time from indocyanine green onset to maximum intensity (Tmax), the time elapsed from the fluorescence onset to half the maximum intensity (T1/2), and the time from maximum intensity to declining to 90% of the maximum intensity (Td90%). These indocyanine green angiography parameters were measured at region of interest 1 (the Chopart joint), region of interest 2 (the Lisfranc joint), and region of interest 3 (the distal region of the first metatarsal bone). In the comparison between the dialysis and non-dialysis groups, a significant difference was observed regarding Tmax, T1/2, and Td90%, especially in region of interest 3. In this study, we show that regional tissue perfusion is more deteriorated in dialysis patients compared with non-dialysis patients using indocyanine green angiography. Tmax, T1/2, and Td90% could be useful clinical parameters to compare ischemic severity of the lower limb between dialysis and non-dialysis patients.

  1. Dialysis access, infections, and hospitalisations in unplanned dialysis start patients: results from the OPTiONS study.

    PubMed

    Machowska, Anna; Alscher, Mark D; Vanga, Satyanarayana Reddy; Koch, Michael; Aarup, Michael; Qureshi, Abdul R; Lindholm, Bengt; Rutherford, Peter

    2017-03-16

    Unplanned dialysis start (UPS) associates with worse clinical outcomes, higher utilisation of healthcare resources, lower chances to select dialysis modality and UPS patients typically commenced in-centre haemodialysis (HD) with central venous catheter (CVC). We evaluated patient outcomes and healthcare utilisation depending on initial dialysis access (CVC or PD catheter) and subsequent pathway of UPS patients. In this study patient demographics, access procedures, hospitalisations, and major infectious complications were analysed over 12 months in 270 UPS patients. PD technique survival and impact of switching from HD to PD was examined along with logistic regression to investigate factors predicting AV fistula formation. 72 UPS patients started with PD catheter and 198 with CVC. PD patients were older and more comorbid but had a significantly lower number of access procedures while there was no difference in hospitalisation or major infections. 13/72 initial PD patients switched to HD and 1-year technique survival was 79%. 158/198 patients remained on HD and 73/158 reported permanent access formation. Older age, OR = 0.34 (CI,0.17-0.68) and cardiac failure, OR = 0.31(CI,0.13-0.78), were significant negative predictors of receiving fistula. Younger patients, OR = 0.29 (CI, 0.11-0.79) and those who received AVF, OR = 0.11 (CI,0.03-0.38), had significantly lower odds of death. UPS with initial PD was possible in many patients and was associated with lower requirement for access procedures. AVF formation in UPS patients starting on HD was associated with better 1-year survival. Modality switching in UPS patients requires careful clinical management, including clinical practice patterns promoting permanent HD access formation.

  2. Advanced wasting in peritoneal dialysis patients.

    PubMed

    Xu, Zhi; Murata, Glen H; Glew, Robert H; Sun, Yijuan; Vigil, Darlene; Servilla, Karen S; Tzamaloukas, Antonios H

    2017-05-06

    To identify patients with end-stage renal disease treated by peritoneal dialysis (PD) who had zero body fat (BF) as determined by analysis of body composition using anthropometric formulas estimating body water (V) and to compare nutritional parameters between these patients and PD patients whose BF was above zero. Body weight (W) consists of fat-free mass (FFM) and BF. Anthropometric formulas for calculating V allow the calculation of FFM as V/0.73, where 0.73 is the water fraction of FFM at normal hydration. Wasting from loss of BF has adverse survival outcomes in PD. Advanced wasting was defined as zero BF when V/0.73 is equal to or exceeds W. This study, which analyzed 439 PD patients at their first clearance study, used the Watson formulas estimating V to identify patients with VWatson/0.73 ≥ W and compared their nutritional indices with those of PD patients with VWatson/0.73 < W. The study identified at the first clearance study two male patients with VWatson/0.73 ≥ W among 439 patients on PD. Compared to 260 other male patients on PD, the two subjects with advanced wasting had exceptionally low body mass index and serum albumin concentration. The first of the two subjects also had very low values for serum creatinine concentration and total (in urine and spent peritoneal dialysate) creatinine excretion rate while the second subject had an elevated serum creatinine concentration and high creatinine excretion rate due, most probably, to non-compliance with the PD prescription. Advanced wasting (zero BF) in PD patients, identified by the anthropometric formulas that estimate V, while rare, is associated with indices of poor somatic and visceral nutrition.

  3. Dietary intakes and biochemical status of B vitamins in a group of children receiving dialysis.

    PubMed

    Don, Tania; Friedlander, Stella; Wong, William

    2010-01-01

    We investigated the dietary intake and biochemical status of B vitamins (thiamin, riboflavin, vitamin B6, and vitamin B12) in a group of mainly unsupplemented children with endstage renal disease receiving dialysis, to determine if B vitamin supplementation is indicated. This was a cross-sectional, observational clinical trial. Children with endstage renal disease were receiving dialysis, under the care of Renal Services, at Starship Children's Health (Grafton, Auckland, New Zealand). We studied 12 children (including 7 girls, and 8 children receiving peritoneal dialysis) mean age 7.8 +/- 5.3 years (SD). Three-day diet records were collected and analyzed with FoodWorks software. Blood was collected for vitamin assay testing. Dietary intake of B vitamins was measured as a percentage of recommended dietary intake (RDI) or adequate intakes (AIs) for age. Biochemical status was measured as the concentration of each B vitamin compared with reference ranges. Mean intakes from diet alone comprised <100% of the RDI or AI for each B vitamin. Mean intakes, with nutritional support, reached >100% of the RDI or AI for each B vitamin. All children achieved >100% RDI or AI for thiamin, riboflavin, and vitamin B12. Two children who were not receiving nutritional support received <100% of the RDI for vitamin B6. Blood levels of B vitamins were normal to high, compared with reference ranges, for each B vitamin in all children, indicating adequate status. Intakes were adequate in the majority of children. Status was adequate in all children. In this group of children undergoing dialysis, B-vitamin supplementation was not indicated.

  4. The impact of nutritional status, physical function, comorbidity and early versus late start in dialysis on quality of life in older dialysis patients.

    PubMed

    Lægreid, Inger Karin; Aasarød, Knut; Bye, Asta; Leivestad, Torbjørn; Jordhøy, Marit

    2014-02-01

    For the majority of the older patients in dialysis, the treatment will be lifelong. Thus, quality of life (QoL) is a crucial outcome. Our aim was to assess the QoL of older Norwegian dialysis patients and to investigate the impact of early (estimated glomerular filtration rate, eGFR ≥10 mL/min) versus late (eGFR <10 mL/min) start in dialysis, comorbidity, nutritional status and physical capacity. A self-report questionnaire including SF-36 (QoL) and the Subjective Global Assessment (SGA; nutritional status) was mailed to all patients (n = 320) ≥75 years registered in the Norwegian Renal Registry (NRR) as being in dialysis by September 2009. Reply was received from 233 patients (73%). Medical data including comorbidities and eGFR at dialysis start (obtained for 194 patients) were retrieved from the NRR. Functional capacity was determined from the SGA. Compared to reports from younger dialysis patients, our patients scored poorer on all SF-36 subscales. Early start in dialysis was registered for 52 patients, 142 patients started late, 51.4% were well nourished (SGA A), 32.3% moderately malnourished (SGA B) and 16.4% were severely malnourished (SGA C). No significant association between any SF-36 scores and early versus late start, nutritional status or comorbidity was found. Better physical function was significantly associated with better scores on all SF-36 scales. Our results indicate that physical function is important to all QoL aspects. Increased focus on physical rehabilitation seems pertinent. Early start of dialysis treatment was not associated with better long term QoL scores.

  5. Restless legs syndrome in dialysis patients: a meta-analysis.

    PubMed

    Mao, Song; Shen, Hua; Huang, Songming; Zhang, Aihua

    2014-12-01

    Restless legs syndrome (RLS) occurs frequently in dialysis patients. However, it remains elusive regarding the risk factors for RLS onset in dialysis patients. A meta-analysis was performed to investigate the association between clinical measures (age, gender, diabetes mellitus or DM etc.) and RLS in dialysis patients. We searched electronic databases from January 1990 to February 2014 to identify studies that met inclusion criteria. Either a fixed-effects or, in the presence of heterogeneity, a random-effects model was used to calculate the pooled odds ratios (ORs)/standard mean differences (SMDs) and their corresponding confidence intervals (CIs). Twenty-three studies were included in this study. Dialysis patients with RLS demonstrated significantly higher OR of DM compared with non-RLS in Asians (OR: 1.238, 95% CI: 1.032-1.484, P = 0.021). Dialysis patients with RLS showed markedly lower level of hemoglobin (Hb)/iron compared with non-RLS in overall populations/Caucasians (SMD: -0.178/-0.104, 95% CI: -0.352/-0.206 to -0.004/-0.002, P = 0.045/0.045; SMD: -0.283/-0.158, 95% CI: -0.552/-0.304 to -0.013/-0.012, P = 0.04/0.034). No differences of female populations, age, duration of dialysis, body mass index (BMI), blood urea nitrogen (BUN), creatinine, albumin, phosphorus, parathyroid hormone (PTH), and calcium were observed between dialysis patients with RLS and non-RLS in overall populations, Caucasians and Asians. No evidence of publication bias was observed. Our findings indicate that dialysis patients with DM are nearly 24% more susceptible to RLS in Asians. Decreased Hb/iron is a risk factor for RLS onset in dialysis patients in overall populations including Caucasians. Copyright © 2014 Elsevier B.V. All rights reserved.

  6. Comparison of oral Lactobacillus and Streptococcus mutans between diabetic dialysis patients with non-diabetic dialysis patients and healthy people

    PubMed Central

    Rezazadeh, Fahimeh; Bazargani, Abdollah; Roozbeh-Shahroodi, Jamshid; Pooladi, Ali; Arasteh, Peyman; Zamani, Khosro

    2016-01-01

    Introduction: Diabetes is associated with higher rates of caries, on the other hand some studies have shown that renal failure can be protective against dental caries. Objectives: In this study we compared oral Lactobacillus and Streptococcus mutans between diabetic dialysis and non-diabetic dialysis patients and the normal population. Patients and Methods: During November 2014 to January 2014, 85 people that referred to our medical care center entered the study. The sample included 30 diabetic dialysis, 28 non-diabetic dialysis patients and 27 healthy people. Oral saliva samples were obtained from their tongue and oral floor for microbiological examination. Patients’ data were compared before and after dialysis. Results: The amount of Lactobacillus and S. mutans did not show a significant difference between the three groups (P=0.092 and P=0.966 for S. mutans and lactobacillus, respectively). A positive and meaningful correlation was seen between fasting blood sugar (FBS) levels and the amount of S. mutans in the diabetic dialysis group (P=0.023; r=0.413). A meaningful and positive correlation was also seen between the amount of blood urea nitrogen (BUN) after dialysis and the amount of oral S. mutans in the non-diabetic dialysis group (P=0.03; r=0.403). Conclusion: Despite the differences in the prevalence of caries that have been reported between renal failure patients and diabetic patients, we did not find any significant difference between diabetic dialysis, non-diabetic dialysis patients and the healthy population, regarding their amount of oral cariogenic bacteria. PMID:27689112

  7. Calcium balance and negative impact of calcium load in peritoneal dialysis patients.

    PubMed

    Wang, Angela Yee-Moon

    2014-06-01

    Like hemodialysis patients, peritoneal dialysis (PD) patients are facing an excessively increased burden of vascular and valvular calcification. According to some surveys, more than 80% of prevalent PD patients are complicated with vascular calcification, and more than one third have heart valve calcification. Dysregulated phosphate metabolism is well recognized to play an important role in inducing vascular calcification, but increasing evidence is suggesting that dysregulated calcium metabolism also promotes vascular calcification and might in fact be more potent than phosphate in inducing that calcification. Growing evidence from randomized controlled trials shows more progression of vascular calcification and higher mortality among chronic kidney disease (CKD) patients receiving calcium-based phosphate binders than among those receiving non-calcium-containing phosphate binders. Those results raise important safety concern about the use of high-dose calcium-based phosphate binders in the CKD population, including both non-dialysis and dialysis patients (especially anuric dialysis patients), who have markedly reduced urinary calcium excretion. To prevent calcium overload, this review recommends restricting the dose of calcium-based phosphate binders in CKD patients, especially those who are elderly, who have increased cardiovascular risk, who already have baseline vascular or valvular calcification, or who have low intact parathyroid hormone and adynamic bone disease. Copyright © 2014 International Society for Peritoneal Dialysis.

  8. Dialysis or conservative care for frail older patients: ethics of shared decision-making.

    PubMed

    Muthalagappan, Seetha; Johansson, Lina; Kong, Wing May; Brown, Edwina A

    2013-11-01

    Increasing numbers of frail elderly with end-stage renal disease (ESRD) and multiple comorbidities are undertaking dialysis treatment. This has been accompanied by increasing dialysis withdrawal, thus warranting investigation into why this is occurring and whether a different approach to choosing treatment should be implemented. Despite being a potentially life-saving treatment, the physical and psychosocial burdens associated with dialysis in the frail elderly usually outweigh the benefits of correcting uraemia. Conservative management is less invasive and avoids the adverse effects associated with dialysis, but unfortunately it is often not properly considered until patients withdraw from dialysis. Shared decision-making has been proposed to allow patients active participation in healthcare decisions. Through this approach, patients will focus on their personal values to receive appropriate treatment, and perhaps opt for conservative management. This may help address the issue of dialysis withdrawal. Moreover, shared decision-making attempts to resolve the conflict between autonomy and other ethical principles, including physician paternalism. Here, we explore the ethical background behind shared decision-making, and whether it is genuinely in the patient's best interests or whether it is a cynical solution to encourage more patients to consider conservative care, thus saving limited resources.

  9. Intra-procedural continuous dialysis to facilitate interventional catheterization in pediatric patients with severe renal failure.

    PubMed

    Opina, Angeline D; Qureshi, Athar M; Brewer, Eileen; Elenberg, Ewa; Swartz, Sarah; Michael, Mini; Justino, Henri

    2017-07-12

    Interventional catheterization procedures may be needed for patients with severe renal failure who are dependent on dialysis. To avoid the risk of fluid overload and electrolyte derangement during complex procedures in this oliguric/anuric patient population, we performed intra-procedural dialysis, either continuous renal replacement therapy (CRRT) or continous cycling peritoneal dialysis (CCPD). We performed a retrospective review of a cohort of pediatric patients, ages 0-18 years, with dialysis-dependent renal failure who received CRRT or CCPD during catheterization procedures from January 2013 to March 2016. Eight patients underwent a total of nine interventional catheterization procedures while receiving intra-procedural dialysis. Median age was 4.5 years (range 8 months to 17 years) and weight, 11.6 kg (11.2-62.6 kg). Six patients had end-stage renal disease (ESRD) and two patients had acute kidney injury (AKI), one due to hepatorenal syndrome and one due to multifactorial causes associated with congenital heart disease. The most common reason for catheterization was occlusive venous thrombosis requiring recanalization. CRRT was used during five cases and CCPD during four cases. Median procedure time was 337 min (95-651 min) and median contrast dose 4.2 mL kg(-1) (1.2-8.2 mL kg(-1) ). Euvolemia was maintained based on pre- and post-catheterizations weights, and no significant electrolyte abnormalities occurred based on lab monitoring during and post-procedure. Intra-procedural dialysis using CRRT or CCPD enables even small pediatric patients with severe renal failure to undergo long and complex interventional catheterizations by reducing the risk of fluid overload and electrolyte abnormalities. Collaboration between nephrology, cardiology, and dialysis teams is necessary for successful management of this challenging patient population. © 2017 Wiley Periodicals, Inc.

  10. Contamination and radiation exposure from sup 201 Tl in patients undergoing dialysis after a nuclear medicine study

    SciTech Connect

    Serrano, M.; Olson, A.; Man, C.; Galonsky, R.; Stein, R. )

    1991-03-01

    Our institution is a major kidney research and transplant center. Hemodialysis patients that are scheduled for renal transplant are given a 201Tl stress test. Possible radiation exposure and contamination are of concern to attending personnel. We investigated this situation and found measurable activity in the effluent of patients receiving dialysis but no significant contamination of equipment. We determined that dialysis personnel received minimal radiation exposure.

  11. Graves' disease in a dialysis dependent chronic renal failure patient

    PubMed Central

    Nair, C. G.; Jacob, P.; Menon, R.; Babu, M. J. C.

    2014-01-01

    Thyroid hormone level may be altered in chronic renal failure patients. Low levels of thyroxine protect the body from excess protein loss by minimizing catabolism. Hyperthyroidism is rarely encountered in end-stage dialysis dependent patients. Less than 10 well-documented cases of Graves' disease (GD) are reported in literature so far. We report a case of GD in a patient on dialysis. PMID:25484538

  12. [An irritating cough in dialysis patients. A rare differential diagnosis].

    PubMed

    Oursin, C; Meyer, E

    1992-02-01

    Soft tissue calcification is a well-known complication in chronic dialysis patients. These calcifications are mainly located around the large joints. Calcification of the visceral organs also occurs in these patients, even though this fact is far less known. These visceral calcifications are mostly diagnosed post mortem as they tend to be discrete and asymptomatic. In this article, we report on a chronic dialysis patient in whom extensive pulmonary calcifications occurred, leading to clinical symptoms.

  13. Association of Physical Activity with Survival among Ambulatory Patients on Dialysis: The Comprehensive Dialysis Study

    PubMed Central

    Kaysen, George A.; Dalrymple, Lorien S.; Grimes, Barbara A.; Glidden, David V.; Anand, Shuchi; Chertow, Glenn M.

    2013-01-01

    Summary Background and objectives Despite high mortality and low levels of physical activity (PA) among patients starting dialysis, the link between low PA and mortality has not been carefully evaluated. Design, setting, participants, & measurements The Comprehensive Dialysis Study was a prospective cohort study that enrolled patients who started dialysis between June 2005 and June 2007 in a random sample of dialysis facilities in the United States. The Human Activity Profile (HAP) was administered to estimate PA among 1554 ambulatory enrolled patients in the Comprehensive Dialysis Study. Patients were followed until death or September 30, 2009, and the major outcome was all-cause mortality. Results The average age was 59.8 (14.2) years; 55% of participants were male, 28% were black, and 56% had diabetes mellitus. The majority (57.3%) had low fitness estimated from the HAP score. The median follow-up was 2.6 (interquartile range, 2.2–3.1) years. The association between PA and mortality was linear across the range of scores (1–94). After multivariable adjustment, lower adjusted activity score on the HAP was associated with higher mortality (hazard ratio, 1.30; 95% confidence interval, 1.23–1.39 per 10 points). Patients in the lowest level of fitness experienced a 3.5-fold (95% confidence interval, 2.54–4.89) increase in risk of death compared with those with average or above fitness. Conclusions Low levels of PA are strongly associated with mortality among patients new to dialysis. Interventions aimed to preserve or enhance PA should be prospectively tested. PMID:23124787

  14. Pharmacokinetics of icodextrin in peritoneal dialysis patients.

    PubMed

    Moberly, James B; Mujais, Salim; Gehr, Todd; Hamburger, Richard; Sprague, Stuart; Kucharski, Andrew; Reynolds, Robin; Ogrinc, Francis; Martis, Leo; Wolfson, Marsha

    2002-10-01

    Pharmacokinetics of icodextrin in peritoneal dialysis patients. Icodextrin is a glucose polymer osmotic agent used to provide sustained ultrafiltration during long peritoneal dialysis (PD) dwells. A number of studies have evaluated the steady-state blood concentrations of icodextrin during repeated use; however, to date the pharmacokinetics of icodextrin have not been well studied. The current study was conducted to determine the absorption, plasma kinetics and elimination of icodextrin and metabolites following a single icodextrin exchange. Thirteen PD patients were administered 2.0 L of solution containing 7.5% icodextrin for a 12-hour dwell. Icodextrin (total of all glucose polymers) and specific polymers with degrees of polymerization ranging from two to seven (DP2 to DP7) were measured in blood, urine and dialysate during the dwell and after draining the solution from the peritoneal cavity. A median of 40.1% (60.24 g) of the total administered dose (150 g) was absorbed during the 12-hour dwell. Plasma levels of icodextrin and metabolites rose during the dwell and declined after drain, closely corresponding to the one-compartment pharmacokinetic model assuming zero-order absorption and first-order elimination. Peak plasma concentrations (median C peak = 2.23 g/L) were observed at the end of the dwell (median Tmax = 12.7 h) and were significantly correlated with patients' body weight (R2 = 0.805, P < 0.001). Plasma levels of icodextrin and metabolites returned to baseline within 3 to 7 days. Icodextrin had a plasma half-life of 14.73 hours and a median clearance of 1.09 L/h. Urinary excretion of icodextrin and metabolites was directly related to residual renal function (R2 = 0.679 vs. creatinine clearance, P < 0.01). In the nine patients with residual renal function, the average daily urinary excretion of icodextrin was 473 +/- 77 mg per mL of endogenous renal creatinine clearance. Icodextrin metabolites DP2 to DP4 were found in the dialysate of subsequent

  15. Older patients undergoing dialysis treatment: cognitive functioning, depressive mood and health-related quality of life.

    PubMed

    Tyrrell, J; Paturel, L; Cadec, B; Capezzali, E; Poussin, G

    2005-07-01

    An increasing number of older patients receive dialysis treatment to compensate for deficient kidneys due to end-stage renal disease (ESRD). Ethical questions arise about the benefits of dialysis when a patient appears unwilling or unable to comply with this treatment procedure. Such attitudes and behaviour may be due to psychological factors, but these are not routinely assessed. The purpose of this study was to evaluate levels of cognitive impairment, depressive mood and self-reported quality of life in older dialysis patients (>70 years). A total of 51 outpatients receiving dialysis were assessed by psychologists, using a depression scale (MADRS), two cognitive tests (MMSE and BEC 96), and a quality of life questionnaire (NHP). Sixty percent of the patients were depressed, and between 30-47% had cognitive impairment. Almost half of the depressed patients were also cognitively impaired. The scores for self-reported quality of life varied widely within the sample. Cognitive impairment and depressive mood are often overlooked and underestimated in this population. Regular assessments of depressive mood, cognitive ability and quality of life are recommended, given the prevalence of problems in these domains for older dialysis patients. The information obtained should assist staff as they reflect on individual cases where the benefits of continuing treatment are being examined.

  16. Factors Associated with the Choice of Peritoneal Dialysis in Patients with End-Stage Renal Disease

    PubMed Central

    Chiang, Pei-Chun; Hou, Jia-Jeng; Jong, Ing-Ching; Hung, Peir-Haur; Hsiao, Chih-Yen

    2016-01-01

    Background. The purpose of this study was to analyze the factors associated with receiving peritoneal dialysis (PD) in patients with incident end-stage renal disease (ESRD) in a hospital in Southern Taiwan. Methods. The study included all consecutive patients with incident ESRD who participated in a multidisciplinary predialysis education (MPE) program and started their first dialysis therapy between January 1, 2008, and June 30, 2013, in the study hospital. We provided small group teaching sessions to advanced CKD patients and their family to enhance understanding of various dialysis modalities. Multivariate logistic regression models were used to analyze the association of patient characteristics with the chosen dialysis modality. Results. Of the 656 patients, 524 (80%) chose hemodialysis and 132 chose PD. Our data showed that young age, high education level, and high scores of activities of daily living (ADLs) were positively associated with PD treatment. Patients who received small group teaching sessions had higher percentages of PD treatment (30.5% versus 19.5%; P = 0.108) and preparedness for dialysis (61.1% versus 46.6%; P = 0.090). Conclusion. Young age, high education level, and high ADL score were positively associated with choosing PD. Early creation of vascular access may be a barrier for PD. PMID:27042665

  17. Comorbidities in Chronic Pediatric Peritoneal Dialysis Patients: A Report of the International Pediatric Peritoneal Dialysis Network

    PubMed Central

    Neu, Alicia M.; Sander, Anja; Borzych-Dużałka, Dagmara; Watson, Alan R.; Vallés, Patricia G.; Ha, Il Soo; Patel, Hiren; Askenazi, David; Balasz-Chmielewska, Irena; Lauronen, Jouni; Groothoff, Jaap W.; Feber, Janusz; Schaefer, Franz; Warady, Bradley A.

    2012-01-01

    ♦ Background, Objectives, and Methods: Hospitalization and mortality rates in pediatric dialysis patients remain unacceptably high. Although studies have associated the presence of comorbidities with an increased risk for death in a relatively small number of pediatric dialysis patients, no large-scale study had set out to describe the comorbidities seen in pediatric dialysis patients or to evaluate the impact of those comorbidities on outcomes beyond the newborn period. In the present study, we evaluated the prevalence of comorbidities in a large international cohort of pediatric chronic peritoneal dialysis (CPD) patients from the International Pediatric Peritoneal Dialysis Network registry and began to assess potential associations between those comorbidities and hospitalization rates and mortality. ♦ Results: Information on comorbidities was available for 1830 patients 0 - 19 years of age at dialysis initiation. Median age at dialysis initiation was 9.1 years [interquartile range (IQR): 10.9], median follow-up for calculation of hospitalization rates was 15.2 months (range: 0.2 - 80.9 months), and total follow-up time in the registry was 2095 patient-years. At least 1 comorbidity had been reported for 602 of the patients (32.9%), with 283 (15.5%) having cognitive impairment; 230 (12.6%), motor impairment; 167 (9.1%), cardiac abnormality; 76 (4.2%), pulmonary abnormality; 212 (11.6%), ocular abnormality; and 101 (5.5%), hearing impairment. Of the 150 patients (8.2%) that had a defined syndrome, 85% had at least 1 nonrenal comorbidity, and 64% had multiple comorbidities. The presence of at least 1 comorbidity was associated with a higher hospitalization rate [hospital days per 100 observation days: 1.7 (IQR: 5.8) vs 1.2 (IQR: 3.9), p = 0.001] and decreased patient survival (4-year survival rate: 73% vs 90%, p < 0.0001). ♦ Conclusions: Nearly one third of pediatric CPD patients in a large international cohort had at least 1 comorbidity, and multiple

  18. Impact of Pediatric Chronic Dialysis on Long-Term Patient Outcome: Single Center Study

    PubMed Central

    Krause, Irit; Dagan, Amit; Cleper, Roxana; Falush, Yafa; Davidovits, Miriam

    2016-01-01

    Objective. Owing to a shortage of kidney donors in Israel, children with end-stage renal disease (ESRD) may stay on maintenance dialysis for a considerable time, placing them at a significant risk. The aim of this study was to understand the causes of mortality. Study Design. Clinical data were collected retrospectively from the files of children on chronic dialysis (>3 months) during the years 1995–2013 at a single pediatric medical center. Results. 110 patients were enrolled in the study. Mean age was 10.7 ± 5.27 yrs. (range: 1 month–24 yrs). Forty-five children (42%) had dysplastic kidneys and 19 (17.5%) had focal segmental glomerulosclerosis. Twenty-five (22.7%) received peritoneal dialysis, 59 (53.6%) hemodialysis, and 6 (23.6%) both modalities sequentially. Median dialysis duration was 1.46 years (range: 0.25–17.54 years). Mean follow-up was 13.5 ± 5.84 yrs. Seventy-nine patients (71.8%) underwent successful transplantation, 10 (11.2%) had graft failure, and 8 (7.3%) continued dialysis without transplantation. Twelve patients (10.9%) died: 8 of dialysis-associated complications and 4 of their primary illness. The 5-year survival rate was 84%: 90% for patients older than 5 years and 61% for younger patients. Conclusions. Chronic dialysis is a suitable temporary option for children awaiting renal transplantation. Although overall long-term survival rate is high, very young children are at high risk for life-threatening dialysis-associated complications. PMID:27597898

  19. [Dialysis dose quantification in critically ill patients].

    PubMed

    Casino, Francesco Gaetano

    2010-01-01

    Acute kidney injury affects about 35% of intensive care unit patients. Renal replacement therapy is required in about 5% of such patients and is associated with a mortality rate as high as 50% to 80%. The latter is likely more related to the failure of extrarenal organs than to an insufficient dialysis dose. This could explain, at least in part, the findings of 2 recent trials (VA/ NIH and RENAL) where the expected dose-outcome relationship was not confirmed. These results cannot be taken to infer that assessing the dialysis dose is no longer required. The contrary is true, in that the common finding of large differences between prescribed and delivered doses calls for accurate dose assessment, at least to avoid underdialysis. The minimum adequate levels are now a Kt/V urea of 1.2 to 1.4 three times a week (3x/wk) on intermittent hemodialysis (IHD), and an effluent of 20 mL/kg/h for 85% of the time on continuous renal replacement therapy (CRTT). Both these parameters can be easily measured but are far from ideal indices because they account neither for residual renal function nor for irregular dose delivery. The equivalent renal urea clearance (EKRjc), by expressing the averaged renal+dialytic urea clearance over the whole treatment period, is able to account for the above factors. Although assessing EKRjc is quite complex, for regular 3x/wk IHD one could use the formula EKRjc=10 Kt/V+1 to compute that a Kt/V of 1.2 and 1.4 corresponds to an EKRjc of 13 and 15 mL/min, respectively. On the other hand, the hourly effluent per kg is numerically similar to EKRjc. On this basis it can be calculated that in non-prediluted really continuous treatment, the recommended CRRT dose (EKRjc=20 mL/min) is 33% higher than the EKRjc of 15 mL/min, corresponding to the recommended Kt/V of 1.4 on 3x/wk IHD.

  20. Con: Higher serum bicarbonate in dialysis patients is protective.

    PubMed

    Chauveau, Philippe; Rigothier, Claire; Combe, Christian

    2016-08-01

    Metabolic acidosis is often observed in advanced chronic kidney disease, with deleterious consequences on the nutritional status, bone and mineral status, inflammation and mortality. Through clearance of the daily acid load and a net gain in alkaline buffers, dialysis therapy is aimed at correcting metabolic acidosis. A normal bicarbonate serum concentration is the recommended target in dialysis patients. However, several studies have shown that a mild degree of metabolic acidosis in patients treated with dialysis is associated with better nutritional status, higher protein intake and improved survival. Conversely, a high bicarbonate serum concentration is associated with poor nutritional status and lower survival. It is likely that mild acidosis results from a dietary acid load linked to animal protein intake. In contrast, a high bicarbonate concentration in patients treated with dialysis could result mainly from an insufficient dietary acid load, i.e. low protein intake. Therefore, a high pre-dialysis serum bicarbonate concentration should prompt nephrologists to carry out nutritional investigations to detect insufficient dietary protein intake. In any case, a high bicarbonate concentration should be neither a goal of dialysis therapy nor an index of adequate dialysis, whereas mild acidosis could be considered as an indicator of appropriate protein intake. © The Author 2016. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.

  1. Recent Peritonitis Associates with Mortality among Patients Treated with Peritoneal Dialysis

    PubMed Central

    Kemp, Anna; Clayton, Philip; Lim, Wai; Badve, Sunil V.; Hawley, Carmel M.; McDonald, Stephen P.; Wiggins, Kathryn J.; Bannister, Kym M.; Brown, Fiona G.; Johnson, David W.

    2012-01-01

    Peritonitis is a major complication of peritoneal dialysis, but the relationship between peritonitis and mortality among these patients is not well understood. In this case-crossover study, we included the 1316 patients who received peritoneal dialysis in Australia and New Zealand from May 2004 through December 2009 and either died on peritoneal dialysis or within 30 days of transfer to hemodialysis. Each patient served as his or her own control. The mean age was 70 years, and the mean time receiving peritoneal dialysis was 3 years. In total, there were 1446 reported episodes of peritonitis with 27% of patients having ≥2 episodes. Compared with the rest of the year, there were significantly increased odds of peritonitis during the 120 days before death, although the magnitude of this association was much greater during the 30 days before death. Compared with a 30-day window 6 months before death, the odds for peritonitis was six-fold higher during the 30 days immediately before death (odds ratio, 6.2; 95% confidence interval, 4.4–8.7). In conclusion, peritonitis significantly associates with mortality in peritoneal dialysis patients. The increased odds extend up to 120 days after an episode of peritonitis but the magnitude is greater during the initial 30 days. PMID:22626818

  2. Cold Dialysis Solution for Hemodialysis Patients With Fatigue: a Cross-over Study.

    PubMed

    Sajadi, Mahbobeh; Gholami, Zohreh; Hekmatpou, Davood; Soltani, Parvin; Haghverdi, Farshid

    2016-09-01

    The purpose of this study was to explore the effect of cold dialysis on fatigue in hemodialysis patients. In a double-blinded cross-over clinical trial, 46 participants were recruited from a hemodialysis unit in Iran. The participants were allocated into 2 groups through simple random sampling method. Each group received 3 sessions of hemodialysis with a dialysis solution temperature of either 37°C 3 or 35.5°C during the first week and then with for another week with the other temperature.  The self-report Piper Fatigue Scale questionnaire was filled out by the participants. The Piper Fatigue Scale scores in the cold dialysis groups were significantly lower than those in the conventional dialysis solution temperature (P < .001). Reducing the temperature of hemodialysis solution brought a 31.3% reduction in the fatigue score. Cold dialysis can be used for all hemodialysis patients as a routine intervention, and in particular, it is recommended dialysis patients who have severe fatigue as a convenient and inexpensive therapeutic option.

  3. Pro: Higher serum bicarbonate in dialysis patients is protective.

    PubMed

    Misra, Madhukar

    2016-08-01

    Chronic metabolic acidosis is common in dialysis patients. Bicarbonate administration via the dialysate helps maintain the acid-base balance in these patients. Serum bicarbonate level in dialysis patients is determined by several factors that include dietary protein intake, nutritional status and dialysis prescription, etc. Additionally, a meaningful interpretation of serum bicarbonate in dialysis patients requires an understanding of complexities involving its measurement. Both very low as well very high levels of serum bicarbonate have been associated with adverse outcomes in observational studies. However, recent observational data, when adjusted for the confounding effects of nutritional status, do not associate higher predialysis serum bicarbonate with adverse consequences. At this time, there are no prospective studies available that have examined the association of serum bicarbonate with hard outcomes in dialysis patients. The ideal level of serum bicarbonate in dialysis patients is therefore unknown. This article examines the available data with regard to the benefits of higher predialysis serum bicarbonate. © The Author 2016. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.

  4. Association of cinacalcet adherence and costs in patients on dialysis.

    PubMed

    Lee, Andrew; Song, Xue; Khan, Irfan; Belozeroff, Vasily; Goodman, William; Fulcher, Nicole; Diakun, David

    2011-01-01

    In addition to negative impacts on clinical effectiveness in treating secondary hyperparathyroidism, low adherence to cinacalcet may have negative impacts on healthcare costs. This study assessed the relationship between medication adherence and healthcare costs among US patients on dialysis given cinacalcet to manage secondary hyperparathyroidism. Retrospective cohort study of patients who were receiving dialysis with an initial cinacalcet prescription between January 2004 and April 2010 and who survived ≥12 months. Longitudinal, integrated medical, and pharmacy claims data from the MarketScan? database were used to calculate medication possession ratios (MPR) over 12 months and to examine the association of adherence with inpatient, outpatient, emergency room, outpatient medication, and total costs while controlling for patient characteristics, co-morbid medical conditions, and concomitant medication MPR in a multivariate regression model. Patients were dichotomized as adherent (<180 days refill gap) or non-adherent (≥180 day refill gap). Adherent patients were further dichotomized as low adherent (<0.8 MPR) and high adherent (≥0.8 MPR). The final study cohort included 4923 patients. After 12 months, 46% were non-adherent, 27% were low adherent, and 28% were high adherent. Greater cinacalcet adherence was associated with significantly lower inpatient costs with cost-savings of a greater magnitude than the increased medication costs. This study demonstrated that low adherence to cinacalcet, which may be associated with undesirable clinical and health-economic outcomes, is common. Despite limitations inherent in retrospective studies of claims databases, such as unobserved confounding, non-discrimination between prescription fill and actual use, and not knowing the reasons for non-adherence, these results suggest that inpatient cost savings of $8899, more than offset higher medication costs of $5858 associated with increased cinacalcet adherence.

  5. Study of prolonged administration of lanthanum carbonate in dialysis patients.

    PubMed

    Gotoh, Junichi; Kukita, Kazutaka; Tsuchihashi, Seiichiro; Hattori, Masahiro; Iida, Junichi; Horie, Takashi; Onodera, Kazuhiko; Furui, Hidenori; Tamaki, Toru; Meguro, Junichi; Yonekawa, Motoki; Kawamura, Akio

    2013-04-01

    Data of 36 months were accumulated regarding the effects of lanthanum carbonate (LA) on serum phosphate concentrations in dialysis patients. Fifty-three patients (average age and dialysis history 58.4 years and 9.1 years) were included in this study who have been receiving outpatient treatment since March 2009, and who have been unable to maintain serum phosphate concentrations of ≤6.0 mg/dL via traditional therapeutic agents used for hyperphosphatemia. Patients were given dosage of LA in addition to, or instead of, co-hyperphosphatemia treatments already being received. Mean dosages of calcium carbonate (CC) and sevelamer hydrochloride (SH) before starting LA administration were 1301.9 mg and 2462.3 mg, respectively. Dosage of LA for all cases was 750 mg at initial dose; 1528.3 mg at 5 months; and 1416.7 mg at 30 months. Dosage of other phosphate binders were 905.7 mg of CC and 820.8 mg of SH at 5 months; and 687.5 mg of CC and 1031.3 mg of SH at 30 months. Serum phosphorus levels (P levels) were significantly decreased at 1 month of LA administration, and continued until 30 months of La treatment. These results suggest that LA successfully controlled serum P and Ca concentrations simultaneously within target ranges without affecting serum intact parathyroid hormone concentration, although further long-term prospective cohort study on LA would be required.

  6. Promoting self-management improves the health status of patients having peritoneal dialysis.

    PubMed

    Su, Chun-Yan; Lu, Xin-Hong; Chen, Wei; Wang, Tao

    2009-07-01

    This paper is a report of a study conducted to explore the effects of promoting self-management on the well-being of patients having peritoneal dialysis. Peritoneal dialysis is a home-based treatment for end-stage renal disease. Promoting self-management has been shown to improve the health status of people with diabetes mellitus and other chronic diseases. However, little is known about the effects of self-management support for patients having peritoneal dialysis. Thirty patients who had received peritoneal dialysis for at least 6 months and were clinically stable were enrolled in the study in 2006. A multidisciplinary team was built to support the patients' self-management. Various forms of education such as group discussion and individual consultation were used to improve patients' self-efficacy and all were followed up for 6 months. We compared the volume status, adequacy of dialysis, nutritional status, quality of life, rehabilitation status, self-management capacity and self-efficacy levels at baseline, 3 and 6 months after enrolment. During follow-up, patients' urine volume and residual renal function decreased, while the adequacy of dialysis (Kt/v and Ccr) did not change. Volume status, quality of life and rehabilitation status all improved, whereas nutritional status did not deteriorate. Both self-management capacity and self-efficacy level increased statistically significantly. A team approach needs to be taken to achieve successful self-management in patients having peritoneal dialysis, as with other chronic disease treatments. Nurses should use multiple strategies based on self-efficacy theory to improve patients' self-efficacy levels and self-management capacities.

  7. Zinc Supplementation Alters Plasma Aluminum and Selenium Status of Patients Undergoing Dialysis: A Pilot Study

    PubMed Central

    Guo, Chih-Hung; Chen, Pei-Chung; Hsu, Guoo-Shyng W.; Wang, Chia-Liang

    2013-01-01

    End stage renal disease patients undergoing long-term dialysis are at risk for abnormal concentrations of certain essential and non-essential trace metals and high oxidative stress. We evaluated the effects of zinc (Zn) supplementation on plasma aluminum (Al) and selenium (Se) concentrations and oxidative stress in chronic dialysis patients. Zn-deficient patients receiving continuous ambulatory peritoneal dialysis or hemodialysis were divided into two groups according to plasma Al concentrations (HA group, Al > 50 μg/L; and MA group, Al > 30 to ≤ 50 μg/L). All patients received daily oral Zn supplements for two months. Age- and gender-matched healthy individuals did not receive Zn supplement. Clinical variables were assessed before, at one month, and after the supplementation period. Compared with healthy subjects, patients had significantly lower baseline plasma Se concentrations and higher oxidative stress status. After two-month Zn treatment, these patients had higher plasma Zn and Se concentrations, reduced plasma Al concentrations and oxidative stress. Furthermore, increased plasma Zn concentrations were related to the concentrations of Al, Se, oxidative product malondialdehyde (MDA), and antioxidant enzyme superoxide dismutase activities. In conclusion, Zn supplementation ameliorates abnormally high plasma Al concentrations and oxidative stress and improves Se status in long-term dialysis patients. PMID:23609777

  8. Zinc supplementation alters plasma aluminum and selenium status of patients undergoing dialysis: a pilot study.

    PubMed

    Guo, Chih-Hung; Chen, Pei-Chung; Hsu, Guoo-Shyng W; Wang, Chia-Liang

    2013-04-22

    End stage renal disease patients undergoing long-term dialysis are at risk for abnormal concentrations of certain essential and non-essential trace metals and high oxidative stress. We evaluated the effects of zinc (Zn) supplementation on plasma aluminum (Al) and selenium (Se) concentrations and oxidative stress in chronic dialysis patients. Zn-deficient patients receiving continuous ambulatory peritoneal dialysis or hemodialysis were divided into two groups according to plasma Al concentrations (HA group, Al > 50 g/L; and MA group, Al > 30 to ≤ 50 g/L). All patients received daily oral Zn supplements for two months. Age- and gender-matched healthy individuals did not receive Zn supplement. Clinical variables were assessed before, at one month, and after the supplementation period. Compared with healthy subjects, patients had significantly lower baseline plasma Se concentrations and higher oxidative stress status. After two-month Zn treatment, these patients had higher plasma Zn and Se concentrations, reduced plasma Al concentrations and oxidative stress. Furthermore, increased plasma Zn concentrations were related to the concentrations of Al, Se, oxidative product malondialdehyde (MDA), and antioxidant enzyme superoxide dismutase activities. In conclusion, Zn supplementation ameliorates abnormally high plasma Al concentrations and oxidative stress and improves Se status in long-term dialysis patients.

  9. Periodontal treatment reduces chronic systemic inflammation in peritoneal dialysis patients.

    PubMed

    Siribamrungwong, Monchai; Yothasamutr, Kasemsuk; Puangpanngam, Kutchaporn

    2014-06-01

    Chronic systemic inflammation, a non traditional risk factor of cardiovascular diseases, is associated with increasing mortality in chronic kidney disease, especially peritoneal dialysis patients. Periodontitis is a potential treatable source of systemic inflammation in peritoneal dialysis patients. Clinical periodontal status was evaluated in 32 stable chronic peritoneal dialysis patients by plaque index and periodontal disease index. Hematologic, blood chemical, nutritional, and dialysis-related data as well as highly sensitive C-reactive protein were analyzed before and after periodontal treatment. At baseline, high sensitive C-reactive protein positively correlated with the clinical periodontal status (plaque index; r = 0.57, P < 0.01, periodontal disease index; r = 0.56, P < 0.01). After completion of periodontal therapy, clinical periodontal indexes were significantly lower and high sensitivity C-reactive protein significantly decreased from 2.93 to 2.21 mg/L. Moreover, blood urea nitrogen increased from 47.33 to 51.8 mg/dL, reflecting nutritional status improvement. Erythropoietin dosage requirement decreased from 8000 to 6000 units/week while hemoglobin level was stable. Periodontitis is an important source of chronic systemic inflammation in peritoneal dialysis patients. Treatment of periodontal diseases can improve systemic inflammation, nutritional status and erythropoietin responsiveness in peritoneal dialysis patients.

  10. Hospitalization Rates for Patients on Assisted Peritoneal Dialysis Compared with In-Center Hemodialysis

    PubMed Central

    Al-Jaishi, Ahmed A.; Dixon, Stephanie N.; Perl, Jeffrey; Jain, Arsh K.; Lavoie, Susan D.; Nash, Danielle M.; Paterson, J. Michael; Lok, Charmaine E.; Quinn, Robert R.

    2016-01-01

    Background and objectives Assisted peritoneal dialysis is a treatment option for individuals with barriers to self-care who wish to receive home dialysis, but previous research suggests that this treatment modality is associated with a higher rate of hospitalization. The objective of our study was to determine whether assisted peritoneal dialysis has a different rate of hospital days compared to in-center hemodialysis. Design, setting, participants, & measurements We conducted a multicenter, retrospective cohort study by linking a quality assurance dataset to administrative health data in Ontario, Canada. Subjects were accrued between January 1, 2004 and July 9, 2013. Individuals were grouped into assisted peritoneal dialysis (family or home care assisted) or in-center hemodialysis on the basis of their first outpatient dialysis modality. Inverse probability of treatment weighting using a propensity score was used to create a sample in which the baseline covariates were well balanced. Results The study included 872 patients in the in–center hemodialysis group and 203 patients in the assisted peritoneal dialysis group. Using an intention to treat approach, patients on assisted peritoneal dialysis had a similar hospitalization rate of 11.1 d/yr (95% confidence interval, 9.4 to 13.0) compared with 12.9 d/yr (95% confidence interval, 10.3 to 16.1) in the hemodialysis group (P=0.19). Patients on assisted peritoneal dialysis were more likely to be hospitalized for dialysis-related reasons (admitted for 2.4 d/yr [95% confidence interval, 1.8 to 3.2] compared with 1.6 d/yr [95% confidence interval, 1.1 to 2.3] in the hemodialysis group; P=0.04). This difference was partly explained by more hospital days because of peritonitis. Modality switching was associated with high rates of hospital days per year. Conclusions Assisted peritoneal dialysis was associated with similar rates of all-cause hospitalization compared with in-center hemodialysis. Patients on assisted

  11. Hydration Status of Patients Dialyzed with Biocompatible Peritoneal Dialysis Fluids.

    PubMed

    Lichodziejewska-Niemierko, Monika; Chmielewski, Michał; Dudziak, Maria; Ryta, Alicja; Rutkowski, Bolesław

    2016-01-01

    ♦ Biocompatible fluids for peritoneal dialysis (PD) have been introduced to improve dialysis and patient outcome in end-stage renal disease. However, their impact on hydration status (HS), residual renal function (RRF), and dialysis adequacy has been a matter of debate. The aim of the study was to evaluate the influence of a biocompatible dialysis fluid on the HS of prevalent PD patients. ♦ The study population consisted of 18 prevalent PD subjects, treated with standard dialysis fluids. At baseline, 9 patients were switched to a biocompatible solution, low in glucose degradation products (GDPs) (Balance; Fresenius Medical Care, Bad Homburg, Germany). Hydration status was assessed through clinical evaluation, laboratory parameters, echocardiography, and bioimpedance spectroscopy over a 24-month observation period. ♦ During the study period, urine volume decreased similarly in both groups. At the end of the evaluation, there were also no differences in clinical (body weight, edema, blood pressure), laboratory (N-terminal pro-brain natriuretic peptide, NTproBNP), or echocardiography determinants of HS. However, dialysis ultrafiltration decreased in the low-GDP group and, at the end of the study, equaled 929 ± 404 mL, compared with 1,317 ± 363 mL in the standard-fluid subjects (p = 0.06). Hydration status assessed by bioimpedance spectroscopy was +3.64 ± 2.08 L in the low-GDP patients and +1.47 ± 1.61 L in the controls (p = 0.03). ♦ The use of a low-GDP biocompatible dialysis fluid was associated with a tendency to overhydration, probably due to diminished ultrafiltration in prevalent PD patients. Copyright © 2016 International Society for Peritoneal Dialysis.

  12. Prevalence of pre-end-stage renal disease care and associated outcomes among urban, micropolitan, and rural dialysis patients.

    PubMed

    Maripuri, Saugar; Ikizler, T Alp; Cavanaugh, Kerri L

    2013-01-01

    Pre-end-stage renal disease (ESRD) care is associated with improved outcomes among patients receiving dialysis. It is unknown what proportion of US micropolitan and rural dialysis patients receive pre-ESRD care and benefit from such care when compared to urban. A retrospective cohort study was performed using data from the US Renal Data System. Patients ≥18 years old who initiated dialysis in 2006 and 2007 were classified as rural, micropolitan or urban and the prevalence of pre-ESRD care (early nephrology care >6 months, permanent vascular access, -dietary education) was determined using the medical evidence report. The association of pre-ESRD care with dialysis mortality and transplantation was assessed using Cox regression with stratification for geographic residence. Of 204,463 dialysis patients, 80% were urban, 10.2% were micropolitan and 9.8% were rural. Overall attainment of pre-ESRD care was poor. After adjustment, there were no significant geographic differences in attainment of early nephrology care or permanent dialysis access. Receiving care reduced all-cause mortality and increased the likelihood of transplantation to a similar degree regardless of geographic residence. Both micropolitan and rural patients received less dietary education (relative risk = 0.80, 95% CI = 0.76-0.84 and relative risk = 0.85, 95% CI = 0.80-0.89, respectively). Among patients who receive dialysis, the prevalence of early nephrology care and permanent dialysis access is poor and does not vary by geographic residence. Micropolitan and rural patients receive less dietary education despite an observed mortality benefit, suggesting that barriers may exist to quality dietary care in more remote locations. Copyright © 2013 S. Karger AG, Basel.

  13. Using tunneled femoral vein catheters for "urgent start" dialysis patients: a preliminary report.

    PubMed

    Hingwala, Jay; Bhola, Cynthia; Lok, Charmaine E

    2014-01-01

    Multiple benefits of arteriovenous fistulas (AVF) and arteriovenous grafts (AVGs) exist over catheters. As part of a strategy to preserve thoracic venous sites and reduce internal jugular (IJ) vein catheter use, we inserted tunneled femoral vein catheters in incident "urgent start" dialysis patients while facilitating a more appropriate definitive dialysis access. "Urgent start" dialysis patients between January 15, 2013 and January 15, 2014 who required chronic dialysis, and did not have prior modality and vascular access plans, had tunneled femoral vein catheters inserted. We determined the femoral vein catheter associated infections rates, thrombosis, and subsequent dialysis access. Eligible patients were surveyed on their femoral vein catheter experience. Twenty-two femoral vein catheters were inserted without complications. Subsequently, one catheter required intraluminal thrombolytic locking, while all other catheters maintained blood flow greater than 300 ml/min. There were no catheter-related infections (exit site infection or bacteremia). Six patients continued to use their tunneled catheter at report end, one transitioned to peritoneal dialysis, thirteen to an arteriovenous graft, and two to a fistula. One patient received a tunneled IJ vein catheter. Of the patients who completed the vascular access survey, all indicated satisfaction with their access and that they had minimal complaints of bruising, bleeding, or swelling at their access sites. Pain/discomfort at the exit site was the primary complaint, but they did not find it interfered with activities of daily living. Femoral vein tunneled catheters appear to be a safe, well tolerated, and effective temporary access in urgent start dialysis patients while they await more appropriate long-term access.

  14. Relationship between dialysis adequacy and sleep quality in haemodialysis patients.

    PubMed

    Tosun, Nuran; Kalender, Nurten; Cinar, Fatma Ilknur; Bagcivan, Gulcan; Yenicesu, Mujdat; Dikici, Dilek; Kaya, Dilek

    2015-10-01

    The aim of this study is to examine the relationship between dialysis adequacy and sleep quality in haemodialysis patients. Sleep problems are common in haemodialysis patients. Dialysis adequacy is one of the factors associated with sleep quality. Studies evaluating the association between dialysis adequacy and sleep quality in haemodialysis patients present different results. Descriptive and cross-sectional study. This study was performed with a total of 119 patients who had applied to dialysis centres for haemodialysis treatment between January and March 2014. The data collection form consists of socio-demographic and medical characteristics as well as laboratory parameters. A modified Post-Sleep Inventory was used to examine sleep quality in the research. There were no statistically significant relationship between sleep quality and dialysis adequacy (p > 0·05). When the Post-Sleep Inventory scores were evaluated according to sleep quality, 63·0% of patients had poor sleep quality, and 37·0% had good sleep quality. Sleep quality was worse in unemployed patients (X(2) = 4·852; p = 0·025) and patients who smoked heavily (Z = 2·289; p = 0·022). In this study, there is no statistically significant relationship between dialysis adequacy and sleep quality. However, it was found that the majority of haemodialysis patients had poor sleep quality. Even if the dialysis adequacy of patients is at the recommended level, their sleep qualities may be poor. Therefore, evaluations of the sleep quality of haemodialysis patients during the clinical practice must be taken into consideration. © 2015 John Wiley & Sons Ltd.

  15. Peritonitis Due to Roseomonas fauriae in a Patient Undergoing Continuous Ambulatory Peritoneal Dialysis

    PubMed Central

    Bibashi, Evangelia; Sofianou, Danai; Kontopoulou, Konstantina; Mitsopoulos, Efstathios; Kokolina, Elisabeth

    2000-01-01

    Roseomonas is a newly described genus of pink-pigmented, nonfermentative, gram-negative bacteria that have been recognized as a cause of human infections. Roseomonas fauriae is a species rarely isolated from clinical specimens. We report the first known case of peritonitis caused by R. fauriae in a patient receiving continuous ambulatory peritoneal dialysis. PMID:10618142

  16. Cost Analysis of Hemodialysis and Peritoneal Dialysis Access in Incident Dialysis Patients

    PubMed Central

    Coentrão, Luis A.; Araújo, Carla S.; Ribeiro, Carlos A.; Dias, Claúdia C.; Pestana, Manuel J.

    2013-01-01

    ♦ Background: Although several studies have demonstrated the economic advantages of peritoneal dialysis (PD) over hemodialysis (HD), few reports in the literature have compared the costs of HD and PD access. The aim of the present study was to compare the resources required to establish and maintain the dialysis access in patients who initiated HD with a tunneled cuffed catheter (TCC) or an arteriovenous fistula (AVF) and in patients who initiated PD. ♦ Methods: We retrospectively analyzed the 152 chronic kidney disease patients who consecutively initiated dialysis treatment at our institution in 2008 (HD-AVF, n = 65; HD-CVC, n = 45; PD, n = 42). Detailed clinical and demographic information and data on access type were collected for all patients. A comprehensive measure of total dialysis access costs, including surgery, radiology, hospitalization for access complications, physician costs, and transportation costs was obtained at year 1 using an intention-to-treat approach. All resources used were valued using 2010 prices, and costs are reported in 2010 euros. ♦ Results: Compared with the HD-AVF and HD-TCC modalities, PD was associated with a significantly lower risk of access-related interventions (adjusted rate ratios: 1.572 and 1.433 respectively; 95% confidence intervals: 1.253 to 1.891 and 1.069 to 1.797). The mean dialysis access-related costs per patient-year at risk were €1171.6 [median: €608.8; interquartile range (IQR): €563.1 - €936.7] for PD, €1555.2 (median: €783.9; IQR: €371.4 - €1571.7) for HD-AVF, and €4208.2 (median: €1252.4; IQR: €947.9 - €2983.5) for HD-TCC (p < 0.001). In multivariate analysis, total dialysis access costs were significantly higher for the HD-TCC modality than for either PD or HD-AVF (β = -0.53; 95% CI: -1.03 to -0.02; and β = -0.50; 95% CI: -0.96 to -0.04). ♦ Conclusions: Compared with patients initiating HD, those initiating PD required fewer resources to establish and maintain a dialysis

  17. Cost analysis of hemodialysis and peritoneal dialysis access in incident dialysis patients.

    PubMed

    Coentrão, Luis A; Araújo, Carla S; Ribeiro, Carlos A; Dias, Claúdia C; Pestana, Manuel J

    2013-01-01

    Although several studies have demonstrated the economic advantages of peritoneal dialysis (PD) over hemodialysis (HD), few reports in the literature have compared the costs of HD and PD access. The aim of the present study was to compare the resources required to establish and maintain the dialysis access in patients who initiated HD with a tunneled cuffed catheter (TCC) or an arteriovenous fistula (AVF) and in patients who initiated PD. We retrospectively analyzed the 152 chronic kidney disease patients who consecutively initiated dialysis treatment at our institution in 2008 (HD-AVF, n = 65; HD-CVC, n = 45; PD, n = 42). Detailed clinical and demographic information and data on access type were collected for all patients. A comprehensive measure of total dialysis access costs, including surgery, radiology, hospitalization for access complications, physician costs, and transportation costs was obtained at year 1 using an intention-to-treat approach. All resources used were valued using 2010 prices, and costs are reported in 2010 euros. Compared with the HD-AVF and HD-TCC modalities, PD was associated with a significantly lower risk of access-related interventions (adjusted rate ratios: 1.572 and 1.433 respectively; 95% confidence intervals: 1.253 to 1.891 and 1.069 to 1.797). The mean dialysis access-related costs per patient-year at risk were €1171.6 [median: €608.8; interquartile range (IQR): €563.1 - €936.7] for PD, €1555.2 (median: €783.9; IQR: €371.4 - €1571.7) for HD-AVF, and €4208.2 (median: €1252.4; IQR: €947.9 - €2983.5) for HD-TCC (p < 0.001). In multivariate analysis, total dialysis access costs were significantly higher for the HD-TCC modality than for either PD or HD-AVF (β = -0.53; 95% CI: -1.03 to -0.02; and β = -0.50; 95% CI: -0.96 to -0.04). Compared with patients initiating HD, those initiating PD required fewer resources to establish and maintain a dialysis access during the first year of treatment.

  18. Less frequent dosing of erythropoiesis stimulating agents in patients undergoing dialysis: a European multicentre cost study.

    PubMed

    Burnier, Michel; Douchamps, Jacques A; Tanghe, Ann; Demey, Jan; Perrault, Louise; Foster, Claire E; Robbins, Sean

    2009-06-01

    To calculate the variable costs involved with the process of delivering erythropoiesis stimulating agents (ESA) in European dialysis practices. A conceptual model was developed to classify the processes and sub-processes followed in the pharmacy (ordering from supplier, receiving/storing/delivering ESA to the dialysis unit), dialysis unit (dose determination, ordering, receipt, registration, storage, administration, registration) and waste disposal unit. Time and material costs were recorded. Labour costs were derived from actual local wages while material costs came from the facilities' accounting records. Activities associated with ESA administration were listed and each activity evaluated to determine if dosing frequency affected the amount of resources required. A total of 21 centres in 8 European countries supplied data for 142 patients (mean) per hospital (range 42-648). Patients received various ESA regimens (thrice-weekly, twice-weekly, once-weekly, once every 2 weeks and once-monthly). Administering ESA every 2 weeks, the mean costs per patient per year for each process and the estimates of the percentage reduction in costs obtainable, respectively, were: pharmacy labour (10.1 euro, 39%); dialysis unit labour (66.0 euro, 65%); dialysis unit materials (4.11 euro, 61%) and waste unit materials (0.43 euro, 49%). Impact on financial costs was not measured. ESA administration has quantifiable labour and material costs which are affected by dosing frequency.

  19. Effect of cinacalcet on cardiovascular disease in patients undergoing dialysis.

    PubMed

    Chertow, Glenn M; Block, Geoffrey A; Correa-Rotter, Ricardo; Drüeke, Tilman B; Floege, Jürgen; Goodman, William G; Herzog, Charles A; Kubo, Yumi; London, Gerard M; Mahaffey, Kenneth W; Mix, T Christian H; Moe, Sharon M; Trotman, Marie-Louise; Wheeler, David C; Parfrey, Patrick S

    2012-12-27

    Disorders of mineral metabolism, including secondary hyperparathyroidism, are thought to contribute to extraskeletal (including vascular) calcification among patients with chronic kidney disease. It has been hypothesized that treatment with the calcimimetic agent cinacalcet might reduce the risk of death or nonfatal cardiovascular events in such patients. In this clinical trial, we randomly assigned 3883 patients with moderate-to-severe secondary hyperparathyroidism (median level of intact parathyroid hormone, 693 pg per milliliter [10th to 90th percentile, 363 to 1694]) who were undergoing hemodialysis to receive either cinacalcet or placebo. All patients were eligible to receive conventional therapy, including phosphate binders, vitamin D sterols, or both. The patients were followed for up to 64 months. The primary composite end point was the time until death, myocardial infarction, hospitalization for unstable angina, heart failure, or a peripheral vascular event. The primary analysis was performed on the basis of the intention-to-treat principle. The median duration of study-drug exposure was 21.2 months in the cinacalcet group, versus 17.5 months in the placebo group. The primary composite end point was reached in 938 of 1948 patients (48.2%) in the cinacalcet group and 952 of 1935 patients (49.2%) in the placebo group (relative hazard in the cinacalcet group vs. the placebo group, 0.93; 95% confidence interval, 0.85 to 1.02; P=0.11). Hypocalcemia and gastrointestinal adverse events were significantly more frequent in patients receiving cinacalcet. In an unadjusted intention-to-treat analysis, cinacalcet did not significantly reduce the risk of death or major cardiovascular events in patients with moderate-to-severe secondary hyperparathyroidism who were undergoing dialysis. (Funded by Amgen; EVOLVE ClinicalTrials.gov number, NCT00345839.).

  20. Palliative care for patients with malignancy and end-stage renal failure on peritoneal dialysis.

    PubMed

    Jing, Lv; Wu-Jun, Xue; Feng, Tan

    2014-05-01

    Many patients on peritoneal dialysis experience a poor quality of life because of a high burden of comorbid conditions. Dialysists must pay more attention to reducing a patient's pain and suffering, both physical and psychological and improve the quality of life for the patients as much as possible. A consensus regarding eligibility for palliative care and the delivery of these inventions does not currently exist. The present study aimed to describe the implementation of palliative care for end-stage renal failure patients on peritoneal dialysis. A report on three cases. This study included three outpatients on peritoneal dialysis who received palliative care and died between January 2008 and June 2010. The patients' comorbidities, nutritional status, and functional status were evaluated using the Charlson comorbidity score, subjective global assessment, and Karnofsky Performance Score index, respectively. The Hamilton depression and Hamilton anxiety scales were also employed. The patients' clinical manifestations and treatments were reviewed. Each patient displayed 11-16 symptoms. The Charlson comorbidity scores were from 11 to 13, the subjective global assessment indicated that two patients were class assigned to "C" and one to class "B", and the mean Karnofsky index was <40. Among these patients, all experienced depression and two experienced anxiety, Low doses of hypertonic glucose solutions, skin care, psychological services, and tranquillizers were intermittently used to alleviate symptoms, after making the decision to terminate dialysis. The patients died 5 days to 2 months after dialysis withdrawal. The considerable burden associated with comorbid conditions, malnutrition, poor functional status, and serious psychological problems are predictors of poor patient prognoses. Withdrawal of dialysis, palliative care, and psychological interventions can reduce patient distress and improve the quality of life before death, with the care provided.

  1. Trends and outcomes of infective endocarditis in patients on dialysis.

    PubMed

    Bhatia, Nirmanmoh; Agrawal, Sahil; Garg, Aakash; Mohananey, Divyanshu; Sharma, Abhishek; Agarwal, Manyoo; Garg, Lohit; Agrawal, Nikhil; Singh, Amitoj; Nanda, Sudip; Shirani, Jamshid

    2017-03-16

    Dialysis patients are at high risk for infective endocarditis (IE); however, no large contemporary data exist on this issue. We examined outcomes of 44 816 patients with IE on dialysis and 202 547 patients with IE not on dialysis from the Nationwide Inpatient Sample database from 2006 thorough 2011. Dialysis patients were younger (59 ± 15 years vs 62 ± 18 years) and more likely to be female (47% vs 40%) and African-American (47% vs 40%; all P < 0.001). Hospitalizations for IE in the dialysis group increased from 175 to 222 per 10 000 patients (P trend  = 0.04). Staphylococcus aureus was the most common microorganism isolated in both dialysis (61%) and nondialysis (45%) groups. IE due to S aureus (adjusted odds ratio [aOR]: 1.79, 95% confidence interval [CI]: 1.73-1.84), non-aureus staphylococcus (aOR: 1.72, 95% CI: 1.64-1.80), and fungi (aOR: 1.4, 95% CI: 1.12-1.78) were more likely in the dialysis group, whereas infection due to gram-negative bacteria (aOR: 0.85, 95% CI: 0.81-0.89), streptococci (aOR: 0.38, 95% CI: 0.36-0.39), and enterococci (aOR: 0.78, 95% CI: 0.74-0.82) were less likely (all P < 0.001). Dialysis patients had higher in-hospital mortality (aOR: 2.13, 95% CI: 2.04-2.21), lower likelihood of valve-replacement surgery (aOR: 0.82, 95% CI: 0.76-0.86), and higher incidence of stroke (aOR: 1.08, 95% CI: 1.03-1.12; all P < 0.001). We demonstrate rising incidence of IE-related hospitalizations in dialysis patients, highlight significant differences in baseline comorbidities and microbiology of IE compared with the general population, and validate the association of long-term dialysis with worse in-hospital outcomes.

  2. Hyperphosphatemia in Dialysis Patients: Beyond Nonadherence to Diet and Binders.

    PubMed

    Sherman, Richard A

    2016-02-01

    Hyperphosphatemia in dialysis patients is routinely attributed to nonadherence to diet, prescribed phosphate binders, or both. The role of individual patient variability in other determinants of phosphate control is not widely recognized. In a manner that cannot be explained by dialysis parameters or serum phosphate levels, dialytic removal of phosphate may vary by >400mg per treatment. Similarly, enteral phosphate absorption, unexplained by diet or vitamin D intake, may differ by ≥250mg/d among patients. Binder efficacy also varies among patients, with 2-fold differences reported. One or more elements of this triple threat-varying dialytic removal, phosphate absorption, and phosphate binding-may account for hyperphosphatemia in dialysis patients rather than nonadherence to therapy. Just as the cause(s) of hyperphosphatemia may vary, so too may an individual patient's response to different therapeutic interventions.

  3. Heart rhythm complexity impairment in patients undergoing peritoneal dialysis

    NASA Astrophysics Data System (ADS)

    Lin, Yen-Hung; Lin, Chen; Ho, Yi-Heng; Wu, Vin-Cent; Lo, Men-Tzung; Hung, Kuan-Yu; Liu, Li-Yu Daisy; Lin, Lian-Yu; Huang, Jenq-Wen; Peng, Chung-Kang

    2016-06-01

    Cardiovascular disease is one of the leading causes of death in patients with advanced renal disease. The objective of this study was to investigate impairments in heart rhythm complexity in patients with end-stage renal disease. We prospectively analyzed 65 patients undergoing peritoneal dialysis (PD) without prior cardiovascular disease and 72 individuals with normal renal function as the control group. Heart rhythm analysis including complexity analysis by including detrended fractal analysis (DFA) and multiscale entropy (MSE) were performed. In linear analysis, the PD patients had a significantly lower standard deviation of normal RR intervals (SDRR) and percentage of absolute differences in normal RR intervals greater than 20 ms (pNN20). Of the nonlinear analysis indicators, scale 5, area under the MSE curve for scale 1 to 5 (area 1–5) and 6 to 20 (area 6–20) were significantly lower than those in the control group. In DFA anaylsis, both DFA α1 and DFA α2 were comparable in both groups. In receiver operating characteristic curve analysis, scale 5 had the greatest discriminatory power for two groups. In both net reclassification improvement model and integrated discrimination improvement models, MSE parameters significantly improved the discriminatory power of SDRR, pNN20, and pNN50. In conclusion, PD patients had worse cardiac complexity parameters. MSE parameters are useful to discriminate PD patients from patients with normal renal function.

  4. Optical indicators of baseline blood status in dialysis patients

    NASA Astrophysics Data System (ADS)

    Lagali, Neil S.; Burns, Kevin D.; Zimmerman, Deborah L.; Munger, Rejean

    2007-06-01

    In a step towards the development of improved long-term prognostic indicators for patients with end-stage renal disease, we utilized absorption spectroscopy to determine the baseline status of whole blood in a cohort of 5 clinically-stable hemodialysis patients. The optical absorption spectrum of pre-dialysis and post-dialysis blood samples in the 400-1700nm wavelength range was measured for the cohort over a four-week period. Absorption spectra were consistent over time, with a maximum coefficient of variation (CV) of absorption under 2% (650-1650nm) for any given patient over the four-week period (pre and post-dialysis). Spectra varied by a greater amount across patients, with a maximum CV of 5% in any given week. Analysis of variance indicated a broad spectral range (650-1400nm) where within-patient spectral variation was significantly less than between-patient variation (p<0.001), providing the potential for development of stable baseline blood status indicators. The spectra were investigated using principal component analysis (PCA) including a further set of whole blood absorption spectra obtained from 4 peritoneal dialysis patients. PCA revealed the fingerprint-like nature of the blood spectrum, an overall similarity of the spectrum within each treatment mode (hemodialysis or peritoneal dialysis), and a distinct spectral difference between the treatment modes.

  5. Calcium Balance and Negative Impact of Calcium Load in Peritoneal Dialysis Patients

    PubMed Central

    Wang, Angela Yee-Moon

    2014-01-01

    Like hemodialysis patients, peritoneal dialysis (PD) patients are facing an excessively increased burden of vascular and valvular calcification. According to some surveys, more than 80% of prevalent PD patients are complicated with vascular calcification, and more than one third have heart valve calcification. Dysregulated phosphate metabolism is well recognized to play an important role in inducing vascular calcification, but increasing evidence is suggesting that dysregulated calcium metabolism also promotes vascular calcification and might in fact be more potent than phosphate in inducing that calcification. Growing evidence from randomized controlled trials shows more progression of vascular calcification and higher mortality among chronic kidney disease (CKD) patients receiving calcium-based phosphate binders than among those receiving non-calcium-containing phosphate binders. Those results raise important safety concern about the use of high-dose calcium-based phosphate binders in the CKD population, including both non-dialysis and dialysis patients (especially anuric dialysis patients), who have markedly reduced urinary calcium excretion. To prevent calcium overload, this review recommends restricting the dose of calcium-based phosphate binders in CKD patients, especially those who are elderly, who have increased cardiovascular risk, who already have baseline vascular or valvular calcification, or who have low intact parathyroid hormone and adynamic bone disease. PMID:24497596

  6. Hypersensitivity reactions in patients receiving hemodialysis.

    PubMed

    Butani, Lavjay; Calogiuri, Gianfranco

    2017-06-01

    To describe hypersensitivity reactions in patients receiving maintenance hemodialysis. PubMed search of articles published during the past 30 years with an emphasis on publications in the past decade. Case reports and review articles describing hypersensitivity reactions in the context of hemodialysis. Pharmacologic agents are the most common identifiable cause of hypersensitivity reactions in patients receiving hemodialysis. These include iron, erythropoietin, and heparin, which can cause anaphylactic or pseudoallergic reactions, and topical antibiotics and anesthetics, which lead to delayed-type hypersensitivity reactions. Many hypersensitivity reactions are triggered by complement activation and increased bradykinin resulting from contact system activation, especially in the context of angiotensin-converting enzyme inhibitor use. Several alternative pharmacologic preparations and dialyzer membranes are available, such that once an etiology for the reaction is established, recurrences can be prevented without affecting the quality of care provided to patients. Although hypersensitivity reactions are uncommon in patients receiving hemodialysis, they can be life-threatening. Moreover, considering the large prevalence of the end-stage renal disease population, the implications of such reactions are enormous. Most reactions are pseudoallergic and not mediated by immunoglobulin E. The multiplicity of potential exposures and the complexity of the environment to which patients on dialysis are exposed make it challenging to identify the precise cause of these reactions. Great diligence is needed to investigate hypersensitivity reactions to avoid recurrence in this high-risk population. Copyright © 2017 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

  7. Assessment and Management of Hypertension in Patients on Dialysis

    PubMed Central

    Flynn, Joseph; Pogue, Velvie; Rahman, Mahboob; Reisin, Efrain; Weir, Matthew R.

    2014-01-01

    Hypertension is common, difficult to diagnose, and poorly controlled among patients with ESRD. However, controversy surrounds the diagnosis and treatment of hypertension. Here, we describe the diagnosis, epidemiology, and management of hypertension in dialysis patients, and examine the data sparking debate over appropriate methods for diagnosing and treating hypertension. Furthermore, we consider the issues uniquely related to hypertension in pediatric dialysis patients. Future clinical trials designed to clarify the controversial results discussed here should lead to the implementation of diagnostic and therapeutic techniques that improve long-term cardiovascular outcomes in patients with ESRD. PMID:24700870

  8. Pregnancy in dialysis patients in the new millennium: a systematic review and meta-regression analysis correlating dialysis schedules and pregnancy outcomes.

    PubMed

    Piccoli, Giorgina Barbara; Minelli, Fosca; Versino, Elisabetta; Cabiddu, Gianfranca; Attini, Rossella; Vigotti, Federica Neve; Rolfo, Alessandro; Giuffrida, Domenica; Colombi, Nicoletta; Pani, Antonello; Todros, Tullia

    2016-11-01

    Advances have been made in the management of pregnancies in women receiving dialysis; however, single-centre studies and small numbers of cases have so far precluded a clear definition of the relationship between dialysis schedules and pregnancy outcomes. The aim of the present systematic review was to analyse the relationship between dialysis schedule and pregnancy outcomes in pregnancies in chronic dialysis in the new millennium. Medline-PubMed, Embase and the Cochrane library were searched (1 January 2000-31 December 2014: MESH, Emtree, free terms on pregnancy and dialysis). A separate analysis was performed for case series (more than five cases) and case reports. Meta-regression was performed in case series dealing with the larger subset of haemodialysis (HD) patients; case reports were analysed separately [according to peritoneal dialysis (PD) versus HD; conception before or during dialysis]. We obtained 190 full texts and 25 congress abstracts from 2048 references. We selected 101 full papers and 25 abstracts (36 series; 90 case reports), for a total of 681 pregnancies in 647 patients. In the case series (574 pregnancies in 543 patients), preterm delivery was extremely frequent (83%). Meta-regression analysis showed a relationship between hours of dialysis per week in HD and preterm delivery, and was significant for preterm deliveries (<37 gestational weeks: P = 0.044; r(2) = 0.22) and for small for gestational age (SGA) (P = 0.017; r(2) = 0.54). SGA was closely associated with the number of dialysis sessions per week (P = 0.003; r(2) = 0.84). Case report analysis suggests a lower incidence of SGA on HD versus PD (31 versus 66.7%; P = 0.015). No evidence of an increased risk of congenital abnormality was found in the retrieved papers. Data on pregnancy on dialysis are heterogeneous but rapidly accumulating; the main determinant of outcomes on HD is the dialysis schedule. The differences between PD and HD should be further analysed. © The Author 2015

  9. Effect of Different Dialysis Methods on Cellular Immunity Function of Maintenance Haemodialysis Patients.

    PubMed

    Xing, L

    2015-12-01

    The study of the effect of different dialysis methods on cellular immune function of maintenance haemodialysis (MHD) patients should provide theoretical support for deciding on the best method of blood purification that effectively improves cellular immune function of haemodialysis patients. Sixty MHD patients were randomly divided into three groups that respectively received treatment of haemodialysis (HD), high flux haemodialysis (HFHD) and haemodiafiltration (HDF). Peripheral blood T lymphocyte subsets [CD4+, CD8+, CD25+ (mIL-2R) and CD4+/CD8+ ratio] and serum interleukin (IL)-2 and soluble IL-2 receptor (sIL-2R) levels were detected before dialysis and 4, 24 and 48 hours after dialysis in all cases. Compared with the HD group, CD4+ and CD25+ cells, CD4+/CD8+ ratio and IL-2 level increased but sIL-2R level decreased in the HFHD and HDF groups at four hours without statistical significance (p > 0.05) and at 24 and 48 hours after dialysis with statistical significance (p < 0.05), while CD8+ cells had no change after dialysis (p > 0.05). Compared with the HFHD group, CD4+ and CD25+ cells, CD4+/CD8+ ratio, and IL-2 level increased but sIL-2R level decreased in the HDF group at four and 24 hours without statistical significance (p > 0.05) and at 48 hours after dialysis with statistical significance (p < 0.05), while CD8+ cells had no change after dialysis (p > 0.05). The results indicate that HD can briefly improve the cellular immune function of MHD patients, while MHD and HFHD can improve it continuously, with HDF having the best effect.

  10. Dialysis in the haemophilia patient: a practical approach to care.

    PubMed

    Lambing, A; Kuriakose, P; Lanzon, J; Kachalsky, E

    2009-01-01

    The major focus of care for patients with haemophilia is to ensure health with minimal joint dysfunction. As this population ages, additional coexisting conditions can develop including rare instances of nephrotic syndrome in haemophilia B inhibitor patients undergoing immune tolerance, hypertension, diabetes, and coronary artery disease, all of which can adversely affect the renal system over time. In haemophilia patients, co-infected with HIV and hepatitis C, these conditions can also increase the risk of renal problems resulting in the need for dialysis. This article provides a practical approach for the haemophilia patient who requires dialysis and outlines the decision making process to ensure a positive outcome. The goal of care is to optimize dialysis treatment without increasing the bleeding risk.

  11. Cost-benefit analysis of supplemented very low-protein diet versus dialysis in elderly CKD5 patients.

    PubMed

    Scalone, Luciana; Borghetti, Francesca; Brunori, Giuliano; Viola, Battista Fabio; Brancati, Barbara; Sottini, Laura; Mantovani, Lorenzo Giovanni; Cancarini, Giovanni

    2010-03-01

    Dialysis increases patient life expectancy but is associated with clinically severe and costly complications. Health and economic benefits could derive from postponing dialysis with a supplemented very low-protein diet (sVLPD). An economic evaluation was conducted to compare benefits and costs of sVLPD versus dialysis in elderly CKD5 patients. Data from 57 patients aged >or=70 years, with glomerular filtration rate (GFR) 5-7 mL/min, previously participating in a clinical trial demonstrating non-inferior mortality and morbidity of starting sVLPD compared to dialysis treatment, were analysed: 30 patients were randomized to dialysis and 27 to sVLPD. A cost-benefit analysis was conducted, in the perspective of the National Health Service (NHS). Direct medical and non-medical benefits and costs occurring in 3.2 mean years of follow-up were quantified: time free from dialysis, cost of dialysis treatment, hospitalization, drugs, laboratory/instrumental tests, medical visits and travel and energy consumption to receive dialysis. Prices/tariffs valid in 2007 were used, with an annual discount rate of 5% applied to benefits and costs occurring after the first year. Sensitivity analyses were conducted to identify how estimates could vary in different contexts of applications. Results are reported as net benefit, expressed as mean euro/patient (patient-year). The opportunity to safely postpone initiation of dialysis of 1 year/patient on average translated into an economic benefit to the NHS, corresponding to 21 180 euro/patient in the first, 6500 euro/patient in the second and 682 euro/patient in the third year of treatment, with a significant net benefit in favour of sVLPD even in a worst-case hypothesis. The initiation of sVLPD in elderly CKD5 subjects is a safe and beneficial strategy for these patients and allows them to gain economic resources that can be allocated to further health care investments.

  12. A Patient on Peritoneal Dialysis with Refractory Volume Overload

    PubMed Central

    2016-01-01

    The management of volume in patients with diabetes on peritoneal dialysis is affected by several factors, including the degree of residual renal function, peritoneal membrane small-solute transport, salt and water intake, blood sugar control, comorbidity, and nutritional status. It requires sequential evaluation of volume status and adjustment of the peritoneal dialysis prescription on the basis of assessments of membrane function and alterations in urine volume. Steps should be taken to preserve residual renal function for as long as possible. Ultimately, in patients who have become anuric and have developed ultrafiltration failure, timely transfer to hemodialysis may be necessary, requiring discussion and planning with the patient. PMID:26185264

  13. Metabolic response to exercise in dialysis patients.

    PubMed

    Castellino, P; Bia, M; DeFronzo, R A

    1987-12-01

    The metabolic and hormonal response to acute moderate intensity (40% of VO2 max) bicycle exercise was examined in eight uremic subjects maintained on chronic dialysis and in 12 age- and weight-matched controls before and after the administration of low dose, selective (metoprolol) and nonselective (propranolol), beta adrenergic antagonists. The fasting plasma glucose concentration and basal rates of hepatic glucose production (HGP) and tissue glucose disappearance (Rd) were similar in control and uremic subjects. In both groups HGP and Rd increased in parallel during exercise, and the plasma glucose concentration remained constant at the fasting level. However, the increments in Rd (2.27 +/- 0.27 vs. 0.87 +/- 0.31 mg/kg.min, P less than 0.01) and HGP (2.47 +/- 0.22 vs. 0.92 +/- 0.19 mg/kg.min, P less than 0.01) were 2.5-3 fold greater in the control compared to uremic subjects. Although the VO2max was decreased by 50% (39 +/- 2 vs. 20 +/- 2 ml/min.kg; P less than 0.01), the correlation between Rd and VO2max was weak (r = 0.33, P less than 0.10), suggesting that factors other than diminished physical fitness contribute to diminished tissue uptake of glucose in the dialyzed uremic patients. Following the cessation of exercise, HGP and Rd promptly returned toward basal levels in both uremic and control subjects. The glucose homeostatic response to exercise was not significantly altered by either propranolol or metoprolol. In the postabsorptive state fasting levels of insulin, glucagon, epinephrine, and norepinephrine all were significantly increased in the uremic group (P less than 0.01 to 0.05). During exercise in the healthy young controls the plasma insulin concentration declined and plasma epinephrine and norepinephrine levels rose three- to fourfold. In contrast, in uremics plasma insulin failed to fall (P less than 0.05) and the increase in circulating epinephrine and norepinephrine levels was markedly impaired (P less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

  14. [Assessment of dietary habits in hemodialysis and peritoneal dialysis patients].

    PubMed

    Kardasz, Małgorzata; Małyszko, Jacek; Stefańska, Ewa; Ostrowska, Lucyna

    2011-01-01

    Adherence to a proper diet has a vast impact on the correct course of dialyses, wellbeing, and the results of some laboratory investigations in patients with declining renal failure. The nutritional status of dialysis patients is closely related to food and specific nutrients intake. The aim of study was assessment of dietary habits in dialysis patients. The study included 27 patients peritoneal dialysis (PD) and 92 hemodialysis (HD). In all of dialysis patients the following measurements were taken: body weight and height. The food intake was assessed by 24-hour dietary recall, (according to nutritional components). The portion size was estimated on the "Album of portions of products and dishes". The results were compared with dietary recommendations for dialysis patients and analyzed by computer software Dietetic 2 designed in the Institute of Food and Nutrition in Warsaw but computer program Statistica 7.0 was used for calculations. In all studied dialysis patients an irregular diet were observed. The diet was characterized by a low energetic value and low intake of proteins, carbohydrates, fiber and calcium, as well as by a too high fats. Among women's and man's in both groups were noted underweight: (W in PD patients--7%, M in DO patients--8%, W in HD patients--4%), overweight (W in PD patients--33%, M in DO patients--25%, W in HD patients--38%, M in HD patients--36%) and obesity (W in PD patients--26%, M in DO patients--33%, W in HD patients--22%, M in HD patients--21%). The study revealed that the daily food rations of peritoneal dialysis women were found to have a significantly higher the average intake dietary fiber (18.3 +/- 5.5 g/day) and higher potassium intake (2758.5 +/- 787.5 mg/day) as compared to the average intake dietary fiber (11.7 +/- 5.4 g/ day; p < 0.0001) and potassium intake (1612.9 +/- 822.9 mg/day; p < 0.0001) of hemodialysis women. The regular dietician advice is necessary for monitoring of patients nutrition.

  15. The Type of Vascular Access and the Incidence of Mortality in Japanese Dialysis Patients.

    PubMed

    Ozeki, Toshikazu; Shimizu, Hideaki; Fujita, Yoshiro; Inaguma, Daijo; Maruyama, Shoichi; Ohyama, Yukako; Minatoguchi, Shun; Murai, Yukari; Terashita, Maho; Tagaya, Tomoki

    2017-01-01

    Objective The National Kidney Foundation (NKF) Kidney Disease Outcome Quality Initiative (KDOQI) guidelines have recommended the use of arteriovenous fistula (AVF) at the initiation of dialysis. However, there are significant differences in the dialysis environments of Japan and the United States, and there are few people who receive hemodialysis via a central venous catheter (CVC) in Japan. The aim of the present study was to examine the association between the type of vascular access at the initiation of dialysis and the incidence of mortality in Japan. Methods This study was a prospective, multicenter, cohort study. The data was collected by the Aichi Cohort study of Prognosis in Patients newly initiated into dialysis (AICOPP) in which 18 Japanese tertiary care centers participated. The present study enrolled 1,524 patients who were newly introduced to dialysis (the patients started maintenance dialysis between October 2011 and September 2013). After excluding 183 patients with missing data, 1,341 patients were enrolled. The Cox proportional hazards model was used to evaluate mortality based on the type of vascular access. The types of vascular access were divided into four categories: AVF, arteriovenous graft (AVG), CVC changed to AVF during the course (CAVF), CVC changed to AVG during the course (CAVG). Results A multivariate analysis revealed that AVG, CAVF and CAVG were associated with a higher risk of mortality in comparison to AVF [hazard ratio (HR), 1.60; p=0.048; HR, 2.26; p=0.003; and HR, 2.45; p=0.001, respectively]. Conclusion The research proved that the survival rate among patients in whom hemodialysis was initiated with AVF was significantly higher than that in patients in whom hemodialysis was initiated with AVG or CVC.

  16. [Management of color-Doppler imaging in dialysis patients].

    PubMed

    Battaglia, Yuri; Granata, Antonio; Zamboli, Pasquale; Lusenti, Tiziano; Di Lullo, Luca; Floccari, Fulvio; Logias, Franco; D'Amelio, Alessandro; Fiorini, Fulvio

    2012-01-01

    In recent decades, the survival of dialysis patients has gradually increased thanks to the evolution of dialysis techniques and the availability of new drug therapies. These elements have led to an increased incidence of a series of dialysis-related diseases that might compromise the role of dialysis rehabilitation: vascular disease, skeletal muscle disease, infectious disease, cystic kidney disease and cancer. The nephrologist is therefore in charge of a patient group with complex characteristics including the presence of indwelling vascular and/or peritoneal catheters, conditions secondary to chronic renal failure (hyperparathyroidism, anemia, amyloid disease, etc.) and superimposed disorders due to old age (cardiac and respiratory failure, cancer, type 2 diabetes mellitus, etc.). Early clinical and organizational management of such patients is essential in a modern and ''economic'' vision of nephrology. The direct provision of ultrasound services by the nephrologist responds to these requirements. A minimum level of expertise in diagnostic ultrasonography of the urinary tract and dialysis access should be part of the nephrologist's cultural heritage, acquired through theoretical and practical training programs validated by scientific societies, especially for those who choose to specialize in these procedures and become experts in imaging or interventional ultrasonography.

  17. An analysis of caregiver burden of patients with hemodialysis and peritoneal dialysis.

    PubMed

    Cantekin, Işın; Kavurmacı, Mehtap; Tan, Mehtap

    2016-01-01

    Since caregivers have roles and responsibilities in all phases from the diagnosis of the disease to discharge and homecare, their care burdens increase. The problems experienced by caregivers, whose care burden increase and accordingly whose life quality is deteriorated, complicate the treatment-receiving patient's adaptation to the disease. This study was performed to determine the burden to primary caregivers of patients undergoing dialysis. This descriptive study was conducted with the family caregivers of 114 patients from Erzurum Ataturk University's Medical Faculty Nephrology Department: 54 were relatives of patients receiving hemodialysis and 60 were relatives of patients receiving peritoneal dialysis during August to December 2014. The percentage of the patients with low levels of caregiver burden is 13% in the hemodialysis group, while it is 35% in the peritoneal dialysis group. These findings are statistically significant. To conclude, chronic diseases affect not only patients, but also their relatives who care for them. Nursing care needs to include both patients and their relatives and support them. It is hoped that this study will guide nursing care in this direction. © 2015 International Society for Hemodialysis.

  18. Validation of Mini Nutritional Assessment Scale in peritoneal dialysis patients.

    PubMed

    Brzosko, Szymon; Hryszko, Tomasz; Kłopotowski, Mariusz; Myśliwiec, Michał

    2013-08-30

    Malnutrition is a negative predictive factor for survival in end stage renal disease (ESRD) patients. Coincidence of malnutrition, inflammation and atherosclerosis (MIA syndrome) in the dialysis population is an exceptionally poor outcome event. Due to flexibility, ease of performance and reproducibility, clinical scales are of particular value in assessment of nutritional status in ESRD patients. The aim of the present study was to evaluate the clinical value of Mini Nutritional Assessment (MNA) in peritoneal dialysis (PD) patients. Nutritional status was assessed in 41 peritoneal dialysis patients by means of the MNA scale and malnutrition inflammation score (MIS). Some other clinical and laboratory parameters associated with nutritional status were analyzed. Patients were followed up for 30 months. In the analyzed group of patients a good nutritional state was diagnosed in 22 patients (54%), risk of malnutrition in 17 (41%) and malnutrition in 2 patients (5%) based on the MNA scale. A strong correlation between MNA based nutritional status and MIS was found (r = -0.85, p < 0.01, ANOVA, p < 0.01). Differences in time on dialysis, body mass index, concentration of albumin, cholesterol and triglycerides were noted between at risk/malnourished and well-nourished (according to MNA) patients. Statistically significant factors determining survival of patients by Cox proportional hazard analysis were age (HR 1.07), being at risk/malnourished according to MNA (HR 5.7), MIS (HR 1.2), and albumin (HR 0.13). The MNA scale is a valuable, clinically suitable tool for assessment of nutritional status in peritoneal dialysis patients. Risk of malnutrition and malnutrition diagnosed by MNA identifies patients at high mortality risk.

  19. Impact of environmental particulate matter and peritoneal dialysis-related infection in patients undergoing peritoneal dialysis.

    PubMed

    Huang, Wen-Hung; Yen, Tzung-Hai; Chan, Ming-Jen; Su, Yi-Jiun

    2014-11-01

    In patients undergoing peritoneal dialysis (PD), PD-related infection is a major cause of PD failure and hospital admission. Good air quality is required when dialysate exchange or exit site wound care is performed. To our knowledge, investigation of air pollution as a factor for PD-related infection in patients undergoing dialysis is limited. This study aimed to assess the effect of environmental particulate matter (PM) and other important risk factors on 1-year PD-related infection in patients undergoing PD.A total of 175 patients undergoing PD were recruited in this 1-year retrospective observational study. Differences in environmental PMs (PM10 and PM2.5) were analyzed with respect to the patients' living areas. The patients undergoing PD were categorized into 2 groups according to PM2.5 exposure: high (n = 61) and low (n = 114). Demographic, hematological, nutritional, inflammatory, biochemical, and dialysis-related data were analyzed. Multivariate binary logistic and multivariate Cox regression analyses were used to analyze 1-year PD-related infection.A total of 175 patients undergoing PD (50 men and 125 women) were enrolled. Thirty-five patients had PD-related infection within 1 year. Multivariate Cox regression analysis showed that high environmental PM2.5 exposure (hazard ratio (HR): 2.0, 95% confidence interval [CI] [1.03-3.91]; P = .04) and female sex (HR: 2.77, 95% CI [1.07-7.19]; P = .03) were risk factors for 1-year PD-related infection.Patients undergoing PD with high environmental PM2.5 exposure had a higher 1-year PD-related infection rate than that in those with low exposure. Therefore, air pollution may be associated with PD-related infection in such patients.

  20. Body size and longitudinal body weight changes do not increase mortality in incident peritoneal dialysis patients of the Brazilian peritoneal dialysis multicenter study

    PubMed Central

    da Silva Fernandes, Natália Maria; Bastos, Marcus Gomes; Franco, Márcia Regina Gianotti; Chaoubah, Alfredo; da Glória Lima, Maria; Divino-Filho, José Carolino; Qureshi, Abdul Rashid

    2013-01-01

    OBJECTIVES: To determine the roles of body size and longitudinal body weight changes in the survival of incident peritoneal dialysis patients. PATIENTS AND METHODS: Patients (n = 1911) older than 18 years of age recruited from 114 dialysis centers (Dec/2004-Oct/2007) and participating in the Brazilian Peritoneal Dialysis Multicenter Cohort Study were included. Clinical and laboratory data were collected monthly (except if the patient received a transplant, recovered renal function, was transferred to hemodialysis, or died). RESULTS: Survival analyses were performed using Kaplan-Meier survival curves and Cox proportional hazards. Total follow-up was 34 months. The mean age was 59 years (54% female). The weight category percentages were as follows: underweight: 8%; normal: 51%; overweight: 29%; and obese 12%. The multivariate model showed a higher risk of death for a body mass index <18.5 kg/m2, a neutral risk between 25 and 29.9 kg/m2 and a protective effect for an index >30 kg/m2. Patients were divided into five categories according to quintiles of body weight changes during the first year of dialysis: <−3.1%, −3.1 to+0.12%, +0.12 to <+3.1% (reference category), +3.1 to +7.1% and >+7.1%. Patients in the lowest quintile had significantly higher mortality, whereas no negative impact was observed in the other quintiles. CONCLUSION: These findings suggest that overweight/obesity and a positive body weight variation during the first year of peritoneal dialysis therapy do not increase mortality in incident dialysis patients in Brazil. PMID:23420157

  1. Exercise in Patients on Dialysis: A Multicenter, Randomized Clinical Trial.

    PubMed

    Manfredini, Fabio; Mallamaci, Francesca; D'Arrigo, Graziella; Baggetta, Rossella; Bolignano, Davide; Torino, Claudia; Lamberti, Nicola; Bertoli, Silvio; Ciurlino, Daniele; Rocca-Rey, Lisa; Barillà, Antonio; Battaglia, Yuri; Rapanà, Renato Mario; Zuccalà, Alessandro; Bonanno, Graziella; Fatuzzo, Pasquale; Rapisarda, Francesco; Rastelli, Stefania; Fabrizi, Fabrizio; Messa, Piergiorgio; De Paola, Luciano; Lombardi, Luigi; Cupisti, Adamasco; Fuiano, Giorgio; Lucisano, Gaetano; Summaria, Chiara; Felisatti, Michele; Pozzato, Enrico; Malagoni, Anna Maria; Castellino, Pietro; Aucella, Filippo; Abd ElHafeez, Samar; Provenzano, Pasquale Fabio; Tripepi, Giovanni; Catizone, Luigi; Zoccali, Carmine

    2017-04-01

    Previous studies have suggested the benefits of physical exercise for patients on dialysis. We conducted the Exercise Introduction to Enhance Performance in Dialysis trial, a 6-month randomized, multicenter trial to test whether a simple, personalized walking exercise program at home, managed by dialysis staff, improves functional status in adult patients on dialysis. The main study outcomes included change in physical performance at 6 months, assessed by the 6-minute walking test and the five times sit-to-stand test, and in quality of life, assessed by the Kidney Disease Quality of Life Short Form (KDQOL-SF) questionnaire. We randomized 296 patients to normal physical activity (control; n=145) or walking exercise (n=151); 227 patients (exercise n=104; control n=123) repeated the 6-month evaluations. The distance covered during the 6-minute walking test improved in the exercise group (mean distance±SD: baseline, 328±96 m; 6 months, 367±113 m) but not in the control group (baseline, 321±107 m; 6 months, 324±116 m; P<0.001 between groups). Similarly, the five times sit-to-stand test time improved in the exercise group (mean time±SD: baseline, 20.5±6.0 seconds; 6 months, 18.2±5.7 seconds) but not in the control group (baseline, 20.9±5.8 seconds; 6 months, 20.2±6.4 seconds; P=0.001 between groups). The cognitive function score (P=0.04) and quality of social interaction score (P=0.01) in the kidney disease component of the KDQOL-SF improved significantly in the exercise arm compared with the control arm. Hence, a simple, personalized, home-based, low-intensity exercise program managed by dialysis staff may improve physical performance and quality of life in patients on dialysis. Copyright © 2017 by the American Society of Nephrology.

  2. PATIENTS' AND RELATIVES' EXPERIENCES OF PERITONITIS WHEN USING PERITONEAL DIALYSIS.

    PubMed

    Baillie, Jessica; Lankshear, Annette

    2015-09-01

    Internationally, increasing numbers of patients are requiring treatment for end-stage kidney disease and greater use of peritoneal dialysis is thus being promoted. However, peritonitis can be a significant problem in this population. It is the leading cause of technique failure in patients using peritoneal dialysis and results in considerable morbidity and mortality. There is a dearth of research exploring patients' and their families' experiences of peritonitis. The aim of this paper is to explore patients' and their families' perspectives and experiences of peritonitis. An ethnographic study was conducted in 2011 in the United Kingdom. Sixteen patients and nine of their relatives were recruited through purposive and convenience sampling. In-depth interviews were undertaken with patients and their families, who were also observed using peritoneal dialysis in their homes. The data were analysed thematically using Wolcott's (1994) three-stage approach. This article describes four themes: learning about the risk of peritonitis; measures taken to prevent the infection; how participants monitored continuously for signs and symptoms of the infection; how they then identified and intervened once peritonitis was suspected. Overall, peritonitis was associated with fear and uncertainty, pain and learning from episodes of the infection. Overall, peritonitis was a distressing experience that participants sought to prevent. However, there was some confusion amongst participants about the signs and symptoms of the infection and further education for patients and their families is thus crucial. © 2015 European Dialysis and Transplant Nurses Association/European Renal Care Association.

  3. Pre-dialysis and post-dialysis hydration status and N-terminal pro-brain natriuretic peptide and survival in haemodialysis patients.

    PubMed

    Tangvoraphonkchai, Kamonwan; Davenport, Andrew

    2016-08-19

    Many dialysis centres have no formal program for assessing and adjusting post-haemodialysis (HD) target weight. Apart from clinical assessment, there are bioimpedance devices and natriuretic peptides that could potentially aid clinical management. We wished to determine whether pre- or post-HD bioimpedance assessment of extracellular water (ECW) or N terminal probrain natriuretic peptide (NT-proBNP) affected patient outcomes. Multi-frequency bioimpedance assessments (MFBIA) were made before and after the midweek dialysis session, along with a post-dialysis NT-proBNP measurement. Data from 362 patients, median age of 63 (50-76) years, 59.7% male, 41.2% Caucasoid, with a median dialysis vintage of 31.4 (13.5-61.7) months were available for review. During a median follow-up of 49.6 (21.9-50.2) months there were 110 (30.4%) deaths. Patients who died had significantly increased ECW, as % over-hydrated both pre-HD 6.6 (5.8-7.6)% vs. survivors 5.1 (4-6.6)%, and post-HD 5.1 (4-6.6)% vs. 0.5 (-1-2.2.0, p<0.001, respectively. They also had higher NT-proBNP 325 (122-791) vs. 102 (48-342) pmol/l, p = 0.002. Using an adjusted Cox model, pre-HD ECW overhydration remained an independent factor associated with mortality (overhydration %: hazard ratio 1.15, 95% limits 1.03-1.28, p = 0.013), with a receiver operator curve (ROC) value of 0.7. ECW excess is associated with increased mortality for HD patients, with ECW excess pre-dialysis being the strongest association, although these patients also had increased ECW post dialysis. Future trials are required to determine whether achieving euvolaemia as determined by bioimpedance improves patient survival.

  4. Risk factor and cost accounting analysis for dialysis patients in Taiwan.

    PubMed

    Su, Bin-Guang; Tsai, Kai-Li; Yeh, Shu-Hsing; Ho, Yi-Yi; Liu, Shin-Yi; Rivers, Patrick A

    2010-05-01

    According to the 2004 US Renal Data System's annual report, the incidence rate of chronic renal failure in Taiwan increased from 120 to 352 per million populations between 1990 and 2003. This incidence rate is the highest in the world. The prevalence rate, which ranks number two in the world (Japan ranks number one), also increased from 384 to 1630 per million populations. Based on 2005 Taiwan national statistics, there were 52,958 end-stage renal disease (ESRD) patients receiving routine dialysis treatment. This number, which comprised less than 0.2% of the total population and consumed $2.6 billion New Taiwan dollars, was more than 6.12% of the total annual spending of national health insurance during 2005. Dialysis expenditures for patients with ESRD rank the highest among all major injuries (traumas) and diseases. This article identifies and discusses the risk factors associated with consumption of medical resources during dialysis. Instead of using reimbursement data to estimate cost, as seen in previous studies, this study uses cost data within organizations and focuses on evaluating and predicting the resource consumption pattern for dialysis patients with different risk factors. Multiple regression analysis was used to identify 23 risk factors for routine dialysis patients. Of these risk factors, six were associated with the increase of dialysis cost: age (i.e. 75 years old and older), liver function disorder, hypertension, bile-duct disorder, cancer and high blood lipids. Patients with liver function disorder incurred much higher costs for injection medication and supplies. Hypertensive patients incurred higher costs for injection medication, supplies and oral medication. Patients with bile-duct disorder incurred a significant difference in check-up costs (i.e. costs were higher for those aged 75 years and older than those who were younger than 30 years of age). Cancer patients also incurred significant differences in cost of medical supplies. Patients

  5. Asymptomatic Effluent Protozoa Colonization in Peritoneal Dialysis Patients.

    PubMed

    Simões-Silva, Liliana; Correia, Inês; Barbosa, Joana; Santos-Araujo, Carla; Sousa, Maria João; Pestana, Manuel; Soares-Silva, Isabel; Sampaio-Maia, Benedita

    Currently, chronic kidney disease (CKD) is a global health problem. Considering the impaired immunity of CKD patients, the relevance of infection in peritoneal dialysis (PD), and the increased prevalence of parasites in CKD patients, protozoa colonization was evaluated in PD effluent from CKD patients undergoing PD. Overnight PD effluent was obtained from 49 asymptomatic stable PD patients. Protozoa analysis was performed microscopically by searching cysts and trophozoites in direct wet mount of PD effluent and after staining smears. Protozoa were found in PD effluent of 10.2% of evaluated PD patients, namely Blastocystis hominis, in 2 patients, and Entamoeba sp., Giardia sp., and Endolimax nana in the other 3 patients, respectively. None of these patients presented clinical signs or symptoms of peritonitis at the time of protozoa screening. Our results demonstrate that PD effluent may be susceptible to asymptomatic protozoa colonization. The clinical impact of this finding should be further investigated. Copyright © 2016 International Society for Peritoneal Dialysis.

  6. Ultrapure dialysis water obtained with additional ultrafilter may reduce inflammation in patients on hemodialysis.

    PubMed

    Di Iorio, Biagio; Di Micco, Lucia; Bruzzese, Dario; Nardone, Luca; Russo, Luigi; Formisano, Pietro; D'Esposito, Vittoria; Russo, Domenico

    2017-08-23

    Patients on standard dialysis, in particular those on high-flux and high-efficiency dialysis, are exposed to hundreds of liters of dialysis-water per week. The quality of dialysis-water is a factor responsible for inflammation in dialysis patients. Inflammation is a potent trigger of atherosclerosis and a pathogenetic factor in anemia, increasing mortality and morbidity in dialysis patients. Current systems for water treatment do not completely eliminate bacteria and endotoxins. This prospective study tested whether improved dialysis-water purity by an additional ultrafilter can reduce inflammation and ameliorate hemoglobin levels, with a consequent reduction in erythropoietin-stimulating agents (ESA). An ultrafilter, composed of two serially positioned devices with polysulfone membranes of 2.0 and 1.0 m(2), respectively, was positioned within the fluid pathway before the dialysis machine. Prevalent dialysis patients were assigned either to continue dialysis with conventional dialysis-water (control phase) or to initiate dialysis sessions with improved dialysis-water purity (study phase). After 6 months, patients were crossed over. Total study duration was 1 year. Routine chemistry, bacterial count, endotoxin levels in dialysis-water as well as blood levels of pro- and anti-inflammatory cytokines, human serum amyloid A, C-reactive protein and fraction 5 of complement were measured. Thirty-two patients completed the study. Mean bacterial count was lower and endotoxin levels were absent in dialysis-water obtained with the ultrafilter. At the end of the study-phase, C-reactive protein and pro-inflammatory cytokines decreased while anti-inflammatory ones increased. Hemoglobin levels were improved with lower ESA doses. An additional ultrafilter improved dialysis-water purity, reduced levels of inflammation markers, ameliorated hemoglobin concentration with reduced ESA doses. These results remain speculative but they may generate studies to assess whether improved

  7. Religious involvement and health in dialysis patients in Saudi Arabia.

    PubMed

    Al Zaben, Faten; Khalifa, Doaa Ahmed; Sehlo, Mohammad Gamal; Al Shohaib, Saad; Binzaqr, Salma Awad; Badreg, Alae Magdi; Alsaadi, Rawan Ali; Koenig, Harold G

    2015-04-01

    Patients on hemodialysis experience considerable psychological and physical stress due to the changes brought on by chronic kidney disease. Religion is often turned to in order to cope with illness and may buffer some of these stresses associated with illness. We describe here the religious activities of dialysis patients in Saudi Arabia and determined demographic, psychosocial, and physical health correlates. We administered an in-person questionnaire to 310 dialysis patients (99.4 % Muslim) in Jeddah, Saudi Arabia, that included the Muslim Religiosity Scale, Structured Clinical Interview for Depression, Hamilton Depression Rating Scale, Global Assessment of Functioning scale, and other established measures of psychosocial and physical health. Bivariate and multivariate analyses identified characteristics of patients who were more religiously involved. Religious practices and intrinsic religious beliefs were widespread. Religious involvement was more common among those who were older, better educated, had higher incomes, and were married. Overall psychological functioning was better and social support higher among those who were more religious. The religious also had better physical functioning, better cognitive functioning, and were less likely to smoke, despite having more severe overall illness and being on dialysis for longer than less religious patients. Religious involvement is correlated with better overall psychological functioning, greater social support, better physical and cognitive functioning, better health behavior, and longer duration of dialysis. Whether religion leads to or is a result of better mental and physical health will need to be determined by future longitudinal studies and clinical trials.

  8. Patient-Staff Interactions and Mental Health in Chronic Dialysis Patients

    ERIC Educational Resources Information Center

    Swartz, Richard D.; Perry, Erica; Brown, Stephanie; Swartz, June; Vinokur, Amiram

    2008-01-01

    Chronic dialysis imposes ongoing stress on patients and staff and engenders recurring contact and long-term relationships. Thus, chronic dialysis units are opportune settings in which to investigate the impact of patients' relationships with staff on patient well-being. The authors designed the present study to examine the degree to which…

  9. Patient-Staff Interactions and Mental Health in Chronic Dialysis Patients

    ERIC Educational Resources Information Center

    Swartz, Richard D.; Perry, Erica; Brown, Stephanie; Swartz, June; Vinokur, Amiram

    2008-01-01

    Chronic dialysis imposes ongoing stress on patients and staff and engenders recurring contact and long-term relationships. Thus, chronic dialysis units are opportune settings in which to investigate the impact of patients' relationships with staff on patient well-being. The authors designed the present study to examine the degree to which…

  10. Prevalence and correlates of functional dependence among maintenance dialysis patients.

    PubMed

    Kavanagh, Niall T; Schiller, Brigitte; Saxena, Anjali B; Thomas, I-Chun; Kurella Tamura, Manjula

    2015-10-01

    Functional dependence is an important determinant of longevity and quality of life. The purpose of the current study was to determine the prevalence and correlates of functional dependence among patients with end-stage renal disease (ESRD) receiving maintenance dialysis. We enrolled 148 participants with ESRD from five clinics. Functional status, as measured by basic and instrumental activities of daily living (ADL, IADL), was ascertained by validated questionnaires. Functional dependence was defined as needing assistance in at least one of seven IADLs or at least one of four ADLs. Demographic characteristics, chronic health conditions, anthropometric measurements, and laboratories were assessed by a combination of self-report and chart review. Cognitive function was assessed with a neurocognitive battery, and depressive symptoms were assessed by questionnaire. Mean age of the sample was 56.2 ± 14.6 years. Eighty-seven participants (58.8%) demonstrated dependence in ADLs or IADLs, 70 (47.2%) exhibited IADL dependence alone, and 17 (11.5%) exhibited combined IADL and ADL dependence. In a multivariable-adjusted model, stroke, cognitive impairment, and higher systolic blood pressure were independent correlates of functional dependence. We found no significant association between demographic characteristics, chronic health conditions, depressive symptoms or laboratory measurements, and functional dependence. Impairment in executive function was more strongly associated with functional dependence than memory impairment. Functional dependence is common among ESRD patients and independently associated with stroke, systolic blood pressure, and executive function impairment.

  11. Nutritional status in dialysis patients: a European consensus.

    PubMed

    Locatelli, Francesco; Fouque, Denis; Heimburger, Olof; Drüeke, Tilman B; Cannata-Andía, Jorge B; Hörl, Walter H; Ritz, Eberhard

    2002-04-01

    Malnutrition is common in dialysis patients and closely related to morbidity and mortality. Therefore, assessment of nutritional status and nutritional management of dialysis patients play a central role in everyday nephrological practice. Achieving a consensus on key points relating to pathogenesis, clinical assessment, and nutritional management of dialysis patients. The assessment of nutritional status should be based on clinical assessment and biochemical parameters, including history of weight loss, per cent standard weight, body mass index, muscle mass, subcutaneous fat mass, and plasma albumin, creatinine, bicarbonate and cholesterol. Co-morbid conditions should be assessed and C-reactive protein (CRP) measured--as a marker of inflammation--as there is a close relation between malnutrition, on one side, and co-morbid conditions and inflammation on the other. For a more detailed assessment, subjective global assessment of nutritional status is a well-validated tool, and dual-energy X-ray absorptiometry (DEXA) is a useful method for routine assessment of lean body mass. Anthropometric methods are also useful. They are cheap and easy to apply, although less precise than DEXA. The recommended daily protein intake is at least 1.2 g/kg standard body weight and the energy intake 35 kcal/kg standard body weight (BW), in patients <60 years, and 30 kcal/kg standard BW in patients >60 years. The standard bicarbonate level should be at least 22 mmol/l. If CRP is >10 mg/l, it is important to seek and treat the underlying cause. Adequate dialysis (for haemodialysis: Kt/V >1.2) should be ensured and, although no definite evidence of the importance of dialysis water quality is available, the opinion of the authors is that the water quality should be high. The role of the biocompatibility of the dialysis membrane is still not clear. The dietitian plays a pivotal role in the nutritional care of dialysis patients, and patients should be provided with dietary counselling from

  12. INVESTIGATION OF SERUM MICROCYSTIN CONCENTRATIONS AMONG DIALYSIS PATIENTS, BRAZIL, 1996

    EPA Science Inventory

    Investigation of Serum Microcystin Concentrations Among Dialysis Patients, Brazil, 1996

    Elizabeth D. Hilborn 1, Wayne W. Carmichael 2, Sandra M.F.O. Azevedo 3
    1- USEPA/ORD/NHEERL, Research Triangle Park, NC
    2- Wright State University, Dayton, OH
    3- Federal Univers...

  13. INVESTIGATION OF SERUM MICROCYSTIN CONCENTRATIONS AMONG DIALYSIS PATIENTS, BRAZIL, 1996

    EPA Science Inventory

    Investigation of Serum Microcystin Concentrations Among Dialysis Patients, Brazil, 1996

    Elizabeth D. Hilborn 1, Wayne W. Carmichael 2, Sandra M.F.O. Azevedo 3
    1- USEPA/ORD/NHEERL, Research Triangle Park, NC
    2- Wright State University, Dayton, OH
    3- Federal Univers...

  14. High cut-off dialysis in chronic haemodialysis patients.

    PubMed

    Girndt, Matthias; Fiedler, Roman; Martus, Peter; Pawlak, Michael; Storr, Markus; Bohler, Torsten; Glomb, Marcus A; Liehr, Kristin; Henning, Christian; Templin, Markus; Trojanowicz, Bogusz; Ulrich, Christof; Werner, Kristin; Zickler, Daniel; Schindler, Ralf

    2015-12-01

    Haemodialysis patients suffer from chronic systemic inflammation and high incidence of cardiovascular disease. One cause for this may be the failure of diseased kidneys to eliminate immune mediators. Current haemodialysis treatment achieves insufficient elimination of proteins in the molecular weight range 15-45 kD. Thus, high cut-off dialysis might improve the inflammatory state. In this randomized crossover trial, 43 haemodialysis patients were treated for 3 weeks with high cut-off or high-flux dialysis. Inflammatory plasma mediators, monocyte subpopulation distribution and leucocyte gene expression were quantified. High cut-off dialysis supplemented by a low-flux filter did not influence the primary end-point, expression density of CD162 on monocytes. Nevertheless, treatment reduced multiple immune mediators in plasma. Such reduction proved - at least for some markers - to be a sustained effect over the interdialytic interval. Thus, for example, soluble TNF-receptor 1 concentration predialysis was reduced from median 13·3 (IQR 8·9-17·2) to 9·7 (IQR 7·5-13·2) ng/mL with high cut-off while remaining constant with high-flux treatment. The expression profile of multiple proinflammatory genes in leucocytes was significantly dampened. Treatment was well tolerated although albumin losses in high cut-off dialysis would be prohibitive against long-term use. The study shows for the first time that a dampening effect of high cut-off dialysis on systemic inflammation is achievable. Earlier studies had failed due to short study duration or insufficient dialysis efficacy. Removal of soluble mediators from the circulation influences cellular activation levels in leucocytes. Continued development of less albumin leaky membranes with similar cytokine elimination is justified. © 2015 Stichting European Society for Clinical Investigation Journal Foundation.

  15. Timing of return to dialysis in patients with failing kidney transplants.

    PubMed

    Molnar, Miklos Z; Ichii, Hirohito; Lineen, James; Foster, Clarence E; Mathe, Zoltan; Schiff, Jeffrey; Kim, S Joseph; Pahl, Madeleine V; Amin, Alpesh N; Kalantar-Zadeh, Kamyar; Kovesdy, Csaba P

    2013-01-01

    In the last decade, the number of patients starting dialysis after a failed kidney transplant has increased substantially. These patients appear to be different from their transplant-naïve counterparts, and so may be the timing of dialysis therapy initiation. An increasing number of studies suggest that in transplant-naïve patients, later dialysis initiation is associated with better outcomes. Very few data are available on timing of dialysis reinitiation in failed transplant recipients, and they suggest that an earlier return to dialysis therapy tended to be associated with worse survival, especially among healthier and younger patients and women. Failed transplant patients may also have unique issues such as continuation of immunosuppression versus withdrawal or the need for remnant allograft nephrectomy with regard to dialysis reinitiation. These patients may have a different predialysis preparation work-up, worse blood pressure control, higher or lower serum phosphorus levels, lower serum bicarbonate concentration, and worse anemia management. The choice of dialysis modality may also represent an important question for these patients, even though there appears to be no difference in mortality between patients starting peritoneal versus hemodialysis. Finally, failed transplant patients returning to dialysis appear to have a higher mortality rate compared with transplant-naïve incident dialysis patients, especially in the first several months of dialysis therapy. In this review, we will summarize the available data related to the timing of dialysis initiation and outcomes in failed kidney transplant patients after returning to dialysis.

  16. Predicting Early Death Among Elderly Dialysis Patients: Development and Validation of a Risk Score to Assist Shared Decision Making for Dialysis Initiation

    PubMed Central

    Thamer, Mae; Kaufman, James S.; Zhang, Yi; Zhang, Qian; Cotter, Dennis J.; Bang, Heejung

    2015-01-01

    Background A shared decision-making tool could help elderly advanced chronic kidney disease (CKD) patients decide about initiating dialysis. Since mortality may be high in the first few months after initiating dialysis, incorporating early mortality predictors in such a tool would be important for an informed decision. Our objective is to derive and validate a predictive risk score for early mortality after initiating dialysis. Study Design Retrospective observational cohort, with development and validation cohorts. Setting & Participants US Renal Data System (USRDS) and claims data from the Centers for Medicare & Medicaid Services for 69,441 (aged ≥67 years) end-stage renal disease (ESRD) patients with previous 2-year Medicare history who initiated dialysis January 1, 2009–December 31, 2010. Candidate Predictors Demographics, predialysis care, laboratory data, functional limitations and medical history. Outcomes All-cause mortality in the first 3 and 6 months. Analytical Approach Predicted mortality via logistic regression. Results The simple risk score (total score, 0–9) included age (0–3 points); low albumin, assistance with daily living, nursing home residence, cancer, heart failure, and hospitalization (1 point each), and showed area under the receiver operating characteristic curve (AUROC) =0.69 in the validation sample. A comprehensive risk score with additional predictors was also developed (with AUROC=0.72, high concordance between predicted vs. observed risk). Mortality probabilities were estimated from these models: the median score of 3 indicating 12% risk in 3 months and 20% in 6 months, and the highest scores (≥8) indicating 39% risk in 3 months and 55% in 6 months. Limitations Patients who did not choose dialysis and who did not have 2 year Medicare history were excluded. Conclusions Routinely available information can be used by CKD patients, families and their nephrologists to estimate risk of early mortality after dialysis initiation

  17. Palliative peritoneal dialysis: Implementation of a home care programme for terminal patients treated with peritoneal dialysis (PD).

    PubMed

    Gorrin, Maite Rivera; Teruel-Briones, José Luis; Vion, Victor Burguera; Rexach, Lourdes; Quereda, Carlos

    2015-01-01

    Terminal-stage patients on peritoneal dialysis (PD) are often transferred to haemodialysis as they are unable to perform the dialysis technique themselves since their functional capacities are reduced. We present our experience with five patients on PD with a shortterm life-threatening condition, whose treatment was shared by primary care units and who were treated with a PD modality adapted to their circumstances, which we call Palliative Peritoneal Dialysis. Copyright © 2015. Published by Elsevier España, S.L.U.

  18. Self-management support for peritoneal dialysis patients.

    PubMed

    Sarian, Mari; Brault, Diane; Perreault, Nathalie

    2012-01-01

    The increasing prevalence of chronic illnesses and kidney disease, in particular, makes it necessary to adopt new approaches towards their management (Wagner, 1998). Evidence suggests that promoting self-management improves the health status of peritoneal dialysis (PD) patients, as they manage upwards of 90% of their own care. Patients who are unable to self-manage suffer from various complications. This project proposes an intervention aimed at improving self-management skills among PD patients. To promote self-management in peritoneal dialysis patients. This is achieved through the following objectives: (a) develop an algorithm that can improve patients' ability to solve the specific problem of fluid balance maintenance, (b) develop an educational session for patients on how to use the algorithm, and (c) develop an implementation strategy in collaboration with the PD nurse. Three measures evaluate the effectiveness of the intervention. First, a telephone call log shows that participating patients call the clinic less to inquire about fluid balance maintenance. Next, a pre- and post-intervention knowledge test measures definite knowledge increase. Finally, a Patient Satisfaction Questionnaire reveals overall satisfaction with the intervention. This project, which proved beneficial to our patient population, could be duplicated in other clinics. The algorithm "How do I choose a dialysis bag" and the slides of the educational sessions can be shared with PD nurses across the country for the benefit of PD patients.

  19. Impact of dialysis adequacy on cardiac function in pediatric CAPD patients.

    PubMed

    Bakkaloğlu, S A; Ekim, M; Koçak, G; Atalay, S; Tümer, N

    2001-01-01

    Left ventricular hypertrophy is a major cause of morbidity and mortality among patients with chronic renal failure. Uremia-related risk factors play a fundamental role in its occurrence, thus better prognosis and prolonged survival can be attained by successful dialytic therapies. To investigate whether dialysis adequacy has a beneficial effect on cardiac structure and function in children receiving continuous ambulatory peritoneal dialysis (CAPD). Cross-sectional study in the Pediatric Peritoneal Dialysis Unit of a university hospital. Eighteen children, aged 13.3 +/- 2.8 years, being treated with CAPD, and 20 healthy age- and sex-matched control subjects were enrolled in this study. Echocardiographic evaluation was performed in all subjects. Dialysis adequacy indices [weekly urea (Kt/V) and creatinine clearance (TCCr)] were calculated in the dialysis group. Interventricular septal thickness, left ventricular (LV) posterior wall thickness, LV mass index (LVMI), and LV end systolic and diastolic dimensions were all found to be significantly higher in the CAPD group compared to the control subjects (p < 0.01). Ejection fraction and fractional shortening of the LV were not significantly different between the two groups. Mean Kt/V was 2.02 +/- 0.71 and mean TCCr was 58 +/- 33 L/wk/1.73 m2. There were significant negative correlations between dialysis adequacy indices and LV end systolic and diastolic dimensions (p < 0.05 and p < 0.001). Ejection fraction and fractional shortening were positively correlated with Kt/V (p < 0.01). Systolic and diastolic blood pressures were positively correlated with LVMI (r= 0.501 and r = 0.523). Significant inverse correlations between mean arterial pressure and both Kt/V and TCCr (r = -0.555 and r = -0.520) were detected. These data clearly document that cardiac structure and function are remarkably influenced by the uremic state and dialysis therapy in pediatric CAPD patients. The close relationships between echocardiographic

  20. Peritoneal Fluid Transport rather than Peritoneal Solute Transport Associates with Dialysis Vintage and Age of Peritoneal Dialysis Patients.

    PubMed

    Waniewski, Jacek; Antosiewicz, Stefan; Baczynski, Daniel; Poleszczuk, Jan; Pietribiasi, Mauro; Lindholm, Bengt; Wankowicz, Zofia

    2016-01-01

    During peritoneal dialysis (PD), the peritoneal membrane undergoes ageing processes that affect its function. Here we analyzed associations of patient age and dialysis vintage with parameters of peritoneal transport of fluid and solutes, directly measured and estimated based on the pore model, for individual patients. Thirty-three patients (15 females; age 60 (21-87) years; median time on PD 19 (3-100) months) underwent sequential peritoneal equilibration test. Dialysis vintage and patient age did not correlate. Estimation of parameters of the two-pore model of peritoneal transport was performed. The estimated fluid transport parameters, including hydraulic permeability (LpS), fraction of ultrasmall pores (α u), osmotic conductance for glucose (OCG), and peritoneal absorption, were generally independent of solute transport parameters (diffusive mass transport parameters). Fluid transport parameters correlated whereas transport parameters for small solutes and proteins did not correlate with dialysis vintage and patient age. Although LpS and OCG were lower for older patients and those with long dialysis vintage, αu was higher. Thus, fluid transport parameters--rather than solute transport parameters--are linked to dialysis vintage and patient age and should therefore be included when monitoring processes linked to ageing of the peritoneal membrane.

  1. Fat tissue and inflammation in patients undergoing peritoneal dialysis

    PubMed Central

    Rincón Bello, Abraham; Bucalo, Laura; Abad Estébanez, Soraya; Vega Martínez, Almudena; Barraca Núñez, Daniel; Yuste Lozano, Claudia; Pérez de José, Ana; López-Gómez, Juan M.

    2016-01-01

    Background Body weight has been increasing in the general population and is an established risk factor for hypertension, diabetes, and all-cause and cardiovascular mortality. Patients undergoing peritoneal dialysis (PD) gain weight, mainly during the first months of treatment. The aim of this study was to assess the relationship between body composition and metabolic and inflammatory status in patients undergoing PD. Methods This was a prospective, non-interventional study of prevalent patients receiving PD. Body composition was studied every 3 months using bioelectrical impedance (BCM®). We performed linear regression for each patient, including all BCM® measurements, to calculate annual changes in body composition. Thirty-one patients in our PD unit met the inclusion criteria. Results Median follow-up was 26 (range 17–27) months. Mean increase in weight was 1.8 ± 2.8 kg/year. However, BCM® analysis revealed a mean increase in fat mass of 3.0 ± 3.2 kg/year with a loss of lean mass of 2.3 ± 4.1 kg/year during follow-up. The increase in fat mass was associated with the conicity index, suggesting that increases in fat mass are based mainly on abdominal adipose tissue. Changes in fat mass were directly associated with inflammation parameters such as C-reactive protein (r = 0.382, P = 0.045) and inversely associated with high-density lipoprotein cholesterol (r=−0.50, P = 0.008). Conclusions Follow-up of weight and body mass index can underestimate the fat mass increase and miss lean mass loss. The increase in fat mass is associated with proinflammatory state and alteration in lipid profile. PMID:27274820

  2. Sleep disorders in patients with end-stage renal disease undergoing dialysis: comparison between hemodialysis, continuous ambulatory peritoneal dialysis and automated peritoneal dialysis.

    PubMed

    Losso, Ricardo L M; Minhoto, Gisele R; Riella, Miguel C

    2015-02-01

    Sleep disorders for patients on dialysis are significant causes of a poorer quality of life and increased morbidity and mortality. No study has evaluated patients undergoing automated peritoneal dialysis (APD) to assess their sleep disorders compared to hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD). A total of 166 clinically stable patients who had been on dialysis for at least 3 months were randomly selected for the study and divided into HD, CAPD or APD. Socio-demographic, clinical and laboratory parameters and self-administered questionnaires were collected for the investigation of insomnia, restless legs syndrome (RLS), bruxism, rapid eye movement sleep behavior disorder, excessive daytime sleepiness (EDS), obstructive sleep apnea syndrome (OSAS), sleepwalking, sleep hygiene, depression and anxiety. Insomnia was detected in more than 80 % of patients on the three modalities. OSAS was lower for patients on HD (36 %) than on CAPD (65 %) (p < 0.01) or APD (60 %) (p < 0.04). Patients on APD were more likely to have RLS compared to those on HD or CAPD (p < 0.04) (50 vs. 23 vs. 33 %). No differences among the modalities were found in bruxism, EDS, sleepwalking, sleep hygiene, depression or anxiety. ESRD patients undergoing any one of the three dialysis modalities studied had a high prevalence of sleep disorders. Patients on HD had a lower proportion of OSAS than those on CAPD and APD, which is most likely attributed to their lower body mass indices. The possible causes of higher RLS rates in APD patients have not been established.

  3. Unusual causes of peritonitis in a peritoneal dialysis patient: Alcaligenes faecalis and Pantoea agglomerans.

    PubMed

    Kahveci, Arzu; Asicioglu, Ebru; Tigen, Elif; Ari, Elif; Arikan, Hakki; Odabasi, Zekaver; Ozener, Cetin

    2011-04-10

    An 87 -year-old female who was undergoing peritoneal dialysis presented with peritonitis caused by Alcaligenes faecalis and Pantoea agglomerans in consecutive years. With the following report we discuss the importance of these unusual microorganisms in peritoneal dialysis patients.

  4. Lanthanum carbonate versus placebo for management of hyperphosphatemia in patients undergoing peritoneal dialysis: a subgroup analysis of a phase 2 randomized controlled study of dialysis patients.

    PubMed

    Hutchison, Alastair J; Gill, Maggie; Copley, J Brian; Poole, Lynne; Wilson, Rosamund J

    2013-02-18

    This short-term study assessed the efficacy and safety of lanthanum carbonate in the treatment of hyperphosphatemia in dialysis patients; here, we report a prespecified subgroup analysis of patients undergoing peritoneal dialysis. Men and women (n=39) who had received continuous ambulatory peritoneal dialysis for chronic kidney disease for 6 months or more were enrolled in eight renal medicine departments in the United Kingdom. A 2-week washout period was followed by a 4-week dose-titration phase during which patients received lanthanum carbonate titrated up to 2250 mg/day. This was followed by a 4-week, randomized, placebo-controlled, parallel-group phase during which patients continued to receive either lanthanum carbonate at the titrated dose, or a matched dose of placebo. The main outcome measure was control of serum phosphate levels (1.3-1.8 mmol/l) at the end of the parallel-group phase. Serum phosphate was controlled in 3/39 (8%) patients at the beginning of the dose-titration phase (after washout) and in 18/31 (58%) patients treated with lanthanum carbonate at its end. After the parallel-group phase, 60% of lanthanum carbonate-treated patients and 10% of those receiving placebo had controlled serum phosphate. There was no difference in mean (95% confidence interval) serum phosphate levels between groups at randomization: lanthanum carbonate, 1.57 (1.34-1.81) mmol/l; placebo, 1.58 (1.40-1.76) mmol/l (p=0.96). However, a difference was seen at the end of the parallel-group phase: lanthanum carbonate, 1.56 (1.33-1.79) mmol/l; placebo, 2.25 (1.81-2.68) mmol/l (p=0.0015). There were no clinically important changes in nutritional parameters and no serious treatment-related adverse events were recorded. At doses up to 2250 mg/day, lanthanum carbonate is well tolerated and controls hyperphosphatemia effectively. Treatment with higher doses of lanthanum carbonate may allow patients undergoing peritoneal dialysis the potential to increase their dietary protein intake

  5. Palliative dialysis in end-stage renal disease.

    PubMed

    Trivedi, Disha D

    2011-12-01

    Dialysis patients are often denied hospice benefits unless they forego dialysis treatments. However, many of those patients might benefit from as-needed dialysis treatments to palliate symptoms of uremia, fluid overload, etc. The current Medicare payment system precludes this "palliative dialysis" except in those few cases where the terminal diagnosis is unrelated to renal failure. As approximately three quarters of all US patients on dialysis have Medicare as their primary insurance, a of review of Medicare policy is suggested, with a goal of creating a new "palliative dialysis" category that would allow patients to receive treatments on a less regular schedule without affecting the quality statistics of the dialysis center.( 1 ).

  6. Timing of dialysis initiation in transplant-naive and failed transplant patients

    PubMed Central

    Molnar, Miklos Z.; Ojo, Akinlolu O.; Bunnapradist, Suphamai; Kovesdy, Csaba P.; Kalantar-Zadeh, Kamyar

    2017-01-01

    Over the past two decades, most guidelines have advocated early dialysis initiation on the basis of studies showing improved survival in patients starting dialysis early. These recommendations led to an increase in the proportion of patients initiating dialysis with an estimated glomerular filtration rate (eGFR) >10 ml/min/1.73 m2, from 20% in 1996 to 52% in 2008. During this period, patients starting dialysis with an eGFR ≥15 ml/min/1.73 m2 increased from 4% to 17%. However, recent studies have failed to substantiate a benefit of early dialysis initiation and some data have suggested worse outcomes in patients starting dialysis with a higher eGFR. Several reasons for this seemingly paradoxical observation have been suggested, including the fact that patients requiring early dialysis are likely to have more severe symptoms and comorbidities, leading to confounding by indication, as well as biological mechanisms that causally relate early dialysis therapy to adverse outcomes. Dialysis reinitiation in patients with a failing renal allograft encounters similar problems. However, unique factors associated with a failed allograft means that the optimal timing of dialysis initiation in failed transplant patients might differ from that in transplant-naive patients. In this Review, we will discuss studies of dialysis initiation and compare risks and benefits of early versus late dialysis therapy. PMID:22371250

  7. Moderator's view: Pretransplant weight loss in dialysis patients: cum grano salis.

    PubMed

    Sever, Mehmet Sukru; Zoccali, Carmine

    2015-11-01

    A high Body Mass Index (BMI) predicts delayed graft function, all cause and cardiovascular death after transplantation but such risk excess is apparently confined to patients included in studies performed before 2000. Perhaps with the exception of morbid obesity (BMI > 40), clinical outcomes in transplanted obese patients are definitely better than in listed dialysis patients who don't receive a renal transplant. Furthermore the new Scientific Registry of Transplant Recipients (SRTR) risk calculator incorporates BMI into the prediction model of the global risk for the graft's and patient's survival appropriately framing the risk of obesity in a multidimensional risk context. In the aggregate, available knowledge suggests that clinical decisions on weight loss before transplantation should be context specific. Renal transplant patients from living donors have substantial better survival in comparison to well matched dialysis patients listed for the same intervention at all BMI categories. Therefore renal transplantation in obese patients with a living donor may be prioritized. The attitude of fully informed obese patients at accepting the risk driven by transplantation, the experience of the surgical team with obese patients (including also robotic surgery) are of obvious importance. Renal transplantation should be timely considered when reasonable attempts at weight loss failed or appear overtly unrealistic. Transplantation in morbidly obese patients with BMI > 40, a category where the survival advantage of transplantation vs dialysis is probably small and still uncertain, particularly so in African-Americans, should be deferred until significant weight loss is achieved.

  8. UK Renal Registry 13th Annual Report (December 2010): Chapter 10: calcium, phosphate, parathyroid hormone, bicarbonate and total cholesterol concentrations amongst patients receiving haemodialysis or peritoneal dialysis in England, Wales and Northern Ireland in 2009: national and centre-specific analyses.

    PubMed

    Castledine, Clare; van Schalkwyk, Dirk; Feest, Terry; Steenkamp, Retha; Dawnay, Anne

    2011-01-01

    The UK Renal Association Clinical Practice Guidelines include clinical performance measures for biochemical variables in dialysis patients [1]. The UK Renal Registry (UKRR) annually audits dialysis centre performance against these measures as part of its role in promoting continuous quality improvement. Cross sectional performance analyses were undertaken to compare dialysis centre achievement of clinical audit measures for prevalent haemodialysis (HD) and peritoneal dialysis (PD) cohorts in 2009. The biochemical variables studied were phosphate, adjusted calcium, parathyroid hormone, bicarbonate and total cholesterol. In addition longitudinal analyses were performed (2000-2009) to show changes in achievement of clinical performance measures over time. Sixty-one percent of HD and 70% of PD patients had phosphate between 1.1-1.8 mmol/L. Seventy-four percent of HD and 75% of PD patients had adjusted calcium between 2.2-2.5 mmol/L. Twenty-eight percent of HD and 32% of PD patients had parathyroid hormone between 16-32 pmol/L. Seventy-two percent of HD and 83% of PD patients achieved the audit measure for bicarbonate. There was significant inter-centre variation for all variables studied. The UKRR consistently demonstrates significant inter-centre variation in achievement of biochemical clinical audit measures. Understanding the causes of this variation is an important part of improving the care of dialysis patients in the UK. Copyright © 2011 S. Karger AG, Basel.

  9. Randomized, controlled trial of glucose-sparing peritoneal dialysis in diabetic patients.

    PubMed

    Li, Philip K T; Culleton, Bruce F; Ariza, Amaury; Do, Jun-Young; Johnson, David W; Sanabria, Mauricio; Shockley, Ty R; Story, Ken; Vatazin, Andrey; Verrelli, Mauro; Yu, Alex W; Bargman, Joanne M

    2013-11-01

    Glucose-containing peritoneal dialysis solutions may exacerbate metabolic abnormalities and increase cardiovascular risk in diabetic patients. Here, we examined whether a low-glucose regimen improves metabolic control in diabetic patients undergoing peritoneal dialysis. Eligible patients were randomly assigned in a 1:1 manner to the control group (dextrose solutions only) or to the low-glucose intervention group (IMPENDIA trial: combination of dextrose-based solution, icodextrin and amino acids; EDEN trial: a different dextrose-based solution, icodextrin and amino acids) and followed for 6 months. Combining both studies, 251 patients were allocated to control (n=127) or intervention (n=124) across 11 countries. The primary endpoint was change in glycated hemoglobin from baseline. Mean glycated hemoglobin at baseline was similar in both groups. In the intention-to-treat population, the mean glycated hemoglobin profile improved in the intervention group but remained unchanged in the control group (0.5% difference between groups; 95% confidence interval, 0.1% to 0.8%; P=0.006). Serum triglyceride, very-low-density lipoprotein, and apolipoprotein B levels also improved in the intervention group. Deaths and serious adverse events, including several related to extracellular fluid volume expansion, increased in the intervention group, however. These data suggest that a low-glucose dialysis regimen improves metabolic indices in diabetic patients receiving peritoneal dialysis but may be associated with an increased risk of extracellular fluid volume expansion. Thus, use of glucose-sparing regimens in peritoneal dialysis patients should be accompanied by close monitoring of fluid volume status.

  10. [Acid-base status in patients treated with peritoneal dialysis].

    PubMed

    Katalinić, Lea; Blaslov, Kristina; Pasini, Eva; Kes, Petar; Bašić-Jukić, Nikolina

    2014-04-01

    When compared to hemodialysis, peritoneal dialysis is very simple yet low cost method of renal replacement therapy. Series of studies have shown its superiority in preserving residual renal function, postponing uremic complications, maintaining the acid-base balance and achieving better post-transplant outcome in patients treated with this method. Despite obvious advantages, its role in the treatment of chronic kidney disease is still not as important as it should be. Metabolic acidosis is an inevitable complication associated with progressive loss of kidney function. Its impact on mineral and muscle metabolism, residual renal function, allograft function and anemia is very complex but can be successfully managed. The aim of our study was to evaluate the efficiency in preserving the acid-base balance in patients undergoing peritoneal dialysis at Zagreb University Hospital Center. Twenty-eight patients were enrolled in the study. The mean time spent on the treatment was 32.39 ± 43.43 months. Only lactate-buffered peritoneal dialysis fluids were used in the treatment. Acid-base balance was completely maintained in 73.07% of patients; 11.54% of patients were found in the state of mild metabolic acidosis, and the same percentage of patients were in the state of mild metabolic alkalosis. In one patient, mixed alkalosis with respiratory and metabolic component was present. The results of this study showed that acid-base balance could be maintained successfully in patients undergoing peritoneal dialysis, even only with lactate-buffered solutions included in the treatment, although they were continuously proclaimed as inferior in comparison with bicarbonate-buffered ones. In well educated and informed patients who carefully use this method, accompanied by the attentive and thorough care of their physicians, this method can provide quality continuous replacement of lost renal function as well as better quality of life.

  11. Clinical analysis of ANCA-associated renal vasculitis patients with chronic dialysis.

    PubMed

    Chen, Yong-Xi; Zhang, Wen; Chen, Xiao-Nong; Ni, Li-Yan; Shen, Ping-Yan; Wang, Wei-Ming; Chen, Nan

    2014-01-01

    Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) constitute a subgroup of life-threatening diseases which affects the kidney in more than half of the patients at diagnosis. Currently, little has been published focusing on AAV patients with dialysis. We analysed AAV patients with chronic dialysis to provide more detailed information. From 1997 to 2011, AAV patients complicated by renal involvement resulting in end-stage renal disease (ESRD) and had undergone haemodialysis (HD) or peritoneal dialysis (PD) for at least 3 months in Shanghai Ruijin hospital were retrospectively analysed in this study. Their data were also compared to those without dialysis at the same time. We enrolled 49 AAV patients with chronic dialysis. 41 required dialysis at initial presentation and rest 8 progressed to ESRD during follow-up. 19 HD patients died and 6 PD patients died during follow-up, and infection was the most common cause among the patients. There was no significant difference regarding survival between HD patients and PD patients (p>0.05). However anaemia and level of triglyceride was more significantly improved in HD patients at the end of observation (p<0.05, p<0.05 respectively). Compared with patients without dialysis dependency, dialysis patients presented higher percentage of hypertension (p<0.01), more severe renal involvement and higher BVAS (p<0.01). For the outcome, survival was significantly higher in non-dialysis patients (p<0.05). Patients with AAV experienced a high rate of renal failure and dialysis dependence. Our study suggests that haemodialysis and peritoneal dialysis are two comparable dialysis modalities for AAV patients with ESRD. However, AAV patients with dialysis dependency had worse outcome in comparison with those without dialysis.

  12. Complications and Mortality in Chronic Renal Failure Patients Undergoing Total Joint Arthroplasty: A Comparison Between Dialysis and Renal Transplant Patients.

    PubMed

    Cavanaugh, Priscilla K; Chen, Antonia F; Rasouli, Mohammad R; Post, Zachary D; Orozco, Fabio R; Ong, Alvin C

    2016-02-01

    In total joint arthroplasty (TJA) literature, there is a paucity of large cohort studies comparing chronic kidney disease (CKD) and end-stage renal disease (ESRD) vs non-CKD/ESRD patients. Thus, the purposes of this study were (1) to identify inhospital complications and mortality in CKD/ESRD and non-CKD/ESRD patients and (2) compare inhospital complications and mortality between dialysis and renal transplantation patients undergoing TJA. We queried the Nationwide Inpatient Sample database for patients with and without diagnosis of CKD/ESRD and those with a renal transplant or on dialysis undergoing primary or revision total knee or hip arthroplasty from 2007 to 2011. Patient comorbidities were identified using the Elixhauser comorbidity index. International Classification of Diseases, Ninth Revision, codes were used to identify postoperative surgical site infections (SSIs), wound complications, deep vein thrombosis, and transfusions. Chronic kidney disease/ESRD was associated with greater risk of SSIs (odds ratio [OR], 1.4; P<.001), wound complications (OR, 1.1; P=.01), transfusions (OR, 1.6; P<.001), deep vein thrombosis (OR, 1.4; P=.03), and mortality (OR, 2.1; P<.001) than non-CKD/ESRD patients. Dialysis patients had higher rates of SSI, wound complications, transfusions, and mortality compared to renal transplant patients. Chronic kidney disease/ESRD patients had a greater risk of SSIs and wound complications compared to those without renal disease, and the risk of these complications was even greater in CKD/ESRD patients receiving dialysis. These findings emphasize the importance of counseling CKD patients about higher potential complications after TJA, and dialysis patients may be encouraged to undergo renal transplantation before TJA. Copyright © 2016 Elsevier Inc. All rights reserved.

  13. Pregnancy outcomes among renal transplant recipients and patients with end-stage renal disease on dialysis.

    PubMed

    Saliem, Sara; Patenaude, Valerie; Abenhaim, Haim A

    2016-04-01

    The purpose of our study is to compare pregnancy outcomes between women with a functioning renal transplant and women with end-stage renal disease (ESRD). We carried out a population-based retrospective cohort study using the Healthcare Cost and Utilization Project Nationwide Inpatient Sample database from 2006 to 2011. Logistic regression analysis was used to estimate the age-adjusted effect of functioning renal transplant vs. ESRD requiring dialysis on pregnancy outcomes. We identified 264 birth records to women with a functional renal transplant and 267 birth records to women with ESRD on dialysis among 5,245,452 births. As compared to women with ESRD on dialysis, renal transplant recipients were less likely to have placental abruption [odds ratio, OR 0.23 (95% confidence interval, CI 0.08-0.70)], to receive blood transfusions [OR 0.17 (95% CI 0.09-0.30)], and to have growth-restricted and small-for-gestational-age babies [OR 0.45 (95% CI 0.23-0.85)]. Renal transplant recipients were more likely to have an instrumental delivery [OR 15.38 (95% CI 1.92-123.3)]. Among renal transplant women, there was a trend towards delivery by cesarean section as compared to patients with ESRD [OR 1.31 (95% CI 0.93-1.85)]. However, these results were not statistically significant. Fetal deaths were less likely to occur in women with a renal transplant [OR 0.41 (95% CI 0.17-0.96)]. There were four maternal deaths among patients with ESRD on dialysis and no maternal deaths among renal transplant patients. Patients with a functional renal graft had an overall lower rate of morbidity and adverse pregnancy complications when compared to patients with ESRD on dialysis.

  14. Frailty Screening Tools for Elderly Patients Incident to Dialysis.

    PubMed

    van Loon, Ismay N; Goto, Namiko A; Boereboom, Franciscus T J; Bots, Michiel L; Verhaar, Marianne C; Hamaker, Marije E

    2017-07-17

    A geriatric assessment is an appropriate method for identifying frail elderly patients. In CKD, it may contribute to optimize personalized care. However, a geriatric assessment is time consuming. The purpose of our study was to compare easy to apply frailty screening tools with the geriatric assessment in patients eligible for dialysis. A total of 123 patients on incident dialysis ≥65 years old were included <3 weeks before to ≤2 weeks after dialysis initiation, and all underwent a geriatric assessment. Patients with impairment in two or more geriatric domains on the geriatric assessment were considered frail. The diagnostic abilities of six frailty screening tools were compared with the geriatric assessment: the Fried Frailty Index, the Groningen Frailty Indicator, Geriatric8, the Identification of Seniors at Risk, the Hospital Safety Program, and the clinical judgment of the nephrologist. Outcome measures were sensitivity, specificity, positive predictive value, and negative predictive value. In total, 75% of patients were frail according to the geriatric assessment. Sensitivity of frailty screening tools ranged from 48% (Fried Frailty Index) to 88% (Geriatric8). The discriminating features of the clinical judgment were comparable with the other screening tools. The Identification of Seniors at Risk screening tool had the best discriminating abilities, with a sensitivity of 74%, a specificity of 80%, a positive predictive value of 91%, and a negative predictive value of 52%. The negative predictive value was poor for all tools, which means that almost one half of the patients screened as fit (nonfrail) had two or more geriatric impairments on the geriatric assessment. All frailty screening tools are able to detect geriatric impairment in elderly patients eligible for dialysis. However, all applied screening tools, including the judgment of the nephrologist, lack the discriminating abilities to adequately rule out frailty compared with a geriatric assessment

  15. Physical Activity in Patients Treated With Peritoneal Dialysis

    PubMed Central

    Thangarasa, Tharshika; Imtiaz, Rameez; Hiremath, Swapnil; Zimmerman, Deborah

    2017-01-01

    Background: Patients with chronic diseases are known to benefit from exercise. Despite a lack of compelling evidence, patients with end-stage kidney disease treated with peritoneal dialysis are often discouraged from participating in exercise programs that include resistance training due to concerns about the development of hernias and leaks. The actual effects of physical activity with or without structured exercise programs for these patients remain unclear. The purpose of this study is to more completely define the risks and benefits of physical activity in the end-stage kidney disease population treated with peritoneal dialysis. Methods/design: We will conduct a systematic review examining the effects of physical activity on end-stage kidney disease patients treated with peritoneal dialysis. For the purposes of this review, exercise will be considered a purposive subcategory of physical activity. The primary objective is to determine if physical activity in this patient population is associated with improvements in mental health, physical functioning, fatigue and quality of life and if there is an increase in adverse outcomes. With the help of a skilled librarian, we will search MEDLINE, EMBASE, CINAHL, and Cochrane Central Register of Controlled Trials for randomized trials and observational studies. We will include adult end-stage kidney disease patients treated with peritoneal dialysis that have participated in an exercise training program or had their level of physical activity assessed directly or by self-report. The study must include an assessment of the association between physical activity and one of our primary or secondary outcomes measures. We will report study quality using the Cochrane Risk of Bias Assessment Tool for randomized controlled trials and the Newcastle–Ottawa Scale for observational studies. Quality across studies will be assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. The

  16. A Patient on Peritoneal Dialysis with Refractory Volume Overload.

    PubMed

    Wilkie, Martin

    2016-01-07

    The management of volume in patients with diabetes on peritoneal dialysis is affected by several factors, including the degree of residual renal function, peritoneal membrane small-solute transport, salt and water intake, blood sugar control, comorbidity, and nutritional status. It requires sequential evaluation of volume status and adjustment of the peritoneal dialysis prescription on the basis of assessments of membrane function and alterations in urine volume. Steps should be taken to preserve residual renal function for as long as possible. Ultimately, in patients who have become anuric and have developed ultrafiltration failure, timely transfer to hemodialysis may be necessary, requiring discussion and planning with the patient. Copyright © 2016 by the American Society of Nephrology.

  17. Continuous ambulatory peritoneal dialysis: nurses' experiences of teaching patients.

    PubMed

    Shubayra, Amnah

    2015-03-01

    Nine nurses were interviewed to determine nurses' experiences of teaching patients to use continuous ambulatory peritoneal dialysis (CAPD). The material was analyzed using content analysis. Data were sorted into four themes and ten subthemes. The themes were presented as follows: Importance of language, individualized teaching, teaching needs and structure of care in teaching. The findings highlighted important insights into how nurses experience teaching patients to perform CAPD. The study revealed some barriers for the nurses during teaching. The major barrier was shortage of Arabic speaking nursing staff. Incidental findings involved two factors that played an important role in teaching, retraining and a special team to perform pre-assessments, including home visits. In conclusion, the findings of this study showed several factors that are considered as barriers for the nurses during teaching the CAPD patients and the need to improve the communication and teaching in the peritoneal dialysis units, including the importance of individualized teaching.

  18. Dialysis Catheter Placement in Patients With Exhausted Access.

    PubMed

    Rahman, Syed; Kuban, Joshua D

    2017-03-01

    Patients with end-stage renal disease undergo renal transplant, peritoneal dialysis, or intermittent hemodialysis for renal replacement therapy. For hemodialysis, native fistulas or grafts are preferred but hemodialysis catheters are often necessary. Per KDOQI, the right jugular vein is the preferred vessel of access for these catheters. However, in patients with long-standing end-stage renal disease vein thrombosis, stenosis and occlusion occurs. In these patients with end-stage vascular access, unconventional routes of placement of dialysis catheters are needed. These methods include placing them by means of sharp recanalization, via a translumbar route directly into the inferior vena cava, and via transhepatic and transrenal routes. These difficult, but potentially lifesaving methods of gaining vascular access are reviewed in this article. Copyright © 2017 Elsevier Inc. All rights reserved.

  19. Pharmacokinetics of Quinupristin-Dalfopristin in Continuous Ambulatory Peritoneal Dialysis Patients

    PubMed Central

    Johnson, Curtis A.; Taylor, Claude A.; Zimmerman, Stephen W.; Bridson, William E.; Chevalier, Paul; Pasquier, Olivier; Baybutt, Robert I.

    1999-01-01

    Quinupristin-dalfopristin may be useful for treatment of organisms causing peritoneal dialysis-related peritonitis, including methicillin-resistant coagulase-negative staphylococci, methicillin-resistant Staphylococcus aureus, and vancomycin-resistant enterococci. The pharmacokinetic profiles of single intravenous doses of this combination streptogramin antibiotic of 7.5 mg/kg of body weight were characterized for eight noninfected patients receiving continuous ambulatory peritoneal dialysis. Comparison was made to pharmacokinetic profiles determined for eight healthy volunteers matched by age, sex, and race. Drug was measured in dialysate up to 6 h following the dose. Plasma and dialysate were assayed for parent compounds and metabolites. Mean pharmacokinetic parameters were compared between groups. No statistically significant differences were observed between groups for maximal concentrations in plasma, times to maximal concentration, areas under the curve, distribution volumes, rates of total body clearance, or half-lives in plasma for quinupristin and dalfopristin. No statistically significant differences were observed in maximal concentrations in plasma, times to maximal concentration, areas under the curve, or half-lives for cysteine, the glutathione conjugates of quinupristin, or the pristinamycin IIA metabolite of dalfopristin. The measurements in dialysate of the parent and most metabolites were below the expected MICs. Dialysis clearance was insignificant. Quinupristin-dalfopristin was well tolerated in both groups, causing only mild adverse events that resolved prior to discharge from the study. The disposition of quinupristin, dalfopristin, or their primary metabolites following a single dose was unaltered in patients receiving peritoneal dialysis. Intravenous dosing of this antibiotic combination is unlikely to be adequate for the treatment of peritonitis associated with peritoneal dialysis. PMID:9869581

  20. Novel inflammatory marker in dialysis patients: YKL-40.

    PubMed

    Okyay, Gülay Ulusal; Er, Ramazan Erdem; Tekbudak, Merve Yasemin; Paşaoğlu, Özge; Inal, Salih; Öneç, Kürşad; Paşaoğlu, Hatice; Altok, Kadriye; Derici, Ülver; Erten, Yasemin

    2013-04-01

    YKL-40 has been introduced as a marker of inflammation in different clinical situations. The association between YKL-40 and inflammation in chronic renal failure patients has not been researched currently. The objectives of this study were to establish serum YKL-40 concentrations in dialysis patients with chronic renal failure compared to healthy subjects and to explore its relationships with a proinflammatory cytokine, interleukine-6 (IL-6) and an acute phase mediator, high sensitivity C-reactive protein (hs-CRP). The study population included hemodialysis patients (N = 43; mean age of 40.9 ± 14.5), peritoneal dialysis patients (N = 38; mean age of 45.8 ± 13.7) and healthy subjects (N = 37; mean age of 45.5 ± 10.6). Serum concentrations of YKL-40, IL-6, hs-CRP and routine laboratory measures were evaluated. Compared to the healthy subjects, hemodialysis and peritoneal dialysis patients had higher concentrations of YKL-40, IL-6, hs-CRP, as well as lower concentrations of hemoglobin, serum albumin and high density lipoprotein-cholesterol (P < 0.001). YKL-40 concentrations were positively correlated with serum creatinine (P < 0.001, r = 0.495), IL-6 (P < 0.001, r = 0.306), hs-CRP (P = 0.001, r = 0.306) levels and inversely correlated with hemoglobin (P = 0.002, r = -0.285), serum albumin (P < 0.001, r = -0.355) and high density lipoprotein-cholesterol (P = 0.001, r = -0.306). In multivariate regression analysis YKL-40 was associated with creatinine, serum albumin and hs-CRP concentrations after adjustments with covariates. Dialysis patients with chronic renal failure have elevated serum YKL-40 concentrations. Associations with standard inflammatory parameters suggest that YKL-40 might be a novel inflammatory marker in this population.

  1. Acute Peritoneal Dialysis in Patients with Acute Kidney Injury.

    PubMed

    Cho, Seong; Lee, Yu-Ji; Kim, Sung-Rok

    2017-01-01

    The purpose of this study was to evaluate the efficacy, complications, and mortality rate associated with acute peritoneal dialysis (PD) in patients with acute kidney injury (AKI). A total of 75 patients who were treated at Samsung Changwon Hospital between February 2005 and March 2016 were included in the study sample. The outcomes included in-hospital survival, renal recovery, metabolic and fluid control rates, and technical success rates. Refractory heart failure was the most frequent cause of acute PD (49.3%), followed by hepatic failure (20.0%), septic shock (14.7%), acute pancreatitis (9.3%), and unknown causes (6.7%). The hospital survival of patients in the acute PD was 48.0%. Etiologies of acute kidney injury (AKI) (refractory heart failure, acute pancreatitis compared with hepatic failure, septic shock or miscellaneous causes), use of inotropes, use of a ventilator, and simplified acute physiology score (SAPS) II were associated with survival differences. Maintenance dialysis required after survival was high (80.1% [29/36]) due to AKI etiologies (heart or hepatic failures). Metabolic and fluid control rates were 77.3%. The technical success rate for acute PD was 93.3%. Acute PD remains a suitable treatment modality for patients with AKI in the era of continuous renal replacement therapy (CRRT). Nearly all patients who require dialysis can be dialyzed with acute PD without mechanical difficulties. This is particularly true in patients with refractory heart failure and acute pancreatitis who had a weak requirement for inotropes. Copyright © 2017 International Society for Peritoneal Dialysis.

  2. Influence of dialysis modality and membrane flux on insomnia severity in haemodialysis patients.

    PubMed

    Knezevic, Marinela Z; Djordjevic, Vladimir V; Jankovic, Slobodan M; Djordjevic, Vidojko M

    2013-11-01

    Insomnia is an important problem in dialysis patients. A greater prevalence of insomnia in chronic kidney disease compared with non-renal patients suggests a role for uraemic toxins in contributing to insomnia. The aim of this study was to examine if dialysis modality and membrane permeability is associated with the frequency and severity of insomnia in haemodialysis patients. In our cross-sectional study, we evaluated 122 patients who were divided into three groups: on-line haemodiafiltration, high flux haemodialysis and low flux haemodialysis. The frequency and severity of insomnia was evaluated with the Insomnia Severity Index. Insomnia was present in 47.5% of all patients. The majority of patients who reported insomnia were receiving low flux haemodialysis (80%), followed by patients on high flux haemodialysis (43.6%) and haemodiafiltration (20.9%). Patients using low flux membranes, had a significantly higher Insomnia Severity Index (11.9 ± 6.6) compared with patients receiving high flux haemodialysis (6.8 ± 6.3) and haemodiafiltration (5.2 ± 7.0). The insomnia severity index did not differ between patients receiving high flux haemodialysis compared with on-line haemodiafiltration. This study indicates that different haemodialysis modalities are associated with insomnia and suggests a potential benefit of using high flux membranes. © 2013 Asian Pacific Society of Nephrology.

  3. Statins and Renin Angiotensin System Inhibitors Dose-Dependently Protect Hypertensive Patients against Dialysis Risk

    PubMed Central

    Wu, Szu-Yuan

    2016-01-01

    Background Taiwan has the highest renal disease incidence and prevalence in the world. We evaluated the association of statin and renin–angiotensin system inhibitor (RASI) use with dialysis risk in hypertensive patients. Methods Of 248,797 patients who received a hypertension diagnosis in Taiwan during 2001–2012, our cohort contained 110,829 hypertensive patients: 44,764 who used RASIs alone; 7,606 who used statins alone; 27,836 who used both RASIs and statins; and 33,716 who used neither RASIs or statins. We adjusted for the following factors to reduce selection bias by using propensity scores (PSs): age; sex; comorbidities; urbanization level; monthly income; and use of nonstatin lipid-lowering drugs, metformin, aspirin, antihypertensives, diuretics, and beta and calcium channel blockers. The statin and RASI use index dates were considered the hypertension confirmation dates. To examine the dose–response relationship, we categorized only statin or RASI use into four groups in each cohort: <28 (nonusers), 28–90, 91–365, and >365 cumulative defined daily doses (cDDDs). Results In the main model, PS-adjusted hazard ratios (aHRs; 95% confidence intervals [CIs]) for dialysis risk were 0.57 (0.50–0.65), 0.72 (0.53–0.98), and 0.47 (0.41–0.54) in the only RASI, only statin, and RASI + statin users, respectively. RASIs dose-dependently reduced dialysis risk in most subgroups and in the main model. RASI use significantly reduced dialysis risk in most subgroups, regardless of comorbidities or other drug use (P < 0.001). Statins at >365 cDDDs protected hypertensive patients against dialysis risk in the main model (aHR = 0.62, 95% CI: 0.54–0.71), regardless of whether a high cDDD of RASIs, metformin, or aspirin was used. Conclusion Statins and RASIs independently have a significant dose-dependent protective effect against dialysis risk in hypertensive patients. The combination of statins and RASIs can additively protect hypertensive patients against dialysis

  4. Statins and Renin Angiotensin System Inhibitors Dose-Dependently Protect Hypertensive Patients against Dialysis Risk.

    PubMed

    Liu, Ju-Chi; Hsu, Yi-Ping; Wu, Szu-Yuan

    2016-01-01

    Taiwan has the highest renal disease incidence and prevalence in the world. We evaluated the association of statin and renin-angiotensin system inhibitor (RASI) use with dialysis risk in hypertensive patients. Of 248,797 patients who received a hypertension diagnosis in Taiwan during 2001-2012, our cohort contained 110,829 hypertensive patients: 44,764 who used RASIs alone; 7,606 who used statins alone; 27,836 who used both RASIs and statins; and 33,716 who used neither RASIs or statins. We adjusted for the following factors to reduce selection bias by using propensity scores (PSs): age; sex; comorbidities; urbanization level; monthly income; and use of nonstatin lipid-lowering drugs, metformin, aspirin, antihypertensives, diuretics, and beta and calcium channel blockers. The statin and RASI use index dates were considered the hypertension confirmation dates. To examine the dose-response relationship, we categorized only statin or RASI use into four groups in each cohort: <28 (nonusers), 28-90, 91-365, and >365 cumulative defined daily doses (cDDDs). In the main model, PS-adjusted hazard ratios (aHRs; 95% confidence intervals [CIs]) for dialysis risk were 0.57 (0.50-0.65), 0.72 (0.53-0.98), and 0.47 (0.41-0.54) in the only RASI, only statin, and RASI + statin users, respectively. RASIs dose-dependently reduced dialysis risk in most subgroups and in the main model. RASI use significantly reduced dialysis risk in most subgroups, regardless of comorbidities or other drug use (P < 0.001). Statins at >365 cDDDs protected hypertensive patients against dialysis risk in the main model (aHR = 0.62, 95% CI: 0.54-0.71), regardless of whether a high cDDD of RASIs, metformin, or aspirin was used. Statins and RASIs independently have a significant dose-dependent protective effect against dialysis risk in hypertensive patients. The combination of statins and RASIs can additively protect hypertensive patients against dialysis risk.

  5. Human herpesvirus 6 infection in hemodialysis and peritoneal dialysis patients.

    PubMed

    Altay, Mustafa; Akay, Hatice; Ünverdi, Selman; Altay, Filiz; Ceri, Mevlüt; Altay, F Aybala; Cesur, Salih; Duranay, Murat; Demiroz, Ali Pekcan

    2011-01-01

    Human herpesvirus 6 (HHV-6) infection occurs worldwide and can be reactivated from latency during periods of immunosuppression, especially after organ transplantation. No previous study has evaluated the influence of dialysis type on HHV-6 infection. The aim of the present study was to determine the prevalence of HHV-6 antibodies in hemodialysis (HD) and peritoneal dialysis (PD) patients. We studied 36 PD patients, 35 HD patients, and 20 healthy subjects, all with no history of organ transplantation. After systematic inquiries and a physical examination, blood was drawn for determination of biochemical parameters, cytomegalovirus immunoglobulin M (IgM) and immunoglobulin G (IgG), hepatitis B surface antigen, and the hepatitis C and human immunodeficiency virus antibodies. Titers of HHV-6 IgM and IgG antibodies were determined by ELISA. Titers for HHV-6 IgM antibody were positive in 9 HD patients (25.7%), 8 PD patients (22.2%), and 2 control subjects (10.0%, p > 0.05). More HD patients (20.0%) than PD patients (5.6%, p = 0.07) or control subjects (0.0%, p = 0.03) were positive for HHV-6 IgG antibody. In HD patients, HHV-6 IgG seropositivity and duration of dialysis were positively correlated (R = 0.33, p = 0.05). Infection with HHV-6 is not rare in PD and HD patients. In addition, HHV-6 IgG seropositivity was significantly higher in HD patients than in control subjects and approached significance when compared with seropositivity in PD patients. Moreover, in HD patients, HHV-6 IgG seropositivity correlated with duration on HD. These preliminary findings provide insight into the pre-transplantation period for patients and may aid our understanding of how to best protect patients against HHV-6 after transplantation.

  6. Low molecular weight heparins and antiplatelet drugs, and bone mineral density in dialysis patients.

    PubMed

    Grzegorzewska, Alicja E; Młot-Michalska, Monika

    2008-01-01

    Variations in results concerning the influence of low molecular weight heparins (LMWHs) and antiplatelet drugs (APtDs) on bone mineral density (BMD) have led us to investigate whether dialysis patients receiving these drugs (group I) are characterized by a BMD different from that of patients not receiving such medications (group II). Group I consisted of 14 patients [mean age: 64.7 +/- 16.0 years; 4 on hemodialysis (HD), 10 on peritoneal dialysis (PD); dialysis duration: 22.7 months (range: 7.9 - 59.6 months)] who were regularly receiving LMWHs (4 HD patients) or APtDs (10 PD patients, 1 HD patient), or both, for at least 2 years. Group II consisted of 16 PD patients [mean age: 48.7 +/- 16.2 years; dialysis duration: 16.3 months (6.3 - 45.5 months)]. We evaluated BMD as assessed in the femoral neck and lumbar spine, serum parathyroid hormone, blood pH, and parameters of calcium-phosphate balance and nutritional state, and compared values between the two groups. As compared with group II, group I had significantly lower measurements in the femoral neck: BMD (0.711 +/- 0.100 g/cm2 vs. 0.904 +/- 0.124 g/cm2, p = 0.000), T score [-2.38 (range: -4.06 to -1.27) vs. -0.71 (range: -3.05 to 2.37), p = 0.000], Z score [-1.34 (range: -2.36 to -0.15) vs. 0.12 (range: -1.0 to 2.97), p = 0.001], BMD as a percentage of peak bone mass (69.1% +/- 9.0% vs. 94.4% +/- 16.6%, p = 0.000), BMD as a percentage age norm (81.6% +/- 9.7% vs. 103.4% +/- 18.5%, p = 0.000). We observed no other significant differences in examined parameters between the groups. Dialysis patients regularly receiving LMWHs or APtDs, or both, show lower BMD measures in the femoral neck; they therefore require more frequent monitoring of BMD and timely prophylaxis against osteoporosis.

  7. Insights into nephrologist training, clinical practice, and dialysis choice.

    PubMed

    Merighi, Joseph R; Schatell, Dorian R; Bragg-Gresham, Jennifer L; Witten, Beth; Mehrotra, Rajnish

    2012-04-01

    There is variable emphasis on dialysis-specific training among US nephrology fellowship programs. Our study objective was to determine the association between nephrology training experience and subsequent clinical practice. We conducted a national survey of clinical nephrologists using a fax-back survey distributed between March 8, 2010 and April 30, 2010 (N = 629). The survey assessed the time distribution of clinical practice, self-assessment of preparedness to provide care for dialysis patients at the time of certification examination, distribution of dialysis modality among patients, and nephrologists' choice of dialysis modality for themselves if their kidneys failed. While respondents spent 28% of their time caring for dialysis patients, 38% recalled not feeling very well prepared to care for dialysis patients when taking the nephrology certification examination. Sixteen percent obtained additional dialysis training after fellowship completion. Only 8% of US dialysis patients use home dialysis; physicians very well prepared to care for dialysis patients at the time of certification or who obtained additional dialysis training were significantly more likely to provide care to home peritoneal dialysis patients. Even though 92% of US dialysis patients receive thrice weekly in-center hemodialysis, only 6% of nephrologists selected this for themselves; selection of therapy for self was associated with dialysis modalities used by their patients. Nephrology training programs need to ensure that all trainees are very well prepared to care for dialysis patients, as this is central to nephrology practice. Utilization of dialysis therapies other than standard hemodialysis is dependent, in part, on training experience.

  8. The Prevalence of Metabolic Syndrome and Factors Associated with Quality of Dialysis among Hemodialysis Patients in Southern Taiwan

    PubMed Central

    Tu, Shu-Fen; Chou, Yu-Ching; Sun, Chien-An; Hsueh, Shu-Chun; Yang, Tsan

    2012-01-01

    Objectives: The purpose of this study was to evaluate the prevalence of metabolic syndrome (MetS) among hemodialysis patients and factors associated with quality of dialysis. Methods: Data were collected from 377 long-term hemodialysis patients who received hemodialysis treatment from clinics in Tainan and Kaohsiung between November 2009 and February 2010. MetS was defined using criteria set by the adult treatment panel III (ATP-III). But, the cutpoint of waist circumference has been modified to adjust for Asian populations. The measurement of Kt/V was used as an indicator of the quality of dialysis. A below 1.4 Kt/V was considered poor dialysis quality. Results: Results showed that the prevalence of MetS among the chronic hemodialysis patients in this sample was 61.0%. Logistic regression results identified that the quality of dialysis in females was better than that in males (odds ratio (OR)=7.98, 95% confidence interval (CI): 2.52-25.31). Better quality dialysis was associated with older age, longer treatment time, and increased blood flow rate (OR=1.49, 13.63, and 1.35, respectively). However, for every one kilogram increase in weight, the quality of dialysis decreased by 13 percents (OR=0.87, 95% CI: 0.83-0.92). Conclusions: MetS is common among hemodialysis patients. The prevalence of hypertension, hyperlipidemia, and hyperglycaemia were significantly higher among hemodialysis patients. Quality of dialysis related to gender, age, weight, and the dialysis prescription (treatment time and blood flow rate). PMID:22980378

  9. Special considerations for antihypertensive agents in dialysis patients.

    PubMed

    Redon, Josep; Martinez, Fernando; Cheung, Alfred K

    2010-01-01

    Hypertension is present in most patients with end-stage renal disease and likely contributes to the premature cardiovascular disease in dialysis patients. Previous practice guidelines have recommended that, in patients on chronic dialysis, blood pressure (BP) should be reduced below 130/80 mm Hg. This is based on opinions but not strong evidence, since no concrete information exists about which BP values should be the parameter to follow and which should be the target BP values. The majority of the antihypertensive agents can be used in this population, but the pharmacokinetics altered by the impaired kidney function and dialyzability influence the appropriate dosage as well as the time and frequency of administration. Combination therapy using multiple agents is often necessary. Because of the prevalence of overactivity of the renin-angiotensin-aldosterone system and sympathetic tone as well as the high calcium influx in vascular smooth muscle cells in dialysis patients, drugs acting in these three specific systems may potentially have additional cardioprotective benefits beyond their BP-lowering effect. Thus, antihypertensive regimens should preferably be based on these classes of drugs, alone or in combination. Other antihypertensive drug classes can play a complementary role. Copyright (c) 2010 S. Karger AG, Basel.

  10. Challenges of nutrition intervention for malnourished dialysis patients.

    PubMed

    Moore, Eileen

    2008-01-01

    Malnutrition, or protein energy wasting (PEW), is prevalent in patients with chronic kidney disease stage 5 dialysis (CKD-5). One criterion of PEW strongly associated with morbidity and mortality in CKD-5 dialysis patients is the serum albumin level. Serum albumin levels have not improved over the past 10 years. Typical intervention strategies need to be reevaluated. Intradialytic parenteral nutrition (IDPN) is a form of parenteral nutrition delivered during dialysis that is a convenient and assured route of nutrition alimentation for high-nutrition-risk PEW patients who cannot improve nutrition status by oral and enteral routes. Recent qualification criteria for IDPN changes in Medicare part D have made this therapy an available option for many more of these high-nutrition-risk PEW patients. Nutrition support knowledge in clinicians is essential to administer IDPN effectively and to optimize clinical response. An improved understanding of the milieu of uremia and PEW of CKD-5, as well as the study of nutrition interventions inclusive of IDPN, will allow for effective strategies toward improved outcomes in the future.

  11. [A burden questionnaire for caregivers of peritoneal dialysis patients].

    PubMed

    Teixidó, J; Tarrats, L; Arias, N; Cosculluela, A

    2006-01-01

    Despite the interest generated by the increasing number of studies that measure Quality of Life among patients and caregivers, few of these studies measure the caregivers burden in Peritoneal Dialysis (PD). The main target of this study was to create a burden measure questionnaire applicable amongst caregivers of PD patients. 1) Patients had to be in PD treatment for more than 3 months; 2) Patients had to receive help with the PD treatment from a caregiver. The study was divided into 3 phases: 1st) design and use of the initial questionnaire; 2nd) a test-retest on a modified scale; and 3rd) to provide the questionnaire-3 to two collaborative centres with similar PD programs. Four groups of caregivers were established: A1:23, A2:17, B:7 and C:16 caregivers. We applied 5 scales (5): 1--Patient Dependence on caregiver, from caregivers' view (D); 2--Complete caregiver burden (CB), including 12 items which measure the caregivers' subjective burden, 3--Reduced caregiver burden (RB), as the one before but with only 8 items, 4--Repercussions on the caregiver (R), which measures objective burden; 5--Specific PD tasks (ST), a scale that measures the effort the tasks implied in the PD treatment represent for the caregiver. We studied 63 caregivers (table I): mean age: 53.43 (SD = 12.3); Sex: Females: 86.4%, Males: 13.6%, corresponding to 63 patients: mean age: 59.79 (SD = 15.9); Sex: Males: 80.3%, Females: 19.7%. Valuable results for reliability, unidimensionality, and discrimination were obtained in the 1st and 2nd phases, except for burden scale which was compound of two factors; then one of those factors was suppressed. In the 3rd phase, ANOVA did not show any differences between centres (table II). Consequently, all caregivers could be analysed together. Reliability results for each one of the third phase scales (table III) were: D: Cronbach alpha = 0,886; CB: alpha = 0,894; RB: alpha = 0,857; R: alpha = 0,892; ST: alpha = 0,62. Although the ST scale obtained an

  12. A Hyperpigmented Reticular Rash in a Patient on Peritoneal Dialysis.

    PubMed

    South, Andrew M; Crispin, Milene K; Marqueling, Ann L; Sutherland, Scott M

    Chronically ill patients often develop uncommon exam findings. A 16-year-old female with end-stage renal disease secondary to immune complex-mediated glomerulonephritis on peritoneal dialysis (PD) developed a pruritic, hyperpigmented reticular rash on her abdomen, sparing the PD catheter insertion site. The rash appeared approximately 6 weeks after initiating PD. She used a heating pad nightly during PD for dialysis drain pain. Testing for systemic and autoimmune disease was negative. She was referred to dermatology, where the diagnosis of erythema ab igne (EAI), a well-described but less well-known hyperpigmented reticular cutaneous eruption caused by chronic exposure to low levels of infrared heat, was confirmed. The eruption is typically painless but is often pruritic. Common sources of heat include fires, stoves, portable heaters, heating pads, and laptop computers. The association between EAI and PD is unknown. Our patient discontinued the heating pad and her rash resolved.

  13. The dose of dialysis in hemodialysis patients: impact on nutrition.

    PubMed

    Schulman, Gerald

    2004-01-01

    Multiple lines of evidence have indicated that the dose of hemodialysis impacts upon patient outcome. Among these outcome measures, nutrition is inextricably linked to the adequacy of the treatment. All of the methods of determining dialysis adequacy are based on assessing the removal of toxic substances retained in renal failure, the majority of which are derivatives of protein metabolism. Urea kinetics, employing urea as a surrogate for quantifying the elimination of small molecular weight nitrogenous substances, is the method that has been most thoroughly validated to date as defining a dose range for thrice-weekly hemodialysis: Both inadequate and optimal levels of hemodialysis dose have been identified by prospective, randomized clinic trials utilizing Kt/V(urea) as the index of adequacy. The impact of urea kinetics on nutritional status during thrice-weekly hemodialysis is discussed. Recently, in an attempt to improve outcome beyond that achievable with thrice-weekly hemodialysis, alternative regimens, consisting of daily treatments, have received increasing interest. In order to compare the dose of hemodialysis associated with these regimens with conventional thrice-weekly regimens in terms of removal of small molecular weight substances, standard Kt/V(urea), a parameter that combines treatment dose with treatment frequency, and thus allows for various intermittent therapies to be compared to continuous therapy, must be used. In addition, membrane flux and middle molecule removal, factors that have not yet been well defined as parameters of adequacy during thrice-weekly regimens, may be shown to be important indices with longer hemodialysis treatments, particularly daily nocturnal hemodialysis. The impact that these alternative regimens have had on nutritional status in hemodialysis patients and how they compare to conventional therapy are important considerations.

  14. Validation of a dietary intake tool for african-american dialysis patients with low literacy.

    PubMed

    Duffrin, Christopher; Carraway-Stage, Virginia G; Briley, Alexis; Christiano, Cynthia

    2015-06-01

    This study analysed the validity and reliability of a food frequency questionnaire designed for African-American patients with low literacy. This instrument was designed specifically to meet the need for a tool that was short, easy to understand, and met clinical reliability and validity standards. Assessing patient nutritional status and dietary intake is crucial to the care of patients in end stage kidney disease. The development of a quick and reliable nutritional assessment tool for patients with low literacy could increase nutritional counselling effectiveness and improve patient outcomes. The renal food frequency questionnaire (RFF) and a standard 24-hour recall were administered to a general population of African-American patients undergoing dialysis. Registered Dieticians and statistical analyses were used to validate the content and structural validity and reliability of the RFF to adequately measure dietary intake. The study sample consisted of 30 African-American patients who received dialysis treatment at a regional teaching hospital facility. The RFF was found to be a simple, easy to understand instrument with low reading complexity (grade level 4.4). Inter-rater reliability was found to be high (.81-1.00), and statistical analysis determined a high level of clinical validity. The RFF was found to be a valid dietary recall tool that is appropriate for patients with limited literacy. It was found to have acceptable reliability and validity when compared with a standard 24-hour recall and has potential for use as a dietary intake and monitoring tool in patients undergoing dialysis. © 2014 European Dialysis and Transplant Nurses Association/European Renal Care Association.

  15. Dialysis access in a patient with multiple central venous stenoses.

    PubMed

    Cui, Tianlei; Zhao, Yuliang; Li, Xiao; Zhou, Li; Liu, Fang; Fu, Ping

    2014-01-01

    We report a female patient, with obstructed right femoral and right brachiocephalic vein, narrowed left femoral vein, left brachiocephalic vein and superior vena cava, due to long-term catheterization for dialysis. Angioplasty and synthesized graft transplant were successfully performed. The new access withstood early cannulation only 3 days after the procedure. Angioplasty can ameliorate existing stenosis and enable permanent access creation, while an artificial graft may provide faster maturation than documented.

  16. Effect of dialysis modality on frailty phenotype, disability, and health-related quality of life in maintenance dialysis patients.

    PubMed

    Kang, Seok Hui; Do, Jun Young; Lee, So-Young; Kim, Jun Chul

    2017-01-01

    Health-related quality of life (HRQoL) surveys are needed to evaluate regional and ethnic specificies. The aim of the present study was to evaluate the differences in HRQoL, frailty, and disability according to dialysis modality in the Korean population. We enrolled relatively stable maintenance dialysis patients. A total of 1,616 patients were recruited into our study. The demographic and laboratory data collected at enrollment included age, sex, comorbidities, frailty, disability, and HRQoL scales. A total of 1,250 and 366 participants underwent hemodialysis (HD) and peritoneal dialysis (PD), respectively. The numbers of participants with pre-frailty and frailty were 578 (46.2%) and 422 (33.8%) in HD patients, and 165 (45.1%) and 137 (37.4%) in PD patients, respectively (P = 0.349). Participants with a disability included 195 (15.6%) HD patients and 109 (29.8%) PD patients (P < 0.001). On multivariate analysis, the mean physical component scale (PCS) and mental component scale (MCS), symptom/problems, and sleep scores were higher in HD patients than in PD patients. Cox regression analyses showed that an increased PCS in both HD and PD patients was positively associated with patient survival and first hospitalization-free survival. An increased MCS in both HD and PD patients was positively associated with first hospitalization-free survival only. There was no significant difference in frailty between patients treated with the two dialysis modalities; however, disability was more common in PD patients than in HD patients. The MCS and PCS were more favorable in HD patients than in PD patients. Symptom/problems, sleep, quality of social interaction, and social support were more favorable in HD patients than in PD patients; however, patient satisfaction and dialysis staff encouragement were more favorable in PD patients than in HD patients.

  17. Assessing the impact of budget controls on the prescribing behaviours of physicians treating dialysis-dependent patients.

    PubMed

    Chang, Ray-E; Tsai, Ya-Hsing; Myrtle, Robert C

    2015-11-01

    This study examined whether outpatient haemodialysis providers changed their treatment practices with the establishment of an outpatient dialysis global budget (ODGB) through analysing the outpatient visits and medication received by those patients. A sample of 4668 observations (patient year) of 1350 haemodialysis with hypertension (HH) patients and 4668 observations of 1436 non-HH (NHH) patients were drawn from the National Health Insurance Research Database over the years from 1999 to 2005. The impact of ODGB on hypertension-related outpatient utilization of HH was estimated using the difference in difference (DID) method and examined in three stages: (1) the fee for service stage, the pre-ODGB (2000), (2) the phase-in stage (2001-2002) and (3) the post-ODGB stage (2003-2005). ODGB implementation did not affect the number of dialysis visits for HH patients. However, it did lead to a reduction in fees for antihypertension drugs used by haemodialysis facilities. There was an increase of 4.06 visits per patient per year (P < 0.001) in the number of non-dialysis outpatient with antihypertensive drugs visits for HH patients compared with the control group. The total fees for antihypertensive drugs for HH patients increased by New Taiwan Dollars (NT$)13 008 (P < 0.001) per patient per year relative to the control group after the implementation of ODGB. As ODGB was implemented, HH patients received fewer antihypertensive drugs during their dialysis visit. In addition, there was an increase in the number of non-dialysis outpatient visits by HH patients as well as increased payment in the drugs associated with their non-dialysis outpatient visits compared with the control group. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2014; all rights reserved.

  18. Does Whey Protein Supplementation Improve the Nutritional Status in Hypoalbuminemic Peritoneal Dialysis Patients?

    PubMed

    Hassan, Kamal

    2017-07-25

    Limited data are available regarding the effects of whey protein on the nutritional status of the peritoneal dialysis population. This study evaluated the effects of whey protein supplementation for 12 weeks on the nutritional status in hypoalbuminemic peritoneal dialysis patients. Thirty-six stable adult patients on maintenance peritoneal dialysis with serum albumin levels <3.5 g/dL were enrolled in the study and were divided into two groups similar in their serum albumin and normalized protein equivalent of total nitrogen appearance (nPNA). Nineteen patients were instructed to receive 1.2 g/kg per day of protein diet and additional whey protein supplement at a dose of 25% of the instructed daily protein diet (whey protein group), and 17 patients were instructed to receive 1.2 g/kg per day protein diet without additional whey protein supplementation (control group). Nutritional status was assessed using two measures: nPNA and lean tissue mass index (LTI) obtained by whole-body bioimpedance spectroscopy technique. In the whey protein group serum albumin and nPNA significantly increased from baseline to week 6 (P < 0.001, P = 0.034; respectively) and from week 6 to week 12 (P < 0.001, P = 0.001; respectively); LTI significantly increased from week 6 to week 12 (P = 0.022). Compared to the control group at week 12, serum albumin, nPNA and LTI values were significantly higher in the whey protein group (P < 0.001, P = 0.002, P = 0.001; respectively). This study demonstrated for the first time that oral supplementation with whey protein improves nutritional status and is well tolerated in hypoalbuminemic PD patients. © 2017 International Society for Apheresis, Japanese Society for Apheresis, and Japanese Society for Dialysis Therapy.

  19. Right Heart Catheterization via Dialysis Arteriovenous Shunts in End-Stage Renal Disease Patients.

    PubMed

    Hsieh, Mu-Yang; Chen, Tsung-Yan; Lin, Lin; Liao, Min-Tsun; Wang, Ren-Huei; Kuo, Ruei-Cheng; Lai, Chao-Lun; Wu, Chih-Cheng

    2016-12-01

    Right heart catheterization is an important diagnostic tool but carries risks of adverse events. Little is known about the feasibility and safety of using dialysis arteriovenous (AV) shunts. We aim to evaluate the feasibility and safety of using dialysis AV shunts for access in right heart catheterization. Hemodialysis patients who required right heart catheterization were prospectively enrolled. A 7 Fr sheath was inserted and a balloon-tipped pulmonary artery catheter was advanced for right heart catheterization. Patients were followed for 1 month, and technical success, procedure details, and complications were recorded. Thirteen patients received right heart catheterization via AV shunts. Three patients were evaluated for heart failure, and 10 were examined for pulmonary hypertension. Median patient age was 69 years (interquartile range [IQR], 58-77 years), and median shunt age was 50 months (IQR, 32-75 months). Five shunts were located in the upper arm, 2 were in the right arm, and 5 were native fistulas. All AV shunt punctures were successful on the first attempt. All right heart catheterizations were completed via AV shunts, and the technical success rate was 100%. Median fluoroscopy time was 6.9 minutes. No venous access complications or right heart catheterization-related complications occurred immediately after the procedure or during the 1-month follow-up period. AV dialysis shunts can be used for venous access for right heart catheterization with acceptable feasibility and patient tolerability. Further randomized studies are needed to confirm the benefits of this approach compared with other approaches.

  20. High doses of oral folate and sublingual vitamin B12 in dialysis patients with hyperhomocysteinemia

    PubMed Central

    Naseri, Mitra; Sarvari, Gholam-Reza; Esmaeeli, Mohammad; Azarfar, Anoush; Rasouli, Zahra; Moeenolroayaa, Giti; Jahanshahi, Shohre; Farhadi, Simin; Heydari, Zohreh; Sagheb-Taghipoor, Narges

    2016-01-01

    Introduction: Folic acid and vitamin B12, alone or in combination have been used to reduce homocysteine (Hcy) levels in dialysis patients. Objectives: We aimed to assess the efficacy of high doses of oral folate and vitamin B12 in reducing plasma Hcy levels after a 12-week treatment. Patients and Methods: Thirty-two dialysis patients aged 10-324 months screened for hyperhomocysteinuria. Then cases with hyperhomocysteinemia received oral folate 10 mg/day with sublingual methylcobalamin 1 mg/day for 12 weeks. In pre- and post-intervention phases plasma Hcy concentration, serum folate, and vitamin B12 levels were measured. Changes in plasma Hcy, serum folate, and vitamin B12 concentrations were analyzed by paired t tests, and P values < 0.05 were considered significant. Results: Eighteen (56.2%) patients had hyperhomocysteinuria. Vitamin B12 and folate levels were normal or high in all cases. Two patients were lost due to transplant or irregular drugs consumption. Plasma Hcy levels were reduced in all, and reached normal values in 50%. A statistically significant differences between first Hcy levels with levels after intervention was found (95% CI, 5.1–8.9, P = 0.0001). Conclusion: Oral folate 10 mg/day in combination with sublingual vitamin B12, 1 mg/day can be considered as a favorable treatment for hyperhomocysteinemia in dialysis patients. PMID:27689109

  1. A Chinese patient with peritoneal dialysis-related peritonitis caused by Gordonia terrae: a case report.

    PubMed

    Hou, Chenrui; Yang, Yun; Li, Ziyang

    2017-02-28

    Gordonia terrae is a rare cause of clinical infections, with only 23 reported cases. We report the first case of peritoneal dialysis-related peritonitis caused by Gordonia terrae in mainland China. A 52-year-old man developed peritoneal dialysis-related peritonitis and received preliminary antibiotic treatment. After claiming that his symptoms had been resolved, the patient insisted on being discharged (despite our recommendations) and did not receive continued treatment after leaving the hospital. A telephone follow-up with the patient's relatives revealed that the patient died 3 months later. Routine testing did not identify the bacterial strain responsible for the infection, although matrix-assisted laser desorption/ionization time-of-flight mass spectrometry identified the strain as Gordonia rubropertincta. However, a 16S rRNA sequence analysis using an isolate from the peritoneal fluid culture revealed that the responsible strain was actually Gordonia terrae. Similar to this case, all previously reported cases have involved a delayed diagnosis and initial treatment failure, and the definitive diagnosis required a 16S rRNA sequence analysis. Changes from an inappropriate antibiotic therapy to an appropriate one have relied on microbiological testing and were performed 7-32 days after the initial treatment. The findings from our case and the previously reported cases indicate that peritoneal dialysis-related peritonitis caused by Gordonia terrae can be difficult to identify and treat. It may be especially challenging to diagnose these cases in countries with limited diagnostic resources.

  2. Frailty in Chinese Peritoneal Dialysis Patients: Prevalence and Prognostic Significance.

    PubMed

    Ng, Jack Kit-Chung; Kwan, Bonnie Ching-Ha; Chow, Kai-Ming; Cheng, Phyllis Mei-Shan; Law, Man-Ching; Pang, Wing-Fai; Leung, Chi-Bon; Li, Philip Kam-Tao; Szeto, Cheuk-Chun

    2016-01-01

    Previous studies showed that frailty is prevalent in both pre-dialysis and dialysis patients. However, the prevalence and prognostic implication of frailty in Chinese peritoneal dialysis (PD) patients remain unknown. We used a validated questionnaire to determine the Frailty Score of 193 unselected prevalent PD patients. All patients were then followed for 2 years for their need of hospitalization and mortality. Amongst the 193 patients, 134 (69.4%) met the criteria of being frail. Frailty Score significantly correlated with Charlson's comorbidity score (r = 0.40, p < 0.0001), Malnutrition Inflammation Score (r = 0.59, p < 0.0001), and inversely with Subjective Global Assessment score (r = -0.44, p < 0.0001). Frailty was closely associated with the need of hospitalization. Patients with nil, mild, moderate, and severe frailty required 2.4 ± 6.0, 1.6 ± 1.6, 2.7 ± 2.5, 5.2 ± 4.8 hospital admissions per year, respectively (p < 0.0001), and they stayed in hospital for 6.4 ± 9.2, 5.3 ± 6.2, 10.0 ± 10.4, 12.9 ± 20.1 days per hospital admission, respectively (p < 0.0001). However, Frailty Score was not an independent predictor of patient or technique survival. Frailty is prevalent among Chinese PD patients. Frail PD patients have a high risk of requiring hospitalization and their hospital stay tends to be prolonged. Early identification may allow timely intervention to prevent adverse health outcomes in this group of patients. © 2016 The Author(s) Published by S. Karger AG, Basel.

  3. Glycemic Control Modifies Difference in Mortality Risk Between Hemodialysis and Peritoneal Dialysis in Incident Dialysis Patients With Diabetes

    PubMed Central

    Lee, Mi Jung; Kwon, Young Eun; Park, Kyoung Sook; Kee, Youn Kyung; Yoon, Chang-Yun; Han, In Mee; Han, Seung Gyu; Oh, Hyung Jung; Park, Jung Tak; Han, Seung Hyeok; Yoo, Tae-Hyun; Kim, Yong-Lim; Kim, Yon Su; Yang, Chul Woo; Kim, Nam-Ho; Kang, Shin-Wook

    2016-01-01

    Abstract Although numerous studies have tried to elucidate the best dialysis modality in end-stage renal disease patients with diabetes, results were inconsistent and varied with the baseline characteristics of patients. Furthermore, none of the previous studies on diabetic dialysis patients accounted for the impact of glycemic control. We explored whether glycemic control had modifying effect on mortality between hemodialysis (HD) and peritoneal dialysis (PD) in incident dialysis patients with diabetes. A total of 902 diabetic patients who started dialysis between August 2008 and December 2013 were included from a nationwide prospective cohort in Korea. Based on the interaction analysis between hemoglobin A1c (HbA1c) and dialysis modalities for patient survival (P for interaction = 0.004), subjects were stratified into good and poor glycemic control groups (HbA1c< or ≥8.0%). Differences in survival rates according to dialysis modalities were ascertained in each glycemic control group after propensity score matching. During a median follow-up duration of 28 months, the relative risk of death was significantly lower in PD compared with HD in the whole cohort and unmatched patients (whole cohort, hazard ratio [HR] = 0.65, 95% confidence interval [CI] = 0.47–0.90, P = 0.01; patients with available HbA1c [n = 773], HR = 0.64, 95% CI = 0.46–0.91, P = 0.01). In the good glycemic control group, there was a significant survival advantage of PD (HbA1c <8.0%, HR = 0.59, 95% CI = 0.37–0.94, P = 0.03). However, there was no significant difference in survival rates between PD and HD in the poor glycemic control group (HbA1c ≥8.0%, HR = 1.21, 95% CI = 0.46–2.76, P = 0.80). This study demonstrated that the degree of glycemic control modified the mortality risk between dialysis modalities, suggesting that glycemic control might partly contribute to better survival of PD in incident dialysis patients with diabetes

  4. Treatment of renal anaemia with erythropoiesis-stimulating agents in predialysis chronic kidney disease patients: Haemoglobin profile during the 6 months before initiation of dialysis.

    PubMed

    Kawahara, Kazuhiko; Minakuchi, Jun; Yokota, Narushi; Suekane, Hiroto; Tsuchida, Kenji; Kawashima, Shu

    2015-12-01

    Erythropoiesis-stimulating agents (ESAs) are all effective for renal anaemia in patients with chronic kidney disease (CKD). However, it was reported that the haemoglobin (Hb) concentration decreases to 8.4 g/dL during the initial phase of dialysis despite treatment with recombinant human erythropoietin (rHuEPO). This study compared Hb at the initiation of dialysis among patients treated with three different ESAs (rHuEPO, darbepoetin alfa [DA], and a continuous erythropoietin receptor activator [CERA]). The subjects were 82 CKD patients who started dialysis at Kawashima Hospital between 1 January 2009 and 28 February 2015 and who received only one kind of ESA for at least 6 months before initiation of dialysis. Baseline characteristics and laboratory data at initiation of dialysis were compared among the three groups. Then changes of the Hb, ESA dose, and erythropoiesis resistance index were assessed over time during the 6 months before initiation of dialysis. Differences of Hb at the initiation of dialysis were also assessed. Among the 82 patients, 36 received rHuEPO, 13 received DA, and 33 received CERA. Baseline characteristics and laboratory data of the patients showed no significant differences among the three groups. The monthly Hb decreased gradually during the 6-month period before initiation of dialysis in all three groups. Hb was significantly higher in the CERA group than the rHuEPO group at the initiation of dialysis. Long-acting ESAs may be more useful for predialysis patients with CKD because they do not attend hospital frequently, unlike haemodialysis patients. © 2015 Asian Pacific Society of Nephrology.

  5. Low-dose dialysis combined with low protein intake can maintain nitrogen balance in peritoneal dialysis patients in poor economies
.

    PubMed

    Su, Chun-Yan; Wang, Tao; Lu, Xin-Hong; Ma, Sha; Tang, Wen; Wang, Pei-Yu

    2017-02-01

    Due to limited economic conditions, we tried to provide "fitted" dialysis doses instead of the doses recommended by the international guidelines to the individual patients. In the present cross-sectional study, we studied the dialysis adequacy and nutritional status of 5 peritoneal dialysis patients who had a low dialysis dose (2 bags, 4,000 mL/day). The 3-day dietary records were reviewed to calculate patients' energy, protein, and nitrogen intake (NI). The nitrogen removal (NR) from urine and dialysate was measured by Kjeldahl technique. Fecal nitrogen was estimated as 0.0155 g/kg/day. Subjective global nutritional assessment was used to evaluate the nutritional status. Among the 5 patients, 1 male and 4 female, mean age was 59 (42 - 81) years, dialysis duration 43 (33 - 74) months, body weight 51.05 ± 2.53 kg. The mean dietary protein intake was 0.66 g/kg/day, total weekly Kt/v was 1.25 (residual kidney Kt/v was 0.09), and total daily fluid removal was 699 mL. However, they achieved lower-level neutral nitrogen balance (NI 5.26 ± 0.93 g/day vs. NR 5.33 ± 0.81 g/day, N balance -0.07 ± 0.60 g/day). All of them maintained good nutritional status (SGA "A") without symptoms of nitrogen retention (serum urea 22 ± 4.18 mmol/L). Lower dialysis dose with lower daily protein intake can achieve a lower-level nitrogen balance and does not lead to malnutrition. It may be an effective approach to solve the dialysis problem for the economically week population in China, especially for people with a smaller body size with lower transport membrane.
.

  6. Hepatitis C risk factor for patients submitted to dialysis.

    PubMed

    Baldessar, Maria Zélia; Bettiol, Jane; Foppa, Fabrício; Oliveira, Lúcia Helena das Chagas

    2007-02-01

    This article reports the results of the research which has evaluated the prevalence and factors associated to the presence of Hepatitis C in patients submitted to dialysis at the Clinica de Doenças Renais (Clinic of Renal Diseases) in Tubarao city (CRDT), Santa Catarina State, Brazil, in the period between January 1st, 2004 to December 31st in the same year. The prevalence of 16.8% of Hepatitis C in the studied population and the time-length of dialysis as significative risk factor have become evident. The non-correlation of seropositivity of the followings factors is also indicated: age, gender, base diseases, infrastructures, the type of clinic machines, the type of dialyser, used membranes, the machine sterilisation and substances for this process as well as the number of times of the dialyser reutilization. The data represented in this project suggest that the Hepatitis C presents high prevalence in patients in dialysis and the time-length of the treatment is a risky factor to acquire the infection.

  7. Views of Canadian patients on or nearing dialysis and their caregivers: a thematic analysis.

    PubMed

    Barnieh, Lianne; King-Shier, Kathryn; Hemmelgarn, Brenda; Laupacis, Andreas; Manns, Liam; Manns, Braden

    2014-01-01

    Quality of life of patients receiving dialysis has been rated as poor. To synthesize the views of Canadian patients on or nearing dialysis, and those who care for them. Secondary analysis of a survey, distributed through dialysis centres, social media and the Kidney Foundation of Canada. Pan-Canadian convenience sample. Patients, their caregivers and health-care providers. Text responses to open-ended questions on topics relevant to end-stage renal disease. Statements related to needs, beliefs or feelings were identified, and were analysed by thematic content analysis. A total of 544 relevant statements from 189 respondents were included for the thematic content analysis. Four descriptive themes were identified through the content analysis: gaining knowledge, maintaining quality of life, sustaining psychosocial wellbeing and ensuring appropriate care. Respondents primarily identified a need for more information, better communication, increased psychosocial and financial support for patients and their families and a strong desire to maintain their previous lifestyle. Convenience sample; questions were originally asked with a different intent (to identify patient-important research issues). Patients on or nearing dialysis and their caregivers identified four major themes, gaining knowledge, maintaining quality of life, sustaining psychosocial wellbeing and ensuring appropriate care, several of which could be addressed by the health care system without requiring significant resources. These include the development of patient materials and resources, or sharing of existing resources across Canadian renal programs, along with adopting better communication strategies. Other concerns, such as the need for increased psychosocial and financial support, require consideration by health care funders.

  8. The Use of Complementary and Alternative Medicine Among Dialysis Patients.

    PubMed

    Koren, Ronit; Zafrir Danieli, Hadas; Doenyas-Barak, Keren; Ziv-Baran, Tomer; Golik, Ahuva

    2017-01-01

    Context • The use of complementary and alternative medicine (CAM) has been on the rise in the last decade. Subpopulations of patients with chronic diseases are at risk for adverse events and potential drug-herb interactions, among them dialysis patients. Objective • The study aimed to evaluate the prevalence of CAM consumption among dialysis patients and to search for potential interactions. Design • The study was cross-sectional, based on questionnaires. Setting • The study occurred in the hemodialysis unit at Assaf Harofeh Medical Center (Zeriffin, Israel). Participants • Participants were patients of the hemodialysis unit. Outcome Measures • The questionnaires obtained demographic data, information about a patient's medical history and use of prescription medication, and all relevant history of CAM use, including the interest of the medical team in the patient's use of supplements. Results • Eighty-four patients participated in the study. Eight patients (9.5%) had used CAM, 5 of whom were women (62.5%). Of the CAM consumers, 4 (50%) had more than 12 y of education vs 14 (8.4%) in the nonconsumer group (P = .061). Six of the consumers were professionals (75%) in comparison with 30 (39.5%) of the nonconsumers, although that difference was not statistically significant (P = .22). The CAM users' monthly incomes were significantly better than that of the nonconsumers (P = .01). No differences were found regarding smoking, alcohol consumption, or physical activity. The study found potential drug-herb interactions in 4 (50%) of the CAM consumers. Moderate potential interactions were found between Aloe vera and diuretics; Aloe vera and insulin; pyridoxine and calcium-channel blockers and diuretics; and niacin and statins. Those interactions had the potential to result in hypoglycemia, hyperglycemia, hypokalemia, and lower blood pressure. Conclusions • The study found a lower prevalence of CAM consumption in dialysis patients than had been found in other

  9. A palliative approach to dialysis care: a patient-centered transition to the end of life.

    PubMed

    Grubbs, Vanessa; Moss, Alvin H; Cohen, Lewis M; Fischer, Michael J; Germain, Michael J; Jassal, S Vanita; Perl, Jeffrey; Weiner, Daniel E; Mehrotra, Rajnish

    2014-12-05

    As the importance of providing patient-centered palliative care for patients with advanced illnesses gains attention, standard dialysis delivery may be inconsistent with the goals of care for many patients with ESRD. Many dialysis patients with life expectancy of <1 year may desire a palliative approach to dialysis care, which focuses on aligning patient treatment with patients' informed preferences. This commentary elucidates what comprises a palliative approach to dialysis care and describes its potential and appropriate use. It also reviews the barriers to integrating such an approach into the current clinical paradigm of care and existing infrastructure and outlines system-level changes needed to accommodate such an approach.

  10. Measured Glomerular Filtration Rate at Dialysis Initiation and Clinical Outcomes of Indian Peritoneal Dialysis Patients.

    PubMed

    Prasad, N; Patel, M R; Chandra, A; Rangaswamy, D; Sinha, A; Bhadauria, D; Sharma, R K; Kaul, A; Gupta, A

    2017-01-01

    The optimal time for dialysis initiation remains controversial. Studies have failed to show better outcomes with early initiation of hemodialysis; even a few had shown increased adverse outcomes including poorer survival. Few studies have examined the same in patients on peritoneal dialysis (PD). Measured glomerular filtration rate (mGFR) not creatinine-based estimated GFR is recommended as the measure of kidney function in end-stage renal disease (ESRD) patients. The objective of this observational study was to compare the outcomes of Indian patients initiated on PD with different residual renal function (RRF) as measured by 24-h urinary clearance method. A total of 352 incident patients starting on chronic ambulatory PD as the first modality of renal replacement therapy were followed prospectively. Patients were categorized into three groups as per mGFR at the initiation of PD (≤5, >5-10, and >10 ml/min/1.73 m(2)). Patient survival and technique survival were compared among the three groups. Patients with GFR of ≤5 ml/min/1.73 m(2) (hazard ratio [HR] - 3.42, 95% confidence interval [CI] - 1.85-6.30, P = 0.000) and >5-10 ml/min/1.73 m(2) (HR - 2.16, 95% CI - 1.26-3.71, P = 0.005) had higher risk of mortality as compared to those with GFR of >10 ml/min/1.73 m(2). Each increment of 1 ml/min/1.73 m(2) in baseline GFR was associated with 10% reduced risk of death (HR - 0.90, 95% CI - 0.85-0.96, P = 0.002). Technique survival was poor in those with an initial mGFR of ≤5 ml/min/1.73 m(2) as compared to other categories. RRF at the initiation was also an important factor predicting nutritional status at 1 year of follow-up. To conclude, initiation of PD at a lower baseline mGFR is associated with poorer patient and technique survival in Indian ESRD patients.

  11. Patient stories about their dialysis experience biases others' choices regardless of doctor's advice: an experimental study.

    PubMed

    Winterbottom, Anna E; Bekker, Hilary L; Conner, Mark; Mooney, Andrew F

    2012-01-01

    Renal services provide resources to support patients in making informed choices about their dialysis modality. Many encourage new patients to talk with those already experiencing dialysis. It is unclear if these stories help or hinder patients' decisions, and few studies have been conducted into their effects. We present two studies comparing the impact of patient and doctor stories on hypothetical dialysis modality choices among an experimental population. In total, 1694 participants viewed online information about haemodialysis and continuous cycling peritoneal dialysis and completed a questionnaire. In Study 1, using actors, treatment information was varied by presenter (Doctor, Patient), order of presenter (Patient first, Doctor first) and mode of delivery (written, video). Information in Study 2 was varied (using actors) by presenter (Doctor, Patient), order of presenter (Patient first, Doctor first), inclusion of a decision table (no table, before story, after story) and sex of the 'patient' (male, female) and 'Doctor' (male, female). Information was controlled to ensure comparable content and comprehensibility. In both studies, participants were more likely to choose the dialysis modality presented by the patient rather than that presented by the doctor. There was no effect for mode of delivery (video versus written) or inclusion of a decision table. As 'new' patients were making choices based on past patient experience of those already on dialysis, we recommend caution to services using patient stories about dialysis to support those new to the dialysis in delivering support to those who are new to the decision making process for dialysis modality.

  12. Exploring the opinion of CKD patients on dialysis regarding end-of-life and Advance Care Planning.

    PubMed

    Sánchez-Tomero, J A; Rodríguez-Jornet, A; Balda, S; Cigarrán, S; Herrero, J C; Maduell, F; Martín, J; Palomar, R

    2011-01-01

    Advance care planning (ACP) and the subsequent advance directive document (ADD), previously known as "living wills", have not been widely used in Spain. The Ethics Group from the Spanish Society of Nephrology has developed a survey in order to investigate the opinion of dialysis patients regarding the ADD and end-of-life care. Patients received documentation explaining ACP and filled out a survey about their familiarity with and approval of the ADD. Seven hospital dialysis centres participated in the study for a total of 416 active dialysis patients. Questionnaires were distributed to 263 patients, 154 of which answered (69.2% completed them without assistance). The rates for ADD implementation (7.9%) and designation of a representative person (6.6%) were very low. Most of the patients clearly expressed their wishes about irreversible coma, vegetative state, dementia and untreatable disease. More than 65% did not want mechanical ventilation, chronic dialysis, tube feeding or resuscitation if cardiorespiratory arrest occurred. They reported that an ADD could be done before starting dialysis but most thought that it should be offered only to those who requested it (65% vs 34%). In conclusion, patients have clear wishes about end-of-life care, although these desires had not been documented due to the very low implementation of the ADD.

  13. Pharmacokinetics of lenalidomide during high cut-off dialysis in a patient with multiple myeloma and renal failure.

    PubMed

    Dao, Kim; Lu, Yimin; Peer, Cody J; Figg, William D; Stadelmann, Raphael; Burnier, Michel; Buclin, Thierry; Kissling, Sebastien

    2017-01-01

    High cut-off dialysis, increasingly used in multiple myeloma patients, is susceptible to influence anticancer drug elimination. We report about lenalidomide disposition in a patient on high cut-off dialysis for renal failure secondary to myeloma cast nephropathy. The patient received a higher dosage of lenalidomide (5 mg b.i.d.), owing to concerns about a potential decrease in lenalidomide exposure during dialysis sessions. A set of blood samples was taken in order to develop a pharmacokinetic model accounting for lenalidomide concentrations in this setting. According to our model, the area under the curve was 3273 µg h/L, i.e., 60% higher than expected under usual dosage (25 mg q.d.) with normal renal function. Despite this, the patient did not develop major hematological toxicity. Lenalidomide doses of 5 mg b.i.d. led to high exposure in a patient with renal failure undergoing high cut-off dialysis. Yet, the dosage of 5 mg q.d. recommended in conventional dialysis would probably be adequate in such patients.

  14. Pulmonary Congestion and Physical Functioning in Peritoneal Dialysis Patients

    PubMed Central

    Enia, Giuseppe; Tripepi, Rocco; Panuccio, Vincenzo; Torino, Claudia; Garozzo, Maurizio; Battaglia, Giovanni Giorgio; Zoccali, Carmine

    2012-01-01

    ♦ Purpose: Decline in physical function is commonly observed in patients with kidney failure on dialysis. Whether lung congestion, a predictable consequence of cardiomyopathy and fluid overload, may contribute to the low physical functioning of these patients has not been investigated. ♦ Methods: In 51 peritoneal dialysis (PD) patients, we investigated the cross-sectional association between the physical functioning scale of the Kidney Disease Quality of Life Short Form (KDQOL-SF: Rand Corporation, Santa Monica, CA, USA) and an ultrasonographic measure of lung water recently validated in dialysis patients. The relationship between physical functioning and lung water was also analyzed taking into account the severity of dyspnea measured using the New York Heart Association (NYHA) classification currently used to grade the severity of heart failure. ♦ Results: Evidence of moderate-to-severe lung congestion was evident in 20 patients, and this alteration was asymptomatic (that is, NHYHA class I) in 11 patients (55%). On univariate analysis, physical functioning was inversely associated with lung water (r = -0.48, p < 0.001), age (r = -0.44, p = 0.001), previous cardiovascular events (r = -0.46, p = 0.001), and fibrinogen (r = -0.34, p = 0.02). Physical functioning was directly associated with blood pressure, the strongest association being with diastolic blood pressure (r = 0.38, p = 0.006). The NYHA class correlated inversely with physical functioning (r = -0.51, p < 0.001). In multiple regression analysis, only lung water and fibrinogen remained independent correlates of physical functioning. The NYHA class failed to maintain its independent association. ♦ Conclusions: This cross-sectional study supports the hypothesis that symptomatic and asymptomatic lung congestion is a relevant factor in the poor physical functioning of patients on PD. PMID:22942271

  15. Reported pica behavior in a sample of incident dialysis patients.

    PubMed

    Ward, P; Kutner, N G

    1999-01-01

    In a prospective study, pica behavior was investigated during baseline interviews with a cohort of incident patients (n = 226) who began chronic dialysis therapy in metropolitan Atlanta, GA, during 1996 to 1997. Pica, defined as current pica behavior and/or reported history of pica behavior, was reported by 16% of the sample. Patients reporting pica were significantly more likely to be African American women and were significantly younger than the remainder of the sample. Approximately two thirds of patients who reported pica behaviors craved and excessively consumed ice; the remainder craved and consumed starch, dirt, flour, or aspirin. Among patients reporting pica, average serum albumin values were low and average phosphorus was increased. The average hematocrit of patients reporting ice pica was low. Over half of the hemodialysis patients reporting pica behavior had excessive usual interdialytic weight gain. Potential symptoms/problems affecting quality of life among patients practicing pica, eg, cramps, are shown in a case report. The data indicate the need for targeted education and support for dietitians' increased interaction with dialysis patients involved in pica behaviors.

  16. Dialysis exercise team: the way to sustain exercise programs in hemodialysis patients.

    PubMed

    Capitanini, Alessandro; Lange, Sara; D'Alessandro, Claudia; Salotti, Emilio; Tavolaro, Alba; Baronti, Maria E; Giannese, Domenico; Cupisti, Adamasco

    2014-01-01

    Patients affected by end-stage renal disease (ESRD) show quite lower physical activity and exercise capacity when compared to healthy individuals. In addition, a sedentary lifestyle is favoured by lack of a specific counseling on exercise implementation in the nephrology care setting. Increasing physical activity level should represent a goal for every dialysis patient care management. Three crucial elements of clinical care may contribute to sustain a hemodialysis exercise program: a) involvement of exercise professionals, b) real commitment of nephrologists and dialysis professionals, c) individual patient adaptation of the exercise program. Dialysis staff have a crucial role to encourage and assist patients during intra-dialysis exercise, but other professionals should be included in the ideal "exercise team" for dialysis patients. Evaluation of general condition, comorbidities (especially cardiovascular), nutritional status and physical exercise capacity are mandatory to propose an exercise program, in either extra-dialysis or intra-dialysis setting. To this aim, nephrologist should lead a team of specialists and professionals including cardiologist, physiotherapist, exercise physiologist, renal dietician and nurse. In this scenario, dialysis nurses play a pivotal role since they guarantee a constant and direct approach. Unfortunately dialysis staff may often lack of information and formation about exercise management while they take care patients during the dialysis session. Building an effective exercise team, promoting the culture of exercise and increasing physical activity levels lead to a more complete and modern clinical care management of ESRD patients.

  17. Incident Dialysis Access in Patients With End-Stage Kidney Disease: What Needs to Be Improved.

    PubMed

    Moist, Louise M; Lok, Charmaine E

    2017-03-01

    The initiation of dialysis is a challenging time of transition for patients, families, and their supporters. Patients with exposure to a comprehensive chronic kidney disease clinic may have had education and subsequent decision making regarding dialysis modality and access; however, many patients with or without prior education will require an urgent start to dialysis, requiring quick decisions regarding dialysis modality and access. In many countries, hemodialysis (HD) using a central venous catheter (CVC) is the most common initial renal replacement modality and dialysis access. Multiple factors, both remedial and nonremedial, contribute to this including late referral, rapid decrease in kidney function, delay in delivery or acceptance of education, and decision making and other system delays. Recent use of urgent peritoneal dialysis as the initial dialysis modality has resulted in decreased exposure to CVCs and in-center HD. This article addresses the current state of incident dialysis access, recent trends toward urgent peritoneal dialysis start, and opportunities to avoid the use of CVCs for HD when appropriate, with a focus on considering dialysis access as a critical component of the end-stage kidney disease life-plan, which requires consideration of future modalities and access when making the choice of the initial dialysis access. Copyright © 2017. Published by Elsevier Inc.

  18. A communication framework for dialysis decision-making for frail elderly patients.

    PubMed

    Schell, Jane O; Cohen, Robert A

    2014-11-07

    Frail elderly patients with advanced kidney disease experience many of the burdens associated with dialysis. Although these patients constitute the fastest-growing population starting dialysis, they often suffer loss of functional status, impaired quality of life, and increased mortality after dialysis initiation. Nephrology clinicians face the challenges of helping patients decide if the potential benefits of dialysis outweigh the risks and preparing such patients for future setbacks. A communication framework for dialysis decision-making that aligns treatment choices with patient goals and values is presented. The role of uncertainty is highlighted, and the concept of a goal-directed care plan is introduced. This plan incorporates a time-limited trial that promotes frequent opportunities for reassessment. Using the communication skills presented, the clinician can prepare and guide patients for the dialysis trajectory as it unfolds.

  19. Accuracy of dialysis medical records in determining patients' interest in and suitability for transplantation.

    PubMed

    Huml, Anne M; Sullivan, Catherine M; Pencak, Julie A; Sehgal, Ashwini R

    2013-01-01

    We sought to determine the accuracy of dialysis medical records in identifying patients' interest in and suitability for transplantation. Cluster randomized controlled trial. A total of 167 patients recruited from 23 hemodialysis facilities. Navigators met with intervention patients to provide transplant information and assistance. Control patients continued to receive usual care. Agreement at study initiation between medical records and (i) patient self-reported interest in transplantation and (ii) study assessments of medical suitability for transplant referral. Medical record assessments, self-reports, and study assessments of patient's interest in and suitability for transplantation. There was disagreement between medical records and patient self-reported interest in transplantation for 66 (40%) of the 167 study patients. In most of these cases, patients reported being more interested in transplantation than their medical records indicated. The study team determined that all 92 intervention patients were medically suitable for transplant referral. However, for 38 (41%) intervention patients, medical records indicated that they were not suitable. About two-thirds of these patients successfully moved forward in the transplant process. Dialysis medical records are frequently inaccurate in determining patient's interest in and suitability for transplantation. © 2013 John Wiley & Sons A/S.

  20. Accuracy of Dialysis Medical Records in Determining Patient Interest in and Suitability for Transplantation

    PubMed Central

    Huml, Anne M.; Sullivan, Catherine M.; Pencak, Julie A.; Sehgal, Ashwini R.

    2013-01-01

    Background We sought to determine the accuracy of dialysis medical records in identifying patient interest in and suitability for transplantation. Study Design Cluster randomized controlled trial Setting and Participants 167 patients recruited from 23 hemodialysis facilities. Intervention Navigators met with intervention patients to provide transplant information and assistance. Control patients continued to receive usual care. Outcomes Agreement at study initiation between medical records and (a) patient self-reported interest in transplantation and (b) study assessments of medical suitability for transplant referral. Measurements Medical record assessments, self-reports, and study assessments of patient interest in and suitability for transplantation. Results There was disagreement between medical records and patient self-reported interest in transplantation for 66 (40%) of the 167 study patients. In most of these cases, patients reported being more interested in transplantation than their medical records indicated. The study team determined that all 92 intervention patients were medically suitable for transplant referral. However, for 38 (41%) intervention patients, medical records indicated that they were not suitable. About two-thirds of these patients successfully moved forward in the transplant process. Conclusion Dialysis medical records are frequently inaccurate in determining patient interest in and suitability for transplantation. PMID:23803012

  1. Valvular calcification, inflammation, and mortality in dialysis patients.

    PubMed

    Mohamed, Bonita A; Yang, Wei; Litt, Harold; Rosas, Sylvia E

    2013-07-01

    The study aim was to determine the correlates of valvular calcification (VC), including clinical and physiologic parameters, in individuals new to dialysis. In addition, the association of VC with coronary artery calcification (CAC) progression and mortality was investigated. A total of 101 incident dialysis individuals underwent electrocardiogram-triggered multislice computed tomography (CT) to monitor the presence and quantification of calcification. The average follow up was 2.85 +/- 0.72 years. Twenty-six (25.7%) patients had only one valve calcified, while 10 (9.9%) had calcifications in both valves. Patients with VC were older, more likely to have a history of diabetes and/or cardiovascular disease (CVD), more likely to have CAC, and to be Caucasian; fibrinogen and interleukin-6 (IL-6) levels were also higher in these patients. Multivariable Poisson regression analysis revealed older age, history of CVD, increasing fibrinogen, and presence of CAC were independently associated with the presence of VC. Patients with VC also had a higher median annualized CAC progression compared to those without VC (2.90 versus 105.2, p = 0.004). The mortality rate per 100 years was 2.57 in patients without VC, compared to 4.20 and 13.76, respectively, for those with one or two calcified valves. An increasing number of calcified valves was associated with a higher mortality after adjustment for gender and race [HR 2.2 (1.03-4.69), p = 0.04], but was not statistically significant after adjustment for inflammatory markers such as IL-6 or fibrinogen. Traditional and novel risk factors are associated with the presence of VC, which is a risk marker for CAC progression and mortality in incident dialysis patients.

  2. Phosphorus metabolism in peritoneal dialysis- and haemodialysis-treated patients.

    PubMed

    Evenepoel, Pieter; Meijers, Björn K I; Bammens, Bert; Viaene, Liesbeth; Claes, Kathleen; Sprangers, Ben; Naesens, Maarten; Hoekstra, Tiny; Schlieper, Georg; Vanderschueren, Dirk; Kuypers, Dirk

    2016-09-01

    Phosphorus control is generally considered to be better in peritoneal dialysis (PD) patients as compared with haemodialysis (HD) patients. Predialysis phosphorus concentrations are misleading as a measure of phosphorus exposure in HD, as these neglect significant dialysis-related fluctuations. Parameters of mineral metabolism, including parathyroid hormone (PTH) and fibroblast growth factor-23 (FGF-23), were determined in 79 HD and 61 PD patients. In PD, phosphorus levels were determined mid-morning. In HD, time-averaged phosphorus concentrations were modelled from measurements before and after the mid-week dialysis session. Weekly renal, dialytic and total phosphorus clearances as well as total mass removal were calculated from urine and dialysate collections. Time-averaged serum phosphorus concentrations in HD (3.5 ± 1.0 mg/dL) were significantly lower than the mid-morning concentrations in PD (5.0 ± 1.4 mg/dL, P < 0.0001). In contrast, predialysis phosphorus concentrations (4.6 ± 1.4 mg/dL) were not different from PD. PTH and FGF-23 levels were significantly higher in PD. Despite higher residual renal function, total phosphorus clearance was significantly lower in PD (P < 0.0001). Total phosphorus mass removal, conversely, was significantly higher in PD (P < 0.05). Our data suggest that the time-averaged phosphorus concentrations in patients treated with PD are higher as compared with patients treated with HD. Despite a better preserved renal function, total phosphorus clearance is lower in patients treated with PD. Additional studies are needed to confirm these findings in a population with a different demographic profile and dietary background and to define clinical implications. © The Author 2016. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.

  3. A Palliative Approach to Dialysis Care: A Patient-Centered Transition to the End of Life

    PubMed Central

    Moss, Alvin H.; Cohen, Lewis M.; Fischer, Michael J.; Germain, Michael J.; Jassal, S. Vanita; Perl, Jeffrey; Weiner, Daniel E.; Mehrotra, Rajnish

    2014-01-01

    As the importance of providing patient-centered palliative care for patients with advanced illnesses gains attention, standard dialysis delivery may be inconsistent with the goals of care for many patients with ESRD. Many dialysis patients with life expectancy of <1 year may desire a palliative approach to dialysis care, which focuses on aligning patient treatment with patients’ informed preferences. This commentary elucidates what comprises a palliative approach to dialysis care and describes its potential and appropriate use. It also reviews the barriers to integrating such an approach into the current clinical paradigm of care and existing infrastructure and outlines system-level changes needed to accommodate such an approach. PMID:25104274

  4. Systemic anticoagulation related to heparin locking of non-tunnelled venous dialysis catheters in intensive care patients.

    PubMed

    Bong, Y C; Walsham, J

    2016-07-01

    Heparin locking of venous dialysis catheters is routinely performed in intensive care to maintain catheter patency when the catheters are not being used. Leakage of heparin into the circulation can potentially cause systemic anticoagulation and may present a risk to intensive care patients. To assess the effect of 5000 units per millilitre heparin locking of non-tunnelled dialysis catheters on systemic anticoagulation, we performed a prospective observational study of ten intensive care patients receiving heparin locking of dialysis catheters in an adult tertiary intensive care unit between July and September 2015. Activated partial thromboplastin time (APTT) was measured prior to, and three minutes after, heparin locking of catheter lumens with the manufacturer's recommended locking volume to assess the effect on systemic anticoagulation. Heparin locking of venous dialysis catheters resulted in a significant rise in APTT (P=0.002). The median rise was by 56 seconds (interquartile range 30-166.5). Following heparin locking, 80% of patients had APTT values within or above the range associated with therapeutic anticoagulation. Heparin locking of non-tunnelled venous dialysis catheters can cause systemic anticoagulation in intensive care patients and therefore poses a potential risk to patient safety.

  5. Lower serum uric acid level predicts mortality in dialysis patients

    PubMed Central

    Bae, Eunjin; Cho, Hyun-Jeong; Shin, Nara; Kim, Sun Moon; Yang, Seung Hee; Kim, Dong Ki; Kim, Yong-Lim; Kang, Shin-Wook; Yang, Chul Woo; Kim, Nam Ho; Kim, Yon Su; Lee, Hajeong

    2016-01-01

    Abstract We evaluated the impact of serum uric acid (SUA) on mortality in patients with chronic dialysis. A total of 4132 adult patients on dialysis were enrolled prospectively between August 2008 and September 2014. Among them, we included 1738 patients who maintained dialysis for at least 3 months and had available SUA in the database. We categorized the time averaged-SUA (TA-SUA) into 5 groups: <5.5, 5.5–6.4, 6.5–7.4, 7.5–8.4, and ≥8.5 mg/dL. Cox regression analysis was used to calculate the hazard ratio (HR) of all-cause mortality according to SUA group. The mean TA-SUA level was slightly higher in men than in women. Patients with lower TA-SUA level tended to have lower body mass index (BMI), phosphorus, serum albumin level, higher proportion of diabetes mellitus (DM), and higher proportion of malnourishment on the subjective global assessment (SGA). During a median follow-up of 43.9 months, 206 patients died. Patients with the highest SUA had a similar risk to the middle 3 TA-SUA groups, but the lowest TA-SUA group had a significantly elevated HR for mortality. The lowest TA-SUA group was significantly associated with increased all-cause mortality (adjusted HR, 1.720; 95% confidence interval, 1.007–2.937; P = 0.047) even after adjusting for demographic, comorbid, nutritional covariables, and medication use that could affect SUA levels. This association was prominent in patients with well nourishment on the SGA, a preserved serum albumin level, a higher BMI, and concomitant DM although these parameters had no significant interaction in the TA-SUA-mortality relationship except DM. In conclusion, a lower TA-SUA level <5.5 mg/dL predicted all-cause mortality in patients with chronic dialysis. PMID:27310949

  6. Impact on peritoneal membrane of use of icodextrin-based dialysis solution in peritoneal dialysis patients.

    PubMed

    Moriishi, Misaki; Kawanishi, Hideki; Tsuchiya, Shinichiro

    2006-01-01

    The usefulness of icodextrin-containing peritoneal dialysis (PD) solution for the management of body fluid and blood pressure has been reported. However, icodextrin PD solution is a foreign solution in the body, and the possible induction of intraperitoneal inflammation has been reported. In this study, we investigated at 6-month intervals the influence of icodextrin solution on peritoneal permeability and inflammatory reactions in patients in whom glucose solution had been changed to icodextrin solution for the overnight dwell. We enrolled 9 anuric PD patients (5 men, 4 women) of mean age 58 +/- 5.9 years (range: 45.6-64.8 years) into the study. The patients' mean duration of PD was 61.9 +/- 42 months (range: 6.7-142.5 months). The cause of end-stage renal disease was chronic glomerulonephritis in all patients. For evaluation ofperitoneal permeability, we performed peritoneal equilibration tests (PETs) immediately after an overnight dwell and determined the dialysate-to-plasma ratios of creatinine (D/P Cr), beta2-microglobulin (D/P beta2m), albumin (D/P Alb), immunoglobulin G (D/P IgG), and alpha2-macroglobulin (D/P alpha2m). We also measured interleukin-6 (IL-6) and fibrinogen degradation products (FDPs) in overnight effluent as indices of inflammation and of the fibrinolysis-coagulation system. The evaluation was performed every 6 months for 24 months. The FDPs in effluent increased significantly at 6 months after the change to icodextrin solution, and IL-6 tended to increase. The D/P beta2m, D/P Alb, D/P IgG, and D/P alpha2m all significantly increased in the course of follow-up. In the PETs, the D/P Cr increased slightly, but the change was nonsignificant. At 30 months after the change to icodextrin solution, 1 patient was diagnosed as having a risk of encapsulating peritoneal sclerosis (pre-EPS). In this patient, rapid increases in IL-6, D/P Cr and macromolecular and small molecular D/P by PET were noted after the change to icodextrin solution. Steroids were

  7. The influence of socioeconomic status on patient survival on chronic dialysis.

    PubMed

    Ward, Frank L; O'Kelly, Patrick; Donohue, Fionnuala; O'Haiseadha, Coilín; Haase, Trutz; Pratschke, Jonathan; deFreitas, Declan G; Johnson, Howard; O'Seaghdha, Conall M; Conlon, Peter J

    2015-10-01

    Socioeconomic status (SES) has been linked to worse end-stage kidney disease survival. The effect of SES on survival on chronic dialysis, including the impact of transplantation, was examined. A retrospective, observational study investigated the association of SES with dialysis patient survival, with censoring at time of transplantation. Adult patients commencing dialysis from 1990 to 2009 in an Irish tertiary center received a spatial SES score using the 2011 Pobal Haase-Pratschke Deprivation Index and were compared by quartile. Cox proportional hazard models and Kaplan-Meier survival analysis examined any association of SES with survival. The 1794 patients included had a median follow-up of 3.8 years. Patients in the lowest SES area quartile were significantly younger than the highest, mean age 56.7 vs. 59 years, P = 0.006, respectively. There was no association between SES area score and survival in an unadjusted model (hazard ratio [HR] 1.00, 95% confidence interval [CI] 0.99-1.01). Survival in the highest SES area quartile was superior to the lowest SES in a multivariable adjusted model including age, gender, and dialysis modality (HR 0.83, 95% CI 0.70-0.99, P = 0.04). These results were only mildly attenuated by censoring at time of transplantation (highest SES area quartile deprived vs. lowest SES area quartile, HR 0.85, 95% CI 0.70-1.03, P = 0.09). Superior patient survival was identified in the highest SES areas compared with the lowest following age-adjusted analyses, despite the older population in the most affluent areas. Further research should focus on identifying modifiable targets for intervention that account for this socioeconomic-related survival advantage.

  8. Calciphylaxis in peritoneal dialysis patients: a single center cohort study

    PubMed Central

    Zhang, Yanchen; Corapi, Kristin M; Luongo, Maria; Thadhani, Ravi; Nigwekar, Sagar U

    2016-01-01

    Background Calciphylaxis is a rare but devastating condition in end-stage renal disease (ESRD) patients. Most research in the field of calciphylaxis is focused on hemodialysis (HD) patients; however, data on calciphylaxis incidence, risk factors, and mortality in peritoneal dialysis (PD) patients are limited. Methods In this cohort study, we examined data from adult patients who initiated PD for ESRD management at our institute’s PD unit from January 2001 to December 2015. Associations with the development of calciphylaxis were examined for clinical, laboratory, and medication exposures. Incidence of calciphylaxis and mortality in PD patients who developed calciphylaxis were analyzed. Treatments administered to treat calciphylaxis in PD patients were summarized. Results In this cohort of 63 patients, 7 patients developed calciphylaxis (incidence rate: 9.0 per 1,000 patient-years). Median age of PD patients who developed calciphylaxis was 50 years, 57% were white, 71% females, and 71% were previously on HD. Female sex, obesity, HD as a prior dialysis modality, recurrent hypotension, elevated time-averaged serum phosphorous levels, reduced time-averaged serum albumin levels, and warfarin therapy were associated with increased calciphylaxis risk in univariate logistic regression analyses. Intravenous sodium thiosulfate was administered in 57% of PD patients who developed calciphylaxis. One-year mortality in PD patients who developed calciphylaxis was 71% despite multimodal treatment including sodium thiosulfate, hyperbaric oxygen, cinacalcet, and wound debridement. Conclusion Calciphylaxis is a rare but frequently fatal condition in PD patients. Our study provides critical early insights into calciphylaxis incidence, risk factors, and prognosis in PD patients. Sample size and characteristics of patients included in our study limit generalizability to overall PD population and warrant examination in larger independent studies. PMID:27698566

  9. Skin disorders in peritoneal dialysis patients: An underdiagnosed subject

    PubMed Central

    Gursu, Meltem; Uzun, Sami; Topcuoğlu, Derya; Koc, Leyli Kadriye; Yucel, Lamiye; Sumnu, Abdullah; Cebeci, Egemen; Ozkan, Oktay; Behlul, Ahmet; Koc, Leyla; Ozturk, Savas; Kazancioglu, Rumeyza

    2016-01-01

    AIM: To examine all skin changes in peritoneal dialysis (PD) patients followed up in our unit. METHODS: Patients on PD program for at least three months without any known chronic skin disease were included in the study. Patients with already diagnosed skin disease, those who have systemic diseases that may cause skin lesions, patients with malignancies and those who did not give informed consent were excluded from the study. All patients were examined by the same predetermined dermatologist with all findings recorded. The demographic, clinical and laboratory data including measures of dialysis adequacy of patients were recorded also. Statistical Package for Social Sciences (SPSS) for Windows 16.0 standard version was used for statistical analysis. RESULTS: Among the patients followed up in our PD unit, those without exclusion criteria who gave informed consent, 38 patients were included in the study with male/female ratio and mean age of 26/12 and 50.3 ± 13.7 years, respectively. The duration of CKD was 7.86 ± 4.16 years and the mean PD duration was 47.1 ± 29.6 mo. Primary kidney disease was diabetic nephropathy in 11, nephrosclerosis in six, uropathologies in four, chronic glomerulonephritis in three, chronic pyelonephritis in three, autosomal dominant polycystic kidney disease in three patients while cause was unknown in eight patients. All patients except for one patient had at least one skin lesion. Loss of lunula, onychomycosis and tinea pedis are the most frequent skin disorders recorded in the study group. Diabetic patients had tinea pedis more frequently (P = 0.045). No relationship of skin findings was detected with primary renal diseases, comorbidities and medications that the patients were using. CONCLUSION: Skin abnormalities are common in in PD patients. The most frequent skin pathologies are onychomycosis and tinea pedis which must not be overlooked. PMID:27458566

  10. Risk of major nonemergent inpatient general surgical procedures in patients on long-term dialysis.

    PubMed

    Gajdos, Csaba; Hawn, Mary T; Kile, Deidre; Robinson, Thomas N; Henderson, William G

    2013-02-01

    Patients on long-term dialysis undergoing major nonemergent general surgical procedures are thought to have high rates of postoperative complications and death. Retrospective cohort study. Academic and private hospitals. The American College of Surgeons National Surgical Quality Improvement Program database was used to select dialysis and nondialysis patients who had undergone nonemergent major general surgical procedures between 2005 and 2008. Multivariable logistic regression analysis was used to examine the effect of dialysis on 30-day surgical outcomes adjusted for age, race, sex, work relative value units, American Society of Anesthesiologists class, and recent operations (within the past 30 days). Patient morbidity, mortality, and failure-to-rescue rates. Dialysis patients undergoing major nonemergent general surgical procedures were significantly more likely to develop pneumonia, unplanned intubation, ventilator dependence, and need for a reoperation within 30 days from the index procedure. Dialysis patients also had a higher risk of vascular complications and postoperative death. Older dialysis patients (aged ≥ 65 years) had a significantly higher postoperative mortality rate compared with their younger counterparts. Dialysis patients were significantly more likely to die after any complication occurred, and mortality rates were especially high following stroke, myocardial infarction, and reintubation. Abnormalities in potentially modifiable preoperative variables (blood urea nitrogen level, albumin level, and hematocrit) did not increase the risk of postoperative complications or death in dialysis patients compared with nondialysis patients. Dialysis patients undergoing nonemergent general surgery have significantly elevated risks of postoperative complications and death, particularly if they are aged 65 years or older.

  11. Outcomes following cardiac surgery in patients with preoperative renal dialysis.

    PubMed

    Vohra, Hunaid A; Armstrong, Lesley A; Modi, Amit; Barlow, Clifford W

    2014-01-01

    A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was that whether patients who are dependent on chronic dialysis have higher morbidity and mortality rates than the general population when undergoing cardiac surgery. These patients often require surgery in view of their heightened risk of cardiac disease. Altogether 278 relevant papers were identified using the below mentioned search, 16 papers represented the best evidence to answer the question. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses were tabulated. Dialysis-dependent (DD) patients undergoing coronary artery bypass grafting (CABG) or valve replacement have higher morbidity but acceptable outcomes. There is some evidence to show that outcomes after off-pump coronary artery bypass grafting (OPCAB) are better than after on-pump coronary artery bypass grafting (ONCAB) and that results are worse in DD patients with diabetic nephropathy. Patients undergoing combined procedures have a higher mortality.

  12. Is Peritonitis Risk Increased in Elderly Patients on Peritoneal Dialysis? Report from the French Language Peritoneal Dialysis Registry (RDPLF).

    PubMed

    Duquennoy, Simon; Béchade, Clémence; Verger, Christian; Ficheux, Maxence; Ryckelynck, Jean-Philippe; Lobbedez, Thierry

    2016-01-01

    ♦ This study was carried out to examine whether or not elderly patients on peritoneal dialysis (PD) had an increased risk of peritonitis. ♦ This was a retrospective cohort study based on data from the French Language Peritoneal Dialysis Registry. We analyzed 8,396 incident patients starting PD between January 2003 and December 2010. The end of the observation period was 31 December 2012. Patients were separated into 2 age groups: up to 75 and over of 75 years old. ♦ Among 8,396 patients starting dialysis there were 3,173 patients older than 75. When using a Cox model, no association was found between age greater than 75 years and increased risk of peritonitis (hazard ratio [HR]: 0.97 [0.88 - 1.07]). Diabetes (HR: 1.14 [1.01 - 1.28] and continuous ambulatory PD (HR: 1.13 [1.04 - 1.23]) were significantly associated with a higher risk of peritoneal infection whereas nurse-assisted PD was associated with a lower risk of peritonitis (HR: 0.85 [0.78 - 0.94]. In the analysis restricted to the 3,840 self-care PD patients, there was no association between age older than 75 years and risk of peritonitis. ♦ The risk of peritonitis is not increased in elderly patients on PD in a country where assisted PD is available. Copyright © 2016 International Society for Peritoneal Dialysis.

  13. Urgent-Start Peritoneal Dialysis and Hemodialysis in ESRD Patients: Complications and Outcomes.

    PubMed

    Jin, Haijiao; Fang, Wei; Zhu, Mingli; Yu, Zanzhe; Fang, Yan; Yan, Hao; Zhang, Minfang; Wang, Qin; Che, Xiajing; Xie, Yuanyuan; Huang, Jiaying; Hu, Chunhua; Zhang, Haifen; Mou, Shan; Ni, Zhaohui

    2016-01-01

    Several studies have suggested that urgent-start peritoneal dialysis (PD) is a feasible alternative to hemodialysis (HD) in patients with end-stage renal disease (ESRD), but the impact of the dialysis modality on outcome, especially on short-term complications, in urgent-start dialysis has not been directly evaluated. The aim of the current study was to compare the complications and outcomes of PD and HD in urgent-start dialysis ESRD patients. In this retrospective study, ESRD patients who initiated dialysis urgently without a pre-established functional vascular access or PD catheter at a single center from January 2013 to December 2014 were included. Patients were grouped according to their dialysis modality (PD and HD). Each patient was followed for at least 30 days after catheter insertion (until January 2016). Dialysis-related complications and patient survival were compared between the two groups. Our study enrolled 178 patients (56.2% male), of whom 96 and 82 patients were in the PD and HD groups, respectively. Compared with HD patients, PD patients had more cardiovascular disease, less heart failure, higher levels of serum potassium, hemoglobin, serum albumin, serum pre-albumin, and lower levels of brain natriuretic peptide. There were no significant differences in gender, age, use of steroids, early referral to a nephrologist, prevalence of primary renal diseases, prevalence of co-morbidities, and other laboratory characteristics between the groups. The incidence of dialysis-related complications during the first 30 days was significantly higher in HD than PD patients. HD patients had a significantly higher probability of bacteremia compared to PD patients. HD was an independent predictor of short-term (30-day) dialysis-related complications. There was no significant difference between PD and HD patients with respect to patient survival rate. In an experienced center, PD is a safe and feasible dialysis alternative to HD for ESRD patients with an urgent need

  14. Urgent-Start Peritoneal Dialysis and Hemodialysis in ESRD Patients: Complications and Outcomes

    PubMed Central

    Fang, Wei; Zhu, Mingli; Yu, Zanzhe; Fang, Yan; Yan, Hao; Zhang, Minfang; Wang, Qin; Che, Xiajing; Xie, Yuanyuan; Huang, Jiaying; Hu, Chunhua; Zhang, Haifen; Mou, Shan; Ni, Zhaohui

    2016-01-01

    Background Several studies have suggested that urgent-start peritoneal dialysis (PD) is a feasible alternative to hemodialysis (HD) in patients with end-stage renal disease (ESRD), but the impact of the dialysis modality on outcome, especially on short-term complications, in urgent-start dialysis has not been directly evaluated. The aim of the current study was to compare the complications and outcomes of PD and HD in urgent-start dialysis ESRD patients. Methods In this retrospective study, ESRD patients who initiated dialysis urgently without a pre-established functional vascular access or PD catheter at a single center from January 2013 to December 2014 were included. Patients were grouped according to their dialysis modality (PD and HD). Each patient was followed for at least 30 days after catheter insertion (until January 2016). Dialysis-related complications and patient survival were compared between the two groups. Results Our study enrolled 178 patients (56.2% male), of whom 96 and 82 patients were in the PD and HD groups, respectively. Compared with HD patients, PD patients had more cardiovascular disease, less heart failure, higher levels of serum potassium, hemoglobin, serum albumin, serum pre-albumin, and lower levels of brain natriuretic peptide. There were no significant differences in gender, age, use of steroids, early referral to a nephrologist, prevalence of primary renal diseases, prevalence of co-morbidities, and other laboratory characteristics between the groups. The incidence of dialysis-related complications during the first 30 days was significantly higher in HD than PD patients. HD patients had a significantly higher probability of bacteremia compared to PD patients. HD was an independent predictor of short-term (30-day) dialysis-related complications. There was no significant difference between PD and HD patients with respect to patient survival rate. Conclusion In an experienced center, PD is a safe and feasible dialysis alternative to HD

  15. Hypotension in patients on chronic peritoneal dialysis: etiology, management, and outcome.

    PubMed

    Malliara, Maria; Passadakis, Ploumis; Panagoutsos, Stylianos; Theodoridis, Marios; Thodis, Elias; Bargman, Joanne; Jassal, Vanita; Vas, Stephen; Vargemezis, Vassilios; Oreopoulos, Dimitrios

    2002-01-01

    We retrospectively evaluated the phenomenon of arterial hypotension in peritoneal dialysis (PD) in a large cohort of 633 PD patients from two centers (Toronto Western Hospital, Toronto, Canada, and Division of Nephrology, Democritus University of Thrace, Greece), thus extending our previously reported experience for an additional 6 years (1995-2000). Together, the units had 81 hypotensive patients (12.8%), whose mean age was 63.8 +/- 14.2 years and whose mean duration of peritoneal dialysis was 49.3 +/- 30 months. Based on the underlying pathophysiology, the hypotensive PD patients were divided into four groups: (A) hypovolemia, 32 patients (39.5%); (B) congestive heart failure (CHF), 15 patients (18.5%); (C) receiving antihypertensive medications, 11 patients (13.6%); and (D) "unknown" etiology, 23 patients (28.4%). All patients in the hypovolemic and antihypertensive groups responded well to treatment (volume expansion and discontinuation of antihypertensive medication, respectively), but in the CHF and "unknown" groups, only 40% improved with the appropriate intervention. Patients in the latter two groups showed the poorest prognosis, with an approximate death rate of 65%. The hypovolemic group had better outcomes, which might reflect prompt response to fluid replacement in that group. We conclude that, in PD patients, careful use of antihypertensive medication, the right evaluation of target weight (especially in patients with cardiac failure), and judicious use of hypertonic exchanges may prevent the severe complication of arterial hypotension.

  16. Moderator's view: Higher serum bicarbonate in dialysis patients is protective.

    PubMed

    Kalantar-Zadeh, Kamyar

    2016-08-01

    Several observational studies have reported an association between higher serum bicarbonate level and high mortality risk in dialysis patients. However, in such studies mere discovery of associations does not allow one to infer causal relationships. This association may be related to inadequate dietary protein intake that may lead to less acid generation and hence a higher serum bicarbonate level. Since undernutrition is a strong predictor of death in hemodialysis patients, the observed association may be an epiphenomenon and not a biologically plausible relationship. Higher protein and fluid intake between two subsequent hemodialysis treatments may lead to lower serum bicarbonate level. This low bicarbonate level may appear protective, as patients with higher food intake and better appetite generally exhibit greater survival. In the contemporary three-stream proportioning system of hemodialysis treatment, the bicarbonate concentrate is separate from the acid concentrate, and the contribution of the acid concentrate organic acid (acetate, citrate or diacetate) to the delivered bicarbonate pool of the patient is negligible. The concept of 'total buffer' that assumes that the combination of bicarbonate and acetate concentrations in the dialysate are added equally as bicarbonate equivalents is likely wrong and based on the misleading notion that the acetate of the acid concentrate is fully metabolized to bicarbonate in the dialysate. Given these uncertainties it is prudent to avoid excessively high or low bicarbonate levels in dialysis patients. © The Author 2016. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.

  17. Quality of Life and Physical Function in Older Patients on Dialysis: A Comparison of Assisted Peritoneal Dialysis with Hemodialysis

    PubMed Central

    Iyasere, Osasuyi U.; Johansson, Lina; Huson, Les; Smee, Joanna; Maxwell, Alexander P.; Farrington, Ken; Davenport, Andrew

    2016-01-01

    Background and objectives In-center hemodialysis (HD) is often the default dialysis modality for older patients. Few centers use assisted peritoneal dialysis (PD), which enables treatment at home. This observational study compared quality of life (QoL) and physical function between older patients on assisted PD and HD. Design, setting, participants, & measurements Patients on assisted PD who were >60 years old and on dialysis for >3 months were recruited and matched to patients on HD (needing hospital transport) by age, sex, diabetes, dialysis vintage, ethnicity, and index of deprivation. Frailty was assessed using the Clinical Frailty Scale. QoL assessments included Hospital Anxiety and Depression Scale (HADS), Short Form-12, Palliative Outcomes Symptom Scale (renal), Illness Intrusiveness Rating Scale, and Renal Treatment Satisfaction Questionnaire (RTSQ). Physical function was evaluated by Barthel Score and timed up and go test. Results In total, 251 patients (129 PD and 122 HD) were recruited. In unadjusted analysis, patients on assisted PD had a higher prevalence of possible depression (HADS>8; PD=38.8%; HD=23.8%; P=0.05) and higher HADS depression score (median: PD=6; HD=5; P=0.05) but higher RTSQ scores (median: PD=55; HD=51; P<0.01). In a generalized linear regression model adjusting for age, sex, comorbidity, dialysis vintage, and frailty, assisted PD continued to be associated with higher RTSQ scores (P=0.04) but not with other QoL measures. Conclusions There are no differences in measures of QoL and physical function between older patients on assisted PD and comparable patients on HD, except for treatment satisfaction, which is higher in patients on PD. Assisted PD should be considered as an alternative to HD for older patients, allowing them to make their preferred choices. PMID:26712808

  18. Quality of Life and Physical Function in Older Patients on Dialysis: A Comparison of Assisted Peritoneal Dialysis with Hemodialysis.

    PubMed

    Iyasere, Osasuyi U; Brown, Edwina A; Johansson, Lina; Huson, Les; Smee, Joanna; Maxwell, Alexander P; Farrington, Ken; Davenport, Andrew

    2016-03-07

    In-center hemodialysis (HD) is often the default dialysis modality for older patients. Few centers use assisted peritoneal dialysis (PD), which enables treatment at home. This observational study compared quality of life (QoL) and physical function between older patients on assisted PD and HD. Patients on assisted PD who were >60 years old and on dialysis for >3 months were recruited and matched to patients on HD (needing hospital transport) by age, sex, diabetes, dialysis vintage, ethnicity, and index of deprivation. Frailty was assessed using the Clinical Frailty Scale. QoL assessments included Hospital Anxiety and Depression Scale (HADS), Short Form-12, Palliative Outcomes Symptom Scale (renal), Illness Intrusiveness Rating Scale, and Renal Treatment Satisfaction Questionnaire (RTSQ). Physical function was evaluated by Barthel Score and timed up and go test. In total, 251 patients (129 PD and 122 HD) were recruited. In unadjusted analysis, patients on assisted PD had a higher prevalence of possible depression (HADS>8; PD=38.8%; HD=23.8%; P=0.05) and higher HADS depression score (median: PD=6; HD=5; P=0.05) but higher RTSQ scores (median: PD=55; HD=51; P<0.01). In a generalized linear regression model adjusting for age, sex, comorbidity, dialysis vintage, and frailty, assisted PD continued to be associated with higher RTSQ scores (P=0.04) but not with other QoL measures. There are no differences in measures of QoL and physical function between older patients on assisted PD and comparable patients on HD, except for treatment satisfaction, which is higher in patients on PD. Assisted PD should be considered as an alternative to HD for older patients, allowing them to make their preferred choices. Copyright © 2016 by the American Society of Nephrology.

  19. Outpatient red blood cell transfusion payments among patients on chronic dialysis

    PubMed Central

    2012-01-01

    Background Payments for red blood cell (RBC) transfusions are separate from US Medicare bundled payments for dialysis-related services and medications. Our objective was to examine the economic burden for payers when chronic dialysis patients receive outpatient RBC transfusions. Methods Using Truven Health MarketScan® data (1/1/02-10/31/10) in this retrospective micro-costing economic analysis, we analyzed data from chronic dialysis patients who underwent at least 1 outpatient RBC transfusion who had at least 6 months of continuous enrollment prior to initial dialysis claim and at least 30 days post-transfusion follow-up. A conceptual model of transfusion-associated resource use based on current literature was employed to estimate outpatient RBC transfusion payments. Total payments per RBC transfusion episode included screening/monitoring (within 3 days), blood acquisition/administration (within 2 days), and associated complications (within 3 days for acute events; up to 45 days for chronic events). Results A total of 3283 patient transfusion episodes were included; 56.4% were men and 40.9% had Medicare supplemental insurance. Mean (standard deviation [SD]) age was 60.9 (15.0) years, and mean Charlson comorbidity index was 4.3 (2.5). During a mean (SD) follow-up of 495 (474) days, patients had a mean of 2.2 (3.8) outpatient RBC transfusion episodes. Mean/median (SD) total payment per RBC transfusion episode was $854/$427 ($2,060) with 72.1% attributable to blood acquisition and administration payments. Complication payments ranged from mean (SD) $213 ($168) for delayed hemolytic transfusion reaction to $19,466 ($15,424) for congestive heart failure. Conclusions Payments for outpatient RBC transfusion episodes were driven by blood acquisition and administration payments. While infrequent, transfusion complications increased payments substantially when they occurred. PMID:23121762

  20. Variation in Dialysis Facility Referral for Kidney Transplantation Among Patients With End-Stage Renal Disease in Georgia.

    PubMed

    Patzer, Rachel E; Plantinga, Laura C; Paul, Sudeshna; Gander, Jennifer; Krisher, Jenna; Sauls, Leighann; Gibney, Eric M; Mulloy, Laura; Pastan, Stephen O

    2015-08-11

    Dialysis facilities in the United States are required to educate patients with end-stage renal disease about all treatment options, including kidney transplantation. Patients receiving dialysis typically require a referral for kidney transplant evaluation at a transplant center from a dialysis facility to start the transplantation process, but the proportion of patients referred for transplantation is unknown. To describe variation in dialysis facility-level referral for kidney transplant evaluation and factors associated with referral among patients initiating dialysis in Georgia, the US state with the lowest kidney transplantation rates. Examination of United States Renal Data System data from a cohort of 15,279 incident, adult (18-69 years) patients with end-stage renal disease from 308 Georgia dialysis facilities from January 2005 to September 2011, followed up through September 2012, linked to kidney transplant referral data collected from adult transplant centers in Georgia in the same period. Referral for kidney transplant evaluation within 1 year of starting dialysis at any of the 3 Georgia transplant centers was the primary outcome; placement on the deceased donor waiting list was also examined. The median within-facility percentage of patients referred within 1 year of starting dialysis was 24.4% (interquartile range, 16.7%-33.3%) and varied from 0% to 75.0%. Facilities in the lowest tertile of referral (<19.2%) were more likely to treat patients living in high-poverty neighborhoods (absolute difference, 21.8% [95% CI, 14.1%-29.4%]), had a higher patient to social worker ratio (difference, 22.5 [95% CI, 9.7-35.2]), and were more likely nonprofit (difference, 17.6% [95% CI, 7.7%-27.4%]) compared with facilities in the highest tertile of referral (>31.3%). In multivariable, multilevel analyses, factors associated with lower referral for transplantation, such as older age, white race, and nonprofit facility status, were not always consistent with the factors

  1. Variation in Dialysis Facility Referral for Kidney Transplantation Among Patients With End-Stage Renal Disease in Georgia

    PubMed Central

    Patzer, Rachel E.; Plantinga, Laura C.; Paul, Sudeshna; Gander, Jennifer; Krisher, Jenna; Sauls, Leighann; Gibney, Eric M.; Mulloy, Laura; Pastan, Stephen O.

    2015-01-01

    IMPORTANCE Dialysis facilities in the United States are required to educate patients with end-stage renal disease about all treatment options, including kidney transplantation. Patients receiving dialysis typically require a referral for kidney transplant evaluation at a transplant center from a dialysis facility to start the transplantation process, but the proportion of patients referred for transplantation is unknown. OBJECTIVE To describe variation in dialysis facility–level referral for kidney transplant evaluation and factors associated with referral among patients initiating dialysis in Georgia, the US state with the lowest kidney transplantation rates. DESIGN, SETTING, AND PARTICIPANTS Examination of United States Renal Data System data from a cohort of 15 279 incident, adult (18–69 years) patients with end-stage renal disease from 308 Georgia dialysis facilities from January 2005 to September 2011, followed up through September 2012, linked to kidney transplant referral data collected from adult transplant centers in Georgia in the same period. MAIN OUTCOMES AND MEASURES Referral for kidney transplant evaluation within 1 year of starting dialysis at any of the 3 Georgia transplant centers was the primary outcome; placement on the deceased donor waiting list was also examined. RESULTS The median within-facility percentage of patients referred within 1 year of starting dialysis was 24.4% (interquartile range, 16.7%–33.3%) and varied from 0% to 75.0%. Facilities in the lowest tertile of referral (<19.2%) were more likely to treat patients living in high-poverty neighborhoods (absolute difference, 21.8% [95% CI, 14.1%–29.4%]), had a higher patient to social worker ratio (difference, 22.5 [95% CI, 9.7–35.2]), and were more likely nonprofit (difference, 17.6% [95% CI, 7.7%–27.4%]) compared with facilities in the highest tertile of referral (>31.3%). In multivariable, multilevel analyses, factors associated with lower referral for transplantation

  2. Why did I start dialysis? A qualitative study on views and expectations from an elderly cohort of patients with end-stage renal failure starting haemodialysis in the United Kingdom.

    PubMed

    Stringer, Stephanie; Baharani, Jyoti

    2012-02-01

    It is now common for elderly patients with end-stage kidney disease to be offered treatment by dialysis. However, what these patients expect from dialysis is not known. Therefore, the purpose of this study was to elucidate the expectations of elderly patients starting dialysis and to investigate whether their views change after 6 months on this treatment. This was a prospective observational qualitative study of patients commencing haemodialysis in our centre from 2006 to 2007. Data were collected by interview and review of case notes at the time of starting dialysis and after 6 months of treatment. Patients were asked about their expectations from dialysis, symptoms, and views on advance care planning. Data were collected from 22 patients (mean age 69.1 years) within a month from starting dialysis. Seventy per cent of these patients had attended a pre-dialysis clinic for at least 4 months previously; despite this, many of the patients complained about having had little choice in starting dialysis and seemed uncertain about what dialysis would involve. Even so, over 90% of those interviewed were optimistic about dialysis, had high expectations from treatment and were not keen to discuss advance care planning at first interview. Sixteen patients were re-interviewed at 6 months (four patients had died meanwhile and two had been transferred to other centres). After 6 months, there was a change in patients' attitude, with only 45% of them still finding dialysis acceptable and more patients now keen to discuss advance care planning. Symptom burden was higher at 6 months than at initiation of dialysis treatment. Most elderly patients have unrealistic expectations from dialysis at the start of treatment. There is a need for more specific counselling of these patients to ensure that they make informed decisions about treatment modality and have realistic expectations if they chose to receive RRT.

  3. Effects of Ginger on Serum Lipids and Lipoproteins in Peritoneal Dialysis Patients: A Randomized Controlled Trial.

    PubMed

    Tabibi, Hadi; Imani, Hossein; Atabak, Shahnaz; Najafi, Iraj; Hedayati, Mehdi; Rahmani, Leila

    2016-01-01

    ♦ In peritoneal dialysis (PD) patients, one of the major risk factors for cardiovascular disease is lipid abnormalities. This study was designed to investigate the effects of ginger supplementation on serum lipids and lipoproteins in PD patients. ♦ In this randomized, double-blind, placebo-controlled trial, 36 PD patients were randomly assigned to either the ginger or the placebo group. The patients in the ginger group received 1,000 mg ginger daily for 10 weeks, while the placebo group received corresponding placebos. At baseline and at the end of week 10, 7 mL of blood were obtained from each patient after a 12- to 14-hour fast, and serum concentrations of triglyceride, total cholesterol, low density lipoprotein-cholesterol (LDL-C), high density lipoprotein-cholesterol (HDL-C), and lipoprotein (a) [Lp (a)] were measured. ♦ Serum triglyceride concentration decreased significantly up to 15% in the ginger group at the end of week 10 compared with baseline (p < 0.01), and the reduction was significant in comparison with the placebo group (p < 0.05). There were no significant differences between the 2 groups in mean changes of serum total cholesterol, LDL-C, HDL-C, and Lp (a). ♦ This study indicates that daily administration of 1,000 mg ginger reduces serum triglyceride concentration, which is a risk factor for cardiovascular disease, in PD patients. Copyright © 2016 International Society for Peritoneal Dialysis.

  4. Assessment of the nutritional state of dialysis patients.

    PubMed

    Kerr, P G; Strauss, B J; Atkins, R C

    1996-01-01

    The importance of the nutritional state of our dialysis patients has been stressed for many years. Although the calculation of the protein catabolic rate has become common practice in many dialysis units, there are several problems with this measurement. In addition, the serum albumin level is subject to multiple influences making its interpretation in individual patients difficult. This paper examines a different approach to nutritional assessment-that of using longer term measures of nutrition. Several techniques for measuring body composition are explored and their use in end-stage renal disease (ESRD) examined. Total body nitrogen measurement is a gold standard technique which has been validated in renal patients, unfortunately it is not widely available. Of the alternatives, dual energy X-ray absorptiometry scanning for assessment of fat-free mass appears to be the best technique with the narrowest limits of agreement compared to gold standard techniques. Whilst bioelectrical impedance is reasonable for body water assessment, it is not reliable in ESRD patients for lean-body mass estimation.

  5. Perceived illness intrusions among continuous ambulatory peritoneal dialysis patients.

    PubMed

    Bapat, Usha; Kedlya, Prashanth G

    2012-09-01

    To study the perceived illness intrusion of continuous ambulatory peritoneal dialysis (CAPD) patients, to examine their demographics, and to find out the association among demographics, duration of illness as well as illness intrusion, 40 chronic kidney disease stage V patients on CAPD during 2006-2007 were studied. Inclusion criteria were patients' above 18 years, willing, stable, and completed at least two months of dialysis. Those with psychiatric co-morbidity were excluded. Sociodemographics were collected using a semi-structured interview schedule. A 14-item illness intrusion checklist covering various aspects of life was administered. The subjects had to rate the illness intrusion in their daily life and the extent of intrusion. The data was analyzed using descriptive statistics and chi square test of association. The mean age of the subjects was 56.05 ± 10.05 years. There was near equal distribution of gender. 82.5% were married, 70.0% belonged to Hindu religion, 45.0% were pre-degree, 25.0% were employed, 37.5% were housewives and 30.0% had retired. 77.5% belonged to the upper socioeconomic strata, 95.0% were from an urban background and 65.0% were from nuclear families. The mean duration of dialysis was 19.0 ± 16.49 months. Fifty-eight percent of the respondents were performing the dialysis exchanges by themselves. More than 95.0%were on three or four exchanges per day. All the 40 subjects reported illness intrusion in their daily life. Intrusion was perceived to some extent in the following areas: health 47.5%, work 25.0%, finance 37.5%, diet 40.0%, and psychological 50.0%. Illness had not intruded in the areas of relationship with spouse 52.5%, sexual life 30.0%, with friends 92.5%, with family 85.5%, social functions 52.5%, and religious functions 75.0%. Statistically significant association was not noted between illness intrusion and other variables. CAPD patients perceived illness intrusion to some extent in their daily life. Elderly, educated

  6. Isotopic bone mineralization rates in maintenance dialysis patients

    SciTech Connect

    Cochran, M.; Stephens, E.

    1983-09-01

    The expanding pool model of radiocalcium kinetics has been used in 13 maintenance dialysis patients to measure bone mineralization rate. No difficulties were met in applying the data to the model, and values for the bone mineralization rate ranged from 0.0 to 2.0 mmol/kg Ca++ per day. The bone histology obtained at the time of the study showed a correlation between the degree of secondary hyperparathyroidism and the bone mineralization rate, with low values of the latter occurring in atypical osteomalacia (two patients) or inactive-looking bone (one patient) and raised values in seven patients. The plasma alkaline phosphatase and immunoassayable parathyroid hormone levels each correlated significantly with the bone mineralization rate. These findings suggest that the technique is valid when applied to hemodialysis patients and provides quantitative information about skeletal calcium metabolism in different types of renal bone disease.

  7. Effects of renal care coordinator case management on outcomes in incident dialysis patients.

    PubMed

    Maddux, Dugan W; Usvyat, Len A; DeFalco, Daniel; Kotanko, Peter; Kooman, Jeroen P; van der Sande, Frank M; Maddux, Franklin W

    2016-03-01

    Pre-dialysis chronic kidney disease (CKD) care impacts dialysis start and incident dialysis outcomes. We describe the use of late stage CKD population data coupled with CKD case management to improve dialysis start. The Renal Care Coordinator (RCC) program is a nephrology practice and Fresenius Medical Care North America (FMCNA) partnership involving a case manager resource and data analytics. We studied patients starting dialysis between August 1, 2009 and February 28, 2013 in 9 nephrology practices partnering in the RCC program. Propensity score matching (PSM) was used to match patients who had participated in the RCC program to patients who had not. Primary outcomes were use of a permanent access or peritoneal dialysis (PD) at first outpatient dialysis. Serum albumin at the first outpatient dialysis treatment and mortality and hospitalization rates in the first 120 days of dialysis were secondary outcomes. In the nephrology practices studied, 7,626 patients started dialysis. Of these, 738 patients (9.7%) were enrolled in the RCC program; 693 RCC patients (93.9%) were matched with 693 patients who did not participate in the RCC program. Logistic regression analysis indicates that RCC program patients are more likely to start PD or use a permanent vascular access at dialysis start and are more likely to start treatment with a serum albumin level ≥ 4.0 g/ dL. Late stage CKD data-driven case management is associated with a higher rate of PD use, lower central venous catheter (CVC) use, and higher albumin levels at first outpatient dialysis.

  8. Cinacalcet administration by gastrostomy tube in a child receiving peritoneal dialysis.

    PubMed

    Nichols, Kristen R; Knoderer, Chad A; Johnston, Bethanne; Wilson, Amy C

    2014-07-01

    A 2-year-old male with chronic kidney disease with secondary hyperparathyroidism developed hypercalcemia while receiving calcitriol, without achieving a serum parathyroid hormone concentration within the goal range. Cinacalcet 15 mg (1.2 mg/kg), crushed and administered via gastrostomy tube, was added to the patient's therapy. This therapy was effective in achieving targeted laboratory parameters in our patient despite instructions in the prescribing information that cinacalcet should always be taken whole.

  9. Effect of health contract intervention on renal dialysis patients in Korea.

    PubMed

    Cho, Mi-Kyoung

    2013-03-01

    This study is a randomized, controlled trial to examine the effect of the health contract intervention, based on the goal attainment theory, on the self-care behavior and physiological indices of renal dialysis patients in Korea. The experimental group (n = 21) underwent health contract intervention for 4 weeks, while the control group (n = 22) received routine care. The data were collected using questionnaires and measurement of physiological indices and analyzed using the SPSS WIN 12.0 program. A P value < 0.05 was considered statistically significant. Total score of self-care behavior (P = 0.011) and individual scores for behaviors, such as diet (P = 0.017), exercise and rest (P = 0.001), and blood pressure and body weight (P = 0.006) were higher in the experimental group. Serum potassium concentration and mean weight gain between dialysis sessions were significantly low in the experimental group (P = 0.002, P = 0.017). Therefore, the health contract intervention based on the goal attainment theory proved effective in improving self-care behavior and physiological indices (K, P, mean weight gain) in renal dialysis patients in Korea. © 2012 Wiley Publishing Asia Pty Ltd.

  10. HMG CoA reductase inhibitors (statins) for dialysis patients.

    PubMed

    Palmer, Suetonia C; Navaneethan, Sankar D; Craig, Jonathan C; Johnson, David W; Perkovic, Vlado; Nigwekar, Sagar U; Hegbrant, Jorgen; Strippoli, Giovanni F M

    2013-09-11

    People with advanced kidney disease treated with dialysis experience mortality rates from cardiovascular disease that are substantially higher than for the general population. Studies that have assessed the benefits of statins (HMG CoA reductase inhibitors) report conflicting conclusions for people on dialysis and existing meta-analyses have not had sufficient power to determine whether the effects of statins vary with severity of kidney disease. Recently, additional data for the effects of statins in dialysis patients have become available. This is an update of a review first published in 2004 and last updated in 2009. To assess the benefits and harms of statin use in adults who require dialysis (haemodialysis or peritoneal dialysis). We searched the Cochrane Renal Group's Specialised Register to 29 February 2012 through contact with the Trials' Search Co-ordinator using search terms relevant to this review. Randomised controlled trials (RCTs) and quasi-RCTs that compared the effects of statins with placebo, no treatment, standard care or other statins on mortality, cardiovascular events and treatment-related toxicity in adults treated with dialysis were sought for inclusion. Two or more authors independently extracted data and assessed study risk of bias. Treatment effects were summarised using a random-effects model and subgroup analyses were conducted to explore sources of heterogeneity. Treatment effects were expressed as mean difference (MD) for continuous outcomes and risk ratios (RR) for dichotomous outcomes together with 95% confidence intervals (CI). The risk of bias was high in many of the included studies. Random sequence generation and allocation concealment was reported in three (12%) and four studies (16%), respectively. Participants and personnel were blinded in 13 studies (52%), and outcome assessors were blinded in five studies (20%). Complete outcome reporting occurred in nine studies (36%). Adverse events were only reported in nine studies (36

  11. A Case Report of Neisseria Mucosa Peritonitis in a Chronic Ambulatory Peritoneal Dialysis Patient

    PubMed Central

    Awdisho, Alan; Bermudez, Maria

    2016-01-01

    Peritonitis is a leading complication of chronic ambulatory peritoneal dialysis. However, very rarely does Neisseria mucosa cause peritonitis. We describe an unusual case of N. mucosa peritonitis in a chronic ambulatory peritoneal dialysis patient. A 28-year-old Hispanic male presents with diffuse abdominal pain exacerbated during draining of the peritoneal fluid. Peritoneal fluid examination was remarkable for leukocytosis and gramnegative diplococci. Bacterial cultures were positive for N. mucosa growth. The patient was treated with ciprofloxacin with preservation of the dialysis catheter. This case highlights the rarity and importance of Neisseria mucosa causing peritonitis in chronic ambulatory peritoneal dialysis patients’. There seems to be a unique association between N. mucosa peritonitis and chronic ambulatory peritoneal dialysis patients’. The patient was successfully managed with ciprofloxacin along with salvaging of the dialysis catheter. PMID:28191300

  12. Assessing the utility of testing aluminum levels in dialysis patients.

    PubMed

    Sharma, Ashish K; Toussaint, Nigel D; Pickering, Janice; Beeston, Tony; Smith, Edward R; Holt, Stephen G

    2015-04-01

    Plasma aluminum (Al) is routinely tested in many dialysis patients. Aluminum exposure may lead to acute toxicity and levels in excess of ∼2.2 μmol/L (60 μg/L) should be avoided. Historically, toxicity has been caused by excessive dialyzate Al but modern reverse osmosis (RO) water should be Al free. Nevertheless, many units continue to perform routine Al levels on dialysis patients. This single-center study retrospectively analyzed Al levels in plasma, raw water feed, and RO product between 2010 and 2013 using our database (Nephworks 6) with the aim of determining the utility of these measurements. Two thousand fifty-eight plasma Al tests in 755 patients (61.9% male, mean age 64.7 years) were reviewed showing mean ± SD of 0.41 ± 0.30 μmol/L. One hundred eleven (5.4%) tests from 61 patients had Al levels >0.74 μmol/L and 45 (73.8%) of these patients were or had been prescribed Al hydroxide (Al(OH)(3)) as a phosphate binder. Seven patients had Al concentrations >2.2 μmol/L with no source of Al identified in 1 patient. One hundred sixty-six patients taking Al(OH)(3) (78.7% of all patients on Al(OH)(3)) had levels ≤0.74 μmol/L, the odds ratio of plasma Al > 0.74 μmol/L on Al(OH)3 was 9. The cost of plasma Al assay is $A30.60; thus, costs were $A62,974.80 over the study period. Despite RO feed water Al levels as high as 48 μmol/L, Al output from the RO was almost always undetectable (<0.1 μmol/L) with dialyzate Al levels > 2.2 μmol/L only 3 times since 2010, and never in the last 3 years. Routine unselected testing of plasma Al appears unnecessary and expensive and more selective testing in dialysis patients should be considered. © 2014 International Society for Hemodialysis.

  13. The grown-up patient. The new customer in dialysis or--how to handle the demanding and emancipated dialysis patient.

    PubMed

    Hippold, I

    2001-01-01

    The treatment of dialysis patients is under pressure. As a result of strict budgeting and increased administrative work, enhancement and the further development of the dialysis health care system is needed. An essential element of that development is a radical change in the patient/nurse relationship. Customer relationship management assumes that the patient is seen as a client, is encouraged to make decisions on their treatment and also emphasises the professionalism of nursing.

  14. Peritoneal dialysis versus hemodialysis in patients with delayed graft function.

    PubMed

    Thomson, B K A; Moser, M A J; Marek, C; Bloch, M; Weernink, C; Shoker, A; Luke, P P

    2013-01-01

    Delayed graft function (DGF) in kidney transplantation affects adverse outcomes. It remains unclear whether the post-transplant dialysis modality alters perioperative or long-term graft outcomes. We performed a retrospective observational quality initiative at two Canadian renal transplant centers, in which DGF occurred in the recipient, necessitating one of peritoneal dialysis (PD) or hemodialysis (HD). There was no difference in baseline factors between patients with post-transplant PD (n = 14) or HD (n = 63). The use of PD was associated with an increased risk of wound infection/leakage (PD 5/14 vs. HD 6/63, p = 0.024), shorter length of hospitalization (13.7 vs. 18.7 d, p = 0.009) and time requiring dialysis post-operatively (6.5 vs 11.0 d, p = 0.043). There were no differences in readmission to hospital within 6 months (4/14 vs. 23/63, p = 0.759), graft loss (0/14 vs. 2/63, p = 1.000) or acute rejection episodes (1/14 vs. 4/63, p = 1.000) at one yr, and GFR did not differ between the PD or HD groups at 30 d (35.7 vs. 33.8 mL/min/m(2), p = 0.731), six months (46.9 vs. 45.5 mL/min/m(2), p = 0.835) or one yr (46.6 vs. 44.5 mL/min/m(2), p = 0.746). Further research is needed to determine which transplant patients are most appropriate to undergo PD catheter removal at the time of transplantation. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  15. Prospective, multicenter, controlled study of quality of life, psychological adjustment process and medical outcomes of patients receiving a preemptive kidney transplant compared to a similar population of recipients after a dialysis period of less than three years--The PreKit-QoL study protocol.

    PubMed

    Sébille, Véronique; Hardouin, Jean-Benoit; Giral, Magali; Bonnaud-Antignac, Angélique; Tessier, Philippe; Papuchon, Emmanuelle; Jobert, Alexandra; Faurel-Paul, Elodie; Gentile, Stéphanie; Cassuto, Elisabeth; Morélon, Emmanuel; Rostaing, Lionel; Glotz, Denis; Sberro-Soussan, Rebecca; Foucher, Yohann; Meurette, Aurélie

    2016-01-19

    Treatment of end stage renal disease has an impact on patients' physical and psychological health, including quality of life (QoL). Nowadays, it is known that reducing the dialysis period has many advantages regarding QoL and medical outcomes. Although preemptive transplantation is the preferred strategy to prevent patients undergoing dialysis, its psychological impact is unknown. Moreover, transplantation can be experienced in a completely different manner among patients who were on dialysis and those who still had a functioning kidney at the time of surgery. Longitudinal data are often collected to allow analyzing the evolution of patients' QoL over time using questionnaires. Such data are often difficult to interpret due to the patients' changing standards, values, or conceptualization of what the questionnaire is intended to measure (e.g. QoL). This phenomenon is referred to as response shift and is often linked to the way the patients might adapt or cope with their disease experience. Whether response shift is experienced in a different way among patients who were on dialysis and those who still had a functioning kidney at time of surgery is unknown and will be studied in the PreKit-QoL study (trial registration number: NCT02154815). Understanding the psychological impact of pre-emptive transplantation is an important issue since it can be associated with long-term patient and graft survival. Adult patients with a pre-emptive transplantation (n = 130) will be prospectively included along with a control group of patients with a pre-transplant dialysis period < 36 months (n = 260). Only first and single kidney transplantation will be considered. Endpoints include: comparison of change between groups in QoL, anxiety and depressive disorders, perceived stress, taking into account response shift. These criteria will be evaluated every 6 months prior to surgery, at hospital discharge, at three and six months, one and two years after transplantation

  16. Geographic Variation in Cardioprotective Antihypertensive Medication Usage in Dialysis Patients

    PubMed Central

    Wetmore, James B.; Mahnken, Jonathan D.; Mukhopadhyay, Purna; Hou, Qingjiang; Ellerbeck, Edward F.; Rigler, Sally K.; Spertus, John A.; Shireman, Theresa I.

    2011-01-01

    Background Despite their high risk for adverse cardiac outcomes, persons on chronic dialysis have been shown to have lower use of antihypertensive medications with cardioprotective properties, such as angiotensin converting enzyme (ACE) inhibitors/angiotensin receptor blockers (ARBs), β-blockers, and calcium channel blockers (CCBs), than might be expected. We constructed a novel database that permits detailed exploration into the demographic, clinical and geographic factors associated with the use these agents of among hypertensive chronic dialysis patients. Study Design National cross-sectional retrospective analysis linking Medicaid prescription drug claims with United States Renal Data System core data. Setting & Participants 48,882 hypertensive chronic dialysis patients who were dually-eligible for Medicaid and Medicare services in 2005. Factors Demographics, comorbidities, functional status, and state of residence. Outcomes Prevalence of cardioprotective antihypertensive agents in Medicaid pharmacy claims and state-specific observed:expected odds ratios of medication exposure. Measurements Factors associated with medication use were modeled using multi-level logistic regression models. Results In multivariable analyses, cardioprotective antihypertensive medication exposure was significantly associated with younger age, female sex, non-Caucasian race, intact functional status, and use of in-center hemodialysis. Diabetes was associated with a statistically-significant 28% higher odds of ACE inhibitor/ARB use, but congestive heart failure (CHF) was associated with only a 9% increase in the odds of β-blockers and no increase in ACE inhibitor/ARB use. There was substantial state-by-state variation in use of all classes of agents, with a greater than 2.9-fold difference in adjusted rate odds ratios between the highest- and lowest-prescribing states for ACE inhibitors/ARBs and a 3.6-fold difference for β-blockers. Limitations Limited generalizability beyond study

  17. Prevalence and management of anemia in pre-dialysis Malaysian patients: A hospital-based study.

    PubMed

    Salman, Muhammad; Khan, Amer Hayat; Adnan, Azreen Syazril; Sulaiman, Syed Azhar Syed; Hussain, Khalid; Shehzadi, Naureen; Islam, Muhammad; Jummaat, Fauziah

    2016-11-01

    Anemia, a common complication of chronic kidney diseases (CKD), is involved in significant cardiovascular morbidity. Therefore, the objective of our study was to investigate the prevalence and severity of anemia in pre-dialysis patients, as well as to determine the predictors of anti-anemic therapy. A retrospective, observational study was conducted on adult pre-dialysis patients receiving treatment at the Hospital Universiti Sains Malaysia from January 2009 to December 2013. A total of 615 eligible cases were included. The mean age of patients was 64.1±12.0 years. The prevalence of anemia was 75.8%, and the severity of anemia was mild in 47.7% of the patients, moderate in 32.2%, and severe in 20%. Based on morphological classification of anemia, 76.9% of our patients had normochromic-normocytic anemia whereas 21.8 and 1.3% had hypochromic-microcytic anemia and macrocytic anemia, respectively. Oral iron supplements were prescribed to 38.0% of the patients and none of the patients was given erythropoietin stabilizing agents (ESA) or intravenous iron preparations. In logistic regression, significant predictors of anti-anemic preparation use were decreased hemoglobin and hematocrit, and advanced stages of CKD. The results of the present study suggest that the prevalence of anemia in pre-dialysis patients is higher than currently accepted and it is found to be correlated with renal function; prevalence increases with declined renal function. An earlier identification as well as appropriate management of anemia will not only have a positive impact on quality of life but also reduce hospitalizations of CKD patients due to cardiovascular events.

  18. The effect of oral niacinamide on plasma phosphorus levels in peritoneal dialysis patients.

    PubMed

    Young, Daniel O; Cheng, Steven C; Delmez, James A; Coyne, Daniel W

    2009-01-01

    Hyperphosphatemia remains a significant problem for patients requiring dialysis and is associated with increased mortality. Current treatment options include dietary restriction, dialysis, and phosphate binders. Treatment using the latter is frequently limited by cost, tolerability, and calcium loading. One open-label trial found niacinamide to be effective at decreasing serum phosphorus values in hemodialysis patients. Niacinamide may effectively reduce phosphorus levels in peritoneal dialysis (PD) patients already receiving standard phosphorus-lowering therapies. An 8 week, randomized, double blind, placebo-controlled trial to evaluate the effectiveness of niacinamide to reduce plasma phosphorus levels in PD patients. Patients had to demonstrate a baseline phosphorus value > 4.9 mg/dL. Patients were randomized to niacinamide or placebo and prescribed 250 mg twice daily, with titration to 750 mg twice daily, as long as safety parameters were not violated. Phosphate binders, active vitamin D, and cinacalcet were kept constant during the study. The primary end point was change in plasma phosphorus. Secondary end points included changes in lipid parameters. 15 patients started on the study drug (8 niacinamide, 7 placebo) and 7 in each arm had at least one on-study phosphorus measurement. The niacinamide treatment group experienced an average 0.7 +/- 0.9 mg/dL decrease in plasma phosphorus and the placebo-treated group experienced an average 0.4 +/- 0.8 mg/dL increase. The treatment effect difference (1.1 mg/dL) was significant (p = 0.037). No significant changes in high- or low-density lipoproteins or triglycerides were demonstrated. Two of the 8 patients randomized to the niacinamide treatment arm had to withdraw from the study due to drug-related adverse effects. Adverse effects may limit the use of niacinamide in PD patients. Niacinamide, when added to standard phosphorus-lowering therapies, resulted in a modest yet statistically significant reduction in plasma

  19. Patients initiating peritoneal dialysis started on two icodextrin exchanges daily.

    PubMed

    Awuah, Kwabena T; Gorban-Brennan, Nancy; Yalamanchili, Hima Bindu; Finkelstein, Fredric O

    2013-01-01

    Patients with end-stage renal disease treated with peritoneal dialysis (PD) are often put on standard one size fits all" regimens, despite having varying degrees of residual renal function (RRF). The present study reports our experience with initiation of PD using 2 icodextrin exchanges daily in patients with RRF corresponding to a weekly Kt/Vurea of at least 1.0. Peritoneal and RRF Kt/Vurea were tracked closely, and total Kt/Vurea was maintained between 1.7 and 2.0. One patient developed a rash and was changed to 3 dextrose exchanges daily. All patients were satisfied with their treatment regimen, and no other adverse events or symptoms were reported.

  20. Social functioning and socioeconomic changes after introduction of regular dialysis treatment and impact of dialysis modality: a multi-centre survey of Japanese patients.

    PubMed

    Nakayama, Masaaki; Ishida, Mari; Ogihara, Masahiko; Hanaoka, Kazushige; Tamura, Masahito; Kanai, Hidetoshi; Tonozuka, Yukio; Marshall, Mark R

    2015-08-01

    Patient socialization and preservation of socioeconomic status are important patient-centred outcomes for those who start dialysis, and retention of employment is a key enabler. This study examined the influence of dialysis inception and modality upon these outcomes in a contemporary Japanese cohort. We conducted a survey of prevalent chronic dialysis patients from 5 dialysis centres in Japan. All patients who had been on peritoneal dialysis (PD) since dialysis inception were recruited, and matched with a sample of those on in-centre haemodialysis (ICHD). We assessed patients' current social functioning (Short Form 36 Health Survey), and evaluated changes to patient employment status, annual income, and general health condition from the pre-dialysis period to the current time. A total of 179 patients were studied (102 PD and 77 ICHD). There were no differences in social functioning by modality. Among them, 113 were employed in the pre-dialysis period with no difference by modality. Of these, 22% became unemployed after dialysis inception, with a corresponding decline in average working hours and annual income. The odds of unemployment after dialysis inception were 5.02 fold higher in those on ICHD compared to those on PD, after adjustment for covariates. There were no changes for those who were already unemployed in the pre-dialysis period. Employment status is significantly hampered by dialysis inception, although PD was associated with superior retention of employment and greater income compared to ICHD. This supports a positive role for PD in preservation of socioeconomic status and potentially other patient-centred outcomes. © 2015 Asian Pacific Society of Nephrology.

  1. Telemedicine system for patients on continuous ambulatory peritoneal dialysis.

    PubMed

    Nakamoto, Hidetomo

    2007-06-01

    Over recent decades, rapid progress in information and telecommunications technology has led to the application of these technologies in the medical field. In 1999, we reported on a telemedicine system (version 1.0) that used an automated peritoneal dialysis machine to collect data on patients with end-stage renal disease. After 2002, we focused on using cellular telephones in a new telemedicine system (version 2.0) to monitor patient data at home, including blood pressure (BP), heart rate, body weight, urine volume, and blood glucose. By 2003, we had developed a fully automatic system called I-converter (version 3.0) to collect data from a fully automatic device and send it via cellular telephone. After the fully automatic device measures a patient's BP, I-converter sends the data directly to the main server in our central data center. That server is directly connected to Web site by application service provider (ASP) technology. Recently, to make the system simpler, we developed a new version called D-converter (version 4.0). The telephone used in this new system is a Personal Handy-phone System (PHS). The PHS has several advantages: high-speed data transmission, low power output, little electromagnetic interference with medical devices, and easy locating of patients. The D-converter system uses a small computer and a PHS card called a Dopa card. Our telemedicine systems monitor continuous ambulatory peritoneal dialysis (CAPD) patients at home. For elderly and handicapped patients, these systems are very advantageous because they reduce visits to the outpatient clinic. In addition, data can be monitored at the patient's home in real time. The present paper reports our recent advances in telemedicine systems for CAPD patients.

  2. Exploring the opinion of hemodialysis patients about their dialysis unit.

    PubMed

    Donia, Ahmed Farouk; Elhadedy, Mohamed Ahmed; El-Maghrabi, Hanzada Mohamed; Abbas, Mohamed Hamed; Foda, Mohamed Ashraf

    2015-01-01

    Hemodialysis (HD) patients are subjected to a number of physical and mental stresses. Physicians might be unaware of some of these problems. We assessed our patients' opinion about the service provided at the dialysis unit. Our unit has 89 patients on HD. A questionnaire exploring our patients' opinion relative to the service provided was prepared. The patients were asked to fill-in the questionnaire in a confidential manner. Questionnaires were then collected and examined while unaware of patient identities. Sixty-nine patients (77.5%) responded to the questionnaire. Eight patients (11.6%) revealed their names on the questionnaire. According to the questionnaire, the patients were asked to assess the service of each service by choosing one of the following grades: "excellent," "mediocre" or "bad." For the whole group of contributing patients, there were 563 "excellent," 85 "mediocre" and five "bad" choices in addition to 37 blank "no comment" choices. Food service had the least percentage (68%) of evaluation as "excellent," while doctor' performance got the highest excellent evaluation (85.5%). Thirty-five patients (50.7%) added further comment(s). An audit meeting was conducted to discuss these results. Exploring the opinion of patients on HD might uncover some areas of dissatisfaction and help in improving the provided service. We recommend widespread usage of questionnaires to assess patient satisfaction as well as to assess other health-care aspects.

  3. Postdialysis urea rebound: determinants and influence on dialysis delivery in chronic hemodialysis patients.

    PubMed

    Leblanc, M; Charbonneau, R; Lalumière, G; Cartier, P; Déziel, C

    1996-02-01

    We measured postdialysis urea rebound (PDUR) 30 minutes after dialysis in 92 chronic hemodialysis patients. The impact of PDUR on the estimation of dialysis delivery assessed by urea reduction ratio and Kt/V was evaluated. Total recirculation, access plus cardiopulmonary, was measured at the end of dialysis with the two-needle low blood flow method. The mean age of the 92 patients (49 men and 43 women) was 59.6 +/- 1.4 years. Thirty-eight patients had been receiving erythropoietin therapy for more than 3 months. Fifteen patients had central venovenous access and 77 had peripheral arteriovenous access. Sixty-five patients were dialyzed using hemophan membranes and 27 were dialyzed using polyacrylonitrile membranes. The mean blood flow rate was 240 +/- 28 mL/min and the mean length of the hemodialysis sessions was 3.6 +/- 0.1 hours. Kt/V was calculated with Daugirdas' second-generation formula. The mean PDUR was 16.6% +/- 0.8% (range, 2% to 44%) (n = 92), and significantly decreased the mean urea reduction ratio from 61.7% +/- 0.8% to 55.5% +/- 0.9%, the mean Kt/V from 1.14 +/- 0.03 to 0.97 +/- 0.02, and the mean protein catabolic rate from 1.06 +/- 0.04 to 0.98 +/- 0.02 (P = 0.0001). The effective Kt/V at 30 minutes postdialysis was well predicted by using a recently proposed equation: eKt/V30 = Kt/Vsp - (0.6 x Kt/Vsp/t) + 0.03, with a mean value corresponding also to 0.97 +/- 0.02. However, this estimation was less predictive in patients with very high PDUR. Moreover, PDUR showed only a weak negative correlation with dialysis session length (r = -0.28) and predialysis patient weight (r = -0.29), and showed no correlation with predialysis serum urea level or with blood flow rate. However, dialysis efficiency, as assessed by K/V, presented a correlation of 0.54 with both PDUR and the difference in Kt/V when using urea immediately postdialysis and at 30 minutes. The mean total recirculation was 7.4% +/- 0.6% (n = 86). Postdialysis urea rebound, calculated between 30

  4. Mesenchymal stroma cells in peritoneal dialysis effluents from patients.

    PubMed

    Liu, Bin; Guan, Qiunong; Li, Jing; da Roza, Gerald; Wang, Hao; Du, Caigan

    2017-04-01

    Mesenchymal stroma cells (MSCs) have potential as an emerging cell therapy for treating many different diseases, but discovery of the practical sources of MSCs is needed for the large-scale clinical application of this therapy. This study was to identify MSCs in peritoneal dialysis (PD) effluents that were discarded after PD. The effluents were collected from patients who were on the dialysis for less than 1 month. Adherent cells from the effluents were isolated by incubation in serum-containing medium in plastic culture dishes. Cell surface markers were determined by a flow cytometric analysis, and the in vitro differentiation to chondrocytes, osteocytes or adipocytes was confirmed by staining with a specific dye. After four passages, these isolated cells displayed the typical morphology of mesenchymal cells in traditional 2-D cultures, and were grown to form spherical colonies in 3-D collagen cultures. Flow cytometric analysis revealed that the unsorted cells from all of seven patient samples showed robust expression of typical mesenchymal marker CD29, CD44, CD73, CD90 and CD166, and the absence of CD34, CD79a, CD105, CD271, SSEA-4, Stro-1 and HLA-DR. In differentiation assays, these cells were induced in vitro to chondrocytes, osteocytes or adipocytes. In conclusion, this preliminary study suggests the presence of MSCs in the "discarded" PD effluents. Further characterization of the phenotypes of these MSCs and evaluation of their therapeutic potential, particularly for the prevention of PD failure, are needed.

  5. Patient and health care professional decision-making to commence and withdraw from renal dialysis: a systematic review of qualitative research.

    PubMed

    Hussain, Jamilla A; Flemming, Kate; Murtagh, Fliss E M; Johnson, Miriam J

    2015-07-07

    To ensure that decisions to start and stop dialysis in ESRD are shared, the factors that affect patients and health care professionals in making such decisions must be understood. This systematic review sought to explore how and why different factors mediate the choices about dialysis treatment. MEDLINE, Embase, CINAHL, and PsychINFO were searched for qualitative studies of factors that affect patients' or health care professionals' decisions to commence or withdraw from dialysis. A thematic synthesis was conducted. Of 494 articles screened, 12 studies (conducted from 1985 to 2014) were included. These involved 206 patients (most receiving hemodialysis) and 64 health care professionals (age ranges: patients, 26-93 years; professionals, 26-61 years). For commencing dialysis, patients based their choice on "gut instinct," as well as deliberating over the effect of treatment on quality of life and survival. How individuals coped with decision-making was influential: Some tried to take control of the problem of progressive renal failure, whereas others focused on controlling their emotions. Health care professionals weighed biomedical factors and were led by an instinct to prolong life. Both patients and health care professionals described feeling powerless. With regard to dialysis withdrawal, only after prolonged periods on dialysis were the realities of life on dialysis fully appreciated and past choices questioned. By this stage, however, patients were physically dependent on treatment. As was seen with commencing dialysis, individuals coped with treatment withdrawal in a problem- or emotion-controlling way. Families struggled to differentiate between choosing versus allowing death. Health care teams avoided and queried discussions regarding dialysis withdrawal. Patients, however, missed the dialogue they experienced during predialysis education. Decision-making in ESRD is complex and dynamic and evolves over time and toward death. The factors at work are

  6. Multidisciplinary team approach to end-stage dialysis access patients.

    PubMed

    Kensinger, Clark; Brownie, Evan; Bream, Peter; Moore, Derek

    2015-11-01

    The hemodialysis reliable outflow (HeRO) access device is a permanent dialysis graft used in patients with central venous obstruction. Given the complexity of care related to end-stage dialysis access (ESDA) patients, a multidisciplinary approach has been used to achieve operative success of HeRO graft placement. The single-center retrospective review included adult patients that were seen in ESDA clinic who underwent a HeRO graft placement from September 2010-September 2014 under the care of a team consisting of a nephrologist, an interventional radiologist, and a surgeon. The effectiveness of the multidisciplinary approach was evaluated using outcome variables including successful HeRO graft placement, operative complications, the rate of obtaining central venous access, and advanced endovascular maneuvers performed by interventional radiology to obtain central venous access. A multidisciplinary approach has been used in 33 ESDA patients. Access to the right atrium was achieved in 100% of cases. Fifty-eight percent of patients required advanced endovascular maneuvers in the interventional radiology suite to obtain central venous access. Successful HeRO graft placement was achieved in 94% (31 of 33) of the study population. No intraoperative complications were encountered. Median primary and secondary patency rates were 83 d (interquartile range: 45-170) and 345 d (interquartile range: 146-579) per HeRO graft placement, respectively. Primary and secondary patency rates at 60 d were 70% (23 of 33) and 79% (26 of 33), respectively. In this difficult patient population, a multidisciplinary team can provide a unique and collaborative approach to HeRO graft placement in patients with complex central venous outflow obstruction. Copyright © 2015 Elsevier Inc. All rights reserved.

  7. High Parathyroid Hormone Level and Osteoporosis Predict Progression of Coronary Artery Calcification in Patients on Dialysis

    PubMed Central

    Blomquist, Gustav; Monier-Faugere, Marie-Claude; Cantor, Thomas L.; Davenport, Daniel L.

    2015-01-01

    Coronary artery calcifications (CACs) are observed in most patients with CKD on dialysis (CKD-5D). CACs frequently progress and are associated with increased risk for cardiovascular events, the major cause of death in these patients. A link between bone and vascular calcification has been shown. This prospective study was designed to identify noninvasive tests for predicting CAC progression, including measurements of bone mineral density (BMD) and novel bone markers in adult patients with CKD-5D. At baseline and after 1 year, patients underwent routine blood tests and measurement of CAC, BMD, and novel serum bone markers. A total of 213 patients received baseline measurements, of whom about 80% had measurable CAC and almost 50% had CAC Agatston scores>400, conferring high risk for cardiovascular events. Independent positive predictors of baseline CAC included coronary artery disease, diabetes, dialysis vintage, fibroblast growth factor-23 concentration, and age, whereas BMD of the spine measured by quantitative computed tomography was an inverse predictor. Hypertension, HDL level, and smoking were not baseline predictors in these patients. Three quarters of 122 patients completing the study had CAC increases at 1 year. Independent risk factors for CAC progression were age, baseline total or whole parathyroid hormone level greater than nine times the normal value, and osteoporosis by t scores. Our results confirm a role for bone in CKD–associated CAC prevalence and progression. PMID:25838468

  8. Standardized Prevalence Ratios for Atrial Fibrillation in Adult Dialysis Patients in Japan

    PubMed Central

    Ohsawa, Masaki; Tanno, Kozo; Okamura, Tomonori; Yonekura, Yuki; Kato, Karen; Fujishima, Yosuke; Obara, Wataru; Abe, Takaya; Itai, Kazuyoshi; Ogasawara, Kuniaki; Omama, Shinichi; Turin, Tanvir Chowdhury; Miyamatsu, Naomi; Ishibashi, Yasuhiro; Morino, Yoshihiro; Itoh, Tomonori; Onoda, Toshiyuki; Kuribayashi, Toru; Makita, Shinji; Yoshida, Yuki; Nakamura, Motoyuki; Tanaka, Fumitaka; Ohta, Mutsuko; Sakata, Kiyomi; Okayama, Akira

    2016-01-01

    Background While it is assumed that dialysis patients in Japan have a higher prevalence of atrial fibrillation (AF) than the general population, the magnitude of this difference is not known. Methods Standardized prevalence ratios (SPRs) for AF in dialysis patients (n = 1510) were calculated compared to data from the general population (n = 26 454) living in the same area. Results The prevalences of AF were 3.8% and 1.6% in dialysis patients and the general population, respectively. In male subjects, these respective values were 4.9% and 3.3%, and in female subjects they were 1.6% and 0.6%. The SPRs for AF were 2.53 (95% confidence interval [CI], 1.88–3.19) in all dialysis patients, 1.80 (95% CI, 1.30–2.29) in male dialysis patients, and 2.13 (95% CI, 0.66–3.61) in female dialysis patients. Conclusions The prevalence of AF in dialysis patients was twice that in the population-based controls. Since AF strongly contributes to a higher risk of cardiovascular mortality and morbidity in the general population, further longitudinal studies should be conducted regarding the risk of several outcomes attributable to AF among Japanese dialysis patients. PMID:26804038

  9. Care of the Patient with Renal Disease: Peritoneal Dialysis and Transplants, Nursing 321A.

    ERIC Educational Resources Information Center

    Hulburd, Kimberly

    A description is provided of a course, "Care of the Patient with Renal Disease," offered at the community college level to prepare licensed registered nurses to care for patients with renal disease, including instruction in performing the treatments of peritoneal dialysis and continuous ambulatory peritoneal dialysis (CAPD). The first…

  10. An observational study of microcirculation in dialysis patients and kidney transplant recipients.

    PubMed

    Yeh, Yu Chang; Chao, Anne; Lee, Chih-Yuan; Lee, Chen-Tse; Yeh, Chi-Chuan; Liu, Chih-Min; Tsai, Meng-Kun

    2017-09-01

    Microcirculatory dysfunction contributes to acute and chronic kidney diseases. To the best of our knowledge, no study has compared differences in microcirculation among healthy volunteers, dialysis patients and kidney transplant recipients. Sublingual microcirculation was examined using sidestream dark field imaging and was compared among 90 healthy volunteers, 40 dialysis patients and 40 kidney transplant recipients. The gender effect on microcirculation and the correlations among the microcirculation parameters, age, body mass index, heart rate and blood pressure were analysed. Total small vessel density, perfused small vessel density and the proportion of perfused small vessels were lower in the dialysis patients than in the healthy volunteers and kidney transplant recipients [total small vessel density; healthy volunteers vs. dialysis patients vs. kidney transplant recipients, 25·2 (2·3) vs. 22·8 (2·6) vs. 24·2 (2·9) mm/mm(2) , P < 0·001]. Systolic blood pressure showed a weak negative correlation with the microvascular flow index scores in the healthy volunteers. By contrast, systolic blood pressure, diastolic blood pressure and mean arterial pressure showed weak positive correlations with proportion of perfused small vessels and the microvascular flow index scores in the dialysis patients. Microcirculatory dysfunction is noted in dialysis patients, and this alteration is ameliorated in KT recipients. The positive correlation between blood pressure and microcirculation in dialysis patients suggests that additional studies should investigate the optimal goal of blood pressure management for dialysis patients. © 2017 Stichting European Society for Clinical Investigation Journal Foundation.

  11. Care of the Patient with Renal Disease: Peritoneal Dialysis and Transplants, Nursing 321A.

    ERIC Educational Resources Information Center

    Hulburd, Kimberly

    A description is provided of a course, "Care of the Patient with Renal Disease," offered at the community college level to prepare licensed registered nurses to care for patients with renal disease, including instruction in performing the treatments of peritoneal dialysis and continuous ambulatory peritoneal dialysis (CAPD). The first…

  12. Bimodal Solutions or Twice-Daily Icodextrin to Enhance Ultrafiltration in Peritoneal Dialysis Patients

    PubMed Central

    Dousdampanis, Periklis; Trigka, Konstantina; Bargman, Joanne M.

    2013-01-01

    The efficacy and safety of icodextrin has been well established. In this paper, we will discuss the pharmacokinetics and biocompatibility of icodextrin and its clinical effect on fluid management in peritoneal dialysis patients. Novel strategies for its prescription for peritoneal dialysis patients with inadequate ultrafiltration are reviewed. PMID:23365749

  13. Cinacalcet Administration by Gastrostomy Tube in a Child Receiving Peritoneal Dialysis

    PubMed Central

    Knoderer, Chad A.; Johnston, Bethanne; Wilson, Amy C.

    2014-01-01

    A 2-year-old male with chronic kidney disease with secondary hyperparathyroidism developed hypercalcemia while receiving calcitriol, without achieving a serum parathyroid hormone concentration within the goal range. Cinacalcet 15 mg (1.2 mg/kg), crushed and administered via gastrostomy tube, was added to the patient’s therapy. This therapy was effective in achieving targeted laboratory parameters in our patient despite instructions in the prescribing information that cinacalcet should always be taken whole. PMID:25309151

  14. Patient and Health Care Professional Decision-Making to Commence and Withdraw from Renal Dialysis: A Systematic Review of Qualitative Research

    PubMed Central

    Flemming, Kate; Murtagh, Fliss E.M.; Johnson, Miriam J.

    2015-01-01

    Background and objective To ensure that decisions to start and stop dialysis in ESRD are shared, the factors that affect patients and health care professionals in making such decisions must be understood. This systematic review sought to explore how and why different factors mediate the choices about dialysis treatment. Design, setting, participants, & measurements MEDLINE, Embase, CINAHL, and PsychINFO were searched for qualitative studies of factors that affect patients’ or health care professionals’ decisions to commence or withdraw from dialysis. A thematic synthesis was conducted. Results Of 494 articles screened, 12 studies (conducted from 1985 to 2014) were included. These involved 206 patients (most receiving hemodialysis) and 64 health care professionals (age ranges: patients, 26–93 years; professionals, 26–61 years). For commencing dialysis, patients based their choice on "gut instinct," as well as deliberating over the effect of treatment on quality of life and survival. How individuals coped with decision-making was influential: Some tried to take control of the problem of progressive renal failure, whereas others focused on controlling their emotions. Health care professionals weighed biomedical factors and were led by an instinct to prolong life. Both patients and health care professionals described feeling powerless. With regard to dialysis withdrawal, only after prolonged periods on dialysis were the realities of life on dialysis fully appreciated and past choices questioned. By this stage, however, patients were physically dependent on treatment. As was seen with commencing dialysis, individuals coped with treatment withdrawal in a problem- or emotion-controlling way. Families struggled to differentiate between choosing versus allowing death. Health care teams avoided and queried discussions regarding dialysis withdrawal. Patients, however, missed the dialogue they experienced during predialysis education. Conclusions Decision-making in

  15. Randomized controlled study of icodextrin on the treatment of peritoneal dialysis patients during acute peritonitis.

    PubMed

    Chow, Kai Ming; Szeto, Cheuk Chun; Kwan, Bonnie Ching Ha; Pang, Wing Fai; Ma, Terry; Leung, Chi Bon; Law, Man Ching; Li, Philip Kam-Tao

    2014-07-01

    The clinical benefits of using icodextrin during acute peritonitis in peritoneal dialysis are uncertain. On the premise that high glucose concentration might jeopardize the peritoneal defense during peritonitis, icodextrin administration during acute peritonitis could have the potential to improve the peritonitis outcome whilst improving ultrafiltration. We conducted a single-center, open-label, randomized controlled trial in which 53 adult continuous ambulatory peritoneal dialysis patients underwent randomization to receive either icodextrin or original glucose-based dialysis solution. The primary outcome measure was the peritoneal dialyzate white cell count on Day 3. Secondary outcome measures comprised the need of additional hypertonic exchanges, fluid control as denoted by changes in body weight, and the clinical outcome of peritonitis including 30-day and 120-day all-cause mortality. Between icodextrin and control treatment groups, there were no statistically significant differences in the peritoneal dialyzate white cell count on day (1829 versus 987/mm(3), P = 0.13). There was neither improvement in primary cure rate (31.8 versus 32.3%, P = 1.00), nor was there any change in 120-day mortality after icodextrin use (13.6 versus 12.9%, P = 1.00). However, requirement of hypertonic dialysis exchange was much more frequent in the control group than in those randomized to icodextrin (35.5 versus 0%, P = 0.001). Body weight did not change significantly in the icodextrin group, but body weight in the control group increased from 63.3 ± 14.5 kg at baseline to 64.2 ± 14.2 kg at Day 5 (P = 0.0002) and 65.2 ± 14.1 kg at Day 10 (P < 0.0001). As compared with glucose-based peritoneal dialysis solution, use of icodextrin achieved better ultrafiltration and fluid control during acute peritonitis complicating continuous ambulatory peritoneal dialysis, although we found no evidence of a worthwhile clinical benefit on peritonitis resolution. (ClinicalTrial.gov number, NCT

  16. Plasma p-Cresol Lowering Effect of Sevelamer in Peritoneal Dialysis Patients: Evidence from a Cross-Sectional Observational Study

    PubMed Central

    Guida, Bruna; Cataldi, Mauro; Riccio, Eleonora; Grumetto, Lucia; Pota, Andrea; Borrelli, Silvio; Memoli, Andrea; Barbato, Francesco; Argentino, Gennaro; Salerno, Giuliana; Memoli, Bruno

    2013-01-01

    p-Cresol is a by-product of the metabolism of aromatic aminoacid operated by resident intestinal bacteria. In patients with chronic kidney disease, the accumulation of p-cresol and of its metabolite p-cresyl-sulphate causes endothelial dysfunction and ultimately increases the cardiovascular risk of these patients. Therapeutic strategies to reduce plasma p-cresol levels are highly demanded but not available yet. Because it has been reported that the phosphate binder sevelamer sequesters p-cresol in vitro we hypothesized that it could do so also in peritoneal dialysis patients. To explore this hypothesis we measured total cresol plasma concentrations in 57 patients with end-stage renal disease on peritoneal dialysis, 29 receiving sevelamer for the treatment of hyperphosphatemia and 28 patients not assuming this drug. Among the patients not assuming sevelamer, 16 were treated with lanthanum whereas the remaining 12 received no drug because they were not hyperphosphatemic. Patients receiving sevelamer had plasma p-cresol and serum high sensitivity C-reactive protein concentrations significantly lower than those receiving lanthanum or no drug. Conversely, no difference was observed among the different groups either in residual glomerular filtration rate, total weekly dialysis dose, total clearance, urine volume, protein catabolic rate, serum albumin or serum phosphate levels. Multiple linear regression analysis showed that none of these variables predicted plasma p-cresol concentrations that, instead, negatively correlated with the use of sevelamer. These results suggest that sevelamer could be an effective strategy to lower p-cresol circulating levels in peritoneal dialysis patients in which it could also favorably affect cardiovascular risk because of its anti-inflammatory effect. PMID:24015307

  17. Plasma p-cresol lowering effect of sevelamer in peritoneal dialysis patients: evidence from a Cross-Sectional Observational Study.

    PubMed

    Guida, Bruna; Cataldi, Mauro; Riccio, Eleonora; Grumetto, Lucia; Pota, Andrea; Borrelli, Silvio; Memoli, Andrea; Barbato, Francesco; Argentino, Gennaro; Salerno, Giuliana; Memoli, Bruno

    2013-01-01

    p-Cresol is a by-product of the metabolism of aromatic aminoacid operated by resident intestinal bacteria. In patients with chronic kidney disease, the accumulation of p-cresol and of its metabolite p-cresyl-sulphate causes endothelial dysfunction and ultimately increases the cardiovascular risk of these patients. Therapeutic strategies to reduce plasma p-cresol levels are highly demanded but not available yet. Because it has been reported that the phosphate binder sevelamer sequesters p-cresol in vitro we hypothesized that it could do so also in peritoneal dialysis patients. To explore this hypothesis we measured total cresol plasma concentrations in 57 patients with end-stage renal disease on peritoneal dialysis, 29 receiving sevelamer for the treatment of hyperphosphatemia and 28 patients not assuming this drug. Among the patients not assuming sevelamer, 16 were treated with lanthanum whereas the remaining 12 received no drug because they were not hyperphosphatemic. Patients receiving sevelamer had plasma p-cresol and serum high sensitivity C-reactive protein concentrations significantly lower than those receiving lanthanum or no drug. Conversely, no difference was observed among the different groups either in residual glomerular filtration rate, total weekly dialysis dose, total clearance, urine volume, protein catabolic rate, serum albumin or serum phosphate levels. Multiple linear regression analysis showed that none of these variables predicted plasma p-cresol concentrations that, instead, negatively correlated with the use of sevelamer. These results suggest that sevelamer could be an effective strategy to lower p-cresol circulating levels in peritoneal dialysis patients in which it could also favorably affect cardiovascular risk because of its anti-inflammatory effect.

  18. Aortic valve reconstruction with autologous pericardium for dialysis patients.

    PubMed

    Kawase, Isamu; Ozaki, Shigeyuki; Yamashita, Hiromasa; Uchida, Shin; Nozawa, Yukinari; Matsuyama, Takayoshi; Takatoh, Mikio; Hagiwara, So

    2013-06-01

    This study aimed to report on original aortic valve reconstruction for patients on dialysis. Aortic valve reconstruction has been performed on 404 cases from April 2007 through September 2011. Among them, 54 cases on haemodialysis were retrospectively studied. Forty-seven patients had aortic stenosis, 5 had aortic regurgitation (AR), and 2 had infective endocarditis. Mean age was 70.2 ± 8.5 years. There were 35 males and 19 females. There were 27 primary aortic valve reconstructions, 11 with CABG, 6 with ascending aortic replacement, 5 with mitral valve repair and 4 with maze. First, in the procedure, harvested pericardium was treated with 0.6% glutaraldehyde solution. After resecting the cusps, we measured the distance between commissures with original sizing instrument. Then, the pericardium was trimmed with the original template. Three cusps were sutured to each annulus. Peak pressure gradient averaged to 66.0 ± 28.2 mmHg preoperatively, and decreased to 23.4 ± 10.7, 13.8 ± 5.5 and 13.3 ± 2.3 mmHg, 1 week, 1 year, and 3 years after the operation, respectively. No calcification was detected with echocardiographic follow-up. Recurrence of AR was not recorded with the mean follow-up of 847 days except for 1 case reoperated on for infective endocarditis 2.5 years after the operation. Three hospital deaths were recorded due to non-cardiac causes. Other patients were in good condition. There was no thromboembolic event. Medium-term results are excellent. Since warfarin for dialysis patients becomes problematic, a postoperative warfarin-free status is desirable. Aortic valve reconstruction can provide patients with a better quality of life without warfarin.

  19. Serum immunoglobulin G levels and peritonitis in peritoneal dialysis patients.

    PubMed

    Courivaud, Cécile; Bardonnet, Karine; Crepin, Thomas; Bresson-Vautrin, Catherine; Rebibou, Jean-Michel; Ducloux, Didier

    2015-08-01

    Peritonitis is a frequent and serious complication of peritoneal dialysis (PD). Whether low immunoglobulin level is associated with PD-related peritonitis is unknown. We conducted a prospective study to assess whether immunoglobulin levels at PD onset could predict the occurrence of peritonitis. All patients starting peritoneal dialysis between 01/2005 and 12/2010 at the University hospital of Besançon, France, were included in the study. Of 240 consecutive PD patients enrolled (mean follow-up 25 ± 12 months), 76 (32%) had at least one episode of peritonitis. Mean immunoglobulin (Ig)G level at PD start was lower in patients who subsequently experienced peritonitis (7.9 + 3.4 vs. 9.7 + 3.4 g/l, p = 0.005). An increased IgG level at PD onset was associated with a reduced risk of peritonitis [hazard ratio (HR) 0.88, 95% confidence interval (CI) 0.80-0.97 for each increase of 1 g/l in IgG, p = 0.008]. IgG level ≤6.4 g/l ("low IgG") was the best predictive value for the occurrence of subsequent peritonitis: 52 patients (24%) had low IgG levels. At multivariate analysis, both low IgG level (HR 2.49, 95% CI 1.32-4.69, p = 0.005) and diabetes (HR 2.78, 95% CI 1.49-5.20, p = 0.001) were predictive of the occurrence of peritonitis. Low IgG levels predict the occurrence of PD-related peritonitis. Randomized studies should determine whether such patients could benefit from intravenous immunoglobulin administration.

  20. Is serum phosphorus control related to parathyroid hormone control in dialysis patients with secondary hyperparathyroidism?

    PubMed

    Frazão, João M; Braun, Johann; Messa, Piergiorgio; Dehmel, Bastian; Mattin, Caroline; Wilkie, Martin

    2012-08-03

    Elevated serum phosphorus (P) levels have been linked to increased morbidity and mortality in dialysis patients with secondary hyperparathyroidism (SHPT) but may be difficult to control if parathyroid hormone (PTH) is persistently elevated. We conducted a post hoc analysis of data from an earlier interventional study (OPTIMA) to explore the relationship between PTH control and serum P. The OPTIMA study randomized dialysis patients with intact PTH (iPTH) 300-799 pg/mL to receive conventional care alone (vitamin D and/or phosphate binders [PB]; n=184) or a cinacalcet-based regimen (n=368). For patients randomized to conventional care, investigators were allowed flexibility in using a non-cinacalcet regimen (with no specific criteria for vitamin D analogue dosage) to attain KDOQI™ targets for iPTH, P, Ca and Ca x P. For those assigned to the cinacalcet-based regimen, dosages of cinacalcet, vitamin D sterols, and PB were optimized over the first 16 weeks of the study, using a predefined treatment algorithm. The present analysis examined achievement of serum P targets (≤ 4.5 and ≤ 5.5 mg/dL) in relation to achievement of iPTH ≤ 300 pg/mL during the efficacy assessment phase (EAP; weeks 17-23). Patients who achieved iPTH ≤ 300 pg/mL (or a reduction of ≥ 30% from baseline) were more likely to achieve serum P targets than those who did not, regardless of treatment group. Of those who did achieve iPTH ≤ 300 pg/mL, 43% achieved P ≤ 4.5 mg/dL and 70% achieved P ≤ 5.5 mg/dL, versus 21% and 46% of those who did not achieve iPTH ≤ 300 pg/mL. Doses of PB tended to be higher in patients not achieving serum P targets. Patients receiving cinacalcet were more likely to achieve iPTH ≤ 300 pg/mL than those receiving conventional care (73% vs 23% of patients). Logistic regression analysis identified lower baseline P, no PB use at baseline and cinacalcet treatment to be predictors of achieving P ≤ 4.5 mg/dL during EAP in patients above this threshold at baseline

  1. Is serum phosphorus control related to parathyroid hormone control in dialysis patients with secondary hyperparathyroidism?

    PubMed Central

    2012-01-01

    Background Elevated serum phosphorus (P) levels have been linked to increased morbidity and mortality in dialysis patients with secondary hyperparathyroidism (SHPT) but may be difficult to control if parathyroid hormone (PTH) is persistently elevated. We conducted a post hoc analysis of data from an earlier interventional study (OPTIMA) to explore the relationship between PTH control and serum P. Methods The OPTIMA study randomized dialysis patients with intact PTH (iPTH) 300–799 pg/mL to receive conventional care alone (vitamin D and/or phosphate binders [PB]; n = 184) or a cinacalcet-based regimen (n = 368). For patients randomized to conventional care, investigators were allowed flexibility in using a non-cinacalcet regimen (with no specific criteria for vitamin D analogue dosage) to attain KDOQI™ targets for iPTH, P, Ca and Ca x P. For those assigned to the cinacalcet-based regimen, dosages of cinacalcet, vitamin D sterols, and PB were optimized over the first 16 weeks of the study, using a predefined treatment algorithm. The present analysis examined achievement of serum P targets (≤4.5 and ≤5.5 mg/dL) in relation to achievement of iPTH ≤300 pg/mL during the efficacy assessment phase (EAP; weeks 17–23). Results Patients who achieved iPTH ≤ 300 pg/mL (or a reduction of ≥30% from baseline) were more likely to achieve serum P targets than those who did not, regardless of treatment group. Of those who did achieve iPTH ≤ 300 pg/mL, 43% achieved P ≤4.5 mg/dL and 70% achieved P ≤5.5 mg/dL, versus 21% and 46% of those who did not achieve iPTH ≤ 300 pg/mL. Doses of PB tended to be higher in patients not achieving serum P targets. Patients receiving cinacalcet were more likely to achieve iPTH ≤300 pg/mL than those receiving conventional care (73% vs 23% of patients). Logistic regression analysis identified lower baseline P, no PB use at baseline and cinacalcet treatment to be predictors of achieving P

  2. The interview with a patient on dialysis: feeling, emotions and fears.

    PubMed

    Brunori, Francesco; Dozio, Beatrice; Colzani, Sara; Pozzi, Marco; Pisano, Lucia; Galassi, Andrea; Santorelli, Gennaro; Auricchio, Sara; Busnelli, Luisa; Di Carlo, Angela; Viganò, Monica; Calabrese, Valentina; Mariani, Laura; Mossa, Monica; Longoni, Stefania; Scanziani, Renzo

    2016-01-01

    This study has been performed in the Nephrology and Dialysis Unit, in Desio Hospital, Italy. The aim of this study is to evaluate, starting from research questions, which information is given to patient in the pre-dialysis colloquia for his/her chosen dialysis methods. Moreover, the study evaluated feelings, emotions and fears since the announcement of the necessity of dialysis treatment. The objective of the study was reached through the interview with patients on dialysis. The fact-finding survey was based on the tools of social research, as the semi-structured interview. Instead of using the questionnaire, even though it make it easier to collect larger set of data, the Authors decided to interview patients in person, since the interview allows direct patient contact and to build a relationship of trust with the interviewer, in order to allow patient explain better his/her feeling.

  3. Organ Donation Campaigns: Perspective of Dialysis Patient's Family Members.

    PubMed

    Tumin, Makmor; Raja Ariffin, Raja Noriza; Mohd Satar, NurulHuda; Ng, Kok-Peng; Lim, Soo-Kun; Chong, Chin-Sieng

    2014-07-01

    Solving the dilemma of the organ shortage in Malaysia requires educating Malaysians about organ donation and transplantation. This paper aims at exploring the average Malaysian households ' preferred channels of campaigns and the preferred campaigners in a family setting, targeting at the dialysis family members. We analyzed the responses of 350 respondents regarding organ donation campaigns. The respondents are 2 family members of 175 dialysis patients from 3 different institutions. The information on respondents' willingness to donate and preferred method and channel of organ donation campaign were collected through questionnaire. Malaysian families have a good tendency to welcome campaigns in both the public and private (their homes) spheres. We also found that campaigns facilitated by the electronic media (Television and Radio) and executed by experienced doctors are expected to optimize the outcomes of organ donation, in general. Chi-square tests show that there are no significant differences in welcoming campaigns among ethnics. However, ethnics preferences over the campaign methods and campaigners are significantly different (P <0.05). Ethnic differences imply that necessary modifications on the campaign channels and campaigners should also be taken under consideration. By identifying the preferred channel and campaigners, this study hopes to shed some light on the ways to overcome the problem of organ shortage in Malaysia.

  4. Organ Donation Campaigns: Perspective of Dialysis Patient's Family Members

    PubMed Central

    TUMIN, Makmor; RAJA ARIFFIN, Raja Noriza; MOHD SATAR, NurulHuda; NG, Kok-Peng; LIM, Soo-Kun; CHONG, Chin-Sieng

    2014-01-01

    Abstract Background Solving the dilemma of the organ shortage in Malaysia requires educating Malaysians about organ donation and transplantation. This paper aims at exploring the average Malaysian households ’ preferred channels of campaigns and the preferred campaigners in a family setting, targeting at the dialysis family members. Methods We analyzed the responses of 350 respondents regarding organ donation campaigns. The respondents are 2 family members of 175 dialysis patients from 3 different institutions. The information on respondents’ willingness to donate and preferred method and channel of organ donation campaign were collected through questionnaire. Results Malaysian families have a good tendency to welcome campaigns in both the public and private (their homes) spheres. We also found that campaigns facilitated by the electronic media (Television and Radio) and executed by experienced doctors are expected to optimize the outcomes of organ donation, in general. Chi-square tests show that there are no significant differences in welcoming campaigns among ethnics. However, ethnics preferences over the campaign methods and campaigners are significantly different (P <0.05). Conclusion Ethnic differences imply that necessary modifications on the campaign channels and campaigners should also be taken under consideration. By identifying the preferred channel and campaigners, this study hopes to shed some light on the ways to overcome the problem of organ shortage in Malaysia. PMID:25909060

  5. Historical Study (1986-2014): Improvements in Nutritional Status of Dialysis Patients.

    PubMed

    Koefoed, Mette; Kromann, Charles Boy; Hvidtfeldt, Danni; Juliussen, Sophie Ryberg; Andersen, Jens Rikardt; Marckmann, Peter

    2016-09-01

    Malnutrition is common in dialysis patients and is associated with adverse clinical outcomes. Despite an increased focus on improved nutrition in dialysis patients, it is claimed that the prevalence of malnutrition in this group of patients has not changed during the last decades. Direct historical comparisons of the nutritional status of dialysis patients have never been published. To directly compare the nutritional status of past and current dialysis patients, we implemented the methodology of a study from 1986 on a population of dialysis patients in 2014. Historical study comparing results of two cross-sectional studies performed in 1986 and 2014. We compared the nutritional status of hemodialysis (HD) and peritoneal dialysis (PD) patients attending the dialysis center at Roskilde Hospital, Denmark, in February to June 2014, with that of HD and PD patients treated at the dialysis center at Fredericia Hospital, Denmark, in April 1986. Maintenance PD and HD patients (n = 64 in 2014 and n = 48 in 1986). We performed anthropometry (body weight, triceps skinfold, and midarm muscle circumferences [MAMCs]) and determined plasma transferrin. Relative body weight, triceps skinfold, MAMC, body mass index, and prevalence of protein-caloric malnutrition as defined in the original study from 1986. Average relative body weight, triceps skinfold, MAMC, and body mass index were significantly higher in 2014 compared with 1986. The prevalence of protein-caloric malnutrition was significantly lower in 2014 (18%) compared with 1986 (52%). The nutritional status of maintenance dialysis patients has improved during the last 3 decades. The reason for this improvement could not be identified in the present study, but the most likely contributors are the higher prevalence of obesity in the general population, less predialytic malnutrition, and an improved focus on nutrition in maintenance dialysis patients. Copyright © 2016 National Kidney Foundation, Inc. Published by

  6. [The Effect of Dialysate Flow Rate on Dialysis Adequacy and Fatigue in Hemodialysis Patients].

    PubMed

    Cha, Sun Mi; Min, Hye Sook

    2016-10-01

    In this single repeated measures study, an examination was done on the effects of dialysate flow rate on dialysis adequacy and fatigue in patients receiving hemodialysis. This study was a prospective single center study in which repeated measures analysis of variance were used to compare Kt/V urea (Kt/V) and urea reduction ratio (URR) as dialysis adequacy measures and level of fatigue at different dialysate flow rates: twice as fast as the participant's own blood flow, 500 mL/min, and 700 mL/min. Thirty-seven hemodialysis patients received all three dialysate flow rates using counterbalancing. The Kt/V (M±SD) was 1.40±0.25 at twice the blood flow rate, 1.41±0.23 at 500 mL/min, and 1.46±0.24 at 700 mL/min. The URR (M±SD) was 68.20±5.90 at twice the blood flow rate, 68.67±5.22 at 500 mL/min, and 70.11±5.13 at 700 mL/min. When dialysate flow rate was increased from twice the blood flow rate to 700 mL/min and from 500 mL/min to 700 mL/min, Kt/V and URR showed relative gains. There was no difference in fatigue according to dialysate flow rate. Increasing the dialysate flow rate to 700 mL/min is associated with a significant nicrease in dialysis adequacy. Hemodialysis with a dialysate flow rate of 700 mL/min should be considered in selected patients not achieving adequacy despite extended treatment times and optimized blood flow rate.

  7. Amino acid losses during sustained low efficiency dialysis in critically ill patients with acute kidney injury.

    PubMed

    Umber, Afia; Wolley, Martin J; Golper, Thomas A; Shaver, Mary J; Marshall, Mark R

    2014-02-01

    Sustained low efficiency dialysis (SLED) involves the use of standard dialysis machines for prolonged intermittent renal replacement therapy in critically ill patients. In this study we aimed to quantify dialysate amino acid (AA) and albumin losses in 5 patients who underwent successful SLED treatment. This was a prospective observational study. The study was performed in a general intensive care unit. The study was performed in critically ill patients with acute kidney injury undergoing SLED using low-flux hemodialyzers. We performed total dialysate collection and measured dialysate AA profiles by reverse phase high-pressure liquid chromatography using an automated AA analyser. Individual and total amino acid losses. Albumin was undetectable in dialysate. The median (mean ± SD) total amino acid loss was 15.7 (23.4 ± 19.2) g/treatment, or 122.1 (180.6 ± 148.5) mmol/treatment. Two patients were receiving intravenous nutrition. One patient had severe hepatic failure with encephalopathy, and had high dialysate AA levels with a total loss of 57 g/treatment. During SLED with low-flux hemodialyzers, albumin losses are negligible but AA losses to dialysate are comparable to those during continuous renal replacement therapy. Patients' nutritional protein prescriptions should be augmented to account for this.

  8. Influence of dialysis modality on complications and patient and graft survival after pancreas-kidney transplantation.

    PubMed

    Jiménez, C; Manrique, A; Morales, J M; Andrés, A; Ortuño, T; Abradelo, M; Gimeno, A; Calvo, J; Cambra, F; Sterup, R L; Moreno, E

    2008-11-01

    We investigated whether hemodialysis or peritoneal dialysis prior to pancreas-kidney transplantation was a risk factor for the development of surgical complications, recipient mortality, or graft loss. From March 1995 to December 2006, 90 patients with type 1 diabetes underwent pancreas transplantation. Dialysis before transplantation was provides to 81 patients. We compared outcomes of recipients classified as two groups: (A) hemodialysis (n = 49, 60.5%) versus (B) peritoneal dialysis (n = 32, 39.5%) groups. Donor and recipient characteristics were similar in both groups. Enteric drainage was more frequently used in the hemodialysis group and bladder drainage in the peritoneal dialysis group (P < .05). The rate of intra-abdominal infections was similar in both groups: 10 patients (20.4%) in the hemodialysis group and 9 patients (28.1%) in the peritoneal dialysis group (P = NS). The incidence of enteric or bladder leakage was slightly higher in the peritoneal dialysis group (5 cases, 15.6% vs 4 cases, 8.2% in the hemodialysis group; P = NS). The rate of reoperations was also slightly higher in the peritoneal dialysis group B (15 cases, 46.9% vs 14 cases, 28.6% in the hemodialysis group; P = .07). Pancreas transplantectomy was significantly greater in the peritoneal dialysis (9 cases; 28.1%) than the hemodialysis group (5 cases; 10.2%; P < .05). The actuarial 3-year patient survival was 95.9% in the hemodialysis group and 93.4% in the peritoneal dialysis group (P = NS); actuarial 3-year pancreas graft survival was 79.3% in the hemodialysis group and 68.3% in the peritoneal dialysis group (P = NS). We noted an insignificantly greater rate of reoperations but significantly higher incidence of pancreas transplantectomy in the peritoneal dialysis group; however, patient and pancreas graft survivals were similar in both study groups.

  9. The economic considerations of patients and caregivers in choice of dialysis modality

    PubMed Central

    Howard, Kirsten; Tong, Allison; Palmer, Suetonia C.; Marshall, Mark R.; Morton, Rachael L.

    2016-01-01

    Abstract Introduction Broader adoption of home dialysis could lead to considerable cost savings for health services. Globally, however, uptake remains low. The aim of this study was to describe patient and caregiver perspectives of the economic considerations that influence dialysis modality choice, and elicit policy‐relevant recommendations. Methods Semistructured interviews with predialysis or dialysis patients and their caregivers, at three hospitals in New Zealand. Interview transcripts were analyzed thematically. Findings 43 patients and 9 caregivers (total n = 52) participated. The three themes related to economic considerations were: (i) productivity losses associated with changes in employment; (ii) the need for personal subsidization of home dialysis expenses; and (iii) the role of socio‐economic disadvantage as a barrier to home dialysis. Patients weighed the flexibility of home dialysis which allowed them to remain employed, against time required for training and out‐of‐pocket costs. Patients saw the lack of reimbursement of home dialysis costs as unjust and suggested that reimbursement would incentivize home dialysis uptake. Social disadvantage was a barrier to home dialysis as patients’ housing was often unsuitable; they could not afford the additional treatment costs. Home hemodialysis was considered to have the highest out‐of‐pocket costs and was sometimes avoided for this reason. Discussion Our data suggests that economic considerations underpin the choices patients make about dialysis treatments, however these are rarely reported. To promote home dialysis, strategies to improve employment retention and housing, and to minimize out‐of‐pocket costs, need to be addressed directly by healthcare providers and payers. PMID:27196634

  10. Antimicrobial agents for preventing peritonitis in peritoneal dialysis patients.

    PubMed

    Campbell, Denise; Mudge, David W; Craig, Jonathan C; Johnson, David W; Tong, Allison; Strippoli, Giovanni Fm

    2017-04-08

    Peritoneal dialysis (PD) is an important therapy for patients with end-stage kidney disease and is used in more than 200,000 such patients globally. However, its value is often limited by the development of infections such as peritonitis and exit-site and tunnel infections. Multiple strategies have been developed to reduce the risk of peritonitis including antibiotics, topical disinfectants to the exit site and antifungal agents. However, the effectiveness of these strategies has been variable and are based on a small number of randomised controlled trials (RCTs). The optimal preventive strategies to reduce the occurrence of peritonitis remain unclear.This is an update of a Cochrane review first published in 2004. To evaluate the benefits and harms of antimicrobial strategies used to prevent peritonitis in PD patients. We searched the Cochrane Kidney and Transplant's Specialised Register to 4 October 2016 through contact with the Information Specialist using search terms relevant to this review. Studies contained in the Specialised Register are identified through search strategies specifically designed for CENTRAL, MEDLINE, and EMBASE; handsearching conference proceedings; and searching the International Clinical Trials Register (ICTRP) Search Portal and ClinicalTrials.gov. RCTs or quasi-RCTs in patients receiving chronic PD, which evaluated any antimicrobial agents used systemically or locally to prevent peritonitis or exit-site/tunnel infection were included. Two authors independently assessed risk of bias and extracted data. Summary estimates of effect were obtained using a random-effects model, and results were expressed as risk ratio (RR) with 95% confidence intervals (CI). Thirty-nine studies, randomising 4435 patients, were included. Twenty additional studies have been included in this update. The risk of bias domains were often unclear or high; risk of bias was judged to be low in 19 (49%) studies for random sequence generation, 12 (31%) studies for

  11. Morbidity and mortality in ESRD patients on dialysis.

    PubMed

    Al Wakeel, Jamal S; Mitwalli, Ahmed H; Al Mohaya, S; Abu-Aisha, Hassan; Tarif, Nauman; Malik, Ghulam H; Hammad, D

    2002-01-01

    End-stage renal disease (ESRD), due to its high morbidity and mortality as well as social and financial implications, is a major public health problem. Outcome depends not only on different modalities of treatment like hemodialysis and peritoneal dialysis, but also on existing co-morbidities, age, duration on dialysis, supportive therapies and infection control strategies. Thus, a detailed study becomes necessary to improve health care delivery, provide medical care and to establish a geographical reference. The present study was undertaken to characterize the ESRD patients by their demographic and co-morbid conditions and relate this to the morbidity and mortality trends. The medical records of 110 ESRD patients seen over a five-year period (June 1995 to December 1999) in two tertiary-care hospitals in Riyadh, Saudi Arabia were studied retrospectively. There were 79 (64.5%) males and 31 (35.5%) females; their age ranged from 17 to 92 years (mean age 53.8 +/- 17.8 years). Diabetes was the commonest cause of ESRD seen in 26 (26.6%) followed by nephrosclerosis, unknown etiology, lupus nephritis, pyelonephritis and primary glomerulonephritis. Diabetes mellitus was the most prevalent co-morbidity seen during the study period and occurred in 65 patients (59%) followed by heart disease in 36 (32.7%), liver disease in 30 (27.3%), cerebrovascular accidents in 13 (11.8%) and neoplasm in 11 (10%). Seven (6.3%) patients only were smokers. Hemodialysis was the most frequent treatment choice as renal replacement therapy. Among the causes of hospitalization, cardiovascular conditions were the leading single cause (19.1%), followed by access related reasons and infections (11.5% each). The overall hospitalization rate was 11.2 days/year. The overall mortality rate was 8.07 deaths/year. The leading cause of death was cardiovascular in 15 (51.7%) followed by unknown/sudden death in eight (27.5%). Other causes of death included fluid overload, gastrointestinal hemorrhage, septicemia

  12. Vascular access in patients receiving hemodialysis in Libya.

    PubMed

    Alashek, Wiam A; McIntyre, Christopher W; Taal, Maarten W

    2012-01-01

    A native arteriovenous fistula (AVF) represents the optimal form of Vascular Access (VA) for patients receiving hemodialysis (HD). In Libya there are several barriers to AVF creation including lack of adequate preparation for dialysis and surgical services. We aimed to conduct the first comprehensive study of VA utilisation in HD patients in Libya. A prospective observational study included all adult patients receiving HD treatment in 25 HD facilities in Libya from May 2009 to Nov 2011. Researchers gathered data regarding VA through interviews with staff and patients as well as medical records. Patients with definitive VA were re-interviewed after 1 year. At baseline the majority of patients (91.9%; n=1573) were using permanent VA in the form of AVF or arteriovenous graft. Patients with permanent VA were more likely to be male and less likely to be diabetic than those with CVCs. Most patients had commenced HD using a temporary CVC (91.8%). VA-related complications were: thrombosis (46.7%), aneurysm (22.6%), infection (11.5%) and haemorrhage (10.2%). Incident VA thrombosis was reported by 14.7% in 1 year. Independent risk factors for incident thrombosis were female gender and diabetes. Hospitalisation for VA related complications was reported by 31.4%. Few patients in Libya initiate HD with definitive VA, but most achieve it thereafter. Improved dialysis preparation and increased provision of surgical services are required to increase the proportion of patients initiating HD with definitive VA and should be a priority in rebuilding health services in Libya after the recent conflict.

  13. Influenza and pneumococcal vaccinations in dialysis patients in a London district general hospital.

    PubMed

    Wilmore, Stephanie M S; Philip, Keir E; Cambiano, Valentina; Bretherton, Christopher P; Harborne, Josephine E; Sharma, Aditi; Jayasena, Shyama D

    2014-02-01

    Patients on dialysis mount reduced immune responses compared with the general population. The Department of Health advises that these patients receive influenza and pneumococcal vaccinations at regular intervals-once yearly and every five years, respectively. This article investigates the uptake of these vaccinations in this patient population and seeks to examine factors that may influence vaccination status such as patient's language and presence of a general practitioner (GP) electronic vaccination reminder system. It also explores preferred site of vaccination for patients and GPs as these are primary care vaccinations yet patients have more frequent contact with their dialysis unit than their GP, blurring the boundaries between primary and specialized care. This is a retrospective study of all patients registered as dialysing at the North Middlesex University Hospital NHS Trust (NMUH) in September 2011. Information was obtained through GP letters, GP and patient questionnaires. Of 154 patients, 133 were included in the data analysis. Nineteen per cent were up-to-date with both vaccinations and 67% with their influenza vaccination. Fifty per cent had received the influenza vaccination in the last two consecutive years. Thirty per cent were not up-to-date with either vaccination. There was no evidence of a difference in uptake in 2009 (P = 0.7564) and in 2010 (P = 0.7435) among those who could and could not speak English. Twenty-five per cent of GPs and 58.6% of patients preferred vaccination to occur in the dialysis unit. Unfortunately a high number of GPs did not provide information on whether they used an electronic vaccination reminder but the analysis from the information provided by the few respondents did not reveal any correlation between the presence of an electronic reminder and vaccination status. Most dialysis patients were not up-to-date with both vaccinations. They were, however, more up-to-date with their influenza than their pneumococcal

  14. Nutritional assessment of elderly patients on dialysis: pitfalls and potentials for practice.

    PubMed

    Rodrigues, Juliana; Cuppari, Lilian; Campbell, Katrina L; Avesani, Carla Maria

    2017-03-22

    The chronic kidney disease (CKD) population is aging. Currently a high percentage of patients treated on dialysis are older than 65 years. As patients get older, several conditions contribute to the development of malnutrition, namely protein energy wasting (PEW), which may be compounded by nutritional disturbances associated with CKD and from the dialysis procedure. Therefore, elderly patients on dialysis are vulnerable to the development of PEW and awareness of the identification and subsequent management of nutritional status is of importance. In clinical practice, the nutritional assessment of patients on dialysis usually includes methods to assess PEW, such as the subjective global assessment, the malnutrition inflammation score, and anthropometric and laboratory parameters. Studies investigating measures of nutritional status specifically tailored to the elderly on dialysis are scarce. Therefore, the same methods and cutoffs used for the general adult population on dialysis are applied to the elderly. Considering this scenario, the aim of this review is to discuss specific considerations for nutritional assessment of elderly patients on dialysis addressing specific shortcomings on the interpretation of markers, in addition to providing clinical practice guidance to assess the nutritional status of elderly patients on dialysis. © The Author 2017. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.

  15. Dihydropyridine type calcium channel blocker-induced turbid dialysate in patients undergoing peritoneal dialysis.

    PubMed

    Yoshimoto, K; Saima, S; Nakamura, Y; Nakayama, M; Kubo, H; Kawaguchi, Y; Nishitani, H; Nakamura, Y; Yasui, A; Yokoyama, K; Kuriyama, S; Shirai, D; Kugiyama, A; Hayano, K; Fukui, H; Horigome, I; Amagasaki, Y; Tsubakihara, Y; Kamekawa, T; Ando, R; Tomura, S; Okamoto, R; Miwa, S; Koyama, T; Echizen, H

    1998-08-01

    We previously reported that manidipine, a new dihydropyridine type calcium channel blocker, produced chylous peritoneal dialysate being visually indistinguishable from infective peritonitis in 5 patients undergoing continuous ambulatory peritoneal dialysis (CAPD) [Yoshimoto et al. 1993]. To study whether such an adverse drug reaction would also be elicited by other commonly prescribed calcium channel blockers in CAPD patients, we have conducted postal inquiry to 15 collaborating hospitals and an institutional survey in International Medical Center of Japan as to the possible occurrence of calcium channel blocker-associated non-infective, turbid peritoneal dialysate in CAPD patients. Our diagnostic criteria for drug-induced turbidity of dialysate as a) it developed within 48 h after the administration of a newly introduced calcium channel blocker to the therapeutic regimen, b) absence of clinical symptoms of peritoneal inflammation (i.e., pyrexia, abdominal pain, nausea or vomiting), c) the fluid containing normal leukocyte counts and being negative for bacterial and fungal culture of the fluid, and d) it disappeared shortly after the withdrawal of the assumed causative agent. Results showed that 19 out of 251 CAPD patients given one of the calcium channel blockers developed non-infective turbid peritoneal dialysis that fulfilled all the above criteria. Four calcium channel blockers were suspected to be associated with the events: benidipine [2 out of 2 (100%) patients given the drug], manidipine [15 out of 36 (42%) patients], nisoldipine [1 out of 11 (9%) patients] and nifedipine [1 out of 159 (0.6%)] in descending order of frequency. None of the patients who received nicardipine, nilvadipine, nitrendipine, barnidipine and diltiazem (25, 7, 2, 1 and 8 patients, respectively) exhibited turbid dialysate. In conclusion, we consider that certain dihydropyridine type calcium channel blockers would cause turbid peritoneal dialysate being similar to that observed in

  16. Falsely Elevated Glucose Concentrations in Peritoneal Dialysis Patients Using Icodextrin.

    PubMed

    Dogan, Kübra; Kayalp, Damla; Ceylan, Gözde; Azak, Alper; Senes, Mehmet; Duranay, Murat; Yucel, Dogan

    2016-09-01

    Peritoneal dialysis (PD) is used as an alternative to hemodialysis in end-stage renal disease (ESRD). Icodextrin has been used as a hyperosmotic agent in PD. The aim of the study was to assess two different point-of-care testing (POCT) glucose strips, affected and not affected by icodextrin, with serum glucose concentrations of the patients using and not using icodextrin. Fifty-two chronic ambulatory peritoneal dialysis (CAPD) patients using icodextrin (Extraneal®) and 20 CAPD patients using another hyperosmotic fluid (Dianeal®) were included in the study. Duplicate capillary and serum glucose concentrations were measured with two different POCT glucose strips and central laboratory hexokinase method. Assay principles of glucose strips were based on glucose dehydrogenase-pyrroloquinoline quinone (GDH-PQQ) and a mutant variant of GDH (Mut Q-GDH). The results of both strips were compared with those of hexokinase method. Regression equations between POCT and hexokinase methods in icodextrin group were y = 2.55x + 1.12 mmol/l and y = 1.057x + 0.16 mmol/l for the GDH-PQQ and Mut Q-GDH methods, respectively. The mean difference between the results of hexokinase and those of GDH-PQQ and Mut Q-GDH in icodextrin group was 3.41 ± 1.56 and 0.72 ± 0.64 mmol/l, respectively. However, the mean differences were found much lower in the control group; 0.64 mmol/l for GDH-PQQ and 0.52 mmol/l for Mut Q-GDH. Compared to GDH-PQQ, glucose strips of Mut Q-GDH correlated better with hexokinase method in PD patients using icodextrin. © 2015 Wiley Periodicals, Inc.

  17. Obese and diabetic patients with end-stage renal disease: Peritoneal dialysis or hemodialysis?

    PubMed

    Ekart, Robert; Hojs, Radovan

    2016-07-01

    Obesity is a chronic disease that is increasingly prevalent around the world and is a well-recognized risk factor for type 2 diabetes and hypertension, leading causes of end-stage renal disease (ESRD). The obese diabetic patient with ESRD is a challenge for the nephrologist with regard to the type of renal replacement therapy that should be suggested and offered to the patient. There is no evidence that either peritoneal dialysis or hemodialysis is contraindicated in obese ESRD patients. In the literature, we can find a discrepancy in the impact of obesity on mortality among hemodialysis vs. peritoneal dialysis patients. Several studies in hemodialysis patients suggest that a higher BMI confers a survival advantage - the so-called "reverse epidemiology". In contrast, the literature among obese peritoneal dialysis patients is inconsistent, with various studies reporting an increased risk of death, no difference, or a decreased risk of death. Many of these studies only spanned across a few years, and this is probably too short of a time frame for a realistic assessment of obesity's impact on mortality in ESRD patients. The decision for dialysis modality in an obese diabetic patient with ESRD should be individualized. According to the results of published studies, we cannot suggest PD or HD as a better solution for all obese diabetic patients. The obese patient should be educated about all their dialysis options, including home dialysis therapies. In this review, the available literature related to the dialysis modality in obese patients with diabetes and ESRD was reviewed.

  18. Iron Supplementation and Mortality in Incident Dialysis Patients: An Observational Study

    PubMed Central

    Kronenberg, Florian; Neyer, Ulrich; Knoll, Florian; Lhotta, Karl; Weiss, Günter

    2014-01-01

    Background Studies on the association between iron supplementation and mortality in dialysis patients are rare and conflicting. Methods In our observational single-center cohort study (INVOR study) we prospectively studied 235 incident dialysis patients. Time-dependent Cox proportional hazards models using all measured laboratory values for up to 7.6 years were applied to study the association between iron supplementation and all-cause mortality, cardiovascular and sepsis-related mortality. Furthermore, the time-dependent association of ferritin levels with mortality in patients with normal C-reactive protein (CRP) levels (<0.5 mg/dL) and elevated CRP levels (≧0.5 mg/dL) was evaluated by using non-linear P-splines to allow flexible modeling of the association. Results One hundred and ninety-one (81.3%) patients received intravenous iron, 13 (5.5%) patients oral iron, whereas 31 (13.2%) patients were never supplemented with iron throughout the observation period. Eighty-two (35%) patients died during a median follow-up of 34 months, 38 patients due to cardiovascular events and 21 patients from sepsis. Baseline CRP levels were not different between patients with and without iron supplementation. However, baseline serum ferritin levels were lower in patients receiving iron during follow up (median 93 vs 251 ng/mL, p<0.001). Iron supplementation was associated with a significantly reduced all-cause mortality [HR (95%CI): 0.22 (0.08–0.58); p = 0.002] and a reduced cardiovascular and sepsis-related mortality [HR (95%CI): 0.31 (0.09–1.04); p = 0.06]. Increasing ferritin concentrations in patients with normal CRP were associated with a decreasing mortality, whereas in patients with elevated CRP values ferritin levels>800 ng/mL were linked with increased mortality. Conclusions Iron supplementation is associated with reduced all-cause mortality in incident dialysis patients. While serum ferritin levels up to 800 ng/mL appear to be safe, higher ferritin levels

  19. Encapsulating peritoneal sclerosis in a peritoneal dialysis patient presenting with complicated Mycobacterium fortuitum peritonitis.

    PubMed

    Simbli, Mohammed Amin; Niaz, Faraz A; Al-Wakeel, Jamal S

    2012-05-01

    Encapsulating peritoneal sclerosis (EPS) is a rare but serious complication seen in patients undergoing continuous ambulatory peritoneal dialysis (CAPD) or automated peritoneal dialysisAPD after prolonged duration on dialysis. Patients usally present with vague complaints of abdominal pain, vomitting, diarrhea, weight loss and change in peritoneal transport characte-ristics. High degree of suspicion is needed in PD patients who have been on dialysis for prolonged duration and have been using high-concentrated dialysis fluid. Mycobacterium fortuitum (MF) is a rapidly growing, non-tuberculous mycobacterium that has rarely been reported as a pathogen causing peritonits in patients on PD. We report a case of CAPD presenting with culture-negative peritonits, which, on specific culture, grew MF and, on radiological evaluation, showed diagnostic features of EPS.

  20. Outpatient Dialysis for Patients with AKI: A Policy Approach to Improving Care.

    PubMed

    Heung, Michael; Faubel, Sarah; Watnick, Suzanne; Cruz, Dinna N; Koyner, Jay L; Mour, Girish; Liu, Kathleen D; Cerda, Jorge; Okusa, Mark D; Lukaszewski, Mark; Vijayan, Anitha

    2015-10-07

    The rate of AKI requiring dialysis has increased significantly over the past decade in the United States. At the same time, survival from AKI seems to be improving, and thus, more patients with AKI are surviving to discharge while still requiring dialysis. Currently, the options for providing outpatient dialysis in patients with AKI are limited, particularly after a 2012 revised interpretation of the Centers for Medicare and Medicaid Services guidelines, which prohibited Medicare reimbursement for acute dialysis at ESRD facilities. This article provides a historical perspective on outpatient dialysis management of patients with AKI, reviews the current clinical landscape of care for these patients, and highlights key areas of knowledge deficit. Lastly, policy changes that have the opportunity to significantly improve the care of this at-risk population are suggested.

  1. Peritoneal Dialysis

    PubMed Central

    Al-Natour, Mohammed; Thompson, Dustin

    2016-01-01

    Peritoneal dialysis is becoming more important in the management of patients with end-stage renal disease. Because of the efforts of the “Fistula First Breakthrough Initiative,” dialysis venous access in the United States has become focused on promoting arteriovenous fistula creation and reducing the number of patients who start dialysis with a tunneled catheter. This is important because tunneled catheters can lead to infection, endocarditis, and early loss of more long-term access. When planned for, peritoneal dialysis can offer patients the opportunity to start dialysis at home without jeopardizing central access or the possibilities of eventual arteriovenous fistula creation. The purpose of this review is to highlight the indications, contraindications, and procedural methods for implanting peritoneal dialysis catheters in the interventional radiology suite. PMID:27011420

  2. Preferences for dialysis withdrawal and engagement in advance care planning within a diverse sample of dialysis patients.

    PubMed

    Kurella Tamura, Manjula; Goldstein, Mary K; Pérez-Stable, Eliseo J

    2010-01-01

    Rates of dialysis withdrawal are higher among the elderly and lower among Blacks, yet it is unknown whether preferences for withdrawal and engagement in advance care planning also vary by age and race or ethnicity. DESIGN, SETTING, PARTICIPANTS AND METHODS: We recruited 61 participants from two dialysis clinics to complete questionnaires regarding dialysis withdrawal preferences in five different health states. Engagement in advance care planning (end-of-life discussions), completion of advance directives and 'do not resuscitate' or 'do not intubate' (DNR/DNI) orders were ascertained by a questionnaire and from dialysis unit records. The mean age was 62 +/- 15 years; 38% were Black, 11% were Latino, 34% were White and 16% of participants were Asian. Blacks were less likely to prefer dialysis withdrawal as compared with Whites (odds ratio 0.16, 95% confidence interval 0.03-0.88) and other race/ethnicity groups, and this difference was not explained by age, education, comorbidity and other confounders. In contrast, older age was not associated with preferences for withdrawal. Rates of engagement in end-of-life discussions were higher than for documentation of advance care planning for all age and most race/ethnicity groups. Although younger participants and minorities were generally less likely to document treatment preferences as compared with older patients and Whites, they were not less likely to engage in end-of-life discussions. Preferences for withdrawal vary by race/ ethnicity, whereas the pattern of engagement in advance care planning varies by age and race/ethnicity. Knowledge of these differences may be useful for improving communication about end-of-life preferences and in implementing effective advance care planning strategies among diverse haemodialysis patients.

  3. 42 CFR 414.310 - Determination of reasonable charges for physician services furnished to renal dialysis patients.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... services furnished to renal dialysis patients. 414.310 Section 414.310 Public Health CENTERS FOR MEDICARE... Program § 414.310 Determination of reasonable charges for physician services furnished to renal dialysis patients. (a) Principle. Physician services furnished to renal dialysis patients are subject to payment if...

  4. 42 CFR 414.310 - Determination of reasonable charges for physician services furnished to renal dialysis patients.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... services furnished to renal dialysis patients. 414.310 Section 414.310 Public Health CENTERS FOR MEDICARE... Program § 414.310 Determination of reasonable charges for physician services furnished to renal dialysis patients. (a) Principle. Physician services furnished to renal dialysis patients are subject to payment if...

  5. 42 CFR 414.310 - Determination of reasonable charges for physician services furnished to renal dialysis patients.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... services furnished to renal dialysis patients. 414.310 Section 414.310 Public Health CENTERS FOR MEDICARE... Program § 414.310 Determination of reasonable charges for physician services furnished to renal dialysis patients. (a) Principle. Physician services furnished to renal dialysis patients are subject to payment if...

  6. Effect of statins on survival in patients undergoing dialysis access for end-stage renal disease.

    PubMed

    De Rango, Paola; Parente, Basso; Farchioni, Luca; Cieri, Enrico; Fiorucci, Beatrice; Pelliccia, Selena; Manzone, Alessandra; Simonte, Gioele; Lenti, Massimo

    2016-12-01

    The benefit of statin therapy in patients with advanced chronic kidney disease remains uncertain. Randomized trials have questioned the efficacy of the drug in improving outcomes for on-dialysis populations, and many patients with end-stage renal disease are not currently taking statins. This study aimed to investigate the impact of statin use on survival of patients with vascular access performed at a vascular center for chronic dialysis. Consecutive end-stage renal disease patients admitted for vascular access surgery in 2006 to 2013 were reviewed. Information on therapy was retrieved and patients on statins were compared to those who were not on statins. Primary endpoint was 5-year survival. Independent predictors of mortality were assessed with Cox regression analysis adjusting for covariates (ie, age, sex, hyperlipidemia, hypertension, cardiac disease, cerebrovascular disease, chronic obstructive pulmonary disease, obesity, diabetes, and statins). Three hundred fifty-nine patients (230 males; mean age 68.9 ± 13.7 years) receiving 554 vascular accesses were analyzed: 127 (35.4%) were on statins. Use of statins was more frequent in patients with hypertension (89.8% v 81%; P = .034), hyperlipidemia (52.4% v 6.2%; P < .0001), coronary disease (54.1% v 42.6%; P = .043), diabetes (39.4% v 21.6%; P = .001), and obesity (11.6% v 2.0%; P < .0001). Mean follow-up was 35 months. Kaplan-Meier survival rates at 3 and 5 years were 84.4% and 75.9% for patients taking statins and 77.0% and 65.1% for those not taking statins (P = .18). Cox regression analysis selected statins therapy as the only independent negative predictor (odds ratio = 0.55; 95% confidence interval = 0.32-0.95; P = .032) of mortality, while age was an independent positive predictor (odds ratio = 1.05; 95% confidence interval = 1.03-1.08; P < .0001). Vascular access patency was comparable in statin takers and those not taking statins (P = .60). Use of statins might halve the risk of all-cause mortality at

  7. Selection bias explains apparent differential mortality between dialysis modalities.

    PubMed

    Quinn, Robert R; Hux, Janet E; Oliver, Matthew J; Austin, Peter C; Tonelli, Marcello; Laupacis, Andreas

    2011-08-01

    The relative risk of death for patients treated with peritoneal dialysis compared with those treated with hemodialysis appears to change with duration of dialysis therapy. Patients who start dialysis urgently are at high risk for mortality and are treated almost exclusively with hemodialysis, introducing bias to such mortality comparisons. To better isolate the association between dialysis treatment modality and patient mortality, we examined the relative risk for mortality for peritoneal dialysis compared with hemodialysis among individuals who received ≥4 months of predialysis care and who started dialysis electively as outpatients. From a total of 32,285 individuals who received dialysis in Ontario, Canada during a nearly 8-year period, 6,573 patients met criteria for elective, outpatient initiation. We detected no difference in survival between peritoneal dialysis and hemodialysis after adjusting for relevant baseline characteristics. The relative risk of death did not change with duration of dialysis therapy in our primary analysis, but it did change with time when we defined our patient population using the more inclusive criteria typical of previous studies. These results suggest that peritoneal dialysis and hemodialysis associate with similar survival among incident dialysis patients who initiate dialysis electively, as outpatients, after at least 4 months of predialysis care. Selection bias, rather than an effect of the treatment itself, likely explains the previously described change in the relative risk of death over time between hemodialysis and peritoneal dialysis.

  8. Factors influencing skin autofluorescence of patients with peritoneal dialysis.

    PubMed

    Mácsai, Emília; Benke, A; Cseh, A; Vásárhelyi, B

    2012-06-01

    Skin autofluorescence (SAF) measurement is a simple, noninvasive method to assess tissue advanced glycation end products (AGE). In patients with end-stage renal disease and in those on hemodialysis AGE production is increased. Less is known about those treated with peritoneal dialysis (PD). In this study we tested if SAF is influenced by clinical and treatment characteristics in PD patients.This cross-sectional study included 198 PD patients (of those, 128 were on traditional glucose-based solutions and 70 patients were partially switched to icodextrin-based PD). SAF measurements were done with a specific AGE Reader device. The impact of patients' age, gender, current diabetes, duration of PD, cumulative glucose exposure, body mass index, smoking habits and use of icodextrin on SAF values were tested with multiple regression analysis.Our analysis revealed that patients' age, current diabetes and icodextrin use significantly increase patients' SAF values (p = 0.015, 0.012, 0.005, respectively). AGE exposure of PD patients with diabetes and on icodextrin solution is increased. Further investigation is required whether this finding is due to the icodextrin itself or for a still unspecified clinical characteristic of PD population treated with icodextrin.

  9. Risk of hypoglycemia during hemodialysis in diabetic patients is related to lower pre-dialysis glycemia.

    PubMed

    Burmeister, Jayme Eduardo; Miltersteiner, Diego da Rosa; Burmeister, Bruna Ortega; Campos, Juliana Fernandes

    2015-04-01

    To compare the occurrence of hypoglycemia during hemodialysis in chronic kidney disease diabetic patients who present different levels of pre-dialysis glycemia both when using dialysis solutions with and without glucose. Twenty type 2 diabetic patients in maintenance hemodialysis were submitted to three dialysis sessions (at a 7-day interval each) with dialysis solutions without glucose, with glucose at 55 mg/dL, and at 90 mg/dL subsequently. Blood glucose levels were measured immediately pre-dialysis and at 4 moments during the session, and values under 70 mg/dL were considered as hypoglycemia. Average pre-dialysis glycemia was lower in those who presented intra-dialytic hypoglycemia than in those who did not, both in glucose-free (140.4 ± 50.7 vs. 277.7 ± 91.0 mg/dL; p = 0.005; 95%CI: 46.4 to 228.1) and in glucose 55 mg/dL (89.5 ± 10.6 vs. 229.7 ± 105.0 mg/dL; p < 0.05; 95%CI: 9.8 to 270.5). In patients with pre-dialysis glycemia under 140 mg/dL, average intradialytic glycemia was significantly lower than pre-dialysis glycemia only when using glucose-free dialysate (p < 0.0001; 95%CI: 29.9 to 56.0 - t-test). Hypoglycemia during dialysis was observed only when using glucose-free or glucose-poor dialysis solutions. The use of glucose-free or glucose-poor dialysis solution presents a high risk of intradialytic hypoglycemia in diabetic renal patients, especially in those with presumed better glycemic control.

  10. Prevalence and Risk Factors of Lower Limb Amputation in Patients with End-Stage Renal Failure on Dialysis: A Systematic Review.

    PubMed

    Gilhotra, Rajit A; Rodrigues, Beverly T; Vangaveti, Venkat N; Malabu, Usman H

    2016-01-01

    Background. Renal dialysis has recently been recognised as a risk factor for lower limb amputation (LLA). However, exact rates and associated risk factors for the LLA are incompletely understood. Aim. Prevalence and risk factors of LLA in end-stage renal failure (ESRF) subjects on renal dialysis were investigated from the existing literature. Methods. Published data on the subject were derived from MEDLINE, PubMed, and Google Scholar search of English language literature from January 1, 1980, to July 31, 2015, using designated key words. Results. Seventy studies were identified out of which 6 full-text published studies were included in this systematic review of which 5 included patients on haemodialysis alone and one included patients on both haemodialysis and peritoneal dialysis. The reported findings on prevalence of amputation in the renal failure on dialysis cohort ranged from 1.7% to 13.4%. Five out of the six studies identified diabetes as the leading risk factor for amputation in subjects with ESRF on renal dialysis. Other risk factors identified were high haemoglobin A1c, elevated c-reactive protein, and low serum albumin. Conclusions. This review demonstrates high rate of LLA in ESRF patients receiving dialysis therapy. It has also identified diabetes and markers of inflammation as risk factors of amputation in ESRF subjects on dialysis.

  11. Prevalence and Risk Factors of Lower Limb Amputation in Patients with End-Stage Renal Failure on Dialysis: A Systematic Review

    PubMed Central

    Vangaveti, Venkat N.

    2016-01-01

    Background. Renal dialysis has recently been recognised as a risk factor for lower limb amputation (LLA). However, exact rates and associated risk factors for the LLA are incompletely understood. Aim. Prevalence and risk factors of LLA in end-stage renal failure (ESRF) subjects on renal dialysis were investigated from the existing literature. Methods. Published data on the subject were derived from MEDLINE, PubMed, and Google Scholar search of English language literature from January 1, 1980, to July 31, 2015, using designated key words. Results. Seventy studies were identified out of which 6 full-text published studies were included in this systematic review of which 5 included patients on haemodialysis alone and one included patients on both haemodialysis and peritoneal dialysis. The reported findings on prevalence of amputation in the renal failure on dialysis cohort ranged from 1.7% to 13.4%. Five out of the six studies identified diabetes as the leading risk factor for amputation in subjects with ESRF on renal dialysis. Other risk factors identified were high haemoglobin A1c, elevated c-reactive protein, and low serum albumin. Conclusions. This review demonstrates high rate of LLA in ESRF patients receiving dialysis therapy. It has also identified diabetes and markers of inflammation as risk factors of amputation in ESRF subjects on dialysis. PMID:27529033

  12. Patients with learning difficulties: outcome on peritoneal dialysis.

    PubMed

    Borràs, Mercè; Sorolla, Carol; Carrera, Dolores; Martín, Marisa; Villagrassa, Esther; Fernández, Elvira

    2006-01-01

    In the present study, we identified patients who had difficulties learning the minimum knowledge and skills required to carry out peritoneal dialysis (PD), and we compared the outcomes in this subgroup of patients with outcomes in the general PD population. We calculated the mean learning sessions needed by our total PD population during the training period. We then assigned patients to one of two groups a