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incremental dialysis

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https://www.readbyqxmd.com/read/29121886/the-strange-case-of-mr-h-starting-dialysis-at-90%C3%A2-years-of-age-clinical-choices-impact-on-ethical-decisions
#1
Giorgina Barbara Piccoli, Andreea Corina Sofronie, Jean-Philippe Coindre
BACKGROUND: Starting dialysis at an advanced age is a clinical challenge and an ethical dilemma. The advantages of starting dialysis at "extreme" ages are questionable as high dialysis-related morbidity induces a reflection on the cost- benefit ratio of this demanding and expensive treatment in a person that has a short life expectancy. Where clinical advantages are doubtful, ethical analysis can help us reach decisions and find adapted solutions. CASE PRESENTATION: Mr...
November 9, 2017: BMC Medical Ethics
https://www.readbyqxmd.com/read/29113779/hospital-acquired-lower-respiratory-tract-infections-among-high-risk-hospitalized-patients-in-a-tertiary-care-teaching-hospital-in-china-an-economic-burden-analysis
#2
Tianyuan Yan, Yingxia Li, Yu Sun, Haiyan Wang, Jingna Wang, Weili Wang, Yunhong Liu, Xiaohui Wu, Shuhui Wang
BACKGROUND: Data on the economic burden of hospital-acquired lower respiratory tract infection (LRTI) among high risk hospitalized patients are lacking in China. This study aims to fill this knowledge gap. METHODS: We used a prospective matched cohort design, comparing patients with LRTIs and 1:1 matched patients without LRTIs. Study period was from January 2013 to December 2015 analyzing inpatients from high risk wards - intensive care unit (ICU), dialysis, hematology, etc...
November 4, 2017: Journal of Infection and Public Health
https://www.readbyqxmd.com/read/29077786/intradialytic-hypertension-frequency-and-short-term-clinical-outcomes-among-individuals-receiving-maintenance-hemodialysis
#3
Magdalene M Assimon, Lily Wang, Jennifer E Flythe
Background: Intradialytic hypertension occurs in 5-20% of hemodialysis treatments. Observational data support an association between intradialytic hypertension and long-term mortality. However, the short-term consequences of recurrent intradialytic hypertension are unknown. Methods: Data were taken from a cohort of prevalent hemodialysis patients receiving treatment at a large U.S. dialysis organization on 01/01/2010. A retrospective cohort design with a 180-day baseline, 30-day exposure assessment and 30-day follow-up period was used to estimate the associations between intradialytic hypertension frequency and 30-day outcomes...
October 25, 2017: American Journal of Hypertension
https://www.readbyqxmd.com/read/29064172/measuring-residual-renal-function-for-hemodialysis-adequacy-is-there-an-easier-option
#4
REVIEW
Andrew Davenport
Most patients starting hemodialysis (HD) have residual renal function. As such, there has been increased interest in starting patients with less frequent and shorter dialysis session times. However, for this incremental approach to be successful, patients require regular monitoring of residual renal function, so that as residual renal function declines, the amount of HD is appropriately increased. Currently most dialysis centers rely on interdialytic urine collections. However, many patients find these inconvenient and there may be marked intrapatient variability due to compliance issues...
October 2017: Hemodialysis International
https://www.readbyqxmd.com/read/29063267/effect-of-post-nephrectomy-acute-kidney-injury-on-renal-outcome-a-retrospective-long-term-study
#5
Carlo Garofalo, Maria Elena Liberti, Domenico Russo, Luigi Russo, Giorgio Fuiano, Paola Cianfrone, Giuseppe Conte, Luca De Nicola, Roberto Minutolo, Silvio Borrelli
PURPOSE: The effects on renal prognosis of acute kidney injury after elective unilateral nephrectomy are ill-defined. We evaluated as whether post-operative acute kidney injury modifies renal outcome over the long term. METHODS: This is a retrospective study examining all consecutive adult patients referred to three Nephrology Units and that had previously undergone elective unilateral nephrectomy. We evaluated the association of post-nephrectomy acute kidney injury with the combined renal outcome of chronic dialysis requirement, ≥ 40% decline in glomerular filtration rate or new-onset severe proteinuria (> 500 mg/24 h)...
October 23, 2017: World Journal of Urology
https://www.readbyqxmd.com/read/29051143/health-care-costs-associated-with-aki
#6
David Collister, Neesh Pannu, Feng Ye, Matthew James, Brenda Hemmelgarn, Betty Chui, Braden Manns, Scott Klarenbach
BACKGROUND AND OBJECTIVES: An understanding of the health care resource use associated with AKI is needed to frame the investment and cost-effectiveness of strategies to prevent AKI and promote kidney recovery. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We assembled population-based cohort of adults hospitalized in Alberta between November of 2002 and March of 2009 without ESRD or an eGFR<15 ml/min per 1.73 m(2). Outpatient serum creatinine measurements 6 months preceding admission defined baseline kidney function, and serum creatinine during the first 14 days of hospitalization defined Acute Kidney Injury Network stage; kidney recovery defined as serum creatinine within 25% of baseline and independence from dialysis was assessed at 90 days after AKI...
November 7, 2017: Clinical Journal of the American Society of Nephrology: CJASN
https://www.readbyqxmd.com/read/29050623/death-and-dialysis-after-transcatheter-aortic-valve-replacement-an-analysis-of-the-sts-acc-tvt-registry
#7
James W Hansen, Andrew Foy, Pradeep Yadav, Ian C Gilchrist, Mark Kozak, Amanda Stebbins, Roland Matsouaka, Sreekanth Vemulapalli, Alice Wang, Dee Dee Wang, Marvin H Eng, Adam B Greenbaum, William O O'Neill
OBJECTIVES: The authors sought to elucidate the true incidence of renal replacement therapy (RRT) after transcatheter aortic valve replacement (TAVR). BACKGROUND: There is a wide discrepancy in the reported rate of RRT after TAVR (1.4% to 40%). The true incidence of RRT after TAVR is unknown. METHODS: The STS/ACC TVT (Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy) registry was linked to the Centers for Medicare & Medicaid database to identify all patients that underwent TAVR from November 2011 through September 2015 and their outcomes...
October 23, 2017: JACC. Cardiovascular Interventions
https://www.readbyqxmd.com/read/29033594/cost-effectiveness-analysis-of-intravenous-ferumoxytol-for-the-treatment-of-iron-deficiency-anemia-in-adult-patients-with-non-dialysis-dependent-chronic-kidney-disease-in-the-usa
#8
Naomi V Dahl, Robert F Kaper, William E Strauss, Frank A Corvino, Marko Zivkovic
OBJECTIVE: Ferumoxytol has demonstrated superior efficacy compared with oral iron in treating iron deficiency anemia in chronic kidney disease (CKD) patients. However, an economic evaluation of ferumoxytol has not been conducted. The aim of this study was to analyze the cost-effectiveness of treating iron deficiency anemia in adult non-dialysis-dependent CKD patients with ferumoxytol as compared with oral iron, alone or in combination with erythropoietin-stimulating agents (ESAs). METHODS: A decision analytic model compared health outcomes and costs associated with 5-week outpatient treatment of adult non-dialysis-dependent CKD patients with ferumoxytol or oral iron, each as monotherapy or in combination with ESAs in the USA...
2017: ClinicoEconomics and Outcomes Research: CEOR
https://www.readbyqxmd.com/read/29020957/social-disparities-in-the-prevalence-of-diabetes-in-australia-and-in-the-development-of-end-stage-renal-disease-due-to-diabetes-for-aboriginal-and-torres-strait-islanders-in-australia-and-maori-and-pacific-islanders-in-new-zealand
#9
Kathleen Hill, Paul Ward, Blair S Grace, Jonathan Gleadle
BACKGROUND: Disparities in health status occur between people with differing socioeconomic status and disadvantaged groups usually have the highest risk exposure and the worst health outcome. We sought to examine the social disparities in the population prevalence of diabetes and in the development of treated end stage renal disease due to type 1 diabetes which has not previously been studied in Australia and New Zealand in isolation from type 2 diabetes. METHODS: This observational study examined the population prevalence of diabetes in a sample of the Australian population (7,434,492) using data from the National Diabetes Services Scheme and of treated end stage renal disease due to diabetes using data from the Australian and New Zealand Dialysis and Transplant Registry...
October 11, 2017: BMC Public Health
https://www.readbyqxmd.com/read/28992335/how-to-set-the-stage-for-a-full-fledged-clinical-trial-testing-incremental-haemodialysis
#10
Francesco Gaetano Casino, Carlo Basile
Most people who make the transition to maintenance haemodialysis (HD) therapy are treated with a fixed dose of thrice-weekly HD (3HD/week) regimen without consideration of their residual kidney function (RKF). The RKF provides an effective and naturally continuous clearance of both small and middle molecules, plays a major role in metabolic homeostasis, nutritional status and cardiovascular health, and aids in fluid management. The RKF is associated with better patient survival and greater health-related quality of life...
July 21, 2017: Nephrology, Dialysis, Transplantation
https://www.readbyqxmd.com/read/28978530/tgf-%C3%AE-1-vegf-a-pathway-induces-neoangiogenesis-with-peritoneal-fibrosis-in-patients-undergoing-peritoneal-dialysis
#11
Tetsuyoshi Kariya, Hayato Nishimura, Masashi Mizuno, Yasuhiro Suzuki, Yoshihisa Matsukawa, Fumiko Sakata, Shoichi Maruyama, Yoshifumi Takei, Yasuhiko Ito
The characteristic features of chronic peritoneal injury with peritoneal dialysis (PD) are submesothelial fibrosis and neoangiogenesis. Transforming growth factor (TGF)-β and vascular endothelial growth factor (VEGF)-A are the main mediators of fibrosis and neoangiogenesis, respectively; however, the effect of the interaction between them on the peritoneum is not well known. In this study, we investigated the relationship between TGF-β1 and VEGF-A in inducing peritoneal fibrosis using human tissues and dialysate, cultured cells, and animal models...
October 4, 2017: American Journal of Physiology. Renal Physiology
https://www.readbyqxmd.com/read/28970364/physical-function-and-physical-activity-in-peritoneal-dialysis-patients
#12
Patricia Painter, Adhish Agarwal, Micah Drummond
BACKGROUND: Physical functioning (PF) and physical activity (PA) are low in patients treated with maintenance hemodialysis (MHD). Little information exists on this topic in patients treated with peritoneal dialysis (PD). The objective of this study was to compare PF and PA in patients with Stage-5 chronic kidney disease (CKD) treated with PD and in-center MHD. METHODS: Physical functioning was measured in 45 prevalent PD patients using standard physical performance measures that include gait speed, chair stand, standing balance, 6-minute-walk, incremental shuttle walk and self-reported PF using the short form (SF)-36 questionnaire...
September 28, 2017: Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis
https://www.readbyqxmd.com/read/28970363/comparison-of-change-in-peritoneal-function-in-patients-on-continuous-ambulatory-pd-vs-automated-pd
#13
Nasreen Samad, Stanley Fan
BACKGROUND: Patients on automated peritoneal dialysis (APD) may have greater exposure to glucose in the PD fluid than those on continuous ambulatory PD (CAPD). If this causes long-term damage to the peritoneal membrane, it will have implications for a patient's choice of modality. METHODS: Membrane function of long-term APD or CAPD patients was followed prospectively. The data were collected from electronic patient records in our unit from 2000 to 2014. The rate of change in membrane transport status (D/Pcr) and ultrafiltration (UF4) for each patient was calculated using the least square regression line equation...
September 28, 2017: Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis
https://www.readbyqxmd.com/read/28941608/economic-evaluation-of-left-ventricular-assist-devices-for-patients-with-end-stage-heart-failure-who-are-ineligible-for-cardiac-transplantation
#14
MULTICENTER STUDY
Derek S Chew, Braden Manns, Robert J H Miller, Nakul Sharma, Derek V Exner
BACKGROUND: Continuous flow (CF) left ventricular assist devices (LVADs) improve survival in end-stage heart failure patients who are ineligible for cardiac transplantation. Their use in this population (referred to as destination therapy) is increasing in many countries, yet they are not routinely funded for this indication in Canada. We assessed the cost-effectiveness of destination therapy CF-LVADs from the perspective of the Canadian health care payer. METHODS: A Markov model was used to project the outcomes and costs of 2 treatment pathways, CF-LVAD implantation and medical management alone, in an end-stage heart failure patient cohort ineligible for transplantation...
October 2017: Canadian Journal of Cardiology
https://www.readbyqxmd.com/read/28910802/effects-of-expanded-hemodialysis-therapy-on-clinical-outcomes
#15
Sandip Mitra, Kunaal Kharbanda
The invention of dialysis has been a phenomenal advance in the treatment of kidney failure. The introduction of artificial kidneys in clinical care remains one of the most successful lifesaving interventions in modern medicine. Its glory, however, has been tempered by poor long-term outcomes and a negative qualitative impact on the lives of patients who suffer from an extremely complex, burdensome, and restricted life on dialysis. There remains a huge gap in patient well-being and outcomes between artificial kidney treatments and kidney transplantation...
2017: Contributions to Nephrology
https://www.readbyqxmd.com/read/28902726/incremental-dialysis-review-of-recent-literature
#16
Thomas A Golper
PURPOSE OF REVIEW: There are clinical, physiological, financial, and practical reasons to perform incremental hemodialysis in selected patients, incident to end-stage renal disease. Recent papers inform us further, especially in the large database studies. RECENT FINDINGS: Small studies suggested, then a larger study corroborated, that incremental hemodialysis was associated with preservation of residual kidney function whenever compared with conventional hemodialysis...
November 2017: Current Opinion in Nephrology and Hypertension
https://www.readbyqxmd.com/read/28871391/hemofiltration-induces-generation-of-leukocyte-derived-cd31-cd41-microvesicles-in-sepsis
#17
Georg Franz Lehner, Ulrich Harler, Clemens Feistritzer, Viktoria Maria Haller, Julia Hasslacher, Romuald Bellmann, Michael Joannidis
BACKGROUND: Microvesicles (MV) are extracellular vesicles known to be associated with cellular activation and inflammation. Hemofiltration is an effective blood purification technique for patients with renal failure and possibly also eliminates inflammatory mediators in the setting of sepsis. On the other hand, proinflammatory stimuli are induced by blood contacting the artificial membrane during extracorporeal blood purification. In chronic dialysis patients a systemic increase in MV has been described...
September 4, 2017: Annals of Intensive Care
https://www.readbyqxmd.com/read/28810244/increasing-haemodialytic-clearances-as-residual-renal-function-declines-an-incremental-approach
#18
Kamonwan Tangvoraphonkchai, Andrew Davenport
Many patients with chronic kidney disease start undergoing thrice-weekly haemodialysis (HD), aiming for an HD sessional dialyzer urea clearance target, irrespective of whether they have residual renal function (RRF). While increasing sessional dialyzer urea clearance above a target of 1.2 has not been shown to improve patient survival, it has been shown that the preservation of RRF improves patient self-reported outcomes and survival. Observational studies have suggested that initiating twice-weekly HD schedules leads to greater preservation of RRF...
2017: Blood Purification
https://www.readbyqxmd.com/read/28795142/plasma-proenkephalin-and-poor-long-term-outcome-in-renal-transplant-recipients
#19
Lyanne M Kieneker, Oliver Hartmann, Joachim Struck, Andreas Bergmann, Ron T Gansevoort, Michel M Joosten, Else van den Berg, Rudolf A de Boer, Stephan J L Bakker
BACKGROUND: Proenkephalin (pro-ENK), a stable and reliable surrogate marker for unstable enkephalins, was found to be associated with acute kidney injury and chronic renal failure in previous studies. We aimed to investigate whether pro-ENK is linked to chronic kidney injury and poor long-term outcome in renal transplant recipients (RTR). METHODS: We included 664 stable RTR and 95 healthy kidney donors. Pro-ENK was measured in plasma with a double monoclonal sandwich immunoassay...
August 2017: Transplantation Direct
https://www.readbyqxmd.com/read/28761233/measured-glomerular-filtration-rate-at-dialysis-initiation-and-clinical-outcomes-of-indian-peritoneal-dialysis-patients
#20
N Prasad, M R Patel, A Chandra, D Rangaswamy, A Sinha, D Bhadauria, R K Sharma, A Kaul, A Gupta
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...
July 2017: Indian Journal of Nephrology
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