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https://www.readbyqxmd.com/read/28441373/cost-effectiveness-analysis-of-interventions-to-reduce-risk-of-aspiration-in-elderly-cancer-survivors-residing-in-skilled-nursing-facilities
#1
S Mantravadi
BACKGROUND: Aspiration can occur in patients of any age group, but it can be prevented. The primary population at risk is made up of survivors of cancer because of their increased risk of mucositis, mucosal atrophy, and dysphagia associated with chemotherapy, radiotherapy, and the disease process itself. The rate of incidence of aspiration cannot be quantified, because minor cases of aspiration often go unreported. Sequelae ensuing from aspirations can include pneumonia, end-stage kidney disease, dialysis, and death...
April 2017: Cancer Control: Journal of the Moffitt Cancer Center
https://www.readbyqxmd.com/read/28421638/renal-replacement-therapy-and-incremental-hemodialysis-for-veterans-with-advanced-chronic-kidney-disease
#2
Kamyar Kalantar-Zadeh, Susan T Crowley, Srinivasan Beddhu, Joline L T Chen, John T Daugirdas, David S Goldfarb, Anna Jin, Csaba P Kovesdy, David J Leehey, Hamid Moradi, Sankar D Navaneethan, Keith C Norris, Yoshitsugu Obi, Ann O'Hare, Tariq Shafi, Elani Streja, Mark L Unruh, Tushar J Vachharajani, Steven Weisbord, Connie M Rhee
Each year approximately 13,000 Veterans transition to maintenance dialysis, mostly in the traditional form of thrice-weekly hemodialysis from the start. Among >6000 dialysis units nationwide, there are currently approximately 70 Veterans Affairs (VA) dialysis centers. Given this number of VA dialysis centers and their limited capacity, only 10% of all incident dialysis Veterans initiate treatment in a VA center. Evidence suggests that, among Veterans, the receipt of care within the VA system is associated with favorable outcomes, potentially because of the enhanced access to healthcare resources...
April 18, 2017: Seminars in Dialysis
https://www.readbyqxmd.com/read/28418614/efficacy-and-safety-of-low-dose-heparin-in-hemodialysis
#3
Mariana Murea, Gregory B Russell, Pirouz Daeihagh, Anita M Saran, Karan Pandya, Mark Cabrera, John M Burkart, Barry I Freedman
INTRODUCTION: The dose of unfractionated heparin (UFH) administered during hemodialysis (HD) varies widely. This prospective study evaluated the safety and efficacy of UFH dose de-escalation. METHODS: Sixty-six prevalent patients on HD receiving UFH per standard-dose protocol (load dose [LD] 50-75 units/kg, maintenance dose [MD] 500-1000 units/hour) had heparin prescription converted to low-dose protocol (start LD 15 units/kg and MD 500 units/hour; dose adjusted in small increments based on assessments of extracorporeal blood circuit)...
April 18, 2017: Hemodialysis International
https://www.readbyqxmd.com/read/28396534/aortic-brachial-arterial-stiffness-gradient-and-cardiovascular-risk-in-the-community-the-framingham-heart-study
#4
Teemu J Niiranen, Bindu Kalesan, Martin G Larson, Naomi M Hamburg, Emelia J Benjamin, Gary F Mitchell, Ramachandran S Vasan
A recent study reported that the aortic-brachial arterial stiffness gradient, defined as carotid-radial/carotid-femoral pulse wave velocity (PWV ratio), predicts all-cause mortality better than carotid-femoral pulse wave velocity (CFPWV) alone in dialysis patients. However, the prognostic significance of PWV ratio for cardiovascular disease (CVD) in the community remains unclear. Accordingly, we assessed the correlates and prognostic value of the PWV ratio in 2114 Framingham Heart Study participants (60±10 years; 56% women) free of overt CVD...
April 10, 2017: Hypertension
https://www.readbyqxmd.com/read/28391343/cost-effectiveness-of-eculizumab-treatment-after-kidney-transplantation-in-patients-with-atypical-haemolytic-uraemic-syndrome
#5
Jan A J G van den Brand, Jacobien C Verhave, Eddy M Adang, Jack F M Wetzels
Background: Kidney transplantation in patients with atypical haemolytic uraemic syndrome (aHUS) is frequently complicated by recurrence of aHUS, often resulting in graft loss. Eculizumab prophylaxis prevents recurrence, improving graft survival. An alternative treatment strategy has been proposed where eculizumab is administered upon recurrence. We combined available evidence and performed a cost-effectiveness analysis of these competing strategies. Methods: A cost-effectiveness analysis using a decision analytical approach with Markov chain analyses was used to compare alternatives for aHUS patients with end-stage renal disease (ESRD): (i) dialysis treatment, (ii) kidney transplantation, (iii) kidney transplantation with eculizumab therapy upon recurrence of aHUS, (iv) kidney transplantation with eculizumab induction consisting of 12 months of prophylaxis and (v) kidney transplantation with lifelong eculizumab prophylaxis...
January 1, 2017: Nephrology, Dialysis, Transplantation
https://www.readbyqxmd.com/read/28345136/twice-weekly-hemodialysis-in-china-can-it-be-a-better-option-for-initiation-or-maintenance-dialysis-therapy
#6
Yucheng Yan, Sylvia Ramirez, Shuchi Anand, Jiaqi Qian, Li Zuo
Cumulative evidence indicates it may be worthwhile revisiting the twice-weekly hemodialysis (HD) regimen as a valid option for individualized or incremental treatments for selected patients with end-stage renal disease. In this article, we will review the current evidences on the potential pros and cons of twice-weekly HD compared to thrice-weekly HD including China's experience in the practice of twice-weekly HD. A prudent patient selection and close dialysis adequacy monitoring might be necessary for this medical treatment choice...
March 26, 2017: Seminars in Dialysis
https://www.readbyqxmd.com/read/28337715/is-incremental-hemodialysis-ready-to-return-on-the-scene-from-empiricism-to-kinetic-modelling
#7
REVIEW
Carlo Basile, Francesco Gaetano Casino, Kamyar Kalantar-Zadeh
Most people who make the transition to maintenance dialysis therapy are treated with a fixed dose thrice-weekly hemodialysis regimen without considering their residual kidney function (RKF). The RKF provides 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, although these effects may be confounded by patient comorbidities...
March 23, 2017: Journal of Nephrology
https://www.readbyqxmd.com/read/28335077/introduction-to-the-critical-balance-residual-kidney-function-and-incremental-transition-to-dialysis
#8
Yoshitsugu Obi, Jason Chou, Kamyar Kalantar-Zadeh
No abstract text is available yet for this article.
March 23, 2017: Seminars in Dialysis
https://www.readbyqxmd.com/read/28295607/incremental-hemodialysis-the-university-of-california-irvine-experience
#9
Mehrdad Ghahremani-Ghajar, Vanessa Rojas-Bautista, Wei-Ling Lau, Madeleine Pahl, Miguel Hernandez, Anna Jin, Uttam Reddy, Jason Chou, Yoshitsugu Obi, Kamyar Kalantar-Zadeh, Connie M Rhee
Incremental hemodialysis has been examined as a viable hemodialysis regimen for selected end-stage renal disease (ESRD) patients. Preservation of residual kidney function (RKF) has been the driving impetus for this approach given its benefits upon the survival and quality of life of dialysis patients. While clinical practice guidelines recommend an incremental start of dialysis in peritoneal dialysis patients with substantial RKF, there remains little guidance with respect to incremental hemodialysis as an initial renal replacement therapy regimen...
March 14, 2017: Seminars in Dialysis
https://www.readbyqxmd.com/read/28291617/blood-pressure-before-initiation-of-maintenance-dialysis-and-subsequent-mortality
#10
Keiichi Sumida, Miklos Z Molnar, Praveen K Potukuchi, Fridtjof Thomas, Jun Ling Lu, Vanessa A Ravel, Melissa Soohoo, Connie M Rhee, Elani Streja, John J Sim, Kunihiro Yamagata, Kamyar Kalantar-Zadeh, Csaba P Kovesdy
BACKGROUND: Mortality is extremely high immediately after the transition to dialysis therapy, but the association of blood pressure (BP) before dialysis therapy initiation with mortality after dialysis therapy initiation remains unknown. STUDY DESIGN: Observational study. SETTING & PARTICIPANTS: 17,729 US veterans transitioning to dialysis therapy in October 2007 to September 2011, with a median follow-up of 2.0 years. PREDICTOR: Systolic (SBP) and diastolic BP (DBP) averaged over the last 1-year predialysis transition period as 6 (<120 to ≥160mmHg in 10-mmHg increments) and 5 (<60 to ≥90mmHg in 10-mmHg increments) categories, respectively, and as continuous measures...
March 10, 2017: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
https://www.readbyqxmd.com/read/28291581/a-real-world-cost-effectiveness-analysis-of-sevelamer-versus-calcium-acetate-in-korean-dialysis-patients
#11
Jang-Hee Cho, Hye Min Jang, Hee-Yeon Jung, Ji-Young Choi, Sun-Hee Park, Chan-Duck Kim, Chul Woo Yang, Dong-Chan Jin, Yong-Lim Kim
PURPOSE: Sevelamer, a noncalcium phosphate binder, has been shown to attenuate the progression of vascular calcification and improve survival in patients with chronic kidney disease undergoing dialysis compared with calcium-based binders. Using real-world data from a cohort study and the Health Insurance Review and Assessment Service database, we conducted a cost-effectiveness analysis comparing sevelamer with calcium acetate in dialysis patients from the perspective of the National Health Insurance Service in South Korea...
March 10, 2017: Clinical Therapeutics
https://www.readbyqxmd.com/read/28240423/nutritional-issues-with-incremental-dialysis-the-role-of-low-protein-diets
#12
Francesco Locatelli, Lucia Del Vecchio, Valeria Aicardi
A gentle start of dialysis is a welcome possibility for both patients and physicians. Incident dialysis patients often maintain residual kidney function (RKF) for a considerable period of time; the start of dialysis is often driven mainly by uremic symptoms. Recently, the combination of a low-protein diet, along with a less-frequent dialysis schedule, has regained interest as an alternative option in selected and motivated patients. In addition, there is renewed interest in a low-protein diet in patients with moderate to advanced chronic kidney disease (CKD)...
February 27, 2017: Seminars in Dialysis
https://www.readbyqxmd.com/read/28228464/current-uses-of-dietary-therapy-for-patients-with-far-advanced-ckd
#13
REVIEW
Norio Hanafusa, Bereket Tessema Lodebo, Joel D Kopple
For several decades, inquiry concerning dietary therapy for nondialyzed patients with CKD has focused mainly on its capability to retard progression of CKD. However, several studies published in recent years indicate that, independent of whether diet can delay progression of CKD, well designed low-protein diets may provide a number of benefits for people with advanced CKD who are close to requiring or actually in need of RRT. Dietary therapy may both maintain good nutritional status and safely delay the need for chronic dialysis in such patients, offering the possibility of improving quality of life and reducing health care costs...
February 22, 2017: Clinical Journal of the American Society of Nephrology: CJASN
https://www.readbyqxmd.com/read/28212787/application-of-a-pattern-of-incremental-haemodialysis-based-on-residual-renal-function-when-starting-renal-replacement-therapy
#14
José L Merino, Patricia Domínguez, Blanca Bueno, Yésika Amézquita, Beatriz Espejo, Vicente Paraíso
INTRODUCTION: The interest in the preservation of residual kidney function on starting renal replacement therapy (RRT) is very common in techniques such as peritoneal dialysis but less so in haemodialysis (HD). In our centre the pattern of incremental dialysis (2 HD/week) has been an option for a group of patients. Here we share our experience with this regimen from March 2008. MATERIAL AND METHODS: We included incident patients with residual diuresis >1,000ml/24h, clinical stability, absence of oedema, absence of hyperkalaemia >6...
January 2017: Nefrología: Publicación Oficial de la Sociedad Española Nefrologia
https://www.readbyqxmd.com/read/28203455/risk-balancing-of-cold-ischemic-time-against-night-shift-surgery-possibly-reduces-rates-of-reoperation-and-perioperative-graft-loss
#15
Nikos Emmanouilidis, Julius Boeckler, Bastian P Ringe, Alexander Kaltenborn, Frank Lehner, Hans Friedrich Koch, Jürgen Klempnauer, Harald Schrem
Background. This retrospective cohort study evaluates the advantages of risk balancing between prolonged cold ischemic time (CIT) and late night surgery. Methods. 1262 deceased donor kidney transplantations were analyzed. Multivariable regression was used to determine odds ratios (ORs) for reoperation, graft loss, delayed graft function (DGF), and discharge on dialysis. CIT was categorized according to a forward stepwise pattern ≤1h/>1h, ≤2h/>2h, ≤3h/>3h,…, ≤nh/>nh. ORs for DGF were plotted against CIT and a nonlinear regression function with best R(2) was identified...
2017: Journal of Transplantation
https://www.readbyqxmd.com/read/28185299/incremental-hemodialysis-a-european-perspective
#16
Kamonwan Tangvoraphonkchai, Andrew Davenport
Most patients initiating hemodialysis have residual renal function (RRF). Whereas RRF is monitored prior to commencing hemodialysis, once dialysis is started most centres simply rely on dialyzer urea clearance to determine adequate uremic toxin clearance and disregard the effect of RRF. However sustaining RRF is important for the dialysis patient, as RRF reduces inter-dialytic weight gains, increases middle molecule and protein bound toxin clearances and is associated with better quality of life assessments...
February 9, 2017: Seminars in Dialysis
https://www.readbyqxmd.com/read/28144977/changing-landscape-for-peritoneal-dialysis-optimizing-utilization
#17
Martin J Schreiber
The future growth of peritoneal dialysis (PD) will be directly linked to the shift in US healthcare to a value-based payment model due to PD's lower yearly cost, early survival advantage over in-center hemodialysis, and improved quality of life for patients treating their kidney disease in the home. Under this model, nephrology practices will need an increased focus on managing the transition from chronic kidney disease to end-stage renal disease (ESRD), providing patient education with the aim of accomplishing modality selection and access placement ahead of dialysis initiation...
March 2017: Seminars in Dialysis
https://www.readbyqxmd.com/read/28096442/kinetic-modeling-of-incremental-ambulatory-peritoneal-dialysis-exchanges
#18
Steven Guest, John K Leypoldt, Michelle Cassin, Martin Schreiber
♦ BACKGROUND: Incremental peritoneal dialysis (PD), the gradual introduction of dialysate exchanges at less than full-dose therapy, has been infrequently described in clinical reports. One concern with less than full-dose dialysis is whether urea clearance targets are achievable with an incremental regimen. In this report, we used a large database of PD patients, across all membrane transport types, and performed urea kinetic modeling determinations of possible incremental regimens for an individual membrane type...
March 2017: Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis
https://www.readbyqxmd.com/read/28090764/incremental-and-infrequent-hemodialysis-a-new-paradigm-for-both-dialysis-initiation-and-conservative-management
#19
Connie M Rhee, Mehrdad Ghahremani-Ghajar, Yoshitsugu Obi, Kamyar Kalantar-Zadeh
Registry or national dialysis data show that a sizeable proportion of contemporary dialysis patients have substantial levels of residual kidney function especially upon transitioning to dialysis therapy. However, among incident hemodialysis patients, the prevailing paradigm has been to initiate "full-dose" triweekly treatment schedules irrespective of native kidney function in most developed countries. Recognizing the benefits of residual kidney function upon the health and survival of dialysis patients, there has been growing interest in incremental hemodialysis, in which dialysis frequency and dose are tailored according to the degree of patients' residual kidney function...
June 2017: Panminerva Medica
https://www.readbyqxmd.com/read/28064159/prognostic-significance-of-pre-end-stage-renal-disease-serum-alkaline-phosphatase-for-post-end-stage-renal-disease-mortality-in-late-stage-chronic-kidney-disease-patients-transitioning-to-dialysis
#20
Keiichi Sumida, Miklos Z Molnar, Praveen K Potukuchi, Fridtjof Thomas, Jun Ling Lu, Yoshitsugu Obi, Connie M Rhee, Elani Streja, Kunihiro Yamagata, Kamyar Kalantar-Zadeh, Csaba P Kovesdy
BACKGROUND: Higher serum alkaline phosphatase (ALP) levels have been associated with excess mortality in patients with non-dialysis-dependent chronic kidney disease (NDD-CKD) and end-stage renal disease (ESRD). However, little is known about the impact of late-stage NDD-CKD ALP levels on outcomes after dialysis initiation. METHODS: Among 17 732 US veterans who transitioned to dialysis between October 2007 and September 2011, we examined the association of serum ALP levels averaged over the last 6 months of the pre-ESRD transition period ('prelude period') with all-cause, cardiovascular and infection-related mortality following dialysis initiation, using Cox (for all-cause mortality) and competing risk (for cause-specific mortality) regressions adjusted for demographics, comorbidities, medications, estimated glomerular filtration rate and serum albumin levels over the 6-month prelude period, and vascular access type at dialysis initiation...
January 7, 2017: Nephrology, Dialysis, Transplantation
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