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incremental dialysis

Li Yang, Seng Chuen Tan, Can Chen, Xingzhi Wang, Xinya Li, Xiaoyan Yang
PURPOSE: To conduct a cost-effectiveness analysis study of sevelamer versus calcium-based binders (CBBs) in treating hyperphosphatemia among patients with end-stage renal disease (ESRD) in China. METHODS: A decision-analytic model of a lifetime horizon was used for base case analysis from the payers' perspective. The transition probabilities between different health states were derived from survival analysis. The overall survival of CBBs was derived from the Dialysis Clinical Outcomes Revisited study for up to 44 months and a Weibull regression model was used to extrapolate the overall survival to a lifetime horizon...
October 14, 2016: Clinical Therapeutics
Hao Yan, Wei Fang, Aiwu Lin, Liou Cao, Zhaohui Ni, Jiaqi Qian
BACKGROUND: Incident patients treated with continuous ambulatory peritoneal dialysis (CAPD) are often prescribed either 3 or 4 exchanges per day. However, the effects on residual kidney function and clinical outcomes of 3 versus 4 exchanges are not known. STUDY DESIGN: Prospective, randomized, controlled, open-label study. SETTING & PARTICIPANTS: Incident CAPD patients aged 18 to 80 years with glomerular filtration rates (GFRs; mean of renal urea and creatinine clearance from a 24-hour urine collection) ≥ 2mL/min and urine volume ≥ 500mL/d...
October 14, 2016: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Francesco Gaetano Casino, Carlo Basile
BACKGROUND: The recent interest in incremental haemodialysis (HD) is hindered by the current prescription based on a fixed target model (FTM) for the total (dialytic + renal) equivalent continuous clearance (ECC). The latter is expressed either as standard Kt/V (stdKt/V), i.e. the pre-dialysis averaged concentration of urea-based ECC, or EKRc, i.e. the time averaged concentration-based ECC, corrected for volume (V) = 40 L. Accordingly, there are two different targets: stdKt/V = 2.3 volumes per week (v/wk) and EKRc = 13 mL/min/40 L...
October 14, 2016: Nephrology, Dialysis, Transplantation
Fabiana Gatti de Menezes, Rodrigo Martins Abreu, Alexander Itria
Introduction: Secondary hyperparathyroidism (SHPT) is a consequence of chronic kidney disease. The treatment at the Brazilian Unified Heath System (SUS) is performed with calcitriol, a drug which favors hypercalcemia and/or hyperphosphatemia, hindering the control of SHPT. Another option is paricalcitol, which causes parathormone (PTH) suppression faster than calcitriol, with minor changes in calcium-phosphorus product and calcium and phosphorus serum levels. Objective: This study aims to develop a cost-effectiveness analysis of paricalcitol versus calcitriol for patients in dialytic treatment with SHPT, from the SUS perspective...
July 2016: Jornal Brasileiro de Nefrologia: ʹorgão Oficial de Sociedades Brasileira e Latino-Americana de Nefrologia
Navdeep Tangri, Lesley A Inker, Brett Hiebert, Jenna Wong, David Naimark, David Kent, Andrew S Levey
BACKGROUND: Predicting the progression of chronic kidney disease (CKD) is vital for clinical decision making and patient-provider communication. We previously developed an accurate static prediction model that used single-timepoint measurements of demographic and laboratory variables. STUDY DESIGN: Development of a dynamic predictive model using demographic, clinical, and time-dependent laboratory data from a cohort of patients with CKD stages 3 to 5. SETTING & PARTICIPANTS: We studied 3,004 patients seen April 1, 2001, to December 31, 2009, in the outpatient CKD clinic of Sunnybrook Hospital in Toronto, Canada...
September 29, 2016: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Ji In Park, Jung Tak Park, Yong-Lim Kim, Shin-Wook Kang, Chul Woo Yang, Nam-Ho Kim, Yun Kyu Oh, Chun Soo Lim, Yon Su Kim, Jung Pyo Lee
BACKGROUND: Recent reports have suggested the possible benefit of beginning hemodialysis (HD) at a rate less frequent than three times weekly and incrementally increasing the dialysis dose. However, the data regarding the benefits and safety of incremental HD are insufficient. METHODS: We analyzed 927 patients with newly initiated HD from the Clinical Research Center for End-Stage Renal Disease cohort from 2008 to 2014. The patients were classified into a thrice-weekly initiation group or an incremental initiation group (one to two sessions per week) according to the frequency of HD per week at baseline...
September 28, 2016: Nephrology, Dialysis, Transplantation
Dilip U Makhija, Surrey Walton, Juan P Mora, Mauricio Sanabria
♦ Background: There is little information regarding the financial burden of peritonitis and the economic impact of continuous quality improvement (CQI) programs in peritoneal dialysis (PD) patients. The objectives of this study were to measure the costs of peritonitis, and determine the net savings of a PD CQI program in Colombia. ♦ Methods: The Renal Therapy Services (RTS) network in Colombia, along with Coomeva EPS, provided healthcare resource utilization data for PD patients with and without peritonitis between January 2012 and December 2013...
September 28, 2016: Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis
Anna Trisia Beby, Tom Cornelis, Raymund Zinck, Frank Xiaoqing Liu
INTRODUCTION: In the Netherlands, the current standard of care for treating patients with end-stage renal disease is three sessions of in-center hemodialysis (conventional ICHD). However, the literature indicates that high dose hemodialysis (high dose HD) may provide better health outcome such as survival and quality of life. The objective of this study was to determine the cost-effectiveness of high dose HD, both in-center and at home, in comparison to conventional ICHD from a Dutch payer's perspective over a 5 year period...
September 23, 2016: Advances in Therapy
Anastasia Markaki, Maria G Grammatikopoulou, Maria Venihaki, John Kyriazis, Kostas Perakis, Kostas Stylianou
OBJECTIVE: The aim of the study was to examine the prevalence of protein-energy wasting (PEW) in hemodialysis (HD) and peritoneal dialysis (PD) patients in our center and determine whether adiponectin and leptin are involved in the development of PEW. DESIGN: Prospective (18 months). SETTING: University Hospital of Heraklion, Crete, Greece. SUBJECTS: Seventy-four end-stage-renal-disease patients, 47 on HD and 27 on PD...
November 2016: Endocrinología y Nutrición: órgano de la Sociedad Española de Endocrinología y Nutrición
Kenji Iino, Hiroaki Miyata, Noboru Motomura, Go Watanabe, Shigeyuki Tomita, Hirofumi Takemura, Shinichi Takamoto
BACKGROUND: The present study aimed to determine whether aortic cross-clamp duration (ACCD) was directly related to postoperative morbidity and mortality rates and to identify the inflection point of ACCD for increased mortality and morbidity rates in patients who had undergone isolated aortic valve replacement (AVR) for aortic stenosis. METHODS: From the Japan Cardiovascular Surgery Database, we extracted data from 16,272 patients with AS who underwent isolated AVR between January 2008 and December 2012...
September 10, 2016: Annals of Thoracic Surgery
Yossef Namir, Matan J Cohen, Yosef S Haviv, Itzchak Slotki, Linda Shavit
BACKGROUND: Vitamin D (Vit D) deficiency plays a central role in the pathogenesis of chronic kidney disease (CKD) complications, both skeletal and nonskeletal. The purpose of this study was to examine whether 25(OH)D levels and supplementation with oral cholecalciferol (Vitamin D3 (Vit D3)) are associated with morbidity and mortality among patients with significant CKD. METHODS: CKD patients attending the nephrology clinic at Shaare Zedek Medical Center between July 1, 2008 and January 31, 2012, tested at least twice for 25(OH)D levels, were enrolled...
October 2016: Clinical Nephrology
Boaz Gedaliahu Samolsky Dekel, Gabriele Donati, Alessio Vasarri, Anna Laura Croci Chiocchini, Alberto Gori, Giuseppe Cavallari, Gianfranco Di Nino, Laura Mercolini, Michele Protti, Roberto Mandrioli, Rita Maria Melotti, Gaetano La Manna
OBJECTIVES: Opioids are the preferred analgesic drugs to treat severe chronic pain conditions among dialysis patients; however, knowledge about their dialyzability features is limited. Oxycodone is increasingly used for the treatment of chronic pain conditions as oral controlled release (CR) tablets; however, evidence about this drug and its metabolites' dialyzability is lacking. METHODS: We assessed, during 4-hour dialysis sessions, the effect of standard hemodialysis (HD) and online hemodiafiltration (HDF) methods on the plasma concentration of oxycodone and its metabolites in n = 20 chronic pain patients with end-stage renal disease who were stably treated with oral CR oxycodone...
September 2, 2016: Pain Practice: the Official Journal of World Institute of Pain
John T Daugirdas
BACKGROUND: The publicly available Solute Solver module allows calculation of a variety of two-pool urea kinetic measures of dialysis adequacy using pre- and postdialysis plasma urea and estimated dialyzer clearance or estimated urea distribution volumes as inputs. However, the existing program does not have a 'what if' module, which would estimate the plasma urea values as well as commonly used measures of hemodialysis adequacy for a patient with a given urea distribution volume and urea nitrogen generation rate dialyzed according to a particular dialysis schedule...
September 1, 2016: Nephrology, Dialysis, Transplantation
Massimo Sandrini, Valerio Vizzardi, Francesca Valerio, Sara Ravera, Luigi Manili, Roberto Zubani, Bernardo J A Lucca, Giovanni Cancarini
INTRODUCTION: Incremental dialysis consists in prescribing a dialysis dose aimed towards maintaining total solute clearance (renal + dialysis) near the targets set by guidelines. Incremental peritoneal dialysis (incrPD) is defined as one or two dwell-times per day on CAPD, whereas standard peritoneal dialysis (stPD) consists in three-four dwell-times per day. PATIENTS AND METHODS: Single-centre cohort study. Enrollement period: January 2002-December 2007; end of follow up (FU): December 2012...
August 31, 2016: Journal of Nephrology
Thomas A Golper
Incremental hemodialysis (incrHD) is not widely used nor is it well understood. In addition, and perhaps with more impact, governmental regulations in the United States and their consequential influences on dialysis provider organizations have made the practice of incrHD more difficult than traditional thrice weekly in-center HD. IncrHD is critically dependent on the amount of residual kidney function (RKF) as well as the individualized goals of end-stage renal disease (ESRD) management. RKF has to be assessed frequently and dialysis adjusted accordingly...
August 25, 2016: Seminars in Dialysis
Anna Mathew, Yoshitsugu Obi, Connie M Rhee, Joline L T Chen, Gaurang Shah, Wei-Ling Lau, Csaba P Kovesdy, Rajnish Mehrotra, Kamyar Kalantar-Zadeh
Most patients with end-stage renal disease in the United States are initiated on thrice-weekly hemodialysis (HD) regimens. However, an incremental approach to HD may provide several patient benefits. We tested whether initiation of incremental HD does or does not compromise survival compared with a conventional HD regimen. The survival of 434 incremental, 50,162 conventional, and 160 frequent HD patients were compared using Cox regression analysis after matching for demographic and comorbid factors in a longitudinal national cohort of adult incident HD patients enrolled between January 2007 and December 2011...
November 2016: Kidney International
Connie M Rhee
PURPOSE OF REVIEW: Hypothyroidism is highly prevalent in chronic kidney disease (CKD) patients, including those receiving dialysis. This review examines potential mechanistic links between thyroid and kidney disease; current evidence for hypothyroidism as a risk factor for de novo CKD and CKD progression; and studies of thyroid functional disorders, cardiovascular disease, and death in the CKD population. RECENT FINDINGS: Epidemiologic data have demonstrated an incrementally higher prevalence of hypothyroidism with increasing severity of kidney dysfunction...
October 2016: Current Opinion in Endocrinology, Diabetes, and Obesity
Benjamin O Yarnoff, Thomas J Hoerger, Siobhan A Simpson, Meda E Pavkov, Nilka R Burrows, Sundar S Shrestha, Desmond E Williams, Xiaohui Zhuo
BACKGROUND: Although major guidelines uniformly recommend iron supplementation and erythropoietin stimulating agents (ESAs) for managing chronic anemia in persons with chronic kidney disease (CKD), there are differences in the recommended hemoglobin (Hb) treatment target and no guidelines consider the costs or cost-effectiveness of treatment. In this study, we explored the most cost-effective Hb target for anemia treatment in persons with CKD stages 3-4. METHODS AND FINDINGS: The CKD Health Policy Model was populated with a synthetic cohort of persons over age 30 with prevalent CKD stages 3-4 (i...
2016: PloS One
Denis Fouque, Jing Chen, Wei Chen, Liliana Garneata, S J Hwang, Kamyar Kalantar-Zadeh, Joel D Kopple, William E Mitch, Giorgina Piccoli, Vladimir Teplan, Philippe Chauveau
BACKGROUND: Low protein diets (LPD) have long been prescribed to chronic kidney disease patients with the goals of improving metabolic abnormalities and postpone the start of maintenance dialysis. METHODS: We reviewed the recent literature addressing low protein diets supplemented with ketoacids/essential aminoacids prescribed during chronic kidney disease and their effects on metabolic, nutritional and renal parameters since 2013. RESULTS: We show new information on how to improve adherence to these diets, on metabolic improvement and delay of the dialysis needs, and preliminary data in chronic kidney disease associated pregnancy...
July 7, 2016: BMC Nephrology
Candice Torres de Melo Bezerra Cavalcante, Klébia Magalhães Castelo Branco, Valdester Cavalcante Pinto Júnior, Gdayllon Cavalcante Meneses, Fernanda Macedo de Oliveira Neves, Nayana Maria Gomes de Souza, Kiarelle Lourenço Penaforte, Alice Maria Costa Martins, Alexandre Braga Libório
OBJECTIVE: Acute kidney injury is a common occurrence after pediatric cardiac surgery and is associated with adverse patient outcomes. Syndecan-1 is a biomarker of endothelial glycocalyx damage, and its early increment after surgery can be associated with acute kidney injury. METHODS: We performed a prospective cohort study with 289 patients aged less than 18 years who underwent cardiac surgery at 1 reference institution. Postoperative plasma syndecan-1 was collected within the first 2 hours after cardiac surgery...
July 2016: Journal of Thoracic and Cardiovascular Surgery
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