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Maddux Franklin

Kevin E Chan, Robert P Giugliano, Manesh R Patel, Stuart Abramson, Meg Jardine, Sophia Zhao, Vlado Perkovic, Franklin W Maddux, Jonathan P Piccini
Nonvitamin K-dependent oral anticoagulant agents (NOACs) are currently recommended for patients with atrial fibrillation at risk for stroke. As a group, NOACs significantly reduce stroke, intracranial hemorrhage, and mortality, with lower to similar major bleeding rates compared with warfarin. All NOACs are dependent on the kidney for elimination, such that patients with creatinine clearance <25 ml/min were excluded from all the pivotal phase 3 NOAC trials. It therefore remains unclear how or if NOACs should be prescribed to patients with advanced chronic kidney disease and those on dialysis...
June 21, 2016: Journal of the American College of Cardiology
Sagar U Nigwekar, Sophia Zhao, Julia Wenger, Jeffrey L Hymes, Franklin W Maddux, Ravi I Thadhani, Kevin E Chan
Accurate identification of risk factors for calcific uremic arteriolopathy (CUA) is necessary to develop preventive strategies for this morbid disease. We investigated whether baseline factors recorded at hemodialysis initiation would identify patients at risk for future CUA in a matched case-control study using data from a large dialysis organization. Hemodialysis patients with newly diagnosed CUA (n=1030) between January 1, 2010, and December 31, 2014, were matched by age, sex, and race in a 1:2 ratio to hemodialysis patients without CUA (n=2060)...
April 14, 2016: Journal of the American Society of Nephrology: JASN
Andreja Marn Pernat, Vanja Peršič, Len Usvyat, Lynn Saunders, John Rogus, Franklin W Maddux, Eduardo Lacson, Peter Kotanko
OBJECTIVE: Patients with diabetes are at increased risk of foot ulcers, which may result in limb amputations. While regular foot care prevents ulcerations and amputation in those patients with diabetes not on dialysis, evidence is limited in diabetic hemodialysis patients. We investigated the association between the implementation of a routine foot check program in diabetic incident hemodialysis patients, and major lower limb amputations. METHODS: In 1/2008, monthly intradialytic foot checks were implemented as part of standard clinic care in all Fresenius Medical Care North America hemodialysis facilities...
2016: BMJ Open Diabetes Research & Care
Franklin W Maddux
The treatment of chronically ill patients with end stage renal disease (ESRD) receiving dialysis therapies has advanced greatly over the years and accomplished many successes in prolonging the life of patients with ESRD, yet has had considerable failures due to the inability to compensate for all functions of the kidneys. In addition, the focus to achieve quality goals for laboratories and vascular access measures may indicate a good quality of care from providers, but meeting these clinical and physiological goals may not fully maximize individual benefit to a patient, may not be aligned with the patient's care goals, and could conceivably impact negatively the patient's experience of care and quality of life...
March 2016: Seminars in Dialysis
Dugan W Maddux, Len A Usvyat, Daniel DeFalco, Peter Kotanko, Jeroen P Kooman, Frank M van der Sande, Franklin W Maddux
BACKGROUND: 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. METHODS: 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...
March 2016: Clinical Nephrology
Stephan Thijssen, Michelle M Y Wong, Len A Usvyat, Qingqing Xiao, Peter Kotanko, Franklin W Maddux
BACKGROUND AND OBJECTIVES: Dialysis patients have a high risk for inadequate nutrition. Their nutritional status is particularly susceptible to deterioration when faced with intercurrent events such as hospitalization. This study was conducted to improve the understanding of the temporal evolution of nutritional parameters as a foundation for rational and proactive nutritional intervention. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: A retrospective cohort study was performed to investigate the temporal evolution of nutritional parameters (serum albumin, serum phosphate, serum creatinine, equilibrated normalized protein catabolic rate, and interdialytic weight gain) and a composite nutritional score derived from these parameters, in two populations: (1) incident hemodialysis (HD) patients who started HD between January 2006 and December 2011 and were followed for up to 54 months (median 16...
September 4, 2015: Clinical Journal of the American Society of Nephrology: CJASN
Natascha J H Broers, Len A Usvyat, Jeroen P Kooman, Frank M van der Sande, Eduardo Lacson, Peter Kotanko, Franklin W Maddux
BACKGROUND/AIM: Physical component summary (PCS) and mental component summary (MCS) scores are associated with hospitalization and mortality in patients with end-stage renal disease. Most studies in these patients are cross-sectional in nature. This study aimed to assess the dynamics of health-related quality of life (HRQOL) over time, as well as determinants of changes in HRQOL. Also, the relation between changes in HRQOL with respect to both hospitalization and mortality was assessed...
2015: Nephron
Eric Weinhandl, Edward Constantini, Susan Everson, David Gilbertson, Suying Li, Craig Solid, Michael Anger, J Ganesh Bhat, Peter DeOreo, Mahesh Krishnan, Allen Nissenson, Doug Johnson, T Alp Ikizler, Franklin Maddux, John Sadler, Leanna Tyshler, Tom Parker, Brigitte Schiller, Barry Smith, Stan Lindenfeld, Allan J Collins
No abstract text is available yet for this article.
June 2015: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Mark E Williams, Neal Mittman, Lin Ma, Julia I Brennan, Ann Mooney, Curtis D Johnson, Chinu M Jani, Franklin W Maddux, Eduardo Lacson
The validity of hemoglobin A1c (HgbA1c) is undergoing increasing scrutiny in the advanced CKD/ESRD (chronic kidney disease/end-stage renal disease) population, where it appears to be discordant from other glycemic indices. In the Glycemic Indices in Dialysis Evaluation (GIDE) Study, we sought to assess correlation of HgbA1c with casual glucose, glycated albumin, and serum fructosamine in a large group of diabetic patients on dialysis. From 26 dialysis facilities in the United States, 1758 diabetic patients (hemodialysis = 1476, peritoneal dialysis = 282) were enrolled in the first quarter of 2013...
October 2015: Hemodialysis International
Kevin E Chan, Christopher Newton-Cheh, James F Gusella, Franklin W Maddux
Patients on dialysis are 20 times more likely to have a cardiac arrest compared with the general population. We considered whether inherited factors associate with cardiac arrest among patients on dialysis. From a sample of 647,457 patients on chronic dialysis, we identified 5117 pairs of patients who came from the same family. These patients were each matched to a control subject from the same population. McNemar's tests were used to compare the risk of cardiac arrest between the familial related and unrelated pairs...
November 2015: Journal of the American Society of Nephrology: JASN
Kevin E Chan, Elazer R Edelman, Julia B Wenger, Ravi I Thadhani, Franklin W Maddux
BACKGROUND: Dabigatran and rivaroxaban are new oral anticoagulants that are eliminated through the kidneys. Their use in dialysis patients is discouraged because these drugs can bioaccumulate to precipitate inadvertent bleeding. We wanted to determine whether prescription of dabigatran or rivaroxaban was occurring in the dialysis population and whether these practices were safe. METHODS AND RESULTS: Prevalence plots were used to describe the point prevalence (monthly) of dabigatran and rivaroxaban use among 29977 hemodialysis patients with atrial fibrillation...
March 17, 2015: Circulation
Franklin W Maddux, Allen R Nissenson
The medical director has been a part of the fabric of Medicare's ESRD program since entitlement was extended under Section 299I of Public Law 92-603, passed on October 30, 1972, and implemented with the Conditions for Coverage that set out rules for administration and oversight of the care provided in the dialysis facility. The role of the medical director has progressively increased over time to effectively extend to the physicians serving in this role both the responsibility and accountability for the performance and reliability related to the care provided in the dialysis facility...
February 6, 2015: Clinical Journal of the American Society of Nephrology: CJASN
Eduardo Lacson, Lisa Bruce, Nien-Chen Li, Ann Mooney, Franklin W Maddux
BACKGROUND AND OBJECTIVES: Recent studies demonstrated an association between depressive affect and higher mortality risk in incident hemodialysis patients. This study sought to determine whether an association also exists with hospitalization risk. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: All 8776 adult incident hemodialysis patients with Medical Outcomes Study Short Form 36 survey results treated in Fresenius Medical Care North America facilities in 2006 were followed for 1 year from the date of survey, and all hospitalization events lasting >24 hours were tracked...
October 7, 2014: Clinical Journal of the American Society of Nephrology: CJASN
Joseph Pulliam, Nien-Chen Li, Franklin Maddux, Raymond Hakim, Frederic O Finkelstein, Eduardo Lacson
BACKGROUND: Patterns of early outcomes in peritoneal dialysis (PD) are not well studied and dialysis providers need to establish a baseline of key outcomes for continuous quality improvement initiatives. STUDY DESIGN: Retrospective cohort study. SETTING & PARTICIPANTS: Incident PD patients from Fresenius Medical Care, North America from January 1 through December 31, 2009. FACTORS: Case-mix, comorbid illness, and baseline laboratory values...
November 2014: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Kevin E Chan, Ravi I Thadhani, Franklin W Maddux
Hemodialysis patients often do not attend their scheduled treatment session. We investigated factors associated with missed appointments and whether such nonadherence poses significant harm to patients and increases overall health care utilization in an observational analysis of 44 million hemodialysis treatments for 182,536 patients with ESRD in the United States. We assessed the risk of hospitalization, emergency room visit, or intensive-coronary care unit (ICU-CCU) admission in the 2 days after a missed treatment relative to the risk for patients who received hemodialysis...
November 2014: Journal of the American Society of Nephrology: JASN
Mahesh Krishnan, Steven M Brunelli, Franklin W Maddux, Thomas F Parker, Douglas Johnson, Allen R Nissenson, Allan Collins, Eduardo Lacson
The Centers for Medicare and Medicaid Services oversees the ESRD Quality Incentive Program to ensure that the highest quality of health care is provided by outpatient dialysis facilities that treat patients with ESRD. To that end, Centers for Medicare and Medicaid Services uses clinical performance measures to evaluate quality of care under a pay-for-performance or value-based purchasing model. Now more than ever, the ESRD therapeutic area serves as the vanguard of health care delivery. By translating medical evidence into clinical performance measures, the ESRD Prospective Payment System became the first disease-specific sector using the pay-for-performance model...
June 6, 2014: Clinical Journal of the American Society of Nephrology: CJASN
Franklin W Maddux, Stephen McMurray, Allen R Nissenson
Under the Patient Protection and Affordable Care Act of 2010, accountable care organizations (ACOs) will be the primary mechanism for achieving the dual goals of high-quality patient care at managed per capita costs. To achieve these goals in the newly emerging health care environment, the nephrology community must plan for and direct integrated delivery and coordination of renal care, focusing on population management. Even though the ESRD patient population is a complex group with comorbid conditions that may confound integration of care, the nephrology community has unique experience providing integrated care through ACO-like programs...
2013: Blood Purification
Jeffrey J Sands, Len A Usvyat, Terry Sullivan, Jonathan H Segal, Paul Zabetakis, Peter Kotanko, Franklin W Maddux, Jose A Diaz-Buxo
Intradialytic hypotension (IH) is a frequent complication of hemodialysis (HD) and is associated with increased patient mortality and cardiovascular events. We studied IH to determine its variability, correlates, and clinical impact in 13 outpatient HD facilities. Blood pressure was captured by machine download. IH was defined as >30 mmHg decrease in systolic blood pressure to <90 mmHg. Risk factors were assessed by logistic regression and hospitalization by Poisson regression. Time to death and first hospitalization were assessed using Kaplan-Meier analysis in patients completing >20 HD treatments...
April 2014: Hemodialysis International
Alex Rosenblum, Weiling Wang, Lynda K Ball, Carolyn Latham, Franklin W Maddux, Eduardo Lacson
BACKGROUND: The prevalence of central venous catheters (CVCs) for hemodialysis remains high and, despite infection-control protocols, predisposes to bloodstream infections (BSIs). STUDY DESIGN: Stratified, cluster-randomized, quality improvement initiative. SETTING & PARTICIPANTS: All in-center patients with a CVC within 211 facility pairs matched by region, facility size, and rate of positive blood cultures (January to March 2011) at Fresenius Medical Care, North America...
February 2014: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Mark E Williams, Rajesh Garg, Weiling Wang, Ronilda Lacson, Franklin Maddux, Eduardo Lacson
While hyperglycemia is central to the pathogenesis and management of diabetes mellitus, hypoglycemia and glucose variability also contribute to outcomes. We previously reported on the relationship of glycemic control to outcomes in a large population of diabetic end-stage renal disease (ESRD) patients. Recognizing that ESRD is a risk factor for severe hypoglycemia, we have now analyzed the association between glycosylated hemoglobin A1c (HgbA1c) levels and glycemic variability in those with hypoglycemia. This is a retrospective study of patients with diabetes enrolled in a large hemodialysis program...
April 2014: Hemodialysis International
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