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Elderly dialysis

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https://www.readbyqxmd.com/read/29791896/deterioration-of-cortical-bone-microarchitecture-critical-component-of-renal-osteodystrophy-evaluation
#1
Ashish K Sharma, Nigel D Toussaint, Rosemary Masterson, Stephen G Holt, Chamith S Rajapakse, Peter R Ebeling, Sindhu T Mohanty, Paul Baldock, Grahame J Elder
BACKGROUND: Cortical bone is a significant determinant of bone strength and its deterioration contributes to bone fragility. Thin cortices and increased cortical porosity have been noted in patients with chronic kidney disease (CKD), but the "Turnover Mineralization Volume" classification of renal osteodystrophy does not emphasize cortical bone as a key parameter. We aimed to assess trabecular and cortical bone microarchitecture by histomorphometry and micro-CT in patients with CKD G5 and 5D (dialysis)...
May 23, 2018: American Journal of Nephrology
https://www.readbyqxmd.com/read/29785661/atrial-fibrillation-in-dialysis-patients-is-there-a-place-for-non-vitamin-k-antagonist-oral-anticoagulants
#2
REVIEW
Elzbieta Mlodawska, Paulina Lopatowska, Jolanta Malyszko, Maciej Banach, Bożena Sobkowicz, Adrian Covic, Anna Tomaszuk-Kazberuk
Atrial fibrillation (AF) occurs approximately in 3% of general population, with greater prevalence in elderly. Non-vitamin K-dependent oral anticoagulant agents (NOACs) according to the current European guidelines are recommended for patients with AF at high risk for stroke as a first-choice treatment. NOACs are not inferior to warfarin or some of them are better than warfarin in reducing the rate of ischemic stroke. Moreover, they significantly reduce the rate of intracranial hemorrhages, major bleedings, and mortality compared with warfarin...
May 21, 2018: International Urology and Nephrology
https://www.readbyqxmd.com/read/29776756/sex-hormone-binding-globulin-is-a-biomarker-associated-with-nonvertebral-fracture-in-men-on-dialysis-therapy
#3
Jasna Aleksova, Phillip Wong, Robert McLachlan, Kay Weng Choy, Peter R Ebeling, Frances Milat, Grahame J Elder
Gonadal hormones impact bone health and higher values of sex hormone-binding globulin (SHBG) have been independently associated with fracture risk in men without chronic kidney disease. People with chronic kidney disease have a greatly increased fracture risk, and gonadal dysfunction is common in men receiving dialysis treatment. Nevertheless, in these men the effect of gonadal steroids and SHBG on bone mineral density (BMD) and fracture risk is unknown. Here we investigate relationships between gonadal steroids, SHBG, BMD and fracture in men on long-term dialysis therapy, awaiting kidney or simultaneous pancreas kidney transplantation...
May 15, 2018: Kidney International
https://www.readbyqxmd.com/read/29775762/aortic-vascular-calcification-is-inversely-associated-with-the-trabecular-bone-score-in-patients-receiving-dialysis
#4
Jasna Aleksova, Samantha Kurniawan, Mirna Vucak-Dzumhur, Peter Kerr, Peter R Ebeling, Frances Milat, Grahame J Elder
INTRODUCTION: Progressive chronic kidney disease (CKD) confers a marked increase in risk for vascular calcification, cardiovascular disease, fracture and mortality, with likely contributing factors including dysregulated bone metabolism and mineral homeostasis. In general population studies, increased vascular calcification is directly related to mortality and inversely related to bone mineral density (BMD) measured by dual-energy X-ray absorptiometry (DXA). In patients with CKD, abnormalities in turnover, mineralization and bone volume, reduce the ability of DXA to predict fracture...
May 15, 2018: Bone
https://www.readbyqxmd.com/read/29750636/outcomes-of-very-elderly-treated-with-dialysis-for-acute-kidney-injury
#5
Ezra Gabbay, Yehudit Zangi, Alon Bnayah, Jawad Atrash, Itzchak Slotki, Linda Shavit
BACKGROUND: The factors that determine prognosis in elderly patients with dialysis-requiring acute kidney injury (AKI-D) is uncertain. The purpose of this study was to examine predictors of in-hospital mortality in these patients. MATERIALS AND METHODS: A retrospective, single-center study of hospitalized patients ≥ 70 years old with AKI-D. Clinical and demographic variables were compared between survivors and non-survivors, independent predictors of hospital mortality were identified by logistic regression...
May 11, 2018: Clinical Nephrology
https://www.readbyqxmd.com/read/29736929/determinants-of-regret-in-elderly-dialysis-patients
#6
Edlyn Gui Fang Tan, Irene Teo, Eric A Finkelstein, Choong Meng Chan
BACKGROUND: In Singapore, most elderly end stage renal disease (ESRD) patients choose dialysis over palliative management. However, dialysis may not be the optimal treatment option given only moderate survival benefits and high costs and treatment burden compared to non-dialysis management. Elderly patients may therefore come to regret this decision. This study investigated (1) extent of patients' decision regret after starting dialysis, and (2) potentially modifiable predictors of regret: satisfaction with chronic kidney disease education, decisional conflict, and decision-making involvement...
May 7, 2018: Nephrology
https://www.readbyqxmd.com/read/29736915/planning-and-evaluation-for-vascular-access-in-the-elderly
#7
Candice Halinski, Holly M Koncicki
Vascular access is of vital importance for patients requiring dialysis therapies. AV fistulas have been endorsed by many professional societies as the access of choice, however, subsequent creation does not go without consequences. As the population ages and patients become more medically complex, access failure has become a major cause of treatment complication. For the elderly, this is especially true and there are multiple decision points that require careful reflection before an AVF is placed. This article reviews access considerations for AVF placement in the elderly population and considers the possibility that the fistula first approach to vascular access should not be an absolute...
May 8, 2018: Seminars in Dialysis
https://www.readbyqxmd.com/read/29734155/role-of-frailty-on-outcomes-of-dialysis-patients
#8
Kosaku Nitta, Norio Hanafusa, Ken Tsuchiya
Frailty is a clinical state in which there is an increase in the individual's vulnerability to developing increased dependency and/or mortality when exposed to a stressor. Since the mean age of dialysis patients is increasing worldwide, frailty has recently come to be considered one of the risk factors for mortality in the older dialysis population. The prevalence of frailty among dialysis patients has ranged from 3.0- to 10-fold higher than in community-dwelling elderly, depending on the method of assessing frailty and patient characteristics...
2018: Contributions to Nephrology
https://www.readbyqxmd.com/read/29731493/current-practice-and-outcomes-of-peritoneal-dialysis-in-the-nippon-medical-school-musashi-kosugi-hospital
#9
Yuichiro Sumi, Yukinao Sakai, Koji Mugishima, Anna Suzuki, Yusuke Otsuka, Tomoyuki Otsuka, Shuichi Tsuruoka
INTRODUCTION: Various innovations for preventing complications and improving a patient's quality of life have been implemented for peritoneal dialysis (PD), which was established in Japan approximately 35 years ago and introduced at our hospital in 1999. Herein, we investigate the outcomes of patients undergoing PD to identify approaches for improving their long-term prognosis. METHODS: This retrospective study included 114 patients who underwent PD between September 1999 and August 2017 and included various parameters such as patient survival rate, technical survival rate, cause (s) of PD withdrawal, incidence of peritonitis, dialysis duration, and change in residual renal function (RRF)...
2018: Journal of Nippon Medical School, Nippon Ika Daigaku Zasshi
https://www.readbyqxmd.com/read/29703177/functional-status-pre-dialysis-health-and-clinical-outcomes-among-elderly-dialysis-patients
#10
Silvi Shah, Anthony C Leonard, Charuhas V Thakar
BACKGROUND: Elderly patients comprise the fastest growing population initiating dialysis in United States. The impact of poor functional status and pre-dialysis health status on clinical outcomes in elderly dialysis patients is not well studied. METHODS: We studied a retrospective cohort of 49,645 incident end stage renal disease patients that initiated dialysis between January 1, 2008 and December 31, 2008 from the United States Renal Data System with linked Medicare data covering at least 2 years prior to dialysis initiation...
April 27, 2018: BMC Nephrology
https://www.readbyqxmd.com/read/29684185/factors-associating-with-differences-in-the-incidence-of-renal-replacement-therapy-among-elderly-data-from-the-era-edta-registry
#11
Jaakko Helve, Anneke Kramer, Jose M Abad-Diez, Cecile Couchoud, Gabriel de Arriba, Johan de Meester, Marie Evans, Florence Glaudet, Carola Grönhagen-Riska, James G Heaf, Visnja Lezaic, Maurizio Nordio, Runolfur Palsson, Ülle Pechter, Halima Resic, Rafael Santamaria, Carmen Santiuste de Pablos, Ziad A Massy, Óscar Zurriaga, Kitty J Jager, Patrik Finne
Background: The incidence of renal replacement therapy (RRT) in the general population ≥75 years of age varies considerably between countries and regions in Europe. Our aim was to study characteristics and survival of elderly RRT patients and to find explanations for differences in RRT incidence. Methods: Patients ≥75 years of age at the onset of RRT in 2010-2013 from 29 national or regional registries providing data to the European Renal Association-European Dialysis and Transplant Association Registry were included...
April 18, 2018: Nephrology, Dialysis, Transplantation
https://www.readbyqxmd.com/read/29673501/association-of-sarcopenia-with-nutritional-parameters-quality-of-life-hospitalization-and-mortality-rates-of-elderly-patients-on-hemodialysis
#12
Juliana Giglio, Maria Ayako Kamimura, Fernando Lamarca, Juliana Rodrigues, Fernanda Santin, Carla Maria Avesani
OBJECTIVE: This study aimed to assess whether diminished muscle mass, diminished muscle strength, or both conditions (sarcopenia) are associated with worse nutritional status, poor quality of life (QoL), and hard outcomes, such as hospitalization and mortality, in elderly patients on maintenance hemodialysis (MHD). DESIGN AND SUBJECTS: This is a multicenter observational longitudinal study that included 170 patients on MHD (age 70 ± 7 years, 65% male) from 6 dialysis centers...
May 2018: Journal of Renal Nutrition
https://www.readbyqxmd.com/read/29670340/the-design-and-evaluation-of-psychometric-properties-for-a-questionnaire-on-elderly-abuse-by-family-caregivers-among-older-adults-on-hemodialysis
#13
Amaneh Mahmoudian, Razieh Torabi Chafjiri, Atefeh Alipour, Abbas Shamsalinia, Fatemeh Ghaffari
Introduction: Older adults with chronic disease are more vulnerable to abuse. Early and accurate detection of the elderly abuse phenomenon can help identify health-promoting solutions for the elderly, their family, and society. The purpose of this study was to design and evaluate the psychometric properties of a questionnaire on elderly abuse by family caregivers among older adults on hemodialysis. Methods: Qualitative and quantitative research methodologies were used to develop the questionnaire...
2018: Clinical Interventions in Aging
https://www.readbyqxmd.com/read/29665164/elderly-kidney-donors-better-than-their-reputation-but-where-are-the-limits
#14
Thomas Fehr
Kidney allograft from elderly donors bear higher peri- and posttransplant risks, such as delayed graft function with or without need for dialysis, lower allograft function at the early phase and shorter allograft survival. In contrast, allografts from younger donors perform better - in young and old recipients. Thus, in a perfect world without organ shortage, allograft from younger donors would be preferred irrespective of the recipient's age. So far, the maths is simple. This article is protected by copyright...
April 17, 2018: Transplant International: Official Journal of the European Society for Organ Transplantation
https://www.readbyqxmd.com/read/29664922/patterns-of-emergency-department-utilization-by-patients-on-chronic-dialysis-a-population-based-study
#15
Paul Komenda, Navdeep Tangri, Evan Klajncar, Amanda Eng, Michelle Di Nella, Brett Hiebert, Trevor Strome, Ricardo Lobato de Faria, James M Zacharias, Mauro Verrelli, Manish M Sood, Claudio Rigatto
IMPORTANCE: Patients on dialysis are often elderly and frail, with multiple comorbid conditions, and are heavy users of Emergency Department (ED) services. However, objective data on the frequency and pattern of ED utilization by dialysis patients are sparse. Such data could identify periods of highest risk for ED visits and inform health systems interventions to mitigate these risks and improve outcomes. OBJECTIVE: To describe the pattern and frequency of presentation to ER by dialysis patients...
2018: PloS One
https://www.readbyqxmd.com/read/29644067/a-scheme-based-on-icd-10-diagnoses-and-drug-prescriptions-to-stage-chronic-kidney-disease-severity-in-healthcare-administrative-records
#16
Leif Friberg, Alessandro Gasparini, Juan Jesus Carrero
Background: Information about renal function is important for drug safety studies using administrative health databases. However, serum creatinine values are seldom available in these registries. Our aim was to develop and test a simple scheme for stratification of renal function without access to laboratory test results. Methods: Our scheme uses registry data about diagnoses, contacts, dialysis and drug use. We validated the scheme in the Stockholm CREAtinine Measurements (SCREAM) project using information on approximately 1...
April 2018: Clinical Kidney Journal
https://www.readbyqxmd.com/read/29602630/medicare-costs-associated-with-arteriovenous-fistulas-among-us-hemodialysis-patients
#17
Mae Thamer, Timmy C Lee, Haimanot Wasse, Marc H Glickman, Joyce Qian, Daniel Gottlieb, Scott Toner, Timothy A Pflederer
BACKGROUND: An arteriovenous fistula (AVF) is the recommended vascular access for hemodialysis (HD). Previous studies have not examined the resources and costs associated with creating and maintaining AVFs. STUDY DESIGN: Retrospective observational study. SETTING & PARTICIPANTS: Elderly US Medicare patients initiating hemodialysis therapy during 2010 to 2011. PREDICTOR: AVF primary and secondary patency and nonuse in the first year following AVF creation...
March 28, 2018: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
https://www.readbyqxmd.com/read/29594145/exit-site-infection-due-to-mycobacterium-chelonae-in-an-elderly-patient-on-peritoneal-dialysis
#18
Arata Hibi, Takahisa Kasugai, Keisuke Kamiya, Chiharu Ito, Satoru Kominato, Toshiyuki Miura, Katsushi Koyama
Nontuberculous mycobacteria (NTM) are rarely isolated from peritoneal dialysis (PD)-associated catheter infections. However, NTM infection is usually difficult to treat and leads to catheter loss. Prompt diagnosis is essential for appropriate treatment. A 70-year-old Japanese man who had been on PD for 2 years and with a medical history of 2 episodes of exit site infections (ESIs) due to methicillin-resistant Staphylococcus aureus was admitted to the hospital due to suspected ESI recurrence. However, Gram staining of the pus revealed no gram-positive cocci...
January 2018: Case Reports in Nephrology and Dialysis
https://www.readbyqxmd.com/read/29584720/cost-effectiveness-of-multidisciplinary-care-in-mild-to-moderate-chronic-kidney-disease-in-the-united-states-a-modeling-study
#19
Eugene Lin, Glenn M Chertow, Brandon Yan, Elizabeth Malcolm, Jeremy D Goldhaber-Fiebert
BACKGROUND: Multidisciplinary care (MDC) programs have been proposed as a way to alleviate the cost and morbidity associated with chronic kidney disease (CKD) in the US. METHODS AND FINDINGS: We assessed the cost-effectiveness of a theoretical Medicare-based MDC program for CKD compared to usual CKD care in Medicare beneficiaries with stage 3 and 4 CKD between 45 and 84 years old in the US. The program used nephrologists, advanced practitioners, educators, dieticians, and social workers...
March 2018: PLoS Medicine
https://www.readbyqxmd.com/read/29566211/is-kt-v-useful-in-elderly-dialysis-patients-pro-and-con-arguments
#20
James Tattersall, Ken Farrington, Giorgio Gentile, Jeroen Kooman, Juan F Macias Núñez, Ionut Nistor, Wim Van Biesen, Adrian Covic
Current guidelines for dialysis specify a minimum Kt/V. For haemodialysis (HD) patients, minimum treatment time and frequency is also specified. The guidelines allow for modification to take account of renal function. The guidelines are not specifically aimed at the elderly and may not be appropriate for all patients in this group. Increasing age is accompanied by physiological and pathological changes that may modify the patient's response to uraemia and dialysis. Frailty and multi-morbidity are likely, but to a variable extent...
May 1, 2018: Nephrology, Dialysis, Transplantation
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