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Elderly dialysis

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https://www.readbyqxmd.com/read/28538218/dialysis-therapy-and-conservative-management-of-advanced-chronic-kidney-disease-in-the-elderly-a-systematic-review
#1
Supakanya Wongrakpanich, Paweena Susantitaphong, Suramath Isaranuwatchai, Jirat Chenbhanich, Somchai Eiam-Ong, Bertrand L Jaber
BACKGROUND: Dialysis in older adults with chronic kidney disease (CKD) and comorbidities may not be associated with improved life expectancy compared to conservative management. To inform clinical practice, we performed a systematic review of all available studies examining this hypothesis. METHODS: We performed a systematic review of retrospective and prospective cohort studies of older adults with stage-5 CKD who chose dialysis (hemodialysis or peritoneal dialysis) or opted for conservative management (including management of complications of CKD and palliative care)...
May 25, 2017: Nephron
https://www.readbyqxmd.com/read/28514785/effect-of-age-on-the-association-of-vascular-access-type-with-mortality-in-a-cohort-of-incident-end-stage-renal-disease-patients
#2
Tarek Saleh, Keiichi Sumida, Miklos Z Molnar, Praveen K Potukuchi, Fridtjof Thomas, Jun Ling Lu, Geeta G Gyamlani, Elani Streja, Kamyar Kalantar-Zadeh, Csaba P Kovesdy
BACKGROUND/AIMS: All hemodialysis (HD) patients are generally recommended to create a fistula first; but to create a mature arteriovenous fistula (AVF) can be challenging in elderly individuals. It is unclear if elderly incident HD patients derive a survival benefit from an AVF over an arteriovenous graft (AVG) or a tunneled central venous catheter (TDC). METHODS: We examined the association of vascular access type (AVF, AVG, and TDC with and without a maturing AVF/AVG at dialysis transition) at HD initiation with all-cause, cardiovascular (CV), and infection-related mortality in 46,786 US veterans using Cox models with adjustment for confounders...
May 18, 2017: Nephron
https://www.readbyqxmd.com/read/28514783/dialysis-access-as-an-area-of-improvement-in-elderly-incident-hemodialysis-patients-results-from-a-cohort-study-from-the-international-monitoring-dialysis-outcomes-initiative
#3
Jochen G Raimann, Claudia Barth, Len A Usvyat, Priscila Preciado, Bernard Canaud, Michael Etter, Xiaoqi Xu, Adrian Guinsburg, Christina Marelli, Neill Duncan, Albert Power, Frank M van der Sande, Jeroen P Kooman, Stephan Thijssen, Yuedong Wang, Peter Kotanko
BACKGROUND: Commencing hemodialysis (HD) using a catheter is associated with a higher risk of adverse outcomes, and early conversion from central-venous catheter (CVC) to arteriovenous fistula/graft (non-CVC) improves outcomes. We investigated CVC prevalence and conversion, and their effects on outcomes during the first year of HD in a multinational cohort of elderly patients. METHODS: Patients ≥70 years from the MONDO Initiative who commenced HD between 2000 and 2010 in Asia-Pacific, Europe, North-, and South-America and survived at least 6 months were included in this investigation...
May 17, 2017: American Journal of Nephrology
https://www.readbyqxmd.com/read/28493896/candidemia-in-the-elderly-what-does-it-change
#4
Francesco Barchiesi, Elena Orsetti, Sara Mazzanti, Francesca Trave, Aldo Salvi, Cinzia Nitti, Esther Manso
BACKGROUND: Candidemia is a life-threatening fungal infection and it can affect patients of all ages. Characterization of candidemia in the elderly is lacking. METHODS: We performed a retrospective study of adults (≥ 18 years) with candidemia diagnosed in our center in 2010-2015. Demographics, comorbidities, clinical and microbiologic characteristics, antifungal treatment and outcome were compared between older (≤65 years) and younger (>65 years) patients...
2017: PloS One
https://www.readbyqxmd.com/read/28448971/pre-esrd-dementia-and-post-esrd-mortality-in-a-large-cohort-of-incident-dialysis-patients
#5
Miklos Z Molnar, Keiichi Sumida, Abduzhappar Gaipov, Praveen K Potukuchi, Tibor Fülöp, Kiran Joglekar, Jun Ling Lu, Elani Streja, Kamyar Kalantar-Zadeh, Csaba P Kovesdy
BACKGROUND: Conservative management may be a desirable option for elderly, fragile, or demented patients who reach end-stage renal disease (ESRD), yet some patients with dementia are placed on renal replacement therapy nonetheless. METHODS: From a nationwide cohort of 45,076 US veterans who transitioned to ESRD over 4 contemporary years (October 1, 2007 to September 30, 2011), we identified 1,336 (3.0%) patients with International Classification of Diseases, Ninth Revision, Clinical Modification code-based dementia diagnosis during the prelude (predialysis) period...
April 28, 2017: Dementia and Geriatric Cognitive Disorders
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
#6
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/28429551/the-role-of-calcium-and-non-calcium-based-phosphate-binders-in-chronic-kidney-disease
#7
Grahame J Elder, Jacqueline Center
Rising levels of serum phosphate occur late in the course of chronic kidney disease (CKD) and have been easy targets for nephrologists to treat using phosphate binding drugs, as well as fertile ground for the pharmaceutical industry, for meta-analysis and for the earnest pontifications of guideline writers. Unfortunately, the evidence does little to support this focus, which might be better applied to earlier, adaptive hormonal changes, and to phosphate balance rather than serum phosphate levels. Nevertheless, phosphate binders are ubiquitously prescribed to patients on dialysis, and often prescribed to patients with earlier stages of CKD; for which there is no evidence of benefit and some evidence that calcium-based binders (CBBs) and possibly non-CBBs may cause more harm than placebo...
March 2017: Nephrology
https://www.readbyqxmd.com/read/28414758/early-dialysis-initiation-does-not-improve-clinical-outcomes-in-elderly-end-stage-renal-disease-patients-a-multicenter-prospective-cohort-study
#8
MULTICENTER STUDY
Jae Yoon Park, Kyung Don Yoo, Yong Chul Kim, Dong Ki Kim, Kwon Wook Joo, Shin-Wook Kang, Chul Woo Yang, Nam-Ho Kim, Yong-Lim Kim, Chun-Soo Lim, Yon Su Kim, Jung Pyo Lee
BACKGROUND: The optimal timing for initiating dialysis in end-stage renal disease (ESRD) is controversial, especially in the elderly. METHODS: 665 patients ≥65 years old who began dialysis from August 2008 to February 2015 were prospectively enrolled in the Clinical Research Center for End-Stage Renal Disease cohort study. Participants were divided into 2 groups based on the median estimated glomerular filtration rate at the initiation of dialysis. Propensity score matching (PSM) was used to compare the overall survival rate, cardiovascular events, Kidney Disease Quality of Life Short Form 36 (KDQOL-36) results, Karnofsky performance scale values, Beck's depression inventory values, and subjective global assessments...
2017: PloS One
https://www.readbyqxmd.com/read/28407764/severe-hypertriglyceridemia-secondary-to-venlafaxine-use-in-an-older-adult-on-dialysis-case-report
#9
Hsiang-Wen Lin, Cory A Simonavice, Chiung-Ray Lu, Wen-Ling Lin, Po-Lun Wu, Che-Yi Chou, Chun-Hui Liao, Hsieh-Yuan Lane
BACKGROUND: Although the prescribing information for Venlafaxine extended release includes a discussion about possible increases in total cholesterol and triglycerides (TG) seen in healthier adult patients during premarketing clinical trials, no post-marketing studies or case reports, that discuss the effects of venlafaxine on TG in elderly patients with chronic kidney disease. CASE PRESENTATION: We report a 71 year-old male patient with end-stage renal disease on hemodialysis, with a history of coronary artery disease, mild hyperlipidemia, and hypertension...
April 13, 2017: BMC Health Services Research
https://www.readbyqxmd.com/read/28405987/cardiorenal-syndrome-clinical-outcome-study
#10
H R Shah, N P Singh, N P Aggarwal, D Singhania, A Kumar
BACKGROUND: Over recent years, the field of medicine has been challenged by the twin epidemic of heart failure and renal insufficiency. The coexistence of the two problems in the same patient, referred to as cardiorenal syndrome (CRS), is defined as 'disorders of the heart and kidneys whereby acute or chronic dysfunction in one organ may induce acute or chronic dysfunction of the other. The mechanisms underlying this interaction are complex and multifactorial in nature. OBJECTIVE OF STUDY: Identify and classify patients admitted with cardiorenal syndrome into various subtypes and assess clinical outcome at discharge and at three months...
December 2016: Journal of the Association of Physicians of India
https://www.readbyqxmd.com/read/28404621/longitudinal-risk-of-adverse-events-in-patients-with-acute-kidney-injury-after-percutaneous-coronary-intervention-insights-from-the-national-cardiovascular-data-registry
#11
Javier A Valle, Lisa A McCoy, Thomas M Maddox, John S Rumsfeld, P Michael Ho, Ivan P Casserly, Brahmajee K Nallamothu, Matthew T Roe, Thomas T Tsai, John C Messenger
BACKGROUND: Acute kidney injury (AKI) remains a common complication after percutaneous coronary intervention (PCI) and is associated with adverse in-hospital patient outcomes. The incidence of adverse events after hospital discharge in patients having post-PCI AKI is poorly defined, and the relationship between AKI and outcomes after hospital discharge remains understudied. METHODS AND RESULTS: Using the National Cardiovascular Data Registry CathPCI registry, we assessed the incidence of AKI among Medicare beneficiaries after PCI from 2004 to 2009 and subsequent post-discharge adverse events at 1 year...
April 2017: Circulation. Cardiovascular Interventions
https://www.readbyqxmd.com/read/28396733/current-trends-in-european-renal-epidemiology
#12
James Heaf
The incidence of end-stage renal disease (ESRD) continues to vary substantially between the countries in Europe that contribute data to the ERA-EDTA Registry. Differences can be attributed to socioeconomic factors and prophylaxis programs for patients with chronic kidney disease (CKD) and may also express real differences in CKD incidence. Recently, age-adjusted ESRD incidence has begun to fall in many countries, probably related to improved prophylaxis. However, absolute rates may increase, partly due to socioeconomic advances in countries with a low gross domestic product and partly due to continuing increases in the proportion of elderly patients...
April 2017: Clinical Kidney Journal
https://www.readbyqxmd.com/read/28388944/renal-function-had-an-independent-relationship-with-coronary-artery-calcification-in-chinese-elderly-men
#13
Shihui Fu, Zhao Zhang, Leiming Luo, Ping Ye
BACKGROUND: Although previous studies have analyzed the relationship between renal function and coronary artery calcification (CAC) in pre-dialysis and dialysis patients, limited studies have discussed the relationship between renal function and CAC in Chinese elderly men without obvious damage of renal function. The present study was designed to explore the relationship between renal function and CAC in Chinese elderly men without obvious damage of renal function. METHODS: This cross-sectional study was carried out in 105 male participants older than 60 years with glomerular filtration rate (GFR) ≥ 45 ml/min/1...
April 7, 2017: BMC Geriatrics
https://www.readbyqxmd.com/read/28385160/dementia-is-a-risk-factor-for-major-adverse-cardiac-and-cerebrovascular-events-in-elderly-korean-patients-initiating-hemodialysis-a-korean-national-population-based-study
#14
Sung Min Jung, Clara Tammy Kim, Ea Wha Kang, Kyoung Hoon Kim, Shina Lee, Hyung Jung Oh, Seung-Jung Kim, Duk-Hee Kang, Kyu Bok Choi, Dong-Ryeol Ryu, Hyunwook Kim
BACKGROUND: Dementia is common in end-stage renal disease (ESRD) patients on hemodialysis (HD) and is associated with worse outcomes. This study aimed to investigate the risk of major adverse cardiac and cerebrovascular event (MACCE) in elderly patients with dementia initiating HD. METHODS: Using the database from the Health Insurance Review & Assessment Service, we analyzed 10,171 patients aged 65 years or older who had initiated dialysis from 2005 to 2008. MACCE was defined as a composite outcome of all-cause mortality, nonfatal acute myocardial infarction, target vessel revascularization, and nonfatal ischemic and hemorrhagic stroke...
April 6, 2017: BMC Nephrology
https://www.readbyqxmd.com/read/28383177/low-socioeconomic-status-adversely-effects-dialysis-survival-in-australia
#15
Rathika Krishnasamy, Nicholas A Gray
BACKGROUND: Low socioeconomic status (SES) is associated with increased incidence of end stage kidney disease and in the USA poorer dialysis survival. All Australians have access to a universal health care system. METHODS: The study included all non-indigenous adult Australians registered with the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) who commenced dialysis between 2003 and 2013. SES at dialysis start was classified into quartiles of advantaged through to disadvantaged using Australian Bureau of Statistics socio-economic indexes for areas...
April 6, 2017: Nephrology
https://www.readbyqxmd.com/read/28371919/nutritional-assessment-of-elderly-patients-on-dialysis-pitfalls-and-potentials-for-practice
#16
Juliana Rodrigues, Lilian Cuppari, Katrina L Campbell, Carla Maria Avesani
The chronic kidney disease (CKD) population is aging. Currently a high percentage of patients treated on dialysis are older than 65 years. As patients get older, several conditions contribute to the development of malnutrition, namely protein energy wasting (PEW), which may be compounded by nutritional disturbances associated with CKD and from the dialysis procedure. Therefore, elderly patients on dialysis are vulnerable to the development of PEW and awareness of the identification and subsequent management of nutritional status is of importance...
March 22, 2017: Nephrology, Dialysis, Transplantation
https://www.readbyqxmd.com/read/28360253/to-dialyse-or-delay-a-qualitative-study-of-older-new-zealanders-perceptions-and-experiences-of-decision-making-with-stage-5-chronic-kidney-disease
#17
Sarah Lovell, Robert J Walker, John B W Schollum, Mark R Marshall, Bronwen M McNoe, Sarah Derrett
BACKGROUND: Issues related to renal replacement therapy in elderly people with end stage kidney disease (ESKD) are complex. There is inadequate empirical data related to: decision-making by older populations, treatment experiences, implications of dialysis treatment and treatment modality on quality of life, and how these link to expectations of ageing. STUDY POPULATION: Participants for this study were selected from a larger quantitative study of dialysis and predialysis patients aged 65 years or older recruited from three nephrology services across New Zealand...
March 29, 2017: BMJ Open
https://www.readbyqxmd.com/read/28356062/successful-multigravid-pregnancy-in-a-42-year-old-patient-on-continuous-ambulatory-peritoneal-dialysis-and-a-review-of-the-literature
#18
Thiam Seong Christopher Lim, Malini Shanmuganathan, Irene Wong, Bak Leong Goh
BACKGROUND: For peritoneal dialysis patients, the likelihood of conception is low and the probability of getting through the pregnancy successfully is even lower. Almost 60 years after the first reported case of a successful pregnancy in a dialysis patient, many issues concerning pregnancy in dialysis patients remain unresolved. Our patient's pregnancy is considered high risk as she has end stage renal failure and falls in the category of advance maternal age for pregnancy. We describe here the course of her uneventful pregnancy which we hope will contribute to the overall knowledge and management of pregnancy in elderly patients receiving peritoneal dialysis...
March 29, 2017: BMC Nephrology
https://www.readbyqxmd.com/read/28329829/-end-of-life-care-i-m-not-going-to-worry-about-that-yet-health-literacy-gaps-and-end-of-life-planning-among-elderly-dialysis-patients
#19
Keren Ladin, Katie Buttafarro, Emily Hahn, Susan Koch-Weser, Daniel E Weiner
Purpose: Between 2000 and 2012, the incident dialysis population in the United States increased by nearly 60%, most sharply among adults 75 years and older. End-of-life (EOL) conversations among dialysis patients are associated with better patient-centered outcomes and lower use of aggressive interventions in the last month of life. This study examined how health literacy may affect engagement, comprehension, and satisfaction with EOL conversations among elderly dialysis patients. Design and Methods: Qualitative/descriptive study with semi-structured interviews about health literacy, EOL conversations, and goals of care with 31 elderly dialysis patients at 2 centers in Boston...
March 10, 2017: Gerontologist
https://www.readbyqxmd.com/read/28329396/heart-transplantation-in-selected-patients-aged-60-years-and-older-a-two-decade-retrospective-and-multicentre-analysis
#20
Christian Bosseau, Bernard Lelong, Sabine Pattier, Jean-Noël Trochu, Jean-Christian Roussel, Agnès Sirinelli, Michel Aupart, Céline Chabanne, Richard Dorent, Christelle Cantrelle, Philippe Mabo, Christophe Leclercq, Jean-Philippe Verhoye, Erwan Flécher
OBJECTIVES: This study analysed survival and long-term outcomes of heart transplantation in patients aged 60 years and older. We also analysed the impact of a national graft allocation priority [Super Emergency (SE)] and compared survival with younger patients in our centres and in France. METHODS: We performed a multicentre (University Hospitals in Nantes, Rennes and Tours), 2-decade retrospective study between 1 January 1994 and 31 December 2013. Elderly recipients were placed on the same list as younger patients; the use of marginal donors remained occasional...
May 1, 2017: European Journal of Cardio-thoracic Surgery
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