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Hemodialysis causes death

Cunlin Wang, Robert Kane, Mark Levenson, Jeffrey Kelman, Michael Wernecke, Joo-Yeon Lee, Steven Kozlowski, Carmen Dekmezian, Zhiwei Zhang, Aliza Thompson, Kimberly Smith, Yu-Te Wu, Yuqin Wei, Yoganand Chillarige, Qin Ryan, Chris Worrall, Thomas E MaCurdy, David J Graham
Importance: In 2011, the US Centers for Medicare & Medicaid Services (CMS) changed its reimbursement policy for hemodialysis to a bundled comprehensive payment system that included the cost of erythrocyte-stimulating agents (ESAs). Also in 2011, the US Food and Drug Administration revised the drug label for ESAs, recommending more conservative dosing in patients with chronic kidney disease. In response to concerns that these measures could have adverse effects on patient care and outcomes, the CMS and the FDA initiated a collaboration to assess the effect...
October 24, 2016: JAMA Internal Medicine
Peter A McCullough, Christopher T Chan, Eric D Weinhandl, John M Burkart, George L Bakris
The prevalence of cardiovascular disease, including cardiac arrhythmia, coronary artery disease, cardiomyopathy, and valvular heart disease, is higher in hemodialysis (HD) patients than in the US resident population. Cardiovascular disease is the leading cause of death in HD patients and the principal discharge diagnosis accompanying 1 in 4 hospital admissions. Furthermore, the rate of hospital admissions for either heart failure or fluid overload is persistently high despite widespread use of β-blockers and renin-angiotensin system inhibitors and attempts to manage fluid overload with ultrafiltration...
November 2016: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Jose A Morfin, Richard J Fluck, Eric D Weinhandl, Sheru Kansal, Peter A McCullough, Paul Komenda
Hemodialysis (HD) treatment can be difficult to tolerate. Common complications are intradialytic hypotension (IDH) and long time to recovery after an HD session. IDH, as defined by nadir systolic blood pressure < 90mmHg and intradialytic decline > 30mmHg, occurs in almost 8% of HD sessions. IDH may be caused by aggressive ultrafiltration in response to interdialytic weight gain, can lead to myocardial stunning and cardiac arrhythmias, and is associated with increased risk for death. Long recovery time after a treatment session is also common...
November 2016: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Jong Hwan Jung, Yoon Jung Chae, Dong Hwan Lee, Young I Cho, Mi Mi Ko, Sung Kwang Park, Won Kim
Whole blood viscosity (WBV) plays a role in hemorheology and is determined by many factors such as red blood cell factors, plasma protein and blood volume. As WBV changes during hemodialysis, mortality may be due to changes in WBV in patients on hemodialysis. However, there are few prospective data on the relationship between changes in WBV and overall mortality in dialysis patients. We tried to investigate the correlations between values of WBV at variable shear rates before and after hemodialysis and overall or atherosclerosis-related mortality in patients with end-stage kidney disease...
October 20, 2016: Clinical Hemorheology and Microcirculation
Paik Seong Lim, Yachung Jeng, Ming Ying Wu, Mei-Ann Pai, Tsai-Kun Wu, Chang Hsu Chen
Background. Peripheral arterial disease (PAD) and its relevant complications are more common in hemodialysis (HD) patients, while the evidence regarding antiplatelet therapy in CKD patients is scarce. We retrospectively analyzed the efficacy of cilostazol on outcomes in HD patients with asymptomatic PAD (aPAD). Methods. This cohort study enrolled 217 HD patients (median follow-up time: 5.75 years). Associations between cilostazol use and the outcomes were evaluated by time-dependent Cox regression analysis...
2016: BioMed Research International
Takeshi Kuroda, Naohito Tanabe, Yukiko Nozawa, Hiroe Sato, Takeshi Nakatsue, Daisuke Kobayashi, Yoko Wada, Takako Saeki, Masaaki Nakano, Ichiei Narita
Objective Our objective was to examine the safety and effects of therapy with biologics on the prognosis of rheumatoid arthritis (RA) patients with reactive amyloid A (AA) amyloidosis on hemodialysis (HD). Methods Twenty-eight patients with an established diagnosis of reactive AA amyloidosis participated in the study. The survival was calculated from the date of HD initiation until the time of death, or up to end of June 2015 for the patients who were still alive. HD initiation was according to the program of HD initiation for systemic amyloidosis patients associated with RA...
2016: Internal Medicine
Eduardo Verde, Armando Pérez de Prado, Juan M López-Gómez, Borja Quiroga, Marian Goicoechea, Ana García-Prieto, Esther Torres, Javier Reque, José Luño
BACKGROUND AND OBJECTIVES: Supraventricular arrhythmias are associated with high morbidity and mortality. Nevertheless, this condition has received little attention in patients on hemodialysis. The objective of this study was to analyze the incidence of intradialysis supraventricular arrhythmia and its long-term prognostic value. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We designed an observational and prospective study in a cohort of patients on hemodialysis with a 10-year follow-up period...
October 3, 2016: Clinical Journal of the American Society of Nephrology: CJASN
Ching-Wei Hsu, Cheng-Hao Weng, Cheng-Chia Lee, Dan-Tzu Lin-Tan, Kuan-Hsing Chen, Tzung-Hai Yen, Wen-Hung Huang
BACKGROUND: The National Kidney Foundation-Kidney Disease Outcomes Quality Initiative recommends that the serum aluminum level (SAL) should be below 20 µg/L for patients with maintenance hemodialysis (MHD). However, serum aluminum may have toxic effects on MHD patients even when it is in the apparently acceptable range (below 20 µg/L). METHODS: The Medical Ethics Committee approved this study. Initially, 954 MHD patients in dialysis centers were recruited. A total of 901 patients met the inclusion criteria and were followed-up for 1 year...
2016: Therapeutics and Clinical Risk Management
Lynda K Ball, Cheryl A George, Linda Duval, Niloufar Nellie F Hedrick
Introduction Infection in our immunocompromised patients is the second leading cause of death, according to the Centers for Disease Control and Prevention (CDC). In an effort to improve quality of care, engage patients in their own care, and reduce morbidity and mortality secondary to infection, the Network designed a joint quality improvement/patient engagement activity to decrease bloodstream infection (BSI) rates. Methods Dialysis facilities were ranked utilizing 2014 National Healthcare Safety Network (NHSN) data...
October 2016: Hemodialysis International
Emilie Trinh, Christopher T Chan
BACKGROUND: Left ventricular hypertrophy (LVH) is an independent risk factor for mortality and cardiovascular events in patients with end-stage renal disease. Studies have shown that frequent hemodialysis leads to LVH regression, but the impact of left ventricular mass (LVM) regression on clinical outcomes remains unknown. METHODS: This observational cohort study assessed the impact of LVH regression on the composite outcome of time to all-cause mortality, technique failure or cardiovascular hospitalization in patients on home hemodialysis...
2016: American Journal of Nephrology
Matthew B Rivara, Chang Huei Chen, Anupama Nair, Denise Cobb, Jonathan Himmelfarb, Rajnish Mehrotra
BACKGROUND: Initiation of maintenance dialysis therapy for patients with chronic kidney failure is a period of high risk for adverse patient outcomes. Whether indications for dialysis therapy initiation are associated with mortality in this population is unknown. STUDY DESIGN: Retrospective cohort study. SETTING & PARTICIPANTS: 461 patients who initiated dialysis therapy (hemodialysis, 437; peritoneal dialysis, 24) from January 1, 2004, through December 31, 2012, and were treated in facilities operated by a single dialysis organization...
September 13, 2016: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Thomas A Mavrakanas, David M Charytan
PURPOSE OF REVIEW: This review article focuses on the most significant cardiovascular complications in dialysis patients [sudden cardiac death (SCD), acute coronary syndromes, heart failure, and atrial fibrillation]. RECENT FINDINGS: Current and ongoing research aims to quantify the rate and pattern of significant arrhythmia in dialysis patients and to determine the predominant mechanism of SCD. Preliminary findings from these studies suggest a high rate of atrial fibrillation and that bradycardia and asystole may be more frequent than ventricular arrhythmia as a cause of sudden death...
November 2016: Current Opinion in Nephrology and Hypertension
Daniel Kraus, Christoph Wanner
Critically ill patients who are treated in an intensive care unit are at increased risk of developing acute renal failure. Every episode of renal failure decreases life expectancy. However, acute renal failure is no longer an immediate cause of death because renal function can be substituted medically and mechanically, by the use of renal replacement therapy. Hemodialysis and hemofiltration are the 2 fundamental modalities of renal replacement therapy and may be performed intermittently or continuously. The decision for one particular therapy has to be made for each patient individually...
September 2016: Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS
Chandana Papudesu, Shyamasundaran Kottilil, Shashwatee Bagchi
Hepatitis C is the leading cause of progressive liver fibrosis worldwide and results in cirrhosis, liver cancer, liver failure and death. Successful treatment for hepatitis C virus (HCV) has rapidly evolved in recent years to a well-tolerated, highly efficacious all-oral therapy. Elbasvir/grazoprevir (Zepatier) is the newest of the oral combinations of HCV direct-acting agents that was approved by the US Federal Drug Administration. This review focuses on the pharmacology, mechanism of action and clinical trial data that support the use of this new combination treatment for HCV infection...
September 13, 2016: Hepatology International
Scott Burdette, Lynn P Roppolo, Walter Green, Nashid Shinthia, Peter Ye, Linda S Hynan
BACKGROUND: Unfunded patients with end-stage renal disease (ESRD) who do not have routinely scheduled hemodialysis often receive medications known to prolong the QTc interval for their uremic symptoms even though they may have pre-existing QTc prolongation. OBJECTIVES: The purpose of this study was to determine the effects of these medications on the QTc interval in these patients. METHODS: Unfunded patients with ESRD presenting to the emergency department (ED) for emergent hemodialysis (HD) with QTc prolongation on their initial electrocardiogram (ECG) were recruited...
August 2016: Journal of Emergency Medicine
Chantal Kopecky, Sanam Ebtehaj, Bernd Genser, Christiane Drechsler, Vera Krane, Marlies Antlanger, Johannes J Kovarik, Christopher C Kaltenecker, Mojtaba Parvizi, Christoph Wanner, Thomas Weichhart, Marcus D Säemann, Uwe J F Tietge
The cardioprotective effect of HDL is thought to be largely determined by its cholesterol efflux capacity, which was shown to inversely correlate with atherosclerotic cardiovascular disease in populations with normal kidney function. Patients with ESRD suffer an exceptionally high cardiovascular risk not fully explained by traditional risk factors. Here, in a post hoc analysis in 1147 patients with type 2 diabetes mellitus on hemodialysis who participated in the German Diabetes Dialysis Study (4D Study), we investigated whether the HDL cholesterol efflux capacity is predictive for cardiovascular risk...
September 9, 2016: Journal of the American Society of Nephrology: JASN
Miklos Z Molnar, Vanessa Ravel, Elani Streja, Csaba P Kovesdy, Matthew B Rivara, Rajnish Mehrotra, Kamyar Kalantar-Zadeh
OBJECTIVES: To compare the mortality of elderly adults with end-stage renal disease (ESRD) treated with home hemodialysis (HD) with that of those receiving a kidney transplant (KTx). DESIGN: Prospective cohort. SETTING: Pertinent data for the two groups were obtained from electronic medical records from a large dialysis provider and the U.S. Renal Data System. PARTICIPANTS: Using data from elderly adults (aged ≥65) who started home HD and underwent KTx in the US between 2007 and 2011, a 1:1 propensity score (PS)-matched cohort of 960 elderly adults was created, and the association between treatment modality and all-cause mortality was examined using Cox proportional hazards and competing risk regression survival models using modality failure as a competing event...
September 9, 2016: Journal of the American Geriatrics Society
Masaru Obokata, Hiroaki Sunaga, Hideki Ishida, Kyoko Ito, Tetsuya Ogawa, Yoshitaka Ando, Masahiko Kurabayashi, Kazuaki Negishi
UNLABELLED: End-stage renal disease is a major clinical and public health problem, and cardiovascular disease accounts for half of the mortality in hemodialysis patients. An existing mortality risk score (AROii score) or N-terminal pro-brain natriuretic peptide (NT-proBNP) level have modest predictive power, but there is room for improvement. There are emerging cardiac biomarkers (soluble isoforms of ST2 [sST2], galectin-3 [Gal-3]), and uremic toxicity (indoxyl sulfate). We sought to determine whether these biomarkers predict cardiovascular outcomes in hemodialysis patients and have incremental prognostic value over the clinical score and NT-proBNP level...
September 2016: American Heart Journal
Akeem A Yusuf, Yan Hu, Bhupinder Singh, José A Menoyo, James B Wetmore
BACKGROUND: Hyperkalemia is common in patients receiving maintenance hemodialysis. However, few studies have examined the association between serum potassium level and mortality. METHODS: This study used annual cohorts of hemodialysis patients during 2007-2010. To determine hyperkalemia prevalence, monthly hyperkalemia was defined as serum potassium level ≥5.5 mEq/l; prevalence was calculated as a ratio of hyperkalemia episodes to follow-up time, reported separately by long and short interdialytic interval...
2016: American Journal of Nephrology
Magdalene M Assimon, Julia B Wenger, Lily Wang, Jennifer E Flythe
BACKGROUND: Observational data have demonstrated an association between higher ultrafiltration rates and greater mortality among hemodialysis patients. Prior studies were small and did not consider potential differences in the association across body sizes and other related subgroups. No study has investigated ultrafiltration rates normalized to anthropometric measures beyond body weight. Also, potential methodological shortcomings in prior studies have led to questions about the veracity of the ultrafiltration rate-mortality association...
August 26, 2016: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
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