Improving Chronic Kidney Disease Awareness and Early Dialysis Access Placement: A Hospital Initiative

Interprofessional care for chronic kidney disease facilitates the delivery of high quality, comprehensive care to a complex, at-risk population. Interprofessional care is resource intensive and requires a value proposition. Joint Commission certification is a voluntary process that improves patient outcomes, provides external validity to hospital administration and enhances visibility to patients and referring providers. This is a single-center, retrospective study describing quality assurance and performance improvement in chronic kidney disease, Joint Commission certification and quality outcomes. A total of 440 patients were included in the analysis. Thirteen quality indicators consisting of clinical and process of care indicators were developed and measured for a period of two years from 2009–2017. Significant improvements or at least persistently high performance were noted for key quality indicators such as blood pressure control (85%), estimation of cardiovascular risk (100%), measurement of hemoglobin A1c (98%), vaccination (93%), referrals for vascular access and transplantation (100%), placement of permanent dialysis access (61%), discussion of advanced directives (94%), online patient education (71%) and completion of office visit documentation (100%). High patient satisfaction scores (94–96%) are consistent with excellent quality of care provided.

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Independent correlates of chronic kidney disease awareness among adults with type 2 diabetes

Journal of Diabetes and its Complications ◽

10.1016/j.jdiacomp.2017.03.004 ◽

2017 ◽

Vol 31 (6) ◽

pp. 988-991 ◽

Cited By ~ 1

Author(s):

Ndidiamaka O. Obadan ◽

Rebekah J. Walker ◽

Leonard E. Egede

Keyword(s):

Type 2 Diabetes ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Disease Awareness

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Arterial Revascularization for Upper Extremity Ischemia in Patients with Chronic Kidney Disease

The American Surgeon ◽

10.1177/000313480907500919 ◽

2009 ◽

Vol 75 (9) ◽

pp. 848-852 ◽

Cited By ~ 1

Author(s):

Jeremy A. Warren ◽

Gautam Agarwal ◽

James J. Wynn

Keyword(s):

Chronic Kidney Disease ◽

Renal Failure ◽

Kidney Disease ◽

Upper Extremity ◽

Arterial Occlusion ◽

Arterial Disease ◽

Endothelial Damage ◽

Dialysis Access ◽

Chronic Ischemia

Surgical revascularization of the upper extremity is uncommon, comprising only 4 to 18 per cent of all vascular surgical interventions. Patients with renal failure have higher rates of atherosclerotic cardiovascular and peripheral arterial disease resulting from chronic inflammation, endothelial damage associated with hemodialysis, and vascular trauma. Upper extremity arterial disease with chronic ischemia may be underrecognized in these patients. We reviewed our experience with upper extremity revascularization in patients with renal failure presenting with chronic ischemia. Four patients with longstanding chronic kidney disease developed chronic severe ischemia affecting the forearm or hand. All had previous dialysis access in the symptomatic arm, although none had a functional ipsilateral access at the time of presentation. All patients had successful revascularization with resolution of symptoms and patent bypass grafts at follow up. There was one death 4 months postoperatively and one patient has not returned for follow up. Patients with renal failure with symptomatic upper extremity arterial occlusion should be considered for revascularization of the infrabrachial arteries.

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Regional Anesthesia: Boon for Chronic Kidney Disease Patients Undergoing Vascular Access Surgery

International Journal of Recent Surgical and Medical Sciences ◽

10.1055/s-0040-1701373 ◽

2019 ◽

Vol 5 (02) ◽

pp. 37-41

Author(s):

Prapti Rath ◽

Archana Shivashankar ◽

Luv Luthra ◽

Nivedita Mitta

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Regional Anesthesia ◽

Indian Population ◽

High Morbidity ◽

Dialysis Access ◽

Vascular Access Surgery ◽

Stage Renal Disease ◽

End Stage ◽

Access Surgery

AbstractThe incidence of chronic kidney disease (CKD) is alarmingly high in Indian population with a steep rise in end-stage renal disease patients requiring dialysis access. The preexisting comorbidities associated with high morbidity further necessitate an anesthetic plan which provides benefits intraoperatively as well postoperatively. Different anesthesia techniques can be employed in CKD patients which are associated with complications. The aim of this review is to study the role and benefits of regional anesthesia in CKD patients.

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Metabolic Syndrome and Outcomes after Renal Intervention

Cardiology Research and Practice ◽

10.4061/2011/781035 ◽

2011 ◽

Vol 2011 ◽

pp. 1-4

Author(s):

Daynene Vykoukal ◽

Mark G. Davies

Keyword(s):

Insulin Resistance ◽

Metabolic Syndrome ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Observational Studies ◽

Dialysis Access ◽

Fasting Insulin ◽

Prothrombotic State ◽

Atherosclerotic Renal Artery Stenosis ◽

Increased Risk

Metabolic syndrome significantly increases the risk for cardiovascular disease and chronic kidney disease. The increased risk for cardiovascular diseases can partly be caused by a prothrombotic state that exists because of abdominal obesity. Multiple observational studies have consistently shown that increased body mass index as well as insulin resistance and increased fasting insulin levels is associated with chronic kidney disease, even after adjustment for related disorders. Metabolic syndrome appears to be a risk factor for chronic kidney disease, likely due to the combination of dysglycemia and high blood pressure. Metabolic syndrome is associated with markedly reduced renal clinical benefit and increased progression to hemodialysis following endovascular intervention for atherosclerotic renal artery stenosis. Metabolic syndrome is associated with inferior early outcomes for dialysis access procedures.

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322: Chronic Kidney Disease Awareness Is Limited in Patients Seen By Nephrologists

American Journal of Kidney Diseases ◽

10.1053/j.ajkd.2010.02.329 ◽

2010 ◽

Vol 55 (4) ◽

pp. B112

Author(s):

Julie Wright ◽

T. Alp Ikizler ◽

Kerri Cavanaugh

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Disease Awareness

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The Associations Between Mental Disorders and Cascade of Care in Managing Hypertension, Diabetes, Dyslipidemia, Chronic Kidney Disease in China: A Pooled Cross-Sectional Analysis

10.21203/rs.3.rs-122429/v1 ◽

2020 ◽

Author(s):

Zheng Zhang ◽

Grace Sum ◽

Vicky Mengqi Qin ◽

Yang Zhao ◽

Tilahun Nigatu Haregu ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Mental Disorder ◽

Chronic Conditions ◽

Adult Population ◽

Health Condition ◽

Cross Sectional ◽

Mixed Effect ◽

Disease Awareness ◽

Cascade Of Care

Abstract Physical non-communicable diseases (NCDs) and mental disorder are a rapidly increasing health burden in low-and middle-income countries. This study aims to examine the relationships between mental disorder and cascade of care in managing four common physical NCDs (hypertension, diabetes, dyslipidemia, chronic kidney disease) in China. We utilized two waves of nationally-representative China Health and Retirement Longitudinal Study (CHARLS 2011, 2015) of older adult population aged 45 and above. A series of multivariate mixed-effect logistic regression was applied to evaluate the association between presence of mental disorder and physical chronic disease awareness, treatment, and control. We found that the odds of dyslipidemia (AOR=2.88, 95% CI=2.21-3.74) and kidney disease awareness (AOR=4.14, 95% CI=2.95-5.81) were higher for individuals with mental chronic conditions, compared to those without mental chronic conditions. The odds of having hypertension treatment was higher for subjects with mental disorder, compared to those without (AOR=1.57, 95% CI=1.23-2.01). The odds of having physical chronic conditions controlled was not significantly associated with having mental chronic conditions. These results indicated that adults with mental disorder have a greater likelihood of awareness of having dyslipidemia and kidney disease, and receiving treatment for hypertension. Strategies to address growing burden of physical-mental NCDs in China should include efforts to improve management of patients with comorbid health condition and improve access to continual high-quality treatment after the first diagnosis.

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