scholarly journals The unaccomplished mission of reducing mortality in patients on kidney replacement therapy

2020 ◽  
Vol 13 (6) ◽  
pp. 948-951
Author(s):  
Alberto Ortiz
Keyword(s):  
Risk Factors ◽  
Kidney Disease ◽  
Replacement Therapy ◽  
Early Death ◽  
Gene Encoding ◽  
Mineral And Bone Disorder ◽  
Transplant Patients ◽  
Kidney Replacement Therapy ◽  
End Stage ◽  
The Impact

Abstract Six years ago, a comprehensive review by the EURECA-m working group of the ERA-EDTA thoroughly addressed the drivers of mortality in patients with end-stage kidney disease. Not unexpectedly, the key global driver of early death in these patients was the lack of access to kidney replacement therapy. However, and contrary to the expectations of non-nephrologists, mortality was still high when kidney replacement therapy was provided. This was due to excess cardiovascular and non-cardiovascular mortality, and the need to further characterize correctable risk factors and eventually test the impact of correcting them was emphasized. In this issue of ckj, seven reports address risk factors for death in non-dialysis chronic kidney disease (CKD), dialysis and kidney transplant patients. They characterize irreversible (e.g. sex; age; genetic variants of the KL gene encoding the anti-ageing protein Klotho) and reversible (obesity; mineral and bone disorder parameters; anti-depressant drugs, especially those that increase the QT; amputation; public health investments) factors associated with mortality of CKD patients on or off kidney replacement therapy.

scholarly journals Pregnancy and delivery in women treated with renal replacement therapy: A literature review

2021 ◽  
pp. 86-90
Author(s):  
V. Medved ◽  
L. Bulik
Keyword(s):  
Kidney Disease ◽  
Replacement Therapy ◽  
Perinatal Outcomes ◽  
Published Data ◽  
Perinatal Complications ◽  
End Stage Kidney Disease ◽  
Dialysis Therapy ◽  
Pregnancy And Delivery ◽  
Kidney Replacement Therapy ◽  
End Stage

Abstract. The problem of pregnancy and delivery in women with end-stage kidney disease is becoming increasingly important, and the number of such women who are pregnant, receiving kidney replacement therapy, is growing every year. Improvements in dialysis therapy have led to improved obstetric and perinatal outcomes, but the risk of various obstetric and perinatal complications remains extremely high. In this review, we analyzed recently published data on management and outcomes of pregnancy in women with end-stage kidney disease receiving dialysis.

scholarly journals Outcomes of patients with COVID-19 on kidney replacement therapy: a comparison among modalities in England

2021 ◽  
Author(s):  
Manuela Savino ◽  
Shalini Santhakumaran ◽  
Katharine M Evans ◽  
Retha Steenkamp ◽  
Fran Benoy-Deeney ◽  
...  
Keyword(s):  
Kidney Disease ◽  
Replacement Therapy ◽  
Retrospective Cohort ◽  
Excess Mortality ◽  
Mortality Data ◽  
Kidney Replacement Therapy ◽  
Poor Outcomes ◽  
The Uk ◽  
The Impact ◽  
Excess Deaths

Abstract Background Chronic kidney disease (CKD) is a recognised risk factor of poor outcomes from COVID-19. Methods This retrospective cohort study used the UK Renal Registry (UKRR) database of people on kidney replacement therapy (KRT) at the end of 2019 in England and who tested positive for SARS-CoV-2 between 01/03/2020 and 31/08/2020, to analyse incidence and outcomes of COVID-19 among different KRT modalities. Comparisons with 2015-2019 mortality data were used to estimate excess deaths. Results 2,783 individuals on KRT tested positive for SARS-CoV-2. Patients from more deprived areas (most deprived vs least deprived HR 1.20, 95% CI 1.04-1.39) and those with diabetes compared to those without (HR 1.51, 95% CI 1.39-1.64) were more likely to test positive. Approximately 25% of in-centre haemodialysis and transplanted patients died within 28 days of testing positive, compared to 36% of those on home therapies. Mortality was higher in those aged ≥80 years compared to those aged 60-79 years (OR 1.71, 95% CI 1.34-2.19) and much lower in those listed for transplantation compared to those not listed (OR 0.56, 95% CI 0.40-0.80). Overall, excess mortality in 2020 for people on KRT was 36% higher than the 2015-2019 average. Excess deaths peaked in April 2020 at the height of the pandemic and were characterised by wide ethnic and regional disparities. Conclusions The impact of COVID-19 on the English KRT population highlights their extreme vulnerability and emphasises the need to protect and prioritise this group for vaccination. COVID-19 has widened underlying inequalities in people with kidney disease making interventions that address health inequalities a priority.

scholarly journals Status of care for end stage kidney disease in countries and regions worldwide: international cross sectional survey

BMJ ◽  
2019 ◽  
pp. l5873 ◽  
Author(s):  
Aminu K Bello ◽  
Adeera Levin ◽  
Meaghan Lunney ◽  
Mohamed A Osman ◽  
Feng Ye ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Kidney Disease ◽  
Replacement Therapy ◽  
Low Income ◽  
Care Delivery ◽  
End Stage Kidney Disease ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Kidney Replacement Therapy ◽  
End Stage

Abstract Objective To determine the global capacity (availability, accessibility, quality, and affordability) to deliver kidney replacement therapy (dialysis and transplantation) and conservative kidney management. Design International cross sectional survey. Setting International Society of Nephrology (ISN) survey of 182 countries from July to September 2018. Participants Key stakeholders identified by ISN’s national and regional leaders. Main outcome measures Markers of national capacity to deliver core components of kidney replacement therapy and conservative kidney management. Results Responses were received from 160 (87.9%) of 182 countries, comprising 97.8% (7338.5 million of 7501.3 million) of the world’s population. A wide variation was found in capacity and structures for kidney replacement therapy and conservative kidney management—namely, funding mechanisms, health workforce, service delivery, and available technologies. Information on the prevalence of treated end stage kidney disease was available in 91 (42%) of 218 countries worldwide. Estimates varied more than 800-fold from 4 to 3392 per million population. Rwanda was the only low income country to report data on the prevalence of treated disease; 5 (<10%) of 53 African countries reported these data. Of 159 countries, 102 (64%) provided public funding for kidney replacement therapy. Sixty eight (43%) of 159 countries charged no fees at the point of care delivery and 34 (21%) made some charge. Haemodialysis was reported as available in 156 (100%) of 156 countries, peritoneal dialysis in 119 (76%) of 156 countries, and kidney transplantation in 114 (74%) of 155 countries. Dialysis and kidney transplantation were available to more than 50% of patients in only 108 (70%) and 45 (29%) of 154 countries that offered these services, respectively. Conservative kidney management was available in 124 (81%) of 154 countries. Worldwide, the median number of nephrologists was 9.96 per million population, which varied with income level. Conclusions These comprehensive data show the capacity of countries (including low income countries) to provide optimal care for patients with end stage kidney disease. They demonstrate substantial variability in the burden of such disease and capacity for kidney replacement therapy and conservative kidney management, which have implications for policy.

scholarly journals Capturing and monitoring global differences in untreated and treated end-stage kidney disease, kidney replacement therapy modality, and outcomes

2020 ◽  
Vol 10 (1) ◽  
pp. e3-e9 ◽  
Author(s):  
Roberto Pecoits-Filho ◽  
Ikechi G. Okpechi ◽  
Jo-Ann Donner ◽  
David C.H. Harris ◽  
Harith M. Aljubori ◽  
...  
Keyword(s):  
Kidney Disease ◽  
Replacement Therapy ◽  
End Stage Kidney Disease ◽  
Kidney Replacement Therapy ◽  
End Stage

scholarly journals “Is It Removed During Dialysis?”—Cognitive Dysfunction in Advanced Kidney Failure—A Review Article

2021 ◽  
Vol 12 ◽  
Author(s):  
Kirsty Crowe ◽  
Terence J. Quinn ◽  
Patrick B. Mark ◽  
Mark D. Findlay
Keyword(s):  
Cognitive Impairment ◽  
Kidney Disease ◽  
Replacement Therapy ◽  
Kidney Failure ◽  
Renal Complication ◽  
Kidney Replacement Therapy ◽  
Developing Area ◽  
Evidence Supported Treatments ◽  
Historical Accounts ◽  
The Impact

Cognitive impairment is independently associated with kidney disease and increases in prevalence with declining kidney function. At the stage where kidney replacement therapy is required, with dialysis or transplantation, cognitive impairment is up to three times more common, and can present at a younger age. This is not a new phenomenon. The cognitive interactions of kidney disease are long recognized from historical accounts of uremic encephalopathy and so-called “dialysis dementia” to the more recent recognition of cognitive impairment in those undergoing kidney replacement therapy (KRT). The understanding of cognitive impairment as an extra-renal complication of kidney failure and effect of its treatments is a rapidly developing area of renal medicine. Multiple proposed mechanisms contribute to this burden. Advanced vascular aging, significant multi-morbidity, mood disorders, and sleep dysregulation are common in addition to the disease-specific effects of uremic toxins, chronic inflammation, and the effect of dialysis itself. The impact of cognitive impairment on people living with kidney disease is vast ranging from increased hospitalization and mortality to decreased quality of life and altered decision making. Assessment of cognition in patients attending for renal care could have benefits. However, in the context of a busy clinical service, a pragmatic approach to assessing cognitive function is necessary and requires consideration of the purpose of testing and resources available. Limited evidence exists to support treatments to mitigate the degree of cognitive impairment observed, but promising interventions include physical or cognitive exercise, alteration to the dialysis treatment and kidney transplantation. In this review we present the history of cognitive impairment in those with kidney failure, and the current understanding of the mechanisms, effects, and implications of impaired cognition. We provide a practical approach to clinical assessment and discuss evidence-supported treatments and future directions in this ever-expanding area which is pivotal to our patients' quality and quantity of life.

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