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 Excess mortality in Guadeloupe and Martinique, islands of the French West Indies, during the chikungunya epidemic of 2014

2018 ◽  
Vol 146 (16) ◽  
pp. 2059-2065 ◽  
Author(s):  
A. R. R. Freitas ◽  
P. M. Alarcón-Elbal ◽  
M. R. Donalisio
Keyword(s):  
Strong Correlation ◽  
Excess Mortality ◽  
Pearson Correlation ◽  
Age Groups ◽  
Epidemiological Data ◽  
Mortality Data ◽  
Surveillance Systems ◽  
Mortality And Morbidity ◽  
The Impact ◽  
Excess Deaths

AbstractIn some chikungunya epidemics, deaths are not completely captured by traditional surveillance systems, which record case and death reports. We evaluated excess deaths associated with the 2014 chikungunya virus (CHIKV) epidemic in Guadeloupe and Martinique, Antilles. Population (784 097 inhabitants) and mortality data, estimated by sex and age, were accessed from the Institut National de la Statistique et des Études Économiques in France. Epidemiological data, cases, hospitalisations and deaths on CHIKV were obtained from the official epidemiological reports of the Cellule de Institut de Veille Sanitaire in France. Excess deaths were calculated as the difference between the expected and observed deaths for all age groups for each month in 2014 and 2015, considering the upper limit of 99% confidence interval. The Pearson correlation coefficient showed a strong correlation between monthly excess deaths and reported cases of chikungunya (R= 0.81,p< 0.005) and with a 1-month lag (R= 0.87,p< 0.001); and a strong correlation was also observed between monthly rates of hospitalisation for CHIKV and excess deaths with a delay of 1 month (R= 0.87,p< 0.0005). The peak of the epidemic occurred in the month with the highest mortality, returning to normal soon after the end of the CHIKV epidemic. There were excess deaths in almost all age groups, and excess mortality rate was higher among the elderly but was similar between male and female individuals. The overall mortality estimated in the current study (639 deaths) was about four times greater than that obtained through death declarations (160 deaths). Although the aetiological diagnosis of all deaths associated with CHIKV infection is not always possible, already well-known statistical tools can contribute to the evaluation of the impact of CHIKV on mortality and morbidity in the different age groups.

scholarly journals Early estimates of the excess mortality associated with the 2008-9 influenza season in Portugal

2009 ◽  
Vol 14 (18) ◽  
Author(s):  
P J Nogueira ◽  
B Nunes ◽  
A Machado ◽  
E Rodrigues ◽  
V Gómez ◽  
...  
Keyword(s):  
Excess Mortality ◽  
Total Population ◽  
Influenza Season ◽  
Statistical Modelling ◽  
Mortality Data ◽  
Age Group ◽  
Gender And Age ◽  
Influenza Activity ◽  
The Impact ◽  
Excess Deaths

The aim of this study was to estimate the excess mortality associated with the influenza activity registered in Portugal between week 49 of 2008 and week 5 of 2009. For this purpose available mortality data from the Portuguese Daily Mortality Monitoring (VDM) System were used. Several estimates of excess deaths associated with the recent recorded influenza activity were determined through statistical modelling (cyclic regression) for the total population and disaggregated by gender and age group. The results show that the impact of the 2008-9 influenza season was 1,961 excess deaths, with approximately 82% of these occurring in the age group of 75 years and older.

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 “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.

Excess Mortality During the COVID-19 Pandemic in Philadelphia

2021 ◽  
pp. e1-e6
Author(s):  
Megan Todd ◽  
Meagan Pharis ◽  
Sam P. Gulino ◽  
Jessica M. Robbins ◽  
Cheryl Bettigole
Keyword(s):  
Public Health ◽  
Excess Mortality ◽  
Poisson Model ◽  
People Of Color ◽  
Mortality Data ◽  
Registration System ◽  
Vital Registration System ◽  
All Cause Mortality ◽  
Race Ethnicity ◽  
Excess Deaths

Objectives. To estimate excess all-cause mortality in Philadelphia, Pennsylvania, during the COVID-19 pandemic and understand the distribution of excess mortality in the population. Methods. With a Poisson model trained on recent historical data from the Pennsylvania vital registration system, we estimated expected weekly mortality in 2020. We compared these estimates with observed mortality to estimate excess mortality. We further examined the distribution of excess mortality by age, sex, and race/ethnicity. Results. There were an estimated 3550 excess deaths between March 22, 2020, and January 2, 2021, a 32% increase above expectations. Only 77% of excess deaths (n=2725) were attributed to COVID-19 on the death certificate. Excess mortality was disproportionately high among older adults and people of color. Sex differences varied by race/ethnicity. Conclusions. Excess deaths during the pandemic were not fully explained by COVID-19 mortality; official counts significantly undercount the true death toll. Far from being a great equalizer, the COVID-19 pandemic has exacerbated preexisting disparities in mortality by race/ethnicity. Public Health Implications. Mortality data must be disaggregated by age, sex, and race/ethnicity to accurately understand disparities among groups. (Am J Public Health. Published online ahead of print June 10, 2021: e1–e6. https://doi.org/10.2105/AJPH.2021.306285 )

scholarly journals The Difference of Potassium Level in Stage 5 Kidney Chronic Disease Patients Whose Using New and Re-use Hemodialyzer in RSD dr. Soebandi Jember

2019 ◽  
Vol 5 (3) ◽  
pp. 148
Author(s):  
Yuli Hermansyah ◽  
Dinda Ayu Wanodya Supriatiningsih ◽  
Bagus Hermansyah
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Replacement Therapy ◽  
Potassium Level ◽  
Good Condition ◽  
Total Sample ◽  
Kidney Replacement Therapy ◽  
Quasi Experimental ◽  
The Difference ◽  
The Cost

Stage 5 chronic kidney disease (CKD) is a condition where the renal function decrease, marked by the GFR value < 15/ml/minute/1,73 m2 with or without kidney damage history for 3 months or more that needs kidney replacement therapy, including hemodialysis. In Indonesia, hemodialysis was chosen for 82% from all the cases that needs kidney replacement therapy. However, the cost for hemodialysis therapy is considered as too expensive and burdens The National Health Insurance, Badan Penyelenggara Jaminan Sosial (BPJS), allowing the reuse of hemodialyzer as an alternative for cost-effectiveness. Re-use hemodialyzer is a term for using the same hemodialyzer for the same patient but on different therapy session. The main purpose of this research is to investigate the difference of Potassium level in stage 5 chronic kidney disease patients whose using new and re-use hemodialyzer in RSD dr. Soebandi Jember. This research used quasi experimental design by using blood sample that will be measured for the potassium level after using new hemodialyzer and re-use hemodialyzer for the 4th time in Hemodialysis Installation of RSD dr. Soebandi Jember on December 2018. Total sample of 19 patients chosen using inclusion and exclusion criteria. Collected data were analyzed using paired t-test. The result of statistical test shows that there is no significance potassium level difference in stage 5 chronic kidney disease whose using new and re-use hemodialyzer for the 4th time (p=0,094). The effectivity of hemodialyzer that still has a good condition and hemodialysis therapy that has been done in accordance with the procedure until the 4th reuse is the main factor of this result.   Keywords: CKD, potassium, re-use hemodialyzer

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