Patient selection when resources are limited

2018 ◽  
Author(s):  
Bernadette A. Thomas ◽  
Christopher R. Blagg
Keyword(s):  
Population Ageing ◽  
Ethical Considerations ◽  
Number Of Patients ◽  
The World ◽  
History Of ◽  
Developing Societies ◽  
Stage Renal Disease ◽  
End Stage ◽  
Global Growth ◽  
Triage Decisions

More than 50 years ago, outpatient care for patients with end-stage renal disease (ESRD) became possible through the invention of the Scribner shunt. Since that time, renal replacement therapy (RRT) has expanded to include haemodialysis, peritoneal dialysis, and renal transplantation. There has been tremendous global growth in the number of patients with access to RRT for ESRD, but many societies face difficult triage decisions for these costly modalities similar to those faced by the pioneers of outpatient dialysis in the early 1960s. Developed and developing societies will face the complex challenges of addressing the costly needs of an ESRD population that is projected to rise rapidly secondary to population ageing, as well as the increased burden of chronic diseases such as diabetes mellitus and hypertension. The history of outpatient RRT is outlined and trends in RRT growth throughout the world noted. The ethical considerations with which both developed and developing societies will have to contend to address the growing global burden of ESRD are discussed.

Pathological damage of bones and joints in patients on hemodialysis in Saint Petersburg

2019 ◽  
Vol 23 (6) ◽  
pp. 73-82
Author(s):  
A. N. Tsed ◽  
A. V. Smirnov ◽  
A. К. Dulaev ◽  
A. Sh. Rumyantsev ◽  
A. N. Ananyev
Keyword(s):  
Pathological Fractures ◽  
X Ray ◽  
Saint Petersburg ◽  
Number Of Patients ◽  
Calcium Phosphorus ◽  
History Of ◽  
Examination Methods ◽  
Stage Renal Disease ◽  
End Stage

BACKGROUND. The number of patients with end-stage renal disease is steadily increasing. One of the main complications arising from the disorders of calcium-phosphorus metabolism in patients on hemodialysis is various types of renal osteodystrophy. The frequency of pathological fractures among patients receiving renal replacement therapy is twice as high as in the general population. The prevalence and structure of injuries, especially the diagnosis of injuries of the musculoskeletal system in hemodialysis patients, are not well understood. THE AIM: to determine the prevalence and structure of injuries and the consequences of pathological injuries of bones and joints undergoing hemodialysis in Saint-Petersburg. To achieve this goal, the authors developed a special questionnaire, consisting of 4 blocks, including 32 questions.PATIENTS AND METHODS. An analysis of questionnaires of 798 patients from 15 hemodialysis centers of Saint-Petersburg was carried out.RESULTS. A number of problems were identified, such as insufficient coverage of patients not only with specific instrumental examination methods (MSCT, MRI), but also with radiographic ones. Satisfaction with quality of life and physical activity was noted in less than half of patients. 46.4% had a history of fractures and injuries, while the proportion of operated patients was half that, which indicates the need for more active work of hemodialysis centers with city hospitals with traumatology and orthopedic departments.CONCLUSION. Patients on HD require regular x-ray examination and densitometry to detect pathological damage to bones and joints. Based on the results of these studies, it is advisable to consult a traumatologist at least 1 time per year.

Birth of a Benefit—Brief History of the ESRD Program

2020 ◽  
pp. 13-20
Author(s):  
Nancy C. Armistead ◽  
Jeffrey A. Perlmutter
Keyword(s):  
Focal Point ◽  
Patient Centered ◽  
Legislative History ◽  
Technological Advances ◽  
Number Of Patients ◽  
Centered Care ◽  
History Of ◽  
Returning To Work ◽  
Stage Renal Disease ◽  
End Stage

The story of the end-stage renal disease (ESRD) entitlement program is told through progressive scientific and technological advances, selection committees, and exploration of public policy values. The legislative history shows a program thought to accommodate a limited number of patients who, returning to work, would contribute to the social security program paying for their benefits. The reality has been different. Treatment is offered to virtually all patients with ESRD, often with little regard to the individual’s likelihood of benefit from dialysis and quality of life. The program’s next chapter will tell whether patient-centered care becomes a focal point in the program’s history.

scholarly journals Laparoscopic-Assisted Recipient Nephrectomy and Recipient Kidney Procurement during Orthotopic Living-Related Kidney Transplantation

2011 ◽  
Vol 2011 ◽  
pp. 1-4 ◽  
Author(s):  
Dimitri Mikhalski ◽  
Karl Martin Wissing ◽  
Renaud Bollens ◽  
Daniel Abramowicz ◽  
Vincent Donckier ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Antiphospholipid Antibodies ◽  
Graft Function ◽  
Renal Vessels ◽  
Short Period ◽  
History Of ◽  
Stage Renal Disease ◽  
End Stage ◽  
Living Related ◽  
Laparoscopic Assisted

Advanced atherosclerosis or thrombosis of iliac vessels can constitute an absolute contraindication for heterotopic kidney transplantation. We report the case of a 42-year-old women with end-stage renal disease due to lupus nephritis and a history of bilateral thrombosis of iliac arteries caused by antiphospholipid antibodies. Occlusion had been treated by the bilateral placement of wall stents which precluded vascular anastomosis. The patient was transplanted with a right kidney procured by laparoscopic nephrectomy from her HLA semi-identical sister. The recipient had left nephrectomy after laparoscopical transperitoneal dissection. The donor kidney was orthotopically transplanted with end-to-end anastomosis of graft vessels to native renal vessels and of the graft and native ureter. Although, the patient received full anticoagulation because of a cardiac valve and antiphospholipid antibodies, she had no postoperative complication in spite of a short period of delayed graft function. Serum creatinine levels three months after transplantation were at 1.0 mg/dl. Our case documents that orthotopical transplantation of laparoscopically procured living donor kidneys at the site of recipient nephrectomy is a feasible procedure in patients with surgical contraindication of standard heterotopic kidney transplantation.

scholarly journals Chronic kidney disease – pediatric risk factors

PRILOZI ◽  
2016 ◽  
Vol 37 (1) ◽  
pp. 9-13
Author(s):  
Velibor Tasic ◽  
Aleksandra Janchevska ◽  
Nora Emini ◽  
Emilija Sahpazova ◽  
Zoran Gucev ◽  
...  
Keyword(s):  
Risk Factors ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Pediatric Nephrologist ◽  
Children And Adolescent ◽  
The World ◽  
Stage Renal Disease ◽  
End Stage ◽  
Standard Risk ◽  
Final Consequence

Abstract The knowledge about the progression of chronic kidney disease is an important issue for every pediatric nephrologist and pediatrician in order to implement appropriate measures to prevent wasting of renal function and the final consequence – end stage renal disease with the need for the dialysis and transplantation. Therefore it is important to know, treat or ameliorate the standard risk factors such as hypertension, proteinuria, anemia, hyperparathyroidism etc. In this review devoted to the World Kidney Day 2016 we will pay attention to the low birth parameters, obesity, hyperuricemia and smoking which emerged as particularly important risk factors for children and adolescent with chronic kidney disease.

scholarly journals Sustainability of the Peritoneal Dialysis-First Policy in Hong Kong

2015 ◽  
Vol 40 (4) ◽  
pp. 320-325 ◽  
Author(s):  
Agnes Shin-Man Choy ◽  
Philip Kam-Tao Li
Keyword(s):  
Hong Kong ◽  
Peritoneal Dialysis ◽  
Financial Burden ◽  
Training Programme ◽  
Number Of Patients ◽  
Ultrafiltration Failure ◽  
Average Annual Cost ◽  
The Government ◽  
Stage Renal Disease ◽  
End Stage

In Hong Kong, the average annual cost of haemodialysis (HD) per patient is more than double of that of peritoneal dialysis (PD). As the number of patients with end-stage renal disease (ESRD) has surged, it has posed a great financial burden to the government and society. A PD-first policy has been implemented in Hong Kong for three decades based on its cost-effectiveness, and has achieved successful outcomes throughout the years. A successful PD-first policy requires medical expertise in PD, the support of dedicated staff and a well-designed patient training programme. Addressing patients' PD problems is the key to sustainability of the PD-first policy. In this article, we highlight three important groups of patients: those with frequent peritonitis, ultrafiltration failure or inadequate dialysis. Potential strategies to improve the outcomes of these groups will be discussed. Moreover, enhancing HD as back-up support and promoting organ transplantation are needed in order to maintain sustainability of the PD-first policy.

scholarly journals Medical Adjuvant Therapy in Reducing Thrombosis With Arteriovenous Grafts and Fistulae Use: A Meta-Analysis of Randomized Controlled Trials

2021 ◽  
Vol 27 ◽  
pp. 107602962110638
Author(s):  
Kaleem Ullah ◽  
Maham Bashir ◽  
Noor Ul Ain ◽  
Azza Sarfraz ◽  
Zouina Sarfraz ◽  
...  
Keyword(s):  
Adjuvant Therapy ◽  
Adjuvant Treatment ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Graft Thrombosis ◽  
Av Fistula ◽  
Number Of Patients ◽  
Long Term Follow Up ◽  
Stage Renal Disease ◽  
End Stage

Hemodialysis is required for patients with end-stage renal disease (ESRD) that require arteriovenous (AV) grafts or fistulas for vascular access. These access points are prone to thrombosis. To determine the effect of medical adjuvant therapy on AV graft/fistula patency among patients with ESRD on hemodialysis. Adhering to the PRISMA 2020 statement, a systematic search was conducted until August 20, 2021, with keywords including arteriovenous graft, fistula, patency, thrombosis, hemodialysis, adjuvant treatment. The following databases were searched: PubMed, Scopus, Web of Science, CINAHL Plus, and Cochrane. A random-effects model was employed using Review Manager 5.4 for data analysis. The meta-analysis pooled in 1985 participants with 1000 (50.4%) in the medical adjuvant treatment group. At a snapshot, medical adjuvant therapy reduced the risk for graft thrombosis (RR = 0.64, P = .02). Notable medications included aspirin for graft thrombosis (RR = 0.36, P = .006) and ticlopidine for fistula thrombosis (RR = 0.53, P = .01). Certain antiplatelet therapies (aspirin and ticlopidine) reduced the number of patients with AV fistula/graft thrombosis among patients with high heterogeneity among the trials. Other therapies (fish oil, sulfinpyrazone, clopidogrel, and aspirin/dipyridamole) did not demonstrate significant improvement but may be promising once concrete evidence is available. Potential benefits of anti-platelet therapies may be explored to maintain the potency of AV grafts/fistulas through well-designed placebo-controlled trials and long-term follow-up.

scholarly journals Alterations of Left Ventricular Hypertrophy in and Survival of Patients Receiving Hemodialysis: Follow-up of an Interventional Study

2001 ◽  
Vol 12 (12) ◽  
pp. 2759-2767 ◽  
Author(s):  
Gérard M. London ◽  
Bruno Pannier ◽  
Alain P. Guerin ◽  
Jacques Blacher ◽  
Sylvain J. Marchais ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Left Ventricular ◽  
Independent Effect ◽  
Lv Mass ◽  
History Of ◽  
Cv Disease ◽  
Stage Renal Disease ◽  
End Stage

ABSTRACT. Left ventricular (LV) hypertrophy (LVH) is a risk factor for mortality in patients with end-stage renal disease (ESRD). Whether the attenuation of LVH has a positive effect on survival of patients with ESRD has not been documented. The aim of this study was to determine the effect of parallel treatment of hypertension and anemia on LV mass (LVM) and to determine the effect of LVM changes on survival. A cohort of 153 patients receiving hemodialysis was studied. The duration of follow-up was 54 ± 37 mo. All patients had echocardiographic determination of LV dimensions and LVM at baseline and regular intervals until the end of the follow-up period. During the study, BP decreased from (mean ± SD) 169.4 ± 29.7/90.2 ± 15.6 to 146.7 ± 29/78 ± 14.1 mmHg (P< 0.001), and hemoglobin increased from 8.65 ± 1.65 to 10.5 ± 1.45 g/dl (P< 0.001). The LV end-diastolic diameter and mean wall thickness decreased from 56.6 ± 6.5 to 54.8 ± 6.5 mm (P< 0.001), and from 10.4 ± 1.6 to 10.2 ± 1.6 mm (P< 0.05), respectively. The LVM decreased from 290 ± 80 to 264 ± 86 g (P< 0.01). Fifty-eight deaths occurred, 38 attributed to cardiovascular (CV) disease and 20 attributed to non-CV causes. According to Cox analyses after adjustment for age, gender, diabetes, history of CV disease, and all nonspecific CV risk factors, LVM regression positively affected the survival. The hazard risk ratio associated with a 10% LVM decrease was 0.78 (95% confidence interval, 0.63 to 0.92) for all-causes mortality and 0.72 (95% confidence interval, 0.51 to 0.90) for mortality due to CV disease. These results show that a partial LVH regression in patients with ESRD had a favorable and independent effect on patients’ all-cause and CV survival.

scholarly journals Cardiac Arrest Secondary to Bilateral Pulmonary Emboli following Arteriovenous Fistula Thrombectomy: A Case Report with Review of the Literature

2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
Avni Shah ◽  
Naheed Ansari ◽  
Zaher Hamadeh
Keyword(s):  
Cardiac Arrest ◽  
Arteriovenous Fistula ◽  
Pulmonary Emboli ◽  
Hemodialysis Access ◽  
Number Of Patients ◽  
Life Threatening ◽  
Timely Fashion ◽  
Pulmonary Embolization ◽  
Stage Renal Disease ◽  
End Stage

Number of patients with End Stage Renal Disease (ESRD) is growing worldwide. Hemodialysis remains the main modality of renal replacement therapy for ESRD patients. A patent hemodialysis access (arteriovenous fistula or arteriovenous graft) plays a key role in successful delivery of hemodialysis. Common vascular access issues encountered by patients and nephrologists are thrombosis and infection. The thrombosed access is declotted by various percutaneous techniques these days by multiple outpatient access centers in a timely fashion. Thrombolysis can give rise to various complications, a few of which can be life threatening. A young hemodialysis patient underwent percutaneous thrombolysis of his clotted arteriovenous fistula. Outpatient access thrombectomy was complicated immediately afterwards with cardiac arrest requiring cardiac resuscitation in the recovery room. The patient was admitted to intensive care unit after life sustaining care. Work up revealed multiple pulmonary emboli to both lung fields on CT scan of the chest. Patient was anticoagulated and discharged from the hospital. Thrombolysis of clotted hemodialysis access is associated commonly with occurrences of pulmonary embolic which are usually asymptomatic. Massive pulmonary embolization due to access thrombolysis is rare. Nephrologists and radiologists should be aware of this dangerous complication particularly in patients with preexisting cardiopulmonary disease.

Case of eustachian valve endocarditis and the importance of synergistic antibiotic therapy

2021 ◽  
Vol 14 (6) ◽  
pp. e242553
Author(s):  
Dilpat Kumar ◽  
James Boyer ◽  
Warsha Fnu ◽  
Harry Boamah
Keyword(s):  
End Stage Renal Disease ◽  
Altered Mental Status ◽  
Blood Levels ◽  
Chronic Haemodialysis ◽  
Dialysis Catheter ◽  
Left Forearm ◽  
Eustachian Valve ◽  
History Of ◽  
Stage Renal Disease ◽  
End Stage

A 46-year-old woman with a history of end-stage renal disease on chronic haemodialysis presented with 1 week of fever, chills, altered mental status and hand pain. She was febrile and ill-appearing on presentation with a pulse rate of 102 beats per minute. She had a tunnelled dialysis catheter in her right neck. Hand examination demonstrated a swollen, erythematous and tender wrist. Cardiovascular examination demonstrated no murmurs. CT of the hand showed abscesses involving the left forearm. Blood and abscess cultures grew methicillin-resistant Staphylococcus aureus (MRSA). Transesophageal echocardiography (TEE) showed a 1.0×1.0 cm mobile vegetation involving the eustachian valve (EV), confirming EV endocarditis. She remained bacteraemic for 18 days despite being on vancomycin with appropriate blood levels. Vancomycin was switched to daptomycin and ceftaroline, which cleared her cultures. Repeat TEE showed improved vegetation size. Our case highlights the rarity and management of EV endocarditis and the importance of synergy for treatment of persistent MRSA bacteraemia.

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