scholarly journals P0865A QUALITATIVE STUDY OF PATIENTS' PREFERENCE FOR THE TREATMENT OF ANAEMIA ASSOCIATED WITH CHRONIC KIDNEY DISEASE

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Ana Filipa Alexandre ◽  
Antonia Morga ◽  
Kevin Marsh ◽  
Caitlin Thomas
Keyword(s):  
Chronic Kidney Disease ◽  
Peritoneal Dialysis ◽  
Kidney Disease ◽  
Oral Treatment ◽  
Treatment Options ◽  
Injection Pain ◽  
Primary Concern ◽  
Shortness Of Breath ◽  
Self Administration ◽  
Mode Of Administration

Abstract Background and Aims Anaemia is a common complication of chronic kidney disease (CKD) that is associated with fatigue, shortness of breath, and lethargy. CKD anaemia is commonly treated with oral or intravenous (IV) iron and IV or subcutaneous (SC) erythropoiesis-stimulating agents (ESAs). The objectives of this study were to understand patients’ experiences with CKD anaemia and their preferences related to treatment. Method Qualitative 60-minute semi-structured interviews were conducted with ESA-treated adult CKD patients with anaemia, either non–dialysis-dependent (ND) or dialysis-dependent (DD), and with practicing nephrologists in France, Germany, Spain, the UK, and Japan. The patients’ interviews, appropriately tailored for ND and DD patients, comprised three sections: 1) patients’ views on the burden of the disease and its treatment; 2) discussion of vignettes describing different treatment options; and 3) non-experimental choice questions between two hypothetical treatments including mode of administration, need for iron supplement, and risk of adverse events (AEs). Results A total of 51 patients were enrolled (ND, n=6 per country except for France [n=7]; DD [haemodialysis or peritoneal dialysis], n=4 per country). Two nephrologists per country were interviewed. The most commonly reported symptoms associated with anaemia were tiredness (ND, 77%; DD, 85%) and shortness of breath (ND, 42%; DD, 30%); these two symptoms were also reported by nephrologists, who considered clinical efficacy the most important aspect of treatment. In Japan, dizziness was the most common (n=5/6, 83%) symptom among ND patients. Anaemia symptoms were reported to negatively affect different aspects of patients’ lives, including the ability to carry out daily activities (ND, 61%; DD, 65%), work (ND, 42%; DD, 50%), and exercise (ND, 26%; DD, 30%). ESA treatments were perceived to be effective in improving patients’ symptoms and quality of life. Many patients had not experienced AEs associated with treatment and were not concerned about them, however patients who had experienced gastrointestinal (GI) AEs due to oral iron were sensitive to the risk of GI effects. Out of 23 ND patients who were asked, 19 (83%) preferred an oral treatment due to the convenience of administration, and to avoid injection pain and drug storage requirements associated with SC administration. Self-administering SC ESAs was a concern among Japanese ND patients, who often had a healthcare professional administer the medication. Haemodialysis patients (n=12), who often receive IV ESAs during their dialysis sessions, were less likely to prefer oral treatments due to lack of perceived convenience. Peritoneal dialysis patients (n=8), who often receive home dialysis and SC ESAs, preferred oral treatment to avoid self-administration and storage requirements, and to make travel easier. Limitations of the study included the small number of participants and amendments to the eligibility criteria implemented during data collection, including more relaxed requirements for blood pressure, blood transfusion, and insulin use. Conclusion Patients considered the available treatment options to effectively treat CKD anaemia. Besides efficacy, patients’ primary concern was the mode of administration of their medication, rather than safety considerations.

scholarly journals Metabolomics Evaluation of Patients With Stage 5 Chronic Kidney Disease Before Dialysis, Maintenance Hemodialysis, and Peritoneal Dialysis

2021 ◽  
Vol 11 ◽  
Author(s):  
Sang Zhu ◽  
Feng Zhang ◽  
Ai-Wen Shen ◽  
Bo Sun ◽  
Tian-Yi Xia ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Peritoneal Dialysis ◽  
Kidney Disease ◽  
High Performance ◽  
Treatment Options ◽  
Plasma Concentrations ◽  
Current Treatment ◽  
Maintenance Hemodialysis ◽  
Liquid Chromatography Tandem Mass ◽  
The Impact

ObjectiveCurrent treatment options for patients with stage 5 chronic kidney disease before dialysis (predialysis CKD-5) are determined by individual circumstances, economic factors, and the doctor’s advice. This study aimed to explore the plasma metabolic traits of patients with predialysis CKD-5 compared with maintenance hemodialysis (HD) and peritoneal dialysis (PD) patients, to learn more about the impact of the dialysis process on the blood environment.MethodsOur study enrolled 31 predialysis CKD-5 patients, 31 HD patients, and 30 PD patients. Metabolite profiling was performed using a targeted metabolomics platform by applying an ultra-high-performance liquid chromatography-tandem mass spectrometry method, and the subsequent comparisons among all three groups were made to explore metabolic alterations.ResultsCysteine metabolism was significantly altered between predialysis CKD-5 patients and both groups of dialysis patients. A disturbance in purine metabolism was the most extensively changed pathway identified between the HD and PD groups. A total of 20 discriminating metabolites with large fluctuations in plasma concentrations were screened from the group comparisons, including 2-keto-D-gluconic acid, kynurenic acid, s-adenosylhomocysteine, L-glutamine, adenosine, and nicotinamide.ConclusionOur study provided a comprehensive metabolomics evaluation among predialysis CKD-5, HD, and PD patients, which described the disturbance of metabolic pathways, discriminating metabolites and their possible biological significances. The identification of specific metabolites related to dialysis therapy might provide insights for the management of advanced CKD stages and inform shared decision-making.

scholarly journals Parathyroidectomy is a reliable treatment option for chronic kidney disease patients with secondary hyperthyroidism (SHPT)

2019 ◽  
Author(s):  
Changying Xing ◽  
Hongqing Cui ◽  
Jingjing Wu ◽  
Li Zhang ◽  
Chunxia Mao ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Peritoneal Dialysis ◽  
Kidney Disease ◽  
Treatment Option ◽  
Treatment Options ◽  
Test Group ◽  
Surgical Removal ◽  
Dialysis Patients ◽  
Haematological Profile ◽  
Calcium Phosphorus

Abstract Background: Secondary hyperthyroidism (SHPT) is a common complication in chronic kidney disease patients undergoing peritoneal dialysis. It develops as a result of distortions in the regulation of calcium, phosphorus and parathyroid hormone (PTH). SHPT increases with decreasing kidney function. Factors that affect the levels of calcium, phosphorus, and PTH include diet, residual renal function, peritoneal transport properties, and dialysate calcium concentration. Treatment options for SHPT include pharmaceutical and surgical removal of parathyroid glands. Although there are treatment options for kidney disease patients with SHPT, little improvement has been made in the overall outcome of the patients. Method: Here, we present that parathyroidectomy is a treatment option for patients with SHPT. A test group (peritoneal dialysis patients with SHPT who had surgery plus forearm transplantation) were compared with control group (normal peritoneal dialysis patients without surgery). In both groups, clinical, biochemical and haematological profile assessments were done. Results: The test group after surgery show improved clinical, biochemical and haematological profile comparing with the control (non-surgery) group. Conclusion: parathyroidectomy (PTX) is a reliable treatment option for patients with SHPT, which brings about improvement in the biochemical, haematological, physiological and clinical parameters as compared with peritoneal dialysis patients with secondary hyperthyroidism without parathyroidectomy plus forearm transplantation.

scholarly journals Efficacy and safety of gout flare prophylaxis and therapy use in people with chronic kidney disease: a Gout, Hyperuricemia and Crystal-Associated Disease Network (G-CAN)-initiated literature review

2021 ◽  
Vol 23 (1) ◽  
Author(s):  
Huai Leng Pisaniello ◽  
Mark C. Fisher ◽  
Hamish Farquhar ◽  
Ana Beatriz Vargas-Santos ◽  
Catherine L. Hill ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Renal Function ◽  
Kidney Disease ◽  
Literature Review ◽  
Interleukin 1 ◽  
Treatment Options ◽  
Cochrane Library ◽  
Efficacy And Safety ◽  
Clinical Trial Results ◽  
Gout Flare

AbstractGout flare prophylaxis and therapy use in people with underlying chronic kidney disease (CKD) is challenging, given limited treatment options and risk of worsening renal function with inappropriate treatment dosing. This literature review aimed to describe the current literature on the efficacy and safety of gout flare prophylaxis and therapy use in people with CKD stages 3–5. A literature search via PubMed, the Cochrane Library, and EMBASE was performed from 1 January 1959 to 31 January 2018. Inclusion criteria were studies with people with gout and renal impairment (i.e. estimated glomerular filtration rate (eGFR) or creatinine clearance (CrCl) < 60 ml/min/1.73 m2), and with exposure to colchicine, interleukin-1 inhibitors, non-steroidal anti-inflammatory drugs (NSAIDs), and glucocorticoids. All study designs were included. A total of 33 studies with efficacy and/or safety analysis stratified by renal function were reviewed—colchicine (n = 20), anakinra (n = 7), canakinumab (n = 1), NSAIDs (n = 3), and glucocorticoids (n = 2). A total of 58 studies reported these primary outcomes without renal function stratification—colchicine (n = 29), anakinra (n = 10), canakinumab (n = 6), rilonacept (n = 2), NSAIDs (n = 1), and glucocorticoids (n = 10). Most clinical trials excluded study participants with severe CKD (i.e. eGFR or CrCl of < 30 mL/min/1.73 m2). Information on the efficacy and safety outcomes of gout flare prophylaxis and therapy use stratified by renal function is lacking. Clinical trial results cannot be extrapolated for those with advanced CKD. Where possible, current and future gout flare studies should include patients with CKD and with study outcomes reported based on renal function and using standardised gout flare definition.

scholarly journals Peginesatide to Manage Anemia in Chronic Kidney Disease Patients on Peritoneal Dialysis

2015 ◽  
Vol 35 (4) ◽  
pp. 481-489 ◽  
Author(s):  
Raja Zabaneh ◽  
Simon D. Roger ◽  
Mohamed El-Shahawy ◽  
Michael Roppolo ◽  
Grant Runyan ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Adverse Event ◽  
Peritoneal Dialysis ◽  
Kidney Disease ◽  
Common Adverse Event ◽  
Erythropoietin Receptor ◽  
Open Label ◽  
Evaluation Period ◽  
Red Blood Cell Transfusions ◽  
The Mean

♦BackgroundPeginesatide is a novel, synthetic, peptide-based pegylated erythropoiesis-stimulating agent that is designed specifically to stimulate the erythropoietin receptor. The purpose of the present study was to assess, for the first time, the efficacy and safety of peginesatide in chronic kidney disease (CKD) patients receiving peritoneal dialysis (PD) and previously on epoetin treatment.♦MethodsIn this open-label multicenter study, 59 PD patients with CKD were converted from epoetin (alfa or beta) to once-monthly peginesatide. Doses were titrated to maintain hemoglobin levels between 10 g/dL and 12 g/dL during the 25 weeks of the study. The primary endpoint was change from baseline in mean hemoglobin values during the evaluation period (weeks 20 – 25).♦ResultsThe mean hemoglobin value during the evaluation period was 11.3 ± 1.07 g/dL, and the mean change from baseline was 0.10 ± 1.15 g/dL (95% confidence limits: –0.24, 0.44 g/dL). During the evaluation period, most patients maintained hemoglobin levels between 10 g/dL and 12 g/dL (63.0%) and within ±1.0 g/dL of baseline (60.9%). The median weekly epoetin dose at baseline was 96.0 U/kg, and the median starting peginesatide dose was 0.047 mg/kg. Forty-three patients (72.9%) completed the study. Six patients (10.2%) received red blood cell transfusions. The observed adverse event profile was consistent with underlying conditions in the PD patient population. The most common adverse event was peritonitis (20.3%), a complication commonly associated with PD. Four deaths occurred during the study (2 related to septic shock, and 1 each to myocardial ischemia and myasthenia gravis).♦ConclusionsIn this study, once-monthly peginesatide maintained hemoglobin levels in PD patients after conversion from epoetin.

scholarly journals Association between gut dysbiosis and chronic kidney disease: a narrative review of the literature

2021 ◽  
Vol 49 (10) ◽  
pp. 030006052110532
Author(s):  
Zhe Feng ◽  
Ting Wang ◽  
Sheng Dong ◽  
Hongli Jiang ◽  
Jianzhong Zhang ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Communicable Disease ◽  
Treatment Options ◽  
Narrative Review ◽  
Gut Dysbiosis ◽  
Significant Burden ◽  
Intestinal Ecology ◽  
The Relationship ◽  
Non Communicable Disease

Chronic kidney disease (CKD) is a serious non-communicable disease that poses a significant burden on healthcare and society. It is essential to devise new strategies to better treat patients with CKD. Research has illustrated that gut dysbiosis, describing an abnormal intestinal ecology, is closely associated with CKD. In this narrative review, we summarized the evidence of their mutual relationship and discussed the potential treatment options to correct gut dysbiosis in patients with CKD. Gut dysbiosis significantly increases the risk of CKD, especially in the older population. Gut dysbiosis also plays a role in CKD complications, such as hypertension, cardiovascular events, and cognitive dysfunction. The relationship between gut dysbiosis and CKD is bidirectional, and CKD itself can lead to changes in gut microecology. The usual therapies for CKD can also increase the incidence of gut dysbiosis. Meanwhile, probiotics and antibiotics are generally used to correct gut dysbiosis. Further studies are required to elaborate the association between gut dysbiosis and CKD, and more treatment options should be explored to prevent CKD in patients with gut dysbiosis.

scholarly journals Etiologic-sociodemographic assessment and comparison of dialysis modalities in pediatric Syrian migrants with chronic kidney disease

2021 ◽  
Author(s):  
Mehtap Çelakıl ◽  
Yasemin Çoban
Keyword(s):  
Chronic Kidney Disease ◽  
Peritoneal Dialysis ◽  
Kidney Disease ◽  
Clinical Laboratory ◽  
Kidney Diseases ◽  
Pediatric Nephrology ◽  
Refugee Children ◽  
Mortality And Morbidity ◽  
Ventricle Hypertrophy ◽  
Hospital Pediatric

Abstract Background: Chronic kidney disease (CKD) and end-stage renal disease (ESRD) are among the important causes of mortality and morbidity in childhood. Early diagnosis and treatment of the underlying primary disease may prevent most of CKD patients from progressing to ESRD. There is no study examining chronic kidney diseases and dialysis modalities in Syrian immigrant children. We aimed to retrospectively research the etiologic, sociodemographic, and clinical factors in CKD among Syrian refugee children, and at the same time, to compare the clinical characteristics of patients with ESRD on peritoneal dialysis and hemodialysis. Methods: Our study included a total of 79 pediatric Syrian patients aged from 2-16 years monitored at Hatay State Hospital pediatric nephrology clinic with diagnosis of various stages of CKD and with ESRD. Physical-demographic features and clinical-laboratory information were retrospectively screened. Results: The most common cause of CKD was congenital anomalies of the kidneys and urinary tracts (CAKUT) (37.9%). Other causes were urolitiasis (15.1%), nephrotic syndrome (10.1%), spina bifida (8.8%), hemolytic uremic syndrome (7.5%), and glomerulonephritis (7.5%). Twenty-five patients used hemodialysis due to bad living conditions. Only 2 of the patients with peritoneal dialysis were using automatic peritoneal dialysis (APD), with 5 using continuous ambulatory peritoneal dialysis (CAPD). Long-term complications like left ventricle hypertrophy and retinopathy were significantly higher among hemodialysis patients. There was no difference identified between the groups in terms of hypertension and sex. Conclusion: Progression to ESRD due to preventable reasons is very frequent among CKD patients. For more effective use of peritoneal dialysis in pediatric patients, the responsibility of states must be improved.

scholarly journals Differences in the quality of life of chronic kidney disease patients undergoing hemodialysis and continuous ambulatory peritoneal dialysis

2021 ◽  
Vol 10 (2) ◽  
Author(s):  
Ika Setyo Rini ◽  
Titik Rahmayani ◽  
Efris Kartika Sari ◽  
Retno Lestari
Keyword(s):  
Quality Of Life ◽  
Chronic Kidney Disease ◽  
Peritoneal Dialysis ◽  
Kidney Disease ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Life Quality ◽  
P Value ◽  
Minimal Amount ◽  
Cross Sectional

Background: Chronic kidney disease (CKD) is defined as a progressive disease that causes renal failure and requires extended and long-term therapies. CKD patients need to choose one of these therapies to improve their quality of life. This study aims to investigate differences in the quality of life of chronic kidney disease patients undergoing hemodialysis and continuous ambulatory peritoneal dialysis (CAPD).Design and Methods: The study design used is similar to the cross-sectional design. Therefore, in this study observations were carried out, a EQ_5D life quality questionnaire sheet was administered to respondents, and a purposive sampling method was used. The total number of respondents was 250 and consisted of 125 hemodialysis and CAPD patients each.Results: The results obtained using the Mann Whitney method was a p-value (0.515)> α (0.05). These results also included five components, namely the ability to move/walk to an acceptable degree, adequate self-care, performance of usual activities, minimal amount of pain/discomfort during hemodialysis and CAPD, and acceptable levels of anxiety/sadness.Conclusions: This research concludes that there is no difference in the quality of life between CKD patients  undergoing hemodialysis and CAPD.

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