scholarly journals P1542DIALYSIS MODALITY AND OUTCOMES IN GERIATRIC END STAGE RENAL DISEASE (ESRD) PATIENTS. AN ASIAN SINGLE CENTER EXPERIENCE

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Jeevita Supayah ◽  
Hin Seng Wong ◽  
Fei Yee Lee ◽  
Suryati Yakob
Keyword(s):  
Dialysis Initiation ◽  
Dialysis Modality ◽  
Single Center Experience ◽  
Co Morbidity ◽  
The Mean ◽  
Maintenance Dialysis ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Abstract Background and Aims The prevalence of CKD increases with age and more elderly patients are on maintenance dialysis as advanced age is no longer an impediment. The selection of dialysis modality can be difficult for the simultaneous benefit and burden of individual modality on top of the complexity of co-morbidity and quality of life. To study the survival outcomes based on dialysis modality in geriatric ESRD patients Method The cohort of geriatric patients (aged > 65 years) with ESRD who were referred to our pre-dialysis clinic from 1st January 2016 to 31st December 2018 and started on maintenance dialysis were identified via the hospital information system. Demographics, co-morbidities, dialysis modalities and clinical outcome in terms of survival were obtained from the hospital electronic medical record. Glomerular filtration rates (eGFR) were calculated using the CKD-EPI formula in mls/min/1.73m2. The statistical analysis was done using SPSS version 23. Results A total of 145 geriatric ESRD patients were initiated on chronic dialysis. The cohort was predominated by male with 77 patients (53.1%). The mean age was 72.5±5.2 years. Majority had multiple comorbidities with 95% having hypertension, 82.8% with diabetes, 65.5% and 32.8% having dyslipidemia and ischemic heart disease, respectively. The mean eGFR at point of referral and dialysis initiation were 12.5±4.9 mls/min/1.73m2 and 6.57±2.33 mls/min/1.73m2 respectively. Mean duration to initiate dialysis from first review was 6.7±5.8 months. Majority opted for hemodialysis (HD) with 106 patients (73.1%). 74% patients in the HD cohort initiated dialysis via a catheter and remainder with an arteriovenous fistula (AVF). 39 patients (27.1%) opted for peritoneal dialysis (PD) and all were initiated via tenckhoff catheter. Mean eGFR at dialysis initiation were 6.44±2.47 (HD) and 6.9±1.9(PD) respectively. At 6 months, all PD patients survived and 18.2% of HD patients died with statistically significance difference at p=0.003. No survival predictors were identified. Conclusion PD modality has advantage in survival outcome in geriatric ESRD patients.

scholarly journals Kidney Transplant in an Old Woman-A Case Report and Review of the Literature

2015 ◽  
Vol 12 (1) ◽  
pp. 62-64
Author(s):  
Lidija Orlic ◽  
Ivana Mikolasevic ◽  
Branka Sladoje-Martinovic ◽  
Ivan Bubic and Sanjin Racki
Keyword(s):  
Quality Of Life ◽  
Renal Transplantation ◽  
Elderly Patients ◽  
End Stage Renal Disease ◽  
Older Patients ◽  
Review Of The Literature ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Abstract The number of elderly patients with chronic kidney disease (CKD) as well as those with end-stage renal disease (ESRD) are increasing worldwide. Renal transplantation is now the treatment of choice for all ESRD patients, including those that are aged 65 or over. Namely, there is a growing evidence that elderly patients, in the absence of contraindications, have better outcomes after renal transplantation than alternative forms of RRT. Although survival, quality of life and economic advantages have been shown after transplantation, renal transplantation is still infrequently offered to older patients. Hereby, we present a case of an old woman who was transplanted in 1994 when “senior” program was still not established and when kidney transplantation at this age was rarity in many countries. She lived 16 years and 8 months with a well-functioning graft and died at the age of 89.

scholarly journals Variation in end-stage renal disease patient outcomes: what we know, what should we know, and how do we find it out?

1993 ◽  
Vol 3 (11) ◽  
pp. 1738-1747
Author(s):  
P Kurtin ◽  
A R Nissenson
Keyword(s):  
Patient Outcomes ◽  
Outcome Measure ◽  
Disease Patient ◽  
Patient Specific ◽  
Quality Cost ◽  
Current State ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

The size and expense of the ESRD program exceed all predictions made when the program was first initiated. Although the effectiveness of dialytic therapy is unquestioned, its value (quality/cost) is actively debated in this era of constricting resources. To better evaluate the quality of the ESRD program, it is essential to first define and quantitate the outcomes of dialytic care. Although mortality is a convenient outcome measure, it may be affected by many patient-specific as well as other factors that must be considered when evaluating and comparing new and existing technologies or advances. Quality of life is only beginning to be used in depth as an outcome measure, and much work is needed to standardize research methodology and thus move this area forward. The following review describes the current state of knowledge regarding outcomes of ESRD patients and proposes areas for future investigation, which should help increase the understanding of the value of the ESRD program to patients, providers, and payors.

scholarly journals Health-Related Quality of Life in End-Stage Renal Disease Patients: How Often Should We Ask and What Do We Do with the Answer?

2016 ◽  
Vol 41 (1-3) ◽  
pp. 218-224 ◽  
Author(s):  
Shan Shan Chen ◽  
Saleem Al Mawed ◽  
Mark Unruh
Keyword(s):  
Quality Of Life ◽  
Patient Reported Outcomes ◽  
Dialysis Patients ◽  
Patient Reported ◽  
Related Quality ◽  
Health Related ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Background: End-stage renal disease (ESRD) patients have poor health-related quality of life (HRQOL) comparing to general population and comparable HRQOL to patients with other major chronic diseases. Poor HRQOL is associated with shorter survival. There is a limited threshold to which dialysis dose and parameters management can improve HRQOL in ESRD patients. Numerous studies have sought to find interventions to improve HRQOL. This article is to review the symptoms associated with poor HRQOL and how frequent the quality of life (QOL) should be evaluated to improve the outcome. Summary: It is required by the Center for Medicare and Medicaid Services to evaluate HRQOL of dialysis patients annually. KDIGO recommends the symptoms to be assessed regularly and the treatment is redirected toward a patient-centered care model. Studies have shown that measuring patient-reported outcomes frequently, from 4 times a day to every 3-6 months, without intervention did not improve the HRQOL significantly. Appropriate intervention of the symptoms may improve the quality of life (QOL). Studies in oncology have also showed a similar result. The commonly used tools to evaluate the HRQOL in dialysis patients take up to 30 min for completion. Therefore, frequent assessment of all the symptoms can provide more burden than benefit to the patients. In addition to the annual HRQOL measurements, more frequent evaluation of targeted symptoms can be helpful. For appropriate intervention of the symptoms, effective communication between providers, as well as a multidisciplinary approach, is essential to improve HRQOL and outcomes in dialysis patients. Key Messages: Measurement of patient-reported outcomes may provide an opportunity to improve outcomes in ESRD. The frequent measurement of symptoms and QOL may be burdensome. Consider targeted measurement of symptoms to complement HRQOL measurement. Improved communication and the use of a multidisciplinary team provide mechanisms to improve HRQOL in ESRD.

scholarly journals Patient Survival Between Hemodialysis and Peritoneal Dialysis Among End-Stage Renal Disease Patients Secondary to Myeloperoxidase-ANCA-Associated Vasculitis

2022 ◽  
Vol 8 ◽  
Author(s):  
Xueqin Wu ◽  
Yong Zhong ◽  
Ting Meng ◽  
Joshua Daniel Ooi ◽  
Peter J. Eggenhuizen ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Patient Survival ◽  
Dialysis Initiation ◽  
Dialysis Modality ◽  
Significant Difference ◽  
Stage Renal Disease ◽  
End Stage

BackgroundA significant proportion of anti-neutrophil cytoplasmic antibody (ANCA) associated glomerulonephritis eventually progresses to end-stage renal disease (ESRD) thus requiring long-term dialysis. There is no consensus about which dialysis modality is more recommended for those patients with associated vasculitis (AAV-ESRD). The primary objective of this study was to compare patient survival in patients with AAV-ESRD treated with hemodialysis (HD) or peritoneal dialysis (PD).MethodsThis double-center retrospective cohort study included dialysis-dependent patients who were treated with HD or PD. Clinical data were collected under standard format. The Birmingham vasculitis activity score (BVAS) was used to evaluate disease activity at diagnosis and organ damage was assessed using the vasculitis damage index (VDI) at dialysis initiation.ResultsIn total, 85 patients were included: 64 with hemodialysis and 21 with peritoneal dialysis. The patients with AAV-PD were much younger than the AAV-HD patients (48 vs. 62, P < 0.01) and more were female (76.2 vs. 51.6%, P = 0.05). The laboratory data were almost similar. The comorbidities, VDI score, and immuno-suppressive therapy at dialysis initiation were almost no statistical difference. Patient survival rates between HD and PD at 1 year were 65.3 vs. 90% (P = 0.062), 3 year were 59.6 vs. 90% (P < 0.001), and 5 years were 59.6 vs. 67.5% (P = 0.569). The overall survival was no significant difference between the two groups (P = 0.086) and the dialysis modality (HD or PD) was not shown to be an independent predictor for all-cause death (hazard ratio (HR) 0.73; 95% confidence interval (CI) 0.31–1.7; P = 0.473). Cardio-cerebrovascular events were the main cause of death among AAV-HD patients while infection in patients with AAV-PD.ConclusionThese results provide real-world data that the use of either hemodialysis or peritoneal dialysis modality does not affect patient survival for patients with AAV-ESRD who need long-term dialysis.

scholarly journals Quality of Life and Depression in Patients With End-stage Renal Disease: a Comparison of Renal Replacement Therapy Modalities

2021 ◽  
Author(s):  
Fei Yang ◽  
Zheng Yang ◽  
Lu Cheng ◽  
Jiayu Tong ◽  
Pusheng Wang
Keyword(s):  
Quality Of Life ◽  
Depressive Symptoms ◽  
Renal Replacement Therapy ◽  
End Stage Renal Disease ◽  
Sf 36 ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients ◽  
Component Scores

Abstract Purpose. Patients with end-stage renal disease (ESRD) face various physical and mental limitations resulting from different renal replacement therapy (RRT) modalities. Renal transplantation (Tx) is considered as the treatment that impacts most on health-related quality of life (HRQOL). This study aimed to analyze and compare the HRQOL and depression levels of patients undergoing hemodialysis (HD), peritoneal dialysis (PD) and Tx.Methods. A single-center cross-sectional sample of 112 HD patients, 68 PD patients and 97 Tx patients participated in our questionnaire survey. The HRQOL and depression levels were assessed through the 36-Item Short-Form Health Survey (SF-36) and Mental Health Inventory (MHI-5), respectively. The multiple linear regression model was performed to examine the factors associated with each of the HRQOL scale scores. Results. The SF-36 HRQOL of Tx patients differed significantly from that in HD and PD groups in all eight dimensions and two components (all P<0.001). More than 45% of patients in each group were facing depressive symptoms. HD patients (63.4%) and PD (67.6%) patients were more depressive compared with Tx patients (45.4%, P =0.006). Depression in ESRD patients contributed to a worse quality of life (P<0.001). Patients ranging in age from 31 to 50, having full-time jobs, receiving Tx and without depression were associated with better HRQOL in the domain of Physical Component Scores (PCS). Patients with unemployment, dismissal or being looking for a job, receiving Tx and without depression were associated with better HRQOL in the domain of Mental Component Scores (MCS).Conclusions. Tx patients had better HRQOL and less depressive symptoms than HD and PD patients. Depression was related to an impaired HRQOL, which was common in ESRD patients. The severity of depression in ESRD patients and the effectiveness of Tx on HRQOL improvement need to be underscored.

scholarly journals Cytomegalovirus (CMV) and C-Reactive Protein (CRP) and their Association with Atherosclerosis in Patients with End Stage Renal Disease

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
A M Okba ◽  
M A Raafat ◽  
M N Farres ◽  
N A Melek ◽  
M M Doss ◽  
...  
Keyword(s):  
Mean Value ◽  
Control Group ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
The Mean ◽  
Stage Renal Disease ◽  
End Stage ◽  
Serum Crp ◽  
Atherosclerotic Changes ◽  
Esrd Patients

Abstract Background ESRD (end stage renal disease) is associated with an increase in the risk for cardiovascular disease, which can only be partially explained by known classical risk factors. However, chronic inflammation and endothelial dysfunction are key events in the development of atherosclerosis; both are observed in ESRD patients . The significance of C-Reactive Protein (CRP) and inflammation has increased over time, especially in the ESRD population. From being a simple marker, it now shown that CRP has an active participation in pro-atherosclerotic phenomenon including local pro-inflammatory and thrombotic events. Studies in the general population indicate the usefulness of CRP in prognosis and in monitoring response to therapy. Cytomegalovirus (CMV) is an important pathogen in immunocompromised individuals. Patients with ESRD display signs of frequent CMV re-activation, which may be caused by the uraemia-associated defect in cellular immunity. It has been well documented that hemodialysis patients have impaired immune response, which may result in higher prevalence rates of viral infections, including CMV. Infections in these patients may be due to primary infection or, more commonly, by reactivation of latent virus or re-infection with exogenous virus, which may be introduced by blood transfusion or kidney transplant. Infection with CMV is also considered a risk factor for progression of atherosclerotic disease. Methods CRP and CMV IgG level was measured in the blood samples of sixty adult patients diagnosed as ESRD, 30 ESRD patients with atherosclerotic changes(Group I) and 30 ESRD patients without atherosclerotic changes (Group II) and in comparison with 30 control subjects(Group III) (Control Group). Results The mean value of CRP in the control group (6.0 ± 4.2), the mean value in the ESRD patients with atherosclerotic changes group (15.8 ± 5.6) and the mean value in the ESRD patients without atherosclerotic changes group (11.2 ± 3.9),thus the mean values of CRP in ESRD patients groups were significantly higher than that of the control group (P &lt; 0.001) and the mean value of CRP in ESRD with atherosclerotic changes is significantly higher compared to ESRD without atherosclerotic changes group (P &lt; 0.001). Regarding CMV IgG antibodies it was significantly higher in ESRD patients compared to the control group and was also significantly higher in ESRD with atherosclerotic changes compared to ESRD without atherosclerotic changes. Conclusions ESRD are at greater risk of inflammatory reaction against factors originating from graft, fistula, dialysis membrane, infection sites. These reactions are associated with increased levels inflammatory markers such as serum CRP. Serum CRP seems to have a contribution in the development of cardiovascular complications in ESRD patients.CMV seropositivity is also significantly associated with atherosclerotic disease in ESRD patients. Our data suggest that the risk for progressive atherosclerosis is specifically increased in patients with an inflammatory response to CMV and elevated CRP level.

Rehabilitating a Dialysis Patient

2003 ◽  
Vol 23 (2_suppl) ◽  
pp. 81-83 ◽  
Author(s):  
Yuk-Yee Cheng ◽  
Ying-Fan Wong ◽  
Bonnie Y.C. Chu ◽  
Woon-Or Lam ◽  
Yiu-Wing Ho
Keyword(s):  
Rehabilitation Program ◽  
Social Psychological ◽  
Dialysis Unit ◽  
Patient Support Group ◽  
Group A ◽  
Stage Renal Disease ◽  
End Stage ◽  
Renal Patient ◽  
Esrd Patients

End-stage renal disease (ESRD) patients undergoing dialysis face much stress and have to make adjustments in their lives. To optimize health and improve quality of life, rehabilitation of renal patients is a necessity. Renal rehabilitation includes physical, social, psychological, and vocational elements. We established a renal rehabilitation program—including predialysis education, in-center training, and community rehabilitation—in our regional dialysis unit. The program is organized by a multidisciplinary team of health professionals with the help of a renal-patient support group. A patient who joined the rehabilitation program showed significant lifestyle change.

Characteristics and Clinical Outcomes of End-Stage Renal Disease Patients on Peritoneal Dialysis for over 15 Years: A Single-Center Experience

2017 ◽  
Vol 37 (5) ◽  
pp. 535-541 ◽  
Author(s):  
Youn Kyung Kee ◽  
Jung Tak Park ◽  
Chang-Yun Yoon ◽  
Hyoungnae Kim ◽  
Seohyun Park ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Clinical Outcomes ◽  
End Stage Renal Disease ◽  
Short Term ◽  
Factors Associated ◽  
The Mean ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Background Maintaining peritoneal dialysis (PD) for a long time is problematic owing to a number of factors. This study aimed to clarify the characteristics and examine the clinical outcomes of patients who received PD as a long-term dialysis modality. Methods All end-stage renal disease (ESRD) patients who initiated PD at Yonsei University Health System between 1987 and 2000 were screened. Patients who maintained PD for over 15 years were classified as the long-term PD group and those who were treated with PD for less than 5 years were included in the short-term PD group. Demographic and biochemical data and clinical outcomes were compared between the groups. Independent factors associated with long-term PD maintenance were ascertained using multivariate logistic regression analysis. Results Among 1,116 study patients, 87 (7.8%) were included in the long-term group and 293 (26.3%) were included in the short-term group. In the long-term group, the mean patient age at PD initiation was 39.6 ± 11.5 years, 35 patients (40.2%) were male, and the mean PD duration was 205.3 ± 32.7 months. Patients were younger, body weight was lower, the proportion of patients with diabetes or cardiovascular diseases was lower, and the proportion of low to low-average transporters was higher in the long-term group than in the short-term group ( p < 0.001). Multiple logistic regression analysis revealed that age, body mass index (BMI), serum creatinine, type of PD solution, and diabetes were significant independent factors associated with long-term PD maintenance. Conclusion Peritoneal dialysis can be considered as a long-term renal replacement therapy option, especially in non-diabetic, not overweight, and young ESRD patients.

scholarly journals Effects of Peer Support Program on Self-Management in Patients with End-Stage Renal Disease Undergoing Hemodialysis

2020 ◽  
Vol 10 (2) ◽  
pp. 171-181 ◽  
Author(s):  
Fida' Husain ◽  
Henni Kusuma ◽  
Andrew Johan
Keyword(s):  
Peer Support ◽  
End Stage Renal Disease ◽  
Intervention Group ◽  
Support Programs ◽  
Self Management ◽  
Control Group ◽  
The Mean ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Background: End-stage renal disease (ESRD) patients undergoing hemodialysis require essential self-management to lifestyle changes to minimize the risk of complications, morbidity, and mortality. Efforts made to improve self-management of hemodialysis patients in previous studies were carried out by health workers that may not provide 'real' knowledge, while peer support programs carried out by patients as peers to share their experiences may provide more benefits.Purpose: The purpose of this study was to determine the effects of peer support programs on improving self-management in patients with ESRD undergoing hemodialysis.Methods: This study employed a quasi-experimental design and involved a total of 33 patients in the control group and 32 patients in the intervention group, who met the inclusion and exclusion criteria. The samples were recruited consecutively. The intervention of peer support programs was implemented through information support, emotional support, and mutual reciprocity in groups of 10-12 people to share experiences related to their self-management. The intervention was given for six sessions; each lasted for 30-45 minutes. The data were collected using the Indonesian version of the hemodialysis self-management instrument (HDSMI) and analyzed using a paired-sample t-test and independent-sample t-test.Results: The results showed that after the intervention, the mean score of self-management in the intervention group increased from 79.47±7.919 to 90.75±7.089, and in the control group, the mean increased from 81.88±8.291 to 82.12±7.692. After the implementation of peer support programs, there was a significant difference in the score of self-management between the intervention and control groups (p<0.001).Conclusion: Peer support programs gave an effect on increasing self-management in patients with ESRD undergoing hemodialysis. Peer support programs should be introduced early to ESRD patients undergoing hemodialysis so that they can learn about self-management from other patients.  

High Pulse-Wave Velocity Defines a Very High Cardiovascular Risk Cohort of Dialysis Patients under Age 60

2016 ◽  
Vol 45 (1) ◽  
pp. 72-81 ◽  
Author(s):  
João Pedro Ferreira ◽  
Nicolas Girerd ◽  
Bruno Pannier ◽  
Patrick Rossignol ◽  
Gerard M. London
Keyword(s):  
Pulse Wave Velocity ◽  
Wave Velocity ◽  
Cardiovascular Mortality ◽  
Pulse Wave ◽  
Prognostic Information ◽  
The Mean ◽  
Stage Renal Disease ◽  
End Stage ◽  
Year 2000 ◽  
Esrd Patients

Background: Patients with end-stage renal disease (ESRD) are at a high risk of cardiovascular mortality (CVM). In patients with ESRD, arterial stiffness increases at an earlier age when compared to the general population and this contributes to the overall risk of cardiovascular mortality. The main objective of this study was to clarify the interplay between age and cardiovascular alterations in ESRD. Methods: Prospective, observational cohort study initiated in April 1987 until the end of 1998 with events recorded until the end of the year 2000 at the F.H. Manhes Hospital Center, Fleury-Mérogis (in the Paris/Ile de France area). Results: The study population consisted of 278 ESRD patients undergoing dialysis therapy. The mean ± SD age was 53 ± 16 years. The mean pulse-wave velocity (PWV) was ∼11 m/s, with ∼37% of patients having a PWV >12 m/s. During the follow-up period, 91 patients died from CV causes. PWV >12 m/s was associated with CVM in the unadjusted model but lost its prognostic value in patients >60 years (p for interaction = 0.008). In patients ≤60 years, PWV was found to be a strong and independent predictor of CVM with hazards ratio (95% CI) of 14.382 (7.120-29.047), p < 0.001, and it improved the prognostic reclassification of a model containing well-established prognostic variables. According to multivariable regression analysis, aortic PWV was strongly associated with age (R2 = 0.37, p < 0.001). Conclusion: A PWV >12 m/s provides important prognostic information in ESRD patients under 60 years of age, whereas in older patients, its prognostic relevance is lost. These findings are of critical relevance for early intervention guidance and trial end-point/treatment effect interpretation.

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