Home and facility haemodialysis patients: a comparison of outcomes in a matched cohort

2020 ◽  
Author(s):  
Emily K Yeung ◽  
Kevan R Polkinghorne ◽  
Peter G Kerr
Keyword(s):  
Graft Survival ◽  
Smoking Status ◽  
Ageing Population ◽  
Matched Cohort ◽  
Home Haemodialysis ◽  
Risk Of Death ◽  
Competing Risks Analysis ◽  
Transplant Registry ◽  
End Stage

Abstract Background Home haemodialysis (HHD) is utilised significantly less often than facility haemodialysis globally with few exceptions despite being associated with improved survival, and better quality of life. Previously, HHD was exclusively offered to younger patients with few comorbidities. However, with the increasing burden of end-stage kidney disease (ESKD) alongside an ageing population, increasing numbers of older patients are being treated with HHD. This study aims to re-evaluate survival and related outcomes in the context of this epidemiological shift. Methods A matched cohort design was used to compare all-cause mortality, transplantation, average biochemical values and graft survival 6 months post-transplant between HHD and facility haemodialysis patients. 181 HHD patients from a major hospital network were included, with 413 facility haemodialysis patients from the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) matched by age, gender, and cause of ESKD. Survival analysis and competing risks analysis (for transplantation) were performed. Results After adjusting for BMI, smoking status, racial group, and comorbidities, HHD was associated with significantly reduced risk of death compared to facility HD patients (HR = 0.47, 95% CI 0.30-0.74). Transplantation rates were comparable, with high rates of graft survival at 6 months in both groups. Haemoglobin, calcium, and parathyroid hormone levels did not vary significantly. However, home HD patients had significantly lower phosphate levels. Conclusions In this study, improved survival outcomes were observed in patients on home compared to facility dialysis, with comparable rates of transplantation, graft survival and biochemical control.

scholarly journals Patients’ experiences of cannulation of arteriovenous access for haemodialysis: A qualitative systematic review

2022 ◽  
pp. 112972982110676
Author(s):  
Catherine Fielding ◽  
Louise Bramley ◽  
Carol Stalker ◽  
Sarah Brand ◽  
Suzanne Toft ◽  
...  
Keyword(s):  
Needle Insertion ◽  
Eligibility Criteria ◽  
Home Haemodialysis ◽  
Research Priority ◽  
Qualitative Systematic Review ◽  
Arteriovenous Access ◽  
The Subject ◽  
Pain Experiences ◽  
End Stage

Introduction: Cannulation is an essential part of haemodialysis with arteriovenous access. Patients’ experiences of cannulation for haemodialysis are problematic but poorly understood. This review aims to synthesise findings related to patients’ experiences of cannulation for haemodialysis from qualitative studies, providing a fuller description of this phenomenon. Methods: Eligibility criteria defined the inclusion of studies with a population of patients with end-stage kidney disease on haemodialysis. The phenomena of interest was findings related to patients’ experiences of cannulation for haemodialysis and the context was both in-centre and home haemodialysis. MedLine, CINAHL, EMBASE, EMCARE, BNI, PsycInfo and PubMed were last searched between 20/05/2019 and 23/05/2019. The quality of studies was assessed using the using Joanna Briggs Critical Appraisal Checklist for Qualitative Research. Meta-aggregation was used to synthesise findings and CERQual to assess the strength of accumulated findings. Results: This review included 26 studies. The subject of included studies covered cannulation, pain, experiences of vascular access, experiences of haemodialysis and a research priority setting exercise. From these studies, three themes were meta-aggregated: (1) Cannulation for haemodialysis is an unpleasant, abnormal and unique procedure associated with pain, abnormal appearance, vulnerability and dependency. (2) The necessity of cannulation for haemodialysis emphasises the unpleasantness of the procedure. Success had multiple meanings for patients and patients worry about whether the needle insertion will be successful. (3) Patients survive unpleasant, necessary and repetitive cannulation by learning to tolerate cannulation and exerting control over the procedure. Feeling safe can help them tolerate cannulation better and the cannulator can invoke feeling safe. However, some patients still avoid cannulation, due to its unpleasantness. Conclusions: Cannulation is a pervasive procedure that impacts on patients’ experiences of haemodialysis. This review illuminates further patients’ experiences of cannulation for haemodialysis, indicating how improvements can be made to cannulation. Registration: PROSPERO (CRD42019134583).

scholarly journals Association of Smoking Status with Outcomes in Hospitalized COVID-19 Patients

2020 ◽  
Author(s):  
Muhammad Adrish ◽  
Sridhar Chilimuri ◽  
Nikhitha Mantri ◽  
Haozhe Sun ◽  
Maleeha Zahid ◽  
...  
Keyword(s):  
Critical Illness ◽  
Cox Model ◽  
Smoking Status ◽  
Severity Of Illness ◽  
Systemic Steroid ◽  
Risk Of Death ◽  
Artery Disease ◽  
Never Smokers ◽  
Stage Renal Disease ◽  
End Stage

Abstract Introduction: Smoking causes inflammation of the lung epithelium by releasing cytokines and impairing muco-ciliary clearance. Some studies have linked smoking with severity of illness of COVID-19 whereas others have found no such association.Methods: This was a retrospective analysis of all adults hospitalized with COVID-19 from March 09 to May 18, 2020. Results: 1173 patients met the study criteria. 837 patients never smoked and 336 patients were either current smokers or past smoker and were grouped together in smokers group. Patients in smokers group were more likely to be male and had higher incidence of underlying COPD (19% vs. 6%, p<0.001), human immunodeficiency virus infection (11% vs. 5%,p<0.001), cancer (11% vs. 6%, p=0.005), congestive heart failure (15% vs. 8%, p<0.001), coronary artery disease (15% vs. 9%, p=0.027), chronic kidney disease (11% vs. 8%, p=0.037), and end-stage renal disease (10% vs. 6%, p=0.009) compared to non-smokers. Smokers were more likely to develop critical illness requiring mechanical ventilation (47% vs. 37% p=0.005). Univariate Cox model for survival analysis by smoking status showed that smokers only current smokers had higher risk of death compared to never-smokers (HR 1.61, 95% confidence interval 1.22–2.12, p<0.001). In the multivariate approach Cox model for the survival, female sex, age, LDH and systemic steroid use were associated with overall survival.Conclusion: In our large single center retrospective database of patients hospitalized with COVID-19, smoking was associated with development of critical illness and higher likelihood of death

scholarly journals HOW TO CONTROL INTERDIALYTIC WEIGHT GAIN (IDWG) AMONG HEMODIALYSIS PATIENTS?

2021 ◽  
Vol 10 (2) ◽  
pp. 214-221
Author(s):  
Lono Wijayanti ◽  
Priyo Mukti Pribadi Winoto ◽  
Nursalam Nursalam
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Renal Failure ◽  
Weight Gain ◽  
Literature Review ◽  
End Stage Renal Failure ◽  
Risk Of Death ◽  
Interdialytic Weight Gain ◽  
End Stage

Background: Chronic kidney failure is a terminal disease that often affects the patient's quality of life. One of the problems that often occurs in patients with end-stage renal failure is the increase in fluid volume between two dialysis times. The increase in Interdialytic Weight Gain (IDWG) has a serious impact, 60-80% of patients die from excess fluid and food intake during the interdialytic period. Objective: This review aimed to describe the importance of Interdialytic Weight Gain (IDWG) in end-stage renal failure patients undergoing hemodialysis. Design: This study design is a systematic review to search and review article from database and the theory underlying this study or guidance in this systematic literature review using PRISMA. Data Sources: This systematic review was conducted using a database with electronic searches on EBSCO, ProQuest, Scopus, SAGE, and Science Direct published in 2017-2021. Review Methods: The method used in the preparation of the Literature review using the PRISMA checklist and PICOT. Secondary data obtained from the journal with a predetermined discussion. Results: The results of the database search strategy were 1,907 articles were obtained, but 1,340 articles were excluded. There were seven articles that met the inclusion criteria. Two articles identified that uncontrolled IDWG is at risk of death in chronic renal failure patients undergoing hemodialysis. Conclusion: Two articles state that IDWG affects hemoglobin concentration and cardiovascular disorders and triggers complications, two other articles state that the factors that contribute to IDWG are fluid intake, thirst, self-efficacy and dietary behavior, one article states that controlled IDWG will improve the quality of life of patients with end-stage renal failure/End-Stage Renal Disease (ESRD undergoing hemodialysis. Uncontrolled IDWG is at risk of death in patients undergoing hemodialysis. Control of IDWG through adherence to dietary behavior will improve the quality of life of end-stage renal failure patients undergoing hemodialysis.

scholarly journals Comparison of physical activity and quality of life in home haemodialysis (HHD) patients versus conventional in-centre haemodialysis (ICHD) patients: the observational, longitudinal, prospective, international, multicentric SeCoIA study protocol

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Natalia Target ◽  
Cécile Courivaud ◽  
Pierre Antoine Michel ◽  
Salima Daoud ◽  
Michel Thomas
Keyword(s):  
Quality Of Life ◽  
Physical Activity ◽  
Rating Scale ◽  
Accurate Information ◽  
Multicentric Study ◽  
Home Haemodialysis ◽  
Large Cohort Study ◽  
Stage Renal Disease ◽  
End Stage

Abstract Background Home haemodialysis (HHD), has shown improved clinical outcomes, as well as a better quality of life, compared to conventional in-centre haemodialysis (ICHD) but still has a global low prevalence among end-stage renal disease patients. Haemodialysis (HD) patients tend to be sedentary but only few studies, mainly in North American ICHD patients, have evaluated the level of activity in HD patients. Methods SeCoIA is an observational, longitudinal, prospective, international, multicentric, study, conducted in metropolitan France and Belgium. The main objective of the study is to quantify the physical activity measured by the total daily number of steps, in HHD patients compared to ICHD patients. The SeCoIA study will include 80 HHD patients and 80 ICHD patients,. Secondary objectives will be to characterize the HHD population and to confirm HHD efficiency on clinical parameters, as well as quality of life (QoL), in current practice. Physical activity will be measured by a 3-axis accelerometer. Accelerometers have been shown to provide accurate information, on both physical activity and sedentary behaviour. Patients will be instructed to wear the device and complete a patient diary 7 consecutive days after inclusion and the first week of each month for 12 months. Decision to undergo HDD or ICHD is independent of the study and follow-up frequency remains at the discretion of the physician/centre. QoL and quality of sleep will be respectively assessed by the Kidney Disease Quality of Life 1.2 (KDQOL™) and the Pittsburg Sleep Quality index (PSQI) questionnaires at inclusion, 6- and 12-month visits. Patients presenting a restless leg syndrome (RLS) will also complete the International Restless Legs Syndrome rating scale (IRLS) questionnaire. Discussion The SeCoIA study will be the first large cohort study (160 patients) evaluating physical activity, objectively measured with a 3-axis accelerometer, in HHD versus ICHD patients. The present study will also include a comparison of QoL with a focus on RLS between HHD and ICHD. It is anticipated that HHD patients will have an improved physical activity and QoL which should encourage physicians to further promote HHD. Trial registration Clinical trial NCT03737578 study registered on November 9, 2018 (Retrospectively registered).

Kidney Graft Survival in Italy and Factors Influencing it

2005 ◽  
Vol 15 (4) ◽  
pp. 385-391 ◽  
Author(s):  
Orsola Pugliese ◽  
Francesca Quintieri ◽  
Dino Alberto Mattucci ◽  
Sante Venettoni ◽  
Emanuela Taioli ◽  
...  
Keyword(s):  
Graft Survival ◽  
Developed Countries ◽  
National Registry ◽  
Kidney Graft ◽  
Allograft Function ◽  
Recipient Age ◽  
Transplant Registry ◽  
Using Data ◽  
National Registry Data

Purpose National registry data are often a suitable basis for examination of transplant outcomes. Using data supplied by the Italian National Transplant Registry, established in 1995, we performed the first nationwide analysis of this kind. Methods A retrospective analysis of 4893 recipients of cadaveric kidneys transplanted in all Italian centers from 1995 through 2000 was done to study 5-year graft survival. The association between some donor and recipient variables and outcomes in renal transplantation was analyzed. Graft survival was 93% at 3 months, 89% at 1 year, 82% at 3 years, and 80% at 5 years after transplantation. Results A significant association between graft survival and donor age (old vs young, relative risk [RR] = 1.62, 95% CI 1.27–2.06) and recipient age (old vs young, RR = 1.25, 95% CI 1.02–1.53). Graft survival was also associated with cold ischemia time (24–36 hours, RR=1.39, 95% CI 1.05–1.85 and >36 hours, RR=1.94, 95% CI 1.32–2.86 vs 0–24 hours) and donor/recipient sex mismatch (female/male vs male/male, RR=1.50, 95% CI 1.17–1.93). Conclusion The quality of kidney transplantation in Italy is satisfactory and is comparable to that in other developed countries. Furthermore, our experience confirms that both donor and recipient factors are major determinants of renal allograft function.

scholarly journals Developments in lung transplantation over the past decade

2020 ◽  
Vol 29 (157) ◽  
pp. 190132 ◽  
Author(s):  
Sophie C. van der Mark ◽  
Rogier A.S. Hoek ◽  
Merel E. Hellemons
Keyword(s):  
Lung Transplantation ◽  
Ex Vivo ◽  
Smoking Status ◽  
Lung Perfusion ◽  
Long Term Outcomes ◽  
Donor Pool ◽  
The Past ◽  
End Stage

With an improved median survival of 6.2 years, lung transplantation has become an increasingly acceptable treatment option for end-stage lung disease. Besides survival benefit, improvement of quality of life is achieved in the vast majority of patients. Many developments have taken place in the field of lung transplantation over the past decade. Broadened indication criteria and bridging techniques for patients awaiting lung transplantation have led to increased waiting lists and changes in allocation schemes worldwide. Moreover, the use of previously unacceptable donor lungs for lung transplantation has increased, with donations from donors after cardiac death, donors with increasing age and donors with positive smoking status extending the donor pool substantially. Use of ex vivo lung perfusion further increased the number of lungs suitable for lung transplantation. Nonetheless, the use of these previously unacceptable lungs did not have detrimental effects on survival and long-term graft outcomes, and has decreased waiting list mortality. To further improve long-term outcomes, strategies have been proposed to modify chronic lung allograft dysfunction progression and minimise toxic immunosuppressive effects. This review summarises the developments in clinical lung transplantation over the past decade.

Cost-effectiveness of minimally invasive midline lumbar interbody fusion versus traditional open transforaminal lumbar interbody fusion

2020 ◽  
Vol 32 (1) ◽  
pp. 31-35
Author(s):  
Mladen Djurasovic ◽  
Jeffrey L. Gum ◽  
Charles H. Crawford ◽  
Kirk Owens ◽  
Morgan Brown ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Minimally Invasive ◽  
Interbody Fusion ◽  
Smoking Status ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Direct Costs ◽  
Lumbar Interbody Fusion ◽  
Related Quality ◽  
Health Related

OBJECTIVEThe midline transforaminal lumbar interbody fusion (MIDLIF) using cortical screw fixation is a novel, minimally invasive procedure that may offer enhanced recovery over traditional open transforaminal lumbar interbody fusion (TLIF). Little information is available regarding the comparative cost-effectiveness of the MIDLIF over conventional TLIF. The purpose of this study was to compare cost-effectiveness of minimally invasive MIDLIF with open TLIF.METHODSFrom a prospective, multisurgeon, surgical database, a consecutive series of patients undergoing 1- or 2-level MIDLIF for degenerative lumbar conditions was identified and propensity matched to patients undergoing TLIF based on age, sex, smoking status, BMI, diagnosis, American Society of Anesthesiologists Physical Status Classification System (ASA) class, and levels fused. Direct costs at 1 year were collected, including costs associated with the index surgical visit as well as costs associated with readmission. Improvement in health-related quality of life was measured using EQ-5D and SF-6D.RESULTSOf 214 and 181 patients undergoing MIDLIF and TLIF, respectively, 33 cases in each cohort were successfully propensity matched. Consistent with propensity matching, there was no difference in age, sex, BMI, diagnosis, ASA class, smoking status, or levels fused. Spondylolisthesis was the most common indication for surgery in both cohorts. Variable direct costs at 1 year were $2493 lower in the MIDLIF group than in the open TLIF group (mean $15,867 vs $17,612, p = 0.073). There was no difference in implant (p = 0.193) or biologics (p = 0.145) cost, but blood utilization (p = 0.015), operating room supplies (p < 0.001), hospital room and board (p < 0.001), pharmacy (p = 0.010), laboratory (p = 0.004), and physical therapy (p = 0.009) costs were all significantly lower in the MIDLIF group. Additionally, the mean length of stay was decreased for MIDLIF as well (3.21 vs 4.02 days, p = 0.05). The EQ-5D gain at 1 year was 0.156 for MIDLIF and 0.141 for open TLIF (p = 0.821). The SF-6D gain at 1 year was 0.071 for MIDLIF and 0.057 for open TLIF (p = 0.551).CONCLUSIONSCompared with patients undergoing traditional open TLIF, those undergoing MIDLIF have similar 1-year gains in health-related quality of life, with total direct costs that are $2493 lower. Although the findings were not statistically significant, minimally invasive MIDLIF showed improved cost-effectiveness at 1 year compared with open TLIF.

ДОЛГОСРОЧНАЯ ПРОФИЛАКТИКА АНГИООТЕКОВ У ПАЦИЕНТОВ С НАО

2019 ◽  
pp. 75-83
Author(s):  
T.V. Latysheva ◽  
E.A. Latysheva ◽  
I.A. Manto
Keyword(s):  
Depressive Disorders ◽  
Daily Life ◽  
Social Activity ◽  
Psychological Impact ◽  
Therapeutic Strategies ◽  
Risk Of Death ◽  
Career Opportunities ◽  
Acute Attacks ◽  
Life Career

Наследственный ангиоотек (НАО) с дефицитом С1ингибитора (С1ИНГ) представляет собой редкое заболевание, которое оказывает сильное воздействие на жизнь пациентов как физически, так и эмоционально. Непредсказуемость атак влияет на повседневную жизнь, выбор профессии, социальную активность. Кроме того, страх перед развитием отека, а также связанными с ним болью и риском смерти приводит к депрессивным расстройствам, характерным для хронических, в особенности жизнеугрожающих заболеваний. Появление современных патогенетических препаратов способно минимизировать влияние НАО и улучшить качество жизни больных. В основе терапии НАО лежат долгосрочная профилактика, краткосрочная профилактика и купирование острых атак. В данной статье речь пойдет о долгосрочной профилактике.Hereditary angioedema (HAE) due to of C1inhibitor deficiency is a rare disease, which causes a strong physical and psychological impact on patients lives. HAE affects daily life, career opportunities, and social activity. In addition, fear of the edema development, as well as the associated with it pain and risk of death leads to depressive disorders specific for chronic (especially lifethreatening) diseases. The emergence of modern pathogenetic drugs can minimize the effect of HAE and improve the patients quality of life. There are three different therapeutic strategies that are used for HAE treatment: longterm prophylaxis, shortterm and ondemand therapy for acute attacks. This article focuses on longterm prophylaxis.

scholarly journals Emergency Medicine Palliative Care Access (EMPallA): protocol for a multicentre randomised controlled trial comparing the effectiveness of specialty outpatient versus nurse-led telephonic palliative care of older adults with advanced illness

BMJ Open ◽  
2019 ◽  
Vol 9 (1) ◽  
pp. e025692 ◽  
Author(s):  
Corita R Grudzen ◽  
Deborah J Shim ◽  
Abigail M Schmucker ◽  
Jeanne Cho ◽  
Keith S Goldfeld
Keyword(s):  
Quality Of Life ◽  
Older Adults ◽  
Palliative Care ◽  
Randomised Controlled Trial ◽  
Case Management ◽  
Controlled Trial ◽  
Chronic Obstructive ◽  
Randomised Controlled ◽  
End Stage

IntroductionEmergency department (ED)-initiated palliative care has been shown to improve patient-centred outcomes in older adults with serious, life-limiting illnesses. However, the optimal modality for providing such interventions is unknown. This study aims to compare nurse-led telephonic case management to specialty outpatient palliative care for older adults with serious, life-limiting illness on: (1) quality of life in patients; (2) healthcare utilisation; (3) loneliness and symptom burden and (4) caregiver strain, caregiver quality of life and bereavement.Methods and analysisThis is a protocol for a pragmatic, multicentre, parallel, two-arm randomised controlled trial in ED patients comparing two established models of palliative care: nurse-led telephonic case management and specialty, outpatient palliative care. We will enrol 1350 patients aged 50+ years and 675 of their caregivers across nine EDs. Eligible patients: (1) have advanced cancer (metastatic solid tumour) or end-stage organ failure (New York Heart Association class III or IV heart failure, end-stage renal disease with glomerular filtration rate <15 mL/min/m2, or global initiative for chronic obstructive lung disease stage III, IV or oxygen-dependent chronic obstructive pulmonary disease); (2) speak English; (3) are scheduled for ED discharge or observation status; (4) reside locally; (5) have a working telephone and (6) are insured. Patients will be excluded if they: (1) have dementia; (2) have received hospice care or two or more palliative care visits in the last 6 months or (3) reside in a long-term care facility. We will use patient-level block randomisation, stratified by ED site and disease. Effectiveness will be compared by measuring the impact of each intervention on the specified outcomes. The primary outcome will measure change in patient quality of life.Ethics and disseminationInstitutional Review Board approval was obtained at all study sites. Trial results will be submitted for publication in a peer-reviewed journal.Trial registration numberNCT03325985; Pre-results.

scholarly journals Investigation of the Impact of Endodontic Therapy on Survival among Dialysis Patients in Taiwan: A Nationwide Population-Based Cohort Study

2021 ◽  
Vol 18 (1) ◽  
pp. 326
Author(s):  
Chih-Chien Chiu ◽  
Ya-Chieh Chang ◽  
Ren-Yeong Huang ◽  
Jenq-Shyong Chan ◽  
Chi-Hsiang Chung ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Root Canal ◽  
Dialysis Patients ◽  
Root Canal Therapy ◽  
Risk Of Death ◽  
Stage Renal Disease ◽  
End Stage

Objectives Dental problems occur widely in patients with chronic kidney disease (CKD) and may increase comorbidities. Root canal therapy (RCT) is a common procedure for advanced decayed caries with pulp inflammation and root canals. However, end-stage renal disease (ESRD) patients are considered to have a higher risk of potentially life-threatening infections after treatment and might fail to receive satisfactory dental care such as RCT. We investigated whether appropriate intervention for dental problems had a potential impact among dialysis patients. Design Men and women who began maintenance dialysis (hemodialysis or peritoneal dialysis) between January 1, 2000, and December 31, 2015, in Taiwan (total 12,454 patients) were enrolled in this study. Participants were followed up from the first reported dialysis date to the date of death or end of dialysis by December 31, 2015. Setting Data collection was conducted in Taiwan. Results A total of 2633 and 9821 patients were classified into the RCT and non-RCT groups, respectively. From the data of Taiwan’s National Health Insurance, a total of 5,092,734 teeth received RCT from 2000 to 2015. Then, a total of 12,454 patients were followed within the 16 years, and 4030 patients passed away. The results showed that members of the non-RCT group (34.93%) had a higher mortality rate than those of the RCT group (22.79%; p = 0.001). The multivariate-adjusted hazard ratio for the risk of death was 0.69 (RCT vs. non-RCT; p = 0.001). Conclusions This study suggested that patients who had received RCT had a relatively lower risk of death among dialysis patients. Infectious diseases had a significant role in mortality among dialysis patients with non-RCT. Appropriate interventions for dental problems may increase survival among dialysis patients. Abbreviations: CKD = chronic kidney disease, ESRD = end-stage renal disease, RCT = root canal therapy.

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