Closing the Organ Gap: A Reciprocity-Based Social Contract Approach

2006 ◽  
Vol 34 (2) ◽  
pp. 415-423 ◽  
Author(s):  
Gil Siegal ◽  
Richard J. Bonnie
Keyword(s):  
The United States ◽  
Waiting Lists ◽  
Organ Shortage ◽  
Success Rates ◽  
Number Of Patients ◽  
The Family ◽  
Stage Renal Disease ◽  
End Stage ◽  
Kidney Liver

Organ transplantation remains one of modern medicine's remarkable achievements. It saves lives, improves quality of life, diminishes healthcare expenditures in end-stage renal patients, and enjoys high success rates. Yet the promise of transplantation is substantially compromised by the scarcity of organs. The gap between the number of patients on waiting lists and the number of available organs continues to grow. As of January 2006, the combined waiting list for all organs in the United States was 90,284 (64,933, 17,269, and 3,006 for kidney, liver, and heart respectively). Unfortunately, thousands of potential organs are lost each year, primarily due to lack of consent to donation from the deceased before death, or from the family thereafter. Only fifty percent of potential donors – the “conversion” rate – become actual donors. The costs attributed to organ shortage are substantial – Medicare paid over $15.5 billion in 2002 for treating patients with end-stage renal-disease, who predominate on organ waiting lists.

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.

Advances in Anemia Management in Chronic Kidney Disease

2002 ◽  
Vol 15 (6) ◽  
pp. 437-455 ◽  
Author(s):  
Joanna Q. Hudson ◽  
Kristine S. Schonder
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
The United States ◽  
Left Ventricular ◽  
Negative Consequences ◽  
Secondary Complications ◽  
Anemia Management ◽  
Stage Renal Disease ◽  
End Stage

The prevalence of chronic kidney disease (CKD) is increasing in the United States. Efforts to promote earlier intervention to screen for CKD and manage secondary complications are of paramount importance to improve overall care of this population. Anemia is a secondary complication of CKD that develops as kidney function declines. Historically, anemia management efforts have been primarily emphasized in patients with end-stage renal disease; however, early detection and treatment of anemia in the early stages of the disease are essential to prevent negative consequences of anemia such as reduced quality of life, left ventricular hypertrophy and mortality. With the increased prevalence of CKD and efforts focused on identifying this disorder early in its course, it is likely that more pharmacists will be involved in the management of CKD and secondary complications such as anemia. Treatment approaches must also be based on the more recently advocated guidelines from the National Kidney Foundation’s Kidney Disease Outcomes Quality Initiative (NKF-K/DOQI). This article reviews therapeutic issues of anemia of CKD, new agents for management, and the NKF-K/DOQI anemia management guidelines from a clinical perspective that will assist pharmacists involved in the care of these patients.

scholarly journals Projecting the Number of Patients with End-Stage Renal Disease in the United States to the Year 2015

2005 ◽  
Vol 16 (12) ◽  
pp. 3736-3741 ◽  
Author(s):  
David T. Gilbertson ◽  
Jiannong Liu ◽  
Jay L. Xue ◽  
Thomas A. Louis ◽  
Craig A. Solid ◽  
...  
Keyword(s):  
United States ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
The United States ◽  
Number Of Patients ◽  
Stage Renal Disease ◽  
End Stage

Clinical Nephrology and Dialysis in the 1990s

1993 ◽  
Vol 6 (3) ◽  
pp. 106-112
Author(s):  
Thomas J. Comstock
Keyword(s):  
Esrd Patient ◽  
The United States ◽  
Hemodialysis Patients ◽  
Infectious Complications ◽  
Technological Advances ◽  
Number Of Patients ◽  
Patients With Diabetes ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

End-stage renal disease (ESRD) afflicts more than 200,000 patients in the United States today, and they undergo chronic dialysis or transplantation in order to sustain life. The primary causes of treated ESRD today are diabetes mellitus, hypertension, and glomerulonephritis. Hemodialysis remains the mainstay of therapy for patients, primarily due to the chronic shortage of organs available for transplantation. Technological advances have led to numerous improvements in hemodialysis therapy during the last 30 years. Dialysis is now provided in a variety of settings, including hospitals, outpatient dialysis units, and the home. Despite these advances, morbidity and mortality remain high for patients with ESRD. Patients with diabetes have the highest mortality rates primarily due to cardiac and infectious complications. Patients undergoing continuous ambulatory peritoneal dialysis (CAPD) are generally younger and healthier than their hemodialysis counterparts. Mortality is lower in the CAPD group for younger patients, whereas mortality is lower among older hemodialysis patients. Various methods have been described to assess adequacy of dialysis in order to develop the optimal dialysis prescription. Although these may ultimately prove beneficial, recent observations indicate an increased mortality in American hemodialysis patients compared with their European counterparts. These differences may be due in part to variances in reimbursement rates for dialysis therapy, and a reduction in dialysis time among U.S. centers. In light of the increasing number of patients and the complexity of their therapy, multiple opportunities exist for pharmacists to become actively involved in the comprehensive care of the ESRD patient.

scholarly journals Evaluation of the Recipient and Donor in Living Kidney Transplantation

2020 ◽  
Vol 95 (4) ◽  
pp. 260-265
Author(s):  
Ha Yeol Park ◽  
Byung Chul Shin
Keyword(s):  
Kidney Transplantation ◽  
Supply And Demand ◽  
Deceased Donor ◽  
Good Health ◽  
Kidney Donation ◽  
Living Kidney Donation ◽  
Number Of Patients ◽  
Stage Renal Disease ◽  
End Stage

Kidney transplantation is the treatment of choice for end-stage renal disease. A successful kidney transplant improves the quality of life and reduces the mortality risk of patients, as compared to maintenance dialysis. The number of patients awaiting kidney transplantation has steadily increased, and the gap between allograft supply and demand continues to widen despite initiatives to expand the use of nonstandard deceased-donor allografts. The use of organs from living donors is one strategy to address the need for transplants. A medical, surgical, and psychosocial evaluation is mandatory prior to living kidney donation to ensure that the donor candidate is in good health and has normal kidney function, is not a risk to the recipient with respect to transmission of infections and malignancy, and will not face unacceptable risks after donation.

scholarly journals In Peritoneal Dialysis, Is There Sufficient Evidence to Make “PD First” Therapy?

2011 ◽  
Vol 2011 ◽  
pp. 1-5 ◽  
Author(s):  
Pranav Dalal ◽  
Harbaksh Sangha ◽  
Kunal Chaudhary
Keyword(s):  
Peritoneal Dialysis ◽  
Low Cost ◽  
The United States ◽  
Sufficient Evidence ◽  
Reimbursement Incentives ◽  
Reduced Rate ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Since its introduction more than 3 decades ago, the use of peritoneal dialysis (PD) has increased greatly due to its simplicity, convenience, and low cost. Advances in technique, antibiotic prophylaxis, and the introduction of newer solutions have improved survival, quality of life, and reduced rate of complications with PD. In Hong Kong, approximately 80% end-stage renal disease (ESRD) patients perform PD; in others, that is, Canada, Australia, and New Zealand, 20%–30% patients use PD. However, in the United States, the annual rate of prevalent patients receiving PD has reduced to 8% from its peak of 15% in mid-1980s. PD as the initial modality is being offered to far less patients than hemodialysis (HD), resulting in the current annual incidence rate of less than 10% in USA. There are many reasons preventing the PD first initiative including the increased numbers of in-center hemodialysis units, physician comfort with the modality, perceived superiority of HD, risk of peritonitis, achieving adequate clearances, and reimbursement incentives to providers. Patient fatigue, membrane failure, and catheter problems are other reasons which discourage PD utilization. In this paper, we discuss the available evidence and provide rationale to support PD as the initial renal replacement modality for ESRD patients.

scholarly journals Translumbar hemodialysis long-term catheters: an alternative for vascular access failure

2019 ◽  
Vol 41 (1) ◽  
pp. 89-94
Author(s):  
Fernando Moura ◽  
Felipe Leite Guedes ◽  
Yuri Dantas ◽  
Ana Helena Maia ◽  
Rodrigo Azevedo de Oliveira ◽  
...  
Keyword(s):  
Vascular Access ◽  
Extubation Failure ◽  
University Hospital ◽  
Success Rates ◽  
Catheter Patency ◽  
Angiography Suite ◽  
Number Of Patients ◽  
Venous Fistula ◽  
Stage Renal Disease ◽  
End Stage

Abstract Introduction: Vascular access (VA) in hemodialysis (HD) is essential to end-stage renal disease (ESRD) patients survival. Unfortunately, after some years in HD program, a significant number of patients may develop VA failure for many reasons. In this situation, arterial venous fistula (AVF) confection or catheters placement in traditional vascular sites (jugular, femoral or subclavian) are not feasible. In this scenario, translumbar tunneled dialysis catheter (TLDC) may be a salvage option. Objectives: To describe placement technic, complications, and patency of 12 TLDC. Methods: A retrospective study was performed to analyze 12 TLDC placement in an angiography suite using fluoroscopic guidance at the University Hospital of the Rio Grande do Norte Federal University from January 2016 to October 2017. The data collected of the total procedures performed consisted of demographic characteristics, success rates, observed complications, patient survival, and catheter patency. Results: All 12 TLDC were placed with success; there were only 2 significant periprocedure complications (major bleeding and extubation failure); 41.6% of patients presented a catheter-related first infection after 98 ± 72.1 (6-201) days, but catheter withdrawal was not necessary, mean total access patency was 315.5 (range 65 - 631) catheter-days, and catheter patency at 3, 6 and 12 months was 91 %, 75%, and 45%. Conclusion: TLDC is an option for patients with VA failure, improving survival and acting as a bridge for renal transplantation.

scholarly journals Nuances of Arteriovenous Fistula Creation for Vascular Access in Hemodialysis

2021 ◽  
Author(s):  
Parag Sahasrabudhe ◽  
Ameya Bindu
Keyword(s):  
Life Expectancy ◽  
Arteriovenous Fistula ◽  
Vascular Access ◽  
Comprehensive Overview ◽  
Standardized Protocol ◽  
Number Of Patients ◽  
Rising Incidence ◽  
Stage Renal Disease ◽  
End Stage

Abstract Background With rising incidence and increased life expectancy of patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD), the number of patients requiring hemodialysis has increased substantially. Vascular access is the lifeline for a patient on hemodialysis (HD), and an arteriovenous fistula (AVF) is the undisputed gold standard for HD access. An effective and long-lasting fistula serves to increase the life expectancy of ESRD patients and improves their quality of life. Learning Objectives This paper aims to give a comprehensive overview of AVF creation, including the various techniques, patient selection, troubleshooting with decision-making, and common complications. Authors share their experience from previous publications and over 2000 AVF surgeries. They have not only described a new modification of the technique of proximal fistula but have also established a direct correlation between bruit and thrill on operation table and success of fistula surgery. Conclusion A standardized, protocol-driven multidisciplinary approach with careful patient and site selection, guided by outcome predictors, is vital in AVF surgery. Knowledge about the potential complications of AVFs contributes to their timely detection and allows measures to be taken that might prevent deleterious consequences that range from loss of vascular access to serious morbidity and mortality.

Hemodynamic Evaluation of Pulmonary Hypertension in Chronic Kidney Disease

2013 ◽  
Vol 12 (2) ◽  
pp. 82-87 ◽  
Author(s):  
Ryan J. Tedford ◽  
Paul R. Forfia
Keyword(s):  
Chronic Kidney Disease ◽  
Pulmonary Hypertension ◽  
Kidney Disease ◽  
End Stage Renal Disease ◽  
The United States ◽  
Common Condition ◽  
True Prevalence ◽  
Number Of Patients ◽  
Stage Renal Disease ◽  
End Stage

Chronic kidney disease (CKD) is a common condition and its prevalence is increasing.12 Likewise, the number of patients reaching end-stage renal disease (ESRD) continues to rise. In the United States in 2010, there were 413,275 patients on dialysis and 179,361 patients with a functioning renal transplant, bringing the rate of prevalent ESRD cases to 1752 per million population.2 Pulmonary hypertension (PH) is a commonly encountered comorbidity of patients with CKD and those who have progressed to ESRD. Although the true prevalence of PH in these populations is unknown, several small, single-center analyses using varied cutoffs for echocardiographically estimated pulmonary pressures have reported estimates as high as 56%.3–7

scholarly journals Emergent Dialysis and its Impact on Quality of Life in Undocumented Patients with End-Stage Renal Disease

2017 ◽  
Vol 27 (1) ◽  
pp. 39 ◽  
Author(s):  
Andrew N. Hogan ◽  
William R. Fox ◽  
Lynn P. Roppolo ◽  
Robert E. Suter
Keyword(s):  
Quality Of Life ◽  
United States ◽  
End Stage Renal Disease ◽  
The United States ◽  
Dialysis Patients ◽  
Study Population ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

<p class="Pa7"><strong>Objective: </strong>This study aimed to define the ethnographic composition and assess the health-related quality of life (HRQoL) of a large population of undocumented patients with end-stage renal disease (ESRD) seeking emergent dialysis in the emergency depart­ment (ED) of a large public hospital in the United States.</p><p class="Pa7"><strong>Design: </strong>All ESRD patients presenting to the hospital’s main ED were identified during a 4-week consecutive enrollment period. Consenting patients completed two surveys—an ethnographic questionnaire and the validated kidney disease quality of life-36 (KDQOL-36) instrument.</p><p class="Pa7"><strong>Setting: </strong>The study was conducted at a large county hospital in Dallas, Texas. In 2013, the hospital recorded &gt;50,000 ED visits and administered approximately 6,000 dialysis treatments to ED patients.</p><p class="Pa7"><strong>Participants: </strong>88 of 101 unfunded patients presenting to the ED during the study period consented to participate, resulting in an 87.1% response rate. 65 of these patients were undocumented immigrants.</p><p class="Pa7"><strong>Main Outcome Measures: </strong>Quantitative scores for the 5 subscales of the KDQOL-36 were calculated for the study population.</p><p class="Pa7"><strong>Results: </strong>Measures of physical and mental health in our study population were lower than those published for scheduled dialysis patients. 79.5% of our patients lost employ­ment due to their dialysis requirements. At least 71.4% of the study patients were unaware that they required dialysis before immigrating to the United States.</p><p class="Pa7"><strong>Conclusions: </strong>Quality of life scores were found to be low among our population of undocumented emergent dialysis patients. Our data also provide some evidence that availability of dialysis at no cost is not a primary driver of illegal immigration of ESRD patients to the United States.</p><p class="Pa7"><em>Ethn Dis. </em>2017;27(1):39-44; doi:10.18865/ed.27.1.39.</p>

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