Geometric Enhancements of an Arteriovenous Graft

End Stage Renal Disease (ESRD) is the degeneration of kidney function to remove uremic toxins from the blood. Currently there are over 484,000 sufferers of ESRD in the United States, with this figure predicted to rise to over 800,000 by 2020 [1]. The total cost of care for patients with ESRD was estimated to exceed 1 billion dollars in the United States [2]. A kidney transplant is the ideal solution for ESRD patients; however with the increasing number of ESRD patients the odds of receiving a donor kidney are poor. The alternative is hemodialysis. This process is involves the extraction of blood from the patient to an extracorporal machine. Blood is pumped at a rate of 350 mL/min to ensure effective dialysis. The blood is then returned to the body cleaned. The gold standard for hemodialysis access is the native arteriovenous fistula [3] with the most common type being the Brescia-Cimino fistula at the wrist [4]. In some subgroups the fistula performs poorly. In diabetics and the elderly, specifically over 70s [2] or can’t be constructed because of unsuitable blood vessels [5]. In this case an alternative is the synthetic AV graft. Made of polytetrafluoroethelyne, it has lower patency rates against the fistula [6] [7] mediated by the susceptibility to thrombosis induced by stenosis development and infection [7].The majority of stenosis development is within the venous anastomosis (kanterman1995). The formation of intimal hyperplasia (IH) leading to stenosis formation is caused by smooth cell proliferation and migration as a result of endothelial cells reacting to shear stress receptors. The development of IH has been linked to local hemodynamics and turbulence in the flow, which in turn are heavily influenced by the geometry of the graft.

Abstract MP10: Increasing Obesity Prevalence in the United States End-stage Renal Disease Population

Circulation ◽

10.1161/circ.137.suppl_1.mp10 ◽

2018 ◽

Vol 137 (suppl_1) ◽

Author(s):

Brittany Shelton ◽

Deanna McWilliams ◽

Rhiannon D Reed ◽

Margaux Mustian ◽

Paul MacLennan ◽

...

Keyword(s):

United States ◽

Renal Disease ◽

End Stage Renal Disease ◽

The United States ◽

Obesity Prevalence ◽

The Us ◽

Prevalence Of Obesity ◽

Stage Renal Disease ◽

End Stage ◽

Background: Obesity has become a national epidemic, and is associated with increased risk for comorbid diseases including end-stage renal disease (ESRD). Among ESRD patients, obesity may improve dialysis-survival but decreases likelihood of transplantation, and as such, obesity prevalence may directly impact growth of the incident dialysis population. Methods: Incident adult ESRD patients with complete body mass index (BMI, kg/m 2 ) data were identified from the United States Renal Data System from 01/01/1995-12/31/2010 (n=1,822,598). Data from the Behavioral Risk Factor Surveillance System of the Centers for Disease Control and Prevention (n=4,303,471) represented the US population when weighted. Trends in BMI and obesity classes I (BMI of 30-34.9), II (BMI of 35-39.9), and III (BMI ≥40) were examined by year of dialysis initiation. Trends in median BMI slope were compared between the ESRD and US populations using linear regression. Results: Median BMI of ESRD patients in 1995 was 24.2 as compared to 28.0 in 2010, a 15.7% increase, while the US population’s median BMI increased from 24.2 in 1995 to 25.6 in 2010, a 5.8% increase. Comparable trends were noted with respect to prevalence of obesity classes I, II, and III (Table). BMI increase among the ESRD population was significantly more rapid than among the US population (β: 0.15, 95% CI: 0.14-0.17, p<0.001) (Figure). Conclusion: The median BMI of ESRD patients and prevalence of obesity among ESRD patients is increasing more rapidly than the US population. Given the increased dialysis-survival and decreased likelihood of transplantation associated with obesity, healthcare costs will likely increase, and thus, future research should be directed at examining medical expenditures.

Emergency Department Use by Patients with End-stage Renal Disease in the United States

10.21203/rs.3.rs-70152/v2 ◽

2020 ◽

Author(s):

Ningyuan Wang ◽

Jiao Pei ◽

Hui Fan ◽

Yaseen Ali ◽

Jian Zhao ◽

...

Keyword(s):

United States ◽

Renal Disease ◽

End Stage Renal Disease ◽

The United States ◽

Adult Age ◽

Ed Visits ◽

Stage Renal Disease ◽

End Stage ◽

Abstract Background: We sought to describe the national characteristics of ED visits by patients with end-stage renal disease (ESRD) in the United States in order to improve the emergency treatment and screening of ESRD patients. Methods: We analyzed data from 2014-2016 ED visits provided by the National Hospital Ambulatory Medical Care Survey. We sampled adult (age ≥ 18 years) ED patients with ESRD. By proportion or means of weighted sample variables, we quantified annual ED visits by patients with ESRD. We investigated demographics, ED resource utilization, clinical characteristics, and disposition of patients with ESRD vs. those without ESRD. Logistic regression models were used to estimate the association between these characteristics and ESRD ED visits. Results: Approximately 722,692 (7.78%) out of 92,899,685 annual ED visits were ESRD patients. ED patients with ESRD were mostly non-Hispanic whites (51.5%) and males were more likely to be ESRD patients than females (aOR: 1.48; 95% CI: 1.47–1.48). ED patients with ESRD were more likely to be admitted to the hospital (aOR: 2.22; 95% CI: 2.21–2.22) and intensive care unit (ICU) (aOR: 1.53; 95% CI: 1.52–1.54) than patients without ESRD. ED patients with ESRD were more likely to receive blood tests, get medical imaging tests.Conclusion: We described the unique demographic, socioeconomic, and clinical characteristics of ED patients with ESRD, using the most comprehensive, nationally representative study to date. These patients’ higher hospital and ICU admission rates indicate that patients with ESRD require a higher level of emergency care.

Emergency Department Use by Patients With End-stage Renal Disease in the United States

10.21203/rs.3.rs-70152/v1 ◽

2020 ◽

Author(s):

Ningyuan Wang ◽

Jiao Pei ◽

Hui Fan ◽

Yaseen Ali ◽

Jian Zhao ◽

...

Keyword(s):

United States ◽

Renal Disease ◽

End Stage Renal Disease ◽

The United States ◽

Adult Age ◽

Ed Visits ◽

Stage Renal Disease ◽

End Stage ◽

GU Evaluation and Management of Renal Transplant Candidates and Recipients

The Scientific World JOURNAL ◽

10.1100/tsw.2004.43 ◽

2004 ◽

Vol 4 ◽

pp. 41-45 ◽

Cited By ~ 2

Author(s):

Peter N. Bretan

Keyword(s):

United States ◽

High Risk ◽

Renal Transplant ◽

End Stage Renal Disease ◽

The United States ◽

Common Cause ◽

Transplant Candidates ◽

Stage Renal Disease ◽

End Stage ◽

There are more than 200,000 end stage renal disease (ESRD) patients who are potential transplant candidates and more than 100,000 previously transplanted renal recipients with functioning allografts in the United States1. Fifty-seven percent of these patients are male and forty percent are greater than 50 years of age2, 3. Diabetes is the most common cause of kidney failure. It is evident that many patients are at high risk for development of urologic problems and thus it is estimated that the average urologist will care for up to ten of these patients yearly4. Thus a review of the genitourinary (GU) evaluation and management of these patients is timely.

Policies Regarding Treatment of End-Stage Renal Disease in the United States and United Kingdom

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462300002063 ◽

1986 ◽

Vol 2 (2) ◽

pp. 253-274 ◽

Cited By ~ 1

Author(s):

Susan Klein Marine ◽

Roberta G. Simmons

Keyword(s):

United States ◽

Kidney Transplantation ◽

Renal Disease ◽

End Stage Renal Disease ◽

Well Being ◽

The United States ◽

The Body ◽

Stage Renal Disease ◽

End Stage ◽

The U.S

The treatment of End-Stage Renal Disease (ESRD) represents a victory for medical technology. Dialysis and kidney transplantation, developed in the early 1960s, offer alternative treatments to patients whose own kidneys no longer function; before, these patients faced a terminal diagnosis. Dialysis is a mechanical treatment in which the patient is connected to a machine that cleanses the blood of impurities and returns it to the body. Although recent innovations (e.g., continuous ambulatory peritoneal dialysis—CAPD) facilitate patient independence from a machine, replacement of the diseased kidneys is the most desirable and least expensive treatment for many patients (33;39). Kidney transplantation remains the most effective and common type of transplantation, and a new kidney (from a living-related or cadaver donor) often dramatically improves the recipient's health and general well-being (20;39). Now, in the mid-1980s, these technologies are no longer new and innovative. Further analysis of these established but costly technologies provides a perspective on the long-range implications of innovations in patient care: while some new issues have emerged, many problems originally associated with these treatments seem to have intensified. Access to treatment remains a central issue, closely linked to the dilemma of equity versus cost. The contrast in the access provided by the United States and Great Britain is dramatic (40); in 1982, the rate of ESRD treatment within the U.S. was twice that of the U.K. (353 versus 160 patients per million) (37). The U.S. policy is basically one of unlimited access, whereas the U.K. has restricted access.

Hemodialysis Quality Metrics in the First Year Following a Failed Kidney Transplant

American Journal of Nephrology ◽

10.1159/000501605 ◽

2019 ◽

Vol 50 (3) ◽

pp. 161-167 ◽

Cited By ~ 1

Author(s):

Anne M. Huml ◽

Ashwini R. Sehgal

Keyword(s):

United States ◽

Kidney Transplant ◽

The United States ◽

Quality Metrics ◽

First Year ◽

Nephrology Care ◽

Dialysis Outcomes ◽

Stage Renal Disease ◽

End Stage ◽

Background: Failure of a previously transplanted kidney is a common cause of end-stage renal disease (ESRD) and represents 5% of incident dialysis patients in the United States. Patients with native kidney failure ESRD (Nat-ESRD) who receive predialysis care from a nephrologist have better outcomes in the first 12 months on dialysis than those who don’t. Because many patients with a failed kidney transplant ESRD (Tx-ESRD) receive care from nephrologists, they would also be expected to have good dialysis outcomes. We sought to compare the quality metrics of Tx-ESRD patients and Nat-ESRD patients during the first 12 months of hemodialysis. Methods: We used data from the United States Renal Data System to identify hemodialysis patients who began treatment between May 2012 and December 2013 and who received nephrology care prior to starting hemodialysis. Quality metrics by quarter for the first 12 months of treatment were dichotomized according to practice guidelines to determine the percentage of patients in each quarter who met quality of care goals. Results: Compared to Nat-ESRD (n = 96,063) patients, Tx-ESRD (n = 5,528) patients had 10–19% lower rates of at goal hemoglobin levels, 6–12% lower rates of at goal serum phosphorus, and 3–11% lower rates of at goal albumin levels. Compared to Nat-ESRD patients, Tx-ESRD patients had a 6% higher rate of fistula use in the first quarter but a 3–7% lower rate in subsequent quarters. Conclusions: Tx-ESRD patients have worse quality metrics related to anemia, phosphorus, albumin, and vascular access compared to Nat-ESRD patients. Nephrology care for patients with Tx-ESRD should be improved to address these quality metrics gaps.

Emergency department use by patients with end-stage renal disease in the United States

BMC Emergency Medicine ◽

10.1186/s12873-021-00420-8 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Ningyuan Wang ◽

Jiao Pei ◽

Hui Fan ◽

Yaseen Ali ◽

Anna Prushinskaya ◽

...

Keyword(s):

United States ◽

Renal Disease ◽

End Stage Renal Disease ◽

The United States ◽

Adult Age ◽

Ed Visits ◽

Stage Renal Disease ◽

End Stage ◽

AbstractBackgroundWe sought to describe the national characteristics of ED visits by patients with end-stage renal disease (ESRD) in the United States in order to improve the emergency treatment and screening of ESRD patients.MethodsWe analyzed data from 2014 to 2016 ED visits provided by the National Hospital Ambulatory Medical Care Survey. We sampled adult (age ≥ 18 years) ED patients with ESRD. By proportion or means of weighted sample variables, we quantified annual ED visits by patients with ESRD. We investigated demographics, ED resource utilization, clinical characteristics, and disposition of patients with ESRD and compared these to those of patients without ESRD. Logistic regression models were used to estimate the association between these characteristics and ESRD ED visits.ResultsApproximately 722,692 (7.78%) out of 92,899,685 annual ED visits represented ESRD patients. Males were more likely to be ESRD patients than females (aOR: 1.34; 95% CI: 1.09–1.66). Compare to whites, non-Hispanic Blacks were 2.55 times more likely to have ESRD (aOR: 2.55; 95% CI: 1.97–3.30), and Hispanics were 2.68 times more likely to have ESRD (95% CI: 1.95–3.69). ED patients with ESRD were more likely to be admitted to the hospital (aOR: 2.70; 95% CI: 2.13–3.41) and intensive care unit (ICU) (aOR: 2.21; 95% CI: 1.45–3.38) than patients without ESRD. ED patients with ESRD were more likely to receive blood tests and get radiology tests.ConclusionWe described the unique demographic, socioeconomic, and clinical characteristics of ED patients with ESRD, using the most comprehensive, nationally representative study to date. These patients’ higher hospital and ICU admission rates indicate that patients with ESRD require a higher level of emergency care.

Forecast of the Number of Patients with End-Stage Renal Disease in the United States to the Year 2010

Journal of the American Society of Nephrology ◽

10.1681/asn.v12122753 ◽

2001 ◽

Vol 12 (12) ◽

pp. 2753-2758 ◽

Cited By ~ 2

Author(s):

Jay L. Xue ◽

Jennie Z. Ma ◽

Thomas A. Louis ◽

Allan J. Collins

Keyword(s):

United States ◽

Renal Disease ◽

End Stage Renal Disease ◽

The United States ◽

Dialysis Patients ◽

Forecasting Models ◽

Stage Renal Disease ◽

End Stage ◽

ABSTRACT. As the United States end-stage renal disease (ESRD) program enters the new millennium, the continued growth of the ESRD population poses a challenge for policy makers, health care providers, and financial planners. To assist in future planning for the ESRD program, the growth of patient numbers and Medicare costs was forecasted to the year 2010 by modeling of historical data from 1982 through 1997. A stepwise autoregressive method and exponential smoothing models were used. The forecasting models for ESRD patient numbers demonstrated mean errors of −0.03 to 1.03%, relative to the observed values. The model for Medicare payments demonstrated −0.12% mean error. The R2 values for the forecasting models ranged from 99.09 to 99.98%. On the basis of trends in patient numbers, this forecast projects average annual growth of the ESRD populations of approximately 4.1% for new patients, 6.4% for long-term ESRD patients, 7.1% for dialysis patients, 6.1% for patients with functioning transplants, and 8.2% for patients on waiting lists for transplants, as well as 7.7% for Medicare expenditures. The numbers of patients with ESRD in 2010 are forecasted to be 129,200 ± 7742 (95% confidence limits) new patients, 651,330 ± 15,874 long-term ESRD patients, 520,240 ± 25,609 dialysis patients, 178,806 ± 4349 patients with functioning transplants, and 95,550 ± 5478 patients on waiting lists. The forecasted Medicare expenditures are projected to increase to $28.3 ± 1.7 billion by 2010. These projections are subject to many factors that may alter the actual growth, compared with the historical patterns. They do, however, provide a basis for discussing the future growth of the ESRD program and how the ESRD community can meet the challenges ahead.

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

Ethnicity & Disease ◽

10.18865/ed.27.1.39 ◽

2017 ◽

Vol 27 (1) ◽

pp. 39 ◽

Cited By ~ 8

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 ◽

Objective: 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.Design: 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.Setting: The study was conducted at a large county hospital in Dallas, Texas. In 2013, the hospital recorded >50,000 ED visits and administered approximately 6,000 dialysis treatments to ED patients.Participants: 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.Main Outcome Measures: Quantitative scores for the 5 subscales of the KDQOL-36 were calculated for the study population.Results: 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.Conclusions: 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.Ethn Dis. 2017;27(1):39-44; doi:10.18865/ed.27.1.39.

Emergency Department Use by Patients with End-stage Renal Disease in the United States

10.21203/rs.3.rs-70152/v3 ◽

2020 ◽

Author(s):

Ningyuan Wang ◽

Jiao Pei ◽

Hui Fan ◽

Yaseen Ali ◽

Anna Prushinskaya ◽

...

Keyword(s):

United States ◽

Renal Disease ◽

End Stage Renal Disease ◽

The United States ◽

Adult Age ◽

Ed Visits ◽

Stage Renal Disease ◽

End Stage ◽

Abstract Background: We sought to describe the national characteristics of ED visits by patients with end-stage renal disease (ESRD) in the United States in order to improve the emergency treatment and screening of ESRD patients. Methods: We analyzed data from 2014-2016 ED visits provided by the National Hospital Ambulatory Medical Care Survey. We sampled adult (age ≥ 18 years) ED patients with ESRD. By proportion or means of weighted sample variables, we quantified annual ED visits by patients with ESRD. We investigated demographics, ED resource utilization, clinical characteristics, and disposition of patients with ESRD and compared these to those of patients without ESRD. Logistic regression models were used to estimate the association between these characteristics and ESRD ED visits. Results: Approximately 722,692 (7.78%) out of 92,899,685 annual ED visits represented ESRD patients. Males were more likely to be ESRD patients than females (aOR: 1.34; 95% CI: 1.09–1.66). Compare to whites, non-Hispanic Blacks were 2.55 times more likely to have ESRD (aOR: 2.55; 95% CI: 1.97 – 3.30), and Hispanics were 2.68 times more likely to have ESRD (95% CI: 1.95–3.69). ED patients with ESRD were more likely to be admitted to the hospital (aOR: 2.70 ; 95% CI: 2.13-3.41) and intensive care unit (ICU) (aOR: 2.21; 95% CI: 1.45-3.38) than patients without ESRD. ED patients with ESRD were more likely to receive blood tests and get radiology tests.Conclusion: We described the unique demographic, socioeconomic, and clinical characteristics of ED patients with ESRD, using the most comprehensive, nationally representative study to date. These patients’ higher hospital and ICU admission rates indicate that patients with ESRD require a higher level of emergency care.