Clostridium difficile infection in dialysis patients

Clostridium difficile infection (CDI) is the most common cause of nosocomial diarrhea. Patients with end-stage renal disease (ESRD) may be at increased risk for CDI. Patients with ESRD with CDI have increased mortality, longer length of stay, and higher costs. The present studies extend these observations and address associated comorbidities, incidence of recurrence, and risk factors for mortality. We queried the United States Renal Data System (USRDS) for patients with ESRD diagnosed with CDI, and assessed for the incidence of infection, comorbidities, and mortality. The records of 419,875 incident dialysis patients from 2005 to 2008 were reviewed. 4.25% had a diagnosis of a first CDI. In the majority of patients with CDI positive, a hospitalization or ICU stay was documented within 90 days prior to the diagnosis of CDI. The greatest adjusted relative risk (aRR) of CDI was present in patients with HIV (aRR 2.68), age ≥65 years (aRR 1.76), and bacteremia (aRR 1.74). The adjusted HR (aHR) for death was 1.80 in patients with CDI. The comorbidities demonstrating the greatest risk for death in dialysis patients with CDI included age ≥65 years and cirrhosis (aHR 2.28 and 1.76, respectively). Recurrent CDI occurred in 23.6%, was more common in Caucasians, and in those who were older. CDI is a common occurrence in patients with ESRD, with elderly patients, patients with HIV positive, and bacteremic patients at highest risk for infection. Patients with CDI had nearly a twofold increased risk of death.

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Concomitant Use of Gabapentinoids with Opioids Is Associated with Increased Mortality and Morbidity among Dialysis Patients

American Journal of Nephrology ◽

10.1159/000507725 ◽

2020 ◽

Vol 51 (6) ◽

pp. 424-432 ◽

Cited By ~ 1

Author(s):

Salina P. Waddy ◽

Adan Z. Becerra ◽

Julia B. Ward ◽

Kevin E. Chan ◽

Chyng-Wen Fwu ◽

...

Keyword(s):

The United States ◽

Future Research ◽

Dialysis Patients ◽

Mortality And Morbidity ◽

Medication Prescription ◽

Risk Of Death ◽

Increased Risk ◽

Stage Renal Disease ◽

End Stage ◽

Dialysis Discontinuation

Background: The opioid epidemic is a public health emergency and appropriate medication prescription for pain remains challenging. Physicians have increasingly prescribed gabapentinoids for pain despite limited evidence supporting their use. We determined the prevalence of concomitant gabapentinoid and opioid prescriptions and evaluated their associations with outcomes among dialysis patients. Methods: We used the United States Renal Data System to identify patients treated with dialysis with Part A, B, and D coverage for all of 2010. Patients were grouped into 4 categories of drugs exposure status in 2010: (1) no prescriptions of either an opioid or gabapentinoid, (2) ≥1 prescription of an opioid and no prescriptions of gabapentinoids, (3) no prescriptions of an opioid and ≥1 prescription of gabapenbtinoids, (4) ≥1 prescription of both an opioid and gabapentinoid. Outcomes included 2-year all-cause death, dialysis discontinuation, and hospitalizations assessed in 2011 and 2012. Results: The study population included 153,758 dialysis patients. Concomitant prescription of an opioid and gabapentin (15%) was more common than concomitant prescription of an opioid and pregabalin (4%). In adjusted analyses, concomitant prescription of an opioid and gabapentin compared to no prescription of either was associated with increased risk of death (hazard ratio [HR] 1.16, 95% CI 1.12–1.19), dialysis discontinuation (HR 1.14, 95% CI 1.03–1.27), and hospitalization (HR 1.33, 95% CI 1.31–1.36). Concomitant prescription of an opioid and pregabalin compared to no prescription of either was associated with increased mortality (HR 1.22, 95% CI 1.16–1.28) and hospitalization (HR 1.37, 95% CI 1.33–1.41), but not dialysis discontinuation (HR 1.13, 95% CI 0.95–1.35). Prescription of opioids and gabepentinoids compared to only being prescribed opioids was associated with higher risk of hospitalizations, but not mortality, or dialysis discontinuation. Conclusions: Concomitant prescription of opioids and gabapentinoids among US dialysis patients is common, and both drugs have independent effects on outcomes. Future research should prospectively investigate the potential harms of such drugs and identify safer alternatives for treatment of pain in end-stage renal disease patients.

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Social support and subsequent mortality among patients with end-stage renal disease.

Journal of the American Society of Nephrology ◽

10.1681/asn.v441028 ◽

1993 ◽

Vol 4 (4) ◽

pp. 1028-1034

Author(s):

W M McClellan ◽

D J Stanwyck ◽

C A Anson

Keyword(s):

Social Support ◽

Renal Disease ◽

Adjusted Relative Risk ◽

Dialysis Patients ◽

Risk Of Death ◽

Increased Risk ◽

Patient Reported ◽

Dialysis Facilities ◽

Stage Renal Disease ◽

End Stage

The association between social support in newly entered dialysis patients and their subsequent risk of mortality was investigated. Two hundred forty-nine dialysis patients were enrolled from dialysis facilities in two southeastern states. A score was calculated for the amount of social support a patient reported giving and receiving from spouse, family, friends, nurses, physicians, staff, and fellow patients. Patients were monitored for 12 months after enrollment into the cohort: 43 (17.6%) died. Mean (SD) scores for giving support to the family were higher among survivors, 3.59 (0.92), than among those who died, 3.17 (1.32) (P = 0.022). Mean scores for giving support to friends were also higher among survivors, 3.38 (1.13), than among nonsurvivors, 2.94 (1.33) (P = 0.044). After other factors associated with increased risk of dying, including age, sex, race, diabetic renal disease, angina pectoris, and functional status, were controlled for, individuals in the lowest quartile of giving social support to friends continued to have a greater risk of dying, with adjusted relative risk (95% confidence interval) = 2.02 (1.01, 4.07). In contrast, there were no differences in risk of death found for differing levels of receiving social support. It was concluded that social support is an independent risk factor for mortality among new dialysis patients.

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

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18010326 ◽

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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Improved survival with renal transplantation for end-stage renal disease due to granulomatosis with polyangiitis: data from the United States Renal Data System

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2018-213452 ◽

2018 ◽

Vol 77 (9) ◽

pp. 1333-1338 ◽

Cited By ~ 2

Author(s):

Zachary S Wallace ◽

Rachel Wallwork ◽

Yuqing Zhang ◽

Na Lu ◽

Frank Cortazar ◽

...

Keyword(s):

United States ◽

Renal Transplantation ◽

Renal Transplant ◽

End Stage Renal Disease ◽

Granulomatosis With Polyangiitis ◽

The United States ◽

Risk Of Death ◽

All Cause Mortality ◽

Stage Renal Disease ◽

End Stage

BackgroundRenal transplantation is the optimal treatment for selected patients with end-stage renal disease (ESRD). However, the survival benefit of renal transplantation among patients with ESRD attributed to granulomatosis with polyangiitis (GPA) is unknown.MethodsWe identified patients from the United States Renal Data System with ESRD due to GPA (ESRD-GPA) between 1995 and 2014. We restricted our analysis to waitlisted subjects to evaluate the impact of transplantation on mortality. We followed patients until death or the end of follow-up. We compared the relative risk (RR) of all-cause and cause-specific mortality in patients who received a transplant versus non-transplanted patients using a pooled logistic regression model with transplantation as a time-varying exposure.ResultsDuring the study period, 1525 patients were waitlisted and 946 received a renal transplant. Receiving a renal transplant was associated with a 70% reduction in the risk of all-cause mortality in multivariable-adjusted analyses (RR=0.30, 95% CI 0.25 to 0.37), largely attributed to a 90% reduction in the risk of death due to cardiovascular disease (CVD) (RR=0.10, 95% 0.06–0.16).DiscussionRenal transplantation is associated with a significant decrease in all-cause mortality among patients with ESRD attributed to GPA, largely due to a decrease in the risk of death to CVD. Prompt referral for transplantation is critical to optimise outcomes for this patient population.

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Risk of Dementia in Peritoneal Dialysis Patients Compared with Hemodialysis Patients

Peritoneal Dialysis International ◽

10.3747/pdi.2014.00213 ◽

2015 ◽

Vol 35 (2) ◽

pp. 189-198 ◽

Cited By ~ 42

Author(s):

Dawn F. Wolfgram ◽

Aniko Szabo ◽

Anne M. Murray ◽

Jeff Whittle

Keyword(s):

Cognitive Impairment ◽

Peritoneal Dialysis ◽

The United States ◽

Dialysis Modality ◽

Dialysis Patients ◽

Incident Dementia ◽

National Cohort ◽

Stage Renal Disease ◽

End Stage ◽

Incidence Of Dementia

Background Compared with similarly aged controls, patients with end-stage renal disease (ESRD) have a higher prevalence of cognitive impairment and more rapid cognitive decline, which is not explained by traditional risk factors alone. Since previous small studies suggest an association of cognitive impairment with dialysis modality, we compared incident dementia among patients initiating hemodialysis (HD) vs peritoneal dialysis (PD) in a large national cohort. Methods This is a retrospective cohort study of incident dialysis patients in the United States from 2006 to 2008 with no diagnosis of dementia prior to beginning dialysis. We evaluated the effect of initial dialysis modality on incidence of dementia, diagnosed by Medicare claims data, adjusted for baseline demographic and clinical data from the USRDS registry. Results Our analysis included 121,623 patients, of whom 8,663 initiated dialysis on PD. The mean age of our cohort was 69.2 years. Patients who initiated PD had a lower cumulative incidence of dementia than those who initiated HD (1.0% vs 2.7%, 2.5% vs 5.3%, and 3.9% vs 7.3% at 1, 2, and 3 years, respectively). The risk of dementia for patients who started on PD was lower compared with those who started on HD, with a hazard ratio (HR) = 0.46 [0.41, 0.53], in an unadjusted model and HR 0.74 [0.64, 0.86] in a matched model. Conclusions Dialysis modality is associated with incident dementia in a cohort of older ESRD patients. This finding warrants further investigation of the effect of dialysis modality on cognitive function and evaluation for possible mechanisms.

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Effect of anti-diabetic drugs in dialysis patients with diabetes: a nationwide retrospective cohort study

Cardiovascular Diabetology ◽

10.1186/s12933-021-01364-w ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Shih-Hsiang Ou ◽

Hsin-Yu Chen ◽

Nai-Wen Fang ◽

Chun-Hao Yin ◽

Chien-Liang Chen ◽

...

Keyword(s):

Drug Use ◽

Rank Test ◽

Insulin Administration ◽

Dialysis Patients ◽

Continuous Administration ◽

Risk Of Death ◽

Patients With Diabetes ◽

Hypoglycemic Drug ◽

Stage Renal Disease ◽

End Stage

Abstract Background Type 2 diabetes mellitus is common in patients undergoing dialysis. However, the association between anti-diabetic drug use and survival outcomes is rarely discussed. We aimed to investigate whether continued anti-diabetic medication use affects the survival of diabetic dialysis patients and whether different hypoglycemic drug use influences prognosis. Methods Using a nationwide database, we enrolled patients with incident end-stage renal disease under maintenance dialysis during 2011–2015 into the pre-existing diabetes dialysis (PDD), incident diabetes after dialysis (IDD), and non-diabetic dialysis (NDD) groups. The PDD group was further subclassified into patients who continued (PDD-M) and discontinued (PDD-NM) anti-diabetic drug use after dialysis. Results A total of 5249 dialysis patients were examined. The PDD-NM group displayed a significantly higher mortality rate than the IDD, PDD-M, and NDD groups (log-rank test P < 0.001). The PDD-M group had a significantly lower risk of death, regardless of insulin (P < 0.001) or oral hypoglycemic agent (OHA) (P < 0.001) use. Initial insulin administration or OHA had no statistically significant effect on overall mortality in the IDD group. But OHA use had better survival trends than insulin administration for the older (P = 0.02) and male subgroups (P = 0.05). Conclusions For dialysis patients with diabetes, continuous administration of anti-diabetic drugs after dialysis and choice of medication may affect outcomes.

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Frailty severity is significantly associated with electrocardiographic QRS duration in chronic dialysis patients

PeerJ ◽

10.7717/peerj.1354 ◽

2015 ◽

Vol 3 ◽

pp. e1354 ◽

Cited By ~ 9

Author(s):

Chia-Ter Chao ◽

Jenq-Wen Huang

Keyword(s):

Regression Analysis ◽

Chronic Hemodialysis ◽

Self Report ◽

Qtc Interval ◽

Dialysis Patients ◽

Increased Risk ◽

Qrs Duration ◽

Stage Renal Disease ◽

End Stage ◽

Esrd Patients

End-stage renal disease (ESRD) patients are at increased risk of sudden cardiac death, the risk of which is presumably related to arrhythmia. Electrocardiographic (ECG) parameters have been found to correlate with arrhythmia and predict cardiovascular outcomes in ESRD patients. Frailty is also a common feature in this population. We investigate whether the severity of dialysis frailty is associated with ECG findings, including PR interval, QRS duration, and QTc interval. Presence and severity of frailty was ascertained using six different self-report questionnaires with proven construct validity. Correlation analysis between frailty severity and ECG was made, and those with significant association entered into multiple regression analysis for confirmation. Among a cohort of chronic hemodialysis patients, we found that frailty severity, assessed by the Edmonton frailty scale, is significantly associated with QRS duration (r= − 0.3,p< 0.05). Dialysis patients with QRS longer than 120 ms had significantly lower severity of frailty than those with QRS less than 120 ms (p= 0.01 for the Edmonton frailty scale and 0.05 for simple FRAIL scale). Regression analysis showed that frailty severity, assessed by the Edmonton frailty scale and simple FRAIL scale, was significantly associated with QRS duration independent of serum electrolyte levels. In conclusion, a significant relationship exists between the severity of frailty and QRS duration in ESRD patients. This might be an under-recognized link between frailty and its adverse cardiovascular impact in these patients.

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Epidemiology of dialysis-treated end-stage renal disease patients in Kazakhstan: data from nationwide large-scale registry 2014–2018

BMC Nephrology ◽

10.1186/s12882-020-02047-6 ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Abduzhappar Gaipov ◽

Alpamys Issanov ◽

Kainar Kadyrzhanuly ◽

Dinara Galiyeva ◽

Marina Khvan ◽

...

Keyword(s):

Mortality Rate ◽

Renal Disease ◽

Survival Probability ◽

End Stage Renal Disease ◽

Older Patients ◽

Large Scale ◽

Dialysis Patients ◽

Risk Of Death ◽

Stage Renal Disease ◽

End Stage

Abstract Background The epidemiology of dialysis patients has been little studied in developing countries and economies in transition. We examined the prevalence, incidence and mortality rate of dialysis patients in Kazakhstan, via aggregation and utilization of large-scale administrative healthcare data. Methods The registry data of 8898 patients receiving dialysis therapy between 2014 and 2018 years were extracted from the Unified National Electronic Health System (UNEHS) and linked with the national population registry of Kazakhstan. We provide descriptive statistics of demographic, comorbidity and dialysis-related characteristics. Results Among all patients undergoing maintenance dialysis for end-stage renal disease (ESRD), there were 3941 (44%) females and 4957 (56%) males. 98.7% of patients received hemodialysis and 1.3% peritoneal dialysis. The majority of the patients (63%) were ethnic Kazakhs, 18% were Russians and 19% were of other ethnicities. The prevalence and incidence rate in 2014 were 135.2 and 68.9 per million population (PMP), respectively, which were different in 2018 [350.2 and 94.9 PMP, respectively]. Overall mortality rate among dialysis patients reduced from 1667/1000 patient-years [95%Confidence Interval (CI): 1473–1886] (PY) in 2014 to 710/1000PY [95%CI: 658–767] in 2018. We observed 13% lower crude survival probability in females compared to males and in older patients compared to younger ones. Russian ethnicity had 58% higher risk of death, while other ethnicities had 34% higher risk of death compared to in those of Kazakh ethnicity. Conclusion We describe for the first time in Kazakhstan an increase in the prevalence and incidence of ESRD on dialysis, while mortality rate decreased over time, during 2014–2018. We observed statistically significant lower survival probability in female dialysis patients compared to males, in older patients compared to younger ones, and in patients of Russian ethnicity compared to Kazakh.

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