The Impact of Warfarin on Patients with End Stage Renal Disease

Introduction. A deficiency in vitamin K through the utilization of warfarin may result in increased vascular calcification and complications. This study aimed to determine the impact of warfarin administration on patients with end stage renal disease (ESRD) in a large, national sample. Methods. A retrospective analysis using the 2005–2010 National Inpatient Sample (NIS), a part of the Health Care Utilization Project (HCUP), was completed using ICD-9 diagnosis codes to capture patients with ESRD prescribed and not prescribed warfarin. Statistical analysis was through ANOVA and chi-squared testing. Results. From 2005–2010, 927,814 patients with ESRD were identified nationally. 3.5% (32,737) were prescribed warfarin. Patients prescribed warfarin had an average age of 64 years and 51% were male. For every comorbid condition (amputation, congestive heart failure, chronic obstructive pulmonary disorder, cerebrovascular accident, diabetes, hypertension, myocardial infarction, peripheral vascular diasese, and valvular disease) patients prescribed Warfarin had significantly higher rates of disease as compared to their nonwarfarin ESRD counterparts. ESRD patients prescribed warfarin had significantly shorter length of stay but increased hospital charges. They were more likely to be discharged to home and had significantly decreased in-hospital mortality. Conclusion. Patients with ESRD taking warfarin are more likely to have comorbidities and/or complications but have a decreased LOS and in-hospital mortality compared to their ESRD counterparts not administered warfarin.

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In-Hospital Mortality in Cirrhotic Patients with End-Stage Renal Disease Treated with Hemodialysis versus Peritoneal Dialysis: A Nationwide Study

Peritoneal Dialysis International ◽

10.3747/pdi.2016.00131 ◽

2017 ◽

Vol 37 (4) ◽

pp. 464-471 ◽

Cited By ~ 3

Author(s):

Mark A. Nader ◽

Rodrigo Aguilar ◽

Prabin Sharma ◽

Parasuram Krishnamoorthy ◽

Dragoi Serban ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Renal Disease ◽

Hospital Mortality ◽

Subgroup Analysis ◽

End Stage Renal Disease ◽

Hospital Charges ◽

Dialysis Modality ◽

Cirrhotic Patients ◽

Stage Renal Disease ◽

End Stage

BackgroundCirrhotic patients often develop end-stage renal disease (ESRD) requiring renal replacement therapy in the form of hemodialysis (HD) or peritoneal dialysis (PD). Studies comparing the outcomes and difference in in-hospital mortality between these 2 groups, particularly among those with ascites, are sparse. We set our objective to determine the dialysis modality with a better in-hospital survival rate among cirrhotic patients with ESRD (ESRD-cirrhosis).MethodsData was extracted from the 2005 to 2012 Nationwide Inpatient Sample (NIS). Using propensity score matching, ESRD-cirrhosis patients on PD were matched with patients on HD at a 1:1 ratio. Another subgroup analysis of ESRD-cirrhosis patients with ascites was performed using the same matching algorithm. Analyses were performed using SAS version 9.3 (SAS Institute, Cary, NC, USA).ResultsAmong 26,135 cirrhotic patients with incident ESRD, 25,686 (98.3%) and 449 (1.7%) were initiated on HD and PD, respectively, during the hospitalization. There was a nonsignificant mortality difference between the ESRD-cirrhosis patients treated with PD and those treated with HD. In a subgroup analysis of these patients with ascites, 18 patients underwent PD while 1,878 patients required HD. Also, PD had a significantly lower in-hospital mortality compared with HD in this subgroup (0% vs 26.67%, p = 0.03). Mean length of stay for those who received HD was 8.34 days compared with 7.06 days for the PD group ( p < 0.0001). Similarly, mean hospital charges were greater for those who had HD compared with PD ($74,501 vs $57,460; p < 0.001).ConclusionCirrhotic patients with ESRD and ascites who undergo PD have a significantly lower mortality than those who are started on HD. However PD is rarely initiated for ESRD in cirrhotic patients with ascites during hospitalization in the United States. Due to the potential advantages of PD, nephrologists should encourage PD when selecting dialysis modality in this subgroup of patients whenever possible.

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Depression among end-stage renal disease patients undergoing hemodialysis: a cross-sectional study from Palestine

Renal Replacement Therapy ◽

10.1186/s41100-021-00331-1 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Samah W. Al-Jabi ◽

Ansam Sous ◽

Fatimah Jorf ◽

Mahmoud Taqatqa ◽

Mahdi Allan ◽

...

Keyword(s):

Renal Disease ◽

Low Income ◽

End Stage Renal Disease ◽

West Bank ◽

Psychological Status ◽

The West ◽

Depression Prevalence ◽

Stage Renal Disease ◽

End Stage ◽

The Impact

Abstract Background The impact of end-stage renal disease on the patient’s psychological status necessitates the value of increasing depression awareness. The current study aimed to assess the depression prevalence among Palestinian hemodialyzed patients and its association with patients’ characteristics. Methods A convenience clustered sampling technique was followed. Sample was collected from ten hemodialysis centers in the West Bank, Palestine, during 3 months in 2015. We used the Beck Depression Inventory-II scale (BDI-II) to evaluate depression among participants. All data were analyzed using Statistical Package for the Social Sciences version 16.0. Results Two hundred and eighty-six hemodialyzed patients were interviewed. The mean age (± standard deviation) of the patients was 52.0 ± 14.3 years, and most participants were males 172 (60.1%). Regarding the dialysis characteristics, the median of years of dialysis was 2 years (1–4). The prevalence of depression was 73.1%. Elderly patients (p = 0.001), female (p = 0.036), living in rural areas or camp (p = 0.032), low income (p = 0.041), unemployment (p = 0.001), not doing regular exercise (p = 0.001), and having multi comorbidities (p = 0.001) were significantly associated with more depression scores. The results of binary logistic regression showed that only patients who were living in camps, patients who were previously employed, and patients who were not practicing exercise remained significantly associated with a higher depression score. Conclusions This study is the first one confirmed about depression and its prevalence among hemodialyzed patients in the West Bank, Palestine. Compared to other communities, the study found a higher depression prevalence rate. There is a need to offer psychological interviews and non-pharmacological and pharmacological interventions.

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