scholarly journals Impact of Pediatric Chronic Dialysis on Long-Term Patient Outcome: Single Center Study

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Daniella Levy Erez ◽  
Irit Krause ◽  
Amit Dagan ◽  
Roxana Cleper ◽  
Yafa Falush ◽  
...  
Keyword(s):  
Survival Rate ◽  
Medical Center ◽  
Significant Risk ◽  
Chronic Dialysis ◽  
Term Survival ◽  
Successful Transplantation ◽  
Life Threatening ◽  
Stage Renal Disease ◽  
End Stage

Objective.Owing to a shortage of kidney donors in Israel, children with end-stage renal disease (ESRD) may stay on maintenance dialysis for a considerable time, placing them at a significant risk. The aim of this study was to understand the causes of mortality.Study Design. Clinical data were collected retrospectively from the files of children on chronic dialysis (>3 months) during the years 1995–2013 at a single pediatric medical center.Results.110 patients were enrolled in the study. Mean age was10.7±5.27 yrs. (range: 1 month–24 yrs). Forty-five children (42%) had dysplastic kidneys and 19 (17.5%) had focal segmental glomerulosclerosis. Twenty-five (22.7%) received peritoneal dialysis, 59 (53.6%) hemodialysis, and 6 (23.6%) both modalities sequentially. Median dialysis duration was 1.46 years (range: 0.25–17.54 years). Mean follow-up was13.5±5.84 yrs. Seventy-nine patients (71.8%) underwent successful transplantation, 10 (11.2%) had graft failure, and 8 (7.3%) continued dialysis without transplantation. Twelve patients (10.9%) died: 8 of dialysis-associated complications and 4 of their primary illness. The 5-year survival rate was 84%: 90%for patients older than 5 years and 61%for younger patients.Conclusions.Chronic dialysis is a suitable temporary option for children awaiting renal transplantation. Although overall long-term survival rate is high, very young children are at high risk for life-threatening dialysis-associated complications.

Impact of statin on long-term outcome among patients with end-stage renal disease with acute myocardial infarction (AMI): a nationwide case–control study

2021 ◽  
pp. postgradmedj-2019-137292
Author(s):  
Feng-You Kuo ◽  
Wei-Chun Huang ◽  
Pei-Ling Tang ◽  
Chin-Chang Cheng ◽  
Cheng-Hung Chiang ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Survival Rate ◽  
Statin Therapy ◽  
End Stage Renal Disease ◽  
Term Survival ◽  
Receptor Blockers ◽  
Stage Renal Disease ◽  
End Stage ◽  
Statin Use

BackgroundUse of statin has been associated with reduced risk of cardiovascular diseases events and mortality. However, in patients with end-stage renal disease (ESRD), the protective effects of statin are controversial. To evaluate the impact of chronic statin use on clinical outcomes of patients with acute myocardial infarction (AMI) with ESRD.MethodsWe enrolled 8056 patients with ESRD who were initially diagnosed and admitted for first AMI from Taiwan’s National Health Insurance Research Database. Of which, 2134 patients underwent statin therapy. We randomly selected and use age, sex, hypertension, diabetes mellitus (DM), peripheral vascular diseases (PVD), heart failure (HF), cerebrovascular accidents (CVA), chronic obstructive pulmonary disease, matched with the study group as controls (non-stain user). We compared the effects of statin use in term of all-cause death among patients with AMI with ESRD.ResultsStatin use resulted in a significantly higher survival rate in patients ith AMI with ESRD compared with non-statin users. After adjusted the comorbidities the male patients and patients with DM, PVD, HF and CVA had lower long-term survival rate (all p<0.001). Patients who underwent percutaneous coronary intervention (p<0.001), ACE inhibitors/angiotensin II receptor blockers (p<0.001), β receptor blockers (p<0.001) and statin therapy (p=0.007) had better long-term survival rate. Patients with AMI with ESRD on statin therapy exhibited a significantly lower risk of mortality compared with non-statin users (p<0.0001).ConclusionAmong patients with ESRD with AMI, statin therapy was associated with reduced all-cause mortality.

Effectiveness of recombinant human erythropoietin, vitamin D3and iron therapy on long-term survival of patients with end-stage renal disease receiving haemodialysis: analysis of 702 patients after 10-year follow-up

2009 ◽  
Vol 12 (12) ◽  
pp. 2410-2415 ◽  
Author(s):  
Huan-Cheng Chang ◽  
Chien-Lung Chen ◽  
Te-Li Chiu ◽  
Shu-I Chen ◽  
Amy Ming-Fang Yen ◽  
...  
Keyword(s):  
Vitamin D ◽  
Survival Rate ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Recombinant Human Erythropoietin ◽  
Term Survival ◽  
Human Erythropoietin ◽  
Stage Renal Disease ◽  
End Stage

AbstractObjectiveFew studies have been conducted to investigate the influence of recombinant human erythropoietin (rhEPO) on the long-term prognosis of end-stage renal disease (ESRD).DesignA retrospective cohort study.SettingThe largest regional hospital renowned for haemodialysis in northern Taiwan.SubjectsA total of 702 ESRD patients undergoing haemodialysis between 1993 and 2002 were evaluated.ResultsThe rate of overall use of rhEPO, vitamin D3or Fe therapy was 62 %. The 10-year survival rate in patients with rhEPO supplementation was statistically more favourable than that in patients without rhEPO (hazard ratio (HR) = 0·38, 95 % CI 0·30, 0·47,P< 0·0001). Similar findings were noted for patients receiving vitamin D3(HR = 0·36, 95 % CI 0·21, 0·64,P= 0.0004) and Fe (HR = 0·45, 95 % CI 0·33, 0·61,P< 0·0001). After adjusting for age, education and aetiology, the administration of rhEPO resulted in statistically significant improvements in long-term survival rate either with (HR = 0·30, 95 % CI 0·22, 0·42) or without (HR = 0·48, 95 % CI 0·38, 0·61) combined use of Fe or vitamin D3.ConclusionsWe demonstrated a reduction in long-term mortality related to supplementation therapy with rhEPO, vitamin D3and Fe. The findings provide a justification for the administration of combined supplement therapy in patients undergoing haemodialysis.

scholarly journals Does a Supplemental Low-Protein Diet Decrease Mortality and Adverse Events After Commencing Dialysis? A Nationwide Cohort Study

Nutrients ◽  
2018 ◽  
Vol 10 (8) ◽  
pp. 1035 ◽  
Author(s):  
Chieh-Li Yen ◽  
Kun-Hua Tu ◽  
Ming-Shyan Lin ◽  
Su-Wei Chang ◽  
Pei-Chun Fan ◽  
...  
Keyword(s):  
Protein Diet ◽  
Low Protein Diet ◽  
Research Database ◽  
Negative Consequences ◽  
Term Survival ◽  
Low Protein ◽  
All Cause Mortality ◽  
Stage Renal Disease ◽  
End Stage

Background: A beneficial effect of a ketoanalogue-supplemented low-protein diet (sLPD) in postponing dialysis has been demonstrated in numerous previous studies. However, evidence regarding its effect on long-term survival is limited. Our study assessed the long-term outcomes of patients on an sLPD after commencing dialysis. Methods: This retrospective study examined patients with new-onset end-stage renal disease with permanent dialysis between 2001 and 2013, extracted from Taiwan’s National Health Insurance Research Database. Patients who received more than 3 months of sLPD treatment in the year preceding the start of dialysis were extracted. The outcomes studied were all-cause mortality, infection rate, and major cardiac and cerebrovascular events (MACCEs). Results: After propensity score matching, the sLPD group (n = 2607) showed a lower risk of all-cause mortality (23.1% vs. 27.6%, hazard ratio (HR) 0.77, 95% confidence interval (CI) 0.70–0.84), MACCEs (19.2% vs. 21.5%, HR 0.86, 95% CI 0.78–0.94), and infection-related death (9.9% vs. 12.5%, HR 0.76, 95% CI 0.67–0.87) than the non-sLPD group did. Conclusion: We found that sLPD treatment might be safe without long-term negative consequences after dialysis treatment.

scholarly journals Risk of Complications and Survival of Patients Dialyzed with Permanent Catheters

Medicina ◽  
2019 ◽  
Vol 56 (1) ◽  
pp. 2
Author(s):  
Anna Szarnecka-Sojda ◽  
Wojciech Jacheć ◽  
Maciej Polewczyk ◽  
Agnieszka Łętek ◽  
Jarosław Miszczuk ◽  
...  
Keyword(s):  
Vascular Access ◽  
Infectious Complications ◽  
Term Survival ◽  
Long Term Survival ◽  
Dialysis Fistula ◽  
Study Population ◽  
Catheter Implantation ◽  
Stage Renal Disease ◽  
End Stage

Background and Objectives: An increase in the incidence of end-stage renal disease (ESRD) is associated with the need for a wider use of vascular access. Although arteriovenous (A-V) fistula is a preferred form of vascular access, for various reasons, permanent catheters are implanted in many patients. Materials and Methods: A retrospective analysis of clinical data was carried out in 398 patients (204 women) who in 2010–2016 were subjected to permanent dialysis catheters implantation as first vascular access or following A-V fistula dysfunction. The factors influencing the risk of complications related to vascular access and mortality were evaluated and the comparison of the group of patients with permanent catheter implantation after A-V fistula dysfunction with patients with first-time catheter implantation was carried out. Results: The population of 398 people with ESRD with mean age of 68.73 ± 13.26 years had a total of 495 permanent catheters implanted. In 129 (32.6%) patients, catheters were implanted after dysfunction of a previously formed dialysis fistula. An upward trend was recorded in the number of permanent catheters implanted in relation to A-V fistulas. Ninety-two infectious complications (23.1%) occurred in the study population in 65 patients (16.3%). Multivariate analysis showed that permanent catheters were more often used as the first vascular access option in elderly patients and cancer patients. Mortality in the mean 1.38 ± 1.17 years (min 0.0, max 6.70 years) follow-up period amounted to 50%. Older age and atherosclerosis were the main risk factors for mortality. Patients with dialysis fistula formed before the catheter implantation had a longer lifetime compared to the group in which the catheter was the first access. Conclusion: The use of permanent catheters for dialysis therapy is associated with a relatively high incidence of complications and low long-term survival. The main factors determining long-term survival were age and atherosclerosis. Better prognosis was demonstrated in patients after the use of A-V fistula as the first vascular access option.

scholarly journals Immunological Characteristics and Management of Kidney Transplantation

2020 ◽  
Vol 95 (1) ◽  
pp. 18-26
Author(s):  
Myung-Gyu Kim
Keyword(s):  
Kidney Transplantation ◽  
De Novo ◽  
Treatment Strategies ◽  
Adaptive Immune System ◽  
Diagnostic Tools ◽  
Term Survival ◽  
Stage Renal Disease ◽  
End Stage ◽  
Transplant Immunology

Kidney transplantation (KT) is the best way to improve the quality of life and survival of patients with end-stage renal disease. However, after KT the adaptive immune system plays important roles in the development of rejection via multiple pathways. Accordingly, the suppression or modulation of these pathways is key to allograft survival. Advances in our understanding of the immunology related to KT with the development of immunosuppressants have reduced the rate of acute rejection and improved short-term transplant outcomes. Nonetheless, <i>de novo</i> donor-specific antibodies and subsequent chronic rejection continue to be responsible for the poor long-term survival of transplanted patients. In addition, the morbidity and mortality rates in patients returning to dialysis after graft failure are high. Better long-term outcomes following KT require innovative treatment strategies that include a focus on de novo antibodies. Here, we review basic transplant immunology as well as the diagnostic tools and medications that contribute to successful KT. We also provide an update on newly developed immunosuppressants.

scholarly journals A májátültetés aneszteziológiai-intenzív terápiás vonatkozásai

2018 ◽  
Vol 159 (46) ◽  
pp. 1891-1897
Author(s):  
János Fazakas ◽  
Anikó Smudla
Keyword(s):  
Organ Transplantation ◽  
Intensive Therapy ◽  
Surgical Techniques ◽  
Interdisciplinary Approach ◽  
Liver Transplants ◽  
Term Survival ◽  
Successful Transplantation ◽  
Almost All ◽  
End Stage

Abstract: One of the most prominent results of our age is organ transplantation, the single treatment option for patients with end-stage organ failure. The success of transplants depends on the donor care, the patient preoperative preassessment, the perioperative care of organ transplantation and aftercare. Successful transplantation therefore requires a prominent level of continuous collaboration between the surgeon, anaesthesiologist, radiologist, internal medicine and hepatologist, laboratory physician and almost all their associates. The complex interdisciplinary approach based on the research results can be used to improve the patient’s condition through pharmacotherapy, physiotherapy and psychotherapy during the time spent on waiting lists. The emergence of more active, targeted therapeutic options in perioperative graft resuscitation may help the currently inferior quality transplantable grafts or resuscitation out (machine perfusion) or in the recipient, thereby increasing the number of liver transplants. Deeper knowledge of hemostatic processes, along with the development of surgical techniques, would increase the number of blood transplant free transplants, thus improving the long-term survival of grafts. The present study aims at presenting the anaesthesia and early intensive therapy aspects of liver transplantation from aptitude assessment, through anaesthesia to early intensive therapeutic treatment. Orv Hetil. 2018; 159(46): 1891–1897.

scholarly journals Diálise Peritoneal nos Dois Primeiros Anos de Vida: Experiência de uma Unidade de Nefrologia e Transplantação Renal Pediátrica

2016 ◽  
Vol 29 (9) ◽  
pp. 525
Author(s):  
Sofia Deuchande ◽  
Tânia Mano ◽  
Cristina Novais ◽  
Rute Machado ◽  
Rosário Stone ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Peritoneal Dialysis ◽  
Renal Transplantation ◽  
Kidney Disease ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Term Survival ◽  
Stage Renal Disease ◽  
End Stage

Introduction: Peritoneal dialysis is the dialytic method of choice in chronic end-stage renal disease in children. This study main purposewas to characterize the long-term survival of a pediatric population who began peritoneal dialysis within the first two years of life.Material and Methods: A descriptive and retrospective study was performed in a portuguese nephrology and renal transplantation pediatric unit, between January 1991 and August 2014. End-stage renal disease etiology, mortality, comorbidities and complications of peritoneal dialysis and end-stage renal disease, growth and psychomotor development were evaluated.Results: Twenty children started peritoneal dialysis within the first two years of life. There were six deaths, but no deaths of children with primary chronic kidney disease were registered over the past decade. The 14 living children were characterized; 13 were males. Congenital abnormalities of the kidney and urinary tract were the leading etiology of chronic kidney disease (45%). The average age start of peritoneal dialysis was 6.1 months; six children started before 30 days of life. Peritonitis was the most frequent cause of hospitalization. Ten children were transplanted at an average age of 5.3 years. All of the children who are still in peritoneal dialysis have short stature, but nine of the transplanted have final height within the expected for their mid-parental height target range. Nine (64%)had some type of neurodevelopmental delay.Discussion: Peritoneal dialysis is a technique possible and feasible since birth, as evidenced in the study, as more than half of children successfully started it before 6 months of life. It allows long-term survival until the possibility of renal transplantation despite the associated morbidity, including peritonitis and complications of chronic renal disease. The ten transplanted children improved their growth, recovered from chronic anemia and improved dyslipidemia, compared with the period of dialysis. However, the average waiting time until the renal transplant was 5.3 years higher than other international centers.Conclusion: These data support the use of peritoneal dialysis from birth, but complications and the worst growth reflect the need to develop strategies to optimize care relating to nutrition, growth and development and to reduce pre-transplant time.

Long-Term Survival After Coronary Arterial Grafts in Patients With End-Stage Renal Disease

2010 ◽  
Vol 90 (3) ◽  
pp. 738-743 ◽  
Author(s):  
Taro Nakatsu ◽  
Nobushige Tamura ◽  
Yutaka Sakakibara ◽  
Kouji Hagio ◽  
Masanosuke Ishigami
Keyword(s):  
Renal Disease ◽  
End Stage Renal Disease ◽  
Arterial Grafts ◽  
Term Survival ◽  
Long Term Survival ◽  
Stage Renal Disease ◽  
End Stage

Renal Transplantation in Diabetes Mellitus

1981 ◽  
Vol 2 (1_suppl) ◽  
pp. 17-19
Author(s):  
Carl J. Cardella ◽  
Paul Y. W. Tam J ◽  
Frank Walker ◽  
George A. DeVeber ◽  
Gerald T. Cook
Keyword(s):  
Renal Transplantation ◽  
Vascular Complications ◽  
Successful Transplantation ◽  
Life Threatening ◽  
One Year ◽  
The One ◽  
Stage Renal Disease ◽  
End Stage ◽  
Patient And Graft Survival

With increasing frequency, renal transplantation has been used to treat uremic diabetics. At this center, during 1981,28% of all cadaveric transplants were performed in diabetics. The one-year patient and graft survival in the 36 diabetics, who had such transplants in this unit (85% and 54% respectively) is lower than in non-diabetic cadaveric recipients, chiefly because of increased mortality and allograft rejection among the diabetics. A major cause of morbidity and mortality is severe progressive vascular disease. In spite of these limitations, nephrologists should consider renal transplantation early in uremic diabetics before they develop life-threatening or disabling complications. Successful transplantation appears to stabilize or improve the non-vascular complications and thus, enhance the quality of life for diabetics with end-stage renal disease.

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