Trends in Anemia Management Practices in Patients Receiving Hemodialysis and Peritoneal Dialysis: A Retrospective Cohort Analysis

2015 ◽  
Vol 41 (4-5) ◽  
pp. 354-361 ◽  
Author(s):  
James B. Wetmore ◽  
Yi Peng ◽  
Keri L. Monda ◽  
Allyson M. Kats ◽  
Deborah H. Kim ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Management Practices ◽  
Cohort Analysis ◽  
Dialysis Patients ◽  
Dialysis Dose ◽  
Retrospective Cohort Analysis ◽  
Anemia Management ◽  
Iv Iron ◽  
The Mean ◽  
Rbc Transfusion

Background/Aims: Recent changes in clinical practice guidelines and reimbursement policies may have affected the use of anemia-related medications and red blood cell (RBC) transfusions in peritoneal dialysis (PD) and hemodialysis (HD) patients. We sought to compare patterns of erythropoiesis-stimulating agents (ESA) and intravenous (IV) iron use, achieved hemoglobin levels, and RBC transfusion use in PD and HD patients. Methods: In quarterly cohorts of prevalent dialysis patients receiving persistent therapy (>3 months), 2007-2011, with Medicare Parts A and B coverage, we assessed ESA and IV iron use and dose, RBC transfusions, and hemoglobin levels. Quarterly transfusion rates were calculated. Results: Observable PD and HD patients numbered 14,958 and 221,866 in Q1/2007 and 17,842 and 256,942 in Q4/2011. Adjusted ESA use was lower in PD (71.4-80.1%) than in HD (86.9-92.0%) patients, decreasing from 80.1% (Q1/2010) to 71.4% (Q4/2011) in PD patients, and from 92.0 to 86.9% in HD patients. The mean adjusted ESA dose decreased by 67.5% in PD and 58.4% in HD patients. IV iron use tended to increase, peaking at 39.3% for PD (Q3/2011) and 80.5% for HD (Q2/2011) patients. Adjusted mean hemoglobin levels fell from 11.7 to 10.6 mg/dl in PD and from 12.0 to 10.7 mg/dl in HD ESA users; adjusted transfusion rates increased from 2.4 to 3.0 per 100 patient-months in PD and from 2.6 to 3.3 in HD patients. Conclusions: In patients receiving persistent dialysis, dose and frequency of ESA administrations decreased during the period 2007-2011. Mean hemoglobin levels decreased by more than 1 g/dl, while transfusion rates increased by approximately 25%.

International Anemia Prevalence and Management in Peritoneal Dialysis Patients

2019 ◽  
Vol 39 (6) ◽  
pp. 539-546 ◽  
Author(s):  
Rachel L. Perlman ◽  
Junhui Zhao ◽  
Douglas S. Fuller ◽  
Brian Bieber ◽  
Yun Li ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Ferritin Level ◽  
Transferrin Saturation ◽  
The United States ◽  
Clinical Practices ◽  
Dialysis Patients ◽  
The Us ◽  
Anemia Management ◽  
Iv Iron ◽  
Dialysis Outcomes

Background The optimal treatment for managing anemia in peritoneal dialysis (PD) patients and best clinical practices are not completely understood. We sought to characterize international variations in anemia measures and management among PD patients. Methods The Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS) enrolled adult PD patients from 6 countries from 2014 to 2017. Hemoglobin (Hb), ferritin levels, and transferrin saturation (TSAT), as well as erythropoiesis stimulating agents (ESAs) and iron use were compared cross-sectionally at study enrollment in Australia and New Zealand (A/NZ), Canada, Japan, the United Kingdom (UK), and the United States (US). Results Among 3,603 PD patients from 193 facilities, mean Hb ranged from 11.0 – 11.3 g/dL across countries. The majority of patients (range 53% – 59%) had Hb 10 – 11.9 g/dL, with 4% – 12% patients ≥ 13 g/dL and 16% – 23% < 10 g/dL. Use of ESAs was higher in Japan (94% of patients) than elsewhere (66% – 79% of patients). In the US, 63% of patients had a ferritin level > 500 ng/mL, compared with 5% – 38% in other countries. In the US and Japan, 87% – 89% of PD patients had TSAT ≥ 20%, compared with 73% – 76% in other countries. Intravenous (IV) iron use within 4 months of enrollment was higher in the US (55% of patients) than elsewhere (6% – 17% patients). Conclusions In this largest international observational study of anemia and anemia management in patients receiving PD, comparable Hb levels across countries were observed but with notable differences in ESA and iron use. Peritoneal dialysis patients in the US have higher ferritin levels and higher IV iron use than other countries.

scholarly journals Predialysis anemia management and outcomes following dialysis initiation: A retrospective cohort analysis

PLoS ONE ◽  
2018 ◽  
Vol 13 (9) ◽  
pp. e0203767 ◽  
Author(s):  
James B. Wetmore ◽  
Suying Li ◽  
Heng Yan ◽  
Hairong Xu ◽  
Yi Peng ◽  
...  
Keyword(s):  
Retrospective Cohort ◽  
Cohort Analysis ◽  
Dialysis Initiation ◽  
Retrospective Cohort Analysis ◽  
Anemia Management

scholarly journals The Diagnosis of Protein Energy Wasting in Chronic Peritoneal Dialysis Patients Is Influenced by the Method of Calculating Muscle Mass. A Prospective, Multicenter Study

2021 ◽  
Vol 8 ◽  
Author(s):  
Cristina Techy Roth-Stefanski ◽  
Naiane Rodrigues de Almeida ◽  
Gilson Biagini ◽  
Natália K. Scatone ◽  
Fabiana B. Nerbass ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Muscle Mass ◽  
Chronic Peritoneal Dialysis ◽  
Dialysis Patients ◽  
Protein Energy Wasting ◽  
Protein Energy ◽  
Multifrequency Bioimpedance ◽  
Study Population ◽  
The Mean ◽  
Main Factor

Objective: To analyze the concordance and agreement between bioimpedance spectroscopy (BIS) and anthropometry for the diagnosis of protein energy wasting (PEW) in chronic peritoneal dialysis patients.Methods: Prospective, multi-center, observational study using multifrequency bioimpedance device (Body Composition Monitor -BCM®- Fresenius Medical Care) and anthropometry for the diagnosis of PEW as recommended by the International Society of Renal Nutrition and Metabolism (ISRNM). Cohen's kappa was the main test used to analyze concordance and a Bland-Altmann curve was built to evaluate the agreement between both methods.Results: We included 137 patients from three PD clinics. The mean age of the study population was 57.7 ± 14.9, 47.8% had diabetes, and 52.2% were male. We calculated the scores for PEW diagnosis at 3 and 6 months after the first collection (T3 and T6) and on average 40% of the study population were diagnosed with PEW. The concordance in the diagnosis of PEW was only moderate between anthropometry and BIS at both T3 and T6. The main factor responsible for our results was a low to moderate correlation for muscle mass in kilograms, with an r-squared (R2) of 0.35. The agreement was poor, with a difference of more than 10 kg of muscle mass on average and with more than a quarter of all cases beyond the limits of agreements.Conclusion: Current diagnosis of PEW may differ depending on the tools used to measure muscle mass in peritoneal dialysis patients.

Cardiovascular Risk After Sepsis: Understanding the Role of Statin Indications and the Impact of Clinical Inertia on Prescribing Patterns

2020 ◽  
Vol 25 (6) ◽  
pp. 541-547
Author(s):  
Vedant A. Gupta ◽  
Talal S. Alnabelsi ◽  
Sandipan Shringi ◽  
Steve W. Leung ◽  
Vincent L. Sorrell
Keyword(s):  
Cohort Analysis ◽  
Prescribing Patterns ◽  
Clinical Inertia ◽  
Major Adverse Cardiovascular Events ◽  
Prescribing Practices ◽  
Retrospective Cohort Analysis ◽  
The Mean ◽  
The Impact ◽  
Statin Use

Introduction: Patients with sepsis have high rates of major adverse cardiovascular events (MACE) in the literature, but the stratification of those at risk has been limited. Statin indicated groups provides clear criteria for therapy, but the risk of MACE after sepsis based on these groups has never been assessed. Materials and Methods: This was a retrospective cohort analysis conducted on adult patients admitted from January 1, 2013, to December 31, 2013, with suspected or confirmed sepsis and data available on statin use. Patients’ past medical history; statin use prior, during, or at time of discharge; and occurrence of MACE were recorded from electronic health records. Result: A total of 321 patients were screened and 265 were found to have data available on statin use. The mean age of the patients was 59 ± 15 years and 47% were female. Overall, 9% were observed to have a MACE at 1 year, with significantly higher rates in those in a statin indicated group (12.2%). On admission, 174 patients were not taking a statin out of whom 52% were in a statin indicated group. Among those in a statin indicated group who survived to hospital discharge, only 10% not on a statin on admission received a statin on discharge, whereas 89% on a statin on admission received a statin on discharge. Conclusion: There is a high risk of MACE after sepsis especially among those in statin indicated groups with significant clinical inertia in prescribing practices.

Association of Carnitine Deficiency in Indian Continuous Ambulatory Peritoneal Dialysis Patients with Anemia, Erythropoietin Use, Residual Renal Function, and Diabetes Mellitus

2007 ◽  
Vol 27 (2_suppl) ◽  
pp. 235-238
Author(s):  
S. Ramalakshmi ◽  
Bjoe Baben ◽  
Ben S. Ashok ◽  
V. Jayanthi ◽  
Nancy Leslie ◽  
...  
Keyword(s):  
Renal Function ◽  
Peritoneal Dialysis ◽  
Residual Renal Function ◽  
Carnitine Deficiency ◽  
Free Carnitine ◽  
Dialysis Patients ◽  
Carnitine Level ◽  
Daily Urine ◽  
The Mean ◽  
Daily Urine Output

♦ In the present study, we aimed to determine levels of free carnitine in hemodialysis (HD) and peritoneal dialysis (PD) patients in India and to correlate carnitine deficiency with various clinical parameters. ♦ Patients on HD and PD at two tertiary care centers were selected for the study. Baseline data were obtained, and a free carnitine analysis was performed. Carnitine deficiency was defined as a free carnitine level of less than 40 μmol/L. ♦ The total number of study patients was 96 (77 on HD, 19 on PD). In the PD group, the mean age was 56 years, with 26.3% of the patients being vegan, 47.4% having diabetes, and 57.9% having a daily urine output of <500 mL. The mean carnitine level in that group was 38.9 μmol/L, and 68.4% of the patients had a carnitine deficiency. A Pearson correlation test failed to show any association of carnitine level with parameters such as anemia, use of erythropoietin, non-vegetarian diet, diabetes, and hypertension. In the HD group, the mean age was 45 years, with 22% of the patients being vegan, 23% having diabetes, and 45.5% having a daily urine output of <500 mL. The mean carnitine level in the group was 38.2 μmol/L, and 64.3% of the patients had a carnitine deficiency. Residual renal function and duration of dialysis were different in HD patients with and without carnitine deficiency. Carnitine levels in the HD group correlated positively and statistically significantly with the presence of diabetes and hypertension. ♦ Conclusion This study is the first demonstration that Indian dialysis patients have carnitine deficiency.

Risk Factors for Early Mortality in U.S. Peritoneal Dialysis Patients: Impact of Residual Renal Function

2002 ◽  
Vol 22 (3) ◽  
pp. 371-379 ◽  
Author(s):  
◽  
Michael V. Rocco ◽  
Diane L. Frankenfield ◽  
Barbara Prowant ◽  
Pamela Frederick ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Renal Function ◽  
Peritoneal Dialysis ◽  
Serum Albumin ◽  
Creatinine Clearance ◽  
Residual Renal Function ◽  
Chronic Peritoneal Dialysis ◽  
Dialysis Patients ◽  
The Mean

Background Potential risk factors for 1-year mortality, including the peritoneal component of dialysis dose, residual renal function, demographic data, hematocrit, serum albumin, dialysate-to-plasma creatinine ratio, and blood pressure, were examined in a national cohort of peritoneal dialysis patients randomly selected for the Centers for Medicare and Medicaid Services End-Stage Renal Disease (ESRD) Core Indicators Project. Methods The study involved retrospective analysis of a cohort of 1219 patients receiving chronic peritoneal dialysis who were alive on December 31, 1996. Results During the 1-year follow-up period, 275 patients were censored and 200 non censored patients died. Among the 763 patients who had at least one calculable adequacy measure, the mean [± standard deviation (SD)] weekly Kt/V urea was 2.16 ± 0.61 and the mean weekly creatinine clearance was 66.1 ± 24.4 L/1.73 m2. Excluding the 365 patients who were anuric, the mean (±SD) urinary weekly Kt/V urea was 0.64 ± 0.52 (median: 0.51) and the mean (±SD) urinary weekly creatinine clearance was 31.0 ± 23.3 L/1.73 m2 (median: 26.3 L/1.73 m2). By Cox proportional hazard modeling, lower quartiles of renal Kt/V urea were predictive of 1-year mortality; lower quartiles of renal creatinine clearance were of borderline significance for predicting 1-year mortality. The dialysate component of neither the weekly creatinine clearance nor the weekly Kt/V urea were predictive of 1-year mortality. Other predictors of 1-year mortality ( p < 0.01) included lower serum albumin level, older age, and the presence of diabetes mellitus as the cause of ESRD, and, for the creatinine clearance model only, lower diastolic blood pressure. Conclusion Residual renal function is an important predictor of 1-year mortality in chronic peritoneal dialysis patients.

scholarly journals Long QT, alteration of calcium-phosphate product, prevalence of ventricular arrhythmias and sudden death in peritoneal dialysis patients: a Holter study

2013 ◽  
pp. 99-104
Author(s):  
Pierluigi Di Loreto ◽  
Claudio Ronco ◽  
Giorgio Vescovo
Keyword(s):  
Peritoneal Dialysis ◽  
Plasma Levels ◽  
Cardiac Death ◽  
Ventricular Arrhythmias ◽  
Holter Monitoring ◽  
Dialysis Patients ◽  
Premature Ventricular Contractions ◽  
Phosphate Product ◽  
The Mean ◽  
Monitoring And Measurement

Materials and methods We studied 79 patients on peritoneal dialysis. Each underwent 24-h electrocardiography (Holter monitoring) and measurement of the rate-corrected QT interval (QTc). We analyzed the correlation between QTc and plasma levels of Ca++, PO4−, K+, Na+, Mg++, and parathyroid hormone (PTH). Results The mean QTc was 0.445 ± 0.04 s. In 55 patients, the QTc was prolonged (> 0.45 s). Mean laboratory values for the group were: PTH 344 ± 25 pg/mL, Ca++ 9.27 ± 0.11 mg/dL, PO4− 5.5 ± 1.5 mg/dL, Na+ 139.6 ± 3.4 mmol/L, K+ 4.04 ± 0.64 mmol/L, and Mg++ 2.52 ± 0.43 mg/dL. Holter monitoring revealed complex premature ventricular contractions in 44 patients, monomorphic premature ventricular contractions in 16, and nonsustained ventricular tachycardia (NSVT) in 10. The QTc was significantly correlated with plasma levels of PO4− (r = 0.045, p < 0.05), PTH (r = 0.077, p < 0.02), and Ca++ (r = 0.076, p < 0.02). Eleven patients had Lown class 4a or 4b ventricular arrhythmias, and their mean QTc was 465 ± 0.02 ms. Ten had NSVT and their QTc was 464 ± 0.03 ms. Eleven patients died suddenly (mean QTc 465 ± 0.03 ms); all 11 had either NSTV or Lown class 4 ventricular arrhythmias. Conclusions Long QTc seems to be associated with an increased prevalence of ventricular arrhythmias that may be the cause of sudden cardiac death.

Hematocrit Values in the CAPD/CCPO Population: A Report of the National CAPO Registry

1990 ◽  
Vol 10 (4) ◽  
pp. 275-278 ◽  
Author(s):  
Anne s. Lindblad ◽  
Karl D. Nolph
Keyword(s):  
Peritoneal Dialysis ◽  
Kidney Disease ◽  
Random Sample ◽  
Recombinant Erythropoietin ◽  
Hematocrit Level ◽  
Polycystic Kidney ◽  
Dialysis Patients ◽  
Population Information ◽  
The Mean ◽  
Anephric Patients

A survey of the National CAPD Registry population was conducted to assess the distribution of hematocrit levels in a large group of peritoneal dialysis patients, to characterize the anemia of the population, and identify factors which relate to variation in hematocrit levels. A random sample of 812 patients was selected from the Registry population. Information was provided on 608 patients. Characteristics of sampled patients were similar to the Registry population as a whole. The mean hematocrit level in this cohort was 29.4% and the median was 29%. Recent peritonitis, time on CAPD, folate therapy, androgen therapy, and iron therapy had no obvious influence on hematocrit distributions. Significantly higher hematocrits were seen in males, whites, and patients with polycystic kidney disease. Significantly lower hematocrits were seen in surgically anephric patients and in patients who had received transfusions 60 days before the survey. Eighty-nine percent of patients had not received a transfusion 60 days prior to the survey. Some patients, especially those with hematocrits below the median, might benefit from recombinant erythropoietin therapy.

scholarly journals A single weekly Kt/Vurea target for peritoneal dialysis patients does not provide an equal dialysis dose for all

2016 ◽  
Vol 90 (6) ◽  
pp. 1342-1347 ◽  
Author(s):  
Sally El-Kateb ◽  
Sivakumar Sridharan ◽  
Ken Farrington ◽  
Stanley Fan ◽  
Andrew Davenport
Keyword(s):  
Peritoneal Dialysis ◽  
Dialysis Patients ◽  
Dialysis Dose

scholarly journals TP7.2.3 The effect of immediate versus early instillation of mitomycin C after transurethral resection of bladder cancer: Is timing everything?

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Ricardo Fernandes ◽  
Ankur Mukherjee ◽  
Ameet Patel
Keyword(s):  
Bladder Cancer ◽  
Mitomycin C ◽  
Cohort Analysis ◽  
Invasive Disease ◽  
Intravesical Instillation ◽  
First Year ◽  
Retrospective Cohort Analysis ◽  
The Mean ◽  
Muscle Invasive

Abstract Introduction and Aims Almost three quarters of patients diagnosed with bladder cancer have non-muscle invasive disease. The European Association of Urology (EAU) guidelines recommend the use of intravesical instillation of Mitomycin C (MMC) to reduce the rate of recurrence. Methods A retrospective cohort analysis was carried out of all patients who underwent a TURBT between January 2016 and January 2019 in our Trust. A comparison of recurrence outcomes was investigated between patients who had immediate instillation of MMC (within 1 hours post-TURBT) versus early instillation (within 24 hours post-TURBT). Recurrence was assessed at 3 months cystoscopy and at 1 year follow-up. Results 201 patients were included. 100 underwent immediate MMC instillation (75% male, 25% female); 101 early instillation (72% male, 28% female). There was 11% recurrence (immediate) versus 13% (early) in instillation groups at 3 months. At first year, recurrence was seen in 12% (immediate) versus 14% (early) groups. Of these recurrences, there was an upstaging of tumour in 27% (immediate) versus 31% (early) at the 3 monthly follow-up and 25% (immediate) versus 28% (early) at the 1st year. The mean period of post-operative stay following initial TURBT was 0.8 days in the immediate versus 1.1 days in the early instillation groups. Conclusion Although no statistical differences were seen in this study, the results appear to favour immediate instillation of MMC after TURBT with respect to reduction in recurrence and upstaging rates. Post-operative length of stay in hospital was also shorter in patients who had an immediate MMC instillation.

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