Description and Clinical Outcomes of Peritoneal Dialysis: Analyses from the United States Renal Data System

2000 ◽  
Vol 20 (2_suppl) ◽  
pp. 114-117 ◽  
Author(s):  
Friedrich K. Port
Keyword(s):  
United States ◽  
Peritoneal Dialysis ◽  
Clinical Outcomes ◽  
The United States ◽  
Data System

scholarly journals Association of Alternative Approaches to Normalizing Peritoneal Dialysis Clearance with Mortality and Technique Failure: A Retrospective Analysis Using the United States Renal Data System-Dialysis Morbidity and Mortality Study, Wave 2

2017 ◽  
Vol 37 (1) ◽  
pp. 85-93 ◽  
Author(s):  
Suzanne M. Boyle ◽  
Yimei Li ◽  
F. Perry Wilson ◽  
Joel D. Glickman ◽  
Harold I. Feldman
Keyword(s):  
United States ◽  
Peritoneal Dialysis ◽  
Urine Volume ◽  
The United States ◽  
Data System ◽  
Morbidity And Mortality ◽  
Urea Clearance ◽  
Mortality Study ◽  
Actual Weight ◽  
Technique Failure

BackgroundTotal body water (V) is an imprecise metric for normalization of dialytic urea clearance (Kt). This poses a risk of early mortality/technique failure (TF). We examined differences in the distribution of peritoneal Kt/V when V was calculated with actual weight (AW), ideal weight (IW), and adjusted weight (ADW). We also examined the associations of these Kt/V measurements, Kt/body surface area (BSA), and non-normalized Kt with mortality and TF.MethodsThis is a retrospective cohort study of 534 incident peritoneal dialysis (PD) patients from the Dialysis Morbidity and Mortality Study Wave 2 linked with United States Renal Data System through 2010. Using Cox-proportional hazard models, we examined the relationship of several normalization strategies for peritoneal urea clearance, including Kt/VAW, Kt/VIW, Kt/VADW, Kt/BSA, and non-normalized Kt, with the outcomes of mortality and TF. Harrell's c-statistics were used to assess the relative predictive ability of clearance metrics for mortality and TF. The distributions of Kt/VAW, KT/VIW, and KT/VADWwere compared within and between body mass index (BMI) strata.ResultsMedian patient age: 59 (54% male; 72% white; 91% continuous ambulatory PD [CAPD]). Median 24-hour urine volume: 700 mL; median estimated glomerular filtration rate (eGFR) at initiation: 7.15 mL/min/1.73 m2. Technique failure and transplant-censored mortality at 5 years: 37%. Death and transplant-censored TF at 5 years: 60%. There were no significant differences in initial eGFR and 24-hour urine volume across BMI strata. There were statistically significant differences in each Kt/V calculation within the underweight, overweight, and obese strata. After adjustment, there were no significant differences in the hazard ratios (HRs) for TF/mortality for each clearance calculation. Harrell's c-statistics for mortality for each clearance calculation were 0.78, and for TF, 0.60 – 0.61.ConclusionsPeritoneal urea clearances are sensitive to subtle changes in the estimation of V. However, there were no detectable significant associations of Kt/VAW, Kt/VIW, Kt/VADW, Kt/BSA, or Kt with TF or mortality.

scholarly journals 1378. Impact of Cytomegalovirus Prophylaxis on Clinical Outcomes in Kidney Transplantation: A United States Renal Data System-Medicare Linked Database Study

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S775-S775
Author(s):  
Amit D Raval ◽  
Michael Ganz ◽  
Priya Saravanan ◽  
Yuexin Tang ◽  
Carlos Santos
Keyword(s):  
United States ◽  
High Risk ◽  
Clinical Outcomes ◽  
Graft Failure ◽  
Fungal Infections ◽  
The United States ◽  
Data System ◽  
Cmv Infection ◽  
Prophylaxis Group ◽  
Cmv Prophylaxis

Abstract Background Guidelines recommends cytomegalovirus (CMV) prophylaxis by CMV serostatus/risk status, as the currently available antiviral agents may lead to myelosuppressive events in kidney transplant recipients (KTRs). Limited data exist for the United States (US) on the such clinical outcomes with CMV prophylaxis KTRs especially stratified by CMV risk strata. We examined the associations between clinical outcomes and CMV prophylaxis among adult KTRs stratified by CMV risk strata. Methods We employed a retrospective cohort design using the US Renal Data System registry-linked Medicare data (2011-2017). The cohort included 22,918 adult KTRs with continuous Medicare Part A & B coverage for ≥ 6-month pre and ≥ 12-month post KT and Part D coverage for ≥ 12-month post- KT. CMV prophylaxis was defined as ≥ 1 prescription fill or medical claim for valacyclovir or valganciclovir at prophylaxis doses within 28 days post-KT. Results CMV prophylaxis was utilized by 75% of the cohort. In no CMV prophylaxis group, 52.2% and 34.2% of high and intermediate risk KTRs received valganciclovir (as either pre-emptive or deferred therapy), respectively. Among high risk KTRs, CMV prophylaxis group had significantly lower proportions of KTRs with CMV infection, opportunistic infections (OIs) including bacterial, and fungal infections, and new onset of diabetes mellitus (NODAT) compared to no prophylaxis group. There were no differences in the rates of acute rejection or death; however, a trend towards lower rate of graft-failure at 12-month post-KT. Nearly 40% of high-risk KTRs had myelosuppressive events (leukopenia: 18%; neutropenia:15% thrombocytopenia :19%); however, their differences were non-significant except for thrombocytopenia by CMV prophylaxis status (Table 1). CMV infection and myelosuppressive event rates were higher in high-risk than intermediate/low risk KTRs irrespective of CMV prophylaxis status. Conclusion CMV prophylaxis was associated with lower rates of CMV infection, OIs, NODAT and graft failure compared to no prophylaxis, however, the burden of CMV infection, OIs and myelosuppression was greater in high-risk KTRs indicating further research is needed on factors associated with greater disease burden in high-risk KTRs. Table 1 Disclosures Amit D. Raval, PhD, Merck and Co., Inc. (Employee) Yuexin Tang, PhD, JnJ (Other Financial or Material Support, Spouse’s employment)Merck & Co., Inc. (Employee, Shareholder)

scholarly journals Underutilization of Home Dialysis in the United States: missed opportunities for quality improvement.

2018 ◽  
Vol 1 (2) ◽  
pp. 59-64
Author(s):  
Vo D Nguyen
Keyword(s):  
United States ◽  
Peritoneal Dialysis ◽  
National Policy ◽  
The United States ◽  
Data System ◽  
Missed Opportunities ◽  
Home Dialysis ◽  
The Us ◽  
Stage Renal Disease ◽  
End Stage

Peritoneal dialysis may offer many potential advantages over in-center hemodialysis: lower cost, better quality of care and lower mortality. However, the United States Renal Data System (USRDS) which is a national data system that collects, analyzes, and distributes information about chronic kidney disease (CKD) and end-stage renal disease (ESRD) in the United States, indicates that the incidence and prevalence of home dialysis remains under-utilized compared with in-center hemodialysis. Future changes in national policy on dialysis may bring about an increase in home dialysis and potentially improve the care and cost in dialysis. This paper is mostly based on the 2017 USRDS Annual Report and centered on the potential missed opportunity caused by the underuse of peritoneal dialysis in the US.

scholarly journals A scoping review of female drowning: an underexplored issue in five high-income countries

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Kym Roberts ◽  
Ogilvie Thom ◽  
Susan Devine ◽  
Peter A. Leggat ◽  
Amy E. Peden ◽  
...  
Keyword(s):  
United States ◽  
Risk Factors ◽  
United Kingdom ◽  
New Zealand ◽  
Clinical Outcomes ◽  
Scoping Review ◽  
The United States ◽  
Clinical Treatment ◽  
High Income ◽  
Public Health Issue

Abstract Background Drowning is a significant public health issue, with females accounting for one third of global drowning deaths. The rate of female drowning has not decreased within high-income countries and presentations to hospital have increased. This scoping review aimed to explore adult female unintentional drowning, including risk factors, clinical treatment and outcomes of females hospitalised for drowning. Methods A systematic search of the literature following the PRISMA-ScR framework was undertaken. The databases OVID MEDLINE, Embase, CINAHL, OVID Emcare, Web of Science, Informit and Scopus were accessed. Study locations of focus were Australia, Canada, New Zealand, the United Kingdom, and the United States. Studies from January 2003 to April 2019 were included. The quality of evidence of included studies was assessed using GRADE guidelines. Results The final search results included 14 studies from Australia (n = 4), Canada (n = 1), New Zealand (n = 1), United States (n = 6), United Kingdom (n = 1), and one study reporting data from both Australia and United States. Nine studies reported risk factors for female drowning including age, with the proportion of female drowning incidence increasing with age. Although females are now engaging in risk-taking behaviours associated with drowning that are similar to males, such as consuming alcohol and swimming in unsafe locations, their exposure to risky situations and ways they assess risk, differ. Females are more likely to drown from accidental entry into water, such as in a vehicle during a flood or fall into water. This review found no evidence on the clinical treatment provided to females in hospital after a drowning incident, and only a small number of studies reported the clinical outcomes of females, with inconsistent results (some studies reported better and some no difference in clinical outcomes among females). Conclusion Adult females are a group vulnerable to drowning, that have lacked attention. There was no single study found which focused solely on female drowning. There is a need for further research to explore female risk factors, the clinical treatment and outcomes of females hospitalised for drowning. This will not only save the lives of females, but also contribute to an overall reduction in drowning.

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