scholarly journals Incidence, Risk Factors, and Treatment of Achilles Tendon Rupture in Patients With End-Stage Renal Disease

2018 ◽  
Vol 39 (7) ◽  
pp. 821-828 ◽  
Author(s):  
Casey Jo Humbyrd ◽  
Sunjae Bae ◽  
Lauren M. Kucirka ◽  
Dorry L. Segev
Keyword(s):  
Risk Factors ◽  
Body Mass Index ◽  
Renal Disease ◽  
Operative Treatment ◽  
End Stage Renal Disease ◽  
Tendon Rupture ◽  
Achilles Tendon Rupture ◽  
Transplant Recipients ◽  
Stage Renal Disease ◽  
End Stage

Background: Dialysis-dependent patients and kidney transplant recipients may be at increased risk for Achilles tendon rupture (ATR). Methods: We studied Medicare patients with end-stage renal disease (ESRD) from 1999 through 2013. Patients were categorized as waitlisted for a transplant, not waitlisted, or received a transplant. We performed multivariate negative binomial regression using demographic characteristics, comorbidities, and year of study entry to estimate adjusted incidence rate ratios (aIRRs), identify ATR risk factors, and determine treatment patterns and outcomes. Results: We identified 1091 ATRs (incidence, 3.80/10 000 person-years; 95% confidence interval [CI], 3.58-4.03). Compared with transplant recipients, nonwaitlisted patients had a lower incidence (aIRR, 0.44; 95% CI, 0.37-0.53), and waitlisted patients had a similar incidence (aIRR, 0.94; 95% CI, 0.78-1.12) of ATR. ATR incidence was higher among patients taking fluoroquinolones (aIRR, 1.65; 95% CI, 1.32-1.84) and corticosteroids (aIRR, 1.72; 95% CI, 1.44-2.05) compared with those who did not. Patients with ATR were younger, had higher mean body mass index, and had fewer comorbidities than patients without ATR. Seventeen percent of patients received operative treatment within 14 days of ATR diagnosis. The 30-day cumulative incidence of operative site infections was 6.5%. Conclusion: The incidence of ATR was higher among transplant recipients and waitlisted patients compared with nonwaitlisted patients. Younger age, higher body mass index, fewer comorbidities, fluoroquinolone use, and corticosteroid use were risk factors for ATR. Patients were more likely to receive nonoperative than operative treatment for ATR. Those who underwent operative treatment had a low incidence of operative site infection. Level of Evidence: Prognostic level III, comparative study.

scholarly journals Incidence, Risk Factors, and Treatment of Achilles Tendon Rupture in Patients with End-Stage Renal Disease

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0025
Author(s):  
Casey Humbyrd ◽  
Sunjae Bae ◽  
Dorry Segev
Keyword(s):  
Risk Factors ◽  
Body Mass Index ◽  
Surgical Treatment ◽  
Body Mass ◽  
End Stage Renal Disease ◽  
Tendon Rupture ◽  
Achilles Tendon Rupture ◽  
Incidence Risk ◽  
Stage Renal Disease ◽  
End Stage

Category: Trauma Introduction/Purpose: Patients who are dialysis-dependent and those who have received kidney transplants may be at increased risk for Achilles tendon rupture (ATR) as a result of compromised kidney function. Our goal was to examine the incidence, risk factors, and type of ATR treatment in patients with end-stage renal disease (ESRD). Methods: We studied all Medicare patients with ESRD from 1999 through 2013, as captured by the Centers for Medicare & Medicaid Services and the United States Renal Data System. Patients were categorized as not waitlisted for a transplant, waitlisted but not yet transplanted, or received a transplant. Patients were migrated to the corresponding groups at the time when they were waitlisted or received a transplant. We performed multivariate negative binomial regression using age, race, sex, body mass index, cause of ESRD, comorbidities, and year of study entry as covariables to estimate the adjusted incidence rate ratios (aIRR) for all groups and to identify risk factors for ATR. We performed a subgroup analysis using the above methods for participants with Medicare Part D to characterize the association of fluoroquinolones and steroids with ATR. Results: We identified 1091 ATRs (incidence, 3.80 per 10,000 person-years; 95% confidence interval [CI], 3.58–4.03). Patients who sustained an ATR were significantly younger, had higher mean body mass index, and had fewer comorbidities than patients without ATR. Compared with the incidence of ATR among transplant recipients, the incidence of ATR was lower in the non-waitlisted group (aIRR, 0.44; 95% CI, 0.37–0.53) and similar in the waitlisted group (aIRR, 0.94; 95% CI, 0.78–1.12). Patients who used fluoroquinolones and steroids had a higher incidence of ATR (aIRR 1.65; 95% CI, 1.32 -1.84 and aIRR 1.72, 95% CI, 1.44-2.05 respectively). A small proportion of patients (n = 184; 17%) received surgical treatment within 14 days of diagnosis of ATR, and the 30-day cumulative incidence of surgical site infections was 6.5%. Conclusion: The incidence of ATR was higher in the transplanted and waitlisted groups compared with the non-waitlisted group. Younger age, higher body mass index, better health, fluoroquinolone use and steroid use were significant risk factors for ATR. Patients were more likely to receive nonoperative than surgical treatment for ATR. Those who underwent surgical treatment for ATR had a low incidence of surgical site infection.

scholarly journals Effects of Variability in Blood Pressure, Glucose, and Cholesterol Concentrations, and Body Mass Index on End-Stage Renal Disease in the General Population of Korea

2019 ◽  
Vol 8 (5) ◽  
pp. 755 ◽  
Author(s):  
Mee Kyoung Kim ◽  
Kyungdo Han ◽  
Hun-Sung Kim ◽  
Yong-Moon Park ◽  
Hyuk-Sang Kwon ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Body Mass Index ◽  
General Population ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
High Variability ◽  
Metabolic Parameters ◽  
Metabolic Parameter ◽  
Stage Renal Disease ◽  
End Stage

Aim: Metabolic parameters, such as blood pressure, glucose, lipid levels, and body weight, can interact with each other, and this clustering of metabolic risk factors is related to the progression to end-stage renal disease (ESRD). The effect of variability in metabolic parameters on the risk of ESRD has not been studied previously. Methods: Using nationally representative data from the Korean National Health Insurance System, 8,199,135 participants who had undergone three or more health examinations between 2005 and 2012 were included in this analysis. Intraindividual variability in systolic blood pressure (SBP), fasting blood glucose (FBG), total cholesterol (TC), and body mass index (BMI) was assessed by examining the coefficient of variation, variability independent of the mean, and average real variability. High variability was defined as the highest quartile of variability and low variability was defined as the lower three quartiles of variability. Results: Over a median (5–95%) of 7.1 (6.5–7.5) years of follow-up after the variability assessment period, 13,600 (1.7/1000 person-years) participants developed ESRD. For each metabolic parameter, an incrementally higher risk of ESRD was observed for higher variability quartiles compared with the lowest quartile. The risk of ESRD was 46% higher in the highest quartile of SBP variability, 47% higher in the highest quartile of FBG variability, 56% higher in the highest quartile of BMI variability, and 108% higher in the highest quartile of TC variability. Compared with the group with low variability for all four parameters, the group with high variability for all four parameters had a significantly higher risk for incident ESRD (hazard ratio (HR) 4.12; 95% CI 3.72–4.57). Conclusions: Variability in each metabolic parameter was an independent predictor of the development of ESRD among the general population. There was a composite effect of the variability in additional metabolic parameters on the risk of ESRD.

Management of Chronic Kidney Disease and its Complications

2018 ◽  
Author(s):  
Joshua S. Hundert ◽  
Ajay K Singh
Keyword(s):  
Risk Factors ◽  
Chronic Kidney Disease ◽  
Renal Failure ◽  
Glomerular Filtration Rate ◽  
Kidney Disease ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Filtration Rate ◽  
Stage Renal Disease ◽  
End Stage

Management of early renal failure helps in the reduction or prevention of end-stage renal disease. The monitoring of renal function is discussed, and the chapter includes a table that shows commonly used methods for monitoring. Risk factors for chronic renal failure include stroke and cardiac disease. Risk factors for renal disease progression are diabetes mellitus, hypertension, proteinuria, smoking, protein intake, and hyperlipidemia. Complications of chronic renal failure that are addressed include sodium and water imbalance, potassium imbalance, acidosis, calcium and phosphorus imbalance, and anemia. There is also a section that discusses the case for early referral to a nephrologist. Tables present the equations used to estimate the glomerular filtration rate (GFR); stages of chronic kidney disease and the appropriate steps in their management; risk factors for chronic kidney disease in which the testing of proteinuria and estimation of GFR are indicated; appropriate diet for patients who have chronic kidney disease; and guidelines for diagnosing and treating anemia resulting from chronic kidney disease. An algorithm outlines the steps in management of calcium and phosphate in patients with kidney disease. This review contains 3 figures, 10 tables and 50 references Key Words End-stage renal disease, chronic kidney disease, glomerular filtration rate, Modification of Diet in Renal Disease, Proteinuric renal disease, Hyperuricemia

scholarly journals Incidence, risk factors and distribution of syphilis in the end-stage renal disease population in the USA

2019 ◽  
Vol 13 (4) ◽  
pp. 625-630
Author(s):  
Erena N Weathers ◽  
Jennifer L Waller ◽  
N Stanley Nahman ◽  
Rhonda E Colombo ◽  
Mufaddal F Kheda ◽  
...  
Keyword(s):  
Risk Factors ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
The United States ◽  
Transmitted Infection ◽  
Sexually Transmitted ◽  
The Usa ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Abstract Background Syphilis is a sexually transmitted infection with an incidence of 14.9 cases per 100 000 persons in the USA in 2011. Untreated syphilis may remain quiescent for years but can also result in clinical sequelae, including neurosyphilis. End-stage renal disease (ESRD) patients may be at risk for syphilis due to a higher incidence of risk factors for the disease, including human immunodeficiency virus (HIV). Despite the presence of these risk factors, the incidence of syphilis in the ESRD population has not been reported. To address this issue, we investigated the incidence and risk factors for syphilis in the ESRD population using the United States Renal Data System (USRDS). Methods This study analyzed incident ESRD patients from 2004 to 2010. Based on International Classification of Diseases, Ninth Revision codes for syphilis, we determined the incidence and risk factors for syphilis following an inpatient diagnosis. Generalized linear modeling was used to examine the relative risk (RR) for the disease when controlling for demographic and other clinical risk factors. Results A total of 383 diagnoses of syphilis were identified after screening 759 066 patients. The 8-year incidence of any type of syphilis was 50.45 cases per 100 000 person-years. Other unspecified syphilis (29.77 cases per 100 000 person-years) and neurosyphilis (10.93 cases per 100 000 person-years) were the most common diagnoses. The greatest incidence was found on the East and West Coasts. Patients with the disease were younger and more likely to be black and non-Hispanic. In the final model, the adjusted RR for syphilis was significantly increased with HIV (7.61), hepatitis C (3.57), herpes simplex (2.06) and hepatitis B (1.75). Conclusions The incidence of syphilis is >3-fold greater in ESRD patients when compared with the general population and is associated with sexually transmitted viral infections. Neurosyphilis is a common occurrence and is treatable, suggesting that all assessments of confusion in dialysis patients should include screening for the disease.

scholarly journals SP916HEIGHT-AGE-SEX SPECIFIC BODY MASS INDEX IN CHILDREN WITH END STAGE RENAL DISEASE - SINGLE CENTER EXPERIENCE

2015 ◽  
Vol 30 (suppl_3) ◽  
pp. iii678-iii679
Author(s):  
Adrian Catalin Lungu ◽  
Oana Piscoran ◽  
Ana-Maria Pop ◽  
Cristina Stoica
Keyword(s):  
Body Mass Index ◽  
Renal Disease ◽  
Body Mass ◽  
End Stage Renal Disease ◽  
Single Center ◽  
Single Center Experience ◽  
Stage Renal Disease ◽  
End Stage

The Success Story of Peritoneal Dialysis in Romania: Analysis of Differences in Mortality by Dialysis Modality and Influence of Risk Factors in a National Cohort

2006 ◽  
Vol 26 (2) ◽  
pp. 266-275 ◽  
Author(s):  
Gabriel Mircescu ◽  
Liliana Garneata ◽  
Laura Florea ◽  
Vasile Cepoi ◽  
Dimitrie Capsa ◽  
...  
Keyword(s):  
Risk Factors ◽  
Peritoneal Dialysis ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Comorbid Conditions ◽  
Cox Regression Analysis ◽  
Risk Of Death ◽  
Significant Difference ◽  
Stage Renal Disease ◽  
End Stage

Background This report describes the status of renal replacement therapy (RRT), particularly continuous ambulatory peritoneal dialysis (CAPD), in Romania (a country with previously limited facilities), outlines the fast development rate of CAPD, and presents national changes in a European context. Methods Trends in the development of RRT were analyzed in 2003 on a national basis using annual center questionnaires from 1995 to 2003. Survival data and prognostic risk factors were calculated retrospectively from a representative sample of 2284 patients starting RRT between 1 January 1995 and 31 December 2001 (44% of the total RRT population investigated). Results The annual rate of increase in the number of RRT patients (11%) was supported mainly by an exponential development of the CAPD population (+600%); the hemodialysis (HD) growth rate was stable (+33%) and renal transplantation had a marginal contribution. The characteristics of both HD and PD incident patients changed according to current European epidemiology (increasing age and prevalence of diabetes and nephroangiosclerosis). There were significant differences between PD and HD incident populations, PD patients being significantly older and having a higher prevalence of diabetic nephropathy and baseline comorbidities, probably reflecting different inclusion policies. The estimated overall survival of RRT patients in Romania was 90.6% at 1 year [confidence interval (CI) 89.4 – 91.8] and 62.2% at 5 years (CI 59.4 – 65.0). The initial treatment modality did not significantly influence patients’ survival. There was no difference in unadjusted technique survival during the first 2 years; afterwards, there was a clear advantage for HD, with more patients being transferred from PD to HD. Several factors seemed to significantly and negatively influence PD patients’ survival (Cox regression analysis): male gender, lack of predialysis erythropoietin treatment, and initial comorbidities. Stratified analysis to discover the influence of these factors on patients’ survival revealed that HD was associated with an increased risk of death in the younger nondiabetic end-stage renal disease population, regardless of other coexisting comorbid conditions. However, in older patients (>65 years) and in diabetics, regardless of the presence or absence of associated comorbid conditions, there was no significant difference in death rates between HD and PD patients. Conclusions We report an impressive quantitative and qualitative development of CAPD in one of the rapidly growing Central and Eastern Europe countries. CAPD should be the method of choice for young nondiabetic end-stage renal disease patients. Improvement in predialysis nephrologic care and in transplantation rates is required to further ensure the ultimate success of the Romanian PD program.

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