Initiation of hemodialysis at one month following fistulogram in patients with advanced kidney disease

Vascular ◽  
2022 ◽  
pp. 170853812110682
Author(s):  
Eelin Wilson ◽  
Yoni Sacknovitz ◽  
Varun Dalmia ◽  
Omar Sanon ◽  
Ayesha Hatch ◽  
...  
Keyword(s):  
Kidney Disease ◽  
Primary Outcome ◽  
Cohort Analysis ◽  
Stage Iv ◽  
Low Contrast ◽  
Factors Associated ◽  
Iodinated Contrast ◽  
Retrospective Cohort Analysis ◽  
Contrast Volume ◽  
Ckd Stage

Objective Previous studies have demonstrated that low contrast volume used in access-related interventions had limited effects on the progression of chronic kidney disease (CKD) after fistulography, but studies are limited and heterogeneous. We sought to evaluate the rate of and factors associated with progression to dialysis (HD) within 1 month after fistulography for patients with advanced CKD. Methods A single-institution retrospective cohort analysis of patients with CKD stage IV and V, not yet on HD, undergoing fistulography from 1 January 2014 to 31 December 2018 was performed. The primary outcome was progression to HD within 1 month. Additional variables and the association with the primary outcome such as medical comorbidities, contrast type or volume were assessed. Results A total of 34 patients underwent 41 fistulograms prior to HD initiation. Progression to HD within 1 month of fistulogram occurred in seven patients (all CKD V). The mean time between fistulogram and HD was 271 days for 31 of 34 patients who ultimately progressed to HD. Those with CKD IV began HD in 549 days on average, while those with CKD V began HD in 190 days on average. Three patients had not initiated HD at a mean of 539 days of follow-up. The only factors associated with progression to HD within 1 month included use of isovue ( p = .005) and elevated contrast volume, with a mean of 40 mL ( p = .027). Conclusion Although none of the patients with CKD IV required HD within 1 month after fistulogram, the use of larger iodinated contrast volume was associated with progression to HD within 1 month of fistulography for patients with CKD V. Further studies should investigate the safety of iodinated and alternative (e.g., carbon dioxide) contrast media in fistulography or duplex-based HD access procedures for CKD patients, especially CKD V, not yet on HD.

scholarly journals Risk Factors for Progression of Chronic Kidney Disease With Glomerular Etiology in Hospitalized Children

2021 ◽  
Vol 9 ◽  
Author(s):  
Guohua He ◽  
Chenglong Li ◽  
Xuhui Zhong ◽  
Fang Wang ◽  
Haibo Wang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Migration Rate ◽  
Primary Outcome ◽  
Study Cohort ◽  
Glomerular Diseases ◽  
Medical Migration ◽  
Factors Associated ◽  
Ckd Stage

Aim: To Identify association between risk factors to Chronic kidney disease (CKD) stage 5 in children with glomerular diseases in children in China.Methods: The Hospital Quality Monitoring System database was used to extract data for the study cohort. The primary outcome included progression to CKD stage 5 or dialysis. Cox regression was used to assess potential risk factors. Patients with lower stages (CKD stage 1 and 2) and higher stages (CKD stage 3 and 4) at baseline were analyzed separately.Results: Of 819 patients (4,089 hospitalization records), 172 (21.0%) patients reached the primary outcome during a median followed-up of 11.4 months. In the lower stages group, factors associated with the primary outcome included older age [Hazard Ratio (HR), 1.21; 95% confidence interval (CI), 1.10–1.34] and out-of-pocket payment (HR, 4.14; 95% CI, 1.57–10.95). In the higher stages group, factors associated with the primary outcome included CKD stage 4 (HR, 2.31; 95% CI, 1.48–3.62) and hypertension (HR, 1.99; 95% CI, 1.29–3.07). The medical migration rate was 38.2% in this study population.Conclusion: There are different risk factors for progression to the primary outcome in different stages in CKD with glomerular etiology. Further prospective studies are needed to assess these risk factors. The high medical migration rate reflected the regional disparities in the accessibility of pediatric kidney care between regions.

scholarly journals Analysof Reticulocyte Hemoglobin Equivalent Levels in Patients with Chronic Kidney Disease Stage IV and V

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Agri Febria Sari ◽  
Rikarni Rikarni ◽  
Deswita Sari
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Iron Status ◽  
Chronic Kidney Disease Stage ◽  
Stage Iv ◽  
Disease Stage ◽  
Cross Sectional ◽  
Iron Storage ◽  
Laboratory Installation ◽  
Ckd Stage

Reticulocyte hemoglobin equivalent (RET-He) represents hemoglobin content in reticulocyte. Reticulocyte hemoglobin equivalent test can be used to asses iron status of chronic kidney disease (CKD). Iron deficiency happens in 40% CKD and could lead to anemia manifestation. Level of RET-He gives real-time assesment of iron availability for hemoglobin production and the level will getting lower when iron storage for erythropoiesis decreasing. Reticulocyte hemoglobin equivalent is more stabil than feritin and transferin saturation in assessing iron status. Aim of this study is to determine RET-He level in patients with CKD stage IV and V. This study is  a cross sectional descripstive study. Subjects were 96 CKD stage IV and V patients that met inclusion and exclusion criterias. Subjects conducted blood tests at Central Laboratory Installation Dr. M. Djamil Hospital Padang from July to September 2020. Examination of RET-He level was analyzed by Sysmex XN-1000 flowcytometry fluorescense method. Data was presented in frequency distribution table. The RET-He level below cutoff (<29,2 pg) indicates the need for iron suplementation therapy for CKD stage IV and V patients. Samples with RET-He level below cutoff were 48 (50%) and 48 (50%) were above cutoff.

scholarly journals Clinical Outcomes of Antipseudomonal vs. Non-Antipseudomonal Therapy in Patients with Osteomyelitis

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S97-S97
Author(s):  
Jeffrey W Jansen ◽  
Ryan P Moenster
Keyword(s):  
Clinical Outcomes ◽  
Primary Outcome ◽  
Cohort Analysis ◽  
Anatomical Site ◽  
Clinical Failure ◽  
Primary Analysis ◽  
Exclusion Criteria ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Retrospective Cohort Analysis ◽  
Culture Negative

Abstract Background Osteomyelitis (OM) in diabetics is frequently a polymicrobial infection that rarely involves Pseudomonas (4–5% of cases). Bone cultures have a low-positive yield of 34–50% and, as a result, many patients receive antimicrobial regimens which include antipseudomonal (AP) therapy. Methods A retrospective cohort analysis of adult Veterans with OM treated with AP compared with non-antipseudomonal (NAP) therapy was conducted. Patients managed by the VA St. Louis outpatient parenteral antimicrobial therapy (OPAT) service from 1/1/2009 to 7/31/2015 were identified and screened for inclusion. Patients with culture negative (CN) or non-pseudomonal superficial swab cultures (SCx) were included. Figure 1 presents the study profile and exclusion criteria. The primary outcome was clinical failure, defined as a composite of: (1) extension of antibiotics beyond 1 week of the planned duration, (2) recurrence of OM at the same anatomical site within 12 months, or (3) any unplanned surgery or amputation at the anatomical site within 12 months of ABx completion. Results Overall, 104 patients with 109 OM encounters were included; there were 29 CN encounters and 80 SCx encounters. Table 1 presents baseline demographics. The overall failure rate was 55/109 (50.5%). The results of the analysis are shown in Table 2. While not included in the primary analysis, Pseudomonas was isolated from 8/88 (9.1%) swab cultures and 5/33 (15%) deep cultures. Conclusion Empiric AP therapy did not improve clinical outcomes in patients with either CN or SCx OM. Disclosures All authors: No reported disclosures.

Factors Associated with Functional Capacity in CKD Patients

2020 ◽  
pp. 105477382095854
Author(s):  
Emanuele Poliana Lawall Gravina ◽  
Bruno Valle Pinheiro ◽  
Luciana Angélica da Silva Jesus ◽  
Fabrício Sciammarella Barros ◽  
Leda Marília Fonseca Lucinda ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Functional Capacity ◽  
Family Income ◽  
Chronic Kidney Disease Stage ◽  
Disease Stage ◽  
Life Questionnaire ◽  
Factors Associated ◽  
Ckd Stage ◽  
Related Quality

To evaluate the factors associated with functional capacity in patients with chronic kidney disease (CKD). All patients were submitted to six-minute walk test (6MWT), 10-repetition sit-to-stand test (STS-10) and SF-36 health-related quality of life questionnaire (HRQoL). Patients with functional capacity ≥80% exhibited higher education level, family income, body mass index, estimated glomerular filtration rate, and lower age and STS-10 time. Multiple linear regression showed that gender, age, family income, chronic kidney disease stage, STS-10 time, and physical component summary of HRQoL were significantly associated with the 6MWT distance. Functional capacity was significantly associated with gender, age, family income, CKD stage, STS-10 time, and physical component of HRQoL. The progression of CKD has an impact on the decrease in functional capacity in these patients.

scholarly journals Prediction of non-responsiveness to pre-dialysis care program in patients with chronic kidney disease: a retrospective cohort analysis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Emily K. King ◽  
Ming-Han Hsieh ◽  
David R. Chang ◽  
Cheng-Ting Lu ◽  
I-Wen Ting ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Cohort Analysis ◽  
Care Program ◽  
Rapid Progression ◽  
Net Benefit ◽  
Risk Equation ◽  
Ckd Stage ◽  
All Cause Mortality ◽  
Stage Renal Disease

AbstractThe responsiveness of patients with chronic kidney disease (CKD) to nephrologists’ care is unpredictable. We defined the longitudinal stages (LSs) 1–5 of estimated glomerular filtration rate (eGFR) by group-based trajectory modeling for repeated eGFR measurements of 7135 patients with CKD aged 20–90 years from a 13-year pre-end-stage renal disease (ESRD) care registry. Patients were considered nonresponsive to the pre-dialysis care if they had a more advanced eGFR LS compared with the baseline. Conversely, those with improved or stable eGFR LS were considered responsive. The proportion of patients with CKD stage progression increased with the increase in the baseline CKD stage (stages 1–2: 29.2%; stage 4: 45.8%). The adjusted times to ESRD and all-cause mortality in patients with eGFR LS-5 were 92% (95% confidence interval [CI] 86–96%) and 57% (95% CI 48–65%) shorter, respectively, than in patients with eGFR LS-3A. Among patients with baseline CKD stages 3 and 4, the adjusted times to ESRD and all-cause death in the nonresponsive patients were 39% (95% CI 33–44%) and 20% (95% CI 14–26%) shorter, respectively, than in the responsive patients. Our proposed Renal Care Responsiveness Prediction (RCRP) model performed significantly better than the conventional Kidney Failure Risk Equation in discrimination, calibration, and net benefit according to decision curve analysis. Non-responsiveness to nephrologists’ care is associated with rapid progression to ESRD and all-cause mortality. The RCRP model improves early identification of responsiveness based on variables collected during enrollment in a pre-ESRD program. Urgent attention should be given to characterize the underlying heterogeneous responsiveness to pre-dialysis care.

scholarly journals Ultra-Low Contrast Volume for Patients with Advanced Chronic Kidney Disease Undergoing Coronary Procedures

Nephron ◽  
2018 ◽  
Vol 138 (4) ◽  
pp. 296-302 ◽  
Author(s):  
Zach Rozenbaum ◽  
Sydney Benchetrit ◽  
Eliezer Rozenbaum ◽  
Eran Neumark ◽  
Morris Mosseri ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Advanced Chronic Kidney Disease ◽  
Low Contrast ◽  
Contrast Volume ◽  
Coronary Procedures
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