scholarly journals Morbidity and Mortality Associated with Hemodialysis Versus Peritoneal Dialysis in Patients with End Stage Renal Disease Caused By Sickle Cell Disease

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 488-488
Author(s):  
Miriam Kwarteng-Siaw ◽  
Mahyar Heydarpour ◽  
Olesya Baker ◽  
Kevin Tucker ◽  
Maureen Achebe
Keyword(s):  
Survival Rates ◽  
Dialysis Initiation ◽  
Advisory Committees ◽  
Patient Demographics ◽  
Kaplan Meier ◽  
Younger Age ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Abstract Background: End stage renal disease (ESRD) is a common complication of sickle cell disease (SCD), contributing to 14% mortality. Most patients with ESRD are managed with dialysis. The relative risk of mortality in hemodialysis (HD) versus peritoneal dialysis (PD) may be influenced by the primary cause of ESRD (Vonesh et al, 2004). The purpose of this study is to compare patients with ESRD primarily caused by SCD (SCD-ESRD) to non-SCD-ESRD controls and to evaluate the association of dialysis type with mortality and hospitalization in SCD-ESRD patients. Methods: This was a retrospective study of SCD-ESRD patients newly initiated on dialysis in the United States Renal Data System between January 1, 2006 and December 31, 2013. SCD-ESRD patients were identified by ICD-9 codes. A sample of 5% of African Americans with incident ESRD caused by conditions other than SCD (non-SCD-ESRD cohort) initiated within the same timeframe were randomly selected as controls. Patient demographics, comorbidities, and dialysis type were compared between SCD and controls. Patient demographics, clinical characteristics, and outcomes were compared between HD and PD patients in the SCD-ESRD cohort. Chi-square, t-test, and Wilcoxon rank sum tests were used for comparative analysis. Survival times were estimated by Kaplan Meier curve and compared using log rank test. Results: 768 SCD-ESRD and 12,402 non-SCD-ESRD patients were included in analysis. SCD-ESRD patients started dialysis at a younger age (44±12.9 vs 58.6±15.4 years; p<0.001), were more likely to be unemployed (44% vs 29.7%; p<0.001) and have Medicaid insurance (55% vs 33%; p<0.001). Most common comorbidities in SCD-ESRD patients were hypertension (71%) and congestive heart failure (26%) and in controls were hypertension (89.3%) and diabetes (61.3%). SCD-ESRD patients had twice the odds of being initiated on PD compared to controls (11.3% vs 5.7%, OR 2.11, p<0.001). Demographics, comorbidities, laboratory values, access to nephrology care prior to dialysis initiation, survival, hospitalization, and kidney transplantation of HD and PD patients in the SCD-ESRD cohort are shown in Table 1. Kaplan Meier survival plot is shown in Figure 1. PD patients were more likely to be female, have full time employment and employer insurance, be students, have lower glomerular filtration rate, and have congestive heart failure as a comorbidity. They were also 1.6 and 1.9 times more likely to have been seen by a nephrologist and received erythropoietin prior to dialysis initiation respectively (p<0.001). PD patients had significantly better survival rates at year 1 (88.5% vs 75.9%, p=0.01). Survival rates were still higher in PD patients at years 3 and 5 although not statistically significant. HD and PD patients were hospitalized equally within a year of dialysis initiation however, HD patients had more intensive care unit (ICU) stays (p=0.003) and ~1.5 times the number of hospitalizations per person. More PD patients had been informed about (90.8% vs 80.47%, p=0.019) and listed for (42.5% vs 19.1%, p<0.001) transplant although no patients in this study had undergone a kidney transplant within the 5 year follow up. Discussion: SCD-ESRD patients in this study were more likely to be started on PD compared to non-SCD-ESRD patients. This could be explained by the younger age of SCD-ESRD patients as younger individuals are more likely to be started on PD in the general ESRD literature. SCD-ESRD patients started on PD had better survival and hospitalization outcomes particularly within the first year of dialysis initiation when mortality and morbidity is known to be high in ESRD. These results suggest a survival benefit of PD over HD in SCD-ESRD patients. This could perhaps be explained by decreased likelihood of vaso-occlusive events due to less fluid shifts and thus hematocrit fluctuations in the PD group (Boyle et al, 2016). A limitation of our study is that we do not have data on the possibility of individuals switching dialysis modalities (crossovers) over the course of follow up that could bias survival rates in either direction. A next step would be to look at the same outcomes in individuals who switch. Moreover, a prospective observational study or randomized control trial could further evaluate differential survival rates in HD versus PD initiation in SCD and inform guidelines in SCD-ESRD care. Acknowledgement: Support was provided to MKS by the Minority Resident Hematology Award Program. Figure 1 Figure 1. Disclosures Achebe: Pharmacosmos: Membership on an entity's Board of Directors or advisory committees; Fulcrum Therapeutics: Consultancy; Global Blood Therapeutics: Membership on an entity's Board of Directors or advisory committees.

scholarly journals Distribution and association of cancer with mortality in end-stage renal disease patients receiving dialysis

2019 ◽  
Vol 32 (6) ◽  
pp. 1003-1009
Author(s):  
Rajkumar Chinnadurai ◽  
Emma Flanagan ◽  
Philip A. Kalra
Keyword(s):  
Cox Regression ◽  
Matched Sample ◽  
Cancer History ◽  
Cancer Group ◽  
All Cause Mortality ◽  
History Of ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Abstract Background and aims Cancer in end-stage renal disease (ESRD) patients is an important comorbidity to be taken into consideration while planning for renal replacement therapy (RRT) options due to its associated increased mortality. This study aims to investigate the natural history and association of cancer with all-cause mortality in an ESRD population receiving dialysis. Method The study was conducted on 1271 ESRD patients receiving dialysis between January 2012 and December 2017. A comparative analysis was carried out between 119 patients with and 1152 without cancer history at entry into this study (baseline). A 1:2 (119 cancer: 238 no cancer) propensity score matched sample of 357 patients was also used for analysis. Cox-regression analysis was used to study the strength of the association between cancer and all-cause mortality. Kaplan–Meier (KM) analysis was used to demonstrate the difference in cumulative survival between the groups. A competing risk analysis was also carried out to calculate the probability of competing events (death, transplant and incident cancer). Results At baseline, 10.1% of the cohort had a history of cancer (current and past) with the annual incident rate being 1.3%. Urological cancers were the leading site of cancer. The median age of our cohort was 63 years with a predominance of males (63%) and Caucasians (79%). The majority (69%) of the cohort were receiving haemodialysis. 47% had a history of diabetes with 88% being hypertensive. During a median follow-up of 28 months, the proportion of deaths observed was similar between the groups in the matched sample (cancer 49.6 versus no-cancer 52.1%, p value 0.77). In a univariable Cox-regression model, there was no significant association between cancer and all-cause mortality (HR 1.28; 95% CI 0.97–1.67; p = 0.07). The KM estimates showed similar observations in the cumulative survival between the groups (matched sample log-rank, p value 0.85). In competing risk analysis, the cumulative probability of death at 5 years was non-significantly higher in the cancer group (cancer group 64% vs no cancer group 51%, p value 0.16). Conclusions In our real-world multi-morbid dialysis cohort of 119 cancer patients, baseline cancer history did not prove to be an independent risk factor for all-cause mortality in the first 5 years of follow-up, suggesting the need for a case-by-case approach in provision of RRT options, including transplantation.

scholarly journals Clinical Outcomes After Coronary Artery Bypass Grafting in Patients with Dialysis-Dependent End-Stage Renal Disease and an Analysis of the Related Influencing Factors

2020 ◽  
Author(s):  
Xihui Li ◽  
Siyu Zhang ◽  
Feng Xiao
Keyword(s):  
End Stage Renal Disease ◽  
Artery Bypass ◽  
Survival Rates ◽  
Postoperative Survival ◽  
Perioperative Mortality ◽  
Term Survival ◽  
Factors Influencing ◽  
Stage Renal Disease ◽  
End Stage

Abstract Backgroud Perioperative and short/mid-term survival rates of dialysis-dependent patients with end-stage renal disease (ESRD), who undergo coronary artery bypass grafting (CABG), and the factors influencing mortality are not well evaluated In China. Method We retrospectively analyzed the perioperative and postoperative 1-, 3-, and 5-year survival rates of 53 dialysis-dependent ESRD patients who underwent CABG, and compared the factors related to perioperative mortality and all-cause mortality during the postoperative follow-up. Survival rates were expressed as Kaplan–Meier survival curves, and factors influencing the follow-up survival rates were analyzed using the log rank (Mantel–Cox) test. Result There were eight perioperative deaths, resulting in 15.1% mortality. Intraoperative intra-aortic balloon pump use (P=0.01), advanced age (P=0.0027), and high EuroSCORE II score (P=0.047) were associated with increased perioperative mortality. Forty-five discharged patients were followed from 2 months to 10 years (median, 4.2 years) postoperatively. There were 19 all-cause deaths, including 10 cardiac deaths (10/19, 52.6%). Comparisons between groups indicated that the presence of peripheral artery disease (PAD) increased mortality during follow-up (P=0.025); 1-, 3-, and 5-year survival rates were 93.3%, 79.5%, and 66.8%, respectively. The results of the long-rank analysis indicated that the presence of PAD was a risk factor for postoperative survival (log rank χ 2 =4.543; P=0.033). Conclusion Dialysis-dependent patients with ESRD had high perioperative mortality and unsatisfactory short- and medium-term survival after CABG. PAD was a risk factor affecting patients’ postoperative survival. Multidisciplinary teamwork is needed to enhance postoperative management and reduce complications, to improve postoperative survival in these patients.

MO641IMPACT OF MAGNESIUM AND L-CARNITINE ADMINISTRATION ON 3-YEAR SURVIVAL IN DIABETIC PATIENTS WITH END-STAGE RENAL DISEASE

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Oleksandr Susla ◽  
Zoriana Litovkina ◽  
Olha Bushtynska
Keyword(s):  
Renal Disease ◽  
End Stage Renal Disease ◽  
Cardiovascular Complications ◽  
Diabetic Patients ◽  
Carnitine Supplementation ◽  
Basic Therapy ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Abstract Background and Aims According to population registries, the survival of diabetic patients with end-stage-renal disease (ESRD) remains low today. In this context, it is reasonable to develop new therapeutic strategies based on advances in science of the important role of magnesium (Mg) and L-carnitine deficiency (via inflammation and endothelial dysfunction) in mechanisms of cardiovascular remodeling, high morbidity and mortality rates. Thus, the purpose of the present study was to evaluate the effect of Mg and L-carnitine supplementation on 3-year survival and development of the cardiovascular complications in diabetic hemodialysis (HD) patients. Method 48 type 2 diabetic ESRD patients were included in this prospective cohort study (male/female, 29/19; age, 59.9±0.6 years; HD duration, 34.8±4.8 month; diabetes mellitus duration, 174.7±7.1 month). The study was performed in accordance with the provisions of the Declaration of Helsinki last revision. Depending on the treatment programme, patients were divided into two groups: the 1st (main) group (n=24) in addition to basic treatment (hypoglycemic, antihypertensive therapy, according to indications - correction of anemia, hyperparathyroidism, hyperphosphatemia) was treated by combination of magnesium aspartate (0.5 g/day orally) and L-carnitine (1 g/day parenterally after each HD session (three times weekly); the 2nd (comparison) group (n=24) was only on the basic therapy. Complex treatment lasted 12-months; administration of L-carnitine was performed continuously throughout the year, while magnesium aspartate – by three 2-months’ courses/year. The follow up period in both groups was 36 months. Quantitative data are expressed as means±SEM, qualitative ones – as %. Kaplan-Meier method and Log-rank test were used to estimate survival of HD patients, χ2-test – to compare the frequency values. Results The cumulative proportion of survivors at the end of follow-up was 60.4%; however, after 36 months, the survival rate of diabetic HD patients who received a combination of magnesium aspartate and L-carnitine as part of their modified treatment was significantly higher (75 vs. 45.8%; Log-rank=2.07, p=0.038) compared to patients who were on basic therapy (Figure). Survival time in main and comparison groups was 31.9±1.7 and 26.4±2.2 months respectively. It is noteworthy, that throughout the year (from 10 to 22 months), no completed events were recorded in subjects who underwent Mg and L-carnitine supplementation. Conclusion (1) The combined use of magnesium aspartate and L-carnitine in addition to the basic 12-month treatment provides an effective reduction of cardiovascular complications and promotes 3-year survival of diabetic HD patients. (2) The results obtained substantiate the advisability of using repeated courses of Mg and L-carnitine administration 1 years after the end of the primary modified treatment to improve the prognosis in these ESRD patients.

scholarly journals Cell-free DNA as a marker for the outcome of end-stage renal disease patients on haemodialysis

2020 ◽  
Author(s):  
Susana Coimbra ◽  
Susana Rocha ◽  
Henrique Nascimento ◽  
Maria João Valente ◽  
Cristina Catarino ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
End Stage Renal Disease ◽  
Stress Markers ◽  
Free Dna ◽  
All Cause Mortality ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients ◽  
And Oxidative Stress

Abstract Background DNA damage and inflammation are common in end-stage renal disease (ESRD). Our aim was to evaluate the levels of circulating cell-free DNA (cfDNA) and the relationship with inflammation, anaemia, oxidative stress and haemostatic disturbances in ESRD patients on dialysis. By performing a 1-year follow-up study, we also aimed to evaluate the predictive value of cfDNA for the outcome of ESRD patients. Methods A total of 289 ESRD patients on dialysis were enrolled in the study: we evaluated cfDNA, haemogram, serum iron, hepcidin, inflammatory and oxidative stress markers, and haemostasis. Events and causes of deaths were recorded throughout the follow-up period. Results ESRD patients, as compared with controls, presented significantly higher levels of cfDNA, hepcidin, and inflammatory and oxidative stress markers, and significantly lower values of iron and anaemia-related haemogram parameters. The all-cause mortality rate was 9.7%; compared with alive patients, deceased patients (n = 28) were older and presented significantly higher values of inflammatory markers and of cfDNA, which was almost 2-fold higher. Furthermore, cfDNA was the best predictor of all-cause mortality and cardiovascular mortality in ESRD patients, in both unadjusted and adjusted models for basic confounding factors in dialysis. Conclusions Our data show cfDNA to be a valuable predictive marker of prognosis in ESRD patients on dialysis treatment; high levels of cfDNA were associated with a poor outcome.

scholarly journals Decreased Incidence of Clotted AV Access in Hemodialysis Patients after the Implementation of Follow up Program

2016 ◽  
Vol 8 (10) ◽  
pp. 81 ◽  
Author(s):  
Awad Magbri ◽  
Patricia McCartney ◽  
Eussera El-Magbri ◽  
Mariam El-Magbri ◽  
Taha El-Magbri
Keyword(s):  
Positive Impact ◽  
Venous Access ◽  
Transluminal Angioplasty ◽  
National Average ◽  
Dialysis Access ◽  
Stage Renal Disease ◽  
End Stage ◽  
Access Complications ◽  
Esrd Patients

<p><strong>Background and Objectives: </strong>Access monitoring and pre-emptive angioplasty is known to decrease the incidence of AVF/AVG thrombosis. The effect on increase the longevity and functionality of Arterial-Venous access (AV access) in end-stage renal disease (ESRD) patients is not settled. Thrombosis is the leading cause of vascular access complications and is almost always associated with the presence of stenosis. Percutaneous transluminal angioplasty (PTA) is an accepted treatment of stenotic lesions in AV access (NKF 2001). The purpose of this study is to assess the effect of follow up of ESRD patients in the dialysis access center with preemptive angioplasty on access thrombosis.</p><p><strong>Design, Setting, Participants, &amp; Measurements:</strong> This is a single center observational interventional study extended over 9 years (Jan 1, 2006 to Dec 31, 2014) at the Dialysis Access Center of Pittsburgh, PA. The study is divided into 2 periods, period A (from Jan 2006 to December 2009), where follow up program was not in place. Period B extends from (January 1, 2011 to December 31, 2014). In this period, a follow up of patients with preemptive angioplasty of AV access has been implemented. We decided not to include 2010 as the program is implemented at the end of that year and including this year might skewed the data. All patients with ESRD on HD are seen in the Dialysis access center of Pittsburgh for access monitoring and interventional PTA if deemed necessary. Patients’ data were abstracted from the electronic medical records. The study is approved by the IRB of Lifeline corp.</p><p><strong>Results:</strong> During period A; a total of 4139 encounters with a mean of 1034, (1653 angioplasties with mean of 413/year, 375 angiogram, mean 94/year, and 303 thrombectomies of AVF/AVG with a mean 76/year) were carried out. Thrombectomies constituted (7.3%) of the total procedures performed.</p><p>Table 1 showed the mean distributions of AVG, AVF, and tunneled dialysis catheters (TDC) frequencies compared to national average in periods A &amp; B.</p><p>In period B, a total of 6229 encounters with mean of 1557 encounter/year were performed, (3202 angioplasties, mean 801/year, 950 angiograms, mean 238/year, and 196 thrombectomies, mean 42/year) were done. Thrombectomies were decreased almost 2 folds in this period (7.3% to 3.15%).</p><p>The percentage of patients being dialyzed via TDC decreased in period B from 31.895% to 17.38%. The numbers of thrombectomies have also been decreased from average 76 to 42 /year (7.3% to 3.15%).</p><p>After implementing the program, as illustrated in period B, compared to the national average, the frequency of thrombectomies (3.15% vs. 9.6%) and TDC use (17.38% vs. 18%), have showed significant improvement. Meanwhile, the number of PTA has doubled from an average of (413 to 801/year) between the 2 periods. Our fistula rate has gone up from 48.7% to 66.2% between the 2 periods. Mild increase of the AVG use (12.07% to 18.07%) has also been observed. However, the use of TDC has decreased from (31.42% to 17.38%). These results are consistent with the motto of (fistula first and catheter last). The growth of PTA may explain the positive impact of this program on the number of thrombectomies as well as maintenance of access functionality in ESRD patients. The rate of PTA has gone up from (39.85% to 51.25%). This trade off may be acceptable if access patency and functionality have to be maintained. It is not clear whether the follow up program with preemptive angioplasty would have a positive effect on the access expenditure and access longevity in this group of patients.</p><p><strong>Conclusion:</strong> Follow up of ESRD patients in the dialysis access center and preemptive angioplasty if need be is an acceptable means to decrease the number of failed accesses, thrombectomies, as well as the use of TDC in ESRD patients.</p>

Hemodialysis Decreases the Etiologically-Related Early Vascular Aging Observed in End-Stage Renal Disease: A 5-Year Follow-Up Study

2016 ◽  
Vol 43 (1-3) ◽  
pp. 18-30 ◽  
Author(s):  
Daniel Bia ◽  
Cintia Galli ◽  
Yanina Zócalo ◽  
Rodolfo Valtuille ◽  
Sandra Wray ◽  
...  
Keyword(s):  
Renal Disease ◽  
End Stage Renal Disease ◽  
Pulse Wave ◽  
Vascular Aging ◽  
Control Subjects ◽  
Potential Association ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Aims: To analyze the early vascular aging (EVA) in end-stage renal disease (ESRD) patients, attempting to determine a potential association between EVA and the etiology of ESRD, and to investigate the association of hemodialysis and EVA in ESRD patients during a 5-year follow-up period. Methods: Carotid-femoral pulse wave velocity (cfPWV) was obtained in 151 chronically hemodialyzed patients (CHP) and 283 control subjects, and in 25 CHP, who were followed-up after a 5-year lapse. Results: cfPWV increased in ESRD patients compared to control subjects. The cfPWV-age relationship was found to have a steeper increase in ESRD patients. The highest cfPWV and EVA values were observed in patients with diabetic nephropathy. Regression analysis demonstrated a significant reduction of the EVA in HD patients on a 5-year follow-up. Conclusion: Patients in ESRD showed higher levels of EVA. cfPWV and EVA differed in ESRD patients depending on their renal failure etiology. CHP showed an EVA reduction after a 5-year follow-up period.

Arteriovenous Fistulas for Hemodialysis Created using a Long-Term Absorbable Suture: A Safe Solution and a Measure to Minimize Myointimal Hyperplasia

2005 ◽  
Vol 6 (4) ◽  
pp. 171-176 ◽  
Author(s):  
S. Occhionorelli ◽  
D. De Tullio ◽  
D. Pellegrini ◽  
S. Ascanelli ◽  
G. Resta ◽  
...  
Keyword(s):  
Survival Rates ◽  
Absorbable Suture ◽  
Trimethylene Carbonate ◽  
Arteriovenous Fistulas ◽  
Vascular Walls ◽  
Kaplan Meier ◽  
Surgical Suture ◽  
Stage Renal Disease ◽  
End Stage

Background/aims The goal of the therapeutic management of patients affected by end-stage renal disease (ESRD) is to maintain the vascular access (VA) as long as possible. Myointimal hyperplasia development in the vascular walls of arteriovenous fistulas (AVFs) is considered one of the most important factors responsible for procedure failure. These alterations could be linked to hemodynamic changes in the anastomosis and to the presence of the surgical suture itself. We report our preliminary experience, discussing the use and the possible benefits of an absorbable suture in polyglycolide trimethylene carbonate (PTC) in AVF creation. Methods Seventy-four AVFs were created as primary access for hemodialysis (HD), using PTC, over 4 years. Age, gender, ESRD etiology, artery and vein preoperative diameters, AVF survival outcome, and the number of AVFs created per year were recorded. The Kaplan-Meier method was used to analyze AVF survival rates. Results No dehiscences, pseudoaneurysms, or failures in the “critical” period related to PTC absorption were recorded. Kaplan-Meier analysis was used to evaluate AVF survival; 12-month primary AVF survival (74.33%) and AVF failure (25.67%) rates, 9 “early” (8.22%) and 10 “late” failures (13.51%), and a 360-day mean survival were found. Conclusions Our data indicate that PTC, a well known and widely used material for sutures in vascular surgery, is safe and effective in AVF creation. Potential advantages of PTC sutures are represented by a reduced myointimal hyperplasia formation in the AVF vascular walls, prolonging the AVF lifespan and avoiding re-interventions.

Utilization of CMS pre-ESRD Kidney Disease Education services and its associations with the home dialysis therapies

2020 ◽  
pp. 089686082097558
Author(s):  
Ashutosh M Shukla ◽  
Shahab Bozorgmehri ◽  
Rupam Ruchi ◽  
Rajesh Mohandas ◽  
Jennifer L Hale-Gallardo ◽  
...  
Keyword(s):  
Kidney Disease ◽  
Claim Data ◽  
Dialysis Initiation ◽  
Medicare Beneficiaries ◽  
Patient Centered ◽  
Advanced Chronic Kidney Disease ◽  
Home Dialysis ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Background: Kidney Disease Education (KDE) has been shown to improve informed dialysis selection and home dialysis use, two long-held but underachieved goals of US nephrology community. In 2010, the Center for Medicare and Medicaid Services launched a policy of KDE reimbursements for all Medicare beneficiaries with advanced chronic kidney disease. However, the incorporation of KDE service in real-world practice and its association with the home dialysis utilization has not been examined. Methods: Using the 2016 US Renal Data System linked to end-stage renal disease (ESRD) and pre-ESRD Medicare claim data, we identified all adult incident ESRD patients with active Medicare benefits at their first-ever dialysis during the study period (1 January 2010 to 31 December 2014). From these, we identified those who had at least one KDE service code before their dialysis initiation (KDE cohort) and compared them to a parsimoniously matched non-KDE control cohort in 1:4 proportions for age, gender, ESRD network, and the year of dialysis initiation. The primary outcome was home dialysis use at dialysis initiation, and secondary outcomes were home dialysis use at day 90 and anytime through the course of ESRD. Results: Of the 369,968 qualifying incident ESRD Medicare beneficiaries with their first-ever dialysis during the study period, 3469 (0.9%) received KDE services before dialysis initiation. African American race, Hispanic ethnicity, and the presence of congestive heart failure and hypoalbuminemia were associated with significantly lower odds of receiving KDE services. Multivariate analyses showed that KDE recipients had twice the odds of initiating dialysis with home modalities (15.0% vs. 6.9%; adjusted odds ratio (aOR):95% confidence interval (CI) 2.0:1.7–2.4) and had significantly higher odds using home dialysis throughout the course of ESRD (home dialysis use at day 90 (17.6% vs. 9.9%, aOR:CI 1.7:1.4–1.9) and cumulatively (24.7% vs. 15.1%, aOR:CI 1.7:1.5–1.9)). Conclusions: Utilization of pre-ESRD KDE services is associated with significantly greater home dialysis utilization in the incident ESRD Medicare beneficiaries. The very low rates of utilization of these services suggest the need for focused systemic evaluations to identify and address the barriers and facilitators of this important patient-centered endeavor.

Outcomes of Simultaneous Peritoneal Dialysis and Arteriovenous Fistula Placement in End-Stage Renal Disease Patients

2017 ◽  
Vol 37 (6) ◽  
pp. 658-661 ◽  
Author(s):  
Nosratollah Nezakatgoo ◽  
Albert Ndzengue ◽  
Manhunath Ramaiah ◽  
Elvira O. Gosmanova
Keyword(s):  
Peritoneal Dialysis ◽  
Renal Disease ◽  
Arteriovenous Fistula ◽  
End Stage Renal Disease ◽  
Catheter Insertion ◽  
The Mean ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Peritoneal dialysis (PD) interruption requiring hemodialysis (HD) is not uncommon and its frequently abrupt nature prevents timely creation of permanent HD access and avoidance of central venous catheters (CVC). We retrospectively studied a cohort of 24 end-stage renal disease (ESRD) patients (mean age 50.7 years, 83.3% African-Americans, 58.3% females, time on dialysis interquartile range [IQR] 0 - 65 days) who had simultaneous PD catheter insertion and backup arteriovenous fistula (AVF) creation between January 1, 2012, and December 31, 2013. The primary outcome of interest was the percent of patients receiving HD through the backup AVF at the time of PD interruption. A median (IQR) for PD catheter use after its insertion was 10.5 (2 - 20) days. After the mean follow-up of 19.6 months, 12 patients remained on PD, 2 patients received a kidney transplant, and 1 patient died. The overall AVF patency was 66.7%. A total of 9 (37.5%) patients had PD interruption requiring permanent (8 patients) or temporary (1 patient) HD after the mean (standard deviation [SD]) follow-up of 12.3 (8.2) months. Arteriovenous fistula was used as the initial access in 4 patients, and in 3 patients the original AVF was used after additional surgical revision. Forty-four percent of patients with a backup AVF fistula avoided CVC at the time of PD interruption requiring HD. The simultaneous AVF creation at the time of PD catheter insertion reduced but did not fully eliminate CVC at the time of PD interruption. Larger studies are needed to evaluate the utility of a backup AVF in PD patients.

scholarly journals P1542DIALYSIS MODALITY AND OUTCOMES IN GERIATRIC END STAGE RENAL DISEASE (ESRD) PATIENTS. AN ASIAN SINGLE CENTER EXPERIENCE

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Jeevita Supayah ◽  
Hin Seng Wong ◽  
Fei Yee Lee ◽  
Suryati Yakob
Keyword(s):  
Dialysis Initiation ◽  
Dialysis Modality ◽  
Single Center Experience ◽  
Co Morbidity ◽  
The Mean ◽  
Maintenance Dialysis ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Abstract Background and Aims The prevalence of CKD increases with age and more elderly patients are on maintenance dialysis as advanced age is no longer an impediment. The selection of dialysis modality can be difficult for the simultaneous benefit and burden of individual modality on top of the complexity of co-morbidity and quality of life. To study the survival outcomes based on dialysis modality in geriatric ESRD patients Method The cohort of geriatric patients (aged &gt; 65 years) with ESRD who were referred to our pre-dialysis clinic from 1st January 2016 to 31st December 2018 and started on maintenance dialysis were identified via the hospital information system. Demographics, co-morbidities, dialysis modalities and clinical outcome in terms of survival were obtained from the hospital electronic medical record. Glomerular filtration rates (eGFR) were calculated using the CKD-EPI formula in mls/min/1.73m2. The statistical analysis was done using SPSS version 23. Results A total of 145 geriatric ESRD patients were initiated on chronic dialysis. The cohort was predominated by male with 77 patients (53.1%). The mean age was 72.5±5.2 years. Majority had multiple comorbidities with 95% having hypertension, 82.8% with diabetes, 65.5% and 32.8% having dyslipidemia and ischemic heart disease, respectively. The mean eGFR at point of referral and dialysis initiation were 12.5±4.9 mls/min/1.73m2 and 6.57±2.33 mls/min/1.73m2 respectively. Mean duration to initiate dialysis from first review was 6.7±5.8 months. Majority opted for hemodialysis (HD) with 106 patients (73.1%). 74% patients in the HD cohort initiated dialysis via a catheter and remainder with an arteriovenous fistula (AVF). 39 patients (27.1%) opted for peritoneal dialysis (PD) and all were initiated via tenckhoff catheter. Mean eGFR at dialysis initiation were 6.44±2.47 (HD) and 6.9±1.9(PD) respectively. At 6 months, all PD patients survived and 18.2% of HD patients died with statistically significance difference at p=0.003. No survival predictors were identified. Conclusion PD modality has advantage in survival outcome in geriatric ESRD patients.

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