Recovery of Renal Function among ESRD Patients in the US Medicare Program

Abstract Background: The erythrocyte sedimentation rate (ESR) is a simple laboratory diagnostic tool for estimating systemic inflammation. It remains unclear, if renal function affects ESR, thereby compromising its validity. This pilot study aims to compare prevalence and extent of ESR elevations in hospitalized patients with or without kidney disease. In addition, the impact of renal replacement therapy (RRT) modality on ESR was determined.Methods: In this single-center, retrospective study, patients were screened for ESR values. ESR was compared in patients with and without renal disease and/or RRT. In addition, ESR was correlated with other inflammatory markers, the extent of renal insufficiency and clinical characteristics.Results: A total of 203 patients was identified, showing an overall elevated ESR in the study population (mean 51.7±34.6 mm/h). ESR was significantly increased in all patients with severe infection, active vasculitis or cancer, respectively, independent from renal function. Interestingly, there was no difference in ESR between patients with and without kidney disease or those having received a prior renal transplant or being on hemodialysis. However, ESRD patients treated with peritoneal dialysis presented with a significantly higher ESR (78.3±33.1 mm/h, p<0.001), while correlation with other inflammatory markers was not persuasive.Conclusions: We showed that ESR: (1) does not differ between various stages of renal insufficiency; (2) may be helpful as a screening tool also in patients with renal insufficiency; and (3) is significantly increased in ESRD patients on peritoneal dialysis per se, while it seems not to be affected by hemodialysis or renal transplantation (see graphical abstract as supplementary material).

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Abstract MP10: Increasing Obesity Prevalence in the United States End-stage Renal Disease Population

Circulation ◽

10.1161/circ.137.suppl_1.mp10 ◽

2018 ◽

Vol 137 (suppl_1) ◽

Author(s):

Brittany Shelton ◽

Deanna McWilliams ◽

Rhiannon D Reed ◽

Margaux Mustian ◽

Paul MacLennan ◽

...

Keyword(s):

United States ◽

Renal Disease ◽

End Stage Renal Disease ◽

The United States ◽

Obesity Prevalence ◽

The Us ◽

Prevalence Of Obesity ◽

Stage Renal Disease ◽

End Stage ◽

Esrd Patients

Background: Obesity has become a national epidemic, and is associated with increased risk for comorbid diseases including end-stage renal disease (ESRD). Among ESRD patients, obesity may improve dialysis-survival but decreases likelihood of transplantation, and as such, obesity prevalence may directly impact growth of the incident dialysis population. Methods: Incident adult ESRD patients with complete body mass index (BMI, kg/m 2 ) data were identified from the United States Renal Data System from 01/01/1995-12/31/2010 (n=1,822,598). Data from the Behavioral Risk Factor Surveillance System of the Centers for Disease Control and Prevention (n=4,303,471) represented the US population when weighted. Trends in BMI and obesity classes I (BMI of 30-34.9), II (BMI of 35-39.9), and III (BMI ≥40) were examined by year of dialysis initiation. Trends in median BMI slope were compared between the ESRD and US populations using linear regression. Results: Median BMI of ESRD patients in 1995 was 24.2 as compared to 28.0 in 2010, a 15.7% increase, while the US population’s median BMI increased from 24.2 in 1995 to 25.6 in 2010, a 5.8% increase. Comparable trends were noted with respect to prevalence of obesity classes I, II, and III (Table). BMI increase among the ESRD population was significantly more rapid than among the US population (β: 0.15, 95% CI: 0.14-0.17, p<0.001) (Figure). Conclusion: The median BMI of ESRD patients and prevalence of obesity among ESRD patients is increasing more rapidly than the US population. Given the increased dialysis-survival and decreased likelihood of transplantation associated with obesity, healthcare costs will likely increase, and thus, future research should be directed at examining medical expenditures.

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Increased Plasma Leptin Concentration in End-Stage Renal Disease1

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jcem.82.3.3817 ◽

1997 ◽

Vol 82 (3) ◽

pp. 847-850 ◽

Cited By ~ 2

Author(s):

Eddine Merabet ◽

Samuel Dagogo-Jack ◽

Daniel W. Coyne ◽

Samuel Klein ◽

Julio V. Santiago ◽

...

Keyword(s):

Renal Function ◽

Residual Renal Function ◽

Intact Protein ◽

Renal Elimination ◽

Men And Women ◽

Males And Females ◽

End Stage ◽

Plasma Leptin ◽

Esrd Patients ◽

Normal Controls

Abstract Leptin is a 16-kDa protein recently identified as the obese gene product involved in body weight regulation. Administration of recombinant leptin to ob/ob mice, which have a genetic defect in leptin production, reduces food intake and increases energy expenditure. Leptin is synthesized by fat cells, and in normal humans, plasma concentrations are proportional to adiposity. The physiological actions and the degradation pathways of leptin in humans are unknown. We investigated renal elimination of leptin by comparing plasma leptin concentrations in end-stage renal disease (ESRD) patients with normal controls. Our hypothesis was that if renal filtration is a significant route of elimination, the hormone would accumulate in ESRD patients. Mean plasma levels in 141 ESRD patients (26.8 ± 5.7 and 38.3 ± 5.6 μg/L for males and females, respectively) were significantly higher (P< 0.001) than mean values obtained in normal controls (11.9 ± 3.1 and 21.2 ± 3.0 μg/L for males and females, respectively). Leptin concentrations in ESRD patients correlated directly with body mass index (BMI; r = 0.77 for men and 0.78 for women). The rate of increase in leptin concentrations with BMI was significantly greater in ESRD patients (5.5 and 6.6 μg/L/U BMI for men and women, respectively) than in normal controls (1.4 and 2.6 μg/L/U for men and women, respectively). Pre- and postdialysis leptin levels in hemodialysis patients were similar. Western blot of plasma from ESRD patients with high leptin levels showed bands corresponding to the intact protein (16 kDa) with no lesser or greater molecular mass species observed. Leptin concentrations in patients with ESRD did not correlate with measures of residual renal function (serum creatinine,β 2-microglobulin, PTH, or GH levels). Similarly, we found no correlation between leptin levels and the number of years patients had been on dialysis or with recent weight changes. We conclude that intact leptin is increased in ESRD patients, but does not appear to cause decreased weight. As leptin levels did not correlate with residual renal function, increased production may account for the high levels observed.

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P1644SAPS AND EPTS SCORES AS PREDICTORS OF RENAL FUNCTION IN RECENT RENAL TRANSPLANTATION

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p1644 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Jimmy Reinaldo Sanchez Gil ◽

Armando Coca ◽

Guadalupe Rodriguez Portela ◽

Carmen Aller Aparicio ◽

Alicia Mendiluce

Keyword(s):

Renal Function ◽

Renal Transplantation ◽

Serum Creatinine ◽

Roc Curve ◽

Graft Function ◽

Risk Scores ◽

Critical Care Units ◽

Saps Ii ◽

Combined Use ◽

The Us

Abstract Background and Aims The risk scores used in Critical Care Units estimate the severity and mortality of patients. The SAPS (Simplified Acute Physiologic Score) and its SAPS II and SAPS III variants calculate the severity by collecting the values recorded in the first 24 hours. The EPTS (Estimated Post-Transplant-Survival) is used as a reference for the allocation of organs in the US by the OPTN. The objective is to determine its use in recent renal transplant units as estimator of subsequent renal function, in services where patients move from the operating room to a nephrological intermediate care unit. Method The SAPS (II and III) and OPTN scores were applied in 87 (N = 87) consecutive renal transplanted patients. The point value of each of the scales was evaluated with the creatinine values at hospital discharge, and one month after the transplant. The scores obtained on the SAPS scales were divided as follows (SAPSIIA <20 points, SAPSIIB ≥20 points) (SAPSIII A <30 points, SAPSIIIB ≥30 points). In the EPTS scale, two cut-off points were used to divide the groups (20% Score; EPTS-IA ≤20%, EPTS-IB> 20%), (Score 40%; EPTS-IIA ≤40%, EPTS -IIB> 40). The sérum creatinine means of each of the groups were compared. Data were analyzed with SPSS 20.0.0 Results Significant differences were found in serum creatinine levels in renal function at the first month of transplantation in the SAPS II groups (SAPS IIA 1.38 mg / dl, SAPS IIB 1.79 mg / dl; P = 0.017 95% CI). With an area under the ROC curve of 0.65 (P = 0.017 95% CI). In the SAPS III groups no significant differences were found. In the EPTS scales, there were also significant differences in creatinine one month after the transplant in the group with a score of 40% (EPTS-IIA ≤40% 1.42 mg / dl, EPTS-IIB> 40 1.81 mg / dl; P = 0.024 95% CI) With an Area under the ROC curve of 0.64 (P = 0.037 95% CI). Conclusion The SAPSII and EPTS scores can be a useful tool in estimating renal function one month after renal transplantation, giving a prognosis of renal graft function. The combined use of these scales together with other functional graft tests could have an important relevance in the management and follow-up of recent renal transplantation. Other studies with larger sample sizes are necessary to establish the appropriate cut-off points for the scales.

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Elective Surgery in Patients with End Stage Renal Disease: What's the Risk?

The American Surgeon ◽

10.1177/000313480907500909 ◽

2009 ◽

Vol 75 (9) ◽

pp. 790-793 ◽

Cited By ~ 22

Author(s):

Christopher R. Schneider ◽

William Cobb ◽

Shivani Patel ◽

David Cull ◽

Cass Anna ◽

...

Keyword(s):

Renal Function ◽

Renal Disease ◽

Surgical Procedures ◽

General Surgery ◽

Normal Renal Function ◽

End Stage Renal Disease ◽

Elective Surgical Procedures ◽

Stage Renal Disease ◽

End Stage ◽

Esrd Patients

Little research has been performed in regards to the morbidity and outcomes associated with elective general surgery performed on patients with end stage renal disease (ESRD). With minimal data about the severity of disease in these patients, we sought to quantify the differences in the ESRD patient undergoing elective surgical procedures compared with matched controls. A review of all ESRD patients undergoing elective surgical procedures at a University Medical Center between 2001 and 2005 was performed. Outcomes included length of hospital stay, 1 year morbidity, and mortality. These patients were then compared with a control group with normal renal function matched 2:1. Fifty-two consecutive ESRD patients undergoing elective general surgery procedures were compared with 104 matched controls. The ESRD group experienced more complications (25 vs 16, P = 0.05) and had a larger number of overall complications compared with the controls (33 vs 19, P < 0.05). Length of stay was significantly longer in the ESRD group as well (8 vs 2.65 days, P < 0.0001). Incidence of death (4%) in the ESRD group was increased as well. Patients with ESRD require longer hospital stays and have an increased overall incidence and frequency of complications than patients with normal renal function undergoing elective general surgery procedures. The significantly increased morbidity should be considered when evaluating expected outcomes.

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The interaction of partial public insurance programs and residual private insurance markets: evidence from the US Medicare program

Journal of Health Economics ◽

10.1016/j.jhealeco.2003.07.003 ◽

2004 ◽

Vol 23 (1) ◽

pp. 1-24 ◽

Cited By ~ 16

Author(s):

Amy Finkelstein

Keyword(s):

Private Insurance ◽

Insurance Markets ◽

Public Insurance ◽

Medicare Program ◽

The Us

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Pregnancy in pancreas–kidney transplant recipients: report of three cases and review of the literature

Obstetric Medicine ◽

10.1258/om.2009.090028 ◽

2010 ◽

Vol 3 (2) ◽

pp. 73-77 ◽

Cited By ~ 11

Author(s):

Kate Bramham ◽

Liz Lightstone ◽

John Taylor ◽

Nadey S Hakim ◽

Kate Harding ◽

...

Keyword(s):

Renal Function ◽

Kidney Transplant ◽

Transplant Recipients ◽

Review Of The Literature ◽

Kidney Transplant Recipients ◽

Hospital Records ◽

The Us ◽

Reported Data ◽

The Uk ◽

Pregnancy Registry

Seventy-three pregnancies in 43 women with SPK have now been described by the US National Transplantation Pregnancy Registry (NTPR) (established in 1991), which contains self-reported data from questionnaires and hospital records. These women have high rates of complications despite normoglycaemia and restoration of renal function. We describe the pregnancies of three SPK recipients in the UK managed in joint renal obstetric clinics and discuss the antenatal and postnatal complications specific to SPK transplants.

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Segmental Abnormalities of White Matter Microstructure in End-Stage Renal Disease Patients: An Automated Fiber Quantification Tractography Study

Frontiers in Neuroscience ◽

10.3389/fnins.2021.765677 ◽

2021 ◽

Vol 15 ◽

Author(s):

Yuhan Jiang ◽

Yangyingqiu Liu ◽

Bingbing Gao ◽

Yiwei Che ◽

Liangjie Lin ◽

...

Keyword(s):

Renal Function ◽

White Matter ◽

Renal Disease ◽

Left Hemisphere ◽

End Stage Renal Disease ◽

Fiber Tracts ◽

White Matter Microstructure ◽

Stage Renal Disease ◽

End Stage ◽

Esrd Patients

Background and Purpose: End-stage renal disease (ESRD) results in extensive white matter abnormalities, but the specific damage segment cannot be identified. This study aimed to determine the segmental abnormalities of white matter microstructure in ESRD and its relationship with cognitive and renal function indicators.Methods: Eighteen ESRD patients and 19 healthy controls (HCs) were prospectively recruited. All participants underwent DTI and clinical assessments. Automatic fiber quantification (AFQ) was applied to generate bundle profiles along 16 main white matter tracts. We compared the DTI parameters between groups. Besides, we used partial correlation and multiple linear regression analyses to explore the associations between white matter integrity and cognitive performance as well as renal function indicators.Results: In the global tract level, compared to HCs, ESRD patients had greater MD, AD, and RD values and lower FA value in several fibers (P < 0.05, FDR correction). In the point-wise level, extensive damage existed in specific locations of different fiber tracts, particularly in the left hemisphere (P < 0.05, FDR correction). Among these tracts, the mean AD values of the left cingulum cingulate correlated negatively with MoCA score. Urea and UA level were independent predictors of the AD value of superior component of the left corticospinal. Besides, urea level was the independent predictors of mean MD value of left anterior thalamic radiation (ATR).Conclusion: White matter fiber tract damage in ESRD patients may be characterized by abnormalities in its specific location, especially in the left hemisphere. Aberrational specific located fibers were related to cognitive impairment and renal dysfunction.

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Solving Medicare’s Fiscal Crisis: An Analysis of Three Policy Options

Policy Perspectives ◽

10.4079/pp.v19i0.10424 ◽

2012 ◽

Vol 19 ◽

pp. 23

Author(s):

Ashley Flint

Keyword(s):

The United States ◽

Policy Options ◽

The Past ◽

Insurance Program ◽

Health Insurance Program ◽

Medicare Program ◽

Cost Growth ◽

The Us ◽

Congressional Action

Health care spending in the United States has increased rapidly over the past several decades. Medicare, the largest public health insurance program in the US, is a key component of these growing costs. While Medicare financing is expected to be stable over the next decade, the long-term solvency will be difficult to sustain absent congressional action. This paper analyzes three policy options for Congress to consider in addressing the problem of rapid cost growth in the Medicare program.

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Efficacy and Safety of Sugammadex for the Reversal of Rocuronium-Induced Neuromuscular Blockade in Patients with End-Stage Renal Disease: A Systematic Review and Meta-Analysis

Medicina ◽

10.3390/medicina57111259 ◽

2021 ◽

Vol 57 (11) ◽

pp. 1259

Author(s):

Young-Sung Kim ◽

Byung-Gun Lim ◽

Young-Ju Won ◽

Seok-Kyeong Oh ◽

Jung-Suk Oh ◽

...

Keyword(s):

Systematic Review ◽

Renal Function ◽

Renal Disease ◽

General Anesthesia ◽

Neuromuscular Blockade ◽

Normal Renal Function ◽

End Stage Renal Disease ◽

Stage Renal Disease ◽

End Stage ◽

Esrd Patients

Background and Objectives: Sugammadex is widely used in anesthesia to reverse rocuronium-induced neuromuscular blockade (NMB). In patients with compromised kidney function, most drugs show alteration of their pharmacokinetic profile with reduced clearance. The purpose of this article is to examine the efficacy, pharmacokinetics, and safety of sugammadex in end-stage renal disease (ESRD) patients receiving general anesthesia, using a systematic review. Materials and Methods: The databases of PubMed, EMBASE, the Cochrane Library, Web of Science, Scopus, KoreaMed, and ClinicalTrials.gov were searched for studies comparing the efficacy or safety outcomes of sugammadex administration for the reversal of rocuronium-induced NMB, in ESRD patients (group R) or in those with normal renal function (group N) undergoing surgery under general anesthesia. Results: We identified nine studies with 655 patients—six prospective, case-control studies with 179 patients (89 and 90 in groups R and N) and three retrospective observational studies with 476 ESRD patients. In the six prospective studies, the times taken to reach a train-of-four ratio ≥0.9, 0.8, and 0.7 were significantly longer in group R than in group N (weighted mean difference [95% confidence interval] [min]: 1.14 [0.29 to 2.00], 0.9 [0.24 to 1.57], 0.89 [0.20 to 1.57], respectively). The total plasma clearance of sugammadex was significantly lower in group R than in group N. There was no significant difference in the incidence of NMB recurrence and prolonged time to recovery between the groups. In the three retrospective studies, the possibility of sugammadex-related adverse events appears to be insignificant. Conclusions: Sugammadex may effectively and safely reverse rocuronium-induced NMB in patients with ESRD, although the recovery to a TOF ratio of 0.9 may be prolonged compared to patients with normal renal function. Further studies are needed, considering the small number of studies included and the high heterogeneity of some of the results.

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