scholarly journals Effect of High-Flux versus Low-Flux Dialysis on the Rate of Bacteremia in Hemodialysis Patients

2021 ◽  
Vol 5 (2) ◽  
pp. 1-5
Author(s):  
Ali Dahouk ◽  
Loubna Sinno ◽  
Housam Rabah
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort ◽  
Positive Culture ◽  
Hemodialysis Patients ◽  
High Flux ◽  
Dialysis Patients ◽  
Dialysis Therapy ◽  
Av Fistula ◽  
Dialysis Center ◽  
The Difference

Bacteremia in dialysis patients is a major risk factor of mortality. The aim of this study was to assess the effectiveness of dialysis with high-flux versus low-flux dialyzer regarding risk of bacteremia in dialysis patients. This was a retrospective cohort study that included dialysis patients who underwent dialysis therapy at old dialysis center where old low-flux dialyzers were used and the new dialysis center where high-flux dialyzers were used. The rate of positive culture was more in high-flux group (37.0%) compared to low-flux group (24.5%), although the difference was not statistically significant (P = 0.13). The vascular access was mostly permanent catheter in high-flux group compared to low-flux group (48.9% vs. 28.6%, respectively; P = 0.06), while arteriovenous (AV) fistula was more prominent in low-flux group compared to high-flux group (65.3% vs. 47.8%, respectively; P = 0.06). This was reflected in the type of bacteria, which was mostly from Gram-positive family (Staphylococcus). The results showed higher risk of bacteremia in high-flux group as compared to low-flux group; however, permanent catheters were more prominent in high-flux group.

scholarly journals Separation and not residency permit restores function in resignation syndrome: a retrospective cohort study

2021 ◽  
Author(s):  
Karl Sallin ◽  
Kathinka Evers ◽  
Håkan Jarbin ◽  
Lars Joelsson ◽  
Predrag Petrovic
Keyword(s):  
Cohort Study ◽  
Social Services ◽  
Residential Care ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Care Home ◽  
Essential Components ◽  
Residential Care Home ◽  
The Difference ◽  
Oriented Approach

AbstractDespite poor treatment results, a family-oriented approach and the securing of residency have been deemed essential to recovery from resignation syndrome (RS). In a retrospective cohort study, we evaluated an alternative method involving environmental therapy, with patients separated from their parents, while actively abstaining from involving the asylum process in treatment. We examined medical records, social services acts, and residential care home acts from 13 individuals treated at Solsidan residential care home between 2005 and 2020. Severity and outcome were assessed with Clinical Global Impression, Severity and Improvement subscales. Thirteen participants were included and out of these nine (69%) recovered, i.e. they very much or much improved. Out of the eight that were separated, all recovered, also, one non-separated recovered. The difference in outcome between subjects separated and not was significant (p = 0.007). Moreover, out of the five which received a residency permit during treatment, one recovered whereas four did not. The difference in outcome between subjects granted residency and not was significant (p = 0.007). The data revealed three (23%) cases of simulation where parents were suspected to have instigated symptoms. Our evaluation suggests that separation from parents and abstaining from invoking residency permit could be essential components when treating RS. Relying on a family-oriented approach, and residency could even be detrimental to recovery. The examined intervention was successful also in cases of probable malingering by proxy.

scholarly journals Dialyzer Classification and Mortality in Hemodialysis Patients: A 3-Year Nationwide Cohort Study

2021 ◽  
Vol 8 ◽  
Author(s):  
Masanori Abe ◽  
Ikuto Masakane ◽  
Atsushi Wada ◽  
Shigeru Nakai ◽  
Kosaku Nitta ◽  
...  
Keyword(s):  
Cohort Study ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Subgroup Analysis ◽  
Hemodialysis Patients ◽  
Type I ◽  
High Flux ◽  
Type Iv ◽  
Japanese Classification ◽  
Type V

Background: Dialyzers are classified as low-flux, high-flux, and protein-leaking membrane dialyzers internationally and as types I, II, III, IV, and V based on β2-microglobulin clearance rate in Japan. Type I dialyzers correspond to low-flux membrane dialyzers, types II and III to high-flux membrane dialyzers, and types IV and V to protein-leaking membrane dialyzers. Here we aimed to clarify the association of dialyzer type with mortality.Methods: This nationwide retrospective cohort study analyzed data from the Japanese Society for Dialysis Therapy Renal Data Registry from 2010 to 2013. We enrolled 238,321 patients on hemodialysis who were divided into low-flux, high-flux, and protein-leaking groups in the international classification and into type I to V groups in the Japanese classification. We assessed the associations of each group with 3-year all-cause mortality using Cox proportional hazards models and performed propensity score matching analysis.Results: By the end of 2013, 55,308 prevalent dialysis patients (23.2%) had died. In the international classification subgroup analysis, the hazard ratio (95% confidence interval) was significantly higher in the low-flux group [1.12 (1.03–1.22), P = 0.009] and significantly lower in the protein-leaking group [0.95 (0.92–0.98), P = 0.006] compared with the high-flux group after adjustment for all confounders. In the Japanese classification subgroup analysis, the hazard ratios were significantly higher for types I [1.10 (1.02–1.19), P = 0.015] and II [1.10 (1.02–1.39), P = 0.014] but significantly lower for type V [0.91 (0.88–0.94), P < 0.0001] compared with type IV after adjustment for all confounders. These significant findings persisted after propensity score matching under both classifications.Conclusions: Hemodialysis using protein-leaking dialyzers might reduce mortality rates. Furthermore, type V dialyzers are superior to type IV dialyzers in hemodialysis patients.

scholarly journals Mycobacterium abscessus Complex Infections: A Retrospective Cohort Study

2018 ◽  
Vol 5 (2) ◽  
Author(s):  
Maroun Sfeir ◽  
Marissa Walsh ◽  
Rossana Rosa ◽  
Laura Aragon ◽  
Sze Yan Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Renal Disease ◽  
Treatment Failure ◽  
Retrospective Cohort Study ◽  
Early Treatment ◽  
Retrospective Cohort ◽  
Positive Culture ◽  
Mycobacterium Abscessus ◽  
Early Treatment Failure

Abstract Background Infections caused by Mycobacterium abscessus group strains are usually resistant to multiple antimicrobials and challenging to treat worldwide. We describe the risk factors, treatment, and clinical outcomes of patients in 2 large academic medical centers in the United States. Methods A retrospective cohort study of hospitalized adults with a positive culture for M. abscessus in Miami, Florida (January 1, 2011, to December 31, 2014). Demographics, comorbidities, the source of infection, antimicrobial susceptibilities, and clinical outcomes were analyzed. Early treatment failure was defined as death and/or infection relapse characterized either by persistent positive culture for M. abscessus within 12 weeks of treatment initiation and/or lack of radiographic improvement. Results One hundred eight patients were analyzed. The mean age was 50.81 ± 21.03 years, 57 (52.8%) were females, and 41 (38%) Hispanics. Eleven (10.2%) had end-stage renal disease, 34 (31.5%) were on immunosuppressive therapy, and 40% had chronic lung disease. Fifty-nine organisms (54.6%) were isolated in respiratory sources, 21 (19.4%) in blood, 10 (9.2%) skin and soft tissue, and 9 (8.3%) intra-abdominal. Antimicrobial susceptibility reports were available for 64 (59.3%) of the patients. Most of the isolates were susceptible to clarithromycin, amikacin, and tigecycline (93.8%, 93.8%, and 89.1%, respectively). None of the isolates were susceptible to trimethoprim/sulfamethoxazole, and only 1 (1.6%) was susceptible to ciprofloxacin. Thirty-six (33.3%) patients early failed treatment; of those, 17 (15.7%) died while hospitalized. On multivariate analysis, risk factors significantly associated with early treatment failure were disseminated infection (odds ratio [OR], 11.79; 95% confidence interval [CI], 1.53–81.69; P = .04), acute kidney injury (OR, 6.55; 95% CI, 2.4–31.25; P = .018), organ transplantation (OR, 2.37; 95% CI, 2.7–23.1; P = .005), immunosuppressive therapy (OR, 2.81; 95% CI, 1.6–21.4; P = .002), intravenous amikacin treatment (OR, 4.1; 95% CI, 0.9–21; P = .04), clarithromycin resistance (OR,79.5; 95% CI, 6.2–3717.1, P < .001), and presence of prosthetic device (OR, 5.43; 95% CI, 1.57–18.81; P = .008). Receiving macrolide treatment was found to be protective against early treatment failure (OR, 0.13; 95% CI, 0.002–1.8; P = .04). Conclusions Our cohort of 108 M. abscessus complex isolates in Miami, Florida, showed an in-hospital mortality of 15.7%. Most infections were respiratory. Clarithromycin and amikacin were the most likely agents to be susceptible in vitro. Resistance to fluoroquinolone and trimethoprim/sulfamethoxazole was highly common. Macrolide resistance, immunosuppression, and renal disease were significantly associated with early treatment failure.

scholarly journals Does tonsillectomy reduce medical care visits for pharyngitis/tonsillitis in children and adults? Retrospective cohort study from Sweden

BMJ Open ◽  
2019 ◽  
Vol 9 (11) ◽  
pp. e033817 ◽  
Author(s):  
Eirik Østvoll ◽  
Ola Sunnergren ◽  
Joacim Stalfors
Keyword(s):  
Cohort Study ◽  
Surgical Treatment ◽  
Medical Care ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Control Group ◽  
Clinical Value ◽  
Recurrent Tonsillitis ◽  
Visit Rate ◽  
The Difference

ObjectiveTo assess the effectiveness of tonsillectomy/adenotonsillectomy in reducing medical care visits for pharyngitis or tonsillitis in children and adults with chronic/recurrent tonsillitis.DesignRetrospective cohort study.SettingData were retrieved from the VEGA register, a comprehensive regional cohort in Sweden.Participants1044 children (<15 years) and 2244 adults.InterventionTonsillectomy/adenotonsillectomy compared with no surgical treatment.Main outcome measuresChanges in yearly mean rates of medical care visits due to pharyngitis/tonsillitis.ResultsIn children, there was a significant decrease in the yearly mean medical care visits rate from 1.93 (1.82 to 2.04) before surgery to 0.129 (0.099 to 0.165) after surgery, with a mean change of −1.80 (−1.90 to −1.69), p<0.0001. In patients who did not undergo surgery, the corresponding mean change was −1.51 (−1.61 to −1.41), resulting in a mean difference in the change in visit rates between the intervention and control groups of −0.283 (−0.436 to −0.135), p=0.0002. In adults, a significant decrease in the yearly mean medical care visit rate was observed from 1.45 (1.39 to 1.51) before surgery to 0.152 (0.132 to 0.173) after surgery, with a mean change of −1.30 (−1.36 to −1.24), p<0.0001, compared with −1.18 (−1.24 to −1.13) in the control group. The difference in the change in yearly mean visit rate between the surgical and non-surgical groups was −0.111 (−0.195 to −0.028), p=0.0097. The subgroup analysis showed a greater effect of surgery in children, in patients with a higher number of medical care visits before surgery and in the first year of follow-up.ConclusionIn this cohort of patients moderately or less affected with chronic/recurrent tonsillitis, the effectiveness of tonsillectomy/adenotonsillectomy in reducing medical care visits for pharyngitis and tonsillitis compared with no surgical treatment was low and of questionable clinical value.

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