scholarly journals Social support and subsequent mortality among patients with end-stage renal disease.

1993 ◽  
Vol 4 (4) ◽  
pp. 1028-1034
Author(s):  
W M McClellan ◽  
D J Stanwyck ◽  
C A Anson
Keyword(s):  
Social Support ◽  
Renal Disease ◽  
Adjusted Relative Risk ◽  
Dialysis Patients ◽  
Risk Of Death ◽  
Increased Risk ◽  
Patient Reported ◽  
Dialysis Facilities ◽  
Stage Renal Disease ◽  
End Stage

The association between social support in newly entered dialysis patients and their subsequent risk of mortality was investigated. Two hundred forty-nine dialysis patients were enrolled from dialysis facilities in two southeastern states. A score was calculated for the amount of social support a patient reported giving and receiving from spouse, family, friends, nurses, physicians, staff, and fellow patients. Patients were monitored for 12 months after enrollment into the cohort: 43 (17.6%) died. Mean (SD) scores for giving support to the family were higher among survivors, 3.59 (0.92), than among those who died, 3.17 (1.32) (P = 0.022). Mean scores for giving support to friends were also higher among survivors, 3.38 (1.13), than among nonsurvivors, 2.94 (1.33) (P = 0.044). After other factors associated with increased risk of dying, including age, sex, race, diabetic renal disease, angina pectoris, and functional status, were controlled for, individuals in the lowest quartile of giving social support to friends continued to have a greater risk of dying, with adjusted relative risk (95% confidence interval) = 2.02 (1.01, 4.07). In contrast, there were no differences in risk of death found for differing levels of receiving social support. It was concluded that social support is an independent risk factor for mortality among new dialysis patients.

Clostridium difficile infection in dialysis patients

2016 ◽  
Vol 65 (2) ◽  
pp. 353-357 ◽  
Author(s):  
Ankita Tirath ◽  
Sandra Tadros ◽  
Samuel L Coffin ◽  
Kristina W Kintziger ◽  
Jennifer L Waller ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
The United States ◽  
Hiv Positive ◽  
Adjusted Relative Risk ◽  
Dialysis Patients ◽  
Risk Of Death ◽  
Nosocomial Diarrhea ◽  
Increased Risk ◽  
Stage Renal Disease ◽  
End Stage

Clostridium difficile infection (CDI) is the most common cause of nosocomial diarrhea. Patients with end-stage renal disease (ESRD) may be at increased risk for CDI. Patients with ESRD with CDI have increased mortality, longer length of stay, and higher costs. The present studies extend these observations and address associated comorbidities, incidence of recurrence, and risk factors for mortality. We queried the United States Renal Data System (USRDS) for patients with ESRD diagnosed with CDI, and assessed for the incidence of infection, comorbidities, and mortality. The records of 419,875 incident dialysis patients from 2005 to 2008 were reviewed. 4.25% had a diagnosis of a first CDI. In the majority of patients with CDI positive, a hospitalization or ICU stay was documented within 90 days prior to the diagnosis of CDI. The greatest adjusted relative risk (aRR) of CDI was present in patients with HIV (aRR 2.68), age ≥65 years (aRR 1.76), and bacteremia (aRR 1.74). The adjusted HR (aHR) for death was 1.80 in patients with CDI. The comorbidities demonstrating the greatest risk for death in dialysis patients with CDI included age ≥65 years and cirrhosis (aHR 2.28 and 1.76, respectively). Recurrent CDI occurred in 23.6%, was more common in Caucasians, and in those who were older. CDI is a common occurrence in patients with ESRD, with elderly patients, patients with HIV positive, and bacteremic patients at highest risk for infection. Patients with CDI had nearly a twofold increased risk of death.

scholarly journals Investigation of the Impact of Endodontic Therapy on Survival among Dialysis Patients in Taiwan: A Nationwide Population-Based Cohort Study

2021 ◽  
Vol 18 (1) ◽  
pp. 326
Author(s):  
Chih-Chien Chiu ◽  
Ya-Chieh Chang ◽  
Ren-Yeong Huang ◽  
Jenq-Shyong Chan ◽  
Chi-Hsiang Chung ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Root Canal ◽  
Dialysis Patients ◽  
Root Canal Therapy ◽  
Risk Of Death ◽  
Stage Renal Disease ◽  
End Stage

Objectives Dental problems occur widely in patients with chronic kidney disease (CKD) and may increase comorbidities. Root canal therapy (RCT) is a common procedure for advanced decayed caries with pulp inflammation and root canals. However, end-stage renal disease (ESRD) patients are considered to have a higher risk of potentially life-threatening infections after treatment and might fail to receive satisfactory dental care such as RCT. We investigated whether appropriate intervention for dental problems had a potential impact among dialysis patients. Design Men and women who began maintenance dialysis (hemodialysis or peritoneal dialysis) between January 1, 2000, and December 31, 2015, in Taiwan (total 12,454 patients) were enrolled in this study. Participants were followed up from the first reported dialysis date to the date of death or end of dialysis by December 31, 2015. Setting Data collection was conducted in Taiwan. Results A total of 2633 and 9821 patients were classified into the RCT and non-RCT groups, respectively. From the data of Taiwan’s National Health Insurance, a total of 5,092,734 teeth received RCT from 2000 to 2015. Then, a total of 12,454 patients were followed within the 16 years, and 4030 patients passed away. The results showed that members of the non-RCT group (34.93%) had a higher mortality rate than those of the RCT group (22.79%; p = 0.001). The multivariate-adjusted hazard ratio for the risk of death was 0.69 (RCT vs. non-RCT; p = 0.001). Conclusions This study suggested that patients who had received RCT had a relatively lower risk of death among dialysis patients. Infectious diseases had a significant role in mortality among dialysis patients with non-RCT. Appropriate interventions for dental problems may increase survival among dialysis patients. Abbreviations: CKD = chronic kidney disease, ESRD = end-stage renal disease, RCT = root canal therapy.

Concomitant Use of Gabapentinoids with Opioids Is Associated with Increased Mortality and Morbidity among Dialysis Patients

2020 ◽  
Vol 51 (6) ◽  
pp. 424-432 ◽  
Author(s):  
Salina P. Waddy ◽  
Adan Z. Becerra ◽  
Julia B. Ward ◽  
Kevin E. Chan ◽  
Chyng-Wen Fwu ◽  
...  
Keyword(s):  
The United States ◽  
Future Research ◽  
Dialysis Patients ◽  
Mortality And Morbidity ◽  
Medication Prescription ◽  
Risk Of Death ◽  
Increased Risk ◽  
Stage Renal Disease ◽  
End Stage ◽  
Dialysis Discontinuation

Background: The opioid epidemic is a public health emergency and appropriate medication prescription for pain remains challenging. Physicians have increasingly prescribed gabapentinoids for pain despite limited evidence supporting their use. We determined the prevalence of concomitant gabapentinoid and opioid prescriptions and evaluated their associations with outcomes among dialysis patients. Methods: We used the United States Renal Data System to identify patients treated with dialysis with Part A, B, and D coverage for all of 2010. Patients were grouped into 4 categories of drugs exposure status in 2010: (1) no prescriptions of either an opioid or gabapentinoid, (2) ≥1 prescription of an opioid and no prescriptions of gabapentinoids, (3) no prescriptions of an opioid and ≥1 prescription of gabapenbtinoids, (4) ≥1 prescription of both an opioid and gabapentinoid. Outcomes included 2-year all-cause death, dialysis discontinuation, and hospitalizations assessed in 2011 and 2012. Results: The study population included 153,758 dialysis patients. Concomitant prescription of an opioid and gabapentin (15%) was more common than concomitant prescription of an opioid and pregabalin (4%). In adjusted analyses, concomitant prescription of an opioid and gabapentin compared to no prescription of either was associated with increased risk of death (hazard ratio [HR] 1.16, 95% CI 1.12–1.19), dialysis discontinuation (HR 1.14, 95% CI 1.03–1.27), and hospitalization (HR 1.33, 95% CI 1.31–1.36). Concomitant prescription of an opioid and pregabalin compared to no prescription of either was associated with increased mortality (HR 1.22, 95% CI 1.16–1.28) and hospitalization (HR 1.37, 95% CI 1.33–1.41), but not dialysis discontinuation (HR 1.13, 95% CI 0.95–1.35). Prescription of opioids and gabepentinoids compared to only being prescribed opioids was associated with higher risk of hospitalizations, but not mortality, or dialysis discontinuation. Conclusions: Concomitant prescription of opioids and gabapentinoids among US dialysis patients is common, and both drugs have independent effects on outcomes. Future research should prospectively investigate the potential harms of such drugs and identify safer alternatives for treatment of pain in end-stage renal disease patients.

scholarly journals Epidemiology of dialysis-treated end-stage renal disease patients in Kazakhstan: data from nationwide large-scale registry 2014–2018

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Abduzhappar Gaipov ◽  
Alpamys Issanov ◽  
Kainar Kadyrzhanuly ◽  
Dinara Galiyeva ◽  
Marina Khvan ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Renal Disease ◽  
Survival Probability ◽  
End Stage Renal Disease ◽  
Older Patients ◽  
Large Scale ◽  
Dialysis Patients ◽  
Risk Of Death ◽  
Stage Renal Disease ◽  
End Stage

Abstract Background The epidemiology of dialysis patients has been little studied in developing countries and economies in transition. We examined the prevalence, incidence and mortality rate of dialysis patients in Kazakhstan, via aggregation and utilization of large-scale administrative healthcare data. Methods The registry data of 8898 patients receiving dialysis therapy between 2014 and 2018 years were extracted from the Unified National Electronic Health System (UNEHS) and linked with the national population registry of Kazakhstan. We provide descriptive statistics of demographic, comorbidity and dialysis-related characteristics. Results Among all patients undergoing maintenance dialysis for end-stage renal disease (ESRD), there were 3941 (44%) females and 4957 (56%) males. 98.7% of patients received hemodialysis and 1.3% peritoneal dialysis. The majority of the patients (63%) were ethnic Kazakhs, 18% were Russians and 19% were of other ethnicities. The prevalence and incidence rate in 2014 were 135.2 and 68.9 per million population (PMP), respectively, which were different in 2018 [350.2 and 94.9 PMP, respectively]. Overall mortality rate among dialysis patients reduced from 1667/1000 patient-years [95%Confidence Interval (CI): 1473–1886] (PY) in 2014 to 710/1000PY [95%CI: 658–767] in 2018. We observed 13% lower crude survival probability in females compared to males and in older patients compared to younger ones. Russian ethnicity had 58% higher risk of death, while other ethnicities had 34% higher risk of death compared to in those of Kazakh ethnicity. Conclusion We describe for the first time in Kazakhstan an increase in the prevalence and incidence of ESRD on dialysis, while mortality rate decreased over time, during 2014–2018. We observed statistically significant lower survival probability in female dialysis patients compared to males, in older patients compared to younger ones, and in patients of Russian ethnicity compared to Kazakh.

scholarly journals End Stage Renal Disease Predicts Increased Risk of Death in First Degree Relatives in the Norwegian Population

PLoS ONE ◽  
2016 ◽  
Vol 11 (11) ◽  
pp. e0165026 ◽  
Author(s):  
Rannveig Skrunes ◽  
Einar Svarstad ◽  
Anna Varberg Reisæter ◽  
Hans-Peter Marti ◽  
Bjørn Egil Vikse
Keyword(s):  
Renal Disease ◽  
End Stage Renal Disease ◽  
Risk Of Death ◽  
First Degree Relatives ◽  
Norwegian Population ◽  
Increased Risk ◽  
Stage Renal Disease ◽  
End Stage

scholarly journals Can Overnutrition Lead to Wasting?—The Paradox of Diabetes Mellitus in End-Stage Renal Disease Treated with Maintenance Hemodialysis

Nutrients ◽  
2022 ◽  
Vol 14 (2) ◽  
pp. 247
Author(s):  
Krzysztof Hoppe ◽  
Krzysztof Schwermer ◽  
Mikołaj Dopierała ◽  
Małgorzata Kałużna ◽  
Anna Hoppe ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Maintenance Hemodialysis ◽  
Protein Energy Wasting ◽  
Risk Of Death ◽  
Increased Risk ◽  
Stage Renal Disease ◽  
End Stage ◽  
The Impact

Background: The population of end-stage renal disease (ESRD) patients with diabetes mellitus (DM) may be at increased risk of protein energy wasting (PEW). The aim of the study was to investigate the impact of DM on selected indicators of PEW in the ESRD population that was undergoing maintenance hemodialysis (MHD). Methods: A total of 515 MHD patients were divided into two subgroups with and without DM. The evaluation of diet composition, Charlson Comorbidity Index (CCI), SGA, and laboratory and BIS analyses were performed. All-cause and cardiovascular mortality was recorded. Results: DM patients had lower albumin (3.93 (3.61–4.20) vs. 4.10 (3.80–4.30) g/dL, p < 0.01), total cholesterol (158 (133–196) vs. 180 (148–206) mg/dL, p < 0.01), and creatinine (6.34 (5.08–7.33) vs. 7.12 (5.70–8.51) mg/dL, p < 0.05). SGA score (12.0 (10.0–15.0) vs. 11.0 (9.0–13.0) points, p < 0.001), BMI (27.9 (24.4–31.8) vs. 25.6 (22.9–28.8) kg/m2, p < 0.001), fat tissue index (15.0 (11.4–19.6) vs. 12.8 (9.6–16.0) %, p < 0.001), and overhydration (2.1 (1.2–4.1) vs. 1.8 (0.7, 2.7) L, p < 0.001) were higher in the DM group. Increased morbidity, reflected in the CCI and mortality—both all-cause and cardiovascular—were observed in DM patients. Conclusions: Hemodialysis recipients with DM experience overnutrition with a paradoxically higher predisposition to PEW, expressed by a higher SGA score and lower serum markers of nutrition. This population is also more comorbid and is at higher risk of death, including from cardiovascular causes.

scholarly journals Frequency of Gastrointestinal Diseases in Patients with End-Stage Renal Disease Treated with Long Term Dialysis

2018 ◽  
Vol 2 (2) ◽  
Author(s):  
Lutfi Zylbeari ◽  
Zamira Bexheti ◽  
Gazmend Zylbeari ◽  
Ferizate Dika Haxhirexha ◽  
Kastriot Haxhirexha
Keyword(s):  
Renal Disease ◽  
Gastrointestinal Diseases ◽  
Control Group ◽  
Dialysis Patients ◽  
Gastrointestinal Complications ◽  
Increased Risk ◽  
High Incidence ◽  
Stage Renal Disease ◽  
End Stage

Background: Gastrointestinal complications are frequent in patients with renal disease and are responsible for substantial morbidity and mortality among these patients in developing countries. Many times, these patients are subjected to endoscopic evaluation and mucosal biopsies are taken for definitive diagnosis. Long before the routine uses of dialysis, patients dying of uremia were found to have a high incidence of gastrointestinal abnormalities (1).Matherials and methods: The survey included 240 persons; 120 of them were dialysis patients, while the remaining 120 were healthy individuals who served as a control group. 54 (45%) of the patients with hemodialysis were females while 66 (55%) of them were males with mean age: 58.20 ± 18.00 years. These patients had been in dialysis for more than 12 years at the Clinic for Nephrology in Skopje and the Clinical Hospital in Tetovo.Results: Gastrointestinal complications were present in 20 (37.0%) out of 54 females while 26 (39.4%) out of 66 males presented with duodenal bulbar ulcers. 84 patients [(females-38/54 (70.4%) and males-46/66 (85.2%)] of the total number of 120 examined patients were found to have chronic gastritis.In conclusion, we found that the incidence of PUD was more than 10 times higher in CKD patients than in those without CKD over a 3-year period between 2008-2010. CKD patients receiving HD, NSAID, or clopidogrel had an increased risk of PUD, compared to CKD patients not receiving these treatments.  

Could Antioxidant Supplementation Delay Progression of Cardiovascular Disease in End-Stage Renal Disease Patients?

2020 ◽  
Vol 19 (1) ◽  
pp. 41-54 ◽  
Author(s):  
Stefanos Roumeliotis ◽  
Athanasios Roumeliotis ◽  
Xenia Gorny ◽  
Peter R. Mertens
Keyword(s):  
Oxidative Stress ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Close Association ◽  
Omega 3 ◽  
Endstage Renal Disease ◽  
Increased Risk ◽  
Underlying Mechanisms ◽  
Stage Renal Disease ◽  
End Stage

In end-stage renal disease patients, the leading causes of mortality are of cardiovascular (CV) origin. The underlying mechanisms are complex, given that sudden heart failure is more common than acute myocardial infarction. A contributing role of oxidative stress is postulated, which is increased even at early stages of chronic kidney disease, is gradually augmented in parallel to progression to endstage renal disease and is further accelerated by renal replacement therapy. Oxidative stress ensues when there is an imbalance between reactive pro-oxidants and physiologically occurring electron donating antioxidant defence systems. During the last decade, a close association of oxidative stress with accelerated atherosclerosis and increased risk for CV and all-cause mortality has been established. Lipid peroxidation has been identified as a trigger for endothelial dysfunction, the first step towards atherogenesis. In order to counteract the deleterious effects of free radicals and thereby ameliorate, or delay, CV disease, exogenous administration of antioxidants has been proposed. Here, we attempt to summarize existing data from studies that test antioxidants for CV protection, such as vitamins E and C, statins, omega-3 fatty acids and N-acetylcysteine.

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