scholarly journals Effects of Erythropoietin Payment Policy on Cardiovascular Outcomes of Peritoneal Dialysis Patients: Observational Study (Preprint)

2020 ◽  
Author(s):  
Ying-Hui Hou ◽  
Feng-Jung Yang ◽  
I-Chun Lai ◽  
Shih-Pi Lin ◽  
Thomas TH Wan ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Cardiovascular Risk ◽  
Propensity Scores ◽  
Cardiovascular Outcomes ◽  
Cardiovascular Risks ◽  
Dialysis Patients ◽  
Before And After ◽  
Patients With Diabetes ◽  
Cardiovascular Endpoint ◽  
The Impact

BACKGROUND The change in the reimbursement policy of erythropoietin administration to patients receiving peritoneal dialysis by the Taiwan National Health Insurance (NHI) system provided a natural experimental venue to examine whether cardiovascular risk differs when maintaining the hematocrit (Hct) level below or above 30%. OBJECTIVE The aim of this study was to analyze the impact of loosening the erythropoietin payment criteria for peritoneal dialysis patients on their cardiovascular outcomes. METHODS Two cohorts of incident peritoneal dialysis patients were identified according to the time before and after relaxation of the NHI’s erythropoietin payment criteria, designated cohort 1 (n=1759) and cohort 2 (n=2981), respectively. The cohorts were matched according to propensity scores (1754 patients in each cohort) and then followed up for cardiovascular events, which were analyzed with Cox regressions. RESULTS For the composite cardiovascular endpoint, patients in cohort 2 had a significantly lower risk than those in cohort 1. However, subgroup analysis showed that this risk reduction was observed only in patients with diabetes. CONCLUSIONS After loosening erythropoietin payment criteria, reduced cardiovascular risks were observed, particularly for patients with diabetes. These results indicate that it is crucial to maintain an Hct level above 30% to reduce the cardiovascular risk in patients with diabetes undergoing peritoneal dialysis.

scholarly journals Effects of Erythropoietin Payment Policy on Cardiovascular Outcomes of Peritoneal Dialysis Patients: Observational Study

10.2196/18716 ◽  
2020 ◽  
Vol 8 (12) ◽  
pp. e18716
Author(s):  
Ying-Hui Hou ◽  
Feng-Jung Yang ◽  
I-Chun Lai ◽  
Shih-Pi Lin ◽  
Thomas TH Wan ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Cardiovascular Risk ◽  
Propensity Scores ◽  
Cardiovascular Outcomes ◽  
Cardiovascular Risks ◽  
Dialysis Patients ◽  
Before And After ◽  
Patients With Diabetes ◽  
Cardiovascular Endpoint ◽  
The Impact

Background The change in the reimbursement policy of erythropoietin administration to patients receiving peritoneal dialysis by the Taiwan National Health Insurance (NHI) system provided a natural experimental venue to examine whether cardiovascular risk differs when maintaining the hematocrit (Hct) level below or above 30%. Objective The aim of this study was to analyze the impact of loosening the erythropoietin payment criteria for peritoneal dialysis patients on their cardiovascular outcomes. Methods Two cohorts of incident peritoneal dialysis patients were identified according to the time before and after relaxation of the NHI’s erythropoietin payment criteria, designated cohort 1 (n=1759) and cohort 2 (n=2981), respectively. The cohorts were matched according to propensity scores (1754 patients in each cohort) and then followed up for cardiovascular events, which were analyzed with Cox regressions. Results For the composite cardiovascular endpoint, patients in cohort 2 had a significantly lower risk than those in cohort 1. However, subgroup analysis showed that this risk reduction was observed only in patients with diabetes. Conclusions After loosening erythropoietin payment criteria, reduced cardiovascular risks were observed, particularly for patients with diabetes. These results indicate that it is crucial to maintain an Hct level above 30% to reduce the cardiovascular risk in patients with diabetes undergoing peritoneal dialysis.

scholarly journals Policy changes and impact rises: Erythropoietin Payment Policy on Cardiovascular Outcomes of Peritoneal Dialysis Patients

2020 ◽  
Author(s):  
I-Chun Lai ◽  
Ying-Hui Hou ◽  
Shih-Pi Lin ◽  
Thomas T.H. Wan ◽  
Feng-Jung Yang ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Cardiovascular Risk ◽  
Cardiovascular Events ◽  
Propensity Scores ◽  
Cardiovascular Outcomes ◽  
Diabetic Patients ◽  
Cardiovascular Risks ◽  
Before And After ◽  
Cardiovascular Endpoint ◽  
The Impact

Abstract Background and Purposes The change in reimbursement policy of erythropoietin application to peritoneal dialysis (PD) patients by Taiwan National Health Insurance (NHI) system provided a natural experimental venue to examine whether cardiovascular risk differs while keeping hematocrit (Hct) below 30% or over 30%. This study intended to analyze the impact of loosening erythropoietin payment criteria for PD patients on their cardiovascular outcomes. Methods Two cohorts of incident PD patients before and after the relaxation of NHI’s erythropoietin payment criteria were identified as Cohort 1 and Cohort 2, respectively, and further matched by propensity scores and then followed up for cardiovascular events. There were 1,759 patients in Cohort 1 and 2,981 patients in Cohort 2. After propensity score matching, 1,754 subjects were selected from each cohort. The outcome measures were cardiovascular events and were analyzed through Cox regressions. Findings and Conclusion For the composite cardiovascular endpoint, Cohort 2 patients had significantly lower risk than Cohort 1. The risk reduction was observed only in diabetic patients. After loosening erythropoietin payment criteria, less cardiovascular risks were observed, particularly for diabetic patients. It is concluded that for diabetic PD patients, maintaining a Hct level higher than 30% is crucial for reducing the cardiovascular risk.

Cardiovascular risk factors in hemodialysis and peritoneal dialysis patients

2005 ◽  
Vol 65 (8) ◽  
pp. 739-745 ◽  
Author(s):  
F. M. Yilmaz ◽  
G. Yilmaz ◽  
M. Duranay ◽  
H. Parpucu ◽  
M. Şeneş ◽  
...  
Keyword(s):  
Risk Factors ◽  
Peritoneal Dialysis ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Dialysis Patients

scholarly journals SP520PERITONEAL ALBUMIN CLEARANCE AND NOT PROTEIN PREDICTS CARDIOVASCULAR RISK IN PERITONEAL DIALYSIS PATIENTS

2015 ◽  
Vol 30 (suppl_3) ◽  
pp. iii550-iii551
Author(s):  
Mooyong Park ◽  
Soo Jeong Choi ◽  
Seung Duk Hwang ◽  
Jin Kuk Kim ◽  
Hye Min Jo
Keyword(s):  
Peritoneal Dialysis ◽  
Cardiovascular Risk ◽  
Dialysis Patients ◽  
Albumin Clearance

scholarly journals Rationale and design for Lowering-hyperUricaemia treatment on cardiovascular outcoMes In peritoNeal diAlysis patients: a prospective, multicentre, double-blind, randomised controlled trial (LUMINA)

BMJ Open ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. e037842
Author(s):  
Wei Chen ◽  
Naya Huang ◽  
Haiping Mao ◽  
Xiao Yang ◽  
Qian Zhou ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Randomised Controlled Trial ◽  
Controlled Trial ◽  
Dropout Rate ◽  
Cardiovascular Outcomes ◽  
Control Group ◽  
Type I ◽  
Dialysis Patients ◽  
Double Blind ◽  
Randomised Controlled

IntroductionThe prevalence of hyperuricaemia in peritoneal dialysis patients is quite high. Studies have demonstrated a correlation between hyperuricaemia and cardiovascular disease and treatment of hyperuricaemia reportedly reduces cardiovascular risk in patients with chronic kidney disease. However, whether hyperuricaemia treatment benefits cardiovascular outcomes in continuous ambulatory peritoneal dialysis (CAPD) patients is not yet known.Methods and analysesThis prospective, multicentre, double-blind, randomised controlled trial was designed to evaluate the effects of hyperuricaemia treatment on cardiovascular event risk in CAPD patients. Based on a power of 80%, with type I error α=0.05, two-sided test and 1:1 parallel control study, considering a dropout rate of 20%, a total of 548 eligible patients are expected to be randomly assigned to either the hyperuricaemia treatment group (febuxostat) or control group (placebo).Ethics and disseminationThis study has been approved by the Medical Ethics Committee of the First Affiliated Hospital, Sun Yat-sen University and the ethics committees of other participating institutions. Written informed consent will be obtained from potential trial participants or authorised surrogates.The findings of the study will be disseminated through publications in peer-reviewed journals, and presentations at national and international conferences.Trial registration numberNCT03200210. 25 June 2017. The trial was started on 13 July 2017, and is expected to end by 31 December 2022. Till 20 Jan 2020, a total of 548 patients have been recruited.Protocol versionThe protocol version number and date are YLT-1604-V2.0 and 15 December 2016.

Longitudinal Trends in Quality of Life and Physical Function in Frail Older Dialysis Patients: A Comparison of Assisted Peritoneal Dialysis and In-Center Hemodialysis

2019 ◽  
Vol 39 (2) ◽  
pp. 112-118 ◽  
Author(s):  
Osasuyi Iyasere ◽  
Edwina Brown ◽  
Fabiana Gordon ◽  
Helen Collinson ◽  
Richard Fielding ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Peritoneal Dialysis ◽  
Mixed Model ◽  
Rating Scale ◽  
Depression Scale ◽  
Dialysis Patients ◽  
The Impact ◽  
Assisted Peritoneal Dialysis

Background In-center hemodialysis (HD) has been the standard treatment for older dialysis patients, but reports suggest an associated decline in physical and cognitive function. Cross-sectional data suggest that assisted peritoneal dialysis (aPD), an alternative treatment, is associated with quality of life (QoL) outcomes that are comparable to in-center HD. We compared longitudinal changes in QoL between modalities. Methods We enrolled 106 aPD patients, matched with 100 HD patients from 20 renal centers in England and Northern Ireland. Patients were assessed quarterly for 2 years using the Hospital Anxiety and Depression Scale (HADS), SF-12 physical and mental scores, symptom score, Illness Intrusiveness Rating Scale (IIRS), Barthel's score, and the Renal Treatment Satisfaction Questionnaire (RTSQ). Mixed model analysis was used to assess the impact of dialysis modality on these outcomes during follow-up. P values were adjusted for multiple significance testing. Results Multivariate analysis showed no difference in any of the outcome measures between aPD and HD. Longitudinal trends in outcomes were also not significantly different. Higher age at baseline was associated with lower IIRS and RTSQ scores during follow-up. One-hundred and twenty-five (60.6%) patients dropped out of the study: 59 (28.6%) died, 61 (29.6%) withdrew during follow-up, and 5 (2.5%) were transplanted. Conclusions Quality of life outcomes in frail older aPD patients were equivalent to those receiving in-center HD. Assisted PD is thus a valid alternative to HD for older people with end-stage kidney disease (ESKD) wishing to dialyze at home.

scholarly journals SP494CORRELATION OF RESIDUAL RENAL FUNCTION WITH CARDIOVASCULAR RISK FACTORS IN PERITONEAL DIALYSIS PATIENTS: A MULTICENTRE STUDY

2015 ◽  
Vol 30 (suppl_3) ◽  
pp. iii542-iii542
Author(s):  
Nikolina Basic-Jukic ◽  
Josipa Radic ◽  
Bozidar Vujicic ◽  
Zeljka Grdan ◽  
Marko Jakic ◽  
...  
Keyword(s):  
Risk Factors ◽  
Renal Function ◽  
Peritoneal Dialysis ◽  
Cardiovascular Risk ◽  
Multicentre Study ◽  
Cardiovascular Risk Factors ◽  
Residual Renal Function ◽  
Dialysis Patients

Four steps to standardize reporting of peritoneal dialysis technique failure: A proposed approach

2020 ◽  
pp. 089686082097693
Author(s):  
Alix Clarke ◽  
Pietro Ravani ◽  
Matthew J Oliver ◽  
Mohamed Mahsin ◽  
Ngan N Lam ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Outcome Measure ◽  
Time Window ◽  
Time Windows ◽  
Dialysis Patients ◽  
Data Set ◽  
The Impact ◽  
Technique Failure ◽  
Standardize Reporting ◽  
Dialysis Technique

Background: Technique failure is an important outcome measure in research and quality improvement in peritoneal dialysis (PD) programs, but there is a lack of consistency in how it is reported. Methods: We used data collected about incident dialysis patients from 10 Canadian dialysis programs between 1 January 2004 and 31 December 2018. We identified four main steps that are required when calculating the risk of technique failure. We changed one variable at a time, and then all steps, simultaneously, to determine the impact on the observed risk of technique failure at 24 months. Results: A total of 1448 patients received PD. Selecting different cohorts of PD patients changed the observed risk of technique failure at 24 months by 2%. More than one-third of patients who switched to hemodialysis returned to PD—90% returned within 180 days. The use of different time windows of observation for a return to PD resulted in risks of technique failure that differed by 16%. The way in which exit events were handled during the time window impacted the risk of technique failure by 4% and choice of statistical method changed results by 4%. Overall, the observed risk of technique failure at 24 months differed by 20%, simply by applying different approaches to the same data set. Conclusions: The approach to reporting technique failure has an important impact on the observed results. We present a robust and transparent methodology to track technique failure over time and to compare performance between programs.

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