Management of Hemodialysis Patients with Suspected or Confirmed COVID-19 Infection: Perspective from the Spanish Nephrology

BackgroundThe recent SARS-CoV-2 coronavirus pandemic has signified a significant effect on the health of the population worldwide. Patients on chronic RRT have been affected by the virus, and they are at higher risk due to the frequent comorbid conditions. Here, we show the results of the COVID-19 Registry of the Spanish Society of Nephrology during the first 6 weeks of the outbreak.MethodsThis study is an analysis of the data recorded on a registry of patients with ESKD on RRT who tested positive for COVID-19. The aim was to evaluate clinical conditions, therapeutic management, and consequences, including outcome. The registry began on March 18th, 2020. It includes epidemiologic data, cause of CKD, signs and symptoms of the infection, treatments, and outcomes. Patients were diagnosed with SARS-CoV-2 infection on the basis of the results of PCR of the virus obtained from nasopharyngeal/oropharyngeal swabs. The tests were performed on symptomatic patients and on those who mentioned contact with infected patients.ResultsAs of May 2, the registry included data on 1397 patients (in-center hemodialysis [IC-HD], 63%; kidney transplant [Tx], 34%; peritoneal dialysis [PD], 3%; and home hemodialysis, 0.3%). The mean age was 67±15 years, and two-thirds were men. Dialysis vintage was 46±41 months, and the time after transplantation was 59±54 months. Eighty-five percent of the patients required hospital admission, and 8% had to be transferred to intensive care units. Overall mortality was 25% (IC-HD, 27%; Tx, 23%; and PD, 15%), and significant proportions of deceased patients have advanced age, are on IC-HD, and presented pneumonia. Age and pneumonia were independently associated with the risk of death.ConclusionsSARS-CoV-2 infection affected a significant number of Spanish patients on RRT, mainly those on IC-HD. Hospitalization rates and mortality were high. The factors more closely related to mortality were age and pneumonia.

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Impact of SARS-CoV-2 infection in the population on peritoneal dialysis. The Spanish experience : preliminary results.

Bulletin de la Dialyse à Domicile ◽

10.25796/bdd.v3i3.57873 ◽

2020 ◽

Vol 3 (3) ◽

pp. 147-154

Author(s):

Emilio Sanchez-Alvarez ◽

Maria Auxiliadora Bajo Rubio ◽

Vicente Paraíso Cuevas ◽

Virginia López de la Manzanara ◽

Rosario Llópez Carratala ◽

...

Keyword(s):

Peritoneal Dialysis ◽

General Population ◽

Signs And Symptoms ◽

Spanish Society ◽

Autonomous Communities ◽

Risk Of Death ◽

Transplant Patients ◽

Hospitalization Rates ◽

Effect Of Pd ◽

Very High

The recent appearance of the SARS-CoV-2 pandemic has had a significant impact on the general population. Patients on renal replacement therapy (RRT) have not been unaware of this situation, and due to their characteristics, they are especially vulnerable. We present the results of the analysis of the COVID-19 Registry of the Spanish Society of Nephrology. This online registry began operating on March 18, 2020. It collects epidemiological variables, contagion and diagnosis data, signs and symptoms, treatments, and outcomes. Patients were diagnosed with SARS-CoV-2 infection based on the results of the PCR of the virus, carried out both in patients who had manifested compatible symptoms or had suspicious signs and in those who had undergone screening after contact with another patient. As of July 18, the registry had data on 1748 patients, from all the autonomous communities. The most represented form of RRT is in-center hemodialysis (HDC), followed by transplant patients. Only 55 (4%) were on peritoneal dialysis (PD). PD patients’ symptoms are similar to those of the general population. A very high percentage (93%) required hospital admission, but none in intensive care units. The most used treatments were hydroxychloroquine, lopinavir–ritonavir, and steroids. Mortality is high and reaches 18%. Age and pneumonia were independently associated with the risk of death. We also found a beneficial effect of PD over HDC. As conclusions, SARS-CoV-2 infection already affects a significant number of Spanish patients on RRT, mainly those on HDC. The proportion of infected patients on PD is significantly lower. Hospitalization rates are very high, and mortality is high; age and the development of pneumonia are factors associated with mortality, while those on PD had lower mortality.

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Use of Renin-Angiotensin System Blockers Increases Serum Potassium in Anuric Hemodialysis Patients

American Journal of Nephrology ◽

10.1159/000491552 ◽

2018 ◽

Vol 48 (2) ◽

pp. 79-86 ◽

Cited By ~ 3

Author(s):

Ezio Movilli ◽

Corrado Camerini ◽

Paola Gaggia ◽

Roberto Zubani ◽

Giovanni Cancarini

Keyword(s):

Blood Pressure ◽

Serum Potassium ◽

Hemodialysis Patients ◽

K Value ◽

Interdialytic Weight Gain ◽

Increased Risk ◽

Dialysis Vintage ◽

Significant Difference ◽

Severe Hyperkalemia ◽

The Mean

Background: Angiotensin converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARB) are increasingly used in uremic patients (pts). However, their effect on serum potassium (sK) concentrations in anuric pts on chronic hemodialysis treatment (HD) is controversial. The aim of the study was to evaluate sK before and after the start of ACEi/ARB therapy. Methods: In the period 1/1/2015 – 31/12/2015, 112 out of 240 prevalent HD pts on thrice weekly HD treatment followed at our institution started the ACEi/ARB therapy. The mean age was 67 ± 14 years, 67/112 were men, dialysis vintage was 6–212 months. In the 3 months before (PRE; N° 36 HD sessions) and after (POST; N° 36 HD sessions) the start of ACEi/ARB therapy, the following variables were evaluated in pre dialysis after the long interdialysis interval: sK (mean of 12 determinations; mmol/L), maximum sK (maximum K value observed during observations; sKmax; mmol/L), serum sodium (sNa; mmol/L), pre dialysis systolic blood pressure (SBP; mm Hg) and diastolic blood pressure (DBP; mm Hg), body weight (BW; Kg), interdialytic weight gain (IWG; Kg), Kt/V, serum bicarbonate concentrations (sBic; mmol/L), protein catabolic rate (PCRn; g/KgBW/day). SBP, DBP, IWG are the mean of the 24 HD sessions. Out of 112 patients, 102 were on antihypertensive therapy. The duration of HD and blood and dialysate flow rates were kept constant. Data are expressed as mean ± SD. Student t test for paired and unpaired data for normally distributed variables, Mann-Whitney test for medians, χ2 test for categorical data were employed to compare groups. A significant difference was defined as p < 0.05. Results: sK increased from 5.0 ± 0.4 mmol/L PRE to 5.7 ± 0.5 mmol/L POST (p < 0.0001). sKmax increased from 5.3 ± 0.5 mmol/L PRE to 6.2 ± 0.6 mmol/L POST (p < 0.0001). The percentage of pts with normal sK concentrations decreased from 82% PRE to 29% POST (p < 0.0001). Mild hyperkalemia increased from 18 to 52% (p < 0.001); in 31% of the patients, it was necessary to reduce the K dialysate concentration. None of the patients had severe hyperkalemia PRE, but 19% developed severe hyperkalemia POST (p < 0.0001) necessitating treatment withdrawal. Mean sK in these pts varied from 5.2 ± 0.3 mmol/L PRE to 6.5 ± 0.2 mmol/L at the moment of withdrawal (p < 0.0001) and sKmax from 5.5 ± mmol/L PRE to 6.9 ± 0.3 mmol/L (p< 0.0001). After withdrawal of ACEi/ARB, sK and sKmax concentrations decreased to basal levels within 1 month. There were no significant changes of BW, IWG, SBP, DBP, Na, Hb, Kt/V, sBic, and PCRn in both periods. Conclusions: ACEi/ARB therapy is associated with an increased risk of hyperkalemia in anuric hemodialysis patients. The proportion of patients with normal sK concentrations decreased from 82 to 29% and with mild hyperkalemia increased from 18 to 52%. Severe hyperkalemia necessitating the interruption of ACEi/ARB therapy developed in 19% of patients. This suggests great caution in the widest utilization of this class of drugs in HD patients.

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P1464ROUTINELY MEASURED CARDIAC TROPONIN I AND NT-PROBNP AS PREDICTORS OF MORTALITY IN JAPANESE HEMOLIALYSIS PATIENTS: THE DIALYSIS OUTCOMES AND PRACTICE PATTERNS STUDY

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p1464 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Masahiro Eriguchi ◽

Kazuhiko Tsuruya ◽

Marcelo Lopes ◽

Brian Bieber ◽

K P McCullough ◽

...

Keyword(s):

Heart Failure ◽

Kidney Disease ◽

Troponin I ◽

Reference Group ◽

Hemodialysis Patients ◽

Cardiac Biomarkers ◽

P Values ◽

Risk Of Death ◽

Dialysis Vintage ◽

Positive Direct

Abstract Background and Aims Due to the interplay of chronic kidney disease and the heart, it is common for myocardial damage and strain to be present in patients with end stage kidney disease. The cardiac biomarkers Troponin I (cTnI) and the N-terminal fragment of prohormone brain natriuretic peptide (NT-proBNP) are strongly predictive of heart failure in the general population, however the value of their routine measurement for stratification of risk in hemodialysis (HD) patients is unknown. International DOPPS data indicate that these cardiac biomarkers are measured in fewer than 2% of hemodialysis patients in real-world practice. We sought to test the associations of cTNI and NT-proBNP with death in a large HD cohort. Method We analyzed data from 1169 prevalent Japanese hemodialysis patients in DOPPS phase 5 (J-DOPPS; 2012-2015) where pre-dialysis levels of cTnI and NT-proBNP at study enrollment by protocol for all participants. We used Cox regression to test the association of the cardiac biomarkers with all-cause mortality, adjusting for potential confounders. We conducted stratified analyses to assess potential effect modification of individual clinical characteristics: age, systolic blood pressure, dialysis vintage, diabetes mellitus, cardiovascular disease, and heart failure (CHF). Results Median (interquartile range) cTnI and NT-proBNP levels were 0.018 [0.005, 0.04] ng/mL and 3432 [1580, 8017] pg/mL, respectively. There was a positive direct association between cTNI and NT-proBNP (Spearman correlation coefficient=0.58). We observed 174 deaths during a median [IQR] follow-up time of 2.8 [2.3, 2.9] years. Compared to the reference group of cTNI<0.01 the hazard ratio (HR) of death (95% CI) was 1.23 (0.57, 2.69) for cTNI ≥0.01 to 0.02; HR=1.94 (1.12, 3.37) for cTNI ≥0.02 to 0.04; and HR=3.65 (2.14, 6.23) forcTNI>0.04. Compared to the reference group of NT-proBNP <2000 pg/mL, HR= 1.20 (0.65, 2.23) for NT-proBNP ≥2000 to 4000 pg/mL; HR= 2.06 (1.22, 3.46) for NT-proBNP >4000 to 8000 pg/mL; and 3.23 (1.71, 6.09) for NT-proBNP > 8000pg/mL. For both variables associations with mortality were comparable in patients with and without heart failure (p values for interaction=0.07 and 0.19, for NT-proBNP and cTNI, respectively) and according to other stratification variables (the p values for interaction were >0.15 for all other stratified models). Conclusion Routinely measured (not by indication) NT-proBNP and Troponin I are strongly associated with mortality among prevalent Japanese HD patients. Routine evaluation of these cardiac biomarkers in HD patients with or without a previous diagnosis of CHF may help identify patients at risk of death who may have undetected heart failure or cardiac strain due to fluid overload.

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THE CHARACTERISTIC DESCRIPTION OF COMPLIANCE WITH FLUID LIMITATION, INTERDYALITIC WEIGHT GAIN (IDWG), AND QUALITY OF LIFE IN HEMODIALYSIS PATIENTS IN PALEMBANG CITY

INTERNATIONAL JOURNAL OF NURSING AND MIDWIFERY SCIENCE (IJNMS) ◽

10.29082/ijnms/2020/vol4/iss2/300 ◽

2020 ◽

Vol 4 (2) ◽

pp. 132-140

Author(s):

Fermata - Sari ◽

Raveinal Raveinal ◽

Esi Apriyanti

Keyword(s):

Quality Of Life ◽

Weight Gain ◽

Average Length ◽

Hemodialysis Patients ◽

Mean Value ◽

Fluid Restriction ◽

Risk Of Death ◽

Routine Identification ◽

The Mean

Patients with hemodialysis are required to carry out routine care, diet arrangements, and fluid restrictions. The highest non-compliance in patients is fluid restriction. Excessive fluid intake can be seen from weight gain between dialysis time (IDWG). IDWG in hemodialysis patients should not be more than 3.5%, where an increase in IDWG can cause the risk of death and decreased quality of life. However, at the hospital itself, routine identification of fluid restriction non-compliance activities was not carried out, so that there were still many patients with hemodialysis who experienced an increase in IDWG in the moderate and severe categories. The purpose of this study is to explore the characteristics, fluid restriction compliance, IDWG, and quality of life in hemodialysis patients. This is done to plan the provision of further intervention in patients. The design in this study was cross-sectional with sampling techniques with simple random sampling. The results of the study characteristics of respondents at the age of 46-55 years (64.7%) more male sex (55.9%), and high school education (47.1%), all respondents were married (100%), most not working (58.8%), the average length of hemodialysis is 18 months. The mean mean liquid restriction compliance was 27.35, the mean value of IDWG was 4.97 and the mean value of quality of life was 51.72.

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The use of epoetin alfa biosimilar in the anemia management in hemodialysis patients

Ukrainian Journal of Nephrology and Dialysis ◽

10.31450/ukrjnd.3(71).2021.05 ◽

2021 ◽

pp. 36-43

Author(s):

I. O. Dudar ◽

E. K. Krasjuk ◽

Y. I. Honchar ◽

O. M. Loboda ◽

I. M. Shifris ◽

...

Keyword(s):

Adverse Events ◽

Mild Hypertension ◽

Hemodialysis Patients ◽

Epoetin Alfa ◽

Serious Adverse Events ◽

Dialysis Vintage ◽

Anemia Management ◽

The Mean ◽

Anemia Treatment

Abstract. The present study aimed to evaluate the efficacy and safety of EMAVAIL (epoetin alfa) in the correction of anemia in hemodialysis patients. Methods. A total of 36 patients undergoing regular hemodialysis were enrolled in this prospective study. Among the patients were 19 (53%) men and 17 (47%) women with severe anemia (hemoglobin (Hb) level ≤ 90 g/L). The mean patients' age was 48.41±1.82 years, an average dialysis vintage consisted of 42.38±10.41 months. All the patients had thrice-weekly hemodialysis sessions, with a mean duration of 12.6 ± 0.51 hours per week and Kt/V 1.27 ± 0.08. All the patients were treated with biosimilar of epoetin alfa EMAVAIL intravenously three times a week in adjustable doses. The follow-up period was 56 days. Results. At the study entry, the mean Hb level in hemodialysis patients was 81.7±0,93 g/L. In 56 days of anemia treatment, the concentration of Hb increased to 109.17±1.75 g/L. Eventually, 32 (89%) patients achieved the target Hb level (110 g/L); 6 (17%) patients had adverse events (mild hypertension). There were no serious adverse events. Conclusions. EMAVAIL is an effective and safe epoetin alfa biosimilar for anemia management in hemodialysis patients.

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Infection-Related Hospitalizations in Home Hemodialysis Patients

Blood Purification ◽

10.1159/000433517 ◽

2015 ◽

Vol 40 (3) ◽

pp. 187-193 ◽

Cited By ~ 2

Author(s):

Shu-Hong Bi ◽

Wen Tang ◽

Nives Rigodanzo-Massey ◽

Bessie A. Young ◽

Christopher R. Blagg ◽

...

Keyword(s):

Cox Regression ◽

Journal Club ◽

Hemodialysis Patients ◽

Dialysis Access ◽

Home Hemodialysis ◽

Cox Regression Analysis ◽

Hospitalization Rates ◽

Dialysis Vintage ◽

System Data

Introduction and Aims: Infection is an important cause of hospitalization and death in patients receiving hemodialysis (HD). Few studies have examined infection-related hospitalizations in home HD (HHD) population. The purpose of this study was to examine the scope of infections and the effect of HHD modality (daily home HD (DHD) and conventional home HD (CHD)) on infection-related hospitalizations in HHD patients. Methods: The study was performed in a large cohort of HHD patients. Infection-related hospitalizations during July 1, 2005, and August 30, 2010, were abstracted from the centralized computer system. Data on demographics, dialysis vintage and dialysis modality were analyzed. Results: One hundred sixty-five patients were included. During a median follow-up of 5 years, infection-related hospitalizations were observed in approximately 35.8% of all hospitalizations, which was the first cause for hospitalization. Rates of non-access-related infections were observed to be higher than that of access-related infections (1.7:1). Rates (per 100 person-years) of soft-tissue infection, pneumonia and sepsis ranged from 0.85 to 1.82 in patients on HHD. Meanwhile, access-related infection was the main cause for access-related hospitalizations (34.8%). Cox regression analysis showed that the usage of different dialysis modalities was not associated with a high risk for infection-related hospitalizations in HHD patients. Conclusions: Infection-related hospitalization occurred frequently in HHD patients. A broad range of infections, many unrelated to dialysis access, resulted in hospitalization in this population. HHD modalities were not associated with infection-related hospitalizations in HHD patients. Video Journal Club ‘Cappuccino with Claudio Ronco' at http://www.karger.com/?doi=433517.

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P1440ASSOCIATION BETWEEN THE USE OF DRUGS FOR CONSTIPATION AND MORTALITY IN HEMODIALYSIS PATIENTS; FROM JAPAN-DIALYSIS OUTCOMES AND PRACTICE PATTERNS STUDY (J-DOPPS)

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p1440 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Seiji Itano ◽

Yu Honda ◽

Eiji Kubo ◽

Yosuke Yamada ◽

Tatsuyoshi Ikenoue ◽

...

Keyword(s):

Risk Factors ◽

Practice Patterns ◽

Cardiovascular Death ◽

Hemodialysis Patients ◽

Gastrointestinal Complications ◽

Cox Regression Analysis ◽

Risk Of Death ◽

Dialysis Vintage ◽

Dialysis Outcomes ◽

Observation Period

Abstract Background and Aims Hemodialysis patients have a high prevalence of constipation related to medication use, water restriction, insufficient dietary fiber intake, and reduced physical activity. Thus, these patients use drugs for constipation (DFC) more than five times that used by healthy individuals. In hemodialysis patients, two pathological factors, namely, reduced defecation function and DFC use itself, occur. These factors could be related to deteriorating life prognosis resulting from altered intestinal microbiota, gastrointestinal complications, or declining quality of life. In the general population, some reports have suggested that constipation and DFC use are risk factors of coronary artery disease, cardiovascular death, or all-cause death. However, whether such risk factors are appropriate for hemodialysis patients has not been clarified. This study aimed to investigate the association between DFC use and risk of death in hemodialysis patients. Method In this prospective cohort study based on the Japan-Dialysis Outcomes and Practice Patterns Study (J-DOPPS), we used J-DOPPS phase 1-5 (1998-2015) data. Hemodialysis patients enrolled in the J-DOPPS whose dialysis vintage was >3 months (n=12,217) were divided into two groups according to usage (DFC group;n=3,721) and non-usage (non-DFC group;n=8,496) of DFC. The primary endpoint was all-cause death. Secondary endpoints were deaths from infection, malignancy, and cardiovascular causes. Hazard ratio (HR) was calculated using multilevel Cox regression analysis with facility level. Potential confounders were adjusted by the inverse probability of treatment weighting using the propensity score. Rubin’s rule was used for combined data. Sensitivity analysis was conducted using instrumental variable method to assess the effect of unmeasured confounders. Missing data were imputed using multilevel multiple imputation repeated 20 times. Results DFCs were prescribed in 30.5% of patients at baseline. Over a median follow-up of 730 [418, 974] days, 1,240 deaths from any cause were noted. Overall data were analyzed first. Although DFC use was associated with increased mortality risk (adjusted HR, 1.12; 95% confidence interval [CI] 1.03, 1.21), proportional assumptions were not met (Figure). Then, we only analyzed data of patients with observation period >1.5 years. In this study, 8,345 patients had an observation period >1.5 years, DFCs were prescribed in 31.0% of patients at baseline, and 389 patients died from any cause. Marked difference was observed after 1.5 years from baseline (adjusted HR, 1.35; 95% CI, 1.17, 1.55). Risks for deaths from infections (adjusted HR 1.62; 95% CI 1.14, 2.29) and malignancy (adjusted HR 1.60; 95% CI, 1.08, 2.36) were higher in the DFC group, but no difference in cardiovascular death risk was found (adjusted HR 1.11; 95% CI, 0.91, 1.36). Conclusion In hemodialysis patients, DFC use was associated with an increased risk of death. Thus, it may be important to manage defecation habit without using DFC by modulating intake of dietary fibers, exercise, or use of medications that are less likely to cause constipation.

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P1584FRAILTY IN MAINTENANCE HEMODIALYSIS PATIENTS

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p1584 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Zauresh Amreyeva ◽

Gulnar Chingayeva ◽

Abay Shepetov ◽

Assiya Kanatbayeva ◽

Arina Yespotayeva

Keyword(s):

Nutritional Status ◽

Elderly Patients ◽

Hemodialysis Patients ◽

Maintenance Hemodialysis ◽

Measurement Tool ◽

Frail Patients ◽

Dialysis Vintage ◽

Significant Difference ◽

The Mean ◽

Elderly Hemodialysis Patients

Abstract Background and Aims The population in Kazakhstan is rapidly aging, as a result the number of geriatric patients on maintenance hemodialysis (MHD) has been increasing. Frailty is prevalent in dialysis patients and is one of the common factors that can lead to increased morbidity and mortality. The primary objectives of this study were to evaluate the prevalence of frailty in elderly patients on MHD by using Edmonton Frailty Scale and assess their association with clinical and laboratory measurements. A secondary objective was to investigate the relationship between nutritional status and frailty. Method From July to September 2018, a total of 65 elderly patients undergoing HD in 7 dialysis facilities in Almaty, Kazakhstan were enrolled in this cross-sectional study. All participants were evaluated for the cognitive status through Mini-Mental State Examination (MMSE), nutritional status by using Mini Nutritional Assessment (MNA), Malnutrition-Inflammation Score (MIS), and anthropometric measurements (body mass index (BMI), triceps skinfold (TSF), mid-arm muscle circumference (MAMC)), functionality (Handgrip strength), as well biochemical data were collected from medical records. Frailty was defined in accordance with the Edmonton Frail scale (EFS). Results The study participants’ median age was 69 (range: 65–88) years old, and median dialysis vintage was 36 (IQR 15–60) months, 53.8% were female. The main comorbidities were hypertension (69.2%) and diabetes (35.4%). The prevalence of frailty assessed by the EFS was 23.1% (men: 13.3%; women: 86.7), 43.1% patients were non-frail (men: 64.3%; women: 35.7%), 33.8% patients were vulnerable (men: 45.5%; women: 54.5%). Based on MIS the prevalence of PEW was 73.8% and, according to MNA, the risk of malnutrition was detected in 47.7%, and 9.2% had malnutrition. No signiﬁcant difference was observed between genders in the frequency of PEW. Mean body weight was 69.1±11.3kg, the mean BMI was slightly overweight 25.6±4.29kg/m2, while hand-grip strength was 21.33±3.36 in men and 15.5±5.51 in women, p=0.008, and it is lower than the normal population standard values. The frail patients group had a higher proportion of women 86.7% (p=0.001), worse nutritional status (93.3% and 86,7% had PEW evaluated by MIS (p=0.018) and MNA (p=0.035), respectively), more frequency of falls (p=0.01), anemia (p=0.038) when compared to group of non-frail and vulnerable patients. 66.7% of frail patients were widowed (p=0.005). The mean MMSE in this group of patients was 26.7±1.9. Conclusion The prevalence of frailty among elderly hemodialysis patients in this study was 23.1%, and we detected that 86.7% of them were female, as well PEW increased in frail patients. Also the study showed that protein-energy wasting is common among elderly hemodialysis patients. Its prevalence varies between 73.8% and 56.9% depending on the measurement tool used to evaluate the nutritional status. In our country with limited resources, EFS, MIS and MNA could help to follow elderly hemodialysis patients.

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Renal Anemia Control in Lithuania: Influence of Local Conditions and Local Guidelines

The Scientific World JOURNAL ◽

10.1155/2013/260915 ◽

2013 ◽

Vol 2013 ◽

pp. 1-8 ◽

Cited By ~ 1

Author(s):

Edita Ziginskiene ◽

Vytautas Kuzminskis ◽

Kristina Petruliene ◽

Ruta Vaiciuniene ◽

Asta Stankuviene ◽

...

Keyword(s):

Relative Risk ◽

Intravenous Iron ◽

Fold Increase ◽

Hemodialysis Patients ◽

Renal Anemia ◽

Local Conditions ◽

Risk Of Death ◽

Hemoglobin Variability ◽

Hospitalization Rates ◽

History Of

Erythropoietin stimulating agents had a long haul in Lithuania—we had no epoetin till 1994 and there was no intravenous iron in 2001–2004. The aim of this study was to assess the changes of renal anemia control in hemodialysis patients from early independence of Lithuania till nowadays and to evaluate the link of anemia with hospitalization rates and survival and hemoglobin variability in association with mortality. In December of each year since 1996 all hemodialysis centers have been visited and data has been collected using special questionnaires. The history of renal anemia control in Lithuania was complicated; however, a significant improvement was achieved: 54.7% of hemodialysis patients reached the target hemoglobin; all patients have a possibility of treatment with epoetin and intravenous iron. The involuntary experiment with an intravenous iron occurred in Lithuania because of economic reasons and confirmed the significant role of intravenous iron in the management of renal anemia. Hemoglobin below 100 g/L was associated with a 2.5-fold increase in relative risk of death and 1.7-fold increase in relative risk of hospitalization in Lithuanian hemodialysis patients. Although hemoglobin variability was common in Lithuanian hemodialysis patients, we did not find the association between hemoglobin variability and all-cause mortality in our study.

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Prescription characteristics of phosphate binders in a high pill burden for hemodialysis patients

Renal Replacement Therapy ◽

10.1186/s41100-021-00322-2 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Nobuo Nagano ◽

Kyoko Ito ◽

Takashi Ono ◽

Yuichi Ariyoshi ◽

Soichiro Masima ◽

...

Keyword(s):

Significant Negative Correlation ◽

Hemodialysis Patients ◽

Chronic Hemodialysis ◽

Phosphate Binders ◽

Pill Burden ◽

Dialysis Patients ◽

Oral Drugs ◽

Dialysis Vintage ◽

The Mean ◽

The Relationship

Abstract Background Dialysis patients have to take many oral drugs, causing a high pill burden. Phosphate binders (PBs) account for a large proportion of daily pill burden; however, the relationship between patient background and prescription status of PBs is not clear. Methods We clarified the characteristics of PBs in the total daily pill burden by analyzing the drugs prescribed for 533 chronic hemodialysis patients in our facility. Results An average of nine different types of oral drugs was prescribed for each patient. The mean and median values of total pill burden were 15.1 and 14.1 pills/day/patient, respectively. The total pill burden showed a significant negative correlation with age and a significant positive correlation with dialysis vintage. In addition, the total pill burden was significantly higher in males than in females. However, there was no difference in the pill burden between patients with and without diabetes mellitus (DM). PBs were prescribed to 409 patients (76.7%), and the mean pill burden derived from PBs was 6.44 pills/day/patient. This was by far the highest of all 35 different drug categories and accounted for 32.84% of all pills. Multiple regression analysis demonstrated that independent predictors of total pill burden were age, dialysis vintage, DM, and serum phosphorus (P) levels, and all these variables, except DM, were also independent predictors of pill burden from PBs. These variables were also selected when considering the use of calcimimetics. Conclusions A high pill burden is more likely to occur in younger patients with longer dialysis vintage, DM, higher serum P levels, and prescription of calcimimetics. In addition, PB was the single largest contributor to the total pill burden that positively and linearly linked to serum P levels. Therefore, P management is a high-priority issue in the mitigation of high pill burdens in dialysis patients.

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