Representativeness of Honeypot Trial Participants to Australasian PD Patients

2017 ◽  
Vol 37 (5) ◽  
pp. 516-522 ◽  
Author(s):  
Lei Zhang ◽  
Sunil V. Badve ◽  
Elaine M. Pascoe ◽  
Elaine Beller ◽  
Alan Cass ◽  
...  
Keyword(s):  
New Zealand ◽  
Kidney Disease ◽  
Cumulative Effect ◽  
Residual Renal Function ◽  
Nasal Mupirocin ◽  
Baseline Characteristics ◽  
Artery Disease ◽  
End Stage ◽  
Anzdata Registry ◽  
Trial Participants

BackgroundThe HONEYPOT trial failed to establish the superiority of exit-site application of Medihoney compared with nasal mupirocin prophylaxis for the prevention of peritonitis in peritoneal dialysis (PD) patients. This study aimed to assess the representativeness of the patients in the HONEYPOT trial to the Australian and New Zealand PD population.MethodsThis study compared baseline characteristics of the 371 PD patients in the HONEYPOT trial with those of 6,085 PD patients recorded on the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry.ResultsCompared with the PD population, the HONEYPOT sample was older (standardized difference [ d] = 0.19, p = 0.003), more likely to be treated with automated PD ( d = 0.58, p < 0.001), had higher residual renal function ( d = 0.26, p < 0.001) and a higher proportion of participants with end-stage kidney disease due to polycystic kidney disease ( d = 0.17) and lower proportion due to diabetes ( d = -0.17) and glomerulonephritis ( d = -0.18) ( p < 0.001), and lower proportions of indigenous people ( d = -0.17, p < 0.001), current smokers ( d = -0.10, p < 0.001), and people with prior histories of hemodialysis ( d = -0.16, p < 0.001), diabetes mellitus ( d = -0.18, p < 0.001), and coronary artery disease ( d = -0.15, p < 0.001).ConclusionsHONEYPOT trial participants tended to be healthier than the Australian and New Zealand PD patient population. Although the differences between the groups were generally modest, it is possible that their cumulative effect may have had some impact on external generalizability, which is not an uncommon occurrence in clinical trials.

scholarly journals Protection of Residual Renal Function and Nutritional Treatment: First Step Strategy for Reduction of Uremic Toxins in End-Stage Kidney Disease Patients

Toxins ◽  
2021 ◽  
Vol 13 (4) ◽  
pp. 289
Author(s):  
Adamasco Cupisti ◽  
Piergiorgio Bolasco ◽  
Claudia D’Alessandro ◽  
Domenico Giannese ◽  
Alice Sabatino ◽  
...  
Keyword(s):  
Kidney Disease ◽  
Residual Renal Function ◽  
The Body ◽  
Uremic Toxins ◽  
End Stage Kidney Disease ◽  
Waste Products ◽  
Hemodialysis Treatment ◽  
Life Saving ◽  
Kidney Replacement Therapy ◽  
End Stage

The retention of uremic toxins and their pathological effects occurs in the advanced phases of chronic kidney disease (CKD), mainly in stage 5, when the implementation of conventional thrice-weekly hemodialysis is the prevalent and life-saving treatment. However, the start of hemodialysis is associated with both an acceleration of the loss of residual kidney function (RKF) and the shift to an increased intake of proteins, which are precursors of uremic toxins. In this phase, hemodialysis treatment is the only way to remove toxins from the body, but it can be largely inefficient in the case of high molecular weight and/or protein-bound molecules. Instead, even very low levels of RKF are crucial for uremic toxins excretion, which in most cases are protein-derived waste products generated by the intestinal microbiota. Protection of RKF can be obtained even in patients with end-stage kidney disease (ESKD) by a gradual and soft shift to kidney replacement therapy (KRT), for example by combining a once-a-week hemodialysis program with a low or very low-protein diet on the extra-dialysis days. This approach could represent a tailored strategy aimed at limiting the retention of both inorganic and organic toxins. In this paper, we discuss the combination of upstream (i.e., reduced production) and downstream (i.e., increased removal) strategies to reduce the concentration of uremic toxins in patients with ESKD during the transition phase from pure conservative management to full hemodialysis treatment.

Epidemiology and resource use in Spanish type 2 diabetes patients without previous cardiorenal disease: CaReMe Spain study

2021 ◽  
Author(s):  
Antoni Sicras-Mainar ◽  
Aram Sicras-Navarro ◽  
Beatriz Palacios ◽  
Miren Sequera ◽  
Julia Blanco ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Kidney Disease ◽  
Resource Use ◽  
Cox Model ◽  
National Health System ◽  
Secondary Data ◽  
Baseline Characteristics ◽  
Artery Disease

Abstract Background.To determine baseline characteristics, the first manifestation of cardiovascular or kidney disease (CVKD) and associated resource use in type 2 diabetes mellitus (T2DM) patients during 7 years of follow up. Methods.Observational-retrospective secondary data study using medical records of patients aged ≥18 years with T2DM and without prior CVKD during 2013-2019. The index date was 01/01/2013 (fixed date). The manifestation of CVKD was defined by the first diagnosis of heart failure (HF), chronic kidney disease (CKD), myocardial infarction (MI), stroke or peripheral artery disease (PAD). The main variables were baseline characteristics, manifestation of CVKD, mortality, resource use and costs (health, indirect related). Descriptive analyses and Cox model were applied to the data.Results.26,542 patients were selected (mean age: 66.6 years, women: 47.8%, mean duration of T2DM: 17.1 years). 18.7% (N=4974) developed a first CVKD manifestation during the 7 years [distribution: HF (22.4%), CKD (36.6%), MI (14.5%), stroke (15.3%) and PAD (11.3%)]. Overall mortality was 8.3% (N=2,214). The mortality risk of the group that developed HF or CKD as the first manifestation compared to the CVKD-free cohort was higher [HR: 2.5 (CI95%: 1.8-3.4) and 1.8 (95%CI: 1.4-2,3)], respectively. The cumulative costs per patient of HF (€50,942.8) and CKD (€48,979.2) were higher than MI (€47.343.2) and stroke (€47,070.3) and similar to PAD (€51,240,0) vs. €13,098.9 in patients who did not develop CVKD, p<0.001.Conclusions.In T2DM patients, HF and CKD were the first most common manifestations over the 7 years of follow up and had higher mortality and re-hospitalization rates. HF and CKD were associated with the highest resource use and costs for the Spanish National Health System.

Role of Imaging in Chronic Kidney Disease

2015 ◽  
Author(s):  
Sameer Ather ◽  
Ayman Farag ◽  
Vikas Bhatia ◽  
Fadi G. Hage
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Risk Stratification ◽  
Non Invasive ◽  
Improve Risk Stratification ◽  
Short And Long Term ◽  
Artery Disease ◽  
Long Term Prognosis ◽  
Stage Renal Disease ◽  
End Stage

Cardiovascular disease is highly prevalent in patients with chronic kidney disease (CKD) and is the biggest contributor of death in these patients. Myocardial perfusion imaging (MPI) is a validated tool for diagnosing coronary artery disease (CAD) and for predicting short and long term prognosis in this patient population. Non-invasive stress imaging, with MPI or other imaging modalities, is widely used for risk stratification in patients with end-stage renal disease (ESRD) being evaluated for kidney transplantation due to the paucity of donor organs and the high cardiovascular risk of patients on the transplant waiting list. In this Chapter we will review the data on diagnostic accuracy and risk stratification using MPI in patients with CKD and ESRD highlighting the special challenges that are unique to this population. We will also discuss novel indicators that have been used in these patients to improve risk stratification.

Obesity is a Risk Factor for Peritonitis in the Australian and New Zealand Peritoneal Dialysis Patient Populations

2004 ◽  
Vol 24 (4) ◽  
pp. 340-346 ◽  
Author(s):  
Stephen P. McDonald ◽  
John F. Collins ◽  
Markus Rumpsfeld ◽  
David W. Johnson
Keyword(s):  
Risk Factor ◽  
Peritoneal Dialysis ◽  
New Zealand ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Peritoneal Dialysis Patient ◽  
Normal Weight ◽  
Long Term Follow Up ◽  
Artery Disease ◽  
Anzdata Registry

Objective The aim of the present investigation was to examine the association between body mass index (BMI) and peritonitis rates among incident peritoneal dialysis (PD) patients in a large cohort with long-term follow-up. Design Retrospective observational cohort study of the Australian and New Zealand PD patient population. Setting Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry. Participants The study included all incident adult patients ( n = 10 709) who received PD in Australia and New Zealand in the 12-year period between 1 April 1991 and 31 March 2003. Patients were classified as obese (BMI ≥ 30 kg/m2), overweight (BMI 25.0 – 29.9 kg/m2), normal weight (20 – 24.9 kg/m2), or underweight (< 20 kg/m2). Main Measurements Time to first peritonitis and episodes of peritonitis per patient-year were recorded over the 12-year period. Results Higher BMI was associated with a shorter time to first peritonitis episode, independent of other risk factors [hazard ratio 1.08 for each 5-kg/m2 increase in BMI, 95% confidence interval (CI) 1.04 – 1.12, p < 0.001]. When peritonitis outcomes were analyzed as episodes of peritonitis per patient-year, these rates were significantly higher among patients with higher BMI: underweight 0.69 episodes/year (95% CI 0.66 – 0.73), normal weight 0.79 (95% CI 0.77 – 0.81), overweight 0.88 (95% CI 0.85 – 0.90), obese 1.06 (95% CI 1.02 – 1.09). Coronary artery disease and chronic lung disease were associated with both shorter time to first peritonitis and higher peritonitis rates, independently of these other factors. There was also a “vintage effect,” with lower peritonitis rates seen among people who commenced dialysis in more recent years. Conclusions Higher BMI at the commencement of renal replacement therapy is a significant risk factor for peritonitis. The mechanisms for this remain undefined.

scholarly journals Absolute risk and risk factors for stroke mortality in patients with end-stage kidney disease (ESKD): population-based cohort study using data linkage

BMJ Open ◽  
2019 ◽  
Vol 9 (2) ◽  
pp. e026263 ◽  
Author(s):  
Nicole Louise De La Mata ◽  
Maria Alfaro-Ramirez ◽  
Patrick J Kelly ◽  
Philip Masson ◽  
Rustam Al-Shahi Salman ◽  
...  
Keyword(s):  
Risk Factors ◽  
New Zealand ◽  
Kidney Disease ◽  
Cerebrovascular Disease ◽  
Cumulative Incidence ◽  
Data Linkage ◽  
Polycystic Kidney ◽  
End Stage Kidney Disease ◽  
End Stage ◽  
Stroke Death

IntroductionPeople with end-stage kidney disease (ESKD) have up to 30-fold higher risk of stroke than the general population.ObjectiveTo determine risk factors associated with stroke death in the ESKD population.MethodsWe identified all patients with incident ESKD in Australia (1980–2013) and New Zealand (1988–2012) from the Australian and New Zealand Dialysis and Transplant Registry (ANZDATA) registry. We ascertained underlying cause of death from data linkage with national death registries and risk factors from ANZDATA. Using a competing risks multivariable regression model, we estimated cumulative incidence of stroke and non-stroke deaths, and risk factors for stroke deaths (adjusted sub-HR, SHR).ResultsWe included 60 823 people with ESKD. There were 941 stroke deaths and 33 377 non-stroke deaths during 381 874 person-years of follow-up. Overall, the cumulative incidence of stroke death was 0.9% and non-stroke death was 36.8% 5 years after starting ESKD treatment. The risk of stroke death was higher at older ages (SHR 1.92, 95% CI 1.45 to 2.55), in females (SHR 1.41, 95% CI 1.21 to 1.64), in people with cerebrovascular disease (SHR 2.39, 95% CI 1.99 to 2.87), with ESKD caused by hypertensive/renovascular disease (SHR 1.39, 95% CI 1.09 to 1.78) or polycystic kidney disease (SHR 1.38, 95% CI 1.00 to 1.90), with earlier year of ESKD treatment initiation (SHR 1.93, 95% CI 1.56 to 2.39) and receiving dialysis (transplant vs haemodialysis SHR 0.27, 95% CI 0.09 to 0.84).ConclusionPatients with ESKD with higher risk of stroke death are older, women, with cerebrovascular disease, with hypertensive/renovascular or polycystic kidney disease cause of ESKD, with earlier year of ESKD treatment and receiving dialysis. These groups may benefit from targeted stroke prevention interventions.

scholarly journals Diuretics in chronic kidney disease

2020 ◽  
Vol 10 (1) ◽  
pp. 10-20
Author(s):  
A. I. Dyadyk ◽  
G. G. Taradin ◽  
Yu. V. Suliman ◽  
S. R. Zborovskyy ◽  
V. I. Merkuriev
Keyword(s):  
Chronic Kidney Disease ◽  
Renal Function ◽  
Kidney Disease ◽  
Diuretic Therapy ◽  
Extracellular Fluid ◽  
Residual Renal Function ◽  
Cardiovascular Complications ◽  
Loop Diuretics ◽  
Stage Renal Disease ◽  
End Stage

The issues of diuretic therapy in patients with chronic kidney disease, pharmacokinetics of diuretics, the problem of diuretic resistance, the tactics of using thiazides and loop diuretics in patients with various stages of chronic kidney disease, according to the recommendations of the National Kidney Foundation Kidney Disease Outcomes Quality Initiative are discussed in the article. Particular attention is paid to the prescription of this group of drugs to patients with end stage renal disease, as well as those undergoing renal replacement therapy (hemodialysis).Diuretics play an important role in the management of patients with chronic kidney disease with the development of hypertension and an increased extracellular fluid volume. In case of impaired renal function leading place is given to loop diuretics. Their combination with thiazide diuretics can increase the diuretic effect. The results of clinical trials assessing the effectiveness of the use of diuretics during decline of residual renal function are provided. It is reported about the effect of potassium-sparing diuretics on the incidence of cardiovascular complications, the development of hyperkalemia in patients undergoing dialysis treatment. The importance of continuation of intensive study about the possibility of antagonists of mineralocorticoid receptors usage, in particular the spironolactone, eplerenone, and finerenone in order to reduce cardiovascular complications and mortality, is indicated.

Causes of death in renal disease

ESC CardioMed ◽  
2018 ◽  
pp. 981-984
Author(s):  
Thomas F. Mueller ◽  
Valerie Luyckx
Keyword(s):  
Coronary Artery Disease ◽  
Renal Function ◽  
Coronary Artery ◽  
Sudden Cardiac Death ◽  
Kidney Disease ◽  
Renal Disease ◽  
Cardiac Death ◽  
End Stage Kidney Disease ◽  
Artery Disease ◽  
End Stage

Chronic kidney disease (CKD) encompasses a spectrum of diseases that are identified by a glomerular filtration rate below 90 mL/min/1.73m2 or the presence of proteinuria, or both of these, persisting for over 3 months. In population-based studies, mortality in patients with CKD is consistently several-fold higher than that in patients without CKD, and the risk increases as the severity of renal function worsens. Mortality risk is, not surprisingly, highest among those with end-stage kidney disease. In developed countries, patients with CKD and end-stage kidney disease do not die of renal disease, but die primarily of non-renal causes, the relative proportions of which change across the spectrum of renal function. In the early stages of CKD, malignancy tends to be the predominant case of death; however, as renal function worsens, the proportion of deaths related to cardiovascular disease increases. Coronary artery disease contributes to most cardiac deaths in those with milder CKD. The proportions of cardiac and overall deaths from heart failure and sudden cardiac death increase progressively as renal function declines. Sudden cardiac death is a major cause of death among patients with end-stage kidney disease. Multiple factors including underlying coronary artery disease, left ventricular hypertrophy, valvular heart disease, arrhythmias, volume and electrolyte abnormalities, uraemia, and inflammation all likely contribute to the increased risk of cardiovascular death. Much work is needed to understand the pathophysiology and develop strategies to prevent cardiovascular deaths especially in the CKD population.

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