Dialysis Events Research Articles

Interaction between Albuminuria and Treatment Group Outcomes for Patients with Renal Artery Stenosis: The NITER Study

PurposeTo perform a post-hoc analysis of the Nephropathy Ischemic Therapy (NITER) trial, which enrolled patients with atherosclerotic renal artery stenosis, to evaluate whether medical therapy plus stent placement is superior to medical therapy alone in patients without elevated albuminuria. Materials and MethodsData from 51 patients were analyzed and stratified into 2 cohorts by median urinary albumin (UAlb) levels: cohort 1 (“low albuminuria,” UAlb ≤0.04 g/24h) and cohort 2 (“high albuminuria,” UAlb >0.04g/24h). Interaction effect between treatment arms and UAlb cohorts was calculated using Cox regression analysis. Survival analysis was followed by test for effect size, power analysis, and construction of a Kaplan-Meier survival table. ResultsAt study completion, 13 patients had an outcome event: 6 (23%) from cohort 1 and 7 (28%) from cohort 2. Patients in cohort 1 had event-free survival of 83% at 3.9 ± 0.3 years from the primary endpoints of all-cause mortality, dialysis, and cardiovascular events when treated with interventional therapy, compared to 45% when treated with medical therapy alone (P = .501), which showed a 62% treatment effect for stent placement. In cohort 2, event-free survival rates were 64% for medical therapy versus 52% for medical plus interventional therapy (P = .64). Using Cox regression analysis, the interaction effect between treatment arms and UAlb cohorts was not significant (P = .32). The power of the study to detect an interaction effect, if one existed, was only 15%. ConclusionsInference cannot be drawn for similar populations because of inadequate sample size, but, in this sample, patients treated with stent placement who had low albuminuria had better outcomes than patients treated with medical therapy alone.

Apolipoprotein B/apolipoprotein A1 ratio and mortality among incident peritoneal dialysis patients

BackgroundTo investigate the association between the ratio of apolipoprotein B (apo B) / apolipoprotein A1 (apo A1) with all-cause mortality and cardiovascular events in peritoneal dialysis (PD) patients.MethodsEight hundred and sixty incident PD patients were enrolled from November 1, 2005, to February 28, 2017, and followed until May 31, 2017. Outcomes were all-cause mortality and cardiovascular events. Associations between the apo B/apo A1 ratio with all-cause mortality and cardiovascular events were evaluated using multivariable-adjusted Cox models.ResultsOf the 860 patients, the mean age was 49.9 ± 14.5 years, 57.6% were men, and 19.3% were diabetic patients. The median apo B/apo A1 ratio was 0.65 (range: 0.22–2.24). During a median follow-up period of 27 months (interquartile range, 13 – 41 months), 202 deaths, and 145 cardiovascular events were recorded. After adjustment for age, sex, body mass index, diabetes, cardiovascular disease, systolic blood pressure, total Kt/V, estimated glomerular filtration rate, hemoglobin level, neutrophil to lymphocyte ratio and albumin, triglyceride, and cholesterol, as well as the use of lipid-lowering agents, the highest apo B/apo A1 ratio tertile was significantly associated with a hazard ratio for all-cause mortality of 1.60 (95% CI: 1.02 to 2.49, P = 0.040) and for cardiovascular events of 2.04 (95% CI: 1.21 to 3.44, P = 0.008).ConclusionAn increased apo B/apo A1 ratio was independently associated with all-cause mortality and cardiovascular events in PD patients.

Opportunities to Improve Patient Engagement in Dialysis Decisions for Older Adults with Life-Limiting Kidney Disease (TH370B)

•Identify opportunities to improve patient engagement in decision making during visits with specialist providers.•Identify how the Best Case/Worst Case tool can help specialists improve patient engagement in conversations regarding life-sustaining treatments.•List key components of physician-patient conversations that promote patient engagement. Older adults who initiate dialysis often passively accept treatment without making an active choice to commit to life-supporting therapy. Interventional strategies that target the dialysis decision-making conversation between patients and their nephrologists may promote earlier access to palliative care, leading to better outcomes. To characterize communication about dialysis and evaluate the proof of concept of an intervention to change nephrologist communication. Pre/post-intervention study design. We recorded 16 outpatient conversations between nephrologists and patients age 70 and older with an eGFR≤20 mL/min/1.73 m2, not on dialysis. After recording the first 12 conversations, we trained seven nephrologists to use the Best Case/Worst Case (BC/WC) communication tool to describe treatment options and potential outcomes within the context of the patient's overall health. We used OPTION 5 and qualitative analysis to measure and characterize patient engagement in decision making before and after BC/WC training. Before training, OPTION 5 scores were low (median 20 out of 100 (IQR 15-35)), suggesting limited patient engagement in decision making. Nephrologists typically discussed lab values and considered when and how patients might receive dialysis. Few acknowledged the option of “no dialysis.” After training, nephrologists used BC/WC with fidelity and OPTION 5 scores increased (median 65 (IQR 50-76)). Using the BC/WC tool, nephrologists presented a choice between dialysis and supportive care without dialysis, described how dialysis and other health events might be experienced, provided prognostic information, and used phrases to elicit patients' goals. Currently nephrologists discuss the mode and timing of dialysis without disclosing prognosis or presenting dialysis as a choice. This leaves limited opportunity for patients to understand the role of supportive care or palliative care concurrent with dialysis. Interventions to support patient engagement in treatment decisions may improve access to palliative care.

A Retrospective Analysis of Dialysis Events over a 3-Year Period in an Outpatient Dialysis Unit in the State of Kuwait

Objective: To determine the difference in the rates of dialysis events stratified by vascular access type and to describe the microbiological profile and sensitivity patterns of positive blood cultures over a 3-year period. Subjects and Methods: The dialysis event data of 10,751 chronic hemodialysis patients collected from March 2013 to February 2016 at an outpatient dialysis unit in Kuwait were reviewed. The dialysis events studied were: intravenous (IV) antimicrobial use, a positive blood culture, and signs of inflammation at the vascular access site. Dialysis event rates were stratified by the type of vascular access used for the dialysis, i.e., fistula, graft, and tunneled/nontunneled central line. Rates were expressed per 100 patient-months. Results: The overall dialysis event rate was (10.7/100 patient-months). The rate of IV antimicrobial use was higher (12.53/100 patient-months) in patients with tunneled central lines than in all other vascular access types (10.29/100 patient-months). Positive blood culture and inflammation at the vascular access site were highest in patients with nontunneled central lines (1.65 and 1.54/100 patient-months, respectively) when compared to those with other types of vascular access. Gram-negative rod isolates were predominant in patients with central lines (n = 35; 46.67%); however, common skin commensals and gram-negative rods were also identified in patients with fistula or graft (n = 4; 44.45%). Conclusion: Dialysis event rates were higher among patients with tunneled or nontunneled central lines than in patients with fistula or graft. Gram-negative rods were the most commonly isolated microbial group.

Use of the RenalGuard system to prevent contrast-induced AKI: A meta-analysis.

Contrast-induced kidney injury (CI-AKI) following cardiovascular interventions results in increased morbidity and mortality. RenalGuard (RG) is a novel, closed loop system which balances volume administration with forced diuresis to maintain a high urine output. We performed a meta-analysis of the existing data comparing use of RG to conventional volume expansion. Ten studies were found eligible, of which four were randomized controlled trials. Of an aggregate sample size (N) of 1585 patients, 698 were enrolled in the four RCTs and 887 belonged to the remaining registries included in this meta-analysis. Primary outcomes included CI-AKI incidence and relative risk. Mortality, dialysis, and major adverse cardiovascular events (MACCE) were secondary outcomes. A random effects model was used and data were evaluated for publication bias. RG was associated with significant risk reduction in CI-AKI compared to control (RR: 0.30, 95%CI: 0.18-0.50, P < 0.01). CI-AKI in RG was found to be 7.7% versus 23.6% in the control group (P < 0.01). Use of RG was associated with decreased mortality (RR: 0.43, 95%CI: 0.18-0.99, P = 0.05), dialysis (RR: 0.20, 95%CI: 0.06-0.61, P = 0.01), and MACCE (RR: 0.42, 95%CI: 0.27-0.65, P < 0.01) compared to control. RG significantly reduces rates of CI-AKI compared to standard volume expansion and is also associated with decreased rates of death, dialysis, and MACCE.

PP.07.07] USE OF BETABLOCKERS ASSOCIATED WITH LESS ORTHOSTATIC RESPONSE IN DIALYSIS PATIENTS

Objective: 1-Analyze the prevalence of orthostatic hypotension in patients on dialysis.2-To establish if orthostatic hypotension is associated with specific hemodynamic changes in supine position and standing.3-Determine independent predictors of orthostatic hypotension Design and method: Within a cardiovascular evaluation program for patients in ESRD (PRECADIA), 68 patients attended the interdialysis day to undergo a hemodynamic evaluation. BP (Microlife-AFIB200) and hemodynamics was determined with impedance cardiography in supine position and after the third minute of standing. Following variables were analyzed: Systolic blood pressure (SBP), Diastolic blood pressure (DBP), heart rate (HR), stroke volume (SV), systemic vascular resistance index(SVRI) and thoracic fluid content (TFC). Patients were classified into 2 groups according to the presence (HIPOT) or not (EST) of orthostatic hypotension defined as a drop of 20mmHg or more of SBP and/or 10mmHg or more of DBP when standing. Hemodynamic variables were analyzed according to: 1-baseline conditions and 2-differences (Delta:standing-lying) between the two groups (t-test and Mann-Whitney U test). Independent predictors of orthostatic hypotension were determined adjusting for age, sex, BP, anthropometric variables, time on dialysis and medication through a logistic regression Results: We included 53 patients (age:61.3 ± 14.85 years, SBP:140 ± 33.49 mmHg, DBP:79.64 ± 14.24mmHg, females 28 (53.8%)). 12 patients (32.7%) had orthostatic hypotension. There were no significant differences in age, sex, BMI, time on dialysis, diabetes prevalence and CV events between both groups. 92,31% of the HYPOT group received BB, the EST group only reached 50% (p = 0.0303). In supine position, there were no hemodynamic differences between the two groups. By standing the HYPOT group showed lower Delta-SVRI (p = 0.026), Delta-DBP (p < 0.0001) and Delta-SBP (p < 0.0001). There were no significant differences in Delta-TFC. In logistic regression, the use of BB was an independent variable for orthostatic hypotension.Conclusions: The use of BB was a determinant factor to attenuate or to nullify the compensatory increase of the vascular resistances by standing, and consequently to favor the development of hypotension when standing. It should be evaluated whether or not this phenomenon is associated with a higher rate of events, and if this measurement adds value when deciding whether to use BB in this population.

Healthcare utilization and expenditures for United States Medicare beneficiaries with systemic vasculitis.

The Medicare federal insurance program is the most common United States insurer of patients with systemic vasculitis (SV). We compared healthcare utilization and expenditures for Medicare beneficiaries with versus without SV. This national, retrospective study used 2010 claims and enrollment data for a 100% cohort of Medicare Part A and B beneficiaries with ≥1 claim including a diagnosis for a form of SV (n = 176,498), and a randomly selected group of non-SV beneficiaries (n = 46,561). Outcomes included annual counts of events in 16 categories of medical services (e.g., inpatient stays, physician visits, tests, and imaging events), and total annual Medicare and patient medical expenditures. We used linear regression with bootstrapped standard errors to compare utilization and expenditures by SV status, before and after matching on age and sex. Prescription drug fills and expenditures for SV (n = 95,157) and non-SV (n = 24,992) beneficiaries with Part D drug benefits were also compared. After matching, Medicare spent $11,004 more per patient in 2010 for medical services, and $773 more on prescription drugs, for SV versus non-SV beneficiaries. SV beneficiaries spent $1547 more for medical services and $211 more for prescription drugs. Except for hospice, SV beneficiaries had greater utilization of all services, including two-to-three times more dialysis events, hospital readmissions, inpatient stays, skilled nursing facility stays, and medical tests. The average Medicare beneficiary with SV incurs about double the annual healthcare expenditures compared to their non-SV counterparts, attributable to increased utilization of almost all categories of care.

Analysis of the evidence-practice gap to facilitate proper medical care for the elderly: investigation, using databases, of utilization measures for National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB)

As Japan becomes a super-aging society, presentation of the best ways to provide medical care for the elderly, and the direction of that care, are important national issues. Elderly people have multi-morbidity with numerous medical conditions and use many medical resources for complex treatment patterns. This increases the likelihood of inappropriate medical practices and an evidence-practice gap. The present study aimed to: derive findings that are applicable to policy from an elucidation of the actual state of medical care for the elderly; establish a foundation for the utilization of National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB), and present measures for the utilization of existing databases in parallel with NDB validation.Cross-sectional and retrospective cohort studies were conducted using the NDB built by the Ministry of Health, Labor and Welfare of Japan, private health insurance claims databases, and the Kyoto University Hospital database (including related hospitals). Medical practices (drug prescription, interventional procedures, testing) related to four issues—potential inappropriate medication, cancer therapy, chronic kidney disease treatment, and end-of-life care—will be described. The relationships between these issues and clinical outcomes (death, initiation of dialysis and other adverse events) will be evaluated, if possible.

Surveillance of Dialysis Events: one-year experience at 33 outpatient hemodialysis centers in China

A multicenter prospective surveillance on dialysis events was carried in 33 dialysis centers in China. Maintenance hemodialysis (HD) outpatients who were dialyzed on the first two days of each month during 2014 were monitored for dialysis events and other infections. During the one-year period, 52,680 patient-months were monitored. Fistula and tunneled or non-tunneled central line were used for 73.70%, 15.70% and 8.85% of vascular access, respectively. There were 773 dialysis events occurred in 671 patients including 589 IV antimicrobial starts, 74 positive blood cultures and 110 local access site infections (LASI). The incidence of dialysis events was 1.47 per 100 patient-months. Among the 74 cases with bloodstream infection (BSI), 38 were access-related BSI (ARB) and there were therefore 148 cases with vascular-related infection (VAI; 38 ARB and 110 LASI). There were 740 cases (1.40 per 100 patient-months) with infections other than BSI and LASI, most (79.19%) of which were respiratory tract infections. For those with dialysis events, there were 425 cases (425/671, 63.34%) admitted to hospital and 12 cases of death (12/671, 1.79%). In conclusion, the surveillance revealed a relatively low incidence of dialysis events and the surveillance may be tailored to target those using central lines in resource-limited settings.

Validation of National Healthcare Safety Network Dialysis Event Data — Georgia 2015

Validation of National Healthcare Safety Network Dialysis Event Data — Georgia 2015

The Association between Biomarker Profiles, Etiology of Chronic Kidney Disease, and Mortality

Background: Prognosis in chronic kidney disease (CKD) for adverse outcomes differs substantially based on the etiology of CKD. We examined whether the biomarker profile differed based on CKD etiology and whether they were associated with mortality. Methods: Prospective observational study of 1,157 patients, 663 with diabetic kidney disease (DKD), 273 with glomerulonephritis (GN), and 221 with cystic/interstitial disease (polycystic kidney disease, pyelonephritis or chronic tubulointerstitial nephritis [PCK/TIN]) were identified in the Canadian Study of Prediction of Dialysis, Death and Interim Cardiovascular events over Time cohort. The outcome of interest was mortality before commencing dialysis. The biomarker profile consisted of N-terminal pro-brain natriuretic peptide (NT-proBNP), troponin I (TnI), asymmetric dimethylarginine (ADMA), interleukin (IL)-6, high sensitivity C-reactive protein, fibroblast growth factor-23 (FGF23), transforming growth factor-beta, 25-hydroxylvitamin D, and cystatin C (CysC). Results: The mean estimated glomerular filtration rate was 27 mL/min/1.73 m² and median follow-up time was 44 months. Mortality before dialysis commencement was the greatest in DKD (20%), followed by PCK/TIN (13%), and was least in those GN (8%). The majority of deaths were cardiovascular in nature, 17, 9, and 5.5% for DKD, PCK/TIN, GN, respectively. Those with DKD had higher hazard for mortality, unadjusted (hazard ratio [HR] 2.7, 95% CI 1.7-4.3) and adjusted (HR 1.7, 95% CI 1.1-2.8). The biomarker profiles associated with mortality differed significantly by CKD etiology as follows: DKD was associated with CysC (HR 1.3, 95% CI 1.0-1.6), ADMA (HR 1.3, 95% CI 1.1-1.6), and NT-proBNP (HR 1.7, 95% CI 1.4-2.1), GN was associated with FGF23 (HR 1.8, 95% CI 1.1-2.8), TnI (HR 3.6, 95% CI 1.3-9.5), and transforming growth factor-beta (HR 0.6, 95% CI 0.4-0.9) and PCK/TIN was associated with ADMA (HR 1.5, 95% CI 1.3-1.8) and IL-6 (HR 2.1, 95% CI 1.5-3.1). Conclusions: Biomarkers profiles differ according to the etiology of CKD and are associated with mortality.

Carvedilol and Cardiac Biomarkers in Dialysis Patients: Secondary Analysis of a Randomized Controlled Trial

Background/Aims: Cardiac biomarkers are associated with cardiac abnormalities and adverse outcomes in dialysis patients. Our aim was to report the effect of the beta-blocker carvedilol on cardiac biomarkers in adult dialysis patients. Methods: The Beta-Blocker to Lower Cardiovascular Dialysis Events Feasibility Study was a randomized controlled trial comparing carvedilol to placebo. Serum and plasma were collected before the run-in, then 6 and 12 months post-randomization to measure B-type Natriuretic Peptide (BNP), N-terminal BNP (NT-ProBNP), high-sensitivity cardiac troponins I (hs-TnI) and T (hs-TnT), and galectin-3. Left ventricular global longitudinal strain (GLS) was measured by echocardiography at baseline. Results: Seventy-two participants were recruited of whom 49 completed the run-in and were randomized to carvedilol (n=26) or placebo (n=23). Baseline echocardiography demonstrated median (inter-quartile range) GLS of -14.27% (-16.63 to -11.93). NTproBNP and hs-TnT correlated with GLS (Spearman’s rho=0.34 [p=0.018] and rho=0.28 [p=0.049], respectively). Median change scores from baseline to 12 months did not differ significantly between participants with complete biomarker data randomized to carvedilol (n=15) or placebo (n=16) for any biomarkers. Conclusions: NT-proBNP and hs-TnT were associated with GLS. However, changes in levels of the biomarkers from baseline to 12 months were not different between groups randomized to carvedilol and placebo.

Combined liver and kidney transplantation in children: analysis of renal graft outcome.

Combined liver-kidney transplantation (CLKT) is the accepted treatment for patients with both liver failure and progressive renal insufficiency. Long-term outcome data for CLKT in children is sparse and controversy exists as to whether simultaneous CLKT with organs from the same donor confers immunologic and survival benefit to the kidney allograft. We report the long-term renal graft outcomes of 40 patients who had simultaneous CLKT. A retrospective analysis of kidney graft survival (time from transplantation to death, return to dialysis or last follow-up event) in all pediatric patients (age < 18years old) who underwent CLKT from March 1994 to January 2015. A 1:1 ratio of controls (deceased donor kidney recipients from our centre matched for age (±2years) at transplant, time from transplant (±1year) and treated with the same immunosuppressive regime) to cases was used to compare outcome. Estimated glomerular filtration rate (e-GFR) was calculated using the Schwartz formula. Survival curves were determined using Kaplan-Meier analysis. The kidney graft survival for CLKT patients was 87.4, 82, and 82% at 1, 5, and 10years; kidney graft survival for isolated KT patients were 97.2, 93, and 93% at 1, 5, and 10years (p = NS). There were two acute rejection episodes (5%) in the CLKT group compared to five (12.5%) episodes in the isolated KT group. There was no statistically significant difference in e-GFR at 1, 5, and 10years in the two groups but there was a statistically significantly greater decline in e-GFR in the KT group compared to CLKT group from 5-10 years following transplant. There are fewer acute rejection episodes following CLKT compared to isolated KT, and we noted a higher mean e-GFR at 1, 5, and 10years with significantly lesser decline in e-GFR from 5 to 10years in the CLKT group.

Dialysis Event Surveillance Report: National Healthcare Safety Network data summary, January 2007 through April 2011

A total of 24,092 adverse events in hemodialysis outpatients during January 2007 through April 2011 were reported to the National Healthcare Safety Network. Of 2,656 bloodstream infections, 67.3% were in patients with central venous catheters. For all events, rates associated with central venous catheters were higher than for other vascular access types.

Recombinant human erythropoietin versus placebo or no treatment for the anaemia of chronic kidney disease in people not requiring dialysis.

Treatment with recombinant human erythropoietin (rHuEPO) in dialysis patients has been shown to be highly effective in terms of correcting anaemia and improving quality of life. There is debate concerning the benefits of rHuEPO use in predialysis patients which may accelerate the deterioration of kidney function. However the opposing view is that if rHuEPO is as effective in predialysis patients, improving the patient's sense of well-being may result in the onset of dialysis being delayed. This is an update of a review first published in 2001 and last updated in 2005. The objective of this review was to ascertain the effects of rHuEPO treatment in predialysis patients primarily in terms of the timing of the onset of dialysis; but also that predialysis rHuEPO: 1) corrects haemoglobin/haematocrit (markers of anaemia); 2) improves quality of life; and 3) is not associated with an increased incidence of adverse events such as hastening of the onset of dialysis, increased hypertension, clotting of arterio-venous fistulae or seizures. We searched the Cochrane Kidney and Transplant's Specialised Register (up to 29 June 2015) through contact with the Trials' Search Co-ordinator using search terms relevant to this review. Randomised controlled trials (RCTs) or quasi-RCTs comparing the use of rHuEPO with no treatment or placebo in predialysis patients. Only published data were used. Quality assessment was performed by two assessors independently. Data were abstracted by a single author onto a standard form, a sample of which was checked by another author. Results were expressed as risk ratio (RR) or mean difference (MD) with 95% confidence intervals (CI). Nineteen studies (enrolling 993 participants) were included. Due to the age of the included studies (most performed prior to 2000) the risk of bias was judged to be unclear in the majority of the studies for most of the domains. There was an improvement in haemoglobin (MD 1.90 gm/L, 95% CI -2.34 to -1.47) and haematocrit (MD 9.85%, 95% CI 8.35 to 11.34) with treatment and a decrease in the number of patients requiring blood transfusions (RR 0.32, 95% CI 0.12 to 0.83). The data from studies reporting quality of life or exercise capacity demonstrated an improvement in the treatment group. Most of the measures of progression of kidney disease showed no statistically significant difference. No significant increase in adverse events was identified. Treatment with rHuEPO in predialysis patients corrects anaemia, avoids the requirement for blood transfusions and also improves quality of life and exercise capacity. We were unable to assess the effects of rHuEPO on progression of kidney disease, delay in the onset of dialysis or adverse events. Based on the current evidence, decisions on the putative benefits in terms of quality of life are worth the extra costs of predialysis rHuEPO need careful evaluation.

The β-Blocker to Lower Cardiovascular Dialysis Events (BLOCADE) Feasibility Study: A Randomized Controlled Trial.

β-Blocking agents reduce cardiovascular mortality in patients with heart disease, but their potential benefit in dialysis patients is unclear. We aimed to determine the feasibility of a randomized controlled trial (RCT). Pilot RCT. Patients who received dialysis for 3 or more months and were 50 years or older (or≥18 years with diabetes or cardiovascular disease) were recruited from 11 sites in Australia and New Zealand. We aimed to recruit 150 participants. After a 6-week run-in with the β-blocker carvedilol, we randomly assigned participants to treatment with carvedilol or placebo for 12 months. The prespecified primary outcome was the proportion of participants who tolerated carvedilol, 6.25mg, twice daily during the run-in period. After randomization, we report participant withdrawal and the incidence of intradialytic hypotension (IDH). Of 1,443 patients screened, 354 were eligible, 91 consented, and 72 entered the run-in stage. 49 of 72 run-in participants (68%; 95% CI, 57%-79%) achieved the primary outcome. 5 of the 23 withdrawals from run-in were attributable to bradycardia or hypotension. After randomization, 10 of 26 allocated to carvedilol and 4 of 23 allocated to placebo withdrew. 4 participants randomly assigned to carvedilol withdrew because of bradycardia or hypotension. Overall, there were 4 IDH events per 100 hemodialysis sessions; in participants allocated to carvedilol versus placebo, respectively, there were 7 versus 2 IDH events per 100 hemodialysis sessions (P=0.1) in the 2 weeks immediately following a dose increase and 4 versus 3 IDH events per 100 hemodialysis sessions after no dose increase (P=0.7). Unable to recruit planned sample size. Recruiting patients receiving dialysis to an RCT of β-blocker versus placebo will prove challenging. Possible solutions include international collaboration and exploring novel trial designs such as a registry-based RCT.

The research about relationship among social support, coping styles and self-perceived burden of elderly patients with peritoneal dialysis

Objective To examine the status of self-perceived burden in patients with continuous ambulatory peritoneal dialysis and explore the relationships among social support, coping styles and self-perceived burden. Methods 103 elderly patients with peritoneal dialysis of outpatient follow-up were recruited. They were investigated using Self-Perceived Burden Scale, Social Support Rating Scale, and Simplified Coping Style Questionnaire. Results The total score of self-perceived burden was at a moderate level and the average score was (36.67±3.67). The total score of social support, the average score of positive coping and negative coping were (40.27±5.83), (1.69±0.26), (1.80±0.40), then the difference was statistically significant when compared with domestic norm (34.56±3.73), (1.78±0.52), (1.59±0.66) (P<0.05). The analysis found that self-perceived burden was negatively correlated with positive coping styles, social support and each dimension (r = -0.239, -0.668, -0.725, -0.252, -0.647,P<0.05). Conclusions Medical personnel should inspire elderly patients to make full use of social resources and guide them to take positive attitude to deal with dialysis event. It would help them maintain well psychological condition for a long time and reduce the self-perceived burden of patients. Key words: Aged; Peritoneal dialysis; Social support; Self-perceived burden; Coping style

Dialysis event surveillance of hemodialysis outpatients in a large hospital

up, the CD4 count has increased to 582 and 602 cells/mm in the 1and 2-dose group, respectively; and the proportion of plasma HIV RNA load<20 copies/ml was 83.0 vs 81.6%, respectively, when nearly 100% of the two groups of the patients were receiving cART. Throughout the 5 years of follow-up, the overall serological response rate to serotype 19F remained the lowest. In multivariate analysis, vaccination with 2 doses of PCV7 was statistically significantly associated with significant serological response than vaccination with 1 dose (adjusted odds ratio, 1.73 [95% CI, 1.04-2.89]). Conclusions: Primary vaccination with 2 doses of PCV7 achieves a significantly better serological responses than that with 1 dose among HIV-infected patients throughout the 5 years of follow-up in the era of cART.

The rationale and design of the Beta-blocker to LOwer CArdiovascular Dialysis Events (BLOCADE) Feasibility Study.

The Beta-blocker to LOwer CArdiovascular Dialysis Events (BLOCADE) Feasibility Study aims to determine the feasibility of a large-scale randomized controlled trial with clinical endpoints comparing the beta-blocking agent carvedilol with placebo in patients receiving dialysis. The BLOCADE Feasibility Study is a randomized, double-blind, placebo-controlled, parallel group feasibility study comparing the beta-blocking agent carvedilol with placebo. Patients receiving dialysis for ≥3 months and who are aged ≥50 years, or who are ≥18 years and have diabetes or cardiovascular disease, were eligible. The primary outcome was the proportion of participants who complete a 6-week run-in phase in which all participants received carvedilol titrated from 3.125 mg twice daily to 6.25 mg twice daily. Other measures included how many patients are screened, the proportion recruited, the overall recruitment rate, the proportion of participants who remain on study drug for 12 months and the incidence of intra-dialytic hypotension while on randomized treatment. The BLOCADE Feasibility Study commenced recruiting in May 2011 and involves 11 sites in Australia and New Zealand. The BLOCADE Feasibility Study will inform the design of a larger clinical endpoint study to determine whether beta-blocking agents provide benefit to patients receiving dialysis, and define whether such a study is feasible.

Proton-pump inhibitors for prevention of upper gastrointestinal bleeding in patients undergoing dialysis.

To investigate the preventive effects of low-dose proton-pump inhibitors (PPIs) for upper gastrointestinal bleeding (UGIB) in end-stage renal disease. This was a retrospective cohort study that reviewed 544 patients with end-stage renal disease who started dialysis at our center between 2005 and 2013. We examined the incidence of UGIB in 175 patients treated with low-dose PPIs and 369 patients not treated with PPIs (control group). During the study period, 41 patients developed UGIB, a rate of 14.4/1000 person-years. The mean time between the start of dialysis and UGIB events was 26.3 ± 29.6 mo. Bleeding occurred in only two patients in the PPI group (2.5/1000 person-years) and in 39 patients in the control group (19.2/1000 person-years). Kaplan-Meier analysis of cumulative non-bleeding survival showed that the probability of UGIB was significantly lower in the PPI group than in the control group (log-rank test, P < 0.001). Univariate analysis showed that coronary artery disease, PPI use, anti-coagulation, and anti-platelet therapy were associated with UGIB. After adjustments for the potential factors influencing risk of UGIB, PPI use was shown to be significantly beneficial in reducing UGIB compared to the control group (HR = 13.7, 95%CI: 1.8-101.6; P = 0.011). The use of low-dose PPIs in patients with end-stage renal disease is associated with a low frequency of UGIB.