Dialysis For End-stage Renal Disease Research Articles

Dignity-related distress and recall among alert, non-delirious critically ill patients.

Critical illness is associated with multiple undesired impacts, including residual psychological distress, frequently associated with recollections of critical illness. Dignity-related distress is highly prevalent among the one-fifth of critically ill patients who are alert. The distress may be associated with unpleasant recollections of care. We examined whether patients at risk for dignity-related distress had recall of their reported distress approximately 1 week after assessment and whether this recall differed from another high-risk group, specifically patients undergoing dialysis for end-stage renal disease. The prospective cohort study included patients with critical illness and patients with end-stage renal disease enrolled from intensive care units (ICUs) and dialysis units at 1 academic center. Distress was assessed using the Patient Dignity Inventory (PDI). Participants received in-patient or telephonic follow-up 7-10 days after the initial interaction. Follow-up encounters focused on recollection of key aspects of the interpersonal interaction as well as the content of the PDI. A total of 32 critically ill patients participated in initial assessment and follow-up. In total, 26 dialysis patients participated in both phases. The groups' demographics differed. Fifty percent (n = 16) of critically ill patients and 58% (n = 15) of dialysis patients reported a mean score per item of >1.6, corresponding with severe distress on the PDI. Among the ICU patients, the 95% upper 2-sided confidence interval for the median level of recall was commensurate with the participant having had no recall of the initial interview beyond remembering that there was an interview. The end-stage renal disease group did not demonstrate significantly better recall. Dignity-related distress is high in both critically ill patients and those with end-stage renal disease; however, recollection of assessment is poor in both groups. Any intervention designed to mitigate dignity-related distress will need either to be immediately deployable or not to be reliant upon recollection for impact.

A landscape of metabolic variation among clinical outcomes of peritoneal dialysis in end-stage renal disease

BackgroundPeritoneal dialysis (PD) helps prevent lethal complications of end-stage renal disease (ESRD). However, the clinical outcomes are affected by PD-related complications. We investigated metabolic biomarkers to estimate the clinical outcomes of PD and identify patients at high risk of downstream complications and recurrent/relapsing infections. MethodsMetabolites of normal control and ESRD patient were compared via an untargeted metabolomic analysis. Potential metabolic biomarkers were selected and quantified using a multiple reaction monitoring-based target metabolite detection method. A nomogram was built to predict the clinical outcomes of PD patients using clinical features and potential metabolic biomarkers with the least absolute shrinkage and selection operator Cox regression model. ResultsTwenty-five endogenous metabolites were identified and analyzed. ESRD-poor clinical outcome-related metabolic modules were constructed. Adenine, isoleucine, tyramine, xanthosine, phenylacetyl-L-glutamine, and cholic acid were investigated using the weighted gene correlation network analysis blue module. Potential metabolic biomarkers were differentially expressed between the NC and ESRD groups and the poor and good clinical outcomes of PD groups. A 3-metabolite fingerprint classifier of isoleucine, cholic acid, and adenine was included in a nomogram predicting the clinical outcomes of PD. ConclusionMetabolic variations can predict the clinical outcomes of PD in ESRD patients.

The Assessment of Infection Risk in Patients with Vitiligo Undergoing Dialysis for End-Stage Renal Disease: A Retrospective Cohort Study.

Vitiligo is an autoimmune condition that causes patchy skin depigmentation. Although the mechanism by which vitiligo induces immunocompromise is unclear, other related autoimmune diseases are known to predispose those affected to infection. Individuals with vitiligo exhibit epidermal barrier disruption, which could potentially increase their susceptibility to systemic infections; patients with renal disease also show a predisposition to infection. Nevertheless, there is little research addressing the risk of infection in dialysis patients with vitiligo in comparison to those without it. A retrospective analysis was performed on patients with end-stage renal disease (ESRD) in the United States Renal Data System who started dialysis between 2004 and 2019 to determine if ESRD patients with vitiligo are at an increased risk of bacteremia, cellulitis, conjunctivitis, herpes zoster, or septicemia. Multivariable logistic regression modeling indicated that female sex, black compared to white race, Hispanic ethnicity, hepatitis C infection, and tobacco use were associated with an enhanced risk of vitiligo, whereas increasing age and catheter, versus arteriovenous fistula, and access type were associated with a decreased risk. After controlling for demographics and clinical covariates, vitiligo was found to be significantly associated with an increased risk of bacteremia, cellulitis, and herpes zoster but not with conjunctivitis and septicemia.

Risk factors of foot ulcers in patients with end-stage renal disease on dialysis: A meta-analysis.

The present study aims to assess the risk factors for foot ulcers in patients undergoing dialysis for end-stage renal disease (ESRD) and to provide evidence-based guidance for prevention and treatment. A systematic search was conducted on PubMed, EMBASE, Cochrane Library, China National Knowledge Infrastructure, Chinese Biomedical Literature Database and Wanfang Data from the database inception until May 2023 to identify relevant studies investigating the risk factors for foot ulcers in dialysis patients with ESRD. Two independent researchers conducted the literature screening and data extraction. The meta-analysis was performed using STATA 17.0 software. Ultimately, six articles comprising 1620 patients were included for analysis. The meta-analysis revealed that male (OR, 1.464; 95% CI: 1.082-1.980, p = 0.013), hypertension (OR, 1.781; 95% CI: 1.293-2.4550, p < 0.001), peripheral artery disease (PAD) (OR, 5.014; 95% CI: 2.514-9.998, p < 0.001), type 1 diabetes mellitus (T1DM) (OR, 2.993; 95% CI: 1.477-6.065, p = 0.002) and type 2 diabetes mellitus (T2DM) (OR, 2.498; 95% CI:1.466-4.256, p = 0.001) were risk factors for foot ulcers in dialysis patients with ESRD. Conversely, the female sex (OR, 0.683; 95% CI: 0.505-0.924, p = 0.013) was a protective factor against foot ulcers. Our analysis revealed that male sex, hypertension, PAD, T1DM and T2DM were risk factors for foot ulcers in patients undergoing dialysis for ESRD. Conversely, the female sex was a protective factor against foot ulcers. Therefore, it is crucial to strengthen health education that targets patients with these risk factors and regularly screen high-risk individuals. Early detection and treatment can help delay disease progression.

Retracted: Comparative Analysis of Efficacy and Prognosis of Hemodialysis and Peritoneal Dialysis for End-Stage Renal Disease: A Meta-analysis.

[This retracts the article DOI: 10.1155/2022/6007698.].

Determinants of medication adherence in hemodialysis patients: a cross-sectional study based on capability-opportunity-motivation and behavior model

BackgroundMedication adherence is a key component of successful dialysis in end-stage renal disease (ESRD). The aim of this study was to use the Capability-Opportunity-Motivation and Behavior (COM-B) model in order to identify the most important determinants of medication adherence among ESRD patients.MethodsThis research was a cross-sectional design that was conducted in two steps in 2021. In the first step, COM-B components of patients undergoing hemodialysis (HD) therapy were extracted through literature review. The second step was a cross-sectional study among 260 ESRD patients referred to the dialysis unit from Kermanshah, in the west of Iran. Data was collected using a written questionnaire by interviews. The data was analyzed in SPSS version 16 software.ResultsThe mean age of respondents was 50.52 years [95% CI: 48.71, 52.33], ranged from 20 to 75 years. The mean score of medication adherence was 11.95 [95% CI: 11.64, 12.26], ranged from 4 to 20. Medication adherence is higher among patients with higher education (P = 0.009) and those who were employed (P < 0.001) and was significantly related to income (r = 0.176), while it was inversely and significantly related to the medication duration (r=-0.250). Motivation (Beta: 0.373), self-efficacy (Beta: 0.244), and knowledge (Beta: 0.116) are stronger determinants of medication adherence.ConclusionCOM-B model can be proposed as an integrated framework in predicting medication adherence among ESRD patients. Our findings provide theory-based recommendations that can help future clinical and research decision-making for the development, implementation, and evaluation of treatment adherence interventions in Iranian ESRD patients. The use of COM-B model can provide a comprehensive explanation about medication adherence in ESRD patients. Future research should be focus on increasing motivation, self-efficacy and knowledge of Iranian ESRD patients in order to increasing medication adherence.

Patient-focused outcomes after initiation of dialysis for ESRD: mortality, hospitalization, and functional impairment.

Outcome data regarding clinically-relevant endpoints after starting dialysis for end-stage renal disease (ESRD) are sparse, and early events after starting dialysis are particularly underestimated. The aim of this study was to describe patient-focused outcomes in ESRD patients starting from first dialysis. The data basis for this retrospective observational study were anonymized healthcare data from Germany's largest statutory health insurer. We identified ESRD patients who initiated dialysis in 2017. Deaths, hospitalizations and occurrence of functional impairment within 4 years after starting dialysis were recorded starting from first treatment. Hazard ratios in dialysis patients compared with an age- and sex-matched reference population without dialysis were generated, stratified by age. The dialysis cohort included 10,328 ESRD patients who started dialysis in 2017. First dialysis was performed in-hospital for 7,324 patients (70.9%), and 865 of these died during the same hospitalization. One-year mortality for ESRD patients initiating dialysis was 33.8%. Functional impairment occurred in 27.1% of patients, while 82.8% of patients required hospitalization within one year. Hazard ratios of dialysis patients compared to the reference population for mortality, functional impairment, and hospitalization at 1-year were 8.6, 4.3, and 6.2. Dialysis patients <50 years were disproportionately affected, with >40-fold increased risk of adverse events compared with their peers. The emergence of morbidity and mortality after starting dialysis for ESRD is significant, especially in younger patients. Patients have a right to be informed about the prognosis associated with their condition.

Effect of Peritoneal Dialysis in End Stage Renal Disease on Apixaban Pharmacokinetics.

Effect of Peritoneal Dialysis in End Stage Renal Disease on Apixaban Pharmacokinetics.

When Patients Make Unexpected Medical Choices.

In the United States, about 500,000 patients are receiving maintenance dialysis for end-stage renal disease. The decision to discontinue dialysis and receive hospice care tends to be more difficult than to withhold or forego dialysis. Supporting patient autonomy is an important health care priority that is recognized by most clinicians. However, some health care professionals are conflicted when patient autonomy varies from their treatment recommendations. This paper describes the case of a patient on kidney dialysis who chose to discontinue a potentially life-prolonging treatment. Respecting a patient's autonomy to make informed decisions about their end-of-life care is a fundamental ethical and legal principle. Medical opinion should not and cannot overrule the wishes of a competent patient who refuses treatment.

Renal Cell Carcinomas in Patients on Chronic Dialysis

Patients on chronic dialysis for end-stage renal disease (ESRD) show an increased incidence of renal cell carcinoma (RCC). We investigated the clinicopathological characteristics and outcomes of 54 patients who underwent nephrectomy for RCC due to ESRD between 1992 and 2019. The patients consisted of 44 men and 10 women, with a median age of 62.9 years. The median duration of dialysis before surgery was 12.9 years. The clinical stage of the 54 RCCs was stage I in 44, stage II in 1, stage III in 1, and stage IV in 8. With a median follow-up of 5.1 years after surgery, the 5-year cancer-specific and overall survival rates were 84.3 and 61.8%, respectively. Patients with symptomatic RCC had a longer period of dialysis, presented with larger tumors of higher grade and stage, and had worse prognosis compared with those with incidentally discovered RCC. Cox proportional hazards analysis performed with clinicopathological features and symptomatic/incidental detection showed that older age and symptomatic RCC were independently associated with worse overall survival. Our data show that early detection is important for a good prognosis.

Evaluation of reading level of online patient education materials discussing dermatologic care for patients undergoing dialysis

To the Editor: Dialysis for end-stage renal disease is associated with dermatologic conditions, including xerosis and uremic pruritus.1 Patient education materials (PEMs) for chronic kidney disease are often presented above the average patient’s literacy level.2 Moreover, the readability of PEMs addressing cutaneous symptoms in patients undergoing dialysis is unknown. The National Institutes of Health recommends that PEMs should not surpass a sixth-grade level in readability,3 and dermatologic PEMs often fail to meet this recommendation.

Prospective First-in-Human Study of the Merit WRAPSODY Endovascular Stent Graft for Treatment of Access Circuit Outflow Stenosis in Hemodialysis Patients

The aim of this study was to evaluate the safety and effectiveness of the WRAPSODY stent graft in the treatment of outflow and central (brachiocephalic and/or subclavian) stenoses or occlusions in the arteriovenous venous circuit of persons requiring dialysis for end-stage renal disease.

Surgical outcomes of acute type A aortic dissection in dialysis patients: lessons learned from a single-center\u2019s experience

There is a paucity of data describing the safety and efficacy of acute type A aortic dissection (ATAAD) repair surgeries in dialysis patients. Our study aimed to investigated the influence of dialysis on early and late outcomes in end-stage renal disease (ESRD) patients who received repair surgery for ATAAD. A total of 882 ATAAD patients who received emergency aortic dissection repair at our center from January 2015 to December 2019 were retrospectively screened in this study and divided into the dialysis group (n = 16) and the non-dialysis group (n = 866), depending on whether they required dialysis for preoperative ESRD. No significant difference of age, preoperative hemodynamics, organ ischemia conditions, operative variables as well as the 30-Day mortality and in-hospital complications was discovered between two groups. However, the survival rates and the proportion of late aortic event (sudden death and reoperation) free population at 1 and 3 years after surgery were significantly decreased in dialysis patients compared to non-dialysis patients. Our study indicated that the short-term surgical outcomes of ATAAD in dialysis patients were comparable to non-dialysis patient. However, the dialysis patients were associated with a worse long-term prognosis.

Comparative Analysis of Efficacy and Prognosis of Hemodialysis and Peritoneal Dialysis for End-Stage Renal Disease: A Meta-analysis.

Objective This meta-analysis is aimed at systematically assessing the efficacy and prognosis of hemodialysis (HD) and peritoneal dialysis (PD) in the treatment of end-stage renal disease (ESRD). Methods China National Knowledge Infrastructure, VIP, SinoMed, Cochrane Library, PubMed, and Embase databases were searched for relevant studies to evaluate the two different dialysis methods for ESRD. The search time was set from 2010 to 2021. Meta-analysis was performed using Stata16.0. The treatment group received PD, while the control group was given HD. Results Out of 317 articles initially retrieved, 14 studies were finally included in our meta-analysis. The analysis results showed that there was no marked difference in the 1-year survival rate between the two groups (RR = 1.05; 95% CI: 1.00, 1.10; P > 0.05), but the incidence rate of adverse reactions in the treatment group was significantly lower than that in the control group (RR = 0.51; 95% CI: 0.37, 0.70; P < 0.05). In addition, PD and HD treatments caused significant decreases in serum creatinine levels (PD, SMD = −2.91; 95% CI: -3.79, -2.04; P < 0.05; HD, SMD = −3.09; 95% CI: -4.01, -2.16; P < 0.05) and blood urea nitrogen levels (PD, SMD = −2.54, 95% CI: -3.37, -1.72, P < 0.05; HD, SMD = −2.62, 95% CI: -3.47, -1.77, P < 0.05); however, there was no significant statistical difference in posttreatment levels of serum creatinine and blood urea nitrogen between the two groups. Compared with the control group, the hemoglobin (SMD = 0.56, 95% CI: 0.07, 1.06; P < 0.05) and serum albumin (SMD = 1.11, 95% CI: 0.46, 1.76, P < 0.05) levels were significantly increased in the treatment group after treatment. Conclusion In summary, both PD and HD can improve renal function in uremic patients, but PD is superior to HD in reducing the incidence of adverse reactions, improving the nutritional status, and therefore improving the quality of life of patients.

Does Far-Infrared Therapy Improve Peritoneal Function and Reduce Recurrent Peritonitis in Peritoneal Dialysis Patients?

The use of peritoneal dialysis in end-stage renal disease is increasing in clinical practice. The main purpose of this study was to evaluate the effect of far-infrared radiation therapy on inflammation and the cellular immunity of patients undergoing peritoneal dialysis. We recruited 56 patients undergoing peritoneal dialysis, and we included 32 patients for the experimental group and 24 patients from the control group in the final analysis. The experimental evaluation in our study was as follows: (1) We used abdominal computed tomography to explore the changes in abdominal blood vessels. (2) We compared the effects of peritoneal dialysis using blood glucose, HbAlC, albumin, urea nitrogen, creatinine, white blood cells, hs-CRP; peritoneal Kt/V of peritoneal function, and eGFR. (3) We compared the cytokines’ concentrations in the two groups while controlling for the other cytokines. Results and Discussion: (1) There was no significant difference in the abdominal blood vessels of the experimental group relative to the control group according to abdominal CT over the 6 months. (2) Our study demonstrates statistically significant effects of FIR therapy on the following parameters: creatinine (p = 0.039 *) and hs-CRP (p < 0.001 **) levels decreased significantly, and eGFR (p = 0.043 *), glucose (p < 0.001 **), and albumin (p = 0.048 *) levels increased significantly. Our study found that in the experimental group, creatinine and hs-CRP levels decreased significantly due to FIR therapy for 6 months. However, our study also found that the glucose level was significantly different after FIR therapy for 6 months. Peritoneal dialysis combined with FIR can reduce the side effects of the glucose in the dialysis buffer, which interferes with peritoneal inflammation and peritoneal mesothelial cell fibrosis. (3) In addition, we also found that no statistically significant difference in any inflammatory cytokine after FIR therapy. IFN-γ (p = 0.124), IL-12p70 (p = 0.093), IL-18 (p = 0.213), and TNF-α (p = 0.254) did not exhibit significant improvements after peritoneal dialysis with FIR treatment over 6 months. Conclusions: We found that the effectiveness of peritoneal dialysis was improved significantly with FIR therapy, and significant improvements in the peritoneal permeability and inflammatory response were observed.

Abstract 12460: The Effect of Alirocumab on the Plasma Metabolome and Lipidome in End-Stage-Renal Disease

Introduction: Atherosclerotic disease is the major cause of morbidity and mortality among patients maintained on dialysis for end-stage renal disease (ESRD). Cardiovascular disease specifically accounts for almost 50% of deaths of these patients. In a pilot study to determine the safety of Alirocumab we investigated the plasma metabolome and lipidome in patients on dialysis and after treatment with a PCSK9 inhibitor. Methods: We recruited 14 subjects (10 male/4 female) from outpatient nephrology practices on hemodialysis (n=12) or peritoneal dialysis (n=2) for 3 months without complications. Subjects received Alirocumab (150 mg, i.m.) every 2 weeks. Blood was drawn from 13 subjects at baseline and after 12 weeks (6 injections) at completion of the trial. In addition, blood was drawn from 21 healthy controls. Plasma obtained was stored at -80 o C for biomarker analysis. Targeted metabolomic analysis allowed quantitative detection of 542 metabolites including 480 lipid species in 13 lipid classes. This analysis was performed by liquid chromatography mass spectrometry using the Quant 500 metabolomic kit. Results: Metabolomic analysis identified 152 metabolites significantly different (FDR p&amp;lt0.05) between control and ESRD subjects. Notably, various elevated metabolites as well as lower triglyceride and phosphatidylcholine lipid species. Twenty-three metabolites were significantly decreased after Alirocumab treatment (FDR paired t-test, p&amp;lt0.05), all of which were lipid species from the following classes: cholesterol esters, ceramides, hexosylceramides and sphingomyelins (Figure 1). Conclusions: Subjects with ESRD have dysregulation of lipid metabolism that may contribute to atherosclerosis. The effect of Alirocumab on plasma ceramides and sphingomyelins is of particular interest since increased levels in these lipid species have been shown to be associated with vascular disease and increased mortality.

THE NATIONWIDE INCIDENCE OF RETINAL ARTERY OCCLUSION FOLLOWING DIALYSIS AS A RESULT OF END-STAGE RENAL DISEASE: 2004 Through 2013.

To examine the incidence and risk of retinal artery occlusion (RAO) in patients who have undergone dialysis in Korea. A nationwide, population-based study using South Korean national health insurance data from 2004 to 2013 was used for analysis. All patients who began dialysis between 2004 and 2013 and the same number of control subjects were selected via propensity score matching. The incidence of RAO in the dialysis and control cohorts was calculated for 2004 to 2013 using washout data from 2003. The multivariable Cox proportional hazards model was used to evaluate the risk of developing RAO in dialysis patients. Cumulative RAO incidence curves were generated using the Kaplan-Meier method. Whether dialysis modalities influenced the incidence of RAO was also evaluated. Seventy-six thousand seven hundred and eighty-two end-stage renal disease patients on dialysis were included in the dialysis cohort, and 76,782 individuals were included in the control cohort. During the study period, 293 patients in the dialysis cohort and 99 patients in the control cohort developed RAO. The person-years incidence of RAO was significantly higher in the dialysis cohort than in the control cohort (dialysis = 1.1/1,000 person-years; control = 0.3/1,000 person-years; P < 0.001). The incidence of RAO was not significantly different between the two methods of dialysis (hemodialysis vs. peritoneal dialysis; P = 0.25, log-rank test). The current study provided epidemiological evidence that undergoing dialysis for end-stage renal disease was associated with an increased risk of developing RAO. The incidence of RAO rapidly increased as the duration of dialysis increased. These results strengthen the significant role of the renal function in retinal vascular disease.

Comparing Primary Total Hip Arthroplasty in Renal Transplant Recipients to Patients on Dialysis for End-Stage Renal Disease: A Nationally Matched Analysis.

Renal transplants are the most commonly performed solid-organ transplants worldwide. It is unclear whether a kidney transplant is associated with reduced postoperative complications in comparison with patients on dialysis for end-stage renal disease (ESRD). The purpose of this study was to utilize a national database to compare readmissions, complications, and costs associated with primary total hip arthroplasty (THA) between matched renal transplant recipients (RTRs) and patients on dialysis for ESRD. Patients with a renal transplant (N = 1,401) and those on dialysis for ESRD (without a transplant) (N = 1,463) prior to being treated with a THA from 2010 to 2019 were identified within the PearlDiver database. RTRs and patients on renal dialysis were frequency-matched 1:1 on the basis of 9 patient characteristics, resulting in 582 patients in each group. Length of hospital stay, readmissions, complication rates up to 2 years, and total costs up to 1 year were compared between the groups using chi-square and multivariable logistic regression analyses to calculate odds ratios (ORs) and 95% confidence intervals (CIs). Patients on renal dialysis had an increased mean length of stay (6.3 days) compared with RTRs (4.6 days, p < 0.01). After adjusting for age, tobacco use, and diabetes, patients on renal dialysis were more likely to be readmitted by 90 days (OR = 1.59; CI = 1.11 to 2.29, p < 0.01) and have mechanical complications (OR = 2.13; CI = 1.08 to 4.45, p = 0.03) and revisions (OR = 2.14; CI = 1.14 to 4.01, p = 0.01) by 2 years. Patients on renal dialysis were also more likely to have periprosthetic joint infections at 1 year (OR = 1.91; CI = 1.02 to 3.71, p = 0.04). Patients on dialysis incurred 14% higher costs at 1 year (p = 0.11). Patients on renal dialysis had more readmissions, complications, and costs after THA when compared with RTRs. Specifically, patients on renal dialysis were more likely to have longer index lengths of stay, more readmissions by 90 days, and more mechanical complications and revision surgery by 2 years. Patients on dialysis also incurred higher costs and had greater odds of PJI. These results suggest that joint surgeons may consider delaying THA in suitable patients until after renal transplantation to reduce postoperative complications and costs. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

A validation study of the kidney failure risk equation in advanced chronic kidney disease according to disease aetiology with evaluation of discrimination, calibration and clinical utility

BackgroundThe Kidney Failure Risk Equation (KFRE) predicts the 2- and 5-year risk of end-stage renal disease (ESRD) in patients with chronic kidney disease (CKD) stages 3a-5. Its predictive performance in advanced CKD and in specific disease aetiologies requires further exploration. This study validates the 4- and 8-variable KFREs in an advanced CKD population in the United Kingdom by evaluating discrimination, calibration and clinical utility.MethodsPatients enrolled in the Salford Kidney Study who were referred to the Advanced Kidney Care Service (AKCS) clinic at Salford Royal NHS Foundation Trust between 2011 and 2018 were included. The 4- and 8-variable KFREs were calculated on the first AKCS visit and the observed events of ESRD (dialysis or pre-emptive transplantation) within 2- and 5-years were the primary outcome. The area under the receiver operator characteristic curve (AUC) and calibration plots were used to evaluate discrimination and calibration respectively in the whole cohort and in specific disease aetiologies: diabetic nephropathy, hypertensive nephropathy, glomerulonephritis, autosomal dominant polycystic kidney disease (ADPKD) and other diseases. Clinical utility was assessed with decision curve analyses, comparing the net benefit of using the KFREs against estimated glomerular filtration rate (eGFR) cut-offs of < 20 ml/min/1.73m2 and < 15 ml/min/1.73m2 to guide further treatment.ResultsA total of 743 patients comprised the 2-year analysis and 613 patients were in the 5-year analysis. Discrimination was good in the whole cohort: the 4-variable KFRE had an AUC of 0.796 (95% confidence interval [CI] 0.762–0.831) for predicting ESRD at 2-years and 0.773 (95% CI 0.736–0.810) at 5-years, and there was good-to-excellent discrimination across disease aetiologies. Calibration plots revealed underestimation of risk at 2-years and overestimation of risk at 5-years, especially in high-risk patients. There was, however, underestimation of risk in patients with ADPKD for all KFRE calculations. The predictive accuracy was similar between the 4- and 8-variable KFREs. Finally, compared to eGFR-based thresholds, the KFRE was the optimal tool to guide further care based on decision curve analyses.ConclusionsThe 4- and 8-variable KFREs demonstrate adequate discrimination and calibration for predicting ESRD in an advanced CKD population and, importantly, can provide better clinical utility than using an eGFR-based strategy to inform decision-making.

Ledipasvir/Sofosbuvir for 8, 12, or 24 Weeks in Hepatitis C Patients Undergoing Dialysis for End-Stage Renal Disease.

We evaluated 8, 12, or 24 weeks of ledipasvir/sofosbuvir in patients with hepatitis C virus and end-stage renal disease undergoing dialysis. Primary efficacy end point was sustained virologic response 12 weeks after treatment. Primary safety end point was treatment discontinuation because of adverse events (AEs). Ninety-four percent (89/95) achieved sustained virologic response 12 weeks after treatment. Six patients died during treatment (n = 4) or before study completion (n = 2); no deaths were related to treatment. No patients discontinued treatment because of AEs. Thirteen percent had serious AEs; none were related to treatment. Treatment with ledipasvir/sofosbuvir was safe and effective in patients with end-stage renal disease undergoing dialysis.