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Annals of Vascular Surgery Jun 2024After autogenous arteriovenous (AV) access creation for end-stage renal disease, a majority of patients will continue on hemodialysis (HD), a minority will receive...
OBJECTIVES
After autogenous arteriovenous (AV) access creation for end-stage renal disease, a majority of patients will continue on hemodialysis (HD), a minority will receive definitive treatment with kidney transplantation, and a subset of patients will convert to peritoneal dialysis (PD). Our goal was to identify patient factors associated with early transition from HD to either kidney transplantation or PD.
METHODS
This is a case-control study of all patients with first-time AV access creation in the Vascular Quality Initiative (2011-2022) who had long-term follow-up. Patients who remained on HD after AV access creation were the control group while patients who received early kidney transplant or who converted to PD were the two case groups. Relationship among demographics, comorbidities, neighborhood social disadvantage, and functional status as they relate to renal replacement therapy modality was assessed.
RESULTS
There were 19,782 patients included; the average age was 62±15 years and 57% were male. During the follow-up period of a median 306 (71-403) days, 1.3% underwent a kidney transplantation and 2.3% underwent conversion to PD. On univariable analysis, rates of kidney transplantation or conversion to PD varied with race (P<.001), insurance status (P<.001), Area Deprivation Index (ADI) quintile (P<.001), and several medical comorbidities. On multivariable analysis, impaired ambulation, current smoking, Medicaid or Medicare insurance, Black race, heart failure, body mass index, and older age were associated with decreased transplantation rates. Conversion to PD was associated with ADI Q5, Q4, and Q3. Decreased conversion to PD was associated with impaired ambulation, Hispanic ethnicity, Black race, former smoking, medication-controlled diabetes, and older age.
CONCLUSION
Decreased kidney transplantation was associated with Black race and non-commercial health insurance but not ADI quintile, suggesting disparities exist beyond community-level access to care. Early kidney transplantation conveyed a 3-year survival benefit compared to HD and PD, which had similar survival. Further work is required to increase access to kidney transplantation and PD.
PubMed: 38942372
DOI: 10.1016/j.avsg.2024.06.002 -
Frontiers in Public Health 2024This study aims to assess the extent of social alienation in patients undergoing peritoneal dialysis and examine how personal mastery and perceived social support...
AIM
This study aims to assess the extent of social alienation in patients undergoing peritoneal dialysis and examine how personal mastery and perceived social support mediate the association between emotional intelligence and social alienation in this patient population.
METHODS
This study adopts a cross-sectional survey design. A total of 192 patients were recruited from a tertiary hospital located in Henan Province, China, using a convenience sampling method. We have developed a structural equation model to investigate the mediating influence of personal mastery and perceived social support on the emotional intelligence and social alienation of patients undergoing Peritoneal dialysis.
RESULTS
Peritoneal patients exhibited an social alienation score of 42.01 ± 3.15. Elevated EI levels (coefficient = -0.616, < 0.001) were significantly correlated with reduced social alienation. The mediation model demonstrated that personal mastery and perceived social support fully mediated the impact of emotional intelligence on social alienation.
CONCLUSION
The social alienation of peritoneal dialysis patients is serious, and healthcare professionals should pay attention to patients' social alienation, improve patients' emotional intelligence through relevant interventions, increase personal mastery and perceived social support, and finally reduce social alienation.
Topics: Humans; Male; Female; Peritoneal Dialysis; Middle Aged; Cross-Sectional Studies; Social Support; China; Emotional Intelligence; Adult; Surveys and Questionnaires; Aged
PubMed: 38939568
DOI: 10.3389/fpubh.2024.1392224 -
Urology Case Reports Jul 2024Peritoneal dialysis (PD) catheter migration is a common complication of PD which usually results in obstruction of dialysate outflow. We report the first known case in...
Peritoneal dialysis (PD) catheter migration is a common complication of PD which usually results in obstruction of dialysate outflow. We report the first known case in the literature of a 62-year-old male with end-stage renal disease on PD who presented with acute renal colic secondary to the PD catheter overlying right mid-ureter causing hydronephrosis with spontaneous resolution of pain and hydronephrosis two days later. The patient was discharged home with a functioning dialysis catheter and complete resolution of both symptoms and radiographic findings of hydronephrosis. While management of migrated PD catheters usually require surgical intervention, our case resolved without intervention.
PubMed: 38939450
DOI: 10.1016/j.eucr.2024.102746 -
Renal Failure Dec 2024This study aims to establish a simplified and effective animal model of catheter malfunction caused by omental wrapped using negative pressure suction.
BACKGROUND
This study aims to establish a simplified and effective animal model of catheter malfunction caused by omental wrapped using negative pressure suction.
METHOD
The peritoneal dialysis catheter outlet was linked to a negative-pressure (0-75mmHg) suction pump to intensify the negative pressure. Different negative pressures were tested for model construction , a model of peritoneal catheter malfunction caused by omental wrapped was constructed in five beagles after catheter placement. Catheter drainage conditions and related complications were monitored before and after the model establishment.
RESULTS
In the vitro experiment, the overall success rate of constructed models was 90% (36/40). The total malfunction rate was higher in 62.5 mmHg (10/10) and 75 mmHg (10/10) than in 12.5 mmHg (8/10) and 37.5 mmHg (8/10). The outflow velocity of dialysate at 62.5 mmHg was significantly lower than that at 12.5 mmHg and 37.5 mmHg, without a statistically significant difference compared to 75 mmHg. In the experiment, catheter outflow velocity increased, and residual fluid volume decreased after omental wrapped (99.6 ± 6.7 ml/min vs. 32.6 ± 4.6 ml/min at initial five minutes, < 0.0001; 69.2 ± 16.3 ml vs. 581.0 ± 109.4 ml, < 0.001). And the outflow velocity was finally below 2 ml/min. No severe related complications (such as infection, organ damage, or bleeding) were observed through laparoscopic examination and dialysate tests seven days post-operation.
CONCLUSION
Utilizing negative pressure suction to increase negative pressure around catheter tip is a simple, safe, and effective method for establishing an animal model of omental wrapped leading to catheter malfunction.
Topics: Animals; Dogs; Omentum; Suction; Equipment Failure; Peritoneal Dialysis; Catheters, Indwelling; Disease Models, Animal; Male; Models, Animal
PubMed: 38938162
DOI: 10.1080/0886022X.2024.2369695 -
Asian Journal of Surgery Jun 2024
PubMed: 38937229
DOI: 10.1016/j.asjsur.2024.06.043 -
Hemodialysis International.... Jun 2024Many individuals start dialysis in an acute setting with suboptimal pre-dialysis education. These individuals are often treated with central venous catheter insertion...
INTRODUCTION
Many individuals start dialysis in an acute setting with suboptimal pre-dialysis education. These individuals are often treated with central venous catheter insertion and initiation of in-center hemodialysis and only a minority will transfer to a home-based therapy. The dialysis start unit is a program performing in-center hemodialysis in a separate space while providing support and education on chronic kidney disease and treatment options in the initial weeks of kidney replacement therapy. We aimed to assess the uptake of home dialysis therapies between 2013 and 2021 among patients who started acute inpatient hemodialysis at University Health Network, Toronto and underwent dialysis at the dialysis start unit.
METHODS
This is a retrospective observational cohort study based on prospectively collected data. Patients' demographics were obtained from electronic charts. In the dialysis start unit, all patients received dialysis modality education by a nurse educator, dedicated home dialysis nurses, and the allied health care team.
FINDINGS
During 2013-2021, 122 patients were dialyzed in the dialysis start unit and included in the study. Among those patients, 68 patients ultimately chose home dialysis (57 peritoneal dialysis and 11 home hemodialysis). Fifty-four patients continued in-center hemodialysis. Patients adopting home dialysis were less likely to have diabetes and hypertension as the etiology of kidney failure and more likely to have glomerulonephritis or vasculitis.
DISCUSSION
Dialysis modality education is implementable in advanced chronic kidney disease. Individualized education and care after unplanned start dialysis can potentially enhance home dialysis choice and utilization.
PubMed: 38937138
DOI: 10.1111/hdi.13165 -
Kidney360 Jun 2024
Topics: Humans; Dyspnea; Peritoneal Dialysis; Kidney Failure, Chronic; Female; Male; Middle Aged
PubMed: 38935494
DOI: 10.34067/KID.0000000000000467 -
Nephron Jun 2024The first version of Animal Research: Reporting of In Vivo Experiments (ARRIVE 1.0) guidelines was introduced to improve reporting of animal research, but did not lead...
INTRODUCTION
The first version of Animal Research: Reporting of In Vivo Experiments (ARRIVE 1.0) guidelines was introduced to improve reporting of animal research, but did not lead to major improvements in this respect, which applied also to animal studies on peritoneal dialysis (PD). Here, we examined the performance of a revised version of these guidelines (ARRIVE 2.0).
METHODS
89 relevant articles published in 2018-2020 (ARRIVE 1.0 period) and 97 published in 2021-2023 (ARRIVE 2.0 period) were identified in PubMed® and analyzed for completeness and transparence of reporting.
RESULTS
In both periods, most studies were carried out in Asia, on rodents, and concerned the peritoneal pathophysiology. During ARRIVE 2.0, more studies were published in higher impact factor journals with the focus on pharmacology and immunology. Compared to ARRIVE 1.0, general aspects of study design and reporting improved during ARRIVE 2.0 period in studies generated in Europe and America, but did not change significantly in Asia. Detailed analysis showed no improvement in completeness of reporting key information included in the ARRIVE 2.0 Essential 10 checklist. Articles from both periods were deficient in sample size calculations, use of blinding, recording adverse events and drop-outs, and specification of appropriate statistical methods. The level of reporting during ARRIVE 2.0 did not correspond to the journal impact factor and the presence of recommendations for the use of ARRIVE 2.0 in their instructions to authors.
CONCLUSION
So far, ARRIVE 2.0 has not produced significant improvements in the reporting of animal studies in PD.
PubMed: 38934165
DOI: 10.1159/000539892 -
Kidney Research and Clinical Practice May 2024Patients with end-stage kidney disease (ESKD) are more susceptible to viral epidemics and are known to have higher incidence and death rates of coronavirus disease 2019...
BACKGROUND
Patients with end-stage kidney disease (ESKD) are more susceptible to viral epidemics and are known to have higher incidence and death rates of coronavirus disease 2019 (COVID-19) compared to the general population. We determined COVID-19 incidence and mortality among chronic hemodialysis (HD), peritoneal dialysis (PD), and kidney transplantation (KT) patients in Korea.
METHODS
We conducted a retrospective cohort study and data regarding Korean ESKD adults (aged ≥18 years) were obtained from the National Health Insurance Service of Korea from October 2020 to December 2021. We examined and compared the incidence of COVID-19-related infections and deaths among the patients receiving HD, PD, and KT.
RESULTS
Of all ESKD patients, 85,018 (68.1%) were on HD, 8,399 (6.7%) on PD, and 31,343 (25.1%) on KT. The COVID-19 incidence was 1.3% for HD, 1.2% for PD, and 1.5% for KT. COVID-19 mortality was 16.3% for HD, 12.2% for PD, and 4.7% for KT. PD patients had a lower incidence of infection compared to HD patients (odds ratio [OR], 0.76; 95% confidence interval [CI], 0.607-0.93), but KT patients had a significantly higher risk of infection (OR, 1.28; 95% CI, 1.13-1.44). Compared with HD, the risk of COVID-19-related death was not different for PD patients but was significantly lower for KT patients (hazard ratio, 0.55; 95% CI, 0.35-0.88).
CONCLUSION
COVID-19 incidence was lower in PD patients than in HD patients, but mortality was not different between them. KT was associated with a higher risk of COVID-19 infection but lower mortality compared to HD.
PubMed: 38934044
DOI: 10.23876/j.krcp.23.287 -
Kidney Research and Clinical Practice May 2024The global coronavirus disease 2019 (COVID-19) pandemic has placed patients with end-stage kidney disease (ESKD) at heightened risk owing to their vulnerability to...
BACKGROUND
The global coronavirus disease 2019 (COVID-19) pandemic has placed patients with end-stage kidney disease (ESKD) at heightened risk owing to their vulnerability to infections. Our study focused on patients with ESKD, examining COVID-19 incidence, hospitalization, and mortality in relation to their renal replacement therapy (RRT) type and identifying factors influencing COVID-19 hospitalization.
METHODS
We conducted a retrospective cohort study using health insurance claims data from the Health Insurance Review and Assessment Service for patients with ESKD between July 2017 and June 2022. COVID-19 data for the general population were sourced from the Korea Disease Control and Prevention Agency.
RESULTS
Patients undergoing hemodialysis (HD) constituted 90.7% of the cohort, followed by kidney transplantation (KT) recipients and peritoneal dialysis (PD). After adjusting for every 10,000 individuals, KT recipients exhibited the highest COVID-19 incidence, followed by those undergoing HD and PD, whereas the general population showed a higher infection rate of 43.64. Patients undergoing HD had the highest hospitalization rates, followed by KT recipients and those undergoing PD. The mortality rate per 10,000 individuals was highest in HD, followed by PD, the general population, and KT. Multivariate analysis indicated that age, RRT duration, residence in a nursing hospital, and comorbidities were associated with COVID-19 hospitalization.
CONCLUSION
Among RRT modalities, KT recipients displayed the highest COVID-19 incidence, whereas those undergoing HD exhibited the highest hospitalization and mortality rates. This study contributes to our understanding of infectious diseases in patients on RRT and aids in preparedness for future infectious disease outbreaks.
PubMed: 38934043
DOI: 10.23876/j.krcp.23.280