Depressive Symptoms & Hospitalization Risk in Incident Hemodialysis Patients
Eduardo Lacson, Jr., MD, MPH, FACP, FASN Vice President Clinical Science, Epidemiology, and Research Fresenius Medical Care, North America More »
Ultraviolet Index and All-Cause Mortality in Dialysis Patients
Hemodialysis.com eInterview with Bryan B. Shapiro More »
Management of protein-energy wasting in non-dialysis-dependent chronic kidney disease: reconciling low protein intake with nutritional therapy.
Hemodialysis.com Author Interview: Csaba P. Kovesdy MD FASN. More »
Erythropoiesis-Stimulating Agent (ESA) Use among Medicare Patients Receiving Hemodialysis and Observations about Pruritus
Hemodialysis.com eInterview:
Scott Sibbel, PhD, MPH
DaVita Clinical Research, Inc.
Minneapolis, MN
Hemodialysis.com: What was the objective of this study?
Dr. Sibbel: Research shows that between 40% and 90% of hemodialysis patients experience pruritus, ranging from mild to severe. Skin itchiness, which is captured in the Kidney Disease Quality of Life (KDQOL) survey component and subscale scores, is an independent predictor of clinical and quality-of-life issues. For a better understanding of pruritus and how it affects patients, we conducted a retrospective cohort study of self‑reported itchiness/dryness and erythropoiesis‑stimulating agent (ESA) use in patients receiving in-center hemodialysis 3 times a week for the first 6 months after a KDQOL assessment between December 1, 2008, and June 30, 2012, at a large dialysis organization. We hypothesized that ESA use, would generally be reduced across the 6 months following the KDQOL survey, consistent with label changes and prescribing patterns, but would be higher with increased patient-reported skin itchiness and dryness.
Marie Benz, MD on Google+Is there an association between elevated or low serum levels of phosphorus, parathyroid hormone, and calcium and mortality in patients with end stage renal disease? A meta-analysis.
Hemodialysis.com eInterview with:
Dr. Vasily Belozeroff
Amgen, Thousand Oaks, CA, USA
Hemodialysis.com: What are the main findings of the study?
Dr. Belozeroff: Our meta analysis of observational studies suggests that there is an association between high levels of parathyroid hormone, calcium, and phosphorus and increased mortality in dialysis patients. Findings were less consistent for low levels of these biomarkers.
Major bleeding events and risk stratification of antithrombotic agents in hemodialysis: results from the DOPPS
Hemodialysis.com eInterview with Dr. Manish M. Sood
Department of Medicine, St. Boniface General Hospital
University of Manitoba, Winnipeg, Manitoba, Canada
Hemodialysis.com: What are the main findings of the study?
Dr. Sood: We examined over 48, 000 international hemodialysis patients from the DOPPS cohort for patterns of antithrombotic medication usage and there association with the outcomes of bleeding, stroke and mortality. We found large variations between and within countries with respect to antithrombotic medication usage. Furthermore, we examined whether clinical characteristics could predict major bleeding or strokes. The CHADS2 score was predictive of stroke risk whereas gastrointestinal bleeding within the past 12 months was highly predictive of bleeding events.
Bloodstream Infection Rates in Outpatient Hemodialysis Facilities Participating in a Collaborative Prevention Effort: A Quality Improvement Report
Dr. Priti R. Patel, MD, MPH
Division of Healthcare Quality Promotion
National Center for Emerging and Zoonotic Infectious Diseases
Centers for Disease Control and Prevention, Atlanta, GA
Hemodialysis.com: What are the main findings of the study?
Dr. Patel: In 2009, the Centers for Disease Control and Prevention (CDC) partnered with a group of outpatient dialysis centers on a collaborative initiative to prevent bloodstream infections (BSIs) in hemodialysis patients. Seventeen outpatient hemodialysis facilities worked together to implement a set of CDC-recommended interventions for BSI prevention. Rates of BSI and access-related BSI reported to CDC’s National Healthcare Safety Network (NHSN) were examined from January 2009 through March 2011. By implementing the interventions in a systematic manner, the facilities participating in this initiative were able to reduce their rate of overall BSI by 32% and rate of access-related BSI by 54%.
The interventions used included chlorhexidine antiseptic for catheter exit-site care, staff training and competency assessments focused on catheter care and aseptic technique, hand hygiene and vascular access care audits, and feedback of infection and adherence rates to staff. Facility staff were also encouraged to use antimicrobial ointment on catheter exit sites. For a complete list of the BSI prevention steps recommended by CDC, please see http://www.cdc.gov/dialysis/prevention-tools/core-interventions.html.
Outcomes of Patients Receiving Maintenance Dialysis Admitted Over Weekends
Hemodialysis.com eInterview with Dr. Ankit Sakhuja
Department of Nephrology and Hypertension, Cleveland Clinic, Cleveland, OH
Department of Nephrology and Hypertension
Glickman Urological and Kidney Institute
Cleveland Clinic, Q7, 9500 Euclid Ave
Cleveland, OH 44195
Hemodialysis.com: What are the main findings of the study?
Answer: Worse outcomes for patients admitted over weekends have been shown in those admitted with acute illnesses like myocardial infarction, stroke, acute kidney injury etc. The reasons for this disparity are not entirely clear but differences in staffing and resources available over weekends have been thought to contribute. Patients on maintenance dialysis have high rates of hospitalizations, have high co-morbidity burden and have worse outcomes than general population. However the differential effect of weekend admissions on their outcomes is not well known.
RAGE Polymorphism Is Associated with Chronic Kidney Disease Progression in Subjects Affected by Nephrocardiovascular Disease
Hemodialysis.com eInterview with Drs. Ivano Baragetti and Giuseppe Danilo Norata
Affiliations: Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, Milan, Italy, Center for the Study of Atherosclerosis, Italian Society for the Study of Atherosclerosis (SISA) Lombardia Chapter, Bassini Hospital, Cinisello Balsamo, Milan, Italy, The Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen’s Mary University, London, United Kingdom
Nephrology and Dialysis Unit, Bassini Hospital, Cinisello Balsamo, Milan, Italy
Written Interview conducted with author by Marie Benz, MD
Hemodialysis.com: What are the main findings of the study?
Answer: The main finding of the present study is the observation of the association of a single nucleotide polymorphism of the Receptor for Advanced Glycation End Products (-374 T/A RAGE) with the progression of chronic kidney disease (CKD). In particular, CKD patients carrying the A allele show a faster decline of renal function (doubled creatinine plasma concentrations and dialysis) than T carriers. This polymorphism induces an enhanced transcription of RAGE mRNA and a potential major expression of membrane RAGE at renal level, thus enhancing the binding of circulating AGEs with RAGE, especially at mesangial level. This effect could in turn sustain local inflammation. Indeed inflammation typical of CKD increases production and accumulation of RAGE ligands: AGEs [1], AOPPs (advanced oxidation protein products), HMGB1, S100 proteins, β2-integrin Mac/CD11b, amyloid β peptide, β sheet-fibrils, complement C3a, lipopolysaccharides and phosphatidylserine on the surface of apoptotic cells [2]. All these molecules are pro-inflammatory [3]. RAGE is expressed at low levels in normal tissues and vessels, but it is upregulated under pathological conditions in sites where the pro-inflammatory ligands accumulate [4] and following activation gives rise to NF-kB mediated cellular responses [5].
Chronic kidney disease is associated with neovascularization and intraplaque hemorrhage in coronary atherosclerosis in elders: results from the Hisayama Study.
Hemodialysis.com eInterview with Toshiaki Nakano, MD, PhD
Department of Medicine and Clinical Science
Graduate School of Medical Sciences, Kyushu University
3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
Written Interview conducted with author by Editor Marie Benz, MD
Hemodialysis.com: What are the main findings of the study?
Dr. Nakano: In this population-based autopsy study, we examined the relationships of chronic kidney disease (CKD) with neovascularization and intraplaque hemorrhage in coronary atherosclerosis from 375 autopsy samples from 126 subjects. Lower eGFR was associated with increased numbers of newly formed blood vessels. The multivariate-adjusted odds ratio of the presence of intraplaque hemorrhages was 6.22 (95% CI, 1.10–35.04) in subjects with an eGFR of <30 mL/min/1.73 m2 compared with those with an eGFR of ≥60 mL/min/1.73 m2. We found that elderly patients with CKD have higher risks of intimal neoangiogenesis and intraplaque hemorrhages in coronary arteries.
Evaluation of colestilan in chronic kidney disease dialysis patients with hyperphosphataemia and dyslipidaemia: a randomized, placebo-controlled, multiple fixed-dose tria
Hemodialysis.com eInterview with
Prof. Francesco Locatelli, MD, FRCP
Department of Nephrology and Dialysis, Ospedale A. Manzoni
Via Dell’Eremo 9–11
IT–23900 Lecco (Italy)
Written Interview conducted with author by Editor Marie Benz, MD
Hemodialysis.com: What are the main findings of the study?
Prof. Locatelli: This global 642 patient study assessed the effect of a range of doses of the new, non-metallic phosphate binder, colestilan, in reducing simultaneously both serum phosphorus and LDL-cholesterol levels in patients with chronic kidney disease stage 5 on dialysis who have both hyperphosphataemia and dyslipidaemia. In this 12 week, double-blind trial, which is probably the largest dual-endpoint study done in this area, we showed that colestilan significantly lowered both serum phosphorus and LDL-cholesterol, over a range of doses, while not influencing calcium levels and is generally well tolerated. Colestilan also was shown to reduce total cholesterol, oxidised LDL-cholesterol, high HbA1c levels and uric acid.
Long-term neurocognitive outcomes of patients with end-stage renal disease during infancy
Hemodialysis.com eInterview: Rebecca J. Johnson, PhD
Licensed Psychologist
Lead Pediatric Health Psychologist
Division of Developmental and Behavioral Sciences
Children’s Mercy Hospitals and Clinics
Assistant Professor, Department of Pediatrics
University of Missouri – Kansas City School of Medicine
Written Interview conducted with author by Editor Marie Benz, MD
Hemodialysis.com: What are the main findings of the study?
Dr. Johnson: We examined the long-term neurocognitive outcomes for 12 children (now an average age of 11 years) who were diagnosed with ESRD during the first 16 months of life. Across multiple indices of neurocognitive functioning, scores were lower than would be expected given a normal distribution, indicating that these patients are at risk for neurocognitive deficits. However, in the absence of major neurological risk factors, we did not find evidence of gross neurocognitive impairment. This finding is consistent with recent research, demonstrating that developmental outcomes have greatly improved for infants with ESRD over the last two decades.
Depressive Symptoms & Hospitalization Risk in Incident Hemodialysis Patients
Hemodialysis.com eInterview with:
Eduardo Lacson, Jr., MD, MPH, FACP, FASN
Vice President
Clinical Science, Epidemiology, and Research
Fresenius Medical Care, North America
Written Interview conducted with author by Editor Marie Benz, MD
Hemodialysis.com: What are the main findings of the study?
Dr. Lacson: Based on retrospective study of the cohort of 9,417 adult incident dialysis patients (i.e. new to dialysis, within 120 days of first ever chronic dialysis) treated in Fresenius Medical Care North America (FMCNA) facilities, we found that self-reported depressive symptoms based on 2 questions indicating frequency of feeling “down in the dumps” or “downhearted and blue” reported on average by the 45th day of chronic dialysis, were associated with shorter time to first hospitalization, greater number of hospitalization events, and more hospital days during the yearlong period immediately following the survey.
Ultraviolet Index and All-Cause Mortality in Dialysis Patients
Hemodialysis.com eInterview with Bryan B. Shapiro
Pomona College ’11
UCLA Fielding School of Public Health ’12
Written Interview conducted with author by Editor Marie Benz, MD
Hemodialysis.com: What is the rationale for your study?
Answer: Although Ultraviolet (UV) radiation is classified as a human carcinogen by the World Health Organization (WHO), emerging evidence suggests that UV exposure may actually reduce risk of several non-dermatologic malignancies (including prostate and breast cancer), cardiovascular-mortality, and all-cause mortality in the general population. Increased endogenous synthesis of Vitamin D as a result of exposure to UV irradiance has been suggested as a mechanistic link. In dialysis patients, a population with an exceedingly high prevalence of vitamin D deficiency, solar and artificial UV exposure has recently been linked to improved vitamin D status, though the implications of these findings have not yet been explored. In our study, we sought to ascertain the association between residential UV exposure with all-cause mortality in a nationwide sample of maintenance dialysis patients. Regional UV exposure was quantified by the “Ultraviolet Index (UVI),” a scale issued daily by the National Oceanic and Atmospheric Administration (NOAA) across 58 major cities and 5,245 zip codes in the United States.
Contrast-induced acute kidney injury following coronary angiography: a cohort study of hospitalized patients with or without chronic kidney disease
Hemodialysis.com eInterview with: Javier A. Neyra, MD
UT Southwestern Medical Center
5323 Harry Hines Blvd.
Dallas, Texas 75390-8516
Hemodialysis.com: What are the main findings of the study?
Dr. Neyra: We found that contrast-induced acute kidney injury (CIAKI) following coronary angiography was associated with adverse in-hospital and long-term outcomes in both CKD and non-CKD patients. It’s important to notice that even small changes in serum creatinine (SCr) adversely affected outcomes, particularly in patients without CKD.
Effects of recombinant human erythropoietin on resistance artery endothelial function in stage 4 chronic kidney disease.
Hemodialysis.com eInterview with Dr. Marie Briet
Department of Pharmacology and Institut National de la Santé et de la Recherche Médicale
U970-PARCC, Hôpital Européen Georges Pompidou,
Assistance Publique-Hôpitaux de Paris, 75015 Paris, France
Ernesto L. Schiffrin, CM, MD, PhD, FRSC, FRCPC, FACP
Physician-in-Chief, Sir Mortimer B. Davis-Jewish General Hospital,
Canada Research Chair in Hypertension and Vascular Research
Lady Davis Institute for Medical Research
Professor and Vice-Chair (Research), Department of Medicine
McGill University.
Written Interview conducted with author by Editor Marie Benz, MD
Hemodialysis.com: What are the main findings of the study?
Dr. Briet: The main finding is that EPO induces an endothelial dysfunction of small resistance arteries isolated from subcutaneous biopsies performed in chronic kidney disease patients. Considering that small arteries are the key determinants of blood pressure levels, the endothelial dysfunction induced by EPO could contribute to the increase in blood pressure and CV events observed in large interventional trials.
