Category Archives: AJKD
Sevelamer Versus Calcium Carbonate in Incident Hemodialysis Patients: Results of an Open-Label 24-Month Randomized Clinical Trial
Hemodialysis.com eInterview with:
Dr. Antonio Bellasi
UOC Nefrologia e Dialisi
Azienda Ospedaliera S.Anna (CO), Via Ravona,
22020 San Fermo della Battaglia (Como), Italy
and Dr. Biagio Raffaele Di Iorio
Università degli Studi di Napoli Federico II
Hemodialysis.com: What are the main findings of the study?
Response: The main findings are that non-calcium containing phosphate binder maybe superior than calcium containing phosphate binder in CKD-5D dialysis patients. Current results expand the existing body of evidence, confirming what reported by Block et al in a secondary analysis of the RIND study (Block et al Kidney Int 2007; 71(5):438-41) and suggesting the survival benefit is mainly driven by the different impact of these 2 phosphate binder regimens on the cardiovascular system.
Indeed, we did not observe any non-CV survival difference between groups.
Finally, numerous studies suggest now that calcium supplementation maybe associated with a significant increase in the CV risk in post-menopausal women further questioning the excessive use of calcium (Bolland et al Br Med J 2010; 341:C3691).
Marie Benz, MD on Google+Temporary Hemodialysis Catheter Placement by Nephrology Fellows: Implications for Nephrology Training
Hemodialysis.com eInterview with: Dr. Edward G. Clark MD
Division of Nephrology
The Ottawa Hospital Riverside Campus
1967 Riverside Dr, Ottawa, Ontario, Canada K1H 7W9
Hemodialysis.com: What are the main findings of the study?
Dr. Clark: We conducted a survey of nephrology fellowship trainees in Canada regarding their practices and attitudes with respect to the placement of temporary hemodialysis catheters. Of 68 trainees in Canada, we received responses from 45 (66%). Respondents indicated that they had inserted a median (IQR) of 5 (2, 11) temporary hemodialysis catheters during the prior 6 months of nephrology training. Over one-third of respondents indicated that they were less than “adequately trained and competent” to place both internal jugular and femoral temporary HD catheters. Most respondents reported adhering to basic infection control procedures at the time of temporary HD catheter insertion. While 85% reported ‘always’ using ultrasound guidance for internal jugular temporary hemodialysis catheter insertions, only 57% reported ‘always’ using ultrasound for insertions at the femoral site.
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.
Current Status and Practical Use of Effluent Biomarkers in Peritoneal Dialysis Patients
Hemodialysis.com eInterview with
Raymond T Krediet, MD,PhD
Professor of Nephrology
Division of Nephrology, Department of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
Hemodialysis.com: What are the main findings of the study?
Dr. Krediet: The review summarizes the current knowledge and potential use of substances, that are present in drained peritoneal dialysate due to local production or release, also called effluent biomarkers. Some of these may give a mirror image of certain morphological changes in the peritoneum. Examples are cancer antigen 125 (CA125), that reflects the mesothelial cell mass, interleukin-6, (Il-6) which indicates peritoneal micro-inflammation in the absence of peritonitis, and plasminogen activator inhibitor-1. An example is given of a patient, in whom an earlier diagnosis of encapsulating peritoneal sclerosis (EPS) would have been possible with the use of biomarkers during his follow-up.
Hyponatremia, Mineral Metabolism, and Mortality in Incident Maintenance Hemodialysis Patients: A Cohort Study
Hemodialysis.com eInterview with Dr. Sagar Nigwekar, MD
Dr. Nigwaker is currently a Clinical and Research Fellow in the Joint Nephrology Fellowship Program at the Brigham and Women’s Hospital and Massachusetts GeneralHospital. His areas of research include calciphylaxis, cardiovascular disease in patients with kidney disease and vascular calcification.
Hemodialysis.com: What are the main finding of the study?
Dr. Nigwekar: In this large cohort study, we investigated associations between hyponatremia, mineral bone disease, and mortality in incident hemodialysis patients. We observed that hyponatremia at the time of hemodialysis initiation is associated with hypercalcemia, increased alkaline phosphatase and hypoparathyroidism suggesting that hyponatremia may have a potential role in bone turnover in hemodialysis patients. Hyponatremia was also associated with increased one-year mortality. Although, causality of these associations could not be determined in this observational study, it provides a platform for future studies to address the role of hyponatremia, a common and potentially modifiable abnormality, in mineral bone disease in dialysis patients.
Heart Failure with Preserved or Reduced Ejection Fraction in Patients Treated With Peritoneal Dialysis
Hemodialysis.com Interview with
Angela Yee-Moon Wang, MD, PhD, FRCP
Research performed at Prince of Wales Hospital, Chinese University of Hong Kong
Current affiliation: Dept of Med, Queen Mary Hospital, University of Hong Kong
Hemodialysis.com: What are the main findings of the study?
Dr. Wang: This prospective study is so far the first to investigate the prevalence of heart failure with preserved ejection fraction (HFPEF) and compare the long-term clinical outcomes of heart failure with preserved or reduced ejection fraction in the dialysis population and specifically in the peritoneal dialysis (PD) patients.
We observed a very high prevalence of heart failure with preserved ejection fraction (HFPEF) (~ 55%) in the PD patients, suggesting that this is a very common heart failure entity in the PD patients. Furthermore, our study is the first to show that PD patients having HFPEF were associated with an increased risk of mortality and adverse cardiovascular outcomes including cardiovascular death, fatal or non-fatal cardiovascular events, and heart failure compared to patients without heart failure. However, the risk for all-cause mortality, cardiovascular death, fatal or non-fatal cardiovascular events, and heart failure was lower when compared to patients having heart failure with reduced ejection fraction (HFREF).
Association Between Aristolochic Acid and CKD: A Cross-sectional Survey in China.
Hemodialysis.com Interview with Authors Wenke Wang and Jian Zhang
Hospital Authority Toxicology Reference Laboratory
Princess Margaret Hospital, Hong Kong SAR, China
Hemodialysis.com: What are the main findings of the study?
Response: Altogether, 467 participants reported long-term AA intake, with an adjusted prevalence of 1.5% (95% CI, 1.2%-1.7%).
After adjusting for age and sex, long-term AA intake was associated with eGFR < 60 mL/min/1.73 m2 and albuminuria, with ORs of 2.20 (95% CI, 1.51-3.12) and 1.67 (95% CI, 1.27-2.20), respectively.
