Category Archives: Outcomes
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.
Marie Benz, MD on Google+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.
Persistent nasal methicillin-resistant staphylococcus aureus carriage in hemodialysis outpatients: a predictor of worse outcome.
Hemodialysis.com eInterview with: Holger Schmid MD, MSc
KfH Nierenzentrum Muenchen-Laim,
Department of Internal Medicine
University Hospital Munich
University of Munich, Munich, Germany
Hemodialysis.com: What are the main findings of the study?
Dr. Schmid: In ambulatory patients receiving long-term hemodialysis (HD) persistent
nasal MRSA carriage with failure of Mupirocin decolonization was
associated with an extremely poor prognosis and an increased all-cause
mortality rate.
A history of malignancy and an increased Charlson Index were significant predictors for nasal MRSA carriers.
Concomitant extra-nasal MRSA colonization in nasal MRSA carriers had no influence on nasal decolonization failure or outcome.
Impaired Kidney Function at Hospital Discharge and Long-Term Renal and Overall Survival in Patients Who Received CRRT
Hemodialysis.com eInterview with Dr. Susanne Stads
Department of Intensive Care
Erasmus Medical Center, H-626
PO Box 2040, 3000 CA Rotterdam, the Netherlands.
Hemodialysis.com: What are the main findings of the study?
Dr. Stads: Acute Kidney Injury requiring renal replacement therapy is associated with high in-hospital mortality. Little is known about renal recovery in surviving patients and the impact of impaired kidney function on long-term renal and overall survival.
In a retrospective cohort study, we evaluated the association between impaired kidney function at hospital discharge with long-term renal and overall survival. The median follow up in our cohort was 8.5 years (range 1-17 years). Only 35% (n=170) of patients in our cohort were discharged with an estimated GFR > 60 ml/min per 1.73m2. An estimated GFR < 30 ml/min per 1.73m2 was a strong and independent predictor for decreased long-term survival and poor renal survival.
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.
Geographic Variation in Black–White Differences in End-of-Life Care for Patients with ESRD
Hemodialysis.com eInterview with
Bernadette Thomas MD
University of Washington
Department of Nephrology
Seattle, Washington
Written Interview conducted with author by Editor Marie Benz, MD
Hemodialysis.com: What are the major findings of your study?
Dr. Thomas: The major findings of the study are:
1. There are pronounced black-white differences in end-of-life outcomes among patients with ESRD.
2. These differences vary substantially across regions of the United States.
3. Geography plays a role in differences in end-of-life outcomes for both whites and blacks.
Adherence to a Healthy Lifestyle and All-Cause Mortality in CKD
Hemodialysis.com Author Interview with
Ana C. Ricardo, MD, MPH
Assistant Professor of Medicine, University of Illinois at Chicago
Department of Medicine, Section of Nephrology
Hemodialysis.com: What are the main findings of the study?
Dr. Ricardo: We conducted a study to evaluate the association of four lifestyle factors (healthy diet, regular physical activity, body mass index and abstinence from smoking) with all-cause mortality among participants in the Third National Health and Nutrition Examination Survey, 1988-1994 (NHANES III) with chronic kidney disease (CKD).
Outcomes Associated With Microalbuminuria: Effect Modification By Chronic Kidney Disease
Hemodialysis.com Author Interview:
Csaba P. Kovesdy MD FASN.
The Fred Hatch Professor of Medicine
Director, Clinical Outcomes and Clinical Trials Program in Nephrology
University of Tennessee Health Science Center
Chief of Nephrology
Division of Nephrology, Memphis VA Medical Center
Hemodialysis.com: What are the main findings of the study?
Dr. Kovesdy: We described an association of urine microalbumin-creatinine ratio (UACR) with mortality and with progression of CKD in close to 300,000 mostly male patients with non-dialysis dependent CKD. We detected a linear association between lower amounts of UACR and better outcomes, down to levels as low as 5 mcg/mg. When we examined these associations in subgroups of patients categorized according to various key characteristics such as level of blood pressure and kidney function, and presence/absence of various comorbid conditions, the same linear associations were present in all except patients with advanced CKD (eGFR<45 ml/min/1.73m2), in whom there was a U-shaped association, and in whom a UACR of 10-20 mcg/mg was associated with the best outcomes.
