Chronic kidney disease: appropriateness of therapeutic management and associated factors in the AVENIR study

Thilly, Nathalie; Boini, Stéphanie; Kessler, Michèle; Briançon, Serge; Frimat, Luc

doi:10.1111/j.1365-2753.2008.00965.x

Cited by 19 publications

(19 citation statements)

References 28 publications

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“…Some studies showed that management of mineral and bone disorder is very far from optimal, especially as compared with other CKD complications [1][2][3] reflecting a lack of awareness among clinicians about this aspect of care. Others provided evidence that calcium-phosphate metabolism disorders, and particularly excess serum phosphate, are implicated in cardiovascular morbidity and mortality through the formation of vascular calcifications [4][5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Hyperphosphatemia in Chronic Kidney Disease: Patient Characteristics and Dialysis Mortality during the First Year of Dialysis

Laurain¹

2012

J Nephrol Therapeutic

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Aims: To describe the characteristics of chronic kidney disease patients with hyperphosphatemia before dialysis. To assess the impact of pre-dialysis hyperphosphatemia on dialysis mortality.Methods: All patients beginning a dialysis treatment in [2005][2006] in all the nephrology units operating in the Lorraine region of northeastern France were considered. Among them, those who were referred to a nephrologist more than 1 month before dialysis and had atleast one pre-dialysis phosphatemia measurement were included. All-cause mortality during the first year of dialysis was the outcome of interest and phosphatemia level the parameter of interest.Results: Of 406 patients included (mean age, 68.2 ± 14.8 years), 53% had pre-dialysis hyperphosphatemia, defined by a mean serum phosphate > 1.45 mmol/L during an average pre-dialysis nephrology follow-up period of 10 months. Patients with hyperphosphatemia were younger than those with normophosphatemia, and more often women. They were more likely to have diabetic nephropathy, less likely to have hypertensive nephropathy and cardiovascular comorbidity, and had fewer comorbidities. We found no association between hyperphosphatemia and mortality.Conclusions: This study shows that patients with pre-dialysis hyperphosphatemia differ from those with normophosphatemia. Larger studies are warranted to confirm or refute the absence of a relationship between predialysis hyperphosphatemia and dialysis mortality.

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Section: Introductionmentioning

confidence: 99%

Hyperphosphatemia in Chronic Kidney Disease: Patient Characteristics and Dialysis Mortality during the First Year of Dialysis

Laurain¹

2012

J Nephrol Therapeutic

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“…Its methodology was approved by the Ethics Board of the Regional University Hospital and is described in detail elsewhere. 29 All adults with CKD who began dialysis in 1 of the 12 units between January 1, 2005 and December 31, 2006 were identified from the regional ESRD registry (The Renal Epidemiology and Information Network registry) and enrolled in the study. Patients with reversible renal failure and those returning to dialysis after kidney graft failure were not included.…”

Section: Setting Study Design and Sample Selectionmentioning

confidence: 99%

“…This first stage showed that therapeutic practices were suboptimal although the level of adherence to guidelines was somewhat uneven, depending on which of the aspects of CKD therapeutic care was being considered: appropriate management of hypertension/proteinuria was identified as a prominent strength of existing services, whereas inappropriate bone disease management was singled out as a prominent weakness (Table 1). 29 Hence, the aim of the present investigation was to evaluate how the appropriateness of pre-ESRD therapeutic practices affects survival and hospitalization during the first year of RRT, and thereafter to determine whether pre-ESRD therapeutic care CPGs are effective with regard to dialysis morbidity and mortality in a routine care setting.…”

mentioning

confidence: 99%

Impact of Predialysis Therapeutic Practices on Patient Outcomes During the First Year of Dialysis

Thilly¹,

Boini²,

Loos-Ayav³

et al. 2012

Medical Care

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“…Its main objective was to assess the consequences of therapeutic care delivered to pre-ESRD patients on their quality of life and morbidity/mortality during RRT [6]. The study’s methodology was approved by the Ethics Board of the regional University hospital and is described in detail elsewhere [7]. …”

Section: Methodsmentioning

confidence: 99%

Outcomes of Patients with Delayed Dialysis Initiation: Results from the AVENIR Study

Thilly

Boini²,

Soudant³

et al. 2010

Am J Nephrol

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Background: Some patients who reach end-stage renal disease refuse to start dialysis at the time suggested by their nephrologist and delay it. Whether this delay may affect health-related quality of life (HRQoL), clinical and biological parameters at dialysis onset, and then survival and hospitalization during dialysis is unknown. Methods: We considered all adult patients who began dialysis in Lorraine (France) in 2005–2006 having previously been followed by a nephrologist. Clinical and biological characteristics at dialysis onset were collected from medical records, and nephrologists were interviewed about compliance with the recommended starting date. HRQoL was measured using the French version of the ‘Kidney Disease Quality of Life’ V36 questionnaire. Mortality and total duration of hospitalization during the first year of dialysis were recorded as part of the end-stage renal disease French registry. The effects of delaying dialysis on survival and on duration of hospitalization were determined using log-rank test and polychotomous logistic regression, respectively. Results: Of 541 patients, 88 (16.3%) declined to initiate dialysis at the time recommended by the nephrologist and delayed it. Compared with patients who were compliant with the advice, noncompliers had more comorbidities, poorer clinical and biological profiles at dialysis start, and a higher risk of beginning dialysis in emergency circumstances with greater decline in the ‘burden of kidney disease’ dimension of HRQoL. However, there were no differences in survival or duration of hospitalization during dialysis. Conclusion: Despite a negative effect on clinical and biological parameters at initiation, delaying dialysis did not impact on survival during treatment.

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Chronic kidney disease: appropriateness of therapeutic management and associated factors in the AVENIR study

Abstract: The quality of therapeutic care delivered to CKD patients in nephrology setting was suboptimal when assessed in terms of adherence to guidelines.

Cited by 19 publications

References 28 publications

Hyperphosphatemia in Chronic Kidney Disease: Patient Characteristics and Dialysis Mortality during the First Year of Dialysis

Hyperphosphatemia in Chronic Kidney Disease: Patient Characteristics and Dialysis Mortality during the First Year of Dialysis

Impact of Predialysis Therapeutic Practices on Patient Outcomes During the First Year of Dialysis

Outcomes of Patients with Delayed Dialysis Initiation: Results from the AVENIR Study

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