Initiation of dialysis.

Hakim, R. M.; Lazarus, J. Michael

doi:10.1681/asn.v651319

Cited by 218 publications

(15 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The timing of initiation of dialysis has recently been a subject of intense debate in the nephrology community (34,35). Proponents of early initiation cite evidence suggesting that initiation of dialysis at low levels of GFR adversely affect nutrition, volume and BP control, resulting in poor ESRD outcomes (7).…”

Section: Discussionmentioning

confidence: 99%

Prevalence, Predictors, and Consequences of Late Nephrology Referral at a Tertiary Care Center

Arora¹,

Obrador²,

Ruthazer³

et al. 1999

Journal of the American Society of Nephrology

302

View full text Add to dashboard Cite

Abstract. Despite improvements in dialysis care, mortality of patients with end-stage renal disease (ESRD) remains high. One factor that has thus far received little attention, but might contribute to morbidity and mortality, is the timing of referral to the nephrologist. This study examines the hypothesis that late referral of patients to the nephrologist might lead to suboptimal pre-ESRD care. Clinical and laboratory data were obtained from the patient records and electronic databases of New England Medical Center, its affiliated dialysis unit (Dialysis Clinics, Inc., Boston), and the office records of the outpatient nephrology clinic. Early (ER) and late (LR) referral were defined by the time of first nephrology encounter greater than or less than 4 mo, respectively, before initiation of dialysis. Multivariate models were built to explore factors associated with LR, and whether LR is associated with hypoalbuminemia or late initiation of dialysis. Of the 135 patients, 30 (22%) were referred late. There were no differences in age, gender, race, and cause of ESRD between ER and LR patients. However, there were significant differences in insurance coverage between these two groups. In the multivariate analysis, patients covered by health maintenance organizations were more likely to be referred late (odds ratio = 4.5) than patients covered by Medicare. Compared to ER, LR patients were more likely to have hypoalbuminemia (56% versus 80%), hematocrit <28% (33% versus 55%), and predicted GFR <5 ml/min per 1.73 m2 (17% versus 40%) at the start of dialysis, and less likely to have received erythropoietin (40% versus 17%) or have a functioning permanent vascular access for the first hemodialysis (40% versus 4%). It is concluded that late referral to the nephrologist is common in the United States and is associated with poor pre-ESRD care. Pre-ESRD care of patients treated by nephrologists was also less than ideal. The patient-, physician-, and system-related factors behind this observation are unclear. Meanwhile, pre-ESRD educational efforts need to target patients, generalists, and nephrologists.

show abstract

Section: Discussionmentioning

confidence: 99%

Prevalence, Predictors, and Consequences of Late Nephrology Referral at a Tertiary Care Center

Arora¹,

Obrador²,

Ruthazer³

et al. 1999

Journal of the American Society of Nephrology

302

View full text Add to dashboard Cite

show abstract

“…1 Life-threatening indications for initiating renal replacement therapy in end-stage renal disease (ESRD) are the presence of uremic symptoms, fluid overload, intractable acidemia, or hyperkalemia. 2,3 However, the definite level of estimated glomerular filtration rate (eGFR) without symptoms associated with chronic kidney disease (CKD) is not well established. Earlier observational studies suggested that initiation of HD at a higher level, eGFR >10 ml/min/1.73 m 2 , might have benefits for mortality, morbidity, and nutritional status.…”

Section: Introductionmentioning

confidence: 99%

“…During the past few decades, the number of patients undergoing maintenance hemodialysis (HD) has been increasing worldwide 1 . Life‐threatening indications for initiating renal replacement therapy in end‐stage renal disease (ESRD) are the presence of uremic symptoms, fluid overload, intractable acidemia, or hyperkalemia 2,3 . However, the definite level of estimated glomerular filtration rate (eGFR) without symptoms associated with chronic kidney disease (CKD) is not well established.…”

Section: Introductionmentioning

confidence: 99%

Early as compared to late initiation of twice‐weekly hemodialysis and short‐term survival among end‐stage renal disease patients

Panaput

Domrongkitchaiporn

Thinkhamrop

et al. 2022

Hemodialysis International

View full text Add to dashboard Cite

Introduction:The impact of timing of hemodialysis (HD) for end-stage renal disease (ESRD) patients treated with twice-weekly HD remains unclear. We aimed to determine the effects of late initiation of HD on short-term mortality and hospitalization.Methods: A multicenter cohort study was conducted in 11 HD centers in Northeastern Thailand (HEmodialysis Network of the NorthEastern Thailand study group). We recruited adult ESRD patients who were treated with twiceweekly HD for more than 3 months and had data on eGFR at HD initiation.Clinical and laboratory values at the time of recruitment were recorded. Late and early (eGFR at start <5 and >5 ml/min/1.73 m 2 ) initiations were defined.Outcomes were disease-related death (excluding any accidental deaths) and first hospitalization. Data analysis was performed by multivariable coxregression analysis.Findings: A total of 407 patients who had data on eGFR at HD initiation (303 in late group and 104 in early group) were included for analysis. There were 56.8% male with a mean age of 55 years. During the 15.1 months of follow-up, there were 27 (6.6%) disease-related deaths. The 1-year survival rate was similar among late and early initiation groups. The incidence density of first hospitalization in the late group was significantly lower than those in the early group (HR adjusted, 0.63; 95% CI, 0.40-0.99, p = 0.047). Among 303 patients who were in the late start group, patients with diabetes had a higher mortality rate (HR, 3.49; 95% CI, 1.40-8.70, p = 0.007) when compared to non-diabetic patients.Discussion: Early initiation of HD at eGFR >5 ml/min/1.73 m 2 had no shortterm survival benefit compared to the late group in ESRD patients treated with

show abstract

“…Dialysis is a treatment that removes wastes and extra fluid from patient blood when patient’s kidneys are no longer able to work effectively. [ 1 ] Patients need dialysis when they develop end stage kidney failure, usually by the time they lose about 85% to 90% of their kidney function and have a glomerular filtration rate that falls below 15 mL/minute/1.73m 2 . [ 2 ] There are 2 types of dialysis procedures, of which 1 is hemodialysis using a machine/artificial kidney-like apparatus, the other is peritoneal dialysis using a peritoneal membrane as a filter.…”

Section: Introductionmentioning

confidence: 99%

Effects and safety of Ophiocordyceps sinensis preparation in the adjuvant treatment for dialysis patients: A protocol for systematic review and meta-analysis

et al. 2022

View full text Add to dashboard Cite

Introduction: Ophiocordyceps sinensis(O. sinensis), a genus of ascomycete fungi, has been intensively studied in various disease models, which is a rich source of various bioactive compounds and used in the treatment for end-stage renal disease patients. This systematic review highlights the therapeutic roles of O. sinensis as adjuvant treatment for dialysis patients with clinical evidence.Methods and analysis: The systematic review will be performed according to the Cochrane Handbook for Systematic Reviews of Interventions. The protocol is being reported in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols Statement. An literature search strategy will be developed and adapted for 9 databases. Searches will be run from the database inception until the date of the search implementation and be updated before the review is completed. Randomized controlled trials that investigate the effects of O. sinensis for dialysis patients (peritoneal dialysis and hemodialysis) will be included. We will focus on outcomes recommended by the core outcome measures in effectiveness trials, including mortality, cardiovascular disease, infection, vascular access problems, dialysis adequacy, hyperkalaemia, life participation. Two researchers will independently screen the studies, extract data and evaluate study quality using the Risk of Bias 2 tool. Subgroup analysis will be performed according to peritoneal dialysis and hemodialysis. Sensitivity analyses will be conducted based on the Leave-1-Out Method. The Grading of Recommendations Assessment, Development, and Evaluation approach will be used to rate the quality of the evidence. Meta analysis will be performed using Review Manager 5.3 and R packages.Objectives: Studies have reported positive results of O. sinensis as adjuvant treatment for patients with dialysis. This review will synthesis current evidence on how O. sinensis can improve dialysis. Thus, it is expected that robust and conclusive evidence of the effects of O. sinensis during or after treatment can be obtained. These findings can inform future research and the selection of O. sinensis to promote quality of life for people with dialysis.

show abstract

Initiation of dialysis.

Cited by 218 publications

References 0 publications

Prevalence, Predictors, and Consequences of Late Nephrology Referral at a Tertiary Care Center

Prevalence, Predictors, and Consequences of Late Nephrology Referral at a Tertiary Care Center

Early as compared to late initiation of twice‐weekly hemodialysis and short‐term survival among end‐stage renal disease patients

Effects and safety of Ophiocordyceps sinensis preparation in the adjuvant treatment for dialysis patients: A protocol for systematic review and meta-analysis

Contact Info

Product

Resources

About