Long-term haemodialysis survival

Heaf, James; Nielsen, Arne Høj; Hansen, Henrik Post

doi:10.1093/ckj/sfs011

Cited by 14 publications

(17 citation statements)

References 9 publications

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“…The longevity of HD patients in general can vary as some receive renal transplants or change dialysis methods. Allowing for this, their survival is typically longer than patients with lung cancer; in one study, survival was reported at 72% after 10 years and has been documented as upwards of 35 years .…”

Section: Discussionmentioning

confidence: 99%

Superior Vena Cava Obstruction in Hemodialysis Patients: Symptoms, Clinical Presentation and Outcomes Compared to Other Etiologies

Siegel

Kuker

2016

Ther Apher Dial

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The incidence of superior vena cava (SVC) obstruction associated with non-malignant diseases is on the rise, and a large percentage of these patients are on hemodialysis (HD). The objective was to characterize the presentation, symptoms and outcomes of HD patients with SVC obstruction identified on computerized tomography (CT) compared to patients with other etiologies such as neoplasm. A search was performed through the PACS system using key words to identify patients with SVC obstruction. The CT scans and charts were reviewed for degree of obstruction, signs, symptoms and outcomes. Thirty-six patients were included in the study. Thirteen were on HD and of these, five had symptoms associated with SVC obstruction and one had concordant findings on physical exam. In comparison, thirteen patients with a chest neoplasm had symptoms and four had concordant findings on physical exam. On follow up, 31% of the HD patients died and of these 60% were symptomatic and died within 2 years. 29% of lung cancer patients died within 16 months. The majority of the HD patients had complete SVC obstruction (85%) as opposed to those with a chest neoplasm who mostly had partial SVC occlusion (67%). In conclusion, patients on HD with SVC obstruction are less often symptomatic than those with a neoplasm. However, these HD patients had a death rate similar to the patients with cancer. This risk seems to increase in those who are symptomatic. Diagnosis of SVC obstruction by CT in HD patients may help identify those with less favorable prognosis.

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Section: Discussionmentioning

confidence: 99%

Superior Vena Cava Obstruction in Hemodialysis Patients: Symptoms, Clinical Presentation and Outcomes Compared to Other Etiologies

Siegel

Kuker

2016

Ther Apher Dial

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“…At least in settings where dialysis efficiency has been a key goal in recent decades, the "skeleton man" is now seldom encountered in dialysis wards, except in cases in which diffuse and severe vascular disease is accompanied by a reduction in food intake, often in a context of cognitive impairment in elderly patients [71][72][73][74]. Another exception is patients with a very long dialysis follow-up, whose clinical situation is often dominated by diffuse precocious bone or vascular disease [75][76][77][78][79][80] (Figure 1).…”

Section: From the "Skeleton Man" To The Obese Sarcopenic Patientmentioning

confidence: 99%

Intradialytic Nutrition and Hemodialysis Prescriptions: A Personalized Stepwise Approach

et al. 2020

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Dialysis and nutrition are two sides of the same coin—dialysis depurates metabolic waste that is typically produced by food intake. Hence, dietetic restrictions are commonly imposed in order to limit potassium and phosphate and avoid fluid overload. Conversely, malnutrition is a major challenge and, albeit to differing degrees, all nutritional markers are associated with survival. Dialysis-related malnutrition has a multifactorial origin related to uremic syndrome and comorbidities but also to dialysis treatment. Both an insufficient dialysis dose and excessive removal are contributing factors. It is thus not surprising that dialysis alone, without proper nutritional management, often fails to be effective in combatting malnutrition. While composite indexes can be used to identify patients with poor prognosis, none is fully satisfactory, and the definitions of malnutrition and protein energy wasting are still controversial. Furthermore, most nutritional markers and interventions were assessed in hemodialysis patients, while hemodiafiltration and peritoneal dialysis have been less extensively studied. The significant loss of albumin in these two dialysis modalities makes it extremely difficult to interpret common markers and scores. Despite these problems, hemodialysis sessions represent a valuable opportunity to monitor nutritional status and prescribe nutritional interventions, and several approaches have been tried. In this concept paper, we review the current evidence on intradialytic nutrition and propose an algorithm for adapting nutritional interventions to individual patients.

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“…Dialysis treatment is continuously improving, ensuring better tolerance and overall higher survival of a population that is steadily getting older and more complicated. Although the therapeutic armamentarium is now far more varied than in the past, virtually all the long-term problems related to uremia and its treatments are still unsolved: cardiovascular diseases are still the main cause of death in a context of accelerated vascular ageing; vascular access malfunction still makes it often difficult to optimize treatment; Chronic Kidney Disease related Mineral and Bone Disorder (CKD-MBD) remains one of the plagues of long-term dialysis treatment [1][2][3][4][5][6].…”

Section: Introductionmentioning

confidence: 99%

New Intravenous Calcimimetic Agents: New Options, New Problems. An Example on How Clinical, Economical and Ethical Considerations Affect Choice of Treatment

Piccoli

Trabace

Chatrenet

et al. 2020

IJERPH

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Background. Dialysis treatment is improving, but several long-term problems remain unsolved, including metabolic bone disease linked to chronic kidney disease (CKD-MBD). The availability of new, efficacious but expensive drugs (intravenous calcimimetic agents) poses ethical problems, especially in the setting of budget limitations. Methods. Reasons of choice, side effects, biochemical trends were discussed in a cohort of 15 patients (13% of the dialysis population) who stared treatment with intravenous calcimimetics in a single center. All patients had previously been treated with oral calcimimetic agents; dialysis efficacy was at target in 14/15; hemodiafiltration was employed in 10/15. Median Charlson Comorbidity Index was 8. The indications were discussed according to the principlist ethics (beneficience, non maleficience, justice and autonomy). Biochemical results were analyzed to support the clinical-ethical choices. Results. In the context of a strict clinical and biochemical surveillance, the lack of side effects ensured “non-maleficence”; efficacy was at least similar to oral calcimimetic agents, but tolerance was better. Autonomy was respected through a shared decision-making model; all patients appreciated the reduction of the drug burden, and most acknowledged better control of their biochemical data. The ethical conflict resides in the balance between the clinical “beneficience, non-maleficience” advantage and “justice” (economic impact of treatment, potentially in attrition with other resources, since the drug is expensive and included in the dialysis bundle). The dilemma is more relevant when a patient’s life expectancy is short (economic impact without clear clinical advantages), or when non-compliance is an issue (unclear advantage if the whole treatment is not correctly taken). Conclusions. In a context of person-centered medicine, autonomy, beneficence and non-maleficence should weight more than economic justice. While ethical discussions are not aimed at finding “the right answer” but asking “the right questions”, this example can raise awareness of the importance of including an ethical analysis in the choice of “economically relevant” drugs.

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Long-term haemodialysis survival

Cited by 14 publications

References 9 publications

Superior Vena Cava Obstruction in Hemodialysis Patients: Symptoms, Clinical Presentation and Outcomes Compared to Other Etiologies

Superior Vena Cava Obstruction in Hemodialysis Patients: Symptoms, Clinical Presentation and Outcomes Compared to Other Etiologies

Intradialytic Nutrition and Hemodialysis Prescriptions: A Personalized Stepwise Approach

New Intravenous Calcimimetic Agents: New Options, New Problems. An Example on How Clinical, Economical and Ethical Considerations Affect Choice of Treatment

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