UK Renal Registry 17th Annual Report: Chapter 5 Survival and Cause of Death in UK Adult Patients on Renal Replacement Therapy in 2013: National and Centre-specific Analyses

Steenkamp, Retha; Rao, Anirudh; Roderick, Paul

doi:10.1159/000370275

Cited by 36 publications

(31 citation statements)

References 6 publications

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“…End-stage kidney disease has a significant and deleterious impact on duration and quality of life 1, 2, 3, 4. Approximately 1.9 million patients receive renal replacement therapy worldwide 5 .…”

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confidence: 99%

A Randomized, Single-Blind, Crossover Trial of Recovery Time in High-Flux Hemodialysis and Hemodiafiltration

Smith

Zimmer

Bell

et al. 2017

American Journal of Kidney Diseases

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BackgroundThe choice between hemodiafiltration (HDF) or high-flux hemodialysis (HD) to treat end-stage kidney disease remains a matter of debate. The duration of recovery time after treatment has been associated with mortality, affects quality of life, and may therefore be important in informing patient choice. We aimed to establish whether recovery time is influenced by treatment with HDF or HD.Study DesignRandomized patient-blinded crossover trial.Settings & Participants100 patients with end-stage kidney disease were enrolled from 2 satellite dialysis units in Glasgow, United Kingdom.Intervention8 weeks of HD followed by 8 weeks of online postdilution HDF or vice versa.OutcomesPosttreatment recovery time, symptomatic hypotension events, dialysis circuit clotting events, and biochemical parameters.MeasurementsPatient-reported recovery time in minutes, incidence of adverse events during treatments, hematology and biochemistry results, quality-of-life questionnaire.ResultsThere was no overall difference in recovery time between treatments (medians for HDF vs HD of 47.5 [IQR, 0-240] vs 30 [IQR, 0-210] minutes, respectively; P = 0.9). During HDF treatment, there were significant increases in rates of symptomatic hypotension (8.0% in HDF vs 5.3% in HD; relative risk [RR], 1.52; 95% CI, 1.2-1.9; P < 0.001) and intradialytic tendency to clotting (1.8% in HDF vs 0.7% in HD; RR, 2.7; 95% CI, 1.5-5.0; P = 0.002). Serum albumin level was significantly lower during HDF (3.2 vs 3.3 g/dL; P < 0.001). Health-related quality-of-life scores were equivalent.LimitationsSingle center; mean achieved HDF convection volume, 20.6 L.ConclusionsPatients blinded to whether they were receiving HD or HDF in a randomized controlled crossover study reported similar posttreatment recovery times and health-related quality-of-life scores.

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confidence: 99%

A Randomized, Single-Blind, Crossover Trial of Recovery Time in High-Flux Hemodialysis and Hemodiafiltration

Smith

Zimmer

Bell

et al. 2017

American Journal of Kidney Diseases

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“…The mortality for hemodialysis patients remains high, with survival probability in the United Kingdom at 1, 3, and 5 years being around 90, 70, and 50%, respectively (1). Intuitively a greater amount of dialysis by removing more azotemic toxins or achieving a critical threshold would be expected to increase patient survival.…”

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confidence: 99%

Dialysis and Patient Factors Which Determine Convective Volume Exchange in Patients Treated by Postdilution Online Hemodiafiltration

Davenport

2016

Artificial Organs

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Recent reports suggest a survival advantage for dialysis patients treated by postdilutional online hemodiafiltration (OL-HDF) who achieve higher volume convective exchanges. As such, the factors associated with achieving higher convective volume exchange were determined. The convective exchange volumes during the midweek OL-HDF session in a cohort of 653 patients with corresponding bio-impedance measurements of volume status and sessional electronic records were audited. Mean patient age was 64.9 ± 14.9 years, 65.3% male, 47.7% diabetes, with 81.6% dialyzing using fistula access. Sessional substitution volume exchanged was 17.0 ± 3.5 L (83.8 ± 13.9 mL/min), with a filtration fraction of 23.3 ± 4.6%, sessional time of 3.8 ± 0.5 h, and blood flow 321 ± 28 mL/min. As expected, convection exchange volume achieved was associated with sessional time (β 3.24, P < 0.001), blood flow (β 0.03, P < 0.001), dialysate flow (β 0.03, P < 0.001), but also patient factors: postsessional intracellular water (ICW) (β 0.07, P = 0.002), and serum albumin (β 0.71, P = 0.011). In addition convective exchange was lower for diabetics (16.6 ± 3.0 vs. 17.3 ± 3.8 L, P < 0.01), and for patients with higher Davies co-morbidity grades (16.6 ± 2.8 vs. 17.0 ± 3.6 vs. 17.9 ± 4.0 L), P = 0.01 respectively. As expected the convective volume exchanged with OL-HDF was associated with sessional time and blood and dialysate flows. However, the convective volume exchange achieved was also associated with patient factors, including ICW, which is related to body cell mass and also co-morbidity. Although some center practices can be modified to increase convective exchange, patient factors are not so readily remediable. As such, highly comorbid patients may not be able to achieve the higher volume convective exchanges reported to be associated with improved patient survival.

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“…Data from the UK Renal Registry suggest an overall incident death rate for patients commencing dialysis of 261 per 1,000 patient years. CVD, infections and dialysis withdrawal account for most of these deaths (27, 21 and 16%, respectively) [26]. There are similar data from the USRDS with an adjusted mortality rate for haemodialysis of 172 per 1,000 patient years, which increases to 400 in the first 2 months after commencing haemodialysis [27].…”

Section: Uncertainty In the Use Of Acei/arbs In Advanced Ckdmentioning

confidence: 98%

Should We STOP Angiotensin Converting Enzyme Inhibitors/Angiotensin Receptor Blockers in Advanced Kidney Disease?

Ahmed

Jorna²,

Bhandari³

2016

Nephron

8,330

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Chronic kidney disease (CKD) is a worldwide public health problem associated with a high prevalence of cardiovascular disease (CVD) and impaired quality of life. Previous research for preventing loss of glomerular filtration rate (GFR) has focused on reducing blood pressure (BP) and proteinuria. Angiotensin converting enzyme inhibitors (ACEi) and angiotensin II receptor antagonists (ARB) are commonly used in patients with early CKD, but their value in advanced CKD (estimated GFR (eGFR) ≤30 ml/min/1.73 m²) is unknown. There remains a debate about the omission of ACEi/ARB in patients with advanced CKD and their use in association with CVD or heart failure. Does the potential gain in eGFR with ACEi/ARB cessation outweigh the potential adverse cardiovascular outcomes? This paper reviews the current literature that addresses this issue. Several controversies are discussed. Although lowering BP reduces cardiovascular events, evidence suggests that ACEi/ARBs are not superior to other antihypertensive agents. There are no studies assessing the benefits of ACEi/ARB therapy in cardiovascular risk reduction in advanced non-dialysis CKD. The STOP ACEi trial will strengthen the evidence base and shed light on the potential merits and dangers of ACEi/ARB use in advanced CKD on renal function and cardiovascular outcomes.

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UK Renal Registry 17th Annual Report: Chapter 5 Survival and Cause of Death in UK Adult Patients on Renal Replacement Therapy in 2013: National and Centre-specific Analyses

Cited by 36 publications

References 6 publications

A Randomized, Single-Blind, Crossover Trial of Recovery Time in High-Flux Hemodialysis and Hemodiafiltration

A Randomized, Single-Blind, Crossover Trial of Recovery Time in High-Flux Hemodialysis and Hemodiafiltration

Dialysis and Patient Factors Which Determine Convective Volume Exchange in Patients Treated by Postdilution Online Hemodiafiltration

Should We STOP Angiotensin Converting Enzyme Inhibitors/Angiotensin Receptor Blockers in Advanced Kidney Disease?

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