Non-Emergency Medical Transportation Needs of Middle-Aged and Older Adults: A Rural-Urban Comparison in Delaware, USA.

Background: Older adults in rural areas have unique transportation barriers to accessing medical care, which include a lack of mass transit options and considerable distances to health-related services. This study contrasts non-emergency medical transportation (NEMT) service utilization patterns and associated costs for Medicaid middle-aged and older adults in rural versus urban areas. Methods: Data were analyzed from 39,194 NEMT users of LogistiCare-brokered services in Delaware residing in rural (68.3%) and urban (30.9%) areas. Multivariable logistic analyses compared trip characteristics by rurality designation. Results: Rural (37.2%) and urban (41.2%) participants used services more frequently for dialysis than for any other medical concern. Older age and personal accompaniment were more common and wheel chair use was less common for rural trips. The mean cost per trip was greater for rural users (difference of $2910 per trip), which was attributed to the greater distance per trip in rural areas. Conclusions: Among a sample who were eligible for subsidized NEMT and who utilized this service, rural trips tended to be longer and, therefore, higher in cost. Over 50% of trips were made for dialysis highlighting the need to address prevention and, potentially, health service improvements for rural dialysis patients

Hepatitis C in hemodialysis centers of golestan province, northeast of Iran (2005)

Background and Aims: Nosocomial transmission of blood-borne pathogens is common in a dialysis setting. Hepatitis C virus (HCV) infection is a common problem that increases morbidity and mortality in hemodialysis patients. Blood transfusion and the duration of hemodialysis are the most important factors in HCV transmission. The aim of the study was to determine the incidence rate of HCV antibody in hemodialysis patients and its association with some factors. Methods: In this descriptive-analytical study, HCV antibody was measured in 93 hemodialysis patients in all hospitals affiliated to Golestan University of Medical Sciences. Standard infection prevention measures in hospital settings and dialysis units were performed including serologic testing for HCV antibody for every new patient in the dialysis unit as well as routine testing of all patients. Negative cases of hepatitis C antibody (confirmed with ELISA 2nd generation and RIBA II Immunoblot methods) were selected and followed for 18 months. Some predisposing factors such as transfusion, duration of hemodialysis, medical procedures including surgery, transplantation, invasive odontology, suspicious sexual contact, diagnostic or therapeutic manipulation, tattooing, and IV drug abuse, were registered and considered. Other rare procedures like acupuncture, manicure and pedicure blood brotherhood rituals, perinatal risk factors, common circumcision rituals and history of abortion were also considered. Ve used a tight control policy through the separation of the rooms within the unit, specific hemodialysis apparatus for suspicious patients and a separate staff caring for the patients. We maintained a low rate of staff turnover in dialysis units and tried to control hepatitis B viral infection. Results: Marital status and living area were significantly related to HCV antibody positivity. It means that more HCV antibody positive cases were observed in married people in urban areas. History of tattooing, medical procedures including surgery, transplantation, invasive odontology and IV drug usage were not significantly related to HCV antibody status. During the follow up, three cases (4.3%) converted to positive. There was a relationship between numbers of hemodialysis per week and HCV antibody positivity (P<0.001). Conclusions: Tight control of transmission routes and severe isolation policy in this study explains an almost ideal decrease in incidence rate of HCV antibody positivity. We suggest periodical screening programs (at least every 6 months) for blood samples that remain in the dialysis apparatus and all procedures used for hemodialysis in these specific patients to achieve a better infection control

Evaluation of bacteriological and chemical quality of dialysis water and fluid in Isfahan, central Iran

Background: Chemical and microbial quality of water used in hemodialysis play key roles in a number of dialysisrelated complications. In order to avoid the complications and to guarantee safety and health of patients therefore, vigorous control of water quality is essential. The objective of present study was to investigate the chemical and bacteriological characteristics of water used in dialysis centers of five hospitals in Isfahan, central Iran. Methods: A total of 30 water samples from the input of dialysis purification system and dialysis water were analyzed for chemical parameters. Heterotrophic plate count and endotoxin concentration of drinking water, dialysis water and dialysis fluid of 40 machines were also monitored over a 5-month period in 2011-2012. Results: Concentration of the determined chemicals (copper, zinc, sulfate, fluoride, chloramines and free chlorine) did not exceed the recommended concentration by the Association for the Advancement of Medical Instrumentation (AAMI) exclude lead, nitrate, aluminum and calcium. Furthermore, the magnesium; cadmium and chromium concentration exceeded the maximum level in some centers. No contamination with heterotrophic bacteria was observed in all samples, while the AMMI standard for endotoxin level in dialysis fluid (<2 EU/ml) was achieved in 95 of samples. Conclusion: Dialysis water and fluid failed to meet the all chemical and bacteriological requirements for hemodialysis. To minimize the risk of contaminants for hemodialysis patients therefore, a water quality management program including monitoring, maintenance and development of water treatment system in hemodialysis centers is extremely important. In addition, an appropriate disinfection program is needed to guarantee better control of bacterial growth and biofilm formation. © 2016, Iranian Journal of Public Health. All rights reserved

Renal Association Clinical Practice Guideline on Haemodialysis

© The Author(s) 2019. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.This guideline is written primarily for doctors and nurses working in dialysis units and related areas of medicine in the UK, and is an update of a previous version written in 2009. It aims to provide guidance on how to look after patients and how to run dialysis units, and provides standards which units should in general aim to achieve. We would not advise patients to interpret the guideline as a rulebook, but perhaps to answer the question: "what does good quality haemodialysis look like?"The guideline is split into sections: each begins with a few statements which are graded by strength (1 is a firm recommendation, 2 is more like a sensible suggestion), and the type of research available to back up the statement, ranging from A (good quality trials so we are pretty sure this is right) to D (more like the opinion of experts than known for sure). After the statements there is a short summary explaining why we think this, often including a discussion of some of the most helpful research. There is then a list of the most important medical articles so that you can read further if you want to - most of this is freely available online, at least in summary form.A few notes on the individual sections: 1. This section is about how much dialysis a patient should have. The effectiveness of dialysis varies between patients because of differences in body size and age etc., so different people need different amounts, and this section gives guidance on what defines "enough" dialysis and how to make sure each person is getting that. Quite a bit of this section is very technical, for example, the term "eKt/V" is often used: this is a calculation based on blood tests before and after dialysis, which measures the effectiveness of a single dialysis session in a particular patient. 2. This section deals with "non-standard" dialysis, which basically means anything other than 3 times per week. For example, a few people need 4 or more sessions per week to keep healthy, and some people are fine with only 2 sessions per week - this is usually people who are older, or those who have only just started dialysis. Special considerations for children and pregnant patients are also covered here. 3. This section deals with membranes (the type of "filter" used in the dialysis machine) and "HDF" (haemodiafiltration) which is a more complex kind of dialysis which some doctors think is better. Studies are still being done, but at the moment we think it's as good as but not better than regular dialysis. 4. This section deals with fluid removal during dialysis sessions: how to remove enough fluid without causing cramps and low blood pressure. Amongst other recommendations we advise close collaboration with patients over this. 5. This section deals with dialysate, which is the fluid used to "pull" toxins out of the blood (it is sometimes called the "bath"). The level of things like potassium in the dialysate is important, otherwise too much or too little may be removed. There is a section on dialysate buffer (bicarbonate) and also a section on phosphate, which occasionally needs to be added into the dialysate. 6. This section is about anticoagulation (blood thinning) which is needed to stop the circuit from clotting, but sometimes causes side effects. 7. This section is about certain safety aspects of dialysis, not seeking to replace well-established local protocols, but focussing on just a few where we thought some national-level guidance would be useful. 8. This section draws together a few aspects of dialysis which don't easily fit elsewhere, and which impact on how dialysis feels to patients, rather than the medical outcome, though of course these are linked. This is where home haemodialysis and exercise are covered. There is an appendix at the end which covers a few aspects in more detail, especially the mathematical ideas. Several aspects of dialysis are not included in this guideline since they are covered elsewhere, often because they are aspects which affect non-dialysis patients too. This includes: anaemia, calcium and bone health, high blood pressure, nutrition, infection control, vascular access, transplant planning, and when dialysis should be started.Peer reviewe

Purification of biomimetic apatite-based hybrid colloids intended for biomedical applications: a dialysis study

The field of nanobiotechnology has lately attracted much attention both from therapeutic and diagnosis viewpoints. Of particular relevance is the development of colloidal formulations of biocompatible nanoparticles capable of interacting with selected cells or tissues. In this context, the purification of such nanoparticle suspensions appears as a critical step as residues of unreacted species may jeopardize biological and medical outcomes, and sample purity is thus increasingly taken into account by regulatory committees. In the present work, we have investigated from a physico-chemical point of view the purification by dialysis of recently developed hybrid colloids based on biomimetic nanocrystalline apatites intended for interacting with cells. Both Eu-doped (2 mol.% relative to Ca) and Eu-free suspensions were studied. The follow-up of the dialysis process was carried out by way of FTIR, TEM, XRD, pH and conductivity measurements. Mathematical modelling of conductivity data was reported. The effects of a change in temperature (25 and 45 ◦C), dialysis medium, and starting colloid composition were evaluated and discussed. We show that the dialysis method is a well-adapted and cheap technique to purify such mineral–organic hybrid suspensions in view of biomedical applications, and we point out some of the characterization techniques that may prove helpful for following the evolution of the purification process with time

Continued monitoring of acute kidney injury survivors might not be necessary in those regaining an estimated glomerular filtration rate > 60 mL/min at 1 year

Background. Severe acute kidney injury (AKI) among hospitalized patients often necessitates initiation of short-term dialysis. Little is known about the long-term outcome of those who recover to normal renal function. The aim of this study was to determine the long-term renal outcome of patients experiencing AKI requiring dialysis secondary to hypoperfusion injury and/or sepsis who recovered to apparently normal renal function. Methods. All adult patients with AKI requiring dialysis in our centre between 1 January 1980 and 31 December 2010 were identified. We included patients who had estimated glomerular filtration rate (eGFR) &gt;60 mL/min/1.73 m2 12 months or later after the episode of AKI. Patients were followed up until 3 March 2015. The primary outcome was time to chronic kidney disease (CKD) (defined as eGFR persistently &lt;60 mL/min/1.73 m2) from first dialysis for AKI. Results. Among 2922 patients with a single episode of dialysis-requiring AKI, 396 patients met the study inclusion criteria. The mean age was 49.8 (standard deviation 16.5) years and median follow-up was 7.9 [interquartile range (IQR) 4.8–12.7] years. Thirty-five (8.8%) of the patients ultimately developed CKD after a median of 5.3 (IQR 2.8–8.0) years from first dialysis for AKI giving an incidence rate of 1 per 100 person-years. Increasing age, diabetes and vascular disease were associated with higher risk of progression to CKD [adjusted hazard ratios (95% confidence interval): 1.06 (1.03, 1.09), 3.05 (1.41, 6.57) and 3.56 (1.80, 7.03), respectively]. Conclusions. Recovery from AKI necessitating in-hospital dialysis was associated with a very low risk of progression to CKD. Most of the patients who progressed to CKD had concurrent medical conditions meriting monitoring of renal function. Therefore, it seems unlikely that regular follow-up of renal function is beneficial in patients who recover to eGFR &gt;60 mL/min/1.73 m2 by 12 months after an episode of AKI

Emergency care of the dialysis patients

End stage renal disease (ESRD) is one of the major health care burdens worldwide. Emergency staff are well aware of the frequent use of their services by dialysis patients. In this article we discuss the urgent and serious medical problems that bring the dialysis patient to the emergency department (ED), and the special considerations in the management of such patients in the acute care setting. The main medical problems in dialysis patients presenting to the emergency department are as follows: emergent acid-base and electrolyte disorders; fever; cardiovascular emergencies; dyspnea; angina/chest pain; anemia and emergencies related to access. In conclusion, hemodialysis (HD) and peritoneal dialysis (PD) patients frequently utilize ED services because of their proneness to a variety of emergency medical problems

National analyses on survival in Maltese adult patients on renal replacement therapy started during 2009–2012

Chronic kidney disease patients on maintenance dialysis (CKD 5D) experience major morbidity and mortality. No data on survival in Maltese dialysis patients exist; therefore, the aim of this study was to rigorously examine survival statistics in a complete cohort of Maltese CKD 5D patients. The study population was comprised of all incident chronic patients (N=328) starting dialysis at the renal unit, Mater Dei hospital, Msida, Malta, for 4 consecutive years (2009–2012). Each yearly cohort was analysed in detail up to 31st December 2017, providing up to 8 years follow-up. Demographics (male 65%; female 35%), aetiology of renal failure (diabetic kidney disease: n=191; 58.2%), comorbidities, transplant status, and death were documented. Data collection and follow up were completed and statistical analysis was performed on the aggregated cohorts with SPSS version 23 with censoring up to 31st December 2017. The cumulative adjusted 5-year overall survival in Maltese CKD 5D patients was 0.36 and 0.25 at 8 years. No statistical difference was observed according to the year of starting dialysis. Cox regression analysis showed that age and transplant status influenced survival. The unadjusted hazard of death increased by 3% for every 1-year increase in age and was increased by 7% if the patient did not receive a transplant, and overall 22% (n=72) of the entire cohort eventually received transplants. This study reports an approximate 65% mortality at 5 years in Maltese haemodialysis patients, a poor prognosis that, despite optimal medical management, is consistent with worldwide reports.peer-reviewe

Assessment of Canine Pancreas-Specific Lipase and Outcomes in Dogs with Hemodialysis-Dependent Acute Kidney Injury.

BackgroundRenal replacement therapies can be life-saving for dogs with severe acute kidney injury (AKI), however, comorbidities including pancreatitis might affect outcome.Hypothesis/objectivesTo investigate the prevalence of pancreas-specific lipase (Spec cPL) measurements consistent with pancreatitis (≥400 μg/L) in dogs undergoing intermittent hemodialysis (IHD) for treatment of AKI and to determine whether there were associations between 30-days outcomes and Spec cPL measurements.AnimalsFifty-three client-owned dogs presented to teaching hospitals between November 2008 and September 2016 that underwent IHD.MethodsRetrospective medical record review from dogs that received IHD for management of AKI and also had a Spec cPL measurement. Association between survival, dialysis-dependency, and Spec cPL measurements was assessed.ResultsForty of 53 (76%) dogs were alive at 30-days and 33/53(62%) had a Spec cPL result ≥400 μg/L. Spec cPL was not significantly different either between surviving (635.5 μg/L, range 29-1,001) and nonsurviving dogs (860 μg/L, range 56-1,001; P = 0.75) or between dialysis-dependent (1,001 μg/L, range 177-1,001) and nondialysis-dependent dogs (520 μg/L, range 29-1,001; P = 0.08). Spec cPL ≥400 μg/L was not significantly associated either with survival (P = 0.74) or dialysis-dependency (P = 0.33).Conclusions and clinical importanceResults revealed a high prevalence of Spec cPL ≥400 μg/L in dogs with AKI treated with IHD. No significant associations between Spec cPL and survival or dialysis-dependency in dogs with AKI at 30 days were identified in the current study, however, the latter could be due to lack of power in this study

Impact of Hemodialysis Catheter Dysfunction on Dialysis and Other Medical Services: An Observational Cohort Study

Practice guidelines define hemodialysis catheter dysfunction as blood flow rate (BFR) <300 mL/min. We conducted a study using data from DaVita and the United States Renal Data System to evaluate the impact of catheter dysfunction on dialysis and other medical services. Patients were included if they had ≥8 consecutive weeks of catheter dialysis between 8/2004 and 12/2006. Actual BFR <300 mL/min despite planned BFR ≥300 mL/min was used to define catheter dysfunction during each dialysis session. Among 9,707 patients, the average age was 62,53% were female, and 40% were black. The median duration of catheter dialysis was 190 days, and the cohort accounted for 1,075,701 catheter dialysis sessions. There were 70,361 sessions with catheter dysfunction, and 6,33 1 (65.2%) patients had at least one session with catheter dysfunction. In multivariate repeated measures analysis, catheter dysfunction was associated with increased odds of missing a dialysis session due to access problems (Odds ratio [OR] 2.50; P < 0.001), having an access-related procedure (OR 2.10; P < 0.001), and being hospitalized (OR 1.10; P = 0.001). Catheter dysfunction defined according to NKF vascular access guidelines results in disruptions of dialysis treatment and increased use of other medical services