Mortality Trends After Transfer From Peritoneal Dialysis to Hemodialysis

Introduction Transition to hemodialysis (HD) is a common outcome in peritoneal dialysis (PD), but the associated mortality risk is poorly understood. This study sought to identify rates of and risk factors for mortality after transitioning from PD to HD. Methods Patients with incident PD (between 2000 and 2014) who transferred to HD for ≥1 day were identified, using data from Australia and New Zealand Dialysis and Transplantation registry (ANZDATA), Canadian Organ Replacement Register (CORR), Europe Renal Association (ERA) Registry, and the United States Renal Dialysis System (USRDS). Crude mortality rates were calculated for the first 180 days after transfer. Separate multivariable Cox models were built for early (180 days) periods after transfer. Results Overall, 6683, 5847, 21,574, and 80,459 patients were included from ANZDATA, CORR, ERA Registry, and USRDS, respectively. In all registries, crude mortality rate was highest during the first 30 days after a transfer to HD declining thereafter to nadir at 4 to 6 months. Crude mortality rates were lower for patients transferring in the most recent years (than earlier). Older age, PD initiation in earlier cohorts, and longer PD vintage were associated with increased risk of death, with the strongest associations during the first 90 days after transfer and attenuating thereafter. Mortality risk was lower for men than women <90 days after transfer, but higher after 180 days. Conclusion In this multinational study, mortality was highest in the first month after a transfer from PD to HD and risk factors varied by time period after transfer. This study highlights the vulnerability of patients at the time of modality transfer and the need to improve transitions

Transition Between Different Renal Replacement Modalities: Gaps in Knowledge and Care-The Integrated Research Initiative

Patients with end-stage kidney disease (ESKD) have different options to replace the function of their failing kidneys. The "integrated care" model considers treatment pathways rather than individual renal replacement therapy (RRT) techniques. In such a paradigm, the optimal strategy to plan and enact transitions between the different modalities is very relevant, but so far, only limited data on transitions have been published. Perspectives of patients, caregivers, and health professionals on the process of transitioning are even less well documented. Available literature suggests that poor coordination causes significant morbidity and mortality.This review briefly provides the background, development, and scope of the INTErnational Group Research Assessing Transition Effects in Dialysis (INTEGRATED) initiative. We summarize the literature on the transition between different RRT modalities. Further, we present an international research plan to quantify the epidemiology and to assess the qualitative aspects of transition between different modalities

Globalization and the Cuban Revolution in the Twenty-First Century

This article questions the assumption that Cuba’s reform process must eventually make concessions to, and perhaps eventually join, the wider global world system dominated by neo-liberal economics and democracy as defined by the advocates of this world order. To undertake this task it is necessary to explain globalization and distinguish it from the preceding post-war period and then seek to understand the consequences of its ascendency, especially its failure to produce a sustainable model of development. In this context Cuba’s socialist experiment will be considered as an alternative, both in the form of its performance in social provision and its ideology of community above that of the individual. While these strengths may be attractive to those forces in the world that wish to resist globalization and build something new, Cuba as a single country example is not viable. Consequently these achievements can only become part of a transformative force if they are integrated with already existing popular resistance to the current neo-liberal order. Finally, it is argued this symbiosis is taking place in Latin America where Cuba is deeply involved with new social movements and progressive governments.Resumen: La globalización y la revolución cubana en el siglo XXIEn este artículo se cuestiona la aserción de que el proceso de reformas en Cuba debe hacer concesiones, y quizás, finalmente, incorporarse al sistema global dominado por la economía neoliberal y la democracia tal como son definidas por los defensores de este orden mundial. Para emprender esta labor, es necesario explicar la globalización y distinguirla del período precedente de posguerra y luego tratar de entender las consecuencias de su influencia, especialmente en su incapacidad de producir un modelo de desarrollo sustentable. En este contexto, el experimento socialista de Cuba será considerado como una alternativa, tanto en cuanto a sus resultados en cuanto a la previsión social como en cuanto a su ideología que pone a la comunidad por sobre el individuo. Aunque estos desarrollos pueden ser atractivos para esos grupos en el mundo que tratan de oponerse a la globalización para construir algo nuevo, el ejemplo de Cuba como un solo país no es viable. Consecuentemente, esos logros sólo se pueden alcanzar como parte de la fuerza transformadora que integra la resistencia popular existente al actual orden neoliberal. Finalmente, se sostiene que esta simbiosis está ocurriendo en América Latina, donde Cuba participa profundamente en los nuevos movimientos sociales y gobiernos progresistas