Overview of the Alberta Kidney Disease Network

<p>Abstract</p> <p>Background</p> <p>The Alberta Kidney Disease Network is a collaborative nephrology research organization based on a central repository of laboratory and administrative data from the Canadian province of Alberta.</p> <p>Description</p> <p>The laboratory data within the Alberta Kidney Disease Network can be used to define patient populations, such as individuals with chronic kidney disease (using serum creatinine measurements to estimate kidney function) or anemia (using hemoglobin measurements). The administrative data within the Alberta Kidney Disease Network can also be used to define cohorts with common medical conditions such as hypertension and diabetes. Linkage of data sources permits assessment of socio-demographic information, clinical variables including comorbidity, as well as ascertainment of relevant outcomes such as health service encounters and events, the occurrence of new specified clinical outcomes and mortality.</p> <p>Conclusion</p> <p>The unique ability to combine laboratory and administrative data for a large geographically defined population provides a rich data source not only for research purposes but for policy development and to guide the delivery of health care. This research model based on computerized laboratory data could serve as a prototype for the study of other chronic conditions.</p

Structural analysis of the factors pertaining to attitudes toward and consciousness of organ donation : Comparison between Japanese and Americans

The purpose of this study is to analyze the background factors relating to opinions on organ donation through factorial and structural comparisons between Japanese and Americans. The data were obtained from responses to a questionnaire (371 Japanese and 41 Americans). The main findings are as follows: 1. Most of the factors, ‘a will for organ donation depending on a recipient’, ‘view of remains’, ‘understanding of brain death’ and so on showed significant differences between Japanese and Americans. 2. Japanese had a better understanding of brain death. On the other hand, the ratio of Americans who were willing to donate an organ was higher than that of Japanese. 3. It was revealed that “the approval of organ donation for the third person, not only for one's family” had an impact for having donor card showing the approval for organ donation. Furthermore, as underlying factors generating differences on organ transplant opinions, differences were found among Japanese between “approval of organ transplant” and the attitude assuming that oneself or a member of one's family was the person concerned with organ transplantation. There were also differences between Japanese and Americans on ideas about a view for life and death such as soul existence or view of remains. The argument for transplantation in Japan should consider these structural differences

Status of care for end stage kidney disease in countries and regions worldwide:international cross sectional survey

ObjectiveTo determine the global capacity (availability, accessibility, quality, and affordability) to deliver kidney replacement therapy (dialysis and transplantation) and conservative kidney management.DesignInternational cross sectional survey.SettingInternational Society of Nephrology (ISN) survey of 182 countries from July to September 2018.ParticipantsKey stakeholders identified by ISN's national and regional leaders.Main outcome measuresMarkers of national capacity to deliver core components of kidney replacement therapy and conservative kidney management.ResultsResponses were received from 160 (87.9%) of 182 countries, comprising 97.8% (7338.5 million of 7501.3 million) of the world's population. A wide variation was found in capacity and structures for kidney replacement therapy and conservative kidney management-namely, funding mechanisms, health workforce, service delivery, and available technologies. Information on the prevalence of treated end stage kidney disease was available in 91 (42%) of 218 countries worldwide. Estimates varied more than 800-fold from 4 to 3392 per million population. Rwanda was the only low income country to report data on the prevalence of treated disease; 5 (&lt;10%) of 53 African countries reported these data. Of 159 countries, 102 (64%) provided public funding for kidney replacement therapy. Sixty eight (43%) of 159 countries charged no fees at the point of care delivery and 34 (21%) made some charge. Haemodialysis was reported as available in 156 (100%) of 156 countries, peritoneal dialysis in 119 (76%) of 156 countries, and kidney transplantation in 114 (74%) of 155 countries. Dialysis and kidney transplantation were available to more than 50% of patients in only 108 (70%) and 45 (29%) of 154 countries that offered these services, respectively. Conservative kidney management was available in 124 (81%) of 154 countries. Worldwide, the median number of nephrologists was 9.96 per million population, which varied with income level.ConclusionsThese comprehensive data show the capacity of countries (including low income countries) to provide optimal care for patients with end stage kidney disease. They demonstrate substantial variability in the burden of such disease and capacity for kidney replacement therapy and conservative kidney management, which have implications for policy

Fluid Volume Expansion and Depletion in Hemodialysis Patients Lack Association with Clinical Parameters

Background: Achievement of normal volume status is crucial in hemodialysis (HD), since both volume expansion and volume contraction have been associated with adverse outcome and events. Objectives: The objectives of this study are to assess the prevalence of fluid volume expansion and depletion and to identify the best clinical parameter or set of parameters that can predict fluid volume expansion in HD patients. Design: This study is cross-sectional. Setting: This study was conducted in three hemodialysis units. Patients: In this study, there are 194 HD patients. Methods: Volume status was assessed by multifrequency bio-impedance spectroscopy (The Body Composition Monitor, Fresenius) prior to the mid-week HD session. Results: Of all patients, 48 % ( n = 94) were volume-expanded and 9 % of patients were volume-depleted ( n = 17). Interdialytic weight gain was not different between hypovolemic, normovolemic, and hypervolemic patients. Fifty percent of the volume-expanded patients were hypertensive. Paradoxical hypertension was very common (31 % of all patients); its incidence was not different between patient groups. Intradialytic hypotension was relatively common and was more frequent among hypovolemic patients. Multivariate regression analysis identified only four predictors for volume expansion (edema, lower BMI, higher SBP, and smoking). None of these parameters displayed both a good sensitivity and specificity. Limitations: The volume assessment was performed once. Conclusions: The study indicates that volume expansion is highly prevalent in HD population and could not be identified using clinical parameters alone. No clinical parameters were identified that could reliably predict volume status. This study shows that bio-impedance can assist to determine volume status. Volume status, in turn, is not related to intradialytic weight gain and is unable to explain the high incidence of paradoxical hypertension

A double-blind, randomized, crossover study of the local tolerability of erythropoietin alfa formulations in dialysis patients

AbstractObjectives: A double-blind, randomized, crossover study was conducted to compare the local tolerability of subcutaneous injections of epoetin alfa formulated with a citrate buffer (epoetin alfa-C) versus epoetin alfa formulated with a sodium phosphate buffer (epoetin alfa-P).Methods: The study utilized a 2-periocl, 2-treatment crossover design, with no washout period. Forty-eight dialysis patients were randomly assigned to receive 6 consecutive subcutaneous injections of epoetin alfa-C or epoetin alfa-P. After completing their first treatment period, patients were switched to the alternate therapy. The primary efficacy outcome was patient-evaluated pain assessed after each injection using a verbal descriptor scale (VDS) and a visual analog scale (VAS). The duration of injection-site discomfort and the degree of redness/and itching were also assessed.Results: At all evaluation time points, subjects rated pain consistently and significantly lower (e.g. VDS day 6, p=0.034; VAS day 6; p=0.023), and the duration of pain significantly shorter with epoetin alfa-P compared to epoetin alfa-C. However, further analysis detected a significant (p≤0.10) carryover effect in several time point comparisons, suggesting that these results be interpreted in light of possible carryover effects.Conclusions: The results of this study indicate that epoetin alfa-P is associated with less, and shorter, injection-site discomfort than epoetin alfa-C.RÉSUMÉObjectifs : Étude randomisée, à double insu avec permutation visant à comparer la tolérance locale des injections sous-cutanées d'époétine alfa préparée avec un tampon de citrate (époétine alfa-C) à celle de l'époétine alfa préparée avec un tampon de phosphate de sodium (époétine alfa-P).Méthodes : L'étude a été menée selon un modèle à deux temps, deux traitements avec permutation, sans période d'épuration thérapeutique. Au total de 48 patients ont été répartis au hasard pour recevoir six injections consécutives soit d'époétine alfa-C, soit d'époétine alfa-P. Après avoir complété leur première période de traitement, les patients ont simplement été permutés pour recevoir l'autre traitement. Le premier paramètre d'efficacité évalué a été la douleur telle que décrite par le patient après chaque injection, à l'aide de l'échelle de description verbale (VDS) et de l'échelle analogique visuelle (VAS). La durée de l'inconfort au point d'injection et le degré de la rougeur/des démangeaisons ont aussi été évalués.Résultats : Pour tous les points clans le temps qui ont été évaluées, les patients ont coté l'intensité de leurs douleurs (p. ex., VDS au jour 6 : p = 0,034; VAS au jour 6 : p = 0,023) la durée de leurs douleurs comme étant significativement et constamment moindre avec l'époétine alfa-P qu'avec l'époétine alfa-C. Cependant, des analyses plus poussées ont décelé un effet différé significatif (p ≤ 0,10) pour de nombreux points clans le temps qui ont été comparés, ce qui porte à croire que ces résultats doivent être interprétés à la lumière d'un probable effet différé.Conclusions : Les résultats de cette étude incliquent que l’époétine alfa-P est associée à un inconfort au point d'injection, d'intensité et de durée moindres qu'avec l'époétine alfa-C

Comparison of Volume Overload with Cycler-Assisted versus Continuous Ambulatory Peritoneal Dialysis

Background and objectives: Cycler-assisted peritoneal dialysis (CCPD) has been associated with decreased sodium removal compared with continuous ambulatory peritoneal dialysis (CAPD) as a result of peritoneal sodium sieving during the short dwells that are associated with CCPD. This may have adverse consequences for management of extracellular fluid volume (ECFV). This study compared ECFV in patients who received CAPD or CCPD; CCPD dwell times were maximized by limiting the number of exchanges, and the use of icodextrin for the long daytime dwells was widespread

Cost Analysis of In-Centre Nocturnal Compared with Conventional Hemodialysis

Background: Provision of in-centre nocturnal hemodialysis (ICNHD; 6–8 hours thrice weekly) is associated with health benefits, but the economic implications of providing this treatment are unclear. Objective: We conducted a health care costing study comparing ICNHD to in-centre thrice-weekly conventional hemodialysis (CvHD). Design: Micro-costing of both ICNHD and CvHD as practiced at our centre. Setting: Hemodialysis unit at a tertiary-care hospital in Edmonton. Participants: An informal survey of 2 other Canadian ICNHD programs was conducted to inform practices that may deviate from ours to guide sensitivity analysis. Measurements: Resources consumed for each strategy were determined, and the cost of each unit (CAN $2012) was used to calculate incremental costs of ICNHD and CvHD. Methods: We focused on resources that differ between strategies (staffing, dialysis materials, and utilities). The reference case considered 1:3 staff to patient ratio; alternate scenarios explored nursing pay grade and ratio, full care vs. self-care dialysis (including training costs), and medication costs. Results: In the reference case, ICNHD was$61 more costly per dialysis treatment compared with CvHD ($9,538 per patient per year). Incremental annual costs for staffing, dialysis materials, and utilities were$8,201, $1,193, and$144, respectively. If ICNHD reduces medication use (anti-hypertensives, bone mineral metabolism medications), the incremental cost of ICNHD decreases to $8,620 per patient per year. In a scenario of self-care ICNHD utilizing a staff-to-patient ratio of 1:10, ICNHD is more costly in year 1 ($15,196), but results in cost savings of $2,625 in subsequent years compared with CvHD. Limitations: The findings of this cost analysis may not be generalizable to other health care systems, including other parts of Canada. Conclusions: Compared to CvHD, provision of ICNHD is more expensive, largely driven by increased staffing costs as patients dialyze longer. Alternate staffing models, including self-care ICNHD with minimal staff, may lead to net cost savings. The incremental cost of treatment should be considered in the context of impact on patient health outcomes, staffing model, and pragmatic factors, such as current capacity for daytime CvHD and the capital costs of new dialysis stations