Separating the Effects of Hemodialysis Dose and Nutrition: In Search of the Optimal Dialysis Dose

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73859/1/j.1525-139X.1999.90218.x.pd

How Will the Results of the HEMO Study Impact Dialysis Practice?

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/71984/1/j.1525-139X.2003.03003_3.x.pd

Prevention of dialysis disequilibrium syndrome by use of high sodium concentration in the dialysate

Prevention of dialysis disequilibrium syndrome by use of high sodium concentration in the dialysate. Nine patients, including four undergoing their first hemodialysis, were observed clinically and by hourly electroencephalographic recordings before, during, and three hours after highly efficient hemodialyses during which plasma osmolality was maintained by use of a dialysate with increased concentrations of sodium and chloride. As a control group, 8 patients (five undergoing their first hemodialysis) were similarly studied but with a dialysate of standard composition (Na=133 mEq/liter). The EEG showed definitely increased abnormality in 10 of 13 control dialyses and in 2 of 9 dialyses in the experimental group (P < 0.01). Symptoms suggestive of the dialysis disequilibrium syndrome appeared in nine of the control dialyses but in none of the experimental group (P < 0.001). No ill effects from increased dialysate sodium concentration could be demonstrated during or after a single hemodialysis.Prévention du syndrome de déséquilibre de la dialyse au moyen d'une concentration de sodium élevée dans le dialysat. Neuf malades, dont quatre subissaient leur première hémodialyse, ont été observés cliniquement et au moyen d'enregistrements électro-encéphalographiques horaires pendant et trois heures après des hémodialyses très efficaces où l'osmolalité plasmatique était maintenue constante grace à un dialysat dont les concentrations de sodium et de chlore étaient augmentées. Un groupe contrôle de 8 malades, dont cinq subissaient leur première hémodialyse, a été étudié de la même façon alors que le dialysat avait une composition standard (Na = 133 mEq/1). L'électroencéphalogramme a montré une augmentation patente des anomalies chez 10 des 13 contrôles et chez deux des neuf sujets du groupe expérimental (P < 0.01). Des symptomes suggérant un syndrome de déséquilibre au cours de la dialyse sont apparus chez neuf sujets du groupe contrôle mais seulement chez un sujet du groupe expérimental (P < 0.001). Aucun effet nuisible du à l'augmentation de la concentration du sodium n'a pu être mis en évidence pendant ou après une unique hémodialyse

A Sequential Stratification Method for Estimating the Effect of a Time-Dependent Experimental Treatment in Observational Studies

Survival analysis is often used to compare experimental and conventional treatments. In observational studies, the therapy may change during follow-up and such crossovers can be summarized by time-dependent covariates. Given the ever-increasing donor organ shortage, higher-risk kidneys from expanded criterion donors (ECD) are being transplanted. Transplant candidates can choose whether to accept an ECD organ (experimental therapy), or to remain on dialysis and wait for a possible non-ECD transplant later (conventional therapy). A three-group time-dependent analysis of such data involves estimating parameters corresponding to two time-dependent indicator covariates representing ECD transplant and non-ECD transplant, each compared to remaining on dialysis on the waitlist. However, the ECD hazard ratio estimated by this time-dependent analysis fails to account for the fact that patients who forego an ECD transplant are not destined to remain on dialysis forever, but could subsequently receive a non-ECD transplant. We propose a novel method of estimating the survival benefit of ECD transplantation relative to conventional therapy (waitlist with possible subsequent non-ECD transplant). Compared to the time-dependent analysis, the proposed method more accurately characterizes the data structure and yields a more direct estimate of the relative outcome with an ECD transplant.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/66010/1/j.1541-0420.2006.00527.x.pd

The Risk of Cancer for Patients on Dialysis: A Review

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/72354/1/j.1525-139X.1991.tb00104.x.pd

Interleukin-1: The Pros and Cons of Its Clinical Relevance

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/75148/1/j.1525-1594.1988.tb02759.x.pd

Recent Trends and Results for Organ Donation and Transplantation in the United States, 2005

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/72853/1/j.1600-6143.2006.01268.x.pd

Comparison of mortality with home hemodialysis and center hemodialysis: A national study

Comparison of mortality with home hemodialysis and center hemodialysis: A national study. We sought to determine whether lower mortality rates reported with hemodialysis (HD) at home compared to hemodialysis in dialysis centers (center HD) could be explained by patient selection. Data are from the United States Renal Data System (USRDS) Special Study Of Case Mix Severity, a random national sample of 4,892 patients who started renal replacement therapy in 1986 to 1987. Intent-to-treat analyses compared mortality between home HD (N =70) and center HD patients (N = 3,102) using the Cox proportional hazards model. Home HD patients were younger and had a lower frequency of comorbid conditions. The unadjusted relative risk (RR) of death for home HD patients compared to center HD was 0.37 (P < 0.001). The RR adjusted for age, sex, race and diabetes, was 44% lower in home HD patients (RR = 0.56, P = 0.02). When additionally adjusted for comorbid conditions, this RR increased marginally (RR = 0.58, P = 0.03). A different analysis using national USRDS data from 1986/7 and without comorbid adjustment showed patients with training for self care hemodialysis at home or in a center (N = 418) had a lower mortality risk (RR = 0.78, P = 0.001) than center HD patients (N = 43,122). Statistical adjustment for comorbid conditions in addition to age, sex, race, and diabetes explains only a small amount of the lower mortality with home HD

A practice-related risk score (PRS): a DOPPS-derived aggregate quality index for haemodialysis facilities

Background. The Dialysis Outcomes and Practice Patterns Study (DOPPS) database was used to develop and validate a practice-related risk score (PRS) based on modifiable practices to help facilities assess potential areas for improving patient care. Methods. Relative risks (RRs) from a multivariable Cox mortality model, based on observational haemodialysis (HD) patient data from DOPPS I (1996-2001, seven countries), were used. The four practices were the percent of patients with Kt/V >= 1.2, haemoglobin >= 11 g/dl (110 g/l), albumin >= 4.0 g/dl (40g/l) and catheter use, and were significantly related to mortality when modelled together. DOPPS II data (2002-2004, 12 countries) were used to evaluate the relationship between PRS and mortality risk using Cox regression. Results. For facilities in DOPPS I and II, changes in PRS over time were significantly correlated with changes in the standardized mortality ratio (SMR). The PRS ranged from 1.0 to 2.1. Overall, the adjusted RR of death was 1.05 per 0.1 points higher PRS (P < 0.0001). For facilities in both DOPPS I and II (N = 119), a 0.2 decrease in PRS was associated with a 0.19 decrease in SMR (P = 0.005). On average, facilities that improved PRS practices showed significantly reduced mortality over the same time frame. Conclusions. The PRS assesses modifiable HD practices that are linked to improved patient survival. Further refinements might lead to improvements in the PRS and will address regional variations in the PRS/mortality relationship