Kotidialyysien lisääminen kannattaa

Vertaisarvioitu. Teema : munuaissairaudetPotilaan ennuste ja elämänlaatu ovat kotidialyysihoidoissa vähintään yhtä hyvät ja useimmiten paremmat kuin keskusdialyysihoidoissa. Kotidialyysihoito voidaan suunnitella yksilölliseksi ja potilaan elämäntapaan sopivaksi. Kustannukset ovat pienemmät kuin keskushemodialyysin. Kullekin potilaalle parhaan hoitomuodon löytämiseksi on välttämätöntä, että tietoa vaihtoehdoista annetaan oikea-aikaisesti, riittävästi ja toistuvasti.Peer reviewe

IgA nephropathy and Henoch-Schönlein nephritis in adults : with special reference to factors affecting outcome

IgA nephropathy (IgAN) is the most common primary glomerulonephritis. In one third of the patients the disease progresses, and they eventually need renal replacement therapy. IgAN is in most cases a slowly progressing disease, and the prediction of progression has been difficult, and the results of studies have been conflicting. Henoch-Schönlein nephritis (HSN) is rare in adults, and prediction of the outcome is even more difficult than in IgAN. This study was conducted to evaluate the clinical and histopathological features and predictors of the outcome of IgAN and HSN diagnosed in one centre (313 IgAN patients and 38 HSN patients), and especially in patients with normal renal function at the time of renal biopsy. The study also aimed to evaluate whether there is a difference in the progression rates in four countries (259 patients from Finland, 112 from UK, 121 from Australia and 274 from Canada), and if so, can this be explained by differences in renal biopsy policy. The third aim was to measure urinary excretions of cytokines interleukin 1ß (IL-1ß) and interleukin 1 receptor antagonist (IL-1ra) in patients with IgAN and HSN and the correlations of excretion of these substances with histopathological damage and clinical factors. A large proportion of the patients diagnosed in Helsinki as having IgAN had normal renal function (161/313 patients). Four factors, (hypertension, higher amounts of urinary erythrocytes, severe arteriolosclerosis and a higher glomerular score) which independently predicted progression (logistic regression analysis), were identified in mild disease. There was geographic variability in renal survival in patients with IgAN. When age, levels of renal function, proteinuria and blood pressure were taken into account, it showed that the variability related mostly to lead-time bias and renal biopsy indications. Amount of proteinuria more than 0.4g/24h was the only factor that was significantly related to the progression of HSN. the Hypertension and the level of renal function were found to be factors predicting outcome in patients with normal renal function at the time of diagnosis. In IgAN patients, IL-1ra excretion into urine was found to be decreased as compared with HSN patients and healthy controls. Patients with a high IL-1ra/IL-1ß ratio had milder histopathological changes in renal biopsy than patients with a low/normal IL-1ra/IL-1ß ratio. It was also found that the excretion of IL-1ß and especially IL-1ra were significantly higher in women. In conclusion, it was shown that factors associated with outcome can reliably be identified even in mild cases of IgAN. Predicting outcome in adult HSN, however, remains difficult.IgA nefropatia (IgAN) on yleisin primaari glomerulonefriitti. On arvioitu, että kolmasosalle potilaista kehittyy dialyysihoitoon johtava munuaisten vajaatoiminta. Taudin eteneminen on yleensä hidasta ja sitä on vaikea ennustaa. Henoch-Schönlein nefriittiä (HSN) pidetään IgAN:n systeemisenä muotona, se on harvinainen aikuisilla, ja siksi sen etenemistä on vieläkin vaikeampi ennustaa. Tutkimuksessa etsittiin kliinisiä ja histopatologisia löydöksiä, jotka voisivat toimia IgAN:n ja HSN:n ete-nemistä ennustavina tekijöinä etenkin niillä potilailla, joilla munuaisten toiminta tautia diagnosoitaessa oli normaali. Tutkimuksen aineistona oli 313 IgAN ja 38 HSN potilasta, jotka oli diagnosoitu munuaisbiopsialla vuosina 1980-1995. Lisäksi selvitettiin, onko IgAN:n ennusteessa alueellisia eroja neljän maan välillä (aineistona 250 suomalaista, 112 skotlantilaista, 121 australialaista ja 274 kanadalaista potilasta), ja mikäli eroja on, johtuvatko ne munuaisbiopsian erilaisista aiheista maiden välillä. Sytokiini interleukiini 1ß (IL-1ß):n ja interleukiini 1 reseptori antagonistin (IL-1 ra) eritystä virtsaan mitattiin IgAN ja HSN potilailla ja selvitettiin korreloiko näiden sytokiinien eritys histopatologiseen vaurioon tai kliini-seen taudinkuvaan. Suurella osalla (161/313) Helsingissä diagnosoiduilla IgAN potilailla oli normaali munuaisten toiminta dianoosivaiheessa. Näillä potilailla itsenäisiksi ennusteeseen vaikuttaviksi tekijöiksi logistisessa regressioanalyysissä osoittautui kohonnut verenpaine, mikroskooppisen hematurian määrä, vaikeammat glomerulusmuutokset ja arterioloskleroosin esiintyminen munuaisbiopsiassa. Neljän maan IgAN poti-laiden munuaisten eloonjäämisanalyysissä oli eroa, ja ero osoittautui pääosin johtuvan erilaisista munuaisbiopsian aiheista. HSN-potilailla proteinurian määrä ennusti taudin etenemistä. IgAN potilailla IL1ra:n eritys oli vähäisempää kuin HSN potilailla tai terveillä verrokeilla. Lisäksi havaittiin, että potilailla joilla IL-1ra:n ja IL-1ß:n välinen suhde oli korkea, oli vähäisempiä histopatologisia vaurioita kuin niillä potilailla joilla näiden sytokiinien erityksen suhde oli matala. Tulokset osoittavat, että luotettavia ennusteeseen vaikuttavia tekijöitä on IgAN:ssa löydettävissä jo taudin varhaisessa vaiheessa. HSN on aikuisilla harvinainen, ja yksilöllinen taudin etenemisen ennustaminen on edelleen vaikeaa

Similar survival on home haemodialysis and automated peritoneal dialysis : an inception cohort study

Background Several studies have shown superior survival of patients on home haemodialysis (HD) compared with peritoneal dialysis (PD), but patients on automated PD (APD) and continuous ambulatory PD (CAPD) have not been considered separately. As APD allows larger fluid volumes and may be more efficient than CAPD, we primarily compared patient survival between APD and home HD. Methods All adult patients who started kidney replacement therapy (KRT) between 2004 and 2017 in the district of Helsinki-Uusimaa in Finland and who were on one of the home dialysis modalities at 90 days from starting KRT were included. We used intention-to-treat analysis. Survival of home HD, APD and CAPD patients was studied using Kaplan-Meier curves and Cox regression with adjustment for propensity scores that were based on extensive data on possible confounding factors. Results The probability of surviving 5 years was 90% for home HD, 88% for APD and 56% for CAPD patients. After adjustment for propensity scores, the hazard ratio of death was 1.1 [95% confidence interval (CI) 0.52-2.4] for APD and 1.6 (95% CI 0.74-3.6) for CAPD compared with home HD. Censoring at the time of kidney transplantation (KTx) or at transfer to in-centre HD did not change the results. Characteristics of home HD and APD patients at the start of dialysis were similar, whereas patients on CAPD had higher median age and more comorbidities and received KTx less frequently. Conclusions Home HD and APD patients had comparable characteristics and their survival appeared similar.Peer reviewe

Kohti käyttäjälähtöisiä kotidialyysin sähköisiä terveyspalveluita : potilaskokemus ja ammattilaisten tarpeet suunnittelun lähtökohtana

Vertaisarvioitu. English abstract.Peer reviewe

Uusi strategia vaikean kroonisen munuaistaudin hoidonohjaukseen

publishedVersionPeer reviewe

Kohti käyttäjälähtöisiä kotidialyysin sähköisiä terveyspalveluita : potilaskokemus ja ammattilaisten tarpeet suunnittelun lähtökohtana

Vertaisarvioitu. English abstract.Peer reviewe

Dialyysi uuteen toimintamalliin

HUS-piirin dialyysipotilaista noin joka neljäs hoidetaan yksityisen yrityksen dialyysipalveluissa. Sen ansiosta myös sairaanhoitopiirin rooli yksilöllisen dialyysihoidon järjestäjänä on terävöitynyt

Rotigotine in Hemodialysis-Associated Restless Legs Syndrome : A Randomized Controlled Trial

Background: Restless legs syndrome (RLS) has been associated with insomnia, decreased quality of life, and increased morbidity and mortality in end-stage renal disease. This randomized controlled trial investigated effects of rotigotine in patients with RLS and end-stage renal disease. Study Design: Double-blind placebo-controlled study. Setting & Participants: Adults with moderate to severe RLS (International RLS Study Group Rating Scale [IRLS] >= 15) and Periodic Limb Movement Index (PLMI) >= 15 who were receiving thrice-weekly hemodialysis enrolled from sites in the United States and Europe. Intervention: Following randomization and titration ( Outcomes & Measurements: Primary efficacy outcome: reduction in PLMI, assessed by ratio of PLMI at end of maintenance to baseline. Secondary/other outcomes (P values exploratory) included mean changes from baseline in PLMI, IRLS, and Clinical Global Impression item 1 (CGI-1 [severity of illness]) score. Results: 30 patients were randomly assigned (rotigotine, 20; placebo, 10); 25 (15; 10) completed the study with evaluable data. Mean (SD) PLMI ratio (end of maintenance to baseline) was 0.7 +/- 0.4 for rotigotine and 1.3 +/- 0.7 for placebo (analysis of covariance treatment ratio, 0.44; 95% CI, 0.22 to 0.88; P = 0.02). Numerical improvements were observed with rotigotine versus placebo in IRLS and CGI-1 (least squares mean treatment differences of -6.08 [95% CI, -12.18 to 0.02; P = 0.05] and -0.81 [95% CI, -1.94 to 0.33; P = 0.2]). 10 of 15 rotigotine and 2 of 10 placebo patients were CGI-1 responders (>= 50% improvement). Hemodialysis did not affect unconjugated rotigotine concentrations. The most common adverse events (>= 2 patients) were nausea (rotigotine, 4 [20%]; placebo, 0); vomiting (3 [15%]; 0); diarrhea (1 [5%]; 2 [20%]); headache (2 [10%]; 0); dyspnea (2 [10%]; 0); and hypertension (2 [10%]; 0). Limitations: Small sample size and short duration. Conclusions: Rotigotine improved periodic limb movements and RLS symptoms in the short term among ESRD patients requiring hemodialysis in a small-scale study. No dose adjustments are necessary for hemodialysis patients. (C) 2016 by the National Kidney Foundation, Inc.Peer reviewe

Epideemisen nefropatian kliininen kuva.

Syventävä työ ei kirjastoss

Developing eHealth for Home Dialysis : Clinicians' Needs for a Digital Patient Engagement Platform

eHealth solutions such as digital patient engagement platforms (DPEPs) aim at enhancing communication and collaboration between patients and clinicians. From the clinicians' viewpoint, concerns exist about new information systems (IS) leading to increased workload and interoperability problems. This article aims to support the development and implementation of DPEPs from the end-users' perspective. We studied clinicians' needs for a new DPEP developed to support home dialysis (HD) care. Eight clinicians participated in remote semi-structured interviews. Clinicians had positive expectations for the new DPEP as it could provide an overall picture of patients' status, support patients' self-care, and save time during patient visits. However, they had concerns about successful implementation, changes to workflows, and integration issues. To conclude, it is important to design and agree on changes in work practices, patient care, and complex IS environments when implementing new DPEP solutions in clinics.Peer reviewe