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Urgent-start peritoneal dialysis reduces infections, boosts survival rates - NephrologyNews.com |
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A protocol for urgent-start peritoneal dialysis results in less blood stream infections and appears to reduce mortality when compared to urgent-start hemodialysis, according to research presented at the National Kidney Foundation’s 2015 Spring Clinical Meetings in Dallas.
Most patients who present with end-stage renal disease in the emergency room are given urgent-start hemodialysis with a central venous catheter. However, researchers at the University of Southern California hypothesized that allowing patients the option of starting with peritoneal dialysis could improve long-range outcomes.
“In general, the overall outcomes for urgent-start PD patients are no different than patients who do traditional, planned PD and hemodialysis in terms of infection rates and outcomes,” said lead researcher Arshia Ghaffari, MD, Assistant Clinical Professor of Medicine, USC Division of Nephrology. “We were also surprised that we didn’t see the rate of complications we thought we would have in these urgent-start PD patients.”
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The research is based on 161 dialysis patients, of which 46 were urgent-start PD patients. Those who had urgent-start hemodialysis with a central venous catheter had a 43% higher hospitalization rate and had 4.3 times higher rates of adjusted catheter-related bacteremia, compared to urgent-start PD patients. There was also a statistically significant reduction in mortality for those on urgent-start PD compared to urgent-start hemodialysis with a central venous catheter.
“I worked at a county hospital where I regularly saw patients crashing into dialysis without a plan,” said Ghaffari. “Most are put on hemodialysis because there is infrastructure for that modality, but this research shows that urgent-start dialysis patients should be given a choice for their treatment.”
Urgent-start PD patients had similar rates of infection and hospitalization when compared to patients who had planned to go on hemodialysis or peritoneal dialysis.
“Many studies indicate better clinical outcomes for those on PD, and many PD patients report feeling better and having more energy for daily tasks,” said Kerry Willis, PhD, Chief Scientific Officer, National Kidney Foundation. “This new protocol appears to offer ESRD patients a safer dialysis choice, even in an urgent-start situation. It would be great to see this study replicated in other centers.”
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Global peritoneal dialysis machine industry: global industry analysis, trends ... - WhaTech |
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- Details
- WhaTech Channel: Medical Market Research Reports
- Published on Tuesday, 31 March 2015 00:14
- Submitted by RNR Market Research. WhaTech Agency
- News from: Deep Research Reports - Industry Reports on China and Global Markets
- Read: 14 times
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http://www.deepresearchreports.com/contacts/purchase.php?name=114092 Page views: 3 < Prev Next >
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Low Magnesium Raises Hemodialysis Patients' Death Risk - Renal and Urology News |
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March 30, 2015
The increased risk is especially pronounced among patients with low serum albumin.
Low serum magnesium levels are associated with an increased risk of death among hemodialysis (HD) patients, especially among patients with low serum albumin levels, according to study findings reported at the National Kidney Foundation's 2015 Spring Clinical Meetings in Dallas.
The study, led by Kamyar Kalantar-Zadeh, MD, MPH, PhD, of the University of California Irvine, and presented by Lin Li, MD, of the same institution, included 9,359 HD patients who initiated dialysis at DaVita facilities. The cohort had a median follow-up of 19 months, during which 2,636 deaths occurred.
Compared with patients who had a serum magnesium level of at least 2.2 but less than 2.4 mg/dL (reference), patients with a level below 2.0 mg/dL had a significantly increased risk of all-cause mortality over time after adjusting for baseline characteristics and co-morbidities. The risk was increased by about 20% for patients with a magnesium level of at least 1.8 but less than 2.0 mg/dL and 40% for those with a level below 1.8 mg/dL.
The association between magnesium level and mortality, however, was not statistically significant after additional adjustment for other laboratory analytes, especially serum albumin, Dr. Kalantar-Zadeh's group reported.
Among patients with low serum albumin (less than 3.5 g/dL), patients with a magnesium level below 2.0 mg/dL had a significant 17% increased risk of death compared with those who had a magnesium level of 2.0 mg/dL or higher.
“These findings may help identify HD patients with higher mortality risk for potential interventions,” the investigators concluded.
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Bladder Cancer-Obesity Link Confirmed - Renal and Urology News |
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March 30, 2015
For every 5 kg/m2 increase in BMI, the risk of bladder cancer rose 4.2%.
Preobese and obese individuals had a 7% and 10% increased risk of bladder cancer, respectively.
A new systematic review and meta-analysis confirms an association between obesity and bladder cancer. Pre-obese individuals also may be at risk.
For the meta-analysis, Yong-Bing Xiang, MD, and colleagues from the Shanghai Cancer Institute at Renji Hospital in China, pooled results from 15 cohort studies published by September 2014 from North America, Europe (including Scandinavia), Asia, and Australia. Among 14 million people, 38,072 bladder cancer cases were identified.
Compared with normal-weight individuals (body mass index [BMI] 18.50–24.99 kg/m2), preobese and obese individuals (BMI 25.00–29.99 and 30 or greater, respectively) had a 7% and 10% increased risk of bladder cancer, respectively, the researchers reported in PLOS One.
Researchers observed a linear relationship between body mass index (BMI) and bladder cancer risk. For each 5 kg/m2 increase in BMI, there was a 4.2% hike in bladder cancer risk.
The findings update and expand a 2013 meta-analysis that reached a similar conclusion. A shortcoming of that study was it did not address confounders.
Investigators in the current study adjusted for smoking and found no meaningful differences. They also examined other possible confounders. Studies that adjusted for physical activity, alcohol consumption, and family history of cancer, for example, actually showed stronger associations.
The researchers presented several theories for how obesity might promote carcinogenesis. Elevated insulin production, which is linked to obesity, might fuel tumor growth. In addition, obesity might promote chronic low-grade inflammation, causing disruptions in levels of cytokines and adipokines that promote cancer.
Given the rising rates of pre-obesity and obesity worldwide, “more in-depth studies are warranted to disentangle the roles of the biological mechanisms involved in obesity-related carcinogenesis,” the researchers concluded.
Source
- Sun, J, et al. PLOS ONE, March 24, 2015; doi: 10.1371/journal.pone.0119313.
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