[HEMODIALYSIS: PRESENT INNOVATIONS FOR PATIENTS' FUTURE].
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End-stage renal disease (ESRD) is a major cause of morbidity and mortality worldwide. Survival of ESRD patients depends on renal replacement therapies, such as kidney transplantation and dialysis. Due to the shortage of potential kidney donors and patients' comorbidities, dialysis is the major therapeutic option offered to such patients. In this review, recent advances in hemodialysis and hemodiafiltration, and their potential impact on improving patient survival will be discussed.Keywords:
Economic shortage
Renal replacement therapy
Artificial kidney
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Objective: Renal replacement therapy (RRT) is essential for maintenance of life for those with end-stage renal disease. However, there remain many areas of uncertainty about which method of RRT should be chosen. This paper reports an economic model based on a systematic review that attempts to determine which method of dialysis, continuous ambulatory peritoneal dialysis (CAPD) or hemodialysis, a patient should have as the initial method of RRT. Methods: A systematic review and a costing exercise carried out in a Scottish hospital were used to populate a Markov model. Scenario analysis was used to model plausible variations in variables included in the model. Results: In 8 of the 16 scenarios developed hemodialysis dominated CAPD. In a further eight scenarios, the cost per life-year displayed considerable variability, ranging from between £5,000 to £51,000. The higher costs per life-year were associated with minimum estimates of additional survival for a patient starting RRT on hospital hemodialysis. Conclusion: It may be more cost-effective to manage patients starting on RRT with hospital hemodialysis than CAPD. This has particular implications for the United Kingdom, given that up to 50% of new patients receive CAPD.
Renal replacement therapy
Home hemodialysis
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Renal replacement therapy
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For medical, psychosocial and economic reasons, renal transplantation is often preferable to dialysis as long-term renal replacement therapy. Nephrologists and transplantation surgeons are contending with an expanding population of patients with end–stage renal disease (ESRD) requiring treatment, and they are forced to weigh increasingly complicated patient–related issues against significant non-patient factors. On the one hand, ESRD patients must be provided with adequate renal replacement therapy, keeping in mind clinical factors that increase morbidity and mortality. On the other hand, there is a tacit obligation to use optimally the limited allograft supply and the available economic resources for the chronic care of ESRD patients. In selecting appropriate renal replacement therapy, we must recognize factors that predict favorable (or adverse) outcome for transplantation compared with dialysis. We must also consider the long-term consequences of our treatment decisions upon individual patients and upon society.
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Background— Kidney transplantation is generally acknowledged as the more clinically effective and more cost-effective option in managing patients with end-stage renal disease, compared with dialysis. This study looked for confirmatory evidence in a Hungarian population. Methods— Patients (n = 242) with end-stage renal disease who received cadaveric kidney transplantation during 1994 were followed up for 3 years. They were compared with patients (n = 840) receiving hemodialysis who were on a waiting list for transplantation. Data were collected retrospectively. Treatments were compared for clinical efficacy and for cost-effectiveness. Results— At month 36, the standard mortality hazard function was 3.5 times higher in the group receiving hemodialysis ( P<.0001) than in the transplant recipients. Average treatment costs per patient over the 3 years were also significantly higher ( P<.0001) in the hemodialysis group than in the group that received transplants. The cost of 1 year gained by transplantation was significantly less ( P<.0001) than the cost associated with hemodialysis. Conclusions— Compared with hemodialysis, kidney transplantation provides greater survival benefits to patients with end-stage renal disease, at less cost.
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Abstract Background: End-stage renal disease (ESRD) is the last stage of chronic kidney disease (CKD) when renal replacement therapy (RRT) is necessary for sustaining life. Assessment of QoL of ESRD patients has become an essential tool to measure how the disease affects patients’ lives, and to develop better plans of care. Little is known about QoL in patients with CKD before RRT. This study aims to examine the various socio-demographic and other factors that affect the daily QoL of ESRD patients on haemodialysis (HD). Methods : A cross-sectional study was conducted at Dr Selma Dialysis Center, Khartoum, Sudan from September to December 2018. A total of 138 adult patients on chronic dialysis were recruited in this observational study. The QoL was assessed using the Kidney Disease Quality of Life-Short Form questionnaire (KDQoL-SF™). Results: Out of 138 enrolled patients, there were 105 patients (76.1%) had a good QoL and 33 patients (23.9%) had a poor QoL.Patients with a poor QoL had an average age of 42.8 ± 12.9 years. The good-QoL group had an average age of 46.9 ± 14.9 years. The total score of KDQoL-SF was 61.6%, while the scores for the physical and mental components were 39.3 ± 9.6 and 50.0 ± 10.6 respectively. Conclusion: This study indicated that the main factors that have a significant impact on the QoL were social status, origin, employment status, duration of the CKD, family history of kidney disease, time on HD, and Hypertension.
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Haemodialysis is the most frequently used renal replacement therapy and in Europe keeps alive more than 80,000 patients with end-stage renal failure. Three times weekly the patient is connected to the artificial kidney and uraemic toxins are removed using a filter permeable for water and small solutes. This treatment lasts about 3-4 hours and can be performed in hospitals, dialysis centers or in the patient's own home. With haemodialysis, patients can survive for many years with a good quality of life. However, dialysis treatment is time-consuming, there are dietary restrictions, and the patients become increasingly dependent on medical personnel and relatives. It is therefore not surprising that most dialysis patients hope for a kidney transplantation.
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Abstract: Despite technological advances in renal replacement therapy, the preservation of health and quality of life for individuals on dialysis still remains a challenge. The high morbidity and mortality in dialysis warrant further research and insight into the clinical domains of the technique and practice of this therapy. In the last 20 years, the focus of development in the field of hemodialysis (HD) has centered around adequate removal of urea and other associated toxins. High-dose HD offers an opportunity to improve mortality, morbidity, and quality of life of patients with end-stage kidney disease. However, the uptake of this modality is low, and the risk associated with the therapy is not fully understood. Recent studies have highlighted the evidence base and improved our understanding of this technique of dialysis. This article provides a review of high-dose and home HD, its clinical impact on patient outcome, and the controversies that exist. Keywords: hemodialysis, home dialysis, high dose, outcomes
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Prevalence of chronic kidney disease (CKD) amongst intensive care unit (ICU) admissions is rising. How mortality and risk of end-stage renal disease (ESRD) differs between those with and without CKD and with acute kidney injury (AKI) is unclear. Determining factors that increase the risk of ESRD is essential to optimise treatment, identify patients requiring nephrological surveillance and for quantification of dialysis provision.This cohort study used the Swedish intensive care register 2005-2011 consisting of 130,134 adult patients. Incomplete cases were excluded (26,771). Patients were classified (using diagnostic and intervention codes as well as admission creatinine values) into the following groups: ESRD, CKD, AKI, acute-on-chronic disease (AoC) or no renal dysfunction (control). Primary outcome was all-cause mortality. Secondary outcome was ESRD incidence.Of 103,363 patients 4,192 had pre-existing CKD; 1389 had ESRD; 5273 developed AKI and 998 CKD patients developed AoC. One-year mortality was greatest in AoC patients (54 %) followed by AKI (48.7 %), CKD (47.6 %) and ESRD (40.3 %) (P < 0.001). Five-year mortality was highest for the CKD and AoC groups (71.3 % and 68.2 %, respectively) followed by AKI (61.8 %) and ESRD (62.9 %) (P < 0.001). ESRD incidence was greatest in the AoC and CKD groups (adjusted incidence rate ratio (IRR) 259 (95 % confidence interval (CI) 156.9-429.1) and 96.4, (95 % CI 59.7-155.6) respectively) and elevated in AKI patients compared with controls (adjusted IRR 24 (95 % CI 3.9-42.0); P < 0.001). Risk factors independently associated with ESRD in 1-year survivors were, according to relative risk ratio, AoC (356; 95 % CI 69.9-1811), CKD (267; 95 % CI 55.1-1280), AKI (30; 95 % CI 5.98-154) and presence of elevated admission serum potassium (4.6; 95 % CI 1.30-16.40) (P < 0.001).Pre-ICU renal disease significantly increases risk of death compared with controls. Subjects with AoC disease had extreme risk of developing ESRD. All patients with CKD who survive critical care should receive a nephrology referral.NCT02424747 April 20th 2015.
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End-stage renal disease (ESRD) is a major cause of morbidity and mortality worldwide. Survival of ESRD patients depends on renal replacement therapies, such as kidney transplantation and dialysis. Due to the shortage of potential kidney donors and patients' comorbidities, dialysis is the major therapeutic option offered to such patients. In this review, recent advances in hemodialysis and hemodiafiltration, and their potential impact on improving patient survival will be discussed.
Economic shortage
Renal replacement therapy
Artificial kidney
Cite
Citations (1)
Kidney transplantation is generally acknowledged as the more clinically effective and more cost-effective option in managing patients with end-stage renal disease, compared with dialysis. This study looked for confirmatory evidence in a Hungarian population.Patients (n = 242) with end-stage renal disease who received cadaveric kidney transplantation during 1994 were followed up for 3 years. They were compared with patients (n = 840) receiving hemodialysis who were on a waiting list for transplantation. Data were collected retrospectively. Treatments were compared for clinical efficacy and for cost-effectiveness.At month 36, the standard mortality hazard function was 3.5 times higher in the group receiving hemodialysis (P < .0001) than in the transplant recipients. Average treatment costs per patient over the 3 years were also significantly higher (P < .0001) in the hemodialysis group than in the group than received transplants. The cost of 1 year gained by transplantation was significantly less (P < .0001) than the cost associated with hemodialysis.Compared with hemodialysis, kidney transplantation provides greater survival benefits to patients with end-stage renal disease, at less cost.
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