Pub Date : 2024-10-09DOI: 10.1016/j.xkme.2024.100911
Phoom Narongkiatikhun MD , Sungho Park PhD , Amy Rydin MD , Callie Rountree-Jablin , Ye Ji Choi MPH , Jo Ann Antenor PhD, MPH , Laura Pyle PhD , Lynette Driscoll PA-C, MA , Daniel van Raalte MD , Maureen Pushea CCLS , Alyssa Caldwell-McGee MS , Vuddhidej Ophascharoensuk MD , Kristen Nadeau MD , Kalie Tommerdahl MD , Richard J. Johnson MD , Lorna Browne MD , Alex J. Barker MD , Petter Bjornstad MD
{"title":"Pegloticase-Induced Rapid Uric Acid Lowering and Kidney and Cardiac Health Markers in Youth-Onset Type 2 Diabetes: A Pilot Clinical Trial","authors":"Phoom Narongkiatikhun MD , Sungho Park PhD , Amy Rydin MD , Callie Rountree-Jablin , Ye Ji Choi MPH , Jo Ann Antenor PhD, MPH , Laura Pyle PhD , Lynette Driscoll PA-C, MA , Daniel van Raalte MD , Maureen Pushea CCLS , Alyssa Caldwell-McGee MS , Vuddhidej Ophascharoensuk MD , Kristen Nadeau MD , Kalie Tommerdahl MD , Richard J. Johnson MD , Lorna Browne MD , Alex J. Barker MD , Petter Bjornstad MD","doi":"10.1016/j.xkme.2024.100911","DOIUrl":"10.1016/j.xkme.2024.100911","url":null,"abstract":"","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"6 12","pages":"Article 100911"},"PeriodicalIF":3.2,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142594065","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-09DOI: 10.1016/j.xkme.2024.100912
Margaux Costes-Albrespic , Sophie Liabeuf , Solène Laville , Christian Jacquelinet , Christian Combe , Denis Fouque , Maurice Laville , Luc Frimat , Roberto Pecoits-Filho , Oriane Lambert , Ziad A. Massy , Bénédicte Sautenet , Natalia Alencar de Pinho
<div><h3>Rationale & Objective</h3><div>Blood pressure (BP) control is essential for preventing cardiorenal complications in chronic kidney disease (CKD), but most patients fail to reach BP target. We assessed longitudinal patterns of antihypertensive drug prescription and systolic BP.</div></div><div><h3>Study Design</h3><div>Prospective observational cohort study.</div></div><div><h3>Setting & Population</h3><div>In total, 2,755 hypertensive patients with CKD stages 3-4, receiving care from a nephrologist, from the French CKD–Renal Epidemiology and Information Network (CKD-REIN cohort study).</div></div><div><h3>Exposure</h3><div>Patient factors, including sociodemographic characteristics, medical history, and laboratory data, and provider factors, including number of primary care physician and specialist encounters.</div></div><div><h3>Outcomes</h3><div>Changes in antihypertensive drug-class prescription during follow-up: add-on or withdrawal.</div></div><div><h3>Analytical Approach</h3><div>Hierarchical shared-frailty models to estimate hazard ratios (HR) to deal with clustering at the nephrologist level and linear mixed models to describe systolic BP trajectory.</div></div><div><h3>Results</h3><div>At baseline, median age was 69 years, and mean estimated glomerular filtration rate was 33<!--> <!-->mL/min/1.73 m². In total, 66% of patients were men, 81% had BP<!--> <!-->≥<!--> <!-->130/80<!--> <!-->mm Hg, and 75% were prescribed<!--> <!-->≥2 antihypertensive drugs. During a median 5-year follow-up, the rate of changes of antihypertensive prescription was 50 per 100 person-years, 23 per 100 for add-ons, and 25 per 100 for withdrawals. After adjusting for risk factors, systolic BP, and the number of antihypertensive drugs, poor medication adherence was associated with increased HR for add-on (1.35, 95% confidence interval [CI], 1.01-1.80), whereas a lower education level was associated with increased HR for withdrawal (1.23, 95% CI, 1.02-1.49) for 9-11 years versus<!--> <!-->≥12 years. More frequent nephrologist visits (≥4 vs none) were associated with higher HRs of add-on and withdrawal (1.52, 95% CI, 1.06-2.18; 1.57, 95% CI, 1.12-2.19, respectively), whereas associations with visit frequency to other physicians varied with their specialty. Mean systolic BP decreased by 4<!--> <!-->mm Hg following drug add-on but tended to increase thereafter.</div></div><div><h3>Limitations</h3><div>Lack of information on prescriber and drug dosing.</div></div><div><h3>Conclusions</h3><div>In patients with CKD and poor BP control, changes in antihypertensive drug prescriptions are common and relate to clinician preferences and patients’ tolerability. Sustainable reduction in systolic BP after add-on of a drug class is infrequently achieved.</div></div><div><h3>Plain-Language Summary</h3><div>Blood pressure (BP) control remains unattained in most patients with chronic kidney disease (CKD), raising questions about how antihypertensive treatment is manag
{"title":"Antihypertensive Treatment Patterns in CKD Stages 3 and 4: The CKD-REIN Cohort Study","authors":"Margaux Costes-Albrespic , Sophie Liabeuf , Solène Laville , Christian Jacquelinet , Christian Combe , Denis Fouque , Maurice Laville , Luc Frimat , Roberto Pecoits-Filho , Oriane Lambert , Ziad A. Massy , Bénédicte Sautenet , Natalia Alencar de Pinho","doi":"10.1016/j.xkme.2024.100912","DOIUrl":"10.1016/j.xkme.2024.100912","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Blood pressure (BP) control is essential for preventing cardiorenal complications in chronic kidney disease (CKD), but most patients fail to reach BP target. We assessed longitudinal patterns of antihypertensive drug prescription and systolic BP.</div></div><div><h3>Study Design</h3><div>Prospective observational cohort study.</div></div><div><h3>Setting & Population</h3><div>In total, 2,755 hypertensive patients with CKD stages 3-4, receiving care from a nephrologist, from the French CKD–Renal Epidemiology and Information Network (CKD-REIN cohort study).</div></div><div><h3>Exposure</h3><div>Patient factors, including sociodemographic characteristics, medical history, and laboratory data, and provider factors, including number of primary care physician and specialist encounters.</div></div><div><h3>Outcomes</h3><div>Changes in antihypertensive drug-class prescription during follow-up: add-on or withdrawal.</div></div><div><h3>Analytical Approach</h3><div>Hierarchical shared-frailty models to estimate hazard ratios (HR) to deal with clustering at the nephrologist level and linear mixed models to describe systolic BP trajectory.</div></div><div><h3>Results</h3><div>At baseline, median age was 69 years, and mean estimated glomerular filtration rate was 33<!--> <!-->mL/min/1.73 m². In total, 66% of patients were men, 81% had BP<!--> <!-->≥<!--> <!-->130/80<!--> <!-->mm Hg, and 75% were prescribed<!--> <!-->≥2 antihypertensive drugs. During a median 5-year follow-up, the rate of changes of antihypertensive prescription was 50 per 100 person-years, 23 per 100 for add-ons, and 25 per 100 for withdrawals. After adjusting for risk factors, systolic BP, and the number of antihypertensive drugs, poor medication adherence was associated with increased HR for add-on (1.35, 95% confidence interval [CI], 1.01-1.80), whereas a lower education level was associated with increased HR for withdrawal (1.23, 95% CI, 1.02-1.49) for 9-11 years versus<!--> <!-->≥12 years. More frequent nephrologist visits (≥4 vs none) were associated with higher HRs of add-on and withdrawal (1.52, 95% CI, 1.06-2.18; 1.57, 95% CI, 1.12-2.19, respectively), whereas associations with visit frequency to other physicians varied with their specialty. Mean systolic BP decreased by 4<!--> <!-->mm Hg following drug add-on but tended to increase thereafter.</div></div><div><h3>Limitations</h3><div>Lack of information on prescriber and drug dosing.</div></div><div><h3>Conclusions</h3><div>In patients with CKD and poor BP control, changes in antihypertensive drug prescriptions are common and relate to clinician preferences and patients’ tolerability. Sustainable reduction in systolic BP after add-on of a drug class is infrequently achieved.</div></div><div><h3>Plain-Language Summary</h3><div>Blood pressure (BP) control remains unattained in most patients with chronic kidney disease (CKD), raising questions about how antihypertensive treatment is manag","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"6 12","pages":"Article 100912"},"PeriodicalIF":3.2,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142586681","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-19DOI: 10.1016/j.xkme.2024.100905
Mariam Charkviani , Andrea G. Kattah , Andrew D. Rule , Jennifer A. Ferguson , Kristin C. Mara , Kianoush B. Kashani , Heather P. May , Jordan K. Rosedahl , Swetha Reddy , Lindsey M. Philpot , Erin F. Barreto
Rationale & Objective
Remote patient monitoring (RPM) could improve the quality and efficiency of acute kidney injury (AKI) survivor care. This study described our experience with AKI RPM and characterized its effectiveness.
Study Design
A cohort study matched 1:3 to historical controls.
Setting & Participants
Patients hospitalized with an episode of AKI who were discharged home and were not treated with dialysis.
Exposure
Participation in an AKI RPM program, which included use of a home vital sign and symptom monitoring technology and weekly in-center laboratory assessments.
Outcomes
Risk of unplanned hospital readmission or emergency department (ED) visit within 6 months.
Analytic Approach
Endpoints were assessed using Cox proportional hazards models.
Results
Forty of the 49 patients enrolled in AKI RPM (82%) participated in the program after hospital discharge. Seventy three percent of patients experienced one AKI RPM alert, most commonly related to fluid status. Among those with stage 3 AKI, the risk of unplanned readmission or ED visit within 6 months of discharge was not different between AKI RPM patients (n = 34) and matched controls (n = 102) (HR 1.33 [95% CI, 0.81-2.18]; P = 0.27). The incidence of an ED visit without hospitalization was significantly higher in the AKI RPM group (HR 1.95, [95% CI, 1.05-3.62]; P = 0.035). The risk of an unplanned readmission or ED visit was higher in those with baseline eGFR < 45 mL/min/1.73 m2 exposed to AKI RPM (HR 2.24 [95% CI, 1.19-4.20]; P = 0.012) when compared with those with baseline eGFR ≥45 mL/min/1.73 m2 (HR 0.69 [95% CI, 0.29-1.67]; P = 0.41) (test of interaction P = 0.04).
Limitations
Small sample size that may have been underpowered for the effectiveness endpoints.
Conclusions
AKI RPM, when used after hospital discharge, led to alerts and interventions directed at optimizing kidney health and AKI complications but did not reduce the risk for rehospitalization.
理论依据& 目标远程患者监护（RPM）可提高急性肾损伤（AKI）幸存者护理的质量和效率。本研究介绍了我们在 AKI RPM 方面的经验，并描述了其有效性。研究设计一项队列研究，与历史对照组进行 1:3 匹配。结果6个月内发生意外再入院或急诊科就诊的风险。分析方法采用Cox比例危险模型评估终点。结果49名参加AKI RPM的患者中有40人（82%）在出院后参加了该项目。73%的患者经历过一次 AKI RPM 警报，最常见的警报与液体状态有关。在 3 期 AKI 患者中，AKI RPM 患者（34 人）与匹配对照组（102 人）在出院后 6 个月内发生意外再入院或急诊就诊的风险没有差异（HR 1.33 [95% CI, 0.81-2.18]；P = 0.27）。AKI RPM 组未住院的急诊就诊发生率明显更高（HR 1.95 [95% CI, 1.05-3.62]；P = 0.035）。与基线 eGFR ≥45 mL/min/1.73 m2 的患者相比（HR 0.69 [95% CI, 0.29-1.67]; P = 0.41），接受 AKI RPM 治疗的基线 eGFR ≥45 mL/min/1.73 m2 患者发生意外再入院或急诊就诊的风险更高（HR 2.24 [95% CI, 1.19-4.20]; P = 0.012）（交互作用检验 P = 0.04）。结论出院后使用AKI RPM可发出警报并采取干预措施，以优化肾脏健康和AKI并发症，但并不能降低再次住院的风险。
{"title":"Acute Kidney Injury Survivor Remote Patient Monitoring: A Single Center’s Experience and an Effectiveness Evaluation","authors":"Mariam Charkviani , Andrea G. Kattah , Andrew D. Rule , Jennifer A. Ferguson , Kristin C. Mara , Kianoush B. Kashani , Heather P. May , Jordan K. Rosedahl , Swetha Reddy , Lindsey M. Philpot , Erin F. Barreto","doi":"10.1016/j.xkme.2024.100905","DOIUrl":"10.1016/j.xkme.2024.100905","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Remote patient monitoring (RPM) could improve the quality and efficiency of acute kidney injury (AKI) survivor care. This study described our experience with AKI RPM and characterized its effectiveness.</div></div><div><h3>Study Design</h3><div>A cohort study matched 1:3 to historical controls.</div></div><div><h3>Setting & Participants</h3><div>Patients hospitalized with an episode of AKI who were discharged home and were not treated with dialysis.</div></div><div><h3>Exposure</h3><div>Participation in an AKI RPM program, which included use of a home vital sign and symptom monitoring technology and weekly in-center laboratory assessments.</div></div><div><h3>Outcomes</h3><div>Risk of unplanned hospital readmission or emergency department (ED) visit within 6 months.</div></div><div><h3>Analytic Approach</h3><div>Endpoints were assessed using Cox proportional hazards models.</div></div><div><h3>Results</h3><div>Forty of the 49 patients enrolled in AKI RPM (82%) participated in the program after hospital discharge. Seventy three percent of patients experienced one AKI RPM alert, most commonly related to fluid status. Among those with stage 3 AKI, the risk of unplanned readmission or ED visit within 6 months of discharge was not different between AKI RPM patients (n<!--> <!-->=<!--> <!-->34) and matched controls (n<!--> <!-->=<!--> <!-->102) (HR 1.33 [95% CI, 0.81-2.18]; <em>P</em> <!-->=<!--> <!-->0.27). The incidence of an ED visit without hospitalization was significantly higher in the AKI RPM group (HR 1.95, [95% CI, 1.05-3.62]; <em>P</em> <!-->=<!--> <!-->0.035). The risk of an unplanned readmission or ED visit was higher in those with baseline eGFR<!--> <!--><<!--> <!-->45<!--> <!-->mL/min/1.73<!--> <!-->m<sup>2</sup> exposed to AKI RPM (HR 2.24 [95% CI, 1.19-4.20]; <em>P</em> <!-->=<!--> <!-->0.012) when compared with those with baseline eGFR<!--> <!-->≥45<!--> <!-->mL/min/1.73<!--> <!-->m<sup>2</sup> (HR 0.69 [95% CI, 0.29-1.67]; <em>P</em> <!-->=<!--> <!-->0.41) (test of interaction <em>P</em> <!-->=<!--> <!-->0.04).</div></div><div><h3>Limitations</h3><div>Small sample size that may have been underpowered for the effectiveness endpoints.</div></div><div><h3>Conclusions</h3><div>AKI RPM, when used after hospital discharge, led to alerts and interventions directed at optimizing kidney health and AKI complications but did not reduce the risk for rehospitalization.</div></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"6 11","pages":"Article 100905"},"PeriodicalIF":3.2,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142418758","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-19DOI: 10.1016/j.xkme.2024.100908
Kiyotaka Uchiyama , Masako Otani , Naoki Chigusa , Kazuya Sugita , Ryosuke Matsuoka , Koji Hosoya , Mina Komuta , Jun Ito , Naoki Washida
Numerous health concerns, primarily kidney injury, have been reported with the use of Beni-kōji CholesteHelp, a functional food containing red yeast rice. Here, we describe 2 cases of kidney injury caused by beni-kōji. The first case had normal kidney function before consuming the product. After several months of use, she developed hypertension. After 6 months of supplement consumption, her estimated glomerular filtration rate (eGFR) dropped to 22.5 mL/min/1.73 m2. A spot urine sample showed a urinary protein-to-creatinine ratio of 2.03 g/g, leading to the diagnosis of Fanconi syndrome. Kidney biopsy showed tubular degeneration. Thirty-five days after discontinuing the supplement, proteinuria resolved and the eGFR returned to baseline level. The second case, who had diabetes and normal kidney function, experienced severe kidney injury (eGFR, 3.5 mL/min/1.73 m2) after 4 months of Beni-kōji CholesteHelp use. He required hemodialysis for >2 weeks but recovered kidney function after the product was discontinued. Kidney biopsy showed tubular injury similar to the first case and glomeruli changes consistent with diabetic nephropathy. These cases indicate that beni-kōji use is associated with tubular toxicity. Further studies are required to identify the precise etiology and mechanism of kidney injury.
{"title":"Acute Kidney Injury Associated With Red Yeast Rice (Beni-kōji) Supplement: A Report of Two Cases","authors":"Kiyotaka Uchiyama , Masako Otani , Naoki Chigusa , Kazuya Sugita , Ryosuke Matsuoka , Koji Hosoya , Mina Komuta , Jun Ito , Naoki Washida","doi":"10.1016/j.xkme.2024.100908","DOIUrl":"10.1016/j.xkme.2024.100908","url":null,"abstract":"<div><div>Numerous health concerns, primarily kidney injury, have been reported with the use of Beni-kōji CholesteHelp, a functional food containing red yeast rice. Here, we describe 2 cases of kidney injury caused by beni-kōji. The first case had normal kidney function before consuming the product. After several months of use, she developed hypertension. After 6 months of supplement consumption, her estimated glomerular filtration rate (eGFR) dropped to 22.5<!--> <!-->mL/min/1.73<!--> <!-->m<sup>2</sup>. A spot urine sample showed a urinary protein-to-creatinine ratio of 2.03<!--> <!-->g/g, leading to the diagnosis of Fanconi syndrome. Kidney biopsy showed tubular degeneration. Thirty-five days after discontinuing the supplement, proteinuria resolved and the eGFR returned to baseline level. The second case, who had diabetes and normal kidney function, experienced severe kidney injury (eGFR, 3.5<!--> <!-->mL/min/1.73<!--> <!-->m<sup>2</sup>) after 4 months of Beni-kōji CholesteHelp use. He required hemodialysis for<!--> <!-->>2 weeks but recovered kidney function after the product was discontinued. Kidney biopsy showed tubular injury similar to the first case and glomeruli changes consistent with diabetic nephropathy. These cases indicate that beni-kōji use is associated with tubular toxicity. Further studies are required to identify the precise etiology and mechanism of kidney injury.</div></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"6 11","pages":"Article 100908"},"PeriodicalIF":3.2,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142528957","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-19DOI: 10.1016/j.xkme.2024.100903
Melanie P. Hoenig , Anna R. Gaddy , Priti Meena , Roger A. Rodby , Leticia Rolón , Juan Carlos Q. Velez , Joshua Waitzman , Amy A. Yau , Joel M. Topf
Renal physiology is considered one of the most challenging medical disciplines to understand and to teach. Eight academic nephrologists have come together to produce a podcast devoted to helping learners at any level improve their understanding of this difficult topic. Using Dr Burton D. Rose’s classic textbook: Clinical Physiology of Acid-Base and Electrolyte Disorders, the podcast faculty systematically attack each chapter of the book in a didactic yet fun-flowing interactive discussion. This education model is unique and helps demystify complex topics.
{"title":"Renal Physiology Education via Podcast: Channel Your Enthusiasm","authors":"Melanie P. Hoenig , Anna R. Gaddy , Priti Meena , Roger A. Rodby , Leticia Rolón , Juan Carlos Q. Velez , Joshua Waitzman , Amy A. Yau , Joel M. Topf","doi":"10.1016/j.xkme.2024.100903","DOIUrl":"10.1016/j.xkme.2024.100903","url":null,"abstract":"<div><div>Renal physiology is considered one of the most challenging medical disciplines to understand and to teach. Eight academic nephrologists have come together to produce a podcast devoted to helping learners at any level improve their understanding of this difficult topic. Using Dr Burton D. Rose’s classic textbook: <em>Clinical Physiology of Acid-Base and Electrolyte Disorders</em>, the podcast faculty systematically attack each chapter of the book in a didactic yet fun-flowing interactive discussion. This education model is unique and helps demystify complex topics.</div></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"6 11","pages":"Article 100903"},"PeriodicalIF":3.2,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142416838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<div><h3>Rationale & Objective</h3><div>Peritoneal dialysis (PD) is a dialysis modality limited by the potential need of transferring to hemodialysis. Optimal hemodialysis vascular access is an arteriovenous fistula. Back-up arteriovenous fistula (bAVF) is a strategy to prevent central venous catheter (CVC) insertion, but its use in the PD population has not been systematically reviewed.</div></div><div><h3>Study Design</h3><div>Systematic review and meta-analysis.</div></div><div><h3>Setting & Study Populations</h3><div>Studies including PD patients with a bAVF and the associated outcomes, including risk of hemodialysis transfer with a CVC and the proportion of bAVFs used.</div></div><div><h3>Selection Criteria for Studies</h3><div>Retrospective or prospective, observational studies, non-randomized or randomized controlled trials.</div></div><div><h3>Data Extractions</h3><div>Vascular access at time of hemodialysis transfer (bAVF vs CVC) for patients with and without a bAVF. The data on bAVF outcomes included bAVFs that stopped working, were never used, and the number of patients requiring hemodialysis.</div></div><div><h3>Analytical Approach</h3><div>Random-effects meta-analysis and meta-proportional analysis were conducted, with risk of bias within studies assessed using the Newcastle-Ottawa Scale.</div></div><div><h3>Results</h3><div>We screened 1,855 studies, 11 of which met the inclusion criteria, comprising 598 (62%) patients with a bAVF and 368 (38%) without. The proportion of bAVFs never used was 69% (95% confidence intervals [CI], 0.58-0.80; <em>I</em><sup>2</sup> <!-->=<!--> <!-->86.2%). Meta-analysis of 8 studies found no difference in hemodialysis transfer between patients with a bAVF and those without (hazard ratio, 1.14; 95% CI, 0.86-1.51). However, the risk of hemodialysis transfer with a CVC was significantly lower in patients with a bAVF (hazard ratio, 0.43; 95% CI, 0.17-0.68).</div></div><div><h3>Limitations</h3><div>Substantial heterogeneity between the studies and large number of studies with poor quality.</div></div><div><h3>Conclusions</h3><div>bAVF was associated with a high rate of non-utilization but a lower risk of starting hemodialysis via a CVC. Future studies assessing long-term clinical outcomes may provide further insights into the role of bAVF creation in shaping dialysis unit policies.</div></div><div><h3>Plain-Language Summary</h3><div>Peritoneal dialysis (PD) is limited by hemodialysis transfer. The optimal vascular access in hemodialysis is the arteriovenous fistula, yet requirements for maturation often necessitate a central venous catheter (CVC) insertion in acute transfers from PD. A back-up arteriovenous fistula (bAVF) is a strategy used to avoid CVC use in such situations. However, no consensus is currently available on the best approach for bAVF in PD. By conducting a systematic review, we found that 69% of bAVFs were never used. Nevertheless, bAVFs reduced the risk of hemodialysis transfer with
{"title":"Back-up Arteriovenous Fistulas in Peritoneal Dialysis Patients: A Systematic Review and Meta-analysis","authors":"Hicham I. Cheikh Hassan , Pauline Byrne , Christie Harrod , Donia George , Karumathil Murali , Jenny H.C. Chen , Judy Mullan","doi":"10.1016/j.xkme.2024.100904","DOIUrl":"10.1016/j.xkme.2024.100904","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Peritoneal dialysis (PD) is a dialysis modality limited by the potential need of transferring to hemodialysis. Optimal hemodialysis vascular access is an arteriovenous fistula. Back-up arteriovenous fistula (bAVF) is a strategy to prevent central venous catheter (CVC) insertion, but its use in the PD population has not been systematically reviewed.</div></div><div><h3>Study Design</h3><div>Systematic review and meta-analysis.</div></div><div><h3>Setting & Study Populations</h3><div>Studies including PD patients with a bAVF and the associated outcomes, including risk of hemodialysis transfer with a CVC and the proportion of bAVFs used.</div></div><div><h3>Selection Criteria for Studies</h3><div>Retrospective or prospective, observational studies, non-randomized or randomized controlled trials.</div></div><div><h3>Data Extractions</h3><div>Vascular access at time of hemodialysis transfer (bAVF vs CVC) for patients with and without a bAVF. The data on bAVF outcomes included bAVFs that stopped working, were never used, and the number of patients requiring hemodialysis.</div></div><div><h3>Analytical Approach</h3><div>Random-effects meta-analysis and meta-proportional analysis were conducted, with risk of bias within studies assessed using the Newcastle-Ottawa Scale.</div></div><div><h3>Results</h3><div>We screened 1,855 studies, 11 of which met the inclusion criteria, comprising 598 (62%) patients with a bAVF and 368 (38%) without. The proportion of bAVFs never used was 69% (95% confidence intervals [CI], 0.58-0.80; <em>I</em><sup>2</sup> <!-->=<!--> <!-->86.2%). Meta-analysis of 8 studies found no difference in hemodialysis transfer between patients with a bAVF and those without (hazard ratio, 1.14; 95% CI, 0.86-1.51). However, the risk of hemodialysis transfer with a CVC was significantly lower in patients with a bAVF (hazard ratio, 0.43; 95% CI, 0.17-0.68).</div></div><div><h3>Limitations</h3><div>Substantial heterogeneity between the studies and large number of studies with poor quality.</div></div><div><h3>Conclusions</h3><div>bAVF was associated with a high rate of non-utilization but a lower risk of starting hemodialysis via a CVC. Future studies assessing long-term clinical outcomes may provide further insights into the role of bAVF creation in shaping dialysis unit policies.</div></div><div><h3>Plain-Language Summary</h3><div>Peritoneal dialysis (PD) is limited by hemodialysis transfer. The optimal vascular access in hemodialysis is the arteriovenous fistula, yet requirements for maturation often necessitate a central venous catheter (CVC) insertion in acute transfers from PD. A back-up arteriovenous fistula (bAVF) is a strategy used to avoid CVC use in such situations. However, no consensus is currently available on the best approach for bAVF in PD. By conducting a systematic review, we found that 69% of bAVFs were never used. Nevertheless, bAVFs reduced the risk of hemodialysis transfer with ","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"6 11","pages":"Article 100904"},"PeriodicalIF":3.2,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142528657","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-19DOI: 10.1016/j.xkme.2024.100907
Billy Zeng MD , Jeanne A. Darbinian MPH , Kenneth K. Chen MD , Hasmik Arzumanyan MD , Sijie Zheng MD, PhD , Joan C. Lo MD
{"title":"Incident Albuminuria and Ethnicity Among Adults With Diabetes in an Integrated Health Care System in the United States","authors":"Billy Zeng MD , Jeanne A. Darbinian MPH , Kenneth K. Chen MD , Hasmik Arzumanyan MD , Sijie Zheng MD, PhD , Joan C. Lo MD","doi":"10.1016/j.xkme.2024.100907","DOIUrl":"10.1016/j.xkme.2024.100907","url":null,"abstract":"","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"6 11","pages":"Article 100907"},"PeriodicalIF":3.2,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142537385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-19DOI: 10.1016/j.xkme.2024.100906
Alexi Vahlkamp , Julia Schneider , Talar Markossian , Salva Balbale , Cara Ray , Kevin Stroupe , Seema Limaye
<div><h3>Rationale & Objective</h3><div>Engaging patients with advanced chronic kidney disease (CKD) in goals of care (GOC) conversations is essential to align life-sustaining treatments with patient preferences. This pilot study described the feasibility of engaging older Veterans with advanced CKD in GOC conversations via telehealth by (1) comparing patient characteristics, including life-sustaining treatment note completion rates and preferences by visit modality, and (2) exploring Veteran and clinician perspectives surrounding telehealth GOC conversations.</div></div><div><h3>Study Design</h3><div>Mixed-method convergent design including a prospective, quantitative observational cohort analysis (n<!--> <!-->=<!--> <!-->40) and qualitative, semi-structured interviews with 4 clinicians and 11 Veterans. Descriptive statistics were used to describe the quantitative data. An inductive, rapid analytic approach and the constant comparison were used to analyze and interpret qualitative data. Quantitative and qualitative data were triangulated to identify practical suggestions to optimize GOC conversations via telehealth.</div></div><div><h3>Setting & Participants</h3><div>Study participants included Veteran patients aged<!--> <!-->≥70 years with advanced CKD stage 4 or 5 from a Veterans Affairs hospital nephrology clinic.</div></div><div><h3>Results</h3><div>The cohort (n<!--> <!-->=<!--> <!-->40) had a high probability of death, hospitalization, or both occurring within 90 days or 1 year. Across visit modalities, patient characteristics did not differ significantly. Two interrelated themes emerged from interviews: (1) GOC conversation feasibility varies by key personal and environmental factors (barriers and facilitators) across visit modalities, although overarching barriers include lack of non-palliative care provider engagement and uncertainty or lack of understanding surrounding illness trajectory, and (2) engaging Veterans in GOC conversations has a positive impact by creating a sense of reassurance regardless of visit modality.</div></div><div><h3>Limitations</h3><div>The sample size was small (n<!--> <!-->=<!--> <!-->40), and the study was unable to detect statistically significant differences in patient characteristics and clinical outcomes between visit modalities. Furthermore, future studies with larger and more diverse samples may be better equipped to identify differences by demographic characteristics.</div></div><div><h3>Conclusions</h3><div>The findings suggest that it is feasible to engage older patients with advanced CKD in GOC conversations via telehealth, as patients wishing to complete a telehealth GOC conversation were able to. Factors increasing the ease of accessing GOC conversations may also increase their benefits, irrespective of visit modality.</div></div><div><h3>Plain-Language Summary</h3><div>Goals of care (GOC) conversations for older patients with advanced chronic kidney disease (CKD) are important to align me
{"title":"Telehealth for Goals of Care Conversations in Advanced CKD: A Mixed-Methods Pilot Study of US Veterans and Their Clinicians","authors":"Alexi Vahlkamp , Julia Schneider , Talar Markossian , Salva Balbale , Cara Ray , Kevin Stroupe , Seema Limaye","doi":"10.1016/j.xkme.2024.100906","DOIUrl":"10.1016/j.xkme.2024.100906","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Engaging patients with advanced chronic kidney disease (CKD) in goals of care (GOC) conversations is essential to align life-sustaining treatments with patient preferences. This pilot study described the feasibility of engaging older Veterans with advanced CKD in GOC conversations via telehealth by (1) comparing patient characteristics, including life-sustaining treatment note completion rates and preferences by visit modality, and (2) exploring Veteran and clinician perspectives surrounding telehealth GOC conversations.</div></div><div><h3>Study Design</h3><div>Mixed-method convergent design including a prospective, quantitative observational cohort analysis (n<!--> <!-->=<!--> <!-->40) and qualitative, semi-structured interviews with 4 clinicians and 11 Veterans. Descriptive statistics were used to describe the quantitative data. An inductive, rapid analytic approach and the constant comparison were used to analyze and interpret qualitative data. Quantitative and qualitative data were triangulated to identify practical suggestions to optimize GOC conversations via telehealth.</div></div><div><h3>Setting & Participants</h3><div>Study participants included Veteran patients aged<!--> <!-->≥70 years with advanced CKD stage 4 or 5 from a Veterans Affairs hospital nephrology clinic.</div></div><div><h3>Results</h3><div>The cohort (n<!--> <!-->=<!--> <!-->40) had a high probability of death, hospitalization, or both occurring within 90 days or 1 year. Across visit modalities, patient characteristics did not differ significantly. Two interrelated themes emerged from interviews: (1) GOC conversation feasibility varies by key personal and environmental factors (barriers and facilitators) across visit modalities, although overarching barriers include lack of non-palliative care provider engagement and uncertainty or lack of understanding surrounding illness trajectory, and (2) engaging Veterans in GOC conversations has a positive impact by creating a sense of reassurance regardless of visit modality.</div></div><div><h3>Limitations</h3><div>The sample size was small (n<!--> <!-->=<!--> <!-->40), and the study was unable to detect statistically significant differences in patient characteristics and clinical outcomes between visit modalities. Furthermore, future studies with larger and more diverse samples may be better equipped to identify differences by demographic characteristics.</div></div><div><h3>Conclusions</h3><div>The findings suggest that it is feasible to engage older patients with advanced CKD in GOC conversations via telehealth, as patients wishing to complete a telehealth GOC conversation were able to. Factors increasing the ease of accessing GOC conversations may also increase their benefits, irrespective of visit modality.</div></div><div><h3>Plain-Language Summary</h3><div>Goals of care (GOC) conversations for older patients with advanced chronic kidney disease (CKD) are important to align me","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"6 11","pages":"Article 100906"},"PeriodicalIF":3.2,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142418580","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-12DOI: 10.1016/j.xkme.2024.100902
Katherine Rizzolo , Colin Gardner , Claudia Camacho , Rebeca Gonzalez Jauregui , Sushrut S. Waikar , Michel Chonchol , Lilia Cervantes
<div><h3>Rationale & Objective</h3><div>Latinx individuals are more likely to start and remain receiving in-center hemodialysis, over home dialysis, than non-Latinx White individuals. The objective of our study was to understand the drivers of sustained in-center dialysis and deterrents of switching to home dialysis use for Latinx individuals receiving in-center dialysis.</div></div><div><h3>Study Design</h3><div>This qualitative study used semistructured one-on-one interviews.</div></div><div><h3>Setting and Participants</h3><div>Latinx adults receiving in-center hemodialysis therapy at 2 urban dialysis clinics in Denver, Colorado between November 2021 and March 2023.</div></div><div><h3>Exposures</h3><div>In-center hemodialysis, Latinx ethnicity.</div></div><div><h3>Outcomes</h3><div>Qualitative.</div></div><div><h3>Analytical Approach</h3><div>Interviews were analyzed with thematic analysis using inductive coding. Theoretical framework development used principles of grounded theory.</div></div><div><h3>Results</h3><div>In total, 25 Latinx adults (10 [40%] female and 15 [60%] male) receiving in-center hemodialysis therapy participated. One theme demonstrated that Latinx individuals experienced hardship with in-center dialysis but used Latinx values to persevere: Psychosocial resilience using Latinx cultural values (faith and spiritual coping, belief in predestination and acceptance, optimism and positive attitude toward treatment, and positive relationships with health care professionals and peers). Two themes illustrate barriers to starting or switching to home dialysis: Insufficient knowledge of kidney replacement therapy (lack of awareness of kidney disease, lack of preparation for dialysis) and Barriers to patient-centered decision making in dialysis treatment (lack of peer perspective to guide dialysis decision making, fear and apprehension of home dialysis, lack of socioemotional support, perception of housing issues).</div></div><div><h3>Limitations</h3><div>Most participants were from the same geographic area and country of origin, and some may have been uninsured because of immigration status.</div></div><div><h3>Conclusions</h3><div>As Latinx people are less likely to be treated with home dialysis modalities, this study offers important context as to what factors drove sustained in-center dialysis use for this population. Coping mechanisms that promoted resilience with in-center dialysis treatment motivated individuals to remain on in-center hemodialysis, and positive dialysis relationships in the dialysis center strengthened this experience. Switching to home dialysis is hindered by lack of knowledge as well as lack of patient-centered dialysis decision making. Understanding the drivers of sustained in-center hemodialysis use for Latinx individuals is important for future efforts at improving patient-centered education, framing conversations around modality choice, and care for this population.</div></div><div><h3>Plain-Language
{"title":"In-Center Hemodialysis Experiences Among Latinx Adults: A Qualitative Study","authors":"Katherine Rizzolo , Colin Gardner , Claudia Camacho , Rebeca Gonzalez Jauregui , Sushrut S. Waikar , Michel Chonchol , Lilia Cervantes","doi":"10.1016/j.xkme.2024.100902","DOIUrl":"10.1016/j.xkme.2024.100902","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Latinx individuals are more likely to start and remain receiving in-center hemodialysis, over home dialysis, than non-Latinx White individuals. The objective of our study was to understand the drivers of sustained in-center dialysis and deterrents of switching to home dialysis use for Latinx individuals receiving in-center dialysis.</div></div><div><h3>Study Design</h3><div>This qualitative study used semistructured one-on-one interviews.</div></div><div><h3>Setting and Participants</h3><div>Latinx adults receiving in-center hemodialysis therapy at 2 urban dialysis clinics in Denver, Colorado between November 2021 and March 2023.</div></div><div><h3>Exposures</h3><div>In-center hemodialysis, Latinx ethnicity.</div></div><div><h3>Outcomes</h3><div>Qualitative.</div></div><div><h3>Analytical Approach</h3><div>Interviews were analyzed with thematic analysis using inductive coding. Theoretical framework development used principles of grounded theory.</div></div><div><h3>Results</h3><div>In total, 25 Latinx adults (10 [40%] female and 15 [60%] male) receiving in-center hemodialysis therapy participated. One theme demonstrated that Latinx individuals experienced hardship with in-center dialysis but used Latinx values to persevere: Psychosocial resilience using Latinx cultural values (faith and spiritual coping, belief in predestination and acceptance, optimism and positive attitude toward treatment, and positive relationships with health care professionals and peers). Two themes illustrate barriers to starting or switching to home dialysis: Insufficient knowledge of kidney replacement therapy (lack of awareness of kidney disease, lack of preparation for dialysis) and Barriers to patient-centered decision making in dialysis treatment (lack of peer perspective to guide dialysis decision making, fear and apprehension of home dialysis, lack of socioemotional support, perception of housing issues).</div></div><div><h3>Limitations</h3><div>Most participants were from the same geographic area and country of origin, and some may have been uninsured because of immigration status.</div></div><div><h3>Conclusions</h3><div>As Latinx people are less likely to be treated with home dialysis modalities, this study offers important context as to what factors drove sustained in-center dialysis use for this population. Coping mechanisms that promoted resilience with in-center dialysis treatment motivated individuals to remain on in-center hemodialysis, and positive dialysis relationships in the dialysis center strengthened this experience. Switching to home dialysis is hindered by lack of knowledge as well as lack of patient-centered dialysis decision making. Understanding the drivers of sustained in-center hemodialysis use for Latinx individuals is important for future efforts at improving patient-centered education, framing conversations around modality choice, and care for this population.</div></div><div><h3>Plain-Language ","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"6 11","pages":"Article 100902"},"PeriodicalIF":3.2,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142418755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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