scholarly journals Impact of the implementation of an assisted peritoneal dialysis service on peritoneal dialysis initiation

2020 ◽  
Vol 35 (9) ◽  
pp. 1595-1601
Author(s):  
Annabel Boyer ◽  
Ivonne Solis-Trapala ◽  
Matthew Tabinor ◽  
Simon J Davies ◽  
Mark Lambie
Keyword(s):  
Peritoneal Dialysis ◽  
Cox Regression ◽  
Limited Information ◽  
Single Centre ◽  
Centre Study ◽  
Renal Replacement Therapies ◽  
Single Centre Study ◽  
The Impact ◽  
Assisted Peritoneal Dialysis ◽  
Over Time

Abstract Background There is limited information available on the impact that provision of an assisted peritoneal dialysis (PD) service has on the initiation of PD. The aim of this study was to assess this impact in a centre following initiation of assisted PD in 2011. Methods This retrospective, single-centre study analysed 1576 patients incident to renal replacement therapies (RRTs) between January 2002 and 2017. Adjusted Cox regression with a time-varying explanatory variable and a Fine and Gray model were used to examine the effect of assisted PD use on the rates and cumulative incidence of PD initiation, accounting for the non-linear impact of RRT starting time and the competing risks (transplant and death). Results Patients starting PD with assistance were older than those starting unassisted: median (interquartile range): 70.0 (61.5–78.3) versus 58.7 (43.8–69.2) years old, respectively. In the adjusted analysis assisted PD service availability was associated with an increased rate of PD initiation [cause-specific hazard ratio (cs-HR) 1.78, 95% confidence interval 1.21–2.61]. During the study period, the rate of starting PD fell before flattening out. Transplantation and death rates increased over time but this did not affect the fall in PD initiation [for each year in the study cs-HR of starting PD 0.95 (0.93–0.98), sub-distribution HR 0.95 (0.94–0.97)]. Conclusions In a single-centre study, introducing an assisted PD service significantly increased the rate of PD initiation, benefitting older patients most. This offsets a fall in PD usage over time, which was not explained by changes in transplantation or death.

scholarly journals Trends in assisted peritoneal dialysis over the last decade: a cohort study from the French Peritoneal Dialysis Registry

2020 ◽  
Vol 13 (6) ◽  
pp. 1003-1011
Author(s):  
Annabel Boyer ◽  
Antoine Lanot ◽  
Mark Lambie ◽  
Sonia Guillouet ◽  
Thierry Lobbedez ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Cox Regression ◽  
Prevalence Ratio ◽  
Economic Incentive ◽  
Economic Incentives ◽  
Limited Information ◽  
Calendar Time ◽  
The Impact ◽  
Assisted Peritoneal Dialysis ◽  
Over Time

Abstract Background There is limited information available on the use of assisted peritoneal dialysis (PD) over time and the impact of economic incentives on its utilization. The aim of this study was to describe the trends in assisted PD utilization and the type of assistance provided. We wanted to estimate if an economic incentive implemented in 2011 in France was associated with an increase in the utilization of nurse-assisted PD. Methods This retrospective, multicentre study, based on data from the French Language Peritoneal Dialysis Registry, analysed 11 987 patients who initiated PD in France between 1 January 2006 and 31 December 2015. Adjusted Cox regression with robust variance was used to examine the initiation of assisted PD, both nurse-assisted and family-assisted, accounting for the nonlinear impact of the PD starting time. Results There were 6149 (51%) incident patients on assisted PD, 5052 (82%) on nurse-assisted PD and 1097 (18%) on family-assisted PD over the study period. In the adjusted analysis, calendar time was associated with the assisted PD rate: it declined from 2008 until 2013 before flattening out and then it increased after 2014. Nurse-assisted PD utilization increased significantly after 2012, whereas family-assisted PD utilization decreased linearly over time (prevalence ratio = 0.94, 95% confidence interval 0.92–0.97). Conclusions The assisted PD rate decreased until 2013, mainly because of a decline in family-assisted PD. The uptake in nurse-assisted PD observed from 2013 reflects the effect of an economic incentive adopted in late 2011 to increase PD utilization.

Revisiting cytomegalovirus serostatus and replication as risk factors for inferior long-term outcomes in the current era of renal transplantation

2020 ◽  
Vol 35 (2) ◽  
pp. 346-356
Author(s):  
Nicole Bischof ◽  
Caroline Wehmeier ◽  
Michael Dickenmann ◽  
Patricia Hirt-Minkowski ◽  
Patrizia Amico ◽  
...  
Keyword(s):  
Risk Factors ◽  
Renal Transplantation ◽  
Patient Survival ◽  
Long Term Outcomes ◽  
Single Centre ◽  
Centre Study ◽  
Single Centre Study ◽  
Cmv Disease ◽  
The Impact

Abstract Background Cytomegalovirus (CMV) serostatus and CMV replication are considered as risk factors for inferior graft and patient survival after renal transplantation, but long-term outcome data are limited. The aim of this retrospective single-centre study was to investigate the impact of CMV serostatus and CMV replication/disease on long-term outcomes in a well-defined cohort managed by a standardized CMV prevention/treatment protocol. Methods We investigated 599 consecutive kidney transplantations having a CMV prevention protocol consisting of either prophylaxis (D+/R− and R+ with ATG induction) or screening/deferred therapy (R+ without ATG induction). Patients were grouped according to CMV serostatus [high risk (D+/R−): n = 122; intermediate risk (R+): n = 306; low risk (D−/R−): n = 171] and occurrence of CMV replication/disease (no CMV replication: n = 419; asymptomatic CMV replication: n = 110; CMV syndrome: n = 39; tissue-invasive CMV disease: n = 31). The median follow-up time was 6.5 years. Results Graft and patient survival were not different among the three CMV serostatus groups as well as the four CMV replication/disease groups (P ≥ 0.44). Eighty-seven patients died, 17 due to infections (21%), but none was attributable to CMV. The overall hospitalization incidence for CMV-related infection was 3% (17/599 patients). The incidence of clinical and (sub)clinical rejection was similar among the groups (P ≥ 0.17). In a multivariate Cox proportional hazard model, neither CMV serostatus, nor CMV replication, nor CMV disease were independent predictors for patient death or graft failure, respectively. Conclusions This retrospective single-centre study suggests that the negative impact of CMV infection on long-term patient and allograft survival as well as on allograft rejection can be largely eliminated with current diagnostic/therapeutic management.

scholarly journals Cumulative burden of inflammation predicts colorectal neoplasia risk in ulcerative colitis: a large single-centre study

Gut ◽  
2017 ◽  
Vol 68 (3) ◽  
pp. 414-422 ◽  
Author(s):  
Chang-Ho Ryan Choi ◽  
Ibrahim Al Bakir ◽  
Nik-Sheng (John) Ding ◽  
Gui-Han Lee ◽  
Alan Askari ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Risk Stratification ◽  
Cox Regression ◽  
Colorectal Neoplasia ◽  
Single Centre ◽  
Centre Study ◽  
Unit Increase ◽  
Single Centre Study ◽  
Microscopic Inflammation ◽  
Inflammatory Burden

ObjectiveUlcerative colitis (UC) is a dynamic disease with its severity continuously changing over time. We hypothesised that the risk of colorectal neoplasia (CRN) in UC closely follows an actuarial accumulative inflammatory burden, which is inadequately represented by current risk stratification strategies.DesignThis was a retrospective single-centre study. Patients with extensive UC who were under colonoscopic surveillance between 2003 and 2012 were studied. Each surveillance episode was scored for a severity of microscopic inflammation (0=no activity; 1=mild; 2=moderate; 3=severe activity). The cumulative inflammatory burden (CIB) was defined as sum of: average score between each pair of surveillance episodes multiplied by the surveillance interval in years. Potential predictors were correlated with CRN outcome using time-dependent Cox regression.ResultsA total of 987 patients were followed for a median of 13 years (IQR, 9-18), 97 (9.8%) of whom developed CRN. Multivariate analysis showed that the CIB was significantly associated with CRN development (HR, 2.1 per 10-unit increase in CIB (equivalent of 10, 5 or 3.3 years of continuous mild, moderate or severe active microscopic inflammation); 95% CI 1.4 to 3.0; P<0.001). Reflecting this, while inflammation severity based on the most recent colonoscopy alone was not significant (HR, 0.9 per-1-unit increase in severity; 95% CI 0.7 to 1.2; P=0.5), a mean severity score calculated from all colonoscopies performed in preceding 5 years was significantly associated with CRN risk (HR, 2.2 per-1-unit increase; 95% CI 1.6 to 3.1; P<0.001).ConclusionThe risk of CRN in UC is significantly associated with accumulative inflammatory burden. An accurate CRN risk stratification should involve assessment of multiple surveillance episodes to take this into account.

scholarly journals Association between Dyslipidemia and Peritoneal Dialysis Technique Survival

2019 ◽  
Vol 7 (15) ◽  
pp. 2467-2473 ◽  
Author(s):  
Natalia Stepanova ◽  
Olena Burdeyna
Keyword(s):  
Peritoneal Dialysis ◽  
Cox Regression ◽  
Large Body ◽  
Atherogenic Dyslipidemia ◽  
Future Research ◽  
Single Centre ◽  
Technique Survival ◽  
Atherogenic Lipid Profile ◽  
The Impact ◽  
Technique Failure

BACKGROUND: A large body of research has investigated the effects of pro-atherogenic lipid profile on cardiovascular diseases (CVD) in peritoneal dialysis (PD) patients. However, there is a general lack of research on the association between atherogenic dyslipidemia and PD technique survival. AIM: The study aimed to define the association between dyslipidemia and PD technique survival. METHODS: It was a prospective single-centre observational study involving 40 outpatients on continuous ambulatory PD treatment for more than 3 months between 2010 and 2016 in a single centre in Ukraine. There were 27 males and 13 females. The mean age of the participants was 49.3 ± 12.2 years. The primary outcome measures were all-cause technique failure. RESULTS: Atherogenic dyslipidemia was identified in 28/40 (70 %) patients and correlated with PD adequacy parameters. During the 36-month- follow-up period technique failure occurred in 2/12 (16.6 %) patients with atherogenic dyslipidemia compared with 12 / 28 (42.9 %) patients without atherogenic dyslipidemia (c2 = 2.5; p = 0.12). In the univariate Cox regression model, atherogenic dyslipidemia at baseline was significantly associated with a higher risk of all-cause PD technique failure (HR 4.5; 95% CI 1.6 to 12.9; c2 = 5.5, p = 0.019). CONCLUSION: The presence of atherogenic dyslipidemia was significantly associated with a higher risk of technique failure in PD patients. This is an important issue for future research. Further well-designed clinical trials are needed to determine the impact of dyslipidemia on PD adequacy and technique survival.

scholarly journals The impact of FSH receptor polymorphism on time-to-pregnancy: a cross-sectional single-centre study

2018 ◽  
Vol 18 (1) ◽  
Author(s):  
Birute Zilaitiene ◽  
Marius Dirzauskas ◽  
Rasa Verkauskiene ◽  
Rytas Ostrauskas ◽  
Joerg Gromoll ◽  
...  
Keyword(s):  
Fsh Receptor ◽  
Single Centre ◽  
Time To Pregnancy ◽  
Cross Sectional ◽  
Centre Study ◽  
Single Centre Study ◽  
The Impact ◽  
Fsh Receptor Polymorphism ◽  
Receptor Polymorphism

Prevalence and impact of anxiety and depression in Chinese peritoneal dialysis patients: A single centre study

Nephrology ◽  
2018 ◽  
Vol 23 (2) ◽  
pp. 155-161 ◽  
Author(s):  
Koon Ming Chan ◽  
Chi Yuen Cheung ◽  
Yiu Han Chan ◽  
Hoi Wong Chan ◽  
Wai Leung Chak ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Anxiety And Depression ◽  
Dialysis Patients ◽  
Single Centre ◽  
Centre Study ◽  
Single Centre Study

scholarly journals The Impact of Body Morphology on Rotation on Chest Radiograph: A Single Centre Study

2020 ◽  
Vol 12 (1) ◽  
Author(s):  
Ogoke AO ◽  
Ugwu AC ◽  
Ugwuanyi DC ◽  
Ohagwu CC ◽  
Ogolodom MP ◽  
...  
Keyword(s):  
Chest Radiograph ◽  
Single Centre ◽  
Body Morphology ◽  
Centre Study ◽  
Single Centre Study ◽  
The Impact
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