Machine learning directed interventions associate with decreased hospitalization rates in hemodialysis patients.

Background: An integrated kidney disease company uses machine learning (ML) models that predict the 12-month risk of an outpatient hemodialysis (HD) patient having multiple hospitalizations to assist with directing personalized interdisciplinary interventions in a Dialysis Hospitalization Reduction Program (DHRP). We investigated the impact of risk directed interventions in the DHRP on clinic-wide hospitalization rates.

Methods: We compared the hospital admission and day rates per-patient-year (ppy) from all hemodialysis patients in 54 DHRP and 54 control clinics identified by propensity score matching at baseline in 2015 and at the end of the pilot in 2018.

Remote Treatment Monitoring on Hospitalization and Technique Failure Rates in Peritoneal Dialysis Patients.

Background: An integrated kidney disease healthcare company implemented a peritoneal dialysis (PD) remote treatment monitoring (RTM) application in 2016. We assessed if RTM utilization associates with hospitalization and technique failure rates.

Methods: We used data from adult (age ≥18 years) patients on PD treated from October 2016 through May 2019 who registered online for the RTM.

Association of all-cause mortality with pre-dialysis systolic blood pressure and its peridialytic change in chronic hemodialysis patients.

Background: Pre-dialysis systolic blood pressure (pre-HD SBP) and peridialytic SBP change have been associated with morbidity and mortality among hemodialysis (HD) patients in previous studies, but the nature of their interaction is not well understood.

Methods: We analyzed pre-HD SBP and peridialytic SBP change (calculated as post-HD SBP minus pre-HD SBP) between January 2001 and December 2012 in HD patients treated in US Fresenius Medical Care facilities. The baseline period was defined as Months 4-6 after HD initiation, and all-cause mortality was noted during follow-up.

Longitudinal patterns of health-related quality of life and dialysis modality: a national cohort study.

Background: Health-related quality of life (HrQoL) varies among dialysis patients. However, little is known about the association of dialysis modality with HrQoL over time. We describe longitudinal patterns of HrQoL among chronic dialysis patients by treatment modality.

A History of Leadership in Dialysis: Perspectives From Seasoned Leaders.

The history of chronic dialysis in the United States highlights the impact nephrology leaders have on improving kidney disease care. Belding Scribner and his Seattle team transformed end-stage renal disease from a fatal illness to a treatable condition with use of the first successful Scribner shunt in 1960. Advances in dialysis machines emerged from Les Babb and Richard Drake finding ways to treat more patients.

Cycles, Arrows and Turbulence: Time Patterns in Renal Disease, a Path from Epidemiology to Personalized Medicine?

Patients with end-stage renal disease (ESRD) experience unique patterns in their lifetime, such as the start of dialysis and renal transplantation. In addition, there is also an intricate link between ESRD and biological time patterns. In terms of cyclic patterns, the circadian blood pressure (BP) rhythm can be flattened, contributing to allostatic load, whereas the circadian temperature rhythm is related to the decline in BP during hemodialysis (HD).

TRANSITION PERIOD CLINICAL TRAJECTORIES FOR PD VERSUS HD STARTERS.

Background: Peritoneal dialysis (PD) starters generally have a better outcome compared with hemodialysis (HD) starters, perhaps related to treatment characteristics or case mix. We previously showed that pre- and post-dialysis start clinical parameter trajectories are related to outcomes. The aim of this study was to investigate these trajectories in PD and HD starters.

The Association of Weekly pre-Hemodialysis Systolic Blood Pressure and Following Week Mortality.

Background/aims: Few studies examine the impact of systolic blood pressure (SBP) on mortality in the incident hemodialysis (HD) period, and throughout the first HD year. This large retrospective observational study analyzes the impact of "current" and cumulative low preSBP <110 mmHg (L), and variations in preSBP on short-term (1 week) mortality over the first HD year.

Methods: Weekly mean preSBP for HD weeks 1 to 51 was categorized into L or high preSBP>=110 mmHg (H) for each patient.

Clinical parameters before and after the transition to dialysis.

Introduction: The transition from pre-dialysis chronic kidney disease (CKD) to post-dialysis start is a critical period associated with high patient mortality and increased hospital admissions. Little is known about the trends of key clinical and laboratory parameters through this time of transition to start dialysis.

Methods: De-identified data including demographics, vital signs, lab results, and eGFR from the Fresenius Medical Care-CKD Registry were analyzed to determine trends in clinical and laboratory parameters through the time of transition from 12 months pre-dialysis start to 12 months post-dialysis start.

Effects of renal care coordinator case management on outcomes in incident dialysis patients.

Background: Pre-dialysis chronic kidney disease (CKD) care impacts dialysis start and incident dialysis outcomes. We describe the use of late stage CKD population data coupled with CKD case management to improve dialysis start.

Methods: The Renal Care Coordinator (RCC) program is a nephrology practice and Fresenius Medical Care North America (FMCNA) partnership involving a case manager resource and data analytics.

The benefits of exercise for CKD patients.

People with chronic kidney disease and end-stage renal disease often suffer from multiple related disorders, progressive deconditioning, and loss of functional capacity. Yet increased physical activity has been shown to improve patients' quality of life and nutrition, reduce inflammation and depression, and decrease treatment costs and the need for hospitalization. Exercise training should thus be considered an important part of the overall care of people with CKD, while increased physical activity is beneficial at all stages of the disease and can help empower patients to take more control over their own health.

The role of the medical director: changing with the times.

The role of the dialysis unit Medical Director has evolved over time to an expanded set of roles from one that used to be strictly "medical" to one that is more "managerial." Physicians providing these Medical Director services are facing increasing demands for a leadership role regarding clinical quality improvement and measurement of performance in core areas of care within the dialysis program. The dialysis Medical Director is asked to lead in group decision-making, in analyzing core process and patient outcomes and in stimulating a team approach to Continuous Quality Improvement (CQI) and patient safety.

Characterizing the ideal clinical office system for nephrology.

Clinical information technology (IT) systems that support nephrology-specific content can facilitate the coordinated, progressive, and comprehensive care of all patients with renal disease including those with each stage of chronic kidney disease (CKD). The ideal clinical IT system should have flexible features to meet the needs of individualized practice patterns, yet also have tools to enhance continuity, measure performance, and deliver decision support features that assist the nephrologist in providing optimal care for the CKD patient. This article provides insight into the complexities of engaging in the process of technology adoption, including selection, integration, and implementation while emphasizing the utility of using a continuous quality improvement paradigm to identify and achieve positive results from the adoption and integration of a clinical IT system into outpatient clinical practice of nephrology.