Acute kidney injury increases risk of ESRD among elderly.

Risk for ESRD among elderly patients with acute kidney injury (AKI) has not been studied in a large, representative sample. This study aimed to determine incidence rates and hazard ratios for developing ESRD in elderly individuals, with and without chronic kidney disease (CKD), who had AKI. In the 2000 5% random sample of Medicare beneficiaries, clinical conditions were identified using Medicare claims; ESRD treatment information was obtained from ESRD registration during 2 yr of follow-up.

Race and end-stage renal disease in the United States Medicare population: the disparity persists.

Aim: A marked preponderance of end-stage renal disease among African Americans was described more than two decades ago. The objective of this study was to determine whether racial disparities in end-stage renal disease in the United States have changed over time.

Methods: The authors compared renal replacement therapy rates in five biennial cohorts (1993-1994, 1995-1996, 1997-1998, 1999-2000, 2001-2002; n = 6 315 283), using annual random samples of 5% of the US Medicare population and the United States Renal Data System registry.

Longitudinal study of racial and ethnic differences in developing end-stage renal disease among aged medicare beneficiaries.

Diabetes and hypertension are the leading causes of renal failure. This study investigated racial differences in developing ESRD by participants' diabetes and hypertension status. This longitudinal study included 1,306,825 Medicare beneficiaries who were aged > or =66 yr at the study start and followed up to 10 yr from January 1, 1993, for the development of ESRD or death.

Incidence and mortality of acute renal failure in Medicare beneficiaries, 1992 to 2001.

This study's objective was to determine the incidence and mortality of acute renal failure (ARF) in Medicare beneficiaries. Data were from hospitalized Medicare beneficiaries (5,403,015 discharges) between 1992 and 2001 from the 5% sample of Medicare claims. For 1992 to 2001, the overall incidence rate of ARF was 23.

Projecting the number of patients with end-stage renal disease in the United States to the year 2015.

The size of the prevalent ESRD population in the United States increased dramatically during the 1990s, from 196,000 in 1991 to 382,000 in 2000. Incidence also increased considerably during the same period, from 53,000 to 93,000 per year. If previous trends in ESRD incidence and prevalence continue, then current levels of health care resources that are devoted to the care of these patients will eventually be unable to meet the demand.

Epidemic of end-stage renal disease in people with diabetes in the United States population: do we know the cause?

Background: The number of individuals initiating renal replacement therapy in the United States population grew exponentially over the past two decades. Cases of end-stage renal diseae (ESRD) attributed to diabetes accounted for most of this increase. In this report we examined factors that may account for the increase to determine whether it truly represents an epidemic of ESRD due to diabetes.

Does predialysis nephrology care influence patient survival after initiation of dialysis?

Background: Early nephrology referral of patients with chronic kidney disease (CKD) has been suggested to reduce mortality after initiation of dialysis. This retrospective cohort study of incident dialysis patients between 1995 and 1998 was performed to address the association between frequency of nephrology care during the 24 months before initiation of dialysis and first-year mortality after initiation of dialysis.

Methods: Patient data were obtained from the Centers for Medicare & Medicaid Services.

Association of heart disease with diabetes and hypertension in patients with ESRD.

Background: No published study has reported the combined effect of diabetes and hypertension on heart disease in patients with renal failure. We determined this effect by using data for all US adults who started renal replacement therapy from 1995 to 1999.

Methods: Data for patient characteristics, diabetes, hypertension, and heart disease were collected from the Medical Evidence Report, on which 6 cardiac conditions were recorded: congestive heart failure, ischemic heart disease, myocardial infarction, cardiac arrest, cardiac arrhythmia, and pericarditis.

The association of initial hemodialysis access type with mortality outcomes in elderly Medicare ESRD patients.

Background: Dialysis access is critical for therapy delivery. Few studies have linked type of dialysis access to patient survival in the elderly population.

Methods: We included 1995 to 1997 incidence Medicare hemodialysis patients (N = 66,595) who were 67 years and older at dialysis therapy initiation.

Anemia treatment in the pre-ESRD period and associated mortality in elderly patients.

Background: Anemia is a common complication of advancing chronic kidney disease, yet little is known about the consistency of anemia treatment before end-stage renal disease (ESRD) and mortality on dialysis therapy.

Methods: We studied 89,193 incident Medicare patients with ESRD in 1995 to 1997 aged 67 plus years with claims 2 years before their dialysis therapy initiation. Patients were classified as follows: no epoetin, 25% or less (least consistent), greater than 25% to 50%, greater than 50% to 75%, and greater than 75% (most consistent) epoetin treatment in the available months from the first pre-ESRD epoetin dose to the first ESRD service date.

Effect of seminal plasma concentration and various extenders on postthaw motility and glass wool-Sephadex filtration of cryopreserved stallion semen.

Objective: To compare the effect of semen extender and seminal plasma on postthaw motility and filtration through a glass wool-Sephadex (GWS) filter for frozen stallion semen.

Sample Population: 7 stallions from which we collected > or = 3 ejaculates/stallion.

Procedures: 4 experiments were conducted to evaluate postthaw quality of frozen stallion semen.

A prospective, randomized comparison of the metabolic effects of pioglitazone or rosiglitazone in patients with type 2 diabetes who were previously treated with troglitazone.

Objective: To characterize potential differences in glycemic control, plasma lipid level, and weight in a cohort of patients previously treated with troglitazone (TROG) who were switched to either pioglitazone or rosiglitazone.

Research Design And Methods: After a 2-week washout from TROG, 186 patients were randomly assigned to receive either pioglitazone (PIO) or rosiglitazone (ROSI). Weight, HbA(1c), and fasting lipid profile were documented before discontinuing TROG and at 4 months after starting either pioglitazone or rosiglitazone.

Peritoneal and hemodialysis: II. Mortality risk associated with initial patient characteristics.

Background: Patients initiating with peritoneal dialysis (PD) have favorable clinical conditions compared with hemodialysis (HD) patients, which may contribute to the varying results found in studies of mortality across the two therapies.

Methods: National incidence data of end-stage renal disease patients from 1995 to 1997 were used, excluding the first 90 days of treatment and including all patients who were on either PD or HD on day 91. Patients were then followed for a one-year period.

Peritoneal and hemodialysis: I. Differences in patient characteristics at initiation.

Background: Comparisons of mortality outcomes between peritoneal dialysis (PD) and hemodialysis (HD) patients have shown varying results, which may be caused by the unequally distributed clinical conditions of patients at initiation. To address this issue, we evaluated the clinical characteristics of 105,954 patients at the initiation of PD and HD, using the U.S.

Forecast of the number of patients with end-stage renal disease in the United States to the year 2010.

As the United States end-stage renal disease (ESRD) program enters the new millennium, the continued growth of the ESRD population poses a challenge for policy makers, health care providers, and financial planners. To assist in future planning for the ESRD program, the growth of patient numbers and Medicare costs was forecasted to the year 2010 by modeling of historical data from 1982 through 1997. A stepwise autoregressive method and exponential smoothing models were used.