Randomized Controlled Trial of the Effect of an Exercise Rehabilitation Program on Symptom Burden in Maintenance Hemodialysis: A Clinical Research Protocol.

Background: People receiving hemodialysis experience high symptom burden that contributes to low functional status and poor health-related quality of life. Management of symptoms is a priority for individuals receiving hemodialysis but limited effective treatments exist. There is emerging evidence that exercise programming can improve several common dialysis-related symptoms.

Clinical Blood Isolates from Hemodialysis Patients: Distribution of Organisms and Antimicrobial Resistance, 2007-2014.

Background: Given the morbidity and mortality associated with bloodstream infections in hemodialysis patients, understanding the microbiology is essential to optimizing treatment in this high-risk population.

Objectives: To conduct a retrospective surveillance study of clinical blood isolates from adult hemodialysis patients, and to predict the microbiological coverage of empiric therapies for bloodstream infections in this population.

Methods: Clinical blood isolate data were collected from the 4 main outpatient hemodialysis units in Winnipeg, Manitoba, from 2007 to 2014.

Patterns of emergency department utilization by patients on chronic dialysis: A population-based study.

Importance: Patients on dialysis are often elderly and frail, with multiple comorbid conditions, and are heavy users of Emergency Department (ED) services. However, objective data on the frequency and pattern of ED utilization by dialysis patients are sparse. Such data could identify periods of highest risk for ED visits and inform health systems interventions to mitigate these risks and improve outcomes.

Association between Duration of Predialysis Care and Mortality after Dialysis Start.

Background And Objectives: Early nephrology referral is recommended for people with CKD on the basis of observational studies showing that longer nephrology care before dialysis start (predialysis care) is associated with lower mortality after dialysis start. This association may be observed because predialysis care truly reduces mortality or because healthier people with an uncomplicated course of disease will have both longer predialysis care and lower risk for death. We examined whether the survival benefit of longer predialysis care exists after accounting for the potential confounding effect of disease course that may also be affected by predialysis care.

Microbiological Trends and Antimicrobial Resistance in Peritoneal Dialysis-Related Peritonitis, 2005 to 2014.

♦ BACKGROUND: Information related to the microbiology of peritonitis is critical to the optimal management of patients receiving peritoneal dialysis (PD). The goal was to characterize the microbiological etiology and antimicrobial susceptibilities of PD-related peritonitis (PDRP) from 2005 to 2014, inclusive. ♦ METHODS: The distribution of organisms in culture-positive PDRP was described for new episodes and relapse infections, and further detailed for monomicrobial and polymicrobial peritonitis.

A before and after cross-sectional analysis of a public health campaign to increase kidney health awareness in a Canadian province.

Background: Chronic kidney disease (CKD) has a major impact on patient health and health system resources. The prevalence of kidney disease is increasing, with Manitoba being one of the provinces in Canada with the highest per capita rate of CKD and end stage renal disease (Anonymous, Canadian organ replacement register annual report: treatment of end-stage organ failure in Canada, 2001-2010, 2011). In 2011, a public health campaign to promote kidney health, by increasing awareness of CKD and its risk factors, was created to target high-risk individuals such as First Nations and those with hypertension and diabetes in urban and rural/remote Manitoba.

Pasteurella species peritoneal dialysis-associated peritonitis: Household pets as a risk factor.

Background: Pasteurella species are Gram-negative coccobacilli that are a part of the normal oropharyngeal flora of numerous domestic animals. They have been recognized as a rare but significant cause of peritonitis in patients undergoing peritoneal dialysis (PD). A consensus about management strategies for PD-associated peritonitis caused by Pasteurella species currently does not exist.

Impact of modality choice on rates of hospitalization in patients eligible for both peritoneal dialysis and hemodialysis.

Background: Hospitalization rates are a relevant consideration when choosing or recommending a dialysis modality. Previous comparisons of peritoneal dialysis (PD) and hemodialysis (HD) have not been restricted to individuals who were eligible for both therapies. ♢

Methods: We conducted a multicenter prospective cohort study of people 18 years of age and older who were eligible for both PD and HD, and who started outpatient dialysis between 2007 and 2010 in four Canadian dialysis programs.

Cost analysis of an intravenous to subcutaneous epoetin α conversion.

Background/aims: A cost analysis of a conversion from intravenous (IV) to subcutaneous (SC) epoetin α in patients receiving chronic in-center hemodialysis (HD).

Methods: This retrospective analysis compared epoetin α drug costs during a 6-month period of IV usage (July to December 2010, period 1) to a 6-month period of SC usage (July to December 2011, period 2) in four large in-center HD units. Data were collected from quarterly counts of HD patients receiving epoetin α and monthly inventory billing records.

Randomized, controlled trial of glucose-sparing peritoneal dialysis in diabetic patients.

Glucose-containing peritoneal dialysis solutions may exacerbate metabolic abnormalities and increase cardiovascular risk in diabetic patients. Here, we examined whether a low-glucose regimen improves metabolic control in diabetic patients undergoing peritoneal dialysis. Eligible patients were randomly assigned in a 1:1 manner to the control group (dextrose solutions only) or to the low-glucose intervention group (IMPENDIA trial: combination of dextrose-based solution, icodextrin and amino acids; EDEN trial: a different dextrose-based solution, icodextrin and amino acids) and followed for 6 months.

Underutilization of peritoneal dialysis: the role of the nephrologist's referral pattern.

Background: The incidence of end-stage renal disease is increasing, placing a tremendous burden on health care resources. Peritoneal dialysis (PD) is cheaper than hemodialysis and has many potential advantages and few contraindications as an initial modality selection. This study examined differences in patient PD attempt rates between nephrologists using technique survival and mortality as outcomes.

Frequency and microbiology of peritonitis and exit-site infection among obese peritoneal dialysis patients.

Background: Data on obesity as a risk factor for peritonitis and catheter infections among peritoneal dialysis (PD) patients are limited. Furthermore, little is known about the microbiology of PD-related infections among patients with a high body mass index (BMI).

Methods: Using a cohort that included all adult patients residing in the province of Manitoba who received PD during the period 1997 - 2007, we studied the relationship between BMI and PD-related infections.

The role of functional status in discharge to assisted care facilities and in-hospital death among dialysis patients.

Background: Functional status is an important component in the assessment of hospitalized patients. We set out to determine the scope, severity, and prognostic significance of impaired functional status in acutely hospitalized dialysis patients.

Study Design: Retrospective cohort study.

High rates of mortality and technique failure in peritoneal dialysis patients after critical illness.

Introduction: Little is known regarding the causes and outcomes of peritoneal dialysis (PD) patients admitted to the intensive care unit (ICU). We explored the outcomes of technique failure and mortality in a cohort of PD patients admitted to the ICU.

Methods: Using a provincial database of 990 incident PD patients followed from January 1997 to June 2009, we identified 90 (9%) who were admitted to the ICU.

Choosing peritoneal dialysis reduces the risk of invasive access interventions.

Background: Patients choosing between hemodialysis (HD) and peritoneal dialysis (PD) should be well informed of the risks and benefits of each modality. Invasive access interventions are important outcomes because frequent interventions lower patient's quality of life and consume limited resources. The objective of this study was to compare the risk of access interventions between the two modalities.

Perceived barriers to guidelines in peritoneal dialysis.

Background: Little is known regarding barriers to guideline adherence in the nephrology community. We set out to identify perceived barriers to evidence-based medicine (EBM) and measurement of continuous quality indicators (CQI) in an international cohort of peritoneal dialysis (PD) practitioners.

Methods: Subscribers to an online nephrology education site (Nephrology Now) were invited to participate in an online survey.

Peritonitis and exit site infections in First Nations patients on peritoneal dialysis.

Background And Objectives: First Nations (FN) patients on peritoneal dialysis experience poor outcomes. Whether discrepancies exist regarding the microbiology, rate of infections, and outcomes between FN and non-FN peoples remains unknown. Design, setting, participants, & measures: All adult peritoneal dialysis patients (n = 727) from 1997 to 2007 residing in Manitoba, Canada, were included.

Adverse outcomes among Aboriginal patients receiving peritoneal dialysis.

Background: The Aboriginal population in Canada experiences high rates of end-stage renal disease and need for dialytic therapies. Our objective was to examine rates of mortality, technique failure and peritonitis among adult aboriginal patients receiving peritoneal dialysis in the province of Manitoba. We also aimed to explore whether differences in these rates may be accounted for by location of residence (i.

Impact of contraindications, barriers to self-care and support on incident peritoneal dialysis utilization.

Background: Targets for peritoneal dialysis (PD) utilization may be difficult to achieve because many older patients have contraindications to PD or barriers to self-care. The objectives of this study were to determine the impact that contraindications and barriers to self-care have on incident PD use, and to determine whether family support increased PD utilization when home care support is available.

Methods: Consecutive incident dialysis patients were assessed for PD eligibility, offered PD if eligible and followed up for PD use.

Canadian randomized trial of hemoglobin maintenance to prevent or delay left ventricular mass growth in patients with CKD.

Background: This randomized clinical trial is designed to assess whether the prevention and/or correction of anemia, by immediate versus delayed treatment with erythropoietin alfa in patients with chronic kidney disease, would delay left ventricular (LV) growth. Study design and sample size calculations were based on previously published Canadian data.

Methods: One hundred seventy-two patients were randomly assigned.