The Seattle Heart Failure Model in Kidney Transplant Recipients.

Cardiovascular disease is the leading cause of mortality following kidney transplantation. Heart failure affects 17-21% of patients with chronic kidney disease and increases along with time receiving dialysis. The Seattle Heart Failure Model (SHFM) is a validated mortality risk model for heart failure patients that incorporates clinical, therapeutic, and laboratory parameters but does not include measures of kidney function.

Utilization of Cystatin C in the Outpatient Setting.

Introduction: Serum creatinine is the traditional biomarker for estimating glomerular filtration rate (eGFR). Cystatin C is an alternative biomarker for which estimating equations exist. The use of cystatin C testing, and the interrelationships among the recently revised Chronic Kidney Disease Epidemiology (CKD-EPI) 2021 estimating equations, was evaluated in a national outpatient laboratory dataset.

Health Disparities in Autosomal Dominant Polycystic Kidney Disease (ADPKD) in the United States.

Background And Objectives: Autosomal dominant polycystic kidney disease (ADPKD) occurs at conception and is often diagnosed decades prior to kidney failure. Nephrology care and transplantation access should be independent of race and ethnicity. However, institutional racism and barriers to health care may affect patient outcomes in ADPKD.

Recipient Obesity and Kidney Transplant Outcomes: A Mate-Kidney Analysis.

Rationale & Objective: The impact of extreme recipient obesity on long-term kidney transplant outcomes has been controversial. This study sought to evaluate the association of various levels of recipient obesity on kidney transplantation outcomes by comparing mate-kidney recipient pairs to address possible confounding effects of donor characteristics on posttransplant outcomes.

Study Design: Nationwide observational cohort study using mate-kidney models.

The Epidemiologic Burden of Tacrolimus Variability among Kidney Transplant Recipients in the United States.

Background: Within-patient tacrolimus level variability >30% has been shown to be a risk factor for de novo donor-specific antibody formation and death-censored graft failure among kidney transplant recipients. The burden of tacrolimus variability and the correlation between variability and subtherapeutic tacrolimus levels were examined in a large national data set.

Methods: All tacrolimus levels drawn at LabCorp® facilities in the United States with a diagnosis code for kidney transplant between November 2011 and September 2017 were examined, excluding values that could represent new allografts.

Maturing arteriovenous accesses in incident haemodialysis patients and first-year outcomes.

Introduction: Nephrologists have increased arteriovenous access placement in patients with chronic kidney disease. Not yet usable 'maturing' arteriovenous fistulas and grafts are nearly as common as mature arteriovenous fistulas or grafts. Little has been reported about patients initiating haemodialysis with unready arteriovenous fistulas or grafts.

Outcomes After Percutaneous Angioplasty of Arteriovenous Fistulas and Grafts in African American Patients.

Purpose: Arteriovenous fistulas and grafts, necessary for hemodialysis, may develop stenoses due to neointimal hyperplasia, which often require percutaneous transluminal angioplasty. Patient and lesion characteristics were evaluated prior to angioplasty and were correlated with 1- and 6-month outcomes.

Materials And Methods: This was an observational study of African American hemodialysis patients who presented for angioplasty of a dysfunctional fistula or graft.

Transfers to Hemodialysis Among US Patients Initiating Renal Replacement Therapy With Peritoneal Dialysis.

Rationale & Objective: Identifying patients who are likely to transfer from peritoneal dialysis (PD) to hemodialysis (HD) before transition could improve their subsequent care. This study developed a prediction tool for transition from PD to HD.

Study Design: Retrospective cohort study.

Hemodynamic effects of hemodialyzer pump speed on arteriovenous fistulas .

Aim: Arteriovenous fistulas (AVF) are the optimal vascular access for hemodialysis although many fistulas fail. The impetus to increase hemodialyzer blood flow (QB) in order to maximize solute clearances may be counterbalanced if AVF suffer adverse hemodynamic effects from accelerated pump flows. The optimal QB to maintain adequate hemodialysis without potentially contributing to AVF dysfunction is unknown.

Perforated appendicitis in patients with schizophrenia: a retrospective cohort study.

Objective: Altered pain sensitivity may affect the outcome of appendicitis in patients with schizophrenia. We aimed to compare the prevalence of perforation in appendicitis between patients with and without schizophrenia.

Design: Retrospective cohort study with random matching.

Potential contribution of lifestyle and socioeconomic factors to healthy user bias in antihypertensives and lipid-lowering drugs.

Objectives: Healthy user bias arises when users of preventive medications such as lipid-lowering drugs (LLDs), hormone replacement therapy and antihypertensive (AH) medications are healthier than non-users due to factors other than medication effects, making the medications appear more beneficial in observational studies of effectiveness and safety. The purpose of the study is to examine factors contributing to healthy user effect in patients taking AHs or LLDs.

Methods: Among patients with hypertension or hyperlipidaemia in a population-based sample from the National Health and Nutrition Examination Survey (1999-2010), we assessed the association between socioeconomic and lifestyle factors and the use of AHs/LLDs by logistic regression with adjustment for demographics and comorbidities in a cross-sectional study.

Sex, race, and hemodialysis vascular access processes.

Purpose: Hemodialysis (HD) patients who are female or black receive fewer arteriovenous fistulas (AVF) and more grafts (AVG). We evaluated race- and sex-based differences for three process exposures: access surgery, peripherally-inserted central catheters (PICCs), and vascular imaging.

Methods: US Renal Data System with linked Medicare claims for patients initiating HD between April 2010 - December 2011 were used to identify PICC placement, imaging, AVF and AVG surgeries, and the vascular accesses in use at individual HD treatments.

Dialysate Composition for Hemodialysis: Changes and Changing Risk.

Dialysate composition is a critical aspect of the hemodialysis prescription. Despite this, trial data are almost entirely lacking to help guide the optimal dialysate composition. Often, the concentrations of key components are chosen intuitively, and dialysate composition may be determined by default based on dialysate manufacturer specifications or hemodialysis facility practices.

Vascular imaging for hemodialysis vascular access planning.

Introduction: Central venous catheters (CVC) increase risks associated with hemodialysis (HD), but may be necessary until an arteriovenous fistula (AVF) or graft (AVG) is achieved. The impact of vascular imaging on achievement of working AVF and AVG has not been firmly established.

Methods: Retrospective cohort of patients initiating HD with CVC in 2010-2011, classified by exposure to venography or Doppler vein mapping, and followed through December 31, 2012.

Peripherally Inserted Central Catheters and Hemodialysis Outcomes.

Background And Objectives: Use of peripherally inserted central catheters has expanded rapidly, but the consequences for patients who eventually require hemodialysis are undefined.

Design, Setting, Participants, & Measurements: Our national, population-based analysis included 33,918 adult Medicare beneficiaries from the US Renal Data System who initiated hemodialysis with central venous catheters as their sole vascular access in 2010 and 2011. We used linked Medicare claims to identify peripherally inserted central catheter exposures and evaluate the associations of peripherally inserted central catheter placement with transition to working arteriovenous fistulas or grafts and patient survival using a Cox model with time-dependent variables.

Inpatient venous access practices: PICC culture and the kidney patient.

Purpose: Depleted venous access is frequently cited as a reason for low fistula achievement. These quality assurance studies were designed to clarify the interactions between kidney disease, acuity of care and vascular access practices, and define the impact of nephrology intervention.

Methods: The inpatient population at an urban teaching hospital was surveyed three times between May 2010 and May 2012.

Anti-glomerular basement membrane disease treated with mycophenolate mofetil, corticosteroids, and plasmapheresis.

An 18-year-old woman presented with anemia, pulmonary hemorrhage, and necrotizing glomerulonephritis, and was diagnosed with anti-glomerular basement membrane (anti-GBM) disease. Treatment was undertaken with plasma exchange, mycophenolate mofetil and corticosteroids, due to patient refusal of cyclophosphamide. Clinical remission was successfully induced with this fertility-sparing regimen.

Transplantation and the primary care physician.

Increasing appreciation of the survival benefits of kidney transplantation, compared with chronic dialysis, has resulted in more patients with kidney disease being referred and receiving organs. The evolving disparity between a rapidly increasing pool of candidates and a smaller pool of available donors has created new issues for the physicians who care for kidney patients and their potential living donors. This article outlines current efforts to address the growing number of patients who await transplantation, including relaxation of traditional donation criteria, maximization of living donation, and donation schemas that permit incompatible donor-recipient pairs to participate through paired donation and transplantation chains.

Cardiac magnetic resonance imaging in hemodialysis patients.

Background: The anatomy of left ventricular hypertrophy (LVH) in dialysis patients was studied with magnetic resonance imaging (MRI). Potential benefits of spironolactone were examined in a subset of patients.

Methods: This was a prospective case series of 30 hemodialysis patients in whom cardiac MRI was performed.

Sorbent hemodialysis: clinical experience with new sorbent cartridges and hemodialyzers.

To recycle spent dialysate, a sorbent hemodialyzer uses a purification cartridge, adapted from water reclamation systems originally designed for the aerospace program. Increasing interest in home hemodialysis has driven a renewed examination of sorbent dialyzer technology, resulting in the development of a modern sorbent hemodialyzer and an array of new sorbent cartridges. Initial clinical experience with the Allient Hemodialysis System and the new sorbent cartridges is presented, with an emphasis on achievable clearances and ultrafiltration, as well as information about symptom profile and electrolyte balance.