Kidney Medicine最新文献

{"title":"Back-up Arteriovenous Fistulas in Peritoneal Dialysis Patients: A Systematic Review and Meta-analysis","authors":"Hicham I. Cheikh Hassan , Pauline Byrne , Christie Harrod , Donia George , Karumathil Murali , Jenny H.C. Chen , Judy Mullan","doi":"10.1016/j.xkme.2024.100904","DOIUrl":"10.1016/j.xkme.2024.100904","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Peritoneal dialysis (PD) is a dialysis modality limited by the potential need of transferring to hemodialysis. Optimal hemodialysis vascular access is an arteriovenous fistula. Back-up arteriovenous fistula (bAVF) is a strategy to prevent central venous catheter (CVC) insertion, but its use in the PD population has not been systematically reviewed.</div></div><div><h3>Study Design</h3><div>Systematic review and meta-analysis.</div></div><div><h3>Setting & Study Populations</h3><div>Studies including PD patients with a bAVF and the associated outcomes, including risk of hemodialysis transfer with a CVC and the proportion of bAVFs used.</div></div><div><h3>Selection Criteria for Studies</h3><div>Retrospective or prospective, observational studies, non-randomized or randomized controlled trials.</div></div><div><h3>Data Extractions</h3><div>Vascular access at time of hemodialysis transfer (bAVF vs CVC) for patients with and without a bAVF. The data on bAVF outcomes included bAVFs that stopped working, were never used, and the number of patients requiring hemodialysis.</div></div><div><h3>Analytical Approach</h3><div>Random-effects meta-analysis and meta-proportional analysis were conducted, with risk of bias within studies assessed using the Newcastle-Ottawa Scale.</div></div><div><h3>Results</h3><div>We screened 1,855 studies, 11 of which met the inclusion criteria, comprising 598 (62%) patients with a bAVF and 368 (38%) without. The proportion of bAVFs never used was 69% (95% confidence intervals [CI], 0.58-0.80; <em>I</em><sup>2</sup> <!-->=<!--> <!-->86.2%). Meta-analysis of 8 studies found no difference in hemodialysis transfer between patients with a bAVF and those without (hazard ratio, 1.14; 95% CI, 0.86-1.51). However, the risk of hemodialysis transfer with a CVC was significantly lower in patients with a bAVF (hazard ratio, 0.43; 95% CI, 0.17-0.68).</div></div><div><h3>Limitations</h3><div>Substantial heterogeneity between the studies and large number of studies with poor quality.</div></div><div><h3>Conclusions</h3><div>bAVF was associated with a high rate of non-utilization but a lower risk of starting hemodialysis via a CVC. Future studies assessing long-term clinical outcomes may provide further insights into the role of bAVF creation in shaping dialysis unit policies.</div></div><div><h3>Plain-Language Summary</h3><div>Peritoneal dialysis (PD) is limited by hemodialysis transfer. The optimal vascular access in hemodialysis is the arteriovenous fistula, yet requirements for maturation often necessitate a central venous catheter (CVC) insertion in acute transfers from PD. A back-up arteriovenous fistula (bAVF) is a strategy used to avoid CVC use in such situations. However, no consensus is currently available on the best approach for bAVF in PD. By conducting a systematic review, we found that 69% of bAVFs were never used. Nevertheless, bAVFs reduced the risk of hemodialysis transfer with ","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"6 11","pages":"Article 100904"},"PeriodicalIF":3.2,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142528657","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incident Albuminuria and Ethnicity Among Adults With Diabetes in an Integrated Health Care System in the United States","authors":"Billy Zeng MD , Jeanne A. Darbinian MPH , Kenneth K. Chen MD , Hasmik Arzumanyan MD , Sijie Zheng MD, PhD , Joan C. Lo MD","doi":"10.1016/j.xkme.2024.100907","DOIUrl":"10.1016/j.xkme.2024.100907","url":null,"abstract":"","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"6 11","pages":"Article 100907"},"PeriodicalIF":3.2,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142537385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Telehealth for Goals of Care Conversations in Advanced CKD: A Mixed-Methods Pilot Study of US Veterans and Their Clinicians","authors":"Alexi Vahlkamp , Julia Schneider , Talar Markossian , Salva Balbale , Cara Ray , Kevin Stroupe , Seema Limaye","doi":"10.1016/j.xkme.2024.100906","DOIUrl":"10.1016/j.xkme.2024.100906","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Engaging patients with advanced chronic kidney disease (CKD) in goals of care (GOC) conversations is essential to align life-sustaining treatments with patient preferences. This pilot study described the feasibility of engaging older Veterans with advanced CKD in GOC conversations via telehealth by (1) comparing patient characteristics, including life-sustaining treatment note completion rates and preferences by visit modality, and (2) exploring Veteran and clinician perspectives surrounding telehealth GOC conversations.</div></div><div><h3>Study Design</h3><div>Mixed-method convergent design including a prospective, quantitative observational cohort analysis (n<!--> <!-->=<!--> <!-->40) and qualitative, semi-structured interviews with 4 clinicians and 11 Veterans. Descriptive statistics were used to describe the quantitative data. An inductive, rapid analytic approach and the constant comparison were used to analyze and interpret qualitative data. Quantitative and qualitative data were triangulated to identify practical suggestions to optimize GOC conversations via telehealth.</div></div><div><h3>Setting & Participants</h3><div>Study participants included Veteran patients aged<!--> <!-->≥70 years with advanced CKD stage 4 or 5 from a Veterans Affairs hospital nephrology clinic.</div></div><div><h3>Results</h3><div>The cohort (n<!--> <!-->=<!--> <!-->40) had a high probability of death, hospitalization, or both occurring within 90 days or 1 year. Across visit modalities, patient characteristics did not differ significantly. Two interrelated themes emerged from interviews: (1) GOC conversation feasibility varies by key personal and environmental factors (barriers and facilitators) across visit modalities, although overarching barriers include lack of non-palliative care provider engagement and uncertainty or lack of understanding surrounding illness trajectory, and (2) engaging Veterans in GOC conversations has a positive impact by creating a sense of reassurance regardless of visit modality.</div></div><div><h3>Limitations</h3><div>The sample size was small (n<!--> <!-->=<!--> <!-->40), and the study was unable to detect statistically significant differences in patient characteristics and clinical outcomes between visit modalities. Furthermore, future studies with larger and more diverse samples may be better equipped to identify differences by demographic characteristics.</div></div><div><h3>Conclusions</h3><div>The findings suggest that it is feasible to engage older patients with advanced CKD in GOC conversations via telehealth, as patients wishing to complete a telehealth GOC conversation were able to. Factors increasing the ease of accessing GOC conversations may also increase their benefits, irrespective of visit modality.</div></div><div><h3>Plain-Language Summary</h3><div>Goals of care (GOC) conversations for older patients with advanced chronic kidney disease (CKD) are important to align me","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"6 11","pages":"Article 100906"},"PeriodicalIF":3.2,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142418580","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In-Center Hemodialysis Experiences Among Latinx Adults: A Qualitative Study","authors":"Katherine Rizzolo , Colin Gardner , Claudia Camacho , Rebeca Gonzalez Jauregui , Sushrut S. Waikar , Michel Chonchol , Lilia Cervantes","doi":"10.1016/j.xkme.2024.100902","DOIUrl":"10.1016/j.xkme.2024.100902","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Latinx individuals are more likely to start and remain receiving in-center hemodialysis, over home dialysis, than non-Latinx White individuals. The objective of our study was to understand the drivers of sustained in-center dialysis and deterrents of switching to home dialysis use for Latinx individuals receiving in-center dialysis.</div></div><div><h3>Study Design</h3><div>This qualitative study used semistructured one-on-one interviews.</div></div><div><h3>Setting and Participants</h3><div>Latinx adults receiving in-center hemodialysis therapy at 2 urban dialysis clinics in Denver, Colorado between November 2021 and March 2023.</div></div><div><h3>Exposures</h3><div>In-center hemodialysis, Latinx ethnicity.</div></div><div><h3>Outcomes</h3><div>Qualitative.</div></div><div><h3>Analytical Approach</h3><div>Interviews were analyzed with thematic analysis using inductive coding. Theoretical framework development used principles of grounded theory.</div></div><div><h3>Results</h3><div>In total, 25 Latinx adults (10 [40%] female and 15 [60%] male) receiving in-center hemodialysis therapy participated. One theme demonstrated that Latinx individuals experienced hardship with in-center dialysis but used Latinx values to persevere: Psychosocial resilience using Latinx cultural values (faith and spiritual coping, belief in predestination and acceptance, optimism and positive attitude toward treatment, and positive relationships with health care professionals and peers). Two themes illustrate barriers to starting or switching to home dialysis: Insufficient knowledge of kidney replacement therapy (lack of awareness of kidney disease, lack of preparation for dialysis) and Barriers to patient-centered decision making in dialysis treatment (lack of peer perspective to guide dialysis decision making, fear and apprehension of home dialysis, lack of socioemotional support, perception of housing issues).</div></div><div><h3>Limitations</h3><div>Most participants were from the same geographic area and country of origin, and some may have been uninsured because of immigration status.</div></div><div><h3>Conclusions</h3><div>As Latinx people are less likely to be treated with home dialysis modalities, this study offers important context as to what factors drove sustained in-center dialysis use for this population. Coping mechanisms that promoted resilience with in-center dialysis treatment motivated individuals to remain on in-center hemodialysis, and positive dialysis relationships in the dialysis center strengthened this experience. Switching to home dialysis is hindered by lack of knowledge as well as lack of patient-centered dialysis decision making. Understanding the drivers of sustained in-center hemodialysis use for Latinx individuals is important for future efforts at improving patient-centered education, framing conversations around modality choice, and care for this population.</div></div><div><h3>Plain-Language ","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"6 11","pages":"Article 100902"},"PeriodicalIF":3.2,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142418755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neighborhood Socioeconomic Status and Cardiovascular Events in Adults With CKD: The CRIC Study","authors":"Avi G. Aronov , Milda R. Saunders , Jesse Y. Hsu , Daohang Sha , Martha Daviglus , Michael J. Fischer , Lawrence J. Appel , James Sondheimer , Jiang He , Hernan Rincon-Choles , Edward J. Horwitz , Tanika N. Kelly , Ana C. Ricardo , James P. Lash","doi":"10.1016/j.xkme.2024.100901","DOIUrl":"10.1016/j.xkme.2024.100901","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>In the general population, neighborhood socioeconomic status (SES) has been found to be associated with cardiovascular risk, but this relationship has not been well studied among patients with chronic kidney disease (CKD). This study seeked to evaluate the association between neighborhood SES and cardiovascular outcomes in a CKD cohort.</div></div><div><h3>Study Design</h3><div>Multicenter prospective cohort.</div></div><div><h3>Setting & Participants</h3><div>In total, 3,197 participants in the Chronic Renal Insufficiency Cohort Study without cardiovascular disease at baseline.</div></div><div><h3>Exposure</h3><div>Neighborhood SES quartiles using a validated neighborhood-level SES summary measure for 6 census-derived variables.</div></div><div><h3>Outcome</h3><div>Incident heart failure, myocardial infarction, and all-cause death.</div></div><div><h3>Analytical Approach</h3><div>Cox proportional hazards.</div></div><div><h3>Results</h3><div>During median follow-up of 8.8 years, there were 465 incident heart failure events, 297 myocardial infarctions, and 891 deaths. In a fully adjusted model, among individuals with estimated glomerular filtration rate<!--> <!-->≥45<!--> <!-->mL/min/1.73<!--> <!-->m<sup>2</sup>, lowest neighborhood SES quartile was associated with higher risk of heart failure (HR, 1.96 [95% CI, 1.04-3.67]) compared with the highest quartile. This association was not significant among those with estimated glomerular filtration rate<!--> <!--><45<!--> <!-->mL/min/1.73<!--> <!-->m<sup>2</sup> (<em>P</em> for interaction<!--> <!--><<!--> <!-->0.1). There was no association between neighborhood SES and myocardial infarction; however, in the same multivariable-adjusted model, less than high school education was associated with higher risk of myocardial infarction (HR, 1.52 [95% CI, 1.06-2.17]). Among those aged greater than 60 years, there was a significant association between the lowest neighborhood SES quartile and death (HR, 1.72 [95% CI, 1.06-2.78]), but this association was not significant among those aged 60 years and younger (<em>P</em> for interaction<!--> <!--><<!--> <!-->0.05).</div></div><div><h3>Limitations</h3><div>Findings are subject to residual confounding and bias.</div></div><div><h3>Conclusions</h3><div>In a CKD cohort, neighborhood-level SES was associated with incident heart failure among individuals with more preserved kidney function and death in those younger than 60 years. Policies and public health and health system interventions are needed to address individual- and neighborhood-level SES factors to improve outcomes for patients with CKD residing in disadvantaged communities.</div></div><div><h3>Plain-Language Summary</h3><div>Because patients with chronic kidney disease (CKD) experience high rates of cardiovascular complications, we evaluated the relationship between neighborhood-level socioeconomic status (SES) and cardiovascular outcomes using data ","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"6 11","pages":"Article 100901"},"PeriodicalIF":3.2,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142418756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chronic Kidney Disease-Associated Pruritus Burden: A Patient Survey Study","authors":"Jeffrey Thompson , Jennifer Kammerer , Tasha Boshears , Juliana Oliveira , Kirsten L. Johansen , Anna Kovar , Lulu Lee , Gil Yosipovitch","doi":"10.1016/j.xkme.2024.100900","DOIUrl":"10.1016/j.xkme.2024.100900","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Chronic kidney disease-associated pruritus (CKD-aP) is a common, underrecognized condition in patients with chronic kidney disease (CKD), especially those receiving hemodialysis (HD). The present study analyzed the clinical treatment journey and overall burden of pruritus among patients with CKD-aP.</div></div><div><h3>Study Design</h3><div>Cross-sectional, patient-reported online survey.</div></div><div><h3>Setting & Participants</h3><div>Data from adult patients undergoing HD (December 2021–May 2022) in the United States.</div></div><div><h3>Exposure</h3><div>Patients participated in an online survey and responded to questions on validated patient-reported outcome instruments related to CKD-aP.</div></div><div><h3>Outcomes</h3><div>Self-reported measures analyzed at the end of this survey include itch characteristics; symptom management; health care provider (HCP) engagement; and effect on HD, quality of life (QoL), sleep, and work productivity.</div></div><div><h3>Analytical Approach</h3><div>Bivariate analysis assessed the association of itch severity with CKD-specific QoL.</div></div><div><h3>Results</h3><div>Overall, 354 patients with CKD-aP were included in analyses, of which 49% and 30% had moderate and severe itch, respectively (22% were mild). Around 68% reported symptoms to HCPs, most commonly a nephrologist or primary care provider, and 55% received a treatment recommendation. The most common treatments were topical lotions/moisturizers (75%) and corticosteroids (48%); use of oral prescriptions was low (20%), with limited satisfaction with treatments. Overall, 23% of patients reported shortening and 17% reported missing HD sessions because of itch. In bivariate analysis, patients with more severe CKD-aP reported significantly worse disease and function scores (kidney disease score, cognitive function, quality of social interaction, sleep [all, <em>P</em> <!--><<!--> <!-->0.001], and sexual function [<em>P</em> <!--><<!--> <!-->0.05]), suggesting a direct effect of CKD-aP on QoL.</div></div><div><h3>Limitations</h3><div>Possible recall bias, especially for questions with longer recall periods.</div></div><div><h3>Conclusions</h3><div>CKD-aP is often inadequately treated and disruptive of dialysis treatment, even among patients who report itch to HCPs. Worse itch severity is associated with poorer QoL, sleep quality, and functional/work impairment.</div></div><div><h3>Plain-Language Summary</h3><div>Chronic kidney disease-associated pruritus (CKD-aP) is a common problem in patients with kidney disease, especially in those who are receiving dialysis. There are few approved treatment options for CKD-aP. Understanding how CKD-related itch affects patients may help identify ways to improve CKD-aP symptoms/signs. This patient-reported survey assessed itch characteristics, symptom management attempts and effectiveness, and burdens caused by itch in patients with CKD-aP. Although<!--> <!-->","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"6 11","pages":"Article 100900"},"PeriodicalIF":3.2,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142418757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preliminary Outcomes of NephSIM Nephrons: A Virtual Mentorship Program to Foster Interest in Nephrology","authors":"Samira S. Farouk , Matthew A. Sparks , Jessica Joseph","doi":"10.1016/j.xkme.2024.100899","DOIUrl":"10.1016/j.xkme.2024.100899","url":null,"abstract":"<div><h3>Background</h3><div>Despite concerted efforts by the nephrology community to increase the quality of nephrology education via a plethora of free open access medical education tools and efforts by national nephrology societies, interest in nephrology has mostly remained stagnant.</div></div><div><h3>Methods</h3><div>A 6-month virtual learning and mentoring program (NephSIM Nephrons) was launched in January 2021 to increase interest in nephrology careers among medical students and residents. Trainees were assigned one faculty mentor and a small group with faculty and other trainees. Learning opportunities consisted of both live and virtual sessions and an asynchronous curriculum. Feedback was collected from trainees at the end of the program each year through an online, anonymous survey. For trainees in the 2021 and 2022 cohort, residency/fellowship status for the July 2024-2025 academic year was assessed by survey.</div></div><div><h3>Results</h3><div>Of 319 and 315 eligible applications received for the 2021 and 2022 programs, 111 and 108 trainees were accepted, respectively; 31 participants in the 2023 cohort completed the exit survey (response rate: 31/84, 37%) and rated the mean overall NephSIM Nephrons experience as 4.7 of 5. All respondents were very likely or somewhat likely to recommend the experience to other trainees. In the 2021 and 2022 cohorts, 37 of 49 (77%) and 29 of 38 (76%) trainees, respectively, who were eligible to match into adult or pediatric nephrology fellowships by July 2024 successfully matched. Similarly, among the 2021 and 2022 cohorts, 11 of 19 (58%) and 21 of 23 (91%), respectively, who could be internal medicine or pediatrics residents in July 2024 successfully matched.</div></div><div><h3>Limitations</h3><div>Low survey response rate.</div></div><div><h3>Conclusions</h3><div>Early outcome analysis of the NephSIM Nephrons program shows promising results, and individuals who participated had high rates of enrollment in nephrology pipeline residencies and nephrology fellowships. More work is needed to first continue rigorous follow-up of program participants, obtain qualitative program feedback, and improve participant and mentor engagement.</div></div><div><h3>Plain-Language Summary</h3><div>Despite concerted efforts by the nephrology community to increase the quality of nephrology education via a plethora of free, open access medical education tools and efforts by national nephrology societies, interest in nephrology has mostly remained stagnant. A 6-month virtual learning and mentoring program (NephSIM Nephrons) was launched in January 2021 to increase interest in nephrology careers among medical students and residents. Early outcome analysis of the NephSIM Nephrons program shows promising results, and individuals who participated had high rates of enrollment in nephrology pipeline residencies and nephrology fellowships. More work is needed to continue rigorous follow-up of program participants, obtain qual","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"6 11","pages":"Article 100899"},"PeriodicalIF":3.2,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142528814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dialysis Modality Education Timing and Home Dialysis Uptake: A Quality Improvement Study","authors":"Declan (Shiyu) Lu , Mishal Akhtar , Lisa Dubrofsky , Bourne L. Auguste","doi":"10.1016/j.xkme.2024.100898","DOIUrl":"10.1016/j.xkme.2024.100898","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Investigating the effect of a quality improvement intervention aimed at enhancing the choice of home dialysis among patients through improved educational sessions on dialysis modalities.</div></div><div><h3>Study Design</h3><div>A new referral protocol initiated on September 15, 2022, sought to direct patients with advanced kidney disease to modality education sessions. This protocol involved an updated referral form and process, requiring nephrologists to refer patients with an estimated glomerular filtration rate below 15<!--> <!-->mL/min/1.73<!--> <!-->m<sup>2</sup> or specified Kidney Failure Risk Equation scores to modality educators for education. The impact was measured by the uptake of the education and the choice of home dialysis by patients.</div></div><div><h3>Setting & Participants</h3><div>The study took place at Sunnybrook Health Sciences Centre in Toronto, Canada, involving 532 patients across 1,723 clinical encounters from October 2019 to June 2023.</div></div><div><h3>Predictor</h3><div>The intervention was predicted to lead to an increase in both the number of patients receiving modality education and those choosing home dialysis.</div></div><div><h3>Outcomes</h3><div>The primary outcome measured was the selection of home dialysis following modality education, with a secondary focus on the proportion of patients educated post intervention.</div></div><div><h3>Analytical Approach</h3><div>Statistical process charts were used for monitoring changes in education uptake and home dialysis selection rates following the intervention.</div></div><div><h3>Results</h3><div>After implementing the standardized referral system, the proportion of patients receiving modality education increased from 27.1%-56.7%. However, the rate of selecting home dialysis remained constant at 50.9%. Overall home dialysis prevalence at our center averaged 19.6%, remaining lower than the provincial average of 24.4% by the end of the study period.</div></div><div><h3>Limitations</h3><div>The study was limited to 1 center, without evaluating patient satisfaction or dissecting the complexity of educational content and delivery.</div></div><div><h3>Conclusions</h3><div>We succeeded in boosting education rates but failed to achieve higher home dialysis choice rates, possibly owing to the complexity involved in modality choices. We plan to further investigate the factors influencing patient choices during modality education to better promote home dialysis selection.</div></div><div><h3>Plain-Language Summary</h3><div>The study focused on whether teaching patients more about their dialysis options would encourage them to choose home dialysis. A new system was introduced at an academic hospital in Toronto, requiring doctors to refer patients with advanced kidney disease to educational sessions. The aim was to see if patients who learned more about dialysis would be more likely to manage their treatment at home. The result","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"6 11","pages":"Article 100898"},"PeriodicalIF":3.2,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142326364","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Alzheimer Disease–Related Biomarkers in Patients on Maintenance Hemodialysis","authors":"Arjun V. Masurkar MD, PhD , Nisha Bansal MD , David K. Prince PhD , Wolfgang C. Winkelmayer MD, MPH, ScD , Daniela F. Ortiz MPH , Gianna Ramos MD , Qandeel Soomro MD , Alok Vedvyas MS , Ricardo S. Osorio MD , Mark A. Bernard PhD , Ludovic Debure BS , Wajiha Ahmed MD , Allal Boutajangout PhD , Thomas Wisniewski MD , David M. Charytan MD, MSc","doi":"10.1016/j.xkme.2024.100897","DOIUrl":"10.1016/j.xkme.2024.100897","url":null,"abstract":"","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"6 11","pages":"Article 100897"},"PeriodicalIF":3.2,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590059524001080/pdfft?md5=5702547619a3b75eadb9c4dc0a448e02&pid=1-s2.0-S2590059524001080-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142241869","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Allopurinol, Febuxostat, and Nonuse of Xanthine Oxidoreductase Inhibitor Treatment in Patients Receiving Hemodialysis: A Longitudinal Analysis","authors":"Takeo Ishii , Nodoka Seya , Masataka Taguri , Hiromichi Wakui , Ashio Yoshimura , Kouichi Tamura","doi":"10.1016/j.xkme.2024.100896","DOIUrl":"10.1016/j.xkme.2024.100896","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Allopurinol and febuxostat, which are xanthine oxidoreductase inhibitors, have been widely used as uric acid-lowering medications. However, evidence regarding their cardiovascular effects in hemodialysis is insufficient. This study compared the effects of allopurinol and febuxostat on mortality and cardiovascular outcomes in patients receiving hemodialysis.</div></div><div><h3>Study Design</h3><div>A retrospective observational cohort study.</div></div><div><h3>Setting & Participants</h3><div>Data of 6,791 patients who had no history of topiroxostat usage and underwent maintenance hemodialysis between March 2016 and March 2019 at Yokohama Daiichi Hospital, Zenjinkai, and its affiliated dialysis clinics in Japan’s Kanagawa and Tokyo metropolitan areas were collected.</div></div><div><h3>Exposure</h3><div>Allopurinol, febuxostat, and nontreatment.</div></div><div><h3>Outcomes</h3><div>All-cause mortality, cardiovascular disease (CVD) events, heart failure (HF), acute myocardial infarction (AMI), and stroke.</div></div><div><h3>Analytical Approach</h3><div>For the main analyses, marginal structural Cox proportional hazards models were used to estimate HRs adjusted for time-varying confounding and selection bias because of censoring.</div></div><div><h3>Results</h3><div>Allopurinol and febuxostat showed significantly better survival than nontreatment for all-cause mortality (HR, 0.40; 95% CI, 0.30-0.54 and HR, 0.49; 95% CI, 0.38-0.63, respectively), without significant difference between allopurinol and febuxostat. Allopurinol showed significantly better survival than nontreatment, whereas febuxostat did not for CVD events (HR, 0.89; 95% CI, 0.84-0.95 and HR, 1.01; 95% CI, 0.96-1.07, respectively), HF (HR, 0.71; 95% CI, 0.56-0.90 and HR, 1.03; 95% CI, 0.87-1.21, respectively), and AMI (HR, 0.48; 95% CI, 0.25-0.91 and HR, 0.76; 95% CI, 0.49-1.19, respectively). No comparisons showed significant results for stroke.</div></div><div><h3>Limitations</h3><div>The ratio of renal or intestinal excretion of uric acid and uremic toxins could not be elucidated, and we could not investigate gene polymorphism because of the large number of cases.</div></div><div><h3>Conclusions</h3><div>Allopurinol and febuxostat improved survival for all-cause mortality. Allopurinol and not febuxostat reduced the risk of CVD events, HF, and AMI.</div></div><div><h3>Plain Language Summary</h3><div>Uric acid-lowering therapy has been used to prevent gout attacks and protect organs by reducing inflammation by lowering uric acid levels. However, uric acid-lowering medications have recently been found to have a side effect of inhibiting a channel responsible for excreting toxins, such as adenosine triphosphate-binding cassette transporter G2; the effects of medications with a strong inhibitory effect, such as febuxostat, are currently under investigation. Patients with kidney failure or dialysis excrete toxins through feces from their i","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"6 11","pages":"Article 100896"},"PeriodicalIF":3.2,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590059524001079/pdfft?md5=0825111d5fdbb51834c89ad06c223f76&pid=1-s2.0-S2590059524001079-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142310680","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}