RESUMO
Acute kidney injury (AKI) requiring dialysis (AKI-D) is an important health care burden and is associated with very high in-hospital mortality. Timely initiation of dialysis in AKI is fundamental to achieve treatment goals and to provide solute clearance and removal of excess fluid while awaiting the recovery of kidney function. The primary outcome of interest of the study was recovery of sufficient kidney function to discontinue haemodialysis therapy and complete recovery of renal function. This prospective observational study has been conducted in Mymensingh Medical College Hospital, Bangladesh from September 2019 to February 2021. All adult patients with AKI-D were included in the study. All patients were followed up till death or complete recovery or for a maximum period of six month. A total of 134 patients of AKI-D were included in the study with the mean age of 42.3±15.7 years. Male (54.5%) were slightly more than female with a male to female ratio of 1.2:1. Diabetes and hypertension were present in 16 (11.9%) and 47 (35.1%) patients respectively. The causes of AKI were sepsis (35.1%), urinary tract infection (34.3%), acute watery diarrhoea (9.7%), leptospirosis (11.2%), obstetric (10.4%), malignancy (8.2%), post renal obstruction (8.2%), drugs (7.5%), surgery (18.7%), rapidly progressive glomerulonephritis (6%), COVID 19 (5.2%), rhabdomyolysis (4.5%), intestinal obstruction (3.7%), acute gastroenteritis (2.2%), wasp bite (2.2%), insecticide poisoning (1.5%), star fruit toxicity (1.5%), haemolytic uremic syndrome (0.7%) and unknown (1.5%). Mean number of dialysis requirement was 5.9±8.6 and length of hospital stay was 15.4±10.5 days. Out of 134 patients, 95(70.9%) were discharged from hospital and 39(29.1%) died in hospital. Total death of patients during the study period were 49(36.6%) including home death of 10(7.5%) patients. Complete recovery of kidney function was achieved in 70(52.2%) patients and partial recoveries of kidney function who can survive without dialysis were observed in 12(9%) patients. Three (2.2%) patients remain on dialysis and 85(63.4%) patients survived during the study period. Survival rate was significantly higher in patients with ≤40 years (72.6%) and significantly lower in patients with malignancy (18.2%) and post renal obstruction (27.3%). Outcomes of patients with AKI-D remain poor. Advanced stage of AKI, older age, late presentation, malignancy, nutritional deficiency and delay at initiation of dialysis were associated with high mortality and reduced survival.
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Injúria Renal Aguda , Diálise Renal , Centros de Atenção Terciária , Humanos , Injúria Renal Aguda/terapia , Injúria Renal Aguda/mortalidade , Injúria Renal Aguda/etiologia , Masculino , Feminino , Diálise Renal/métodos , Diálise Renal/estatística & dados numéricos , Adulto , Estudos Prospectivos , Bangladesh/epidemiologia , Centros de Atenção Terciária/estatística & dados numéricos , Pessoa de Meia-Idade , Países em DesenvolvimentoRESUMO
PURPOSE: This research aimed to explore hesitation towards the COVID-19 booster vaccine among dialysis patients and study the association between COVID-19 pandemic-induced health behavior and vaccination hesitancy. METHODS: A self-administered online questionnaire evaluating dialysis patients' hesitation to take COVID-19 booster vaccination was conducted between March 24 and 22 April 2022 in Taizhou, China. The logistic regression method was applied to identify factors associated with vaccination hesitancy, and all data were analyzed using R software. RESULTS: Of the 365 study participants, 272 (74.5%) individuals hesitated to take the booster dose. Health behavior was found to be a significant factor for hesitation to take COVID-19 vaccines, with OR (95% CI) of 1.09 (1.02-1.17). Influenza vaccination history was also significantly associated with the hesitation (OR (95% CI) = 0.39 (0.21-0.74)). In addition, participants with higher education levels exhibited lower vaccine hesitancy compared to those with junior secondary or below, with ORs (95% CIs) of 0.49 (0.27-0.91) for senior secondary and 0.35 (0.14-0.89) for junior college or above, respectively. CONCLUSION: The proportion of hesitancy for taking the booster vaccination of the COVID-19 vaccine was high among dialysis patients. Health behaviors, influenza vaccination history, and education levels were risk factors in their vaccination hesitancy. These findings may aid efforts to help vaccinate people with underlying diseases against future pandemics.
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Vacinas contra COVID-19 , COVID-19 , Imunização Secundária , Diálise Renal , SARS-CoV-2 , Hesitação Vacinal , Humanos , Masculino , China/epidemiologia , Estudos Transversais , Feminino , Pessoa de Meia-Idade , COVID-19/prevenção & controle , COVID-19/epidemiologia , Imunização Secundária/estatística & dados numéricos , Diálise Renal/estatística & dados numéricos , Vacinas contra COVID-19/administração & dosagem , Idoso , Inquéritos e Questionários , SARS-CoV-2/imunologia , Hesitação Vacinal/estatística & dados numéricos , Hesitação Vacinal/psicologia , Adulto , Vacinação/estatística & dados numéricos , Vacinação/psicologia , Comportamentos Relacionados com a SaúdeRESUMO
BACKGROUND: Hemodialysis (HD)-related nursing research has been growing over the past 2 decades, providing critical insights into improving patient care and outcomes. This study aimed to visualize the hotspots and emerging frontiers in HD-related nursing research, offering valuable references for future studies. METHODS: A bibliometric analysis was conducted on publications related to HD nursing research from the Web of Science Core Collection database, spanning the years 2002 to 2023, and the characteristics of literature such as authors, co-cited authors, countries, research institutions, journal distribution, keywords, and cited literature were visually analyzed using CiteSpace and VOSviewer. RESULTS: A total of 1019 publications were included in this study. The major contributors to this field were the United States, China, and Australia. The University of Sao Paulo emerged as the most prolific institution. The principal contributors were the Nephrology Nursing Journal, followed by Journal of Renal Care and Journal of Clinical Nursing. The top 5 co-occurrence keywords included HD, quality of life, dialysis, chronic kidney disease, and end-stage renal disease. The burst detection of keywords showed that current research frontier trends were pain and validation. The top 5 largest clusters of cited references included research on systematic review research, nurse-led disease management program, family caregiver, end-stage renal disease, and self-care intervention. CONCLUSION: This study reveals productive authors, countries and institutions, research hotspots, and trends of HD-related nursing research over the past 2 decades, offering a comprehensive overview of this field worldwide.
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Bibliometria , Pesquisa em Enfermagem , Diálise Renal , Humanos , Diálise Renal/enfermagem , Diálise Renal/estatística & dados numéricos , Falência Renal Crônica/terapiaRESUMO
BACKGROUND: Hemodialysis (HD) is the most commonly utilized modality for kidney replacement therapy worldwide. This study assesses the organizational structures, availability, accessibility, affordability and quality of HD care worldwide. METHODS: This cross-sectional study relied on desk research data as well as survey data from stakeholders (clinicians, policymakers and patient advocates) from countries affiliated with the International Society of Nephrology from July to September 2022. RESULTS: Overall, 167 countries or jurisdictions participated in the survey. In-center HD was available in 98% of countries with a median global prevalence of 322.7 [interquartile range (IQR) 76.3-648.8] per million population (pmp), ranging from 12.2 (IQR 3.9-103.0) pmp in Africa to 1575 (IQR 282.2-2106.8) pmp in North and East Asia. Overall, home HD was available in 30% of countries, mostly in countries of Western Europe (82%). In 74% of countries, more than half of people with kidney failure were able to access HD. HD centers increased with increasing country income levels from 0.31 pmp in low-income countries to 9.31 pmp in high-income countries. Overall, the annual cost of in-center HD was US$19 380.3 (IQR 11 817.6-38 005.4), and was highest in North America and the Caribbean (US$39 825.9) and lowest in South Asia (US$4310.2). In 19% of countries, HD services could not be accessed by children. CONCLUSIONS: This study shows significant variations that have remained consistent over the years in availability, access and affordability of HD across countries with severe limitations in lower-resourced countries.
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Saúde Global , Diálise Renal , Humanos , Diálise Renal/economia , Diálise Renal/estatística & dados numéricos , Estudos Transversais , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Falência Renal Crônica/terapia , Falência Renal Crônica/epidemiologiaRESUMO
OBJECTIVES: To assess differences between Aboriginal and Torres Strait Islander and non-Indigenous Australian children and young adults in access to and outcomes of kidney transplantation. STUDY DESIGN: A cohort study based on prospectively collected data; analysis of Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) data. SETTING, PARTICIPANTS: Children and young adults aged 0-24 years who commenced kidney replacement therapy in Australia during 1963-2020. MAIN OUTCOME MEASURES: Proportions of children and young adults who received kidney transplants within five years of commencing dialysis; 5- and 10-year death-censored graft survival; and 5- and 10-year survival of children and young adults who received kidney transplants or who remained on dialysis. RESULTS: During 1963-2020, 3736 children and young adults received kidney replacement therapy in Australia: 213 (5.8%) Aboriginal and Torres Strait Islander and 3523 (94.2%) non-Indigenous children and young adults. During follow-up (median, eight years; interquartile range [IQR], 2.6-15 years), 2762 children and young adults received kidney transplants: 93 Aboriginal and Torres Strait Islander (43.7% of those receiving kidney replacement therapy) and 2669 non-Indigenous children and young adults (75.8%). Smaller proportions of Aboriginal and Torres Strait Islander than of non-Indigenous children and young adults received transplants within five years of commencing dialysis (99, 46% v 2924, 83.0%), received living donor transplants (19, 20% v 1170, 43.9%), or underwent pre-emptive transplantation (one, 1.1% v 363, 13.6%). Five-year graft survival for Aboriginal and Torres Strait Islander recipients was similar to non-Indigenous recipients (61% v 75%; adjusted hazard ratio [aHR], 1.43; 95% confidence interval [CI], 0.02-2.05), but 10-year graft survival was lower (35% v 61%; aHR, 1.69; 95% CI, 1.25-2.28). Five- and 10-year survival after kidney transplantation was similar for Aboriginal and Torres Strait Islander and non-Indigenous people. Among those who remained on dialysis, 10-year survival was poorer for Aboriginal and Torres Strait Islander than non-Indigenous children and young adults (aHR, 1.50; 95% CI, 1.08-2.10). CONCLUSIONS: Five-year graft and recipient survival were excellent for Aboriginal and Torres Strait Islander children and young adults who received kidney transplants; however, a lower proportion received transplants within five years of dialysis initiation, than non-Indigenous children and young adults. Improving transplant access within five years of dialysis commencement should be a priority.
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Sobrevivência de Enxerto , Acessibilidade aos Serviços de Saúde , Transplante de Rim , Sistema de Registros , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Adulto Jovem , Austrália , Povos Aborígenes Australianos e Ilhéus do Estreito de Torres , Estudos de Coortes , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Falência Renal Crônica/cirurgia , Falência Renal Crônica/etnologia , Falência Renal Crônica/terapia , Falência Renal Crônica/mortalidade , Transplante de Rim/estatística & dados numéricos , Nova Zelândia , Diálise Renal/estatística & dados numéricosRESUMO
BACKGROUND: Understanding the trend of utilization of renal dialysis in Saudi Arabia (SA) is fundamental as it provides a general overview of renal care. The practice of renal dialysis assists in identifying challenges, opportunities, and potential areas for improvement in the provision of the services. OBJECTIVES: This research investigated the utilization of renal dialysis services in SA by exploring the number of renal dialysis centers, hemodialysis machines (HD), and peritoneodialysis patients. METHODS: The dataset for this study was derived from a collaboration between the General Authority of Statistics (GaStat) and the Ministry of Health (MoH), focusing on indicators for renal dialysis centers and patients across health sectors in 2021. Analysis was conducted using MS Excel 365 and IBM SPSS Version 29, incorporating multiple regression techniques. The health sector was treated as the dependent variable. At the same time, the number of hemodialysis (HD) machines and the counts of HD and peritoneal dialysis patients were considered independent variables. RESULTS: Around 275 renal dialysis centers, over 8000 HD machines, 20,440 HD patients, and 1,861 peritoneal patients were tallied from two resources. The findings revealed a negative relationship between the health sector and several renal dialysis centers and peritoneodialysis patients, as demonstrated by p < 0.05 in multiple regression analysis. CONCLUSION: The number of renal dialysis centers influences the availability of HD machines, affecting the number of HD and peritoneodialysis patients. Most national patients preferred MoH over other semi-governmental and private sectors, and vice versa for non-Saudis.
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Diálise Renal , Arábia Saudita , Humanos , Diálise Renal/estatística & dados numéricos , Diálise Peritoneal/estatística & dados numéricos , Falência Renal Crônica/terapia , MasculinoRESUMO
Moderate physical activity is related to reduced mortality in hemodialysis patients. However, most hemodialysis patients have low physical activity levels for complex reasons. This study investigated the determinants of moderate-to-high physical activity levels and whether psychosocial correlates are associated with engagement in moderate-to-high physical activity among hemodialysis patients. A cross-sectional survey was conducted with 134 hemodialysis outpatients, aged 64.7 years, in three hemodialysis centers in Taiwan. Data on sociodemographics, comorbidities, lifestyles, and psychosocial correlates, including perceived benefits, barriers, and self-efficacy of physical activity, were collected. Multiple logistic regression analyses were performed. Results showed that patients with moderate-to-high physical activity levels constituted a significantly lower proportion of current smokers and had fewer perceived physical activity barriers and higher self-efficacy of physical activity compared with those with low levels. After adjusting for potential sociodemographic covariates, current employment, nonsmoking status, and high self-efficacy of physical activity were significantly associated with moderate-to-high physical activity levels. Developing strategies to improve the self-efficacy of physical activity, support employment, and enhance anti-smoking campaigns in hemodialysis patients can help them engage in moderate-to-high levels of physical activity.
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Exercício Físico , Diálise Renal , Humanos , Estudos Transversais , Masculino , Feminino , Diálise Renal/psicologia , Diálise Renal/métodos , Diálise Renal/estatística & dados numéricos , Pessoa de Meia-Idade , Taiwan , Exercício Físico/psicologia , Exercício Físico/fisiologia , Idoso , Inquéritos e Questionários , Autoeficácia , Modelos LogísticosRESUMO
BACKGROUND: There is limited evidence on the complexity of cardiovascular disease (CVD) and geriatric syndromes in older patients with end-stage renal disease. Our aims were to (1) examine the prevalence of CVD in older patients on chronic hemodialysis, (2) compare the burden of geriatric syndromes in patients with and without CVD, and (3) examine the impact of CVD on hospitalization. METHODS: This prospective, observational, multi-center study was conducted at two dialysis units of two major hospitals in Vietnam. Consecutive older adults receiving chronic hemodialysis were recruited from November 2020 to June 2021. CVD was defined as having one of these conditions: heart failure, ischemic heart disease, or stroke. Participants were assessed for geriatric conditions including frailty, malnutrition, impairment in instrumental activities/activities of daily living, depression, falls, and polypharmacy. Multivariable logistic regression analysis was applied to examine the impact of CVD on 6-month hospitalization, adjusting for age, sex, duration of dialysis, Charlson Comorbidity Index, and geriatric conditions. Results were presented as odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: There were 175 participants (mean age 72.4 ± 8.5 and 58.9% female). CVD was present in 80% of the participants (ischemic heart disease: 49.7%, heart failure: 60.0%, and stroke: 25.7%). Participants with CVD had a higher burden of geriatric syndromes compared to those without CVD. During the 6-month follow-up, 48.6% of the participants were hospitalized (56.4% of those with CVD vs. 17.1% of those without CVD), p < 0.001). CVD independently increased the risk of hospitalization (adjusted OR 3.32, 95% CI 1.12-9.80). CONCLUSIONS: In this study, there was a very high prevalence of CVD in older patients undergoing chronic dialysis. Participants with CVD had a higher burden of geriatric syndromes and their risk of 6-month hospitalization increased by three times. There is a need for a multidisciplinary and patient-centered approach to treatment planning for these patients.
Assuntos
Doenças Cardiovasculares , Diálise Renal , Humanos , Idoso , Feminino , Masculino , Diálise Renal/estatística & dados numéricos , Doenças Cardiovasculares/epidemiologia , Estudos Prospectivos , Idoso de 80 Anos ou mais , Falência Renal Crônica/epidemiologia , Falência Renal Crônica/terapia , Vietnã/epidemiologia , Prevalência , Hospitalização/estatística & dados numéricos , Avaliação Geriátrica/estatística & dados numéricosRESUMO
Background: Patients undergoing hemodialysis (HD) have a high risk of novel coronavirus disease 2019 (COVID-19) and poor clinical outcomes. This study aimed to investigate severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine effectiveness against infection and deaths in the South Korean population undergoing HD. Methods: We conducted a retrospective cohort study to compare the incidence of COVID-19 and post-diagnosis mortality between patients who were either never vaccinated or fully or partially vaccinated. The Korean nationwide COVID-19 registry and the Korean National Health Insurance Service databases were used. Adult patients without a history of COVID-19 were included between October 8, 2020, and December 31, 2021. The study outcomes were COVID-19 diagnosis, severe clinical COVID-19-related events, and post-diagnosis death. Results: Eighty-five thousand eighteen patients undergoing HD were included, of whom 69,601 were fully vaccinated, 2,213 were partially vaccinated and 13,204 were unvaccinated. Compared with the unvaccinated group, the risk of being diagnosed with COVID-19 in patients who were fully vaccinated decreased during the study period (adjusted odds ratio [aOR] = 0.147; 95% confidence interval [CI] = 0.135-0.159). There were 1,140 (1.3%) patients diagnosed with COVID-19. After diagnosis, fully vaccinated patients were significantly less likely to die than unvaccinated patients (aOR = 0.940; 95% CI = 0.901-0.980) and to experience severe clinical events (aOR = 0.952; 95% CI = 0.916-0.988). Conclusion: Full vaccination against COVID-19 was associated with a reduced risk of both infection and severe clinical outcomes in the South Korean population undergoing HD. These findings support the use of vaccination against SARS-CoV-2 among patients undergoing HD.
Assuntos
Vacinas contra COVID-19 , COVID-19 , Diálise Renal , SARS-CoV-2 , Humanos , República da Coreia/epidemiologia , COVID-19/prevenção & controle , COVID-19/mortalidade , COVID-19/epidemiologia , Masculino , Feminino , Diálise Renal/estatística & dados numéricos , Pessoa de Meia-Idade , Estudos Retrospectivos , Idoso , Eficácia de Vacinas/estatística & dados numéricos , Adulto , Vacinação/estatística & dados numéricos , Estudos de Coortes , IncidênciaRESUMO
The objective of this article was to analyze the factors associated with complex multimorbidity (CMM) among hemodialysis patients in a metropolitan region in southeastern Brazil. To this end, a cross-sectional epidemiological survey was carried out with 1,024 individuals in the year 2019. CMM data were collected through the application of a questionnaire to hemodialysis patients. The binary logistic regression model was used to estimate odds ratios (OR) and 95% confidence intervals (95%CI) between independent variables and CMM. The prevalence of CMM was 81% and the results indicated that: living in cities with a low rate of general mortality (OR = 0.395, 95%CI = 0.179-0.870), being aged between 18 and 29 (OR = 0.402, 95%CI = 0.196-0.825), having an elementary education (OR = 0.536, 95%CI = 0.290-0.966) and assessing health as good/very good (OR = 0.446, 95%CI = 0.301-0.661) are factors that reduced the chances of having CMM, whereas a longer period of hemodialysis (OR = 1.779 and 95%CI = 1.057-2.997) increased the chances of CMM. The findings show that characteristics of the social and individual context are associated with CMM in hemodialysis patients, signaling the need for public health policies that include monitoring the complex multimorbidity condition among individuals undergoing hemodialysis treatment.
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Multimorbidade , Diálise Renal , Humanos , Brasil/epidemiologia , Diálise Renal/estatística & dados numéricos , Feminino , Masculino , Adulto , Pessoa de Meia-Idade , Estudos Transversais , Adolescente , Adulto Jovem , Idoso , Prevalência , Inquéritos e Questionários , Fatores de RiscoRESUMO
BACKGROUND: The Covid-19 pandemic has affected patients with end-stage kidney disease (ESKD). Whether dialysis parameters have a prognostic value in ESKD patients with Covid-19 remains unclear. MATERIALS AND METHODS: We retrospectively evaluated clinical characteristics, blood pressure (BP) and dialysis parameters in ESKD patients undergoing maintenance outpatient hemodialysis, with (Covid-ESKD) and without (No-Covid-ESKD) Covid-19, at four Brazilian hemodialysis facilities. The Covid-ESKD (n = 107; 54% females; 60.8 ± 17.7 years) and No-Covid-ESKD (n = 107; 62% females; 58.4 ± 14.6 years) groups were matched by calendar time. The average BP and dialysis parameters were calculated during the pre-infection, acute infection, and post-infection periods. The main outcomes were Covid-19 hospitalization and all-cause mortality. RESULTS: Covid-ESKD patients had greater intradialytic and postdialysis systolic BP and lower predialysis weight, postdialysis weight, ultrafiltration rate, and interdialytic weight gain during acute-illness compared to 1-week-before-illness, while these changes were not observed in No-Covid-ESKD patients. After 286 days of follow-up (range, 276-591), there were 18 Covid-19-related hospitalizations and 28 deaths among Covid-ESKD patients. Multivariable logistic regression analysis showed that increases in predialysis systolic BP from 1-week-before-illness to acute-illness (OR, 95%CI = 1.06, 1.02-1.10; p = .004) and Covid-19 vaccination (OR, 95%CI = 0.16, 0.04-0.69; p = .014) were associated with hospitalization in Covid-ESKD patients. Multivariable Cox-regression analysis showed that Covid-19-related hospitalization (HR, 95%CI = 5.17, 2.07-12.96; p < .001) and age (HR, 95%CI = 1.05, 1.01-1.08; p = .008) were independent predictors of all-cause mortality in Covid-ESKD patients. CONCLUSION: Acute Covid-19 illness is associated with variations in dialysis parameters of volume status in patients with ESKD. Furthermore, increases in predialysis BP during acute Covid-19 illness are associated with an adverse prognosis in Covid-ESKD patients.
Dialysis parameters were influenced by SARS-CoV-2 infection and may have prognostic value in patients with Covid-19.Increases in blood pressure during acute Covid-19 illness and the lack of vaccination for Covid-19 were predictors of hospitalization for Covid-19.Hospitalization for Covid-19 and age were independent risk factors for all-cause death.
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COVID-19 , Falência Renal Crônica , Diálise Renal , SARS-CoV-2 , Humanos , COVID-19/complicações , COVID-19/mortalidade , COVID-19/epidemiologia , COVID-19/terapia , Feminino , Pessoa de Meia-Idade , Masculino , Falência Renal Crônica/terapia , Falência Renal Crônica/complicações , Falência Renal Crônica/mortalidade , Falência Renal Crônica/epidemiologia , Diálise Renal/estatística & dados numéricos , Estudos Retrospectivos , Prognóstico , Idoso , Brasil/epidemiologia , Adulto , Hospitalização/estatística & dados numéricos , Pressão SanguíneaRESUMO
Importance: People with kidney failure receiving maintenance dialysis visit the emergency department (ED) 3 times per year on average, which is 3- to 8-fold more often than the general population. Little is known about the factors that contribute to potentially preventable ED use in this population. Objective: To identify the clinical and sociodemographic factors associated with potentially preventable ED use among patients receiving maintenance dialysis. Design, Setting, and Participants: This cohort study used linked administrative health data within the Alberta Kidney Disease Network to identify adults aged 18 years or older receiving maintenance dialysis (ie, hemodialysis or peritoneal dialysis) between April 1, 2010, and March 31, 2019. Patients who had been receiving dialysis for more than 90 days were followed up from cohort entry (defined as dialysis start date plus 90 days) until death, outmigration from the province, receipt of a kidney transplant, or end of study follow-up. The Andersen behavioral model of health services was used as a conceptual framework to identify variables related to health care need, predisposing factors, and enabling factors. Data were analyzed in March 2024. Main Outcomes and Measures: Rates of all-cause ED encounters and potentially preventable ED use associated with 4 kidney disease-specific ambulatory care-sensitive conditions (hyperkalemia, heart failure, volume overload, and malignant hypertension) were calculated. Multivariable negative binomial regression models were used to examine the association between clinical and sociodemographic factors and rates of potentially preventable ED use. Results: The cohort included 4925 adults (mean [SD] age, 60.8 [15.5] years; 3071 males [62.4%]) with kidney failure receiving maintenance hemodialysis (3183 patients) or peritoneal dialysis (1742 patients) who were followed up for a mean (SD) of 2.5 (2.0) years. In all, 3877 patients had 34â¯029 all-cause ED encounters (3100 [95% CI, 2996-3206] encounters per 1000 person-years). Of these, 755 patients (19.5%) had 1351 potentially preventable ED encounters (114 [95% CI, 105-124] encounters per 1000 person-years). Compared with patients with a nonpreventable ED encounter, patients with a potentially preventable ED encounter were more likely to be in the lowest income quintile (38.8% vs 30.9%; P < .001); to experience heart failure (46.8% vs 39.9%; P = .001), depression (36.6% vs 32.5%; P = .03), and chronic pain (60.1% vs 54.9%; P = .01); and to have a longer duration of dialysis (3.6 vs 2.6 years; P < .001). In multivariable regression analyses, potentially preventable ED use was higher for younger adults (incidence rate ratio [IRR], 1.69 [95% CI, 1.33-2.15] for those aged 18 to 44 years) and patients with chronic pain (IRR, 1.35 [95% CI, 1.14-1.61]), greater material deprivation (IRR, 1.57 [95% CI, 1.16-2.12]), a history of hyperkalemia (IRR, 1.31 [95% CI, 1.09-1.58]), and historically high ED use (ie, ≥3 ED encounters in the prior year; IRR, 1.46 [95% CI, 1.23-1.73). Conclusions and Relevance: In this study of adults receiving maintenance dialysis in Alberta, Canada, among those with ED use, 1 in 5 had a potentially preventable ED encounter; reasons for such encounters were associated with both psychosocial and medical factors. The findings underscore the need for strategies that address social determinants of health to avert potentially preventable ED use in this population.
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Serviço Hospitalar de Emergência , Diálise Renal , Humanos , Masculino , Feminino , Serviço Hospitalar de Emergência/estatística & dados numéricos , Pessoa de Meia-Idade , Diálise Renal/estatística & dados numéricos , Idoso , Alberta/epidemiologia , Adulto , Estudos de Coortes , Falência Renal Crônica/terapia , Falência Renal Crônica/epidemiologiaRESUMO
Importance: Kidney health has received increasing focus as part of comprehensive heart failure (HF) treatment efforts. However, the occurrence of clinically relevant kidney outcomes in contemporary populations with HF has not been well studied. Objective: To examine rates of incident dialysis and acute kidney injury (AKI) among Medicare beneficiaries after HF hospitalization. Design, Setting, and Participants: This retrospective cohort study evaluated adults aged 65 years or older who were hospitalized for HF across 372 sites in the Get With The Guidelines-Heart Failure registry in the US between January 1, 2014, and December 31, 2018. Patients younger than 65 years or requiring dialysis either during or prior to hospitalization were excluded. Data were analyzed from May 4, 2021, to March 8, 2024. Main Outcomes and Measures: The primary outcome was inpatient dialysis initiation in the year after HF hospitalization and was ascertained via linkage with Medicare claims data. Other all-cause and cause-specific hospitalizations were also evaluated. The covariate-adjusted association between discharge estimated glomerular filtration rate (eGFR) and 1-year postdischarge outcomes was examined using Cox proportional hazards regression models. Results: Overall, among 85â¯298 patients included in the analysis (mean [SD] age, 80 [9] years; 53% women) mean (SD) left ventricular ejection fraction was 47% (16%) and mean (SD) eGFR was 53 (29) mL/min per 1.73 m2; 54â¯010 (63%) had an eGFR less than 60 mL/min per 1.73 m2. By 1 year after HF hospitalization, 6% had progressed to dialysis, 7% had progressed to dialysis or end-stage kidney disease, and 7% had been readmitted for AKI. Incident dialysis increased steeply with lower discharge eGFR category: compared with patients with an eGFR of 60 mL/min per 1.73 m2 or more, individuals with an eGFR of 45 to less than 60 and of less than 30 mL/min per 1.73 m2 had higher rates of dialysis readmission (45 to <60: adjusted hazard ratio [AHR], 2.16 [95% CI, 1.86-2.51]; <30: AHR, 28.46 [95% CI, 25.25-32.08]). Lower discharge eGFR (per 10 mL/min per 1.73 m2 decrease) was independently associated with a higher rate of readmission for dialysis (AHR, 2.23; 95% CI, 2.14-2.32), dialysis or end-stage kidney disease (AHR, 2.34; 95% CI, 2.24-2.44), and AKI (AHR, 1.25; 95% CI, 1.23-1.27), with similar findings for all-cause mortality, all-cause readmission, and HF readmission. Baseline left ventricular ejection fraction did not modify the covariate-adjusted association between lower discharge eGFR and kidney outcomes. Conclusions and Relevance: In this study, older adults with HF had substantial risk of kidney complications, with an estimated 6% progressing to dialysis in the year after HF hospitalization. These findings emphasize the need for health care approaches prioritizing kidney health in this high-risk population.
Assuntos
Injúria Renal Aguda , Taxa de Filtração Glomerular , Insuficiência Cardíaca , Hospitalização , Medicare , Humanos , Insuficiência Cardíaca/terapia , Insuficiência Cardíaca/epidemiologia , Masculino , Feminino , Estados Unidos/epidemiologia , Idoso , Hospitalização/estatística & dados numéricos , Estudos Retrospectivos , Idoso de 80 Anos ou mais , Injúria Renal Aguda/terapia , Injúria Renal Aguda/epidemiologia , Diálise Renal/estatística & dados numéricos , Sistema de RegistrosRESUMO
INTRODUCTION: This study explored employment trends among working-age patients undergoing hemodialysis using 5-year surveys from 1996 to 2021. Policy changes affecting individuals with disabilities, the economic environment, and employment status among the general population in Japan were considered. Differences in trends by gender and health status were examined. METHODS: Employment status was categorized into employment and nonemployment; and regular, nonregular, and self. Analytical data with similar characteristics were generated over the six surveys using the propensity score method. RESULTS: The employment rate, especially among women, increased from 1996 to 2021. However, the employment rate ratio to the general population was approximately 80% for men and 50% for women, even in 2021. The employment rate increased with an expansion in nonregular employment. Women's employment trends could be explained by changes in real gross domestic product and employment quotas for individuals with disabilities. CONCLUSION: Employment trends differ by gender and by regular versus nonregular employment.
Assuntos
Emprego , Diálise Renal , Humanos , Masculino , Feminino , Diálise Renal/economia , Diálise Renal/estatística & dados numéricos , Diálise Renal/tendências , Emprego/estatística & dados numéricos , Emprego/tendências , Japão , Pessoa de Meia-Idade , Adulto , Fatores Sexuais , Inquéritos e Questionários , Pessoas com Deficiência/estatística & dados numéricos , Nível de SaúdeRESUMO
BACKGROUND: Acute kidney injury (AKI) is a life-threatening condition, especially in extreme age groups and when kidney replacement therapy (KRT) is necessary. Studies worldwide report mortality rates of 10-63% in pediatric patients undergoing KRT. METHODS: Over 13 years, this multicenter study analyzed data from 693 patients with AKI, all receiving KRT, across 74 hospitals and medical facilities in Rio de Janeiro, Brazil. RESULTS: The majority were male (59.5%), under one year old (55.6%), and treated in private hospitals (76.5%). Sixty-six percent had comorbidities. Pneumonia and congenital heart disease were the most common admission diagnoses (21.5% and 20.2%, respectively). The mortality rate was 65.2%, with lower rates in patients over 12 years (50%). Older age was protective (HR: 2.35, IQR [1.52-3.62] for neonates), and primary kidney disease had a three-fold lower mortality rate. ICU team experience (HR: 0.74, IQR [0.60-0.91]) correlated with lower mortality, particularly in hospitals treating 20 or more patients. Among the deceased, 40% died within 48 h of KRT initiation, suggesting possible late referral or treatment futility. CONCLUSIONS: This study confirms the high mortality in pediatric dialytic AKI in middle-income countries, underlining early mortality and offering critical insights for improving outcomes.
Assuntos
Injúria Renal Aguda , Diálise Renal , Humanos , Masculino , Injúria Renal Aguda/terapia , Injúria Renal Aguda/mortalidade , Injúria Renal Aguda/epidemiologia , Injúria Renal Aguda/etiologia , Criança , Feminino , Pré-Escolar , Lactente , Brasil/epidemiologia , Diálise Renal/estatística & dados numéricos , Adolescente , Recém-Nascido , Estudos Retrospectivos , Comorbidade , Fatores de RiscoRESUMO
BACKGROUND: Access to kidney transplantation (KT) remains challenging for patients with end-stage kidney disease. This study assessed women's access to KT in France by considering comorbidities and neighbourhood social deprivation. METHODS: All incident patients 18-85 years old starting dialysis in France between 1 January 2017 and 31 December 2019 were included. Three outcomes were assessed: access to the KT waiting list after dialysis start, KT access after waitlisting and KT access after dialysis start. Cox and Fine-Gray models were used. Gender-European Deprivation Index and gender-age interactions were tested and analyses were performed among strata if required. RESULTS: A total of 29 395 patients were included (35% of women). After adjusting for social deprivation and comorbidities, women were less likely to be waitlisted at 1 year {adjusted hazard ratio [adjHR] 0.91 [95% confidence interval (CI) 0.87-0.96]} and 3 years [adjHR 0.87 (95% CI 0.84-0.91)] after dialysis initiation. This disparity concerned mainly women ≥60 years of age [adjHR 0.76 (95% CI 0.71-0.82) at 1 year and 0.75 (0.71-0.81) at 3 years]. Access to KT after 2 years of waitlisting was similar between genders. Access to KT was similar between genders at 3 years after dialysis start but decreased for women after 4 years [adjHR 0.93 (95% CI 0.88-0.99)] and longer [adjHR 0.90 (95% CI 0.85-0.96)] follow-up. CONCLUSIONS: In France, women are less likely to be waitlisted and undergo KT. This is driven by the ≥60-year-old group and is not explained by comorbidities or social deprivation level.
Assuntos
Comorbidade , Acessibilidade aos Serviços de Saúde , Falência Renal Crônica , Transplante de Rim , Listas de Espera , Humanos , Transplante de Rim/estatística & dados numéricos , Feminino , Pessoa de Meia-Idade , França/epidemiologia , Idoso , Falência Renal Crônica/terapia , Falência Renal Crônica/cirurgia , Falência Renal Crônica/epidemiologia , Adulto , Masculino , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Adolescente , Adulto Jovem , Privação Social , Idoso de 80 Anos ou mais , Fatores Sexuais , Diálise Renal/estatística & dados numéricos , SeguimentosRESUMO
OBJECTIVES: Restless legs syndrome (RLS) is a common complaint in patients undergoing hemodialysis (HD). Despite the fact that the estimated prevalence of RLS among HD patients is widely reported, these results varied significantly in the relevant literature. Due to this limitation, the aim of this study was to determine the global prevalence of RLS among HD patients. METHODS: This systematic review was conducted and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses 2020 statement. We searched the electronic databases: Cochrane Library, PubMed, Embase, Web of Science, Scopus, Cumulative Index to Nursing and Allied Health Literature, China Knowledge Resource Integrated Database, Wanfang Database, Chinese Biomedical Database, and Weipu Database. A random effects model was employed to calculate pooled prevalence rates. RESULTS: The global pooled prevalence of RLS in HD patients was 27.2% (95% CI: 24.8-29.7). Stratified analyses demonstrated that included studies with sample size <100 had the highest pooled prevalence of RLS. The prevalence of RLS using clinical interviews and questionnaires was 28.7% (95% CI: 25.2-32.2) and 25.9% (95% CI: 22.8-29.1), respectively. RLS prevalence is higher in females (29.7%, 95% CI: 26.2-33.2) HD patients than in males (23.5%, 95% CI: 20.9-26.0), and the African region has the highest prevalence in the world when the diagnostic criteria were restricted to the 2003 version of International RLS Study Group criteria, the prevalence of RLS was highest (28.9%, 95% CI: 25.9-31.9). CONCLUSION: Our results revealed a high RLS prevalence in HD patients worldwide. However, the prevalence of RLS among HD patients varied significantly based on sample size, data collection method, gender, diagnostic criteria, and geographical region.
Assuntos
Diálise Renal , Síndrome das Pernas Inquietas , Síndrome das Pernas Inquietas/epidemiologia , Síndrome das Pernas Inquietas/etiologia , Humanos , Diálise Renal/estatística & dados numéricos , Diálise Renal/efeitos adversos , Prevalência , Saúde Global/estatística & dados numéricos , FemininoRESUMO
INTRODUCTION: Rural areas face significant disparities in dialysis care compared to urban areas due to limited access to dialysis facilities, longer travel distances, and a shortage of healthcare professionals. The objective of this study was to conduct a national examination of rural-urban differences in quality of dialysis care offered across counties in the USA. METHODS: Data were gathered from Medicare-certified dialysis facilities in 2020 from the Centers for Medicare and Medicaid Services website. To identify high-need counties, county-level estimated crude prevalence of diabetes in adults was obtained from the 2022 CDC PLACES data portal. Our analysis reviewed 3,141 counties in the USA. The primary outcome measured was whether the county had a dialysis facility. Among those counties that had a dialysis facility, additional outcomes were the average star rating, whether peritoneal dialysis was offered, and whether home dialysis was offered. RESULTS: The type of services offered by dialysis facilities varied significantly, with peritoneal dialysis being the most commonly offered service (50.8%), followed by home hemodialysis (28.5%) and late-shift services (16.0%). These service availabilities are more prevalent in urban facilities than in rural facilities. The Centers for Medicare and Medicaid Services Five Star Quality ratings were quite different between urban and rural facilities, with 40.4% of rural facilities having a ranking of five, compared to 27.1% in urban. CONCLUSION: The majority of rural counties lack a single dialysis facility. Counties with high rates of chronic kidney disease, diabetes, and blood pressure, deemed high need, were less likely to have a highly rated dialysis facility. The findings can be used to further inform targeted efforts to increase diabetes educational programming and design appropriate interventions to those residing in rural communities and high-need counties who may need it the most.
Assuntos
Acessibilidade aos Serviços de Saúde , Qualidade da Assistência à Saúde , Diálise Renal , Humanos , Estados Unidos , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Acessibilidade aos Serviços de Saúde/normas , Diálise Renal/estatística & dados numéricos , Qualidade da Assistência à Saúde/estatística & dados numéricos , População Rural/estatística & dados numéricos , Falência Renal Crônica/terapia , Falência Renal Crônica/epidemiologia , População Urbana/estatística & dados numéricos , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/terapia , Disparidades em Assistência à Saúde/estatística & dados numéricos , Hemodiálise no Domicílio/estatística & dados numéricos , Diálise Peritoneal/estatística & dados numéricos , Diálise Peritoneal/normas , Medicare/estatística & dados numéricosRESUMO
BACKGROUND: Chronic kidney failure (CKF) is often treated with dialysis, which is invasive and costly and carries major medical risks. The existing studies of patients with CKF requiring dialysis that are based on claims data from German statutory health insurance (SHI) carriers employ varying definitions of this entity, with unclear consequences for the resulting statistical estimates. METHODS: We carried out a cohort study on four random samples, each consisting of 62 200 persons aged 70 or above, from among the insurees of the SHI AOK Nordost, with one sample for each of the years 2012, 2014, 2016, and 2018. The prevalence, incidence, mortality, and direct health care costs of CKF requiring dialysis were estimated and compared on the basis of four different definitions from literature and a new definition developed by the authors in reference to billing data. RESULTS: The different definitions led to variation in 12-month prevalences (range: 0.33-0.61%) and 6-month incidences (0.058-0.100%). The percentage of patients with prior acute kidney injury (AKI) ranged from 27.6% to 61.8%. Among incident patients, three-month survival ranged from 70.2% to 88.1%, and six-month survival from 60.5% to 81.3%. In CKF patients without prior AKI, the survival curves differed less across definitions (80.2-91.8% at three months, 70.7-84.4% at six months). The monthly health care costs ranged from 6010 to 9606, with marked variability across definitions in the costs of inpatient and outpatient care. CONCLUSION: The lack of a standardized definition of CKF requiring dialysis in German SHI claims data leads to variability in the estimated case numbers, mortality, and health care costs. These differences are most probably in part due to the variable inclusion of inpatients who received short-term dialysis after AKI.
Assuntos
Falência Renal Crônica , Diálise Renal , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Estudos de Coortes , Alemanha , Custos de Cuidados de Saúde/estatística & dados numéricos , Incidência , Revisão da Utilização de Seguros/estatística & dados numéricos , Seguro Saúde/estatística & dados numéricos , Falência Renal Crônica/terapia , Prevalência , Diálise Renal/economia , Diálise Renal/estatística & dados numéricosRESUMO
INTRODUCTION: This study aimed to determine the health literacy level and related factors of older adults receiving hemodialysis treatment. METHODS: A cross-sectional study was conducted at the five dialysis centers, using the information form and Turkish Health Literacy Survey-32 (THLS-32). A total of 336 older adults receiving hemodialysis treatment participated. RESULTS: The general health literacy score was found to be 25.69 ± 14.47. Based on the health literacy assessment scores, 62.5% of the participants were in the category of inadequate and limited level of health literacy. The lower level of education, perceived health status, income, and getting help in reading and writing were statistically significant predictors of the health literacy score. CONCLUSION: The health literacy of older adults receiving hemodialysis treatment was inadequate and limited. Findings of this study emphasize the importance of integrating health literacy assessment in clinical care settings and supporting the health literacy of older adults receiving hemodialysis treatment.