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Results: 31 to 40 of 371

Publication Record


Considerations and challenges in defining optimal iron utilization in hemodialysis.
Charytan DM, Pai AB, Chan CT, Coyne DW, Hung AM, Kovesdy CP, Fishbane S, Dialysis Advisory Group of the American Society of Nephrology
(2015) J Am Soc Nephrol 26: 1238-47
MeSH Terms: Anemia, Iron-Deficiency, Animals, Cross-Sectional Studies, Disease Models, Animal, Dose-Response Relationship, Drug, Drug Administration Schedule, Erythropoietin, Ferritins, Hematinics, Humans, Infusions, Intravenous, Iron Compounds, Kidney Failure, Chronic, Prognosis, Randomized Controlled Trials as Topic, Renal Dialysis, Risk Assessment, Treatment Outcome
Show Abstract · Added January 6, 2015
Trials raising concerns about erythropoiesis-stimulating agents, revisions to their labeling, and changes to practice guidelines and dialysis payment systems have provided strong stimuli to decrease erythropoiesis-stimulating agent use and increase intravenous iron administration in recent years. These factors have been associated with a rise in iron utilization, particularly among hemodialysis patients, and an unprecedented increase in serum ferritin concentrations. The mean serum ferritin concentration among United States dialysis patients in 2013 exceeded 800 ng/ml, with 18% of patients exceeding 1200 ng/ml. Although these changes are broad based, the wisdom of these practices is uncertain. Herein, we examine influences on and trends in intravenous iron utilization and assess the clinical trial, epidemiologic, and experimental evidence relevant to its safety and efficacy in the setting of maintenance dialysis. These data suggest a potential for harm from increasing use of parenteral iron in dialysis-dependent patients. In the absence of well powered, randomized clinical trials, available evidence will remain inadequate for making reliable conclusions about the effect of a ubiquitous therapy on mortality or other outcomes of importance to dialysis patients. Nephrology stakeholders have an urgent obligation to initiate well designed investigations of intravenous iron in order to ensure the safety of the dialysis population.
Copyright © 2015 by the American Society of Nephrology.
0 Communities
1 Members
0 Resources
18 MeSH Terms
Phosphorus binding with ferric citrate is associated with fewer hospitalizations and reduced hospitalization costs.
Rodby R, Umanath K, Niecestro R, Jackson JH, Sika M, Lewis JB, Dwyer JP, Collaborative Study Group
(2015) Expert Rev Pharmacoecon Outcomes Res 15: 545-50
MeSH Terms: Adult, Chelating Agents, Cost Savings, Ferric Compounds, Hospital Costs, Hospitalization, Humans, Kidney Failure, Chronic, Phosphorus, Renal Dialysis
Show Abstract · Added January 30, 2015
BACKGROUND - Ferric citrate (FC) is a new phosphorus binder shown to increase serum iron stores while reducing intravenous iron and erythropoiesis-stimulating agent usage. Such reductions could lower hospitalization rates and associated costs.
METHODS - Hospitalizations during a Phase III trial were compared between FC and active control (AC). Hospitalization costs were estimated using the 2013 US Renal Data System Annual Data Report.
RESULTS - 34.6% of FC patients were hospitalized at least once versus 45.6% of the AC group (risk reduction 24.2%; p = 0.02). There were 181 unique hospitalizations in the FC group versus 239 in the AC group, for a difference of 58 hospitalizations. Total potential savings was US$ 867,622 in hospitalization costs in the FC group. If the hospitalization reduction in our study was applied to the general end-stage renal disease population, this could translate into a savings of US$ 3002/patient/year.
CONCLUSIONS - Patients receiving FC experienced fewer hospitalizations with the potential for significant savings.
0 Communities
1 Members
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10 MeSH Terms
Dysfunctional high-density lipoproteins in children with chronic kidney disease.
Kaseda R, Jabs K, Hunley TE, Jones D, Bian A, Allen RM, Vickers KC, Yancey PG, Linton MF, Fazio S, Kon V
(2015) Metabolism 64: 263-73
MeSH Terms: Adolescent, Apoptosis, Biological Transport, Cardiovascular Diseases, Cell Adhesion, Cell Line, Cell Proliferation, Cells, Cultured, Chemotaxis, Child, Child, Preschool, Cholesterol, Coculture Techniques, Endothelium, Vascular, Human Umbilical Vein Endothelial Cells, Humans, Infant, Kidney Failure, Chronic, Lipoproteins, HDL, Macrophages, Renal Insufficiency, Chronic, Risk Factors, Severity of Illness Index, Tennessee
Show Abstract · Added February 12, 2015
OBJECTIVES - Our aim was to determine if chronic kidney disease (CKD) occurring in childhood impairs the normally vasoprotective functions of high-density lipoproteins (HDLs).
MATERIALS AND METHODS - HDLs were isolated from children with end-stage renal disease on dialysis (ESRD), children with moderate CKD and controls with normal kidney function. Macrophage response to HDLs was studied as expression of inflammatory markers (MCP-1, TNF-α, IL-1β) and chemotaxis. Human umbilical vein endothelial cells were used for expression of adhesion molecules (ICAM-1, VCAM-1, E-selectin) and adhesion. Cellular proliferation, apoptosis, and necrosis of endothelial cells were measured by MTS/PMS reagent-based assay, flow cytometry, and ELISA. Cholesterol efflux was assessed by gas chromatographic measurements of cholesterol in macrophages exposed to HDLs.
RESULTS - Compared with HDL(Control), HDL(CKD) and HDL(ESRD) heightened the cytokine response and disrupted macrophage chemotaxis. HDL(Control) reduced endothelial expression of ICAM-1, VCAM-1, E-selectin, whereas HDL(CKD) and HDL(ESRD) were less effective and showed reduced capacity to protect endothelial cells against monocyte adhesion. Compared with a dramatically enhanced endothelial proliferation following injurious stimulus by HDL(Control), neither HDL(CKD) nor HDL(ESRD) caused proliferative effects. HDLs of all three groups were equally protective against apoptosis assessed by flow cytometry and cleaved caspase-3 activity. Compared to HDL(Control), HDL(CKD) and HDL(ESRD) trended toward reduced capacity as cholesterol acceptors.
CONCLUSION - CKD in children impairs HDL function. Even in the absence of long-standing and concomitant risk factors, CKD alters specific HDL functions linked to control of inflammation and endothelial responses.
Copyright © 2015 Elsevier Inc. All rights reserved.
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2 Members
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24 MeSH Terms
Rethinking the restriction on nutrition during hemodialysis treatment.
Kistler BM, Fitschen PJ, Ikizler TA, Wilund KR
(2015) J Ren Nutr 25: 81-7
MeSH Terms: Eating, Humans, Kidney Failure, Chronic, Nutritional Status, Practice Guidelines as Topic, Renal Dialysis, United States
Show Abstract · Added August 5, 2015
The annual mortality rate for patients undergoing maintenance hemodialysis (MHD) treatment in the United States is 20%, a rate higher than most other countries in the world. Poor nutrition status in MHD patients contributes to this adverse outcome as well as poor quality of life. Providing oral nutrition to MHD patients, especially during hemodialysis (HD) treatment has many potential benefits including improvements in nutrition status and attenuating HD-related muscle wasting. However, this practice is generally restricted in the United States presumably because of concerns that include worsening hemodynamic instability, reductions in treatment efficiency, and increased gastrointestinal symptoms. Despite widespread restrictions, few studies have adequately examined the effect of eating during HD on these outcomes, leaving many questions unanswered. This review outlines the current evidence regarding the effects of feeding during HD and provides potential future directions to outline the best practices in this controversial area.
Copyright © 2015 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.
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1 Members
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7 MeSH Terms
Myoglobin cast nephropathy in a kidney transplant patient with normal creatine kinase.
Oliveira da Fonseca E, Jittirat A, Birdwell KA, Fogo AB
(2015) Am J Kidney Dis 65: 628-31
MeSH Terms: Adult, Biomarkers, Biopsy, Creatine Kinase, Delayed Graft Function, Diagnosis, Differential, Female, Graft Rejection, Graft Survival, Humans, Kidney, Kidney Diseases, Kidney Failure, Chronic, Kidney Transplantation, Myoglobin, Treatment Outcome
Show Abstract · Added January 20, 2015
Delayed graft function in kidney transplant recipients is a known complication associated with increased risk of acute rejection and reduced transplant survival after 1 year. There are multiple risk factors, including prolonged cold ischemia time, donor age, and cause of donor's death. Major causes of delayed graft function are acute kidney injury in the donor, often from prolonged terminal ischemia, reflected by acute tubular injury in the recipient. However, the differential diagnosis of delayed graft function includes acute rejection, recurrence of the primary glomerular diseases, and other less commonly encountered conditions. A transplant kidney biopsy usually is required to elucidate the correct cause and initiate the right treatment, which is crucial for transplant survival. We report a case of a transplant recipient who developed delayed graft function due to an uncommon cause. After correct diagnosis, the patient's transplant function improved.
Copyright © 2015 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.
0 Communities
1 Members
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16 MeSH Terms
Changes in symptom burden and physical performance with initiation of dialysis in patients with chronic kidney disease.
Rivara MB, Robinson-Cohen C, Kestenbaum B, Roshanravan B, Chen CH, Himmelfarb J, Mehrotra R
(2015) Hemodial Int 19: 147-50
MeSH Terms: Humans, Kidney Failure, Chronic, Renal Dialysis
Added September 19, 2017
0 Communities
1 Members
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3 MeSH Terms
Role of endothelial nitric oxide synthase in diabetic nephropathy: lessons from diabetic eNOS knockout mice.
Takahashi T, Harris RC
(2014) J Diabetes Res 2014: 590541
MeSH Terms: Albuminuria, Animals, Diabetic Nephropathies, Disease Models, Animal, Disease Progression, Genotype, Humans, Kidney, Kidney Failure, Chronic, Mice, Knockout, Nitric Oxide Synthase Type III, Phenotype
Show Abstract · Added December 8, 2014
Diabetic nephropathy (DN) is the leading cause of end-stage renal disease in many countries. The animal models that recapitulate human DN undoubtedly facilitate our understanding of this disease and promote the development of new diagnostic markers and therapeutic interventions. Based on the clinical evidence showing the association of eNOS dysfunction with advanced DN, we and others have created diabetic mice that lack eNOS expression and shown that eNOS-deficient diabetic mice exhibit advanced nephropathic changes with distinct features of progressive DN, including pronounced albuminuria, nodular glomerulosclerosis, mesangiolysis, and arteriolar hyalinosis. These studies clearly defined a critical role of eNOS in DN and developed a robust animal model of this disease, which enables us to study the pathogenic mechanisms of progressive DN. Further, recent studies with this animal model have explored the novel mechanisms by which eNOS deficiency causes advanced DN and provided many new insights into the pathogenesis of DN. Therefore, here we summarize the findings obtained with this animal model and discuss the roles of eNOS in DN, unresolved issues, and future investigations of this animal model study.
1 Communities
1 Members
0 Resources
12 MeSH Terms
Financial implications to Medicare from changing the dialysis modality mix under the bundled prospective payment system.
Liu FX, Walton SM, Leipold R, Isbell D, Golper TA
(2014) Perit Dial Int 34: 749-57
MeSH Terms: Adult, Aged, Cost-Benefit Analysis, Female, Health Care Costs, Humans, Kidney Failure, Chronic, Male, Medicare, Middle Aged, Models, Economic, Peritoneal Dialysis, Prospective Payment System, Renal Dialysis, United States
Show Abstract · Added August 7, 2015
BACKGROUND - The economic burden of treating end-stage renal disease (ESRD) continues to grow. As one response, effective January 1, 2011, Medicare implemented a bundled prospective payment system (PPS, including injectable drugs) for dialysis patients. This study investigated the 5-year budget impact on Medicare under the new PPS of changes in the distribution of patients undergoing peritoneal dialysis (PD), in-center hemodialysis (ICHD), and home hemodialysis (HHD).
METHODS - An Excel-based budget impact model was created to assess dialysis-associated Medicare costs. The model accounted for dialysis access establishment, the current monthly capitation physician payment for ESRD, Medicare dialysis payments (including start-up costs), training, oral drug costs, and the costs and probabilities of adverse events including access failure, hospitalization for access infection, pneumonia, septicemia, and cardiovascular events. United States Renal Data System (USRDS) data were used to project the US Medicare dialysis patient population across time. The baseline scenario assumed a stable distribution of PD (7.7%), HHD (1.3%) and ICHD (91.0%) over 5 years. Three comparison scenarios raised the proportions of PD and HHD by (1) 1% and 0.5%, (2) 2% and 0.75%, and (3) 3% and 1% each year; a fourth scenario held HHD constant and lowered PD by 1% per year.
RESULTS - Under the bundled PPS, scenarios that increased PD and HHD from 7.7% and 1.3% over 5 years resulted in cumulative savings to Medicare of $114.8M (Scenario 1, 11.7% PD and 3.3% HHD at year 5), $232.9M (Scenario 2, 15.7% PD and 4.3% HHD at year 5), and $350.9M (Scenario 3, 19.7% PD and 5.3% HHD at year 5). When the PD population was decreased from 7.7% in 2013 to 3.7% by 2017 with a constant HHD population, the total Medicare payment for dialysis patients increased by over $121.2M.
CONCLUSIONS - Under Medicare bundled PPS, increasing the proportion of patients on PD and HHD vs ICHD could generate substantial savings in dialysis-associated costs to Medicare.
Copyright © 2014 International Society for Peritoneal Dialysis.
0 Communities
1 Members
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15 MeSH Terms
Hypertension: is it time to reconsider blood pressure guidelines?
Burgner A, Lewis JB
(2014) Nat Rev Nephrol 10: 620-1
MeSH Terms: Female, Humans, Hypertension, Kidney Failure, Chronic, Male
Added February 5, 2016
0 Communities
1 Members
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5 MeSH Terms
Ferric citrate spans mineral metabolism and anemia domains in ESRD: a review of efficacy and safety data.
Sinsakul M, Rodby R, Umanath K, Niecestro R, Dwyer JP
(2014) Expert Rev Clin Pharmacol 7: 705-10
MeSH Terms: Anemia, Chelating Agents, Ferric Compounds, Humans, Hyperphosphatemia, Kidney Failure, Chronic, Phosphates, Phosphorus
Show Abstract · Added October 28, 2014
Ferric citrate (Zerenex™, Keryx Biopharmaceuticals, Inc.), a phosphate binder drug candidate, recently completed a Phase III program confirming efficacy and demonstrating safety when used to treat hyperphosphatemia in patients with end-stage renal disease. Results of these trials demonstrate that ferric citrate effectively controls serum phosphorus and is well tolerated. Additionally, these studies demonstrate that ferric citrate improves iron parameters and reduces IV iron and erythropoietin stimulating agent utilization while maintaining hemoglobin levels. These unique features may further benefit the management of end-stage renal disease-related anemia.
0 Communities
1 Members
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8 MeSH Terms