Cover Stories

Frailty in Dialysis Patients and Increased Hospitalization and Mortality

According to the United States Renal Data System, 44.5% of patients with end-stage renal disease (ESRD) who receive maintenance dialysis are ≥65 years of age. In addition, the prevalence of ESRD patients on dialysis is increasing rapidly among older age groups. In a nationwide ESRD patient registry in Korea, the mean age of these patients increased from 55.2 years in ... Read More »

Temporal Trends in Intensive Procedures at End of Life in Dialysis Patients

The percentage of Medicare spending for treatments for beneficiaries approaching the end of life is disproportionately high; in 2011 Medicare spent approximately $170 billion (28% of the agency’s total budget) in care for beneficiaries in their last 6 months of life. The spending reflects intensive inpatient-oriented patterns of care aimed at treating underlying disease and prolonging survival. Despite recent efforts ... Read More »

Mortality in Patients Initiating Dialysis Therapy Varies by Indications

More than 115,000 patients with chronic kidney failure initiate dialysis therapy in the United States each year. For those patients, the transition period is a vulnerable time. The annual rates of mortality from chronic kidney disease (CKD) stage 5 through the first year of maintenance dialysis therapy are more than 20%. According to Matthew B. Rivara, MD, and colleagues, clinician ... Read More »

Outcomes of Acute Kidney Injury Episodes Vary over Time

One in seven hospital admissions results in acute kidney injury (AKI). Patients with increases in creatinine levels have a four-fold greater rate of hospital mortality than those with no increase in creatinine level. Further, the prognosis for patients who survive to hospital discharge is poor. According to Simon Sawhney, MBChB, and colleagues in Scotland, there are few data on how ... Read More »

Patient Perspectives on Dialysis Modality Decision Making and Choice

More than 100,000 patients initiate replacement therapy for kidney failure each year. Clinical practice guidelines and the Centers for Medicare & Medicaid Services Conditions for Coverage call for patients with kidney failure being provided with information about all options for renal replacement therapy (RRT). However, according to researchers, >90% of patients in the United States initiating RRT are started on ... Read More »

Lifetime Risk of ESRD in the United States Varies by Race/Ethnicity

There were more than 600,000 prevalent patients with end-stage renal disease (ESRD) in the United States at the end of 2012. For prevalent patients 60 to 65 years of age, those in dialysis had a life expectancy of 5.5 years and those who received a kidney transplant had a life expectancy of 15.4 years. Those life expectancies compared with 19.1 ... Read More »

Ultrafiltration Rate and Mortality in Hemodialysis Patients

Among patients on hemodialysis, fluid removal practices likely contribute to poor outcomes, including high rates of morbidity and mortality. There are data that suggest an association between more rapid fluid removal during dialysis and greater mortality. It is plausible that end-organ ischemia of the heart, brain, and gut from overt and subclinical hemodynamic instability underlie this association, according to Magdalene ... Read More »

Nonadherence to Medication Is Risk Factor for Mortality in Predialysis Patients

Patients with end-stage renal disease (ESRD) have high mortality rates, creating a need for the identification and correction of modifiable risk factors that are associated with all-cause mortality in that patient population. The few interventions that have been shown to be associated with improved outcomes in patients with ESRD include timely arteriovenous fistula creation and adequate access to specialist care ... Read More »

High-Dose Continuous Venovenous Hemodiafiltration Not Superior to Conventional Dose

Critically ill patients often experience acute kidney injury (AKI). AKI has a poor prognostic impact on morbidity and mortality among patients with AKI; the mortality rate in that patient population increases to approximately 60% to 80%. The most common cause of AKI is sepsis, particularly among patients admitted to the intensive care unit (ICU). Sepsis accounts for >50% of all ... Read More »

Serum Magnesium Level and Risk of Hospitalization in Peritoneal Dialysis Patients

The fourth most abundant cation in the body is magnesium. After potassium, magnesium is the second most plentiful intracellular cation. Nearly 70% of serum magnesium is in the free ionized form, which has a key role in maintaining internal homeostasis via actions in the endocrine, musculoskeletal, nervous, and cellular messenger systems. In adults, the reference range for total serum magnesium ... Read More »