Age Variations in Risks of Complications Related to CVC Use in Hemodialysis

The most common treatment for patients with chronic kidney failure is hemodialysis, requiring reliable access to the bloodstream. There are three types of vascular access: arteriovenous fistulas (AVFs), arteriovenous grafts (AVGs), and central venous catheters (CVCs). AVFs are strongly recommended in international guidelines; guidelines also discourage the use of CVCs for long-term vascular access. However, the use of CVCs worldwide ... Read More »

Transition versus Nontransition to Dialysis and Glycemic Status and Mortality

Because most previous trials of glycemic control excluded patients with advanced kidney disease, the optimal glycemic target in patients with chronic kidney disease (CKD) remains unclear. Earlier studies have shown microvascular and macrovascular benefits of intensive glycemic control in patients with both type 1 and type 2 diabetes with minimal to no kidney damage. However, more recent trials have shown ... Read More »

Muscle Relaxant Use and Risk for Adverse Outcomes in Patients Receiving Hemodialysis

Muscle relaxants are used by individuals in the United States for a variety of conditions, including musculoskeletal and spastic disorders, despite lack of clear evidence of their efficacy and safety. Associations between use of muscle relaxants and central nervous system side effects such as drowsiness and sedation have been seen in the general population, as well as increased risk for ... Read More »

Cost-Effectiveness of Screening for Latent Tuberculosis Infection in Migrants with CKD

Worldwide, tuberculosis (TB) remains a leading cause of death due to infectious disease despite steady declines in TB incidence. For some countries that receive immigrants, the continuance of TB is due, in part, to reactivation of undetected latent TB infection (LTBI). Identification and effective treatment of LTBI significantly reduces TB reactivation. Mass screening is not cost-effective; however, targeted screening of ... Read More »

Cinacalcet Prescription Varies across US Hemodialysis Facilities

Since the implementation of the Medicare ESRD [end-stage renal disease] Prospective Payment System (PPS), i.e., bundle payments, dialysis facilities are reimbursed at a flat rate for a bundle of ESRD-related drugs, supplies, and services per dialysis treatment. Adjustment to the base rate is made to account for patient-level case-mix and facility-level factors that are associated with higher costs related to ... Read More »

Intensive Blood Pressure Control and Kidney Injury Markers: ACCORD Trial Subset Analysis

The SPRINT (Systolic Blood Pressure Intervention Trial) found a reduction in cardiovascular events in participants randomly assigned to a systolic blood pressure <120 mm Hg compared with those randomly assigned to standard treatment (systolic blood pressure <140 mm Hg). Those findings have increased efforts across the healthcare spectrum for aggressive blood control. However, over time, aggressive blood pressure control may ... Read More »

ESRD Risk Higher in Recurrent Kidney Stone Formers than in Incident Kidney Stone Formers

It is thought that patients who form kidney stones are at increased risk for cardiovascular events, chronic kidney disease (CKD), and end-stage renal disease (ESRD); if that increased risk is accurate, it may also be expected that kidney stone formers are at increased risk for mortality. Those patients also have an increased comorbidity burden, including dyslipidemia, hypertension, diabetes, and metabolic ... Read More »

Missed Hemodialysis Treatments Associated with Increased Risk of Mortality

Hemodialysis therapy is typically provided three times a week for several hours for each treatment, creating considerable burdens on patients. There are wide variations in the extent to which those burdens affect patients’ quality of life; there may be negative effects on patient adherence to their treatment regimens among those who find their regimens particularly burdensome. One form of nonadherence ... Read More »

Levels of Trace Elements in Pediatric Patients with End-Stage Renal Disease

Nutritional disturbances are often seen in children with end-stage renal disease (ESRD), potentially affecting their growth and development. Some nutritional elements and electrolytes are part of routine monitoring in patients with chronic kidney disease (CKD) and in pediatric dialysis patients; however, there are no examinations of levels of trace elements until after significant complications and/or problems arise. Pediatric patients on ... Read More »