201 results found
Crabtree JH, Shrestha BM, Chow K-M, et al., 2019, Creating and maintaining optimal peritoneal dialysis access in the adult patient: 2019 update, Peritoneal Dialysis International, Vol: 39, Pages: 414-436, ISSN: 0896-8608
The success of peritoneal dialysis (PD) as renal replacement therapy depends upon a safe, functional, and durable catheter access to the peritoneal cavity provided in a timely fashion. Catheter complications often lead to catheter loss and contribute to technique failure. With improvements in prevention and treatment of peritonitis, the impact of catheter-related infections and mechanical problems on PD technique survival has become more apparent.Guideline committees under the sponsorship of the International Society for Peritoneal Dialysis (ISPD) periodically update best practices for optimal peritoneal access (1–4). Recent advances in our understanding of the key aspects of providing successful placement and maintenance of peritoneal catheters compels the current update. Assessment of evidence for guidelines recommendations is made using a modification of the Grades of Recommendation Assessment, Development and Evaluation (GRADE) system for classification of the level of evidence and grade of recommendations (5). Where scientific evidence is not available, recommendations are based on a consensus opinion. The bibliography supporting the recommendations is not intended to be comprehensive. When there are multiple similar reports on the same subject, the committee prefers to cite the more recent publications.Within each recommendation, strength is indicated as Level 1 (we recommend), Level 2 (we suggest), or not graded, and the quality of the supporting evidence is shown as A (high quality), B (moderate quality), C (low quality), or D (very low quality). The recommendations are not meant to be implemented indiscriminately in every instance but adapted as necessary according to local circumstances and the clinical situation. While many of the general principles presented here may be applied to pediatric patients, the focus of these guidelines is on adults. Clinicians who take care of pediatric PD patients should refer to the latest ISPD guidelines covering this
Brown EA, Farrington K, 2019, Geriatric Assessment in Advanced Kidney Disease., Clin J Am Soc Nephrol, Vol: 14, Pages: 1091-1093
Beckwith H, Clemenger M, McGrory J, et al., 2019, Repeat peritoneal dialysis exit-site infection: definition and outcomes, Peritoneal Dialysis International, Vol: 39, Pages: 344-349, ISSN: 1718-4304
Background: The most common complication of peritoneal dialysis (PD) is infection. Despite this, there are no clear guidelines for the management of repeat exit-site infection (ESI), and best practice is not known. We describe our unit's experience of repeat ESI and clinical outcomes in this cohort.Methods: Retrospective case note review of all PD patients with positive ESI swabs at our center between 1 January 2012 and 1 January 2018. Patients were included in the study if they had 2 or more ESI with the same organism within a 12-month period and an initial positive response to antibiotic therapy.Results: Overall, 31 of 248 patients had repeat ESI. The 2 most common causative organisms were Staphylococcus aureus (n = 16, 52%) and Pseudomonas aeruginosa (n = 10, 32%). Twenty (65%) patients developed subsequent peritonitis. The infection resolved with further antibiotics alone in 10 (32%) patients and in 6 patients after PD catheter exchange. The PD catheter was removed in 16 (52%) patients (including 5 after an initial catheter exchange) requiring transfer to hemodialysis (HD). Six (19%) patients died within 12 months of repeat ESI. Both repeat Pseudomonas aeruginosa and Staphylococcus aureus infections were associated with high rates of dialysis modality change (70% and 50%, respectively).Conclusion: We have developed the first definition for repeat ESI. Repeat ESI is clinically important and results in significant morbidity and mortality. Following repeat ESI, peritonitis rates are high and a significant number of patients switch dialysis modality. Studies are needed to determine whether interventions such as early catheter exchange would improve outcomes.
Iyasere O, Brown EA, Johansson L, et al., 2019, Quality of life with conservative care compared with assisted peritoneal dialysis and haemodialysis, Clinical Kidney Journal, Vol: 12, Pages: 262-268, ISSN: 2048-8505
BackgroundThere is little information about quality of life (QoL) for patients with end-stage kidney disease (ESKD) choosing conservative kidney management (CKM). The Frail and Elderly Patients on Dialysis (FEPOD) study demonstrated that frailty was associated with poorer QoL outcomes with little difference between dialysis modalities [assisted peritoneal dialysis (aPD) or haemodialysis (HD)]. We therefore extended the FEPOD study to include CKM patients with estimated glomerular filtration rate ≤10 mL/min/1.73 m2 (i.e. individuals with ESKD otherwise likely to be managed with dialysis).MethodsCKM patients were propensity matched to HD and aPD patients by age, gender, ethnicity, diabetes status and index of deprivation. QoL outcomes measured were Short Form-12 (SF12), Hospital Anxiety and Depression Scale depression score, symptom score, Illness Intrusiveness Rating Scale (IIRS) and Renal Treatment Satisfaction Questionnaire. Frailty was assessed using the Clinical Frailty Scale. Generalized linear modelling was used to assess the impact of treatment modality on QoL outcomes, adjusting for baseline characteristics.ResultsIn total, 84 (28 CKM, 28 HD and 28 PD) patients were included. Median age for the cohort was 82 (79–88) years. Compared with CKM, aPD was associated with higher SF12 physical component score (PCS) [Exp B (95% confidence interval) = 1.20 (1.00–1.45), P < 0.05] and lower symptom score [Exp B = 0.62 (0.43–0.90), P = 0.01]; depression score was lower in HD compared with CKM [Exp B = 0.70 (0.52–0.92), P = 0.01]. Worsening frailty was associated with higher depression scores [Exp B = 2.59 (1.45–4.62), P < 0.01], IIRS [Exp B = 1.20 (1.12–1.28), P < 0.01] and lower SF12 PCS [Exp B = 0.87 (0.83–0.93), P < 0.01].ConclusionTr
Iyasere O, Brown E, Gordon F, et al., 2019, LONGITUDINAL TRENDS IN QUALITY OF LIFE AND PHYSICAL FUNCTION IN FRAIL OLDER DIALYSIS PATIENTS: A COMPARISON OF ASSISTED PERITONEAL DIALYSIS AND IN-CENTER HEMODIALYSIS, PERITONEAL DIALYSIS INTERNATIONAL, Vol: 39, Pages: 112-118, ISSN: 0896-8608
Brown EA, 2019, Influence of Reimbursement Policies on Dialysis Modality Distribution around the World, Clinical Journal of the American Society of Nephrology, Vol: 14, Pages: 10-12, ISSN: 1555-9041
Tong A, Manns B, Wang AYM, et al., 2018, Implementing core outcomes in kidney disease: report of the Standardized Outcomes in Nephrology (SONG) implementation workshop., Kidney Int, Vol: 94, Pages: 1053-1068
There are an estimated 14,000 randomized trials published in chronic kidney disease. The most frequently reported outcomes are biochemical endpoints, rather than clinical and patient-reported outcomes including cardiovascular disease, mortality, and quality of life. While many trials have focused on optimizing kidney health, the heterogeneity and uncertain relevance of outcomes reported across trials may limit their policy and practice impact. The international Standardized Outcomes in Nephrology (SONG) Initiative was formed to identify core outcomes that are critically important to patients and health professionals, to be reported consistently across trials. We convened a SONG Implementation Workshop to discuss the implementation of core outcomes. Eighty-two patients/caregivers and health professionals participated in plenary and breakout discussions. In this report, we summarize the findings of the workshop in two main themes: socializing the concept of core outcomes, and demonstrating feasibility and usability. We outline implementation strategies and pathways to be established through partnership with stakeholders, which may bolster acceptance and reporting of core outcomes in trials, and encourage their use by end-users such as guideline producers and policymakers to help improve patient-important outcomes.
Corbett RW, Brown E, Conventional Dialysis in The Elderly: How Lenient Should Our Guidelines Be?, Seminars in Dialysis, ISSN: 0894-0959
Manera K, Johnson D, Craig J, et al., 2018, PATIENT AND CAREGIVER PRIORITIES FOR OUTCOMES IN PERITONEAL DIALYSIS: AN INTERNATIONAL NOMINAL GROUP STUDY, 55th Congress of the European-Renal-Association (ERA) and European-Dialysis-and-Transplantation-Association (EDTA), Publisher: OXFORD UNIV PRESS, ISSN: 0931-0509
Pillay C, Arulkumaran N, Navaratnarajah A, et al., 2018, FACTORS CONTRIBUTING TO ACUTE RENAL REPLACEMENT THERAPY INITIATION IN PATIENTS WITH END-STAGE RENAL DISEASE - OUTCOMES FROM A LARGE RETROSPECTIVE COHORT STUDY, 55th Congress of the European-Renal-Association (ERA) and European-Dialysis-and-Transplantation-Association (EDTA), Publisher: OXFORD UNIV PRESS, Pages: 563-564, ISSN: 0931-0509
Manera KE, Tong A, Craig JC, et al., 2017, STANDARDIZED OUTCOMES IN NEPHROLOGY-PERITONEAL DIALYSIS (SONG-PD): STUDY PROTOCOL FOR ESTABLISHING A CORE OUTCOME SET IN PD, PERITONEAL DIALYSIS INTERNATIONAL, Vol: 37, Pages: 639-647, ISSN: 0896-8608
Vanholder R, Annemans L, Brown E, et al., 2017, Further approaches to reduce the cost of renal replacement therapy, NATURE REVIEWS NEPHROLOGY, Vol: 13, ISSN: 1759-5061
Van Biesen W, Brown EA, 2017, Diagnostic and therapeutic approach to peritonitis, NEPHROLOGY DIALYSIS TRANSPLANTATION, Vol: 32, Pages: 1283-1284, ISSN: 0931-0509
Vanholder R, Annemans L, Brown E, et al., 2017, Reducing the costs of chronic kidney disease while delivering quality health care: a call to action, NATURE REVIEWS NEPHROLOGY, Vol: 13, Pages: 393-409, ISSN: 1759-5061
Brown EA, Bargman J, van Biesen W, et al., 2017, LENGTH OF TIME ON PERITONEAL DIALYSIS AND ENCAPSULATING PERITONEAL SCLEROSIS - POSITION PAPER FOR ISPD: 2017 UPDATE, PERITONEAL DIALYSIS INTERNATIONAL, Vol: 37, Pages: 362-374, ISSN: 0896-8608
Szeto C-C, Li PK-T, Johnson DW, et al., 2017, ISPD CATHETER-RELATED INFECTION RECOMMENDATIONS: 2017 UPDATE, PERITONEAL DIALYSIS INTERNATIONAL, Vol: 37, Pages: 141-154, ISSN: 0896-8608
Brown EA, Finkelstein FO, Iyasere OU, et al., 2017, Peritoneal or hemodialysis for the frail elderly patient, the choice of 2 evils?, KIDNEY INTERNATIONAL, Vol: 91, Pages: 294-303, ISSN: 0085-2538
Sulemane S, Panoulas VF, Bratsas A, et al., 2017, Subclinical markers of cardiovascular disease predict adverse outcomes in chronic kidney disease patients with normal left ventricular ejection fraction, INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING, Vol: 33, Pages: 687-698, ISSN: 1569-5794
Emerging cardiovascular biomarkers, such as speckle tracking echocardiography (STE) and aortic pulse wave velocity (aPWV), have recently demonstrated the presence of subclinical left ventricular dysfunction and arterial stiffening in patients with chronic kidney disease (CKD) and no previous cardiovascular history. However, limited information exists on the prognostic impact of these biomarkers. We aimed to investigate whether STE and aPWV predict major adverse cardiac events (MACE) in this patient population. In this cohort study we prospectively analysed 106 CKD patients with no overt cardiovascular disease (CVD) and normal left ventricular ejection fraction. Cardiac deformation was measured using STE while aPWV was measured using arterial tonometry. The primary end-point was the composite of all-cause mortality, acute coronary syndrome, stable angina requiring revascularization (either using percutaneous coronary intervention or coronary artery bypass surgery), hospitalization for heart failure and stroke. Over a median follow up period of 49 months (interquartile range 11–63 months), 26 patients (24.5%) reached the primary endpoint. In a multivariable Cox hazards model, global longitudinal strain (GLS) (HR 1.12, 95% CI 1.02–1.29, p = 0.041) and aPWV (HR 1.31, 95% CI 1.05–1.41, p = 0.021) were significant, independent predictors of MACE. GLS and aPWV independently predict MACE in CKD patients with normal EF and no clinically overt CVD.
Segall L, Nistor I, Van Biesen W, et al., 2017, Dialysis modality choice in elderly patients with end-stage renal disease: a narrative review of the available evidence, NEPHROLOGY DIALYSIS TRANSPLANTATION, Vol: 32, Pages: 41-49, ISSN: 0931-0509
Bartholomew C, Jones C, Brown E, 2016, CKD and frailty: outcomes from a quality initiative for older patients, Journal of Kidney Care, Vol: 1, Pages: 153-157, ISSN: 2397-9534
Finkelstein FO, Zhao J, Bieber B, et al., 2016, INTERNATIONAL VARIATIONS IN THE EXPERIENCE OF PATIENTS ON PERITONEAL DIALYSIS (PD) IN THE PERITONEAL DIALYSIS OUTCOMES AND PRACTICE PATTERNS STUDY (PDOPPS), 53rd ERA-EDTA Congress, Publisher: OXFORD UNIV PRESS, Pages: 239-240, ISSN: 0931-0509
Sulemane S, Panoulas VF, Konstantinou K, et al., 2016, Erratum to: ‘Left ventricular twist mechanics and its relation with aortic stiffness in chronic kidney disease patients without overt cardiovascular disease’, Cardiovascular Ultrasound, Vol: 14, ISSN: 1476-7120
Sulemane S, Panoulas VF, Konstantinou K, et al., 2016, Left ventricular twist mechanics and its relation with aortic stiffness in chronic kidney disease patients without overt cardiovascular disease., Cardiovascular Ultrasound, Vol: 14, ISSN: 1476-7120
BACKGROUND: Recent studies hypothesized left ventricular (LV) twist as a potential biomarker for evaluation of sub clinical myocardial disease, however its relationship with aortic stiffness has yet to be investigated. Chronic kidney disease (CKD) has been identified as a risk factor for both myocardial and arterial disease. As such we sought to explore the relationship between aortic stiffness and LV twist in CKD patients without known cardiovascular disease (CVD). METHODS: In this prospective, observational study we enrolled 106 CKD patients (Stages 1 to 5) with normal LVEF as assessed by conventional echocardiography. Aortic stiffness was measured using aortic pulse wave velocity (aPWV). We defined increased aPWV as ≥10 m/s. LV Twist was measured using two-dimensional speckle tracking echocardiography. RESULTS: Patients with increased aPWV had higher LV twist (p = 0.002) but similar LVEF (p = 0.486). Aortic PWV correlated crudely with age (p < 0.001), the presence of diabetes (p < 0.001), hypertension (p < 0.001), eGFR (p < 0.001), LVMI (p = 0.01), e/e' (p < 0.001) and LV twist (p = 0.003). In multivariable analyses after adjusting for age, gender, cardiovascular risk factors and hypertensive medication, aPWV was independently associated with LV twist (β = 0.163, p = 0.025). CONCLUSIONS: Aortic stiffness independently associates with LV Twist in asymptomatic CKD patients. These findings suggest a close interaction between LV twist mechanics and arterial remodeling even before CVD becomes clinically relevant.
Lyasere OU, Brown EA, Johansson L, et al., 2016, Quality of Life and Physical Function in Older Patients on Dialysis: A Comparison of Assisted Peritoneal Dialysis with Hemodialysis, CLINICAL JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY, Vol: 11, Pages: 423-430, ISSN: 1555-9041
Levy J, Brown E, Lawrence A, 2016, Oxford Handbook of Dialysis
Johansson L, Brown EA, 2016, How to Choose the Type of Dialysis in the Elderly Patient, Dialysis in Older Adults, Publisher: Springer New York, Pages: 9-19, ISBN: 9781493933181
Brown EA, 2016, Peritoneal Dialysis for the Elderly, Dialysis in Older Adults, Publisher: Springer New York, Pages: 57-65, ISBN: 9781493933181
van Biesen W, van de Luijtgaarden MWM, Brown EA, et al., 2015, Nephrologists' perceptions regarding dialysis withdrawal and palliative care in Europe: lessons from a European Renal Best Practice survey, NEPHROLOGY DIALYSIS TRANSPLANTATION, Vol: 30, Pages: 1951-1958, ISSN: 0931-0509
Meeus F, Brown EA, 2015, Caring for Older Patients on Peritoneal Dialysis at End of Life, Peritoneal Dialysis International, Vol: 35, Pages: 667-670, ISSN: 0896-8608
End of life is the last phase of life, not merely the last few days. For many older patients on peritoneal dialysis (PD), the end-of-life phase commences with the start of dialysis. The principal aim of management of this phase should be optimizing the quality of life of the patient. Evidence suggests that patients on dialysis mostly want involvement in decisions at this stage, but most do not have the opportunity to do so. Management should therefore include discussions with the patient and their family to determine lifestyle goals, treatment wishes, and ceilings of care (including resuscitation and dialysis withdrawal). Care should also include symptom identification and management, psychosocial support, and adaptation of dialysis to the ability and needs of the patient. By doing this, quality of life at end of life is achievable.
Brown EA, 2015, Maximal conservative management, Medicine, Vol: 43, Pages: 493-495, ISSN: 1357-3039
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