Diaverum Medical Scientific Office

Lund, Sweden

Diaverum Medical Scientific Office

Lund, Sweden
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PubMed | Diaverum Medical Scientific Office
Type: Review | Journal: Kidney international | Year: 2015

ESKD patients have a large burden of disease, with high rates of readmission to hospital compared with the general population. A readmission after an acute index hospital discharge is either planned or unplanned. A proportion of unplanned readmissions are potentially avoidable, and could have been prevented with optimized transitional care. Readmissions pose financial cost to the health care system and emotional cost to patients and caregivers. In other chronic diseases with high readmission risk, such as congestive heart failure, interventions have improved transitional care and reduced readmission risk. In reviewing the existing literature on readmissions in ESKD, the definition and risk of readmission varied widely by study, with many potentially associated factors including comorbid diseases such as anemia and hypoalbuminemia. An ESKD patients requisite follow-up in the outpatient dialysis facility provides an opportunity to improve transitional care at the time of discharge. Despite this, our review of existing literature found no studies which have tested interventions to reduce the risk of readmission in ESKD patients. We propose a framework to define the determinants of avoidable readmission in ESKD, and use this framework to define a research agenda. Avoidable readmissions in ESKD patients is a topic prime for in-depth study, given the high-risk nature in this patient population, financial and societal costs, and potential for risk modification through targeted interventions.


Navaneethan S.D.,Cleveland Clinic | Navaneethan S.D.,Cochrane Renal Group | Vecchio M.,Mario Negri Sud Consortium | Johnson D.W.,University of Queensland | And 26 more authors.
American Journal of Kidney Diseases | Year: 2010

Background: Sexual dysfunction is an under-recognized problem in men and women with chronic kidney disease (CKD). The prevalence, correlates, and predictors of this condition in patients with CKD have not been evaluated comprehensively. Study Design Systematic review and meta-analysis. Setting & Population Patients treated using dialysis (dialysis patients), patients treated using transplant (transplant recipients), and patients with CKD not treated using dialysis or transplant (nondialysis nontransplant patients with CKD). Selection Criteria for Studies Observational studies conducted in patients with CKD only or including a control group without CKD. Predictor Type of study population. Outcomes Sexual dysfunction in men and women with CKD using validated tools, such as the International Index of Erectile Function, the Female Sexual Function Index (FSFI), or other measures as reported by study investigators. Results 50 studies (8,343 patients) of variable size (range, 16-1,023 patients) were included in this review. Almost all studies explored sexual dysfunction in men and specifically erectile dysfunction. The summary estimate of erectile dysfunction in men with CKD was 70% (95% CI, 62%-77%; 21 studies, 4,389 patients). Differences in reported prevalence rates of erectile dysfunction between different studies were attributable primarily to age, study populations, and type of study tool used to assess the presence of erectile dysfunction. In women, the reported prevalence of sexual dysfunction was assessed in only 306 patients from 2 studies and ranged from 30%-80%. Compared with the general population, women with CKD had a significantly lower overall FSFI score (8 studies or subgroups, 407 patients; mean difference, -9.28; 95% CI, -12.92 to -5.64). Increasing age, diabetes mellitus, and depression consistently were found to correlate with sexual dysfunction in 20 individual studies of patients with CKD using different methods. Limitations Suboptimal and lack of uniform assessment of outcome measures. Conclusions Sexual dysfunction is highly prevalent in both men and women with CKD, especially among those on dialysis. Larger studies enrolling different ethnic groups, using validated study tools, and analyzing the influence of various factors on the development of sexual dysfunction are needed. © 2010 National Kidney Foundation, Inc.


PubMed | University of Otago, University of Calgary, Princess Alexandra Hospital, University of Piemonte Orientale and 8 more.
Type: Journal Article | Journal: BMJ open | Year: 2015

Adults with end-stage kidney disease (ESKD) treated with haemodialysis experience mortality of between 15% and 20% each year. Effective interventions that improve health outcomes for long-term dialysis patients remain unproven. Novel and testable determinants of health in dialysis are needed. Nutrition and dietary patterns are potential factors influencing health in other health settings that warrant exploration in multinational studies in men and women treated with dialysis. We report the protocol of the DIETary intake, death and hospitalisation in adults with end-stage kidney disease treated with HaemoDialysis (DIET-HD) study, a multinational prospective cohort study. DIET-HD will describe associations of nutrition and dietary patterns with major health outcomes for adults treated with dialysis in several countries.DIET-HD will recruit approximately 10,000 adults who have ESKD treated by clinics administered by a single dialysis provider in Argentina, France, Germany, Hungary, Italy, Poland, Portugal, Romania, Spain, Sweden and Turkey. Recruitment will take place between March 2014 and June 2015. The study has currently recruited 8000 participants who have completed baseline data. Nutritional intake and dietary patterns will be measured using the Global Allergy and Asthma European Network (GA(2)LEN) food frequency questionnaire. The primary dietary exposures will be n-3 and n-6 polyunsaturated fatty acid consumption. The primary outcome will be cardiovascular mortality and secondary outcomes will be all-cause mortality, infection-related mortality and hospitalisation.The study is approved by the relevant Ethics Committees in participating countries. All participants will provide written informed consent and be free to withdraw their data at any time. The findings of the study will be disseminated through peer-reviewed journals, conference presentations and to participants via regular newsletters. We expect that the DIET-HD study will inform large pragmatic trials of nutrition or dietary interventions in the setting of advanced kidney disease.


Nistor I.,Grigore T. Popa University of Medicine and Pharmacy | Nistor I.,Ghent University | Palmer S.C.,University of Otago | Craig J.C.,University of Sydney | And 4 more authors.
American Journal of Kidney Diseases | Year: 2014

Background Convective dialysis therapies (hemofiltration or hemodiafiltration) are associated with lower mortality compared to hemodialysis in observational studies. A previous meta-analysis of randomized trials comparing convective modalities with hemodialysis in 2006 was inconclusive due to insufficient data. Additional randomized trials recently have reported conflicting results. Study Design Systematic review and meta-analysis of randomized trials to February 27, 2013. Setting & Population Patients with chronic kidney failure treated by hemodialysis, hemodiafiltration, hemofiltration, or biofiltration. Selection Criteria for Studies Randomized controlled trials. Intervention Convective therapies (hemodiafiltration, hemofiltration, and acetate-free biofiltration) compared with hemodialysis. Outcomes All-cause and cardiovascular mortality, nonfatal cardiovascular events, hospitalization, change in dialysis modality, health-related quality of life, adverse events, blood pressure, and clearances of urea and β2- microglobulin. Results 35 trials (4,039 participants) were included. In low-quality evidence, convective dialysis had little or no effect on all-cause mortality (relative risk [RR], 0.87; 95% CI, 0.70-1.07) and may reduce cardiovascular mortality (RR, 0.75; 95% CI, 0.58-0.97) and hypotension (RR, 0.72; 95% CI, 0.66-0.80) during dialysis, but had uncertain effects on nonfatal cardiovascular events (RR, 1.14; 95% CI, 0.85-1.52) and hospitalization (RR, 1.21; 95% CI, 0.12-12.05). Adverse events were not reported systematically and health-related quality-of-life outcomes were sparse. Convective therapies reduced predialysis levels of β2-microglobulin (mean difference, -5.77 [95% CI, -10.97 to -0.56] mg/dL) and increased dialysis dose (Kt/V urea mean difference, 0.10; 95% CI, 0.02-0.19), but these effects were very heterogeneous. Sensitivity analyses limited to trials comparing hemodiafiltration with hemodialysis showed similar results. Limitations Studies had important risks of bias leading to low confidence in the summary estimates and generally were limited to patients who had adequate dialysis vascular access. Conclusions Treatment effects of convective dialysis are unreliable due to limitations in trial methods and reporting. Convective dialysis may reduce cardiovascular but not all-cause mortality, and effects on nonfatal cardiovascular events and hospitalization are inconclusive.


Mathew A.T.,Hofstra North Shore LIJ | Strippoli G.F.M.,Diaverum Medical Scientific Office | Strippoli G.F.M.,University of Sydney | Strippoli G.F.M.,University of Bari | And 4 more authors.
Kidney International | Year: 2015

ESKD patients have a large burden of disease, with high rates of readmission to hospital compared with the general population. A readmission after an acute index hospital discharge is either planned or unplanned. A proportion of unplanned readmissions are potentially avoidable, and could have been prevented with optimized transitional care. Readmissions pose financial cost to the health care system and emotional cost to patients and caregivers. In other chronic diseases with high readmission risk, such as congestive heart failure, interventions have improved transitional care and reduced readmission risk. In reviewing the existing literature on readmissions in ESKD, the definition and risk of readmission varied widely by study, with many potentially associated factors including comorbid diseases such as anemia and hypoalbuminemia. An ESKD patient's requisite follow-up in the outpatient dialysis facility provides an opportunity to improve transitional care at the time of discharge. Despite this, our review of existing literature found no studies which have tested interventions to reduce the risk of readmission in ESKD patients. We propose a framework to define the determinants of avoidable readmission in ESKD, and use this framework to define a research agenda. Avoidable readmissions in ESKD patients is a topic prime for in-depth study, given the high-risk nature in this patient population, financial and societal costs, and potential for risk modification through targeted interventions. © 2015 International Society of Nephrology.


Navaneethan S.D.,Cleveland Clinic | Hegbrant J.,Diaverum Medical Scientific Office | Strippoli G.F.M.,Diaverum Medical Scientific Office | Strippoli G.F.M.,Cochrane Renal Group | Strippoli G.F.M.,University of Sydney
Current Opinion in Nephrology and Hypertension | Year: 2011

Purpose of review: Cardiovascular disease accounts for the majority of deaths in chronic kidney disease (CKD). Dyslipidemia is a well established cardiovascular risk factor. We summarize key aspects of available evidence relating to beneficial effects of statins in nondialysis-dependent CKD, dialysis-dependent CKD and renal transplant recipients. Recent findings: Previous trials and their meta-analyses suggested that statins reduce lipid levels, the risk of cardiovascular disease and all-cause mortality in nondialysis-dependent CKD. The Study of Heart and Renal Protection (SHARP) study that enrolled both dialysis-dependent and nondialysis-dependent CKD patients showed a 17% decrease in major atherosclerotic events with statins or ezetimibe. Similar cardiovascular benefits are observed in renal transplant recipients. However, such positive effects were not found in two recent clinical trials that enrolled hemodialysis patients alone. This lack of benefit might be attributed to differences in the cause of cardiovascular death seen in dialysis patients and smaller sample size. The overall benefits-harms tradeoff may benefit from meta-analysis and individual patient data meta-analysis in hemodialysis patients including the SHARP data. Summary: Nondialysis-dependent CKD patients and renal transplant recipients benefit from statins. Statins have also been found to be beneficial in one of the three large trials in hemodialysis patients, a matter which may be further explored. © 2011 Wolters Kluwer Health | Lippincott Williams and Wilkins.


Zsom L.,University of Mississippi Medical Center | Zsom M.,Diaverum Dialysis Center | Fulop T.,University of Mississippi Medical Center | Wells C.,University of Mississippi Medical Center | And 5 more authors.
Blood Purification | Year: 2010

Background: The relationship between treatment time, ultrafiltration rate (UFR) and inflammation has received limited exploration so far. Methods: This is a cross-sectional cohort study of 12 hemodialysis clinics. Statistical models explored the association of multiple patient- and dialysis-specific covariates with low albumin (≤40 g/l) or high C-reactive protein (CRP) (>5 mg/dl) and calculated the ORs and 95% CIs. Results: 616 patients with a mean age of 60.9 ± 14.4 years participated in our study. Mean treatment time was 237.3 ± 23.8 min and mean UFR was 7.0 ± 4.0 ml/kg/h. In stepwise logistic regression, treatment time >4 h reduced the risk of low albumin (OR 0.397, 95% CI 0.235-0.672, p < 0.001). Congestive heart failure (OR 1.634, 95% CI 1.154-2.312, p = 0.006) and acute infection (OR 1.799, 95% CI 1.059-3.056, p = 0.03) were significant correlates of the risk of high CRP. There was no association between UFR and either CRP or albumin. Conclusion: Treatment time had a significant cross-sectional association with serum albumin but not with CRP. Copyright © 2010 S. Karger AG.


Ruospo M.,Diaverum Medical Scientific Office | Palmer S.C.,University of Otago | Craig J.C.,University of Sydney | Gentile G.,Diaverum Medical Scientific Office | And 8 more authors.
Nephrology Dialysis Transplantation | Year: 2014

Background. Oral disease may be increased in people with chronic kidney disease (CKD) and, due to associations with inflammation and malnutrition, represents a potential modifiable risk factor for cardiovascular disease and mortality. We summarized the prevalence of oral disease in adults with CKD and explored any association between oral disease and mortality. Methods. We used systematic review of observational studies evaluating oral health in adults with CKD identified in MEDLINE (through September 2012) without language restriction. We summarized prevalence and associations with all-cause and cardiovascular mortality using random-effects meta-analysis. We explored for sources of heterogeneity between studies using meta-regression. Results. Eighty-eight studies in 125 populations comprising 11 340 adults were eligible. Edentulism affected one in five adults with CKD Stage 5D (dialysis) {20.6% [95% confidence interval (CI), 16.4-25.6]}. Periodontitis was more common in CKD Stage 5D [56.8% (CI, 39.3-72.8)] than less severe CKD [31.6% (CI, 19.0-47.6)], although data linking periodontitis with premature death were scant. One-quarter of patients with CKD Stage 5D reported never brushing their teeth [25.6% (CI, 10.2-51.1)] and a minority used dental floss [11.4% (CI, 6.2-19.8)]; oral pain was reported by one-sixth [18.7% (CI, 8.8-35.4)], while half of patients experienced a dry mouth [48.4% (CI, 37.5-59.5)]. Data for kidney transplant recipients and CKD Stages 1-5 were limited. Conclusions. Oral disease is common in adults with CKD, potentially reflects low use of preventative dental services, and may be an important determinant of health in this clinical setting. © The Author 2013. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.


PubMed | Diaverum Medical Scientific Office
Type: Journal Article | Journal: Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association | Year: 2014

Oral disease may be increased in people with chronic kidney disease (CKD) and, due to associations with inflammation and malnutrition, represents a potential modifiable risk factor for cardiovascular disease and mortality. We summarized the prevalence of oral disease in adults with CKD and explored any association between oral disease and mortality.We used systematic review of observational studies evaluating oral health in adults with CKD identified in MEDLINE (through September 2012) without language restriction. We summarized prevalence and associations with all-cause and cardiovascular mortality using random-effects meta-analysis. We explored for sources of heterogeneity between studies using meta-regression.Eighty-eight studies in 125 populations comprising 11 340 adults were eligible. Edentulism affected one in five adults with CKD Stage 5D (dialysis) {20.6% [95% confidence interval (CI), 16.4-25.6]}. Periodontitis was more common in CKD Stage 5D [56.8% (CI, 39.3-72.8)] than less severe CKD [31.6% (CI, 19.0-47.6)], although data linking periodontitis with premature death were scant. One-quarter of patients with CKD Stage 5D reported never brushing their teeth [25.6% (CI, 10.2-51.1)] and a minority used dental floss [11.4% (CI, 6.2-19.8)]; oral pain was reported by one-sixth [18.7% (CI, 8.8-35.4)], while half of patients experienced a dry mouth [48.4% (CI, 37.5-59.5)]. Data for kidney transplant recipients and CKD Stages 1-5 were limited.Oral disease is common in adults with CKD, potentially reflects low use of preventative dental services, and may be an important determinant of health in this clinical setting.


PubMed | University of Otago, Princess Alexandra Hospital, University of Piemonte Orientale, The Childrens Hospital at Westmead and 2 more.
Type: Journal Article | Journal: American journal of kidney diseases : the official journal of the National Kidney Foundation | Year: 2015

Managing the complex fluid and diet requirements of chronic kidney disease (CKD) is challenging for patients. We aimed to summarize patients perspectives of dietary and fluid management in CKD to inform clinical practice and research.Systematic review of qualitative studies.Adults with CKD who express opinions about dietary and fluid management.MEDLINE, EMBASE, PsycINFO, CINAHL, Google Scholar, reference lists, and PhD dissertations were searched to May2013.Thematic synthesis.We included 46 studies involving 816 patients living in middle- to high-income countries. Studies involved patients treated with facility-based and home hemodialysis (33 studies; 462 patients), peritoneal dialysis (10 studies; 112 patients), either hemodialysis or peritoneal dialysis (3 studies; 73 patients), kidney transplant recipients (9 studies; 89 patients), and patients with non-dialysis-dependent CKD stages 1 to 5 (5 studies; 80 patients). Five major themes were identified: preserving relationships (interference with roles, social limitations, and being a burden), navigating change (feeling deprived, disrupting held truths, breaking habits and norms, being overwhelmed by information, questioning efficacy, and negotiating priorities), fighting temptation (resisting impositions, experiencing mental invasion, and withstanding physiologic needs), optimizing health (accepting responsibility, valuing self-management, preventing disease progression, and preparing for and protecting a transplant), and becoming empowered (comprehending paradoxes, finding solutions, and mastering change and demands).Limited data in non-English languages and low-income settings and for adults with CKD not treated with hemodialysis.Dietary and fluid restrictions are disorienting and an intense burden for patients with CKD. Patient-prioritized education strategies, harnessing patients motivation to stay well for a transplant or to avoid dialysis, and viewing adaptation to restrictions as a collaborative journey are suggested strategies to help patients adjust to dietary regimens in order to reduce their impact on quality of life.

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