PubMed | Nephrologie Dialyse Saint Guilhem, Aix - Marseille University, Montpellier University and NephroCare
Type: Journal Article | Journal: Clinical kidney journal | Year: 2016
While much research is devoted to identifying novel biomarkers, addressing the prognostic value of routinely measured clinical parameters is of great interest. We studied early blood pressure (BP) and body weight (BW) trajectories in incident haemodialysis patients and their association with all-cause mortality.In a cohort of 357 incident patients, we obtained all records of BP and BW during the first 90 days on dialysis (over 12 800 observations) and analysed trajectories using penalized B-splines and mixed linear regression models. Baseline comorbidities and all-cause mortality (median follow-up: 2.2 years) were obtained from the French Renal Epidemiology and Information Network (REIN) registry, and the association with mortality was assessed by Cox models adjusting for baseline comorbidities.During the initial 90 days on dialysis, there were non-linear decreases in BP and BW, with milder slopes after 15 days [systolic BP (SBP)] or 30 days [diastolic BP (DBP) and BW]. SBP or DBP levels at dialysis initiation and changes in BW occurring in the first month or during the following 2 months were significantly associated with survival. In multivariate models adjusting for baseline comorbidities and prescriptions, higher SBP value and BW slopes were independently associated with a lower risk of mortality. Hazard ratios of mortality and 95% confidence intervals were 0.92 (0.85-0.99) for a 10 mmHg higher SBP and 0.76 (0.66-0.88) for a 1 kg/month higher BW change on Days 30-90.BW loss in the first weeks on dialysis is a strong and independent predictor of mortality. Low BP is also associated with mortality and is probably the consequence of underlying cardiovascular diseases. These early markers appear to be valuable prognostic factors.
Kalantar-Zadeh K.,University of California at Los Angeles |
Cano N.J.,Clermont University |
Budde K.,Charité - Medical University of Berlin |
Chazot C.,NephroCare |
And 7 more authors.
Nature Reviews Nephrology | Year: 2011
Protein-energy wasting (PEW), which is manifested by low serum levels of albumin or prealbumin, sarcopenia and weight loss, is one of the strongest predictors of mortality in patients with chronic kidney disease (CKD). Although PEW might be engendered by non-nutritional conditions, such as inflammation or other comorbidities, the question of causality does not refute the effectiveness of dietary interventions and nutritional support in improving outcomes in patients with CKD. The literature indicates that PEW can be mitigated or corrected with an appropriate diet and enteral nutritional support that targets dietary protein intake. In-center meals or oral supplements provided during dialysis therapy are feasible and inexpensive interventions that might improve survival and quality of life in patients with CKD. Dietary requirements and enteral nutritional support must also be considered in patients with CKD and diabetes mellitus, in patients undergoing peritoneal dialysis, renal transplant recipients, and in children with CKD. Adjunctive pharmacological therapies, such as appetite stimulants, anabolic hormones, and antioxidative or anti-inflammatory agents, might augment dietary interventions. Intraperitoneal or intradialytic parenteral nutrition should be considered for patients with PEW whenever enteral interventions are not possible or are ineffective. Controlled trials are needed to better assess the effectiveness of in-center meals and oral supplements. © 2011 Macmillan Publishers Limited. All rights reserved.
News Article | December 16, 2016
Practo Technologies Pvt. Ltd, a web-based clinic management software developer, has today announced the acquisition of US-based advanced analytics firm Enlightiks Inc. and its Indian operations in a cash-and-stock deal. The deal, which details the acquisition of Bengaluru-based Enlightiks Business Solutions Pvt. Ltd, an advanced analytics platform offering business intelligence solutions to healthcare enterprises, is valued at Rs 92 crore (about US$13.9 million). Post acquisition, the entire 50 member team of Enlightiks will join Practo and form part of an analytics business unit within the company. The unit is said to be headed by Enlightiks co-founder and CEO, Vamsi Chandra Kasivajjala. This is Practo 5th acquisition till date and its 3rd in the enterprise space. In 2015, the company has acquired four companies – hospital information management solution provider Insta Health for US$12 million, hospital appointment scheduling firm Qikwell, a web and app-based fitness management platform FithoWellness as well as product outsourcing firm Genii. The primary offering for Enlightiks comes through its proprietary business intelligence and predictive analytics platform – Querent which provides actionable insights for healthcare providers using complex mathematical, statistical, computational and cognitive models. “This brings Practo closer to its vision of simplifying healthcare by providing end-to-end solutions for the entire eco-system,” said Shashank ND, the Founder & CEO of Practo. “With Querent, we will be able to help CXOs make their enterprises run more efficiently which should improve the overall quality of care while making it more affordable.” Enligtiks was co-founded in 2012 by Shilpa Peri, Venkatesh Pagidimarri, Dr. Bas Nair and Vamsi Chandra Kasivajjala. The founding team was later joined by Shaunak Joshi and Sunil Kondala. Their business intelligent solution Querent is capable of providing accurate predictions for key business metrics which will aid enterprises in proactive decision-making that can help create a positive impact on short to medium term business actions. Besides, the platform also has an ability to read both structured and unstructured information and apply advanced machine learning and deep learning techniques to uncover hidden insights. Querent also facilitates visual interpretation of the collected information in order to generate useful insights for healthcare enterprises across various departments including operations, finance, quality, pricing, marketing, customer management and risk assessment. More than 200 healthcare centers including hospitals and clinics across the nation are currently using this platform. The list of clients includes names such as Apollo Sugar Clinics Ltd, Kokilaben Dhirubhai Ambani Hospital, Inamdar Multispecialty Hospital, Fernandez Hospitals Pvt Ltd, Eye-Q Vision Pvt Ltd, Sparsh Sandor Nephrocare Services Pvt Ltd, Ramesh Hospitals and more. While founded in 2008 by Shashank ND and Abhinav Lal, Practo is one of the most well-funded healthcare startups in the country whereby the company has more than US$120 million in funds. The company raised $90 million in August 2015 through a Series C funding led by Chinese media and technology conglomerate Tencent Holdings Pvt Ltd. It raised $30 million in a Series B round from Sequoia India and Matrix Partners in February 2015. While in 2012, Practo had raised $4.6 million from Sequoia Capital in a Series A funding round. The firm helps patients book appointments with doctors online and also enables doctors in primary clinics and hospitals to manage patient records under a software-as-a-service (SaaS) model. Practo also facilitates online delivery of medicines, e-consultation and beauty and wellness products. Commenting on the M&A, co-founder of Enlightiks, Vamsi said “Enlightiks is thrilled to join Practo. We share the same passion for democratising healthcare access for billions of people where business intelligence and analytics are critical.” “We chose Practo so that we can collaborate and work towards offering superior, comprehensive and integrated solutions for healthcare providers. I look forward to working with Shashank and the Practo team in realising our shared vision of transforming healthcare,” he adds.
PubMed | Fresenius Medical Care, NephroCare, Danube University Krems, NephroCare Nephrology Center and 2 more.
Type: Journal Article | Journal: Journal of renal nutrition : the official journal of the Council on Renal Nutrition of the National Kidney Foundation | Year: 2016
In patients with advanced kidney disease, metabolic and nutritional derangements induced by uremia interact and reinforce each other in a deleterious vicious circle. Literature addressing the effect of dialysis initiation on changes in body composition (BC) is limited and contradictory. The aim of this study was to evaluate changes in BC in a large international cohort of incident hemodialysis patients.A total of 8,227 incident adult end-stage renal disease patients with BC evaluation within the initial first 6 months of baseline, defined as 6 months after renal replacement therapy initiation, were considered. BC, including fat tissue index (FTI) and lean tissue index (LTI), were evaluated by Body Composition Monitor (BCM, Fresenius Medical Care, Bad Homburg, Germany). Exclusion criteria at baseline were lack of a BCM measurement before or after baseline, body mass index (BMI) < 18.5 kg/m(2), presence of metastatic solid tumors, treatment with a catheter, and prescription of less or more than 3 treatments per week. Maximum follow-up was 2 years. Descriptive analysis was performed comparing current values with the baseline in each interval (delta analysis). Linear mixed models considering the correlation structure of the repeated measurements were used to evaluate factors associated with different trends in FTI and LTI.BMI increased about 0.6 kg/m(2) over 24 months from baseline. This was associated with increase in FTI of about 0.95 kg/m(2) and a decrease in LTI of about 0.4 kg/m(2). Female gender, diabetic status, and low baseline FTI were associated with a significant greater increase of FTI. Age > 67 years, diabetes, male gender, high baseline LTI, and low baseline FTI were associated with a significant greater decrease of LTI.With the transition to hemodialysis, end-stage renal disease patients presented with distinctive changes in BC. These were mainly associated with gender, older age, presence of diabetes, low baseline FTI, and high baseline LTI. BMI increases did not fully represent the changes in BC.
Catarina Moreira A.,Polytechnic Institute of Coimbra |
Carolino E.,Matematica. Escola Superior de Tecnologia da Saude de Lisbon |
Domingos F.,Nephrocare |
Gaspar A.,Nephrocare |
And 2 more authors.
Nutricion Hospitalaria | Year: 2013
Background: Poor nutritional status and worse healthrelated quality of life (QoL) have been reported in haemodialysis (HD) patients. The utilization of generic and disease specific QoL questionnaires in the same population may provide a better understanding of the significance of nutrition in QoL dimensions. Objective: To assess nutritional status by easy to use parameters and to evaluate the potential relationship with QoL measured by generic and disease specific questionnaires. Methods: Nutritional status was assessed by subjective global assessment adapted to renal patients (SGA), body mass index (BMI), nutritional intake and appetite. QoL was assessed by the generic EuroQoL and disease specific Kidney Disease Quality of Life-Short Form (KDQoL-SF) questionnaires. Results: The study comprised 130 patients of both genders, mean age 62.7 ± 14.7 years. The prevalence of undernutrition ranged from 3.1% by BMI ≤ 18.5 kg/m2 to 75.4% for patients below energy and protein intake recommendations. With the exception of BMI classification, undernourished patients had worse scores in nearly all QoL dimensions (EuroQoL and KDQoL-SF), a pattern which was dominantly maintained when adjusted for demographics and disease-related variables. Overweight/ obese patients (BMI ≥ 25) also had worse scores in some QoL dimensions, but after adjustment the pattern was maintained only in the symptoms and problems dimension of KDQoL-SF (p = 0.011). Conclusion: Our study reveals that even in mildly undernourished HD patients, nutritional status has a significant impact in several QoL dimensions. The questionnaires used provided different, almost complementary perspectives, yet for daily practice EuroQoL is simpler. Assuring a good nutritional status, may positively influence QoL.
Chazot C.,NephroCare |
Wabel P.,Fresenius Medical Care D GmbH |
Chamney P.,Fresenius Medical Care D GmbH |
Moissl U.,Fresenius Medical Care D GmbH |
And 2 more authors.
Nephrology Dialysis Transplantation | Year: 2012
Background. Fluid overload and hypertension are among the most important risk factors for haemodialysis (HD) patients. The aim of this study was to analyse the impact of fluid overload for the survival of HD patients by using a selected reference population from Tassin. Methods. A positively selected HD population (n = 50) from Tassin (Lyon-France) was used as a reference for fluid status and all-cause mortality. This population was compared to one dialysis centre from Giessen (Germany) which was separated into a non-hyperhydrated (n = 123) and a hyperhydrated (n = 35) patient group. The hydration status (ΔHS) of all patients was objectively measured with whole-body bioimpedance spectroscopy in 2003. All-cause mortality was analysed after a 6.5-year follow-up. Results. Most of the reference patients from Tassin were normohydrated (ΔHS = 0.25 ± 1.15 L) at the start of the HD session. The hydration status of the Tassin patients was not different to the non-hyperhydrated Giessen patients (ΔHS = 0.8 ± 1.1 L) but significantly lower than in the hyperhydrated Giessen group (ΔHS = 3.5 ± 1.2 L). Multivariate adjusted all-cause mortality was significantly increased in the hyperhydrated patient group (hazard ratio = 3.41)-no difference in mortality could be observed between the Tassin and the non-hyperhydrated group from Giessen-even considering the fact that Tassin patients presented a significantly lower blood pressure. Conclusions. Fluid overload has a very high predictive value for all-cause mortality and seems to be one of the major killers in the HD population. Patients might strongly benefit from active management of fluid overload. © 2012 The Author.
PubMed | Fresenius Medical Care Renal Services, Fresenius Medical Care, NephroCare Nephrology Center and NephroCare
Type: Journal Article | Journal: Kidney international | Year: 2016
Hyporesponsiveness to erythropoiesis-stimulating agent therapy in dialysis patients is poorly understood. Some studies report an improvement in the erythropoiesis-stimulating agent resistance index (ERI) with hemodiafiltration (HDF) versus high-flux hemodialysis (HD). We explored ERI dynamics in 38,340 incident HDF and HD patients treated in 22 countries over a 7-year period. Groups were matched bypropensity score at baseline (6 months after dialysis initiation). The follow-up period (mean of 1.31 years) was stratified into 1 month intervals with delta analyses performed for key ERI-related parameters. Dialysis modality, time interval, and polycystic kidney disease were included in a linear mixed model with the outcome ERI. Baseline ERI was nonsignificantly higher in HDF versus HD treatment. ERI decreased significantly faster in HDF-treated patients than inHD-treated patients, was decreased in both HD and HDF when patients were treated with intravenous darbepoetin alfa, but only in HDF when treated with intravenous recombinant human erythropoietin (rHuEPO). A clear difference between HD- and HDF-treated patients could only be found for patients with high baseline ERI and assigned to intravenous rHuEPO treatment. A significant advantage in terms of lower ERI for patients treated by HDF was found. Sensitivity analysis limited this advantage for HDF to those patients treated with intravenous rHuEPO (not darbepoetin alfa or subcutaneous rHuEPO) and to patients with a high baseline ERI. Thus, our results allow more accurate planning for future clinical trials addressing anemia management in dialysis patients.
Caetano C.,Nephrocare |
Valente A.,Nephrocare |
Oliveira T.,Nephrocare |
Journal of Renal Nutrition | Year: 2016
Objective: To evaluate how different compartments of body composition can affect survival in hemodialysis (HD) patients. Design: Multicenter longitudinal observational study of a cohort of patients in HD with 12 months of follow-up. Setting: Patients from 34 Nephrocare dialysis units in Portugal were included. Subjects: A total of 697 patients on maintenance HD during 4 hours 3 days per week were enrolled. Intervention: Dry weight, presence of diabetes, body mass index (BMI), lean tissue index (LTI), fat tissue index (FTI), body cell mass index (BCMI), albumin and hydration status were recorded at baseline. In all patients, the assessment of body composition was carried out using the Body Composition Monitor (BCM; Fresenius Medical Care a Deutschland GmbH, Germany). Main Outcome Measure: Survival during a 12-month period of follow-up. Results: Patient's mean (±standard deviation) age was 65.4 ± 14.3 years, and median (interquartile range) HD vintage was 41 (19-81) months. Patients who died during the study period, had higher age (p < .001), lower dry weight (p = .001), BMI (p < .001), albumin (p < .001), LTI (p = .015), and also lower BCMI (p = .046). Patients with diabetes (= .045), BMI < 18.5 kg/m2 (< .001), albumin < 4.0 g/dL (p < .001), relative overhydration ≥ 15% (p = .001), low FTI (p = .019), and also those in the lowest tertile of BCMI (p = .022) displayed a significantly worse survival. In the Cox regression analysis, the overall mortality of patient was related to low FTI, relative overhydration, BMI < 18.5 kg/m2, BCMI ≤ 5.2 kg/m2, and albumin < 4.0 g/dL. Conclusions: Several body composition parameters demonstrated to have an important role in predicting 1-year mortality in HD patients. Albumin, FTI, and BMI were useful predictors of mortality in these patients. © 2016 National Kidney Foundation, Inc.
Di Benedetto A.,NephroCare
Giornale italiano di nefrologia : organo ufficiale della Società italiana di nefrologia | Year: 2010
It has been demonstrated that early diagnosis of chronic kidney disease (CKD) is important in containing the morbidity and mortality of this disease. It postpones the initiation of hemodialysis treatment and reduces the risk of complications. General practitioners (GPs) have a relevant part in this process because they are the first point of contact for persons in risk categories (e.g., diabetic and hypertensive patients). In 2002 NephroCare started a collaboration with GPs in the Italian region of Campania. This program, called Nephro Day, is aimed at screening patients with hypertension and diabetes, and identifying patients with CKD to reduce the late referral phenomenon. Meetings between GPs and Nephrocare nephrologists were held in which the etiology, pathology and risk factors associated with CKD as well as the screening options were discussed. Strong emphasis was placed on the importance of assigning CKD patients with hypertension and diabetes to 1 of the 5 stages of the DOQI guidelines. A clear positive correlation was observed between the age of diabetic and hypertensive patients and the risk of CKD. In the current situation of limited budgets and a limited number of nephrologists, the collaboration between GPs and specialists offers an unique opportunity to handle the problem of late referral, allowing timelier and more adequate treatment of patients with CKD and thus leading to substantial cost savings.
PubMed | Nephrocare
Type: Journal Article | Journal: Journal of renal nutrition : the official journal of the Council on Renal Nutrition of the National Kidney Foundation | Year: 2016
To evaluate how different compartments of body composition can affect survival in hemodialysis (HD) patients.Multicenter longitudinal observational study of a cohort of patients in HD with 12 months of follow-up.Patients from 34 Nephrocare dialysis units in Portugal were included.A total of 697 patients on maintenance HD during 4 hours 3 days per week were enrolled.Dry weight, presence of diabetes, body mass index (BMI), lean tissue index (LTI), fat tissue index (FTI), body cell mass index (BCMI), albumin and hydration status were recorded at baseline. In all patients, the assessment of body composition was carried out using the Body Composition Monitor (BCM; Fresenius Medical Care a Deutschland GmbH, Germany).Survival during a 12-month period of follow-up.Patients mean (standard deviation) age was 65.4 14.3 years, and median (interquartile range) HD vintage was 41 (19-81) months. Patients who died during the study period, had higher age (P < .001), lower dry weight (P = .001), BMI (P < .001), albumin (P < .001), LTI (P = .015), and also lower BCMI (P = .046). Patients with diabetes (P = .045), BMI < 18.5 kg/m(2) (P < .001), albumin < 4.0 g/dL (P < .001), relative overhydration 15% (P = .001), low FTI (P = .019), and also those in the lowest tertile of BCMI (P = .022) displayed a significantly worse survival. In the Cox regression analysis, the overall mortality of patient was related to low FTI, relative overhydration, BMI < 18.5 kg/m(2), BCMI 5.2 kg/m(2), and albumin < 4.0 g/dL.Several body composition parameters demonstrated to have an important role in predicting 1-year mortality in HD patients. Albumin, FTI, and BMI were useful predictors of mortality in these patients.