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Bad Homburg vor der Höhe, Germany

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. Source

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. Source

Gillespie I.A.,Amgen | Macdougall I.C.,Kings College | Richards S.,Amgen | Jones V.,Amgen | And 16 more authors.
Pharmacoepidemiology and Drug Safety | Year: 2015

Purpose: Hyporesponsiveness to erythropoiesis-stimulating agents (ESAs) is clinically and economically important in the treatment of anaemia in chronic kidney disease (CKD) patients. Previous studies focused on baseline predictors of ESA hyporesponsiveness, rather than factors associated with the transition to this state. Reversibility of ESA hyporesponsiveness has also not been studied previously. Methods: Case-crossover methodology was applied to a cohort of 6645 European CKD patients undergoing haemodialysis and prescribed ESAs. Ninety-day ESA exposure periods were defined, haemoglobin (Hb) response was calculated using the last 30days of one period and the first 30days of the next, and periods were classified based on a median ESA dose (80.8IU/kg/week) and a 10g/dL Hb threshold. Clinical, dialysis and laboratory data from patients' first hyporesponsive 'case' period was compared with the preceding responsive 'control' period using conditional logistic regression. A similar approach was applied to hyporesponsiveness reversal. Results: Of the patients, 672 experienced hyporesponsiveness periods with preceding responsive periods; 711 reversed to normality from hyporesponsiveness periods. Transition to hyporesponsiveness was associated with hospitalization, vascular access changes or worsening inflammation, with these factors accounting for over two-thirds of transitions. Findings were largely insensitive to alternative ESA doses and Hb thresholds. Continued hospitalization, catheter insertion and uncontrolled secondary hyperparathyroidism were associated with a lack of regain of responsiveness. Conclusions: Transition to hyporesponsiveness is linked to the development of conditions such as hospitalization events, vascular access issues or episodes of systemic inflammation. However, a third of hyporesponsive episodes remain unexplained. © 2015 John Wiley & Sons, Ltd. Source

Kalantar-Zadeh K.,University of California at Los Angeles | Cano N.J.,Clermont University | Budde K.,Charite - 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. Source

Catarina Moreira A.,Polytechnic Institute of Coimbra | Carolino E.,Matematica. Escola Superior de Tecnologia da Saude de Lisbon | Domingos F.,Nephrocare | Gaspar A.,Nephrocare | Ponce P.,Nephrocare
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. Source

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