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Cardioprotective medication use in hemodialysis patients.

https://arctichealth.org/en/permalink/ahliterature168348
Source
Can J Cardiol. 2006 Jul;22(9):755-60
Publication Type
Article
Date
Jul-2006
Author
Lisa M Miller
Wilma M Hopman
Jocelyn S Garland
Karen E Yeates
Rachel M Pilkey
Author Affiliation
Section of Nephrology, University of Manitoba, Winnipeg, Canada. lmiller@exchange.hsc.mb.ca
Source
Can J Cardiol. 2006 Jul;22(9):755-60
Date
Jul-2006
Language
English
Publication Type
Article
Keywords
Cardiotonic Agents - therapeutic use
Cardiovascular Diseases - complications - mortality - prevention & control
Cross-Sectional Studies
Female
Follow-Up Studies
Humans
Kidney Failure, Chronic - complications - therapy
Male
Middle Aged
Ontario - epidemiology
Renal Dialysis
Retrospective Studies
Survival Rate
Treatment Outcome
Abstract
Cardiovascular disease is the leading cause of mortality in patients with renal failure, accounting for more than 50% of deaths in end-stage renal disease. Risk factor modification with the use of cardioprotective medications such as angiotensin-converting enzyme inhibitors (ACEIs), beta-adrenergic antagonists (beta-blockers), acetylsalicylic acid (ASA) and 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) has been shown to reduce mortality in the general population.
To determine the extent of use of these medications in a hemodialysis population.
This was a cross-sectional study of a cohort of 185 prevalent hemodialysis patients. The inclusion criterion was dialysis dependence and there were no exclusion criteria. Data collection was by chart review. Contraindications to individual medication classes were not obtained.
There were 185 patients enrolled, the mean age was 63.42+/-15.1 years and 126 (68.1%) were male. Sixty-six (35.7%) patients had diabetes and 89 (48.1%) patients had established coronary artery disease (CAD). Forty-six (24.9%) patients were on ACEIs or angiotensin II receptor blockers, 59 (31.9%) were on beta-blockers, 70 (37.8%) were on ASA and 84 (45.4%) were on statins. Although these medications were used in fewer than 60% of patients, those with CAD were more likely to be prescribed an ACEI or an angiotensin II receptor blocker (P=0.026), a beta-blocker (P
Notes
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PubMed ID
16835669 View in PubMed
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DOPPS estimate of patient life years attributable to modifiable hemodialysis practices in Canada.

https://arctichealth.org/en/permalink/ahliterature164201
Source
Nephrol News Issues. 2007 Apr;21(5):69-70, 72, 74-6 passim
Publication Type
Article
Date
Apr-2007
Author
David C Mendelssohn
Karen E Yeates
Jean Ethier
Lilyanna Trpeski
Yingbo Na
Jennifer L Bragg-Gresham
Margaret A Eichleay
Ronald L Pisoni
Fritz K Port
Author Affiliation
University of Toronto, Ontario, Canada.
Source
Nephrol News Issues. 2007 Apr;21(5):69-70, 72, 74-6 passim
Date
Apr-2007
Language
English
Publication Type
Article
Keywords
Attitude to Health
Canada
Humans
Life expectancy
Quality Assurance, Health Care
Renal Dialysis - mortality - standards - statistics & numerical data
Treatment Outcome
Abstract
We examined data from the Canadian Organ Replacement Registry, and from a special substudy of CORR, to determine whether changes have occurred in practice patterns before and after the 1999 Canadian Society of Nephrology guidelines were published. Second, we used data from the Dialysis Outcomes and Practice Patterns Study to calculate the impact of observed deviations from guideline targets and estimated potential gains in life years that might accrue if guideline targets were achieved in all Canadian hemodialysis patients. For dialysis dose and hemoglobin targets, there was a significant improvement in Canadian facility performance over time. On the other hand, vascular access care showed a worse pattern with increased catheter use. A calculation of attributable risk, which assumes causality, suggests that 49 percent of deaths could be averted if all patients currently outside the guidelines achieved them over the next five years. When expressed as an annual death rate per hundred patient years, this corresponds to a decrease from 18 to 10.1 deaths per 100 patient years. We conclude that promoting a facility-based culture of quality improvement based on achievement of guideline targets is supported by international and Canadian observational data from the DOPPS. In the future, the impact of such an approach should be assessed empirically by correlating changes in practice over time with changes in outcomes.
PubMed ID
17427445 View in PubMed
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Optimizing hemodialysis practices in Canada could improve patient survival.

https://arctichealth.org/en/permalink/ahliterature161943
Source
CANNT J. 2007 Apr-Jun;17(2):22-34
Publication Type
Article
Author
Karen E Yeates
David C Mendelssohn
Jean Ethier
Lilyanna Trpeski
Jingbo Na
Jennifer L Bragg-Gresham
Margaret A Eichleay
Ronald L Pisoni
Fritz K Port
Author Affiliation
Division of Nephrology at Queen's University Kingston, Ontario.
Source
CANNT J. 2007 Apr-Jun;17(2):22-34
Language
English
French
Publication Type
Article
Keywords
Canada - epidemiology
Guideline Adherence - organization & administration
Health services needs and demand
Health Services Research
Humans
Kidney Failure, Chronic - mortality - therapy
Nephrology - organization & administration
Organizational Innovation
Outcome Assessment (Health Care)
Physician's Practice Patterns - organization & administration
Practice Guidelines as Topic
Renal Dialysis - adverse effects - methods - mortality - standards
Societies, Medical
Survival Rate
Total Quality Management - organization & administration
Abstract
Data from the Canadian Organ Replacement Registry (CORR) and the Dialysis Outcomes and Practice Patterns Study (DOPPS) were used to determine whether practice patterns have changed in Canada since the introduction of the Canadian Society of Nephrology (CSN) Guidelines in 1999. DOPPS data were then used to calculate the impact of not meeting the proposed guideline targets and to estimate the potential life years gained if all Canadian hemodialysis patients achieved guideline targets. For dialysis dose and hemoglobin targets, Canadian facility performance has significantly improved over time. The vascular access use patterns show trends toward a worse pattern with increased catheter use. A calculation of the percentage of attributable risk suggests that 49% of deaths could possibly be averted if all patients currently outside the guidelines achieved them over the next five years. This corresponds to a decrease in the annual death rate from 18 to 10.1 per hundred patient years. These data support the need for improved adherence to guidelines. If Canadian caregivers were to optimize practice patterns, patient outcomes could be improved.
PubMed ID
17691708 View in PubMed
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Quality of sleep in patients with chronic kidney disease.

https://arctichealth.org/en/permalink/ahliterature182439
Source
Nephrol Dial Transplant. 2004 Jan;19(1):95-9
Publication Type
Article
Date
Jan-2004
Author
Eduard A Iliescu
Karen E Yeates
David C Holland
Author Affiliation
Department of Medicine, 2058 Etherington Hall, Queen's University, Kingston, Ontario, Canada. eai1@post.queensu.ca
Source
Nephrol Dial Transplant. 2004 Jan;19(1):95-9
Date
Jan-2004
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Cross-Sectional Studies
Female
Humans
Kidney Failure, Chronic - complications
Male
Middle Aged
Ontario - epidemiology
Prevalence
Severity of Illness Index
Sleep Disorders - complications - epidemiology
Abstract
Sleep disorders are common in patients with renal failure on dialysis; however, the prevalence of "poor sleep" in patients with chronic kidney disease (CKD) not yet on dialysis is not known. This study aimed to measure the prevalence of "poor sleep" in CKD patients and to examine the association between quality of sleep and the degree of renal impairment in this population.
Quality of sleep was measured using the Pittsburgh Sleep Quality Index (PSQI) in 120 prevalent CKD patients.
Sixty-three subjects (53%) had "poor sleep" defined as a global PSQI score >5. There was no statistically significant relationship between the global PSQI score and the blood urea nitrogen level (BUN), serum creatinine level or calculated creatinine clearance, but the sleep efficiency component score correlated with BUN (r = 0.19, P = 0.04) and serum creatinine (r = 0.20, P = 0.03). A history of depression was the only independent predictor of "poor sleep" (global PSQI >5).
"Poor sleep" is common in CKD patients. Quality of sleep decreases in the early stages of CKD and does not appear to be associated with the subsequent degree of renal failure. Large prospective longitudinal studies of quality of sleep in CKD patients are needed to confirm the high prevalence of impaired quality of sleep in this population and examine the association between renal function and quality of sleep while controlling for potential confounding variables.
PubMed ID
14671044 View in PubMed
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A Retrospective Study of Chronic Kidney Disease Burden in Saskatchewan's First Nations People.

https://arctichealth.org/en/permalink/ahliterature295123
Source
Can J Kidney Health Dis. 2018; 5:2054358118799689
Publication Type
Journal Article
Date
2018
Author
Dorothy A Thomas
Anne Huang
Michelle C E McCarron
Joanne E Kappel
Rachel M Holden
Karen E Yeates
Bonnie R Richardson
Author Affiliation
Division of Nephrology, Department of Medicine, Queen's University, Kingston, ON, Canada.
Source
Can J Kidney Health Dis. 2018; 5:2054358118799689
Date
2018
Language
English
Publication Type
Journal Article
Abstract
Chronic kidney disease is more prevalent among First Nations people than in non-First Nations people. Emerging research suggests that First Nations people are subject to greater disease burden than non-First Nations people.
We aimed to identify the severity of chronic kidney disease and quantify the geographical challenges of obtaining kidney care by Saskatchewan's First Nations people.
This study is a retrospective analysis of the provincial electronic medical record clinical database from January 2012 to December 2013.
The setting involved patients followed by the Saskatchewan provincial chronic kidney care program, run out of two clinics, one in Regina, SK, and one in Saskatoon, SK.
The patients included 2478 individuals (379 First Nations and 2099 non-First Nations) who were older than 18 years old, resident in Saskatchewan, and followed by the provincial chronic kidney care program. First Nations individuals were identified by their Indigenous and Northern Affairs Canada (INAC) Number.
The demographics, prevalence, cause of end-stage renal disease, severity of chronic kidney disease, use of home-based therapies, and distance traveled for care among patients are reported.
Data were extracted from the clinical database used for direct patient care (the provincial electronic medical record database for the chronic kidney care program), which is prospectively managed by the health care staff. Actual distance traveled by road for each patient was estimated by a Geographic Information System Analyst in the First Nations and Inuit Health Branch of Health Canada.
Compared with non-First Nations, First Nations demonstrate a higher proportion of end-stage renal disease (First Nations = 33.0% vs non-First Nations = 21.4%, P
Notes
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PubMed ID
30245841 View in PubMed
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