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Canadian survey of clinical status at dialysis initiation 1998-1999: a multicenter prospective survey.

https://arctichealth.org/en/permalink/ahliterature188002
Source
Clin Nephrol. 2002 Oct;58(4):282-8
Publication Type
Article
Date
Oct-2002
Author
B M Curtis
B J Barret
K. Jindal
O. Djurdjev
A. Levin
P. Barre
K. Bernstein
P. Blake
E. Carlisle
P. Cartier
C. Clase
B. Culleton
C. Deziel
S. Donnelly
J. Ethier
A. Fine
G. Ganz
M. Goldstein
J. Kappel
G. Karr
S. Langlois
D. Mendelssohn
N. Muirhead
B. Murphy
G. Pylpchuk
E. Toffelmire
Author Affiliation
Division of Nephrology, Memorial University of Newfoundland, Canada.
Source
Clin Nephrol. 2002 Oct;58(4):282-8
Date
Oct-2002
Language
English
Publication Type
Article
Keywords
Adult
Age Factors
Aged
Canada
Creatinine - urine
Cross-Sectional Studies
Diabetes Mellitus - metabolism - physiopathology - therapy
Female
Food Habits
Glomerular Filtration Rate - physiology
Health Surveys
Humans
Kidney Failure, Chronic - metabolism - physiopathology - therapy
Male
Middle Aged
Prospective Studies
Renal Dialysis
Serum Albumin - metabolism
Treatment Outcome
Urban health
Abstract
The current growth in end-stage kidney disease populations has led to increased efforts to understand the impact of status at dialysis initiation on long-term outcomes. Our main objective was to improve the understanding of current Canadian nephrology practice between October 1998 and December 1999.
Fifteen nephrology centers in 7 provinces participated in a prospective data collection survey. The main outcome of interest was the clinical status at dialysis initiation determined by: residual kidney function, preparedness for chronic dialysis as measured by presence or absence of permanent peritoneal or hemodialysis access, hemoglobin and serum albumin. Uremic symptoms at dialysis initiation were also recorded, however, in some cases these symptom data were obtained retrospectively.
Data on 251 patients during 1-month periods were collected. Patients commenced dialysis at mean calculated creatinine clearance levels of approximately 10 ml/min, with an average of 3 symptoms. 35% of patients starting dialysis had been known to nephrologists for less than 3 months. These patients are more likely to commence without permanent access and with lower hemoglobin and albumin levels. Even of those known to nephrologists, only 66% had permanent access in place.
Patients commencing dialysis in Canada appear to be doing so in relative concordance with published guidelines with respect to timing of initiation. Despite an increased awareness of kidney disease, a substantial number of patients continues to commence dialysis without previous care by a nephrologist. Of those who are seen by nephrologists, clinical and laboratory parameters are suboptimal according to current guidelines. This survey serves as an important baseline for future comparisons after the implementation of educational strategies for referring physicians and nephrologists.
PubMed ID
12400843 View in PubMed
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Chronic kidney disease: why is current management uncoordinated and suboptimal?

https://arctichealth.org/en/permalink/ahliterature193006
Source
Nephrol Dial Transplant. 2001;16 Suppl 7:61-4
Publication Type
Article
Date
2001
Author
F. Valderrábano
T. Golper
N. Muirhead
E. Ritz
A. Levin
Author Affiliation
Servicio de Nefrologia 6a Planta, Hospital Universitario Gregorio Marañon, Dr Ezquerdo 44-66, E-28007, Madrid, Spain.
Source
Nephrol Dial Transplant. 2001;16 Suppl 7:61-4
Date
2001
Language
English
Publication Type
Article
Keywords
Anemia - drug therapy
Canada
Chronic Disease
Delivery of Health Care
Health Resources
Humans
Kidney Diseases - therapy
Kidney Failure, Chronic - therapy
Quality of Health Care
Referral and Consultation
Abstract
Morbidity and mortality associated with chronic kidney disease (CKD) is higher than that of the normal population, and the incidence of end-stage renal disease (ESRD) continues to increase. Several factors contribute to the uncoordinated and suboptimal management of CKD, including the attitude and behaviour of nephrologists, referring physicians and patients, and economic constraints on healthcare systems. Late referral of at-risk patients to specialist care is an area of particular concern, as this denies nephrologists adequate opportunity to prevent progression of CKD and associated complications such as anaemia. Due to the ageing population and advances in technology, the costs of treating CKD and ESRD continue to escalate and represent another barrier to the delivery of optimal care. Optimizing the care provided to CKD patients requires a coordinated approach to the management of the condition. Closer collaboration and improved communication across specialities is important for the timely referral of patients and for efficient utilization of available resources. A multidisciplinary approach may facilitate patient identification and improve the management of CKD.
PubMed ID
11590260 View in PubMed
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Comparative hospitalization of hemodialysis and peritoneal dialysis patients in Canada.

https://arctichealth.org/en/permalink/ahliterature198345
Source
Kidney Int. 2000 Jun;57(6):2557-63
Publication Type
Article
Date
Jun-2000
Author
S W Murphy
R N Foley
B J Barrett
G M Kent
J. Morgan
P. Barré
P. Campbell
A. Fine
M B Goldstein
S P Handa
K K Jindal
A. Levin
H. Mandin
N. Muirhead
R M Richardson
P S Parfrey
Author Affiliation
Division of Nephrology and Clinical Epidemiology Unit, Memorial University of Newfoundland, St. John's, Newfoundland, Canada.
Source
Kidney Int. 2000 Jun;57(6):2557-63
Date
Jun-2000
Language
English
Publication Type
Article
Keywords
Canada
Cohort Studies
Hospitalization - statistics & numerical data
Humans
Male
Middle Aged
Peritoneal Dialysis - statistics & numerical data
Renal Dialysis - statistics & numerical data
Treatment Outcome
Abstract
Most comparisons of hemodialysis (HD) and peritoneal dialysis (PD) have used mortality as an outcome. Relatively few studies have directly compared the hospitalization rates, an outcome of perhaps equal importance, of patients using these different dialysis modalities.
Eight hundred twenty-two consecutive patients at 11 Canadian institutions with irreversible renal failure had an extensive assessment of comorbid illness and initial mode of dialysis collected prospectively immediately prior to starting dialysis therapy. The cohort was assembled between March 1993 and November 1994. The mean follow-up was 24 months. Admission data were used to compare hospitalization rates in HD and PD.
Thirty-four percent of patients at baseline and 50% at three months used PD. Twenty-five percent of HD and 32% of PD patients switched dialysis modality at least once after their first treatment (P = NS). Nine percent of HD patients and 30% of PD patients switched modality after three months (P
PubMed ID
10844625 View in PubMed
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Comparative mortality of hemodialysis and peritoneal dialysis in Canada.

https://arctichealth.org/en/permalink/ahliterature198945
Source
Kidney Int. 2000 Apr;57(4):1720-6
Publication Type
Article
Date
Apr-2000
Author
S W Murphy
R N Foley
B J Barrett
G M Kent
J. Morgan
P. Barré
P. Campbell
A. Fine
M B Goldstein
S P Handa
K K Jindal
A. Levin
H. Mandin
N. Muirhead
R M Richardson
P S Parfrey
Author Affiliation
The Division of Nephrology and Clinical Epidemiology Unit, Memorial University of Newfoundland, St. John's, Newfoundland, Canada.
Source
Kidney Int. 2000 Apr;57(4):1720-6
Date
Apr-2000
Language
English
Publication Type
Article
Keywords
Canada
Cohort Studies
Comorbidity
Female
Humans
Kidney Failure, Chronic - epidemiology - therapy
Male
Middle Aged
Peritoneal Dialysis - mortality
Proportional Hazards Models
Prospective Studies
Renal Dialysis - mortality
Abstract
Comparisons of mortality rates in patients on hemodialysis versus those on peritoneal dialysis have been inconsistent. We hypothesized that comorbidity has an important effect on differential survival in these two groups of patients.
Eight hundred twenty-two consecutive patients at 11 Canadian institutions with irreversible renal failure had an extensive assessment of comorbid illness collected prospectively, immediately prior to starting dialysis therapy. The cohort was assembled between March 1993 and November 1994; vital status was ascertained as of January 1, 1998.
The mean follow-up was 24 months. Thirty-four percent of patients at baseline, 50% at three months, and 51% at six months used peritoneal dialysis. Values for a previously validated comorbidity score were higher for patients on hemodialysis at baseline (4.0 vs. 3.1, P
PubMed ID
10760108 View in PubMed
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The impact of recombinant human erythropoietin on medical care costs for hemodialysis patients in Canada.

https://arctichealth.org/en/permalink/ahliterature223809
Source
Soc Sci Med. 1992 May;34(9):983-91
Publication Type
Article
Date
May-1992
Author
S. Sheingold
D. Churchill
N. Muirhead
A. Laupacis
R. Labelle
R. Goeree
Author Affiliation
Health Care Financing Administration, Bureau of Policy Development, Baltimore, MD 21207.
Source
Soc Sci Med. 1992 May;34(9):983-91
Date
May-1992
Language
English
Publication Type
Article
Keywords
Anemia - economics - therapy
Blood Transfusion - economics - utilization
Canada
Drug Costs - statistics & numerical data
Erythropoietin - therapeutic use
Female
Health Care Costs - statistics & numerical data
Health Expenditures - statistics & numerical data
Hospitalization - economics - statistics & numerical data
Humans
Kidney Failure, Chronic - economics - therapy
Male
Middle Aged
Quality of Life
Recombinant Proteins - therapeutic use
Renal Dialysis - economics
Treatment Outcome
Abstract
Recombinant human erythropoietin (r-HuEPO) is an established and effective therapy for anemia related to end stage renal disease. In addition to its clinical effects, it has been associated with significant improvements in quality of life for anemic hemodialysis patients. The therapy's impact on overall medical care expenditures for these patients remains uncertain, however. In this study, we examine the costs of r-HuEPO as well as potential offsetting reductions in other medical care costs that might result from the therapy. We used data from a randomized clinical trial, a longitudinal study of hemodialysis patients and the clinical literature to estimate the impact of r-HuEPO on transfusion requirements, transfusion-related illness, hospitalization and transplant success for these patients. We estimate that for patients that otherwise would be transfused, the therapy would reduce blood requirements by nearly 10 units per patient annually and hospital use by 8 days per year. In addition, increased transplant success due to r-HuEPO might result in 150 fewer patient months of dialysis treatments each year. Comparing the dollar value of these reductions with the cost of therapy yields a base case net increase in medical care expenditures of $3425 per patient year. Under varying assumptions, the estimates range from a net cost of $8320 to a net saving of $1775 per patient year.
PubMed ID
1631611 View in PubMed
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Safety and tolerability of cyclosporine and cyclosporine microemulsion during 18 months of follow-up in stable renal transplant recipients: a report of the Canadian Neoral Renal Study Group.

https://arctichealth.org/en/permalink/ahliterature206294
Source
Transplantation. 1998 Feb 27;65(4):505-10
Publication Type
Article
Date
Feb-27-1998
Author
E. Cole
P. Keown
D. Landsberg
P. Halloran
A. Shoker
D. Rush
J. Jeffrey
D. Russell
C. Stiller
N. Muirhead
L. Paul
J. Zaltzman
R. Loertscher
P. Daloze
R. Dandavino
A. Boucher
P. Handa
J. Lawen
P. Belitsky
P. Parfrey
A. Tan
L. Hendricks
Author Affiliation
University of British Columbia and the BC Transplant Society, Vancouver, Canada.
Source
Transplantation. 1998 Feb 27;65(4):505-10
Date
Feb-27-1998
Language
English
Publication Type
Article
Keywords
Administration, Oral
Adult
Blood pressure
Canada
Communicable Diseases - epidemiology
Cyclosporine - administration & dosage - adverse effects - therapeutic use
Emulsions
Female
Follow-Up Studies
Humans
Kidney Transplantation - immunology - mortality - physiology
Living Donors
Male
Middle Aged
Neoplasms - epidemiology
Postoperative Complications - chemically induced - classification - epidemiology
Prospective Studies
Time Factors
Tissue Donors
Abstract
There has been concern that the increased drug exposure associated with treatment with cyclosporine microemulsion (CsA-ME) would lead to an increase in adverse events.
The long-term safety and tolerability of conventional cyclosporine (CsA) and CsA-ME were compared in a randomized, multicenter, pharmacoepidemiologic study involving 1097 stable renal transplant patients after 18 months of follow-up.
No significant difference was seen in change in serum creatinine or calculated creatinine clearance between the two groups. Episodes of deterioration in renal function (change in serum creatinine > or = 20%) were categorized with the following results for CsA-ME versus CsA, respectively: acute rejection, 4.5% vs. 4.5%; chronic rejection, 8% vs. 11%; CsA nephrotoxicity, 12% vs. 7% (P=0.008); transient changes, 17% vs. 12%; other causes, 4% vs. 6%. During the first 6 months of the study, a transient increase in the incidence of gastrointestinal and neurological adverse events was seen in the CsA-ME group compared with the CsA group. Up to 18 months, patients in the CsA group reported significantly fewer hearing and vestibular disorders, but more cardiovascular problems than those in the CsA-ME group (P=0.035).
Tolerance to CsA and CsA-ME was similar. Renal function over 18 months was not adversely affected by the increased drug exposure with CsA-ME, although there was a transient increase in nephrotoxicity. The frequency of acute and chronic rejection did not change.
PubMed ID
9500624 View in PubMed
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6 records – page 1 of 1.