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Active treatment of uremia in the city of Göteborg 1966-1977.

https://arctichealth.org/en/permalink/ahliterature246366
Source
Scand J Urol Nephrol Suppl. 1980;54:16-21
Publication Type
Article
Date
1980
Author
J. Ahlmén
L E Gelin
H. Brynger
H. Bucht
Source
Scand J Urol Nephrol Suppl. 1980;54:16-21
Date
1980
Language
English
Publication Type
Article
Keywords
Adult
Age Factors
Aged
Biometry
Female
Humans
Kidney Failure, Chronic - mortality - therapy
Kidney Transplantation
Male
Middle Aged
Peritoneal dialysis
Retrospective Studies
Sweden
Abstract
137 patients were actively treated because of chronic uremia, during 1966 to 1977 in the city of Göteborg. One year patient survival increased from 51% (1966 to 1968) to 81% (1975 to 1977). Peritoneal dialysis decreased as the initial mode of treatment, and only 3% of the patients started dialysis treatment with this mode of therapy in the last 3-year period. Mean age of the actively treated patients was 44 years. A decreasing mean age of the actively treated patients was found towards the end of the period, reflecting more liberal criteria for accepting young patients with different systemic diseases. If the initial mode of treatment was dialysis, 1-year patient survival in the last 3-year period was 77%.
PubMed ID
7013035 View in PubMed
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Changes in patient and technique survival over time among incident peritoneal dialysis patients in Canada.

https://arctichealth.org/en/permalink/ahliterature124708
Source
Clin J Am Soc Nephrol. 2012 Jul;7(7):1145-54
Publication Type
Article
Date
Jul-2012
Author
Jeffrey Perl
Ron Wald
Joanne M Bargman
Yingbo Na
S Vanita Jassal
Arsh K Jain
Louise Moist
Sharon J Nessim
Author Affiliation
Division of Nephrology, University of Toronto, Ontario, Canada. jeff.perl@utoronto.ca
Source
Clin J Am Soc Nephrol. 2012 Jul;7(7):1145-54
Date
Jul-2012
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Canada
Female
Humans
Kidney Failure, Chronic - mortality - therapy
Male
Middle Aged
Peritoneal Dialysis - methods - trends
Prospective Studies
Survival Rate
Time Factors
Treatment Outcome
Young Adult
Abstract
In the last 15 years in Canada, there have been less stringent guidelines for peritoneal dialysis (PD) adequacy, availability of novel PD solutions, and lower PD-related peritonitis rates. Effects of these changes on outcomes of incident patients treated with PD during this period are unknown.
Risk of PD technique failure and mortality were compared among three incident cohorts of PD patients who initiated dialysis during the following periods: 1995-2000, 2001-2005, and 2006-2009. A multivariable model was used to evaluate time to PD technique failure using inverse probability of treatment and censoring weights accounting for changing survival and transplantation rates.
Between 1995 and 2009,13,120 incident adult PD patients were identified from the Canadian Organ Replacement Register. Compared with the 1995-2000 cohort (n=5183), the risk of PD technique failure was lower among patients between 2001 and 2005 (n=4316) but similar among incident patients between 2006 and 2009 (n=3621). Cause-specific PD technique failure revealed no difference in PD peritonitis-related technique failure over time. PD technique failure due to inadequate PD was initially higher in the 2001-2005 cohort but lower in the 2006-2009 cohort compared with the 1995-2000 cohort. Relative to incident patients between 1995 and 2000, adjusted mortality was lower among incident patients between 2001 and 2005 and 2006 and 2009.
Survival on PD continues to improve with only modest changes in PD technique failure. Peritonitis remains an ongoing and modifiable source of PD technique failure.
Notes
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PubMed ID
22554718 View in PubMed
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Changing patient characteristics in chronic hemodialysis.

https://arctichealth.org/en/permalink/ahliterature48677
Source
Scand J Urol Nephrol. 1991;25(1):59-63
Publication Type
Article
Date
1991
Author
B. Hylander
H. Lundblad
C M Kjellstrand
Author Affiliation
Department of Medicine, Karolinska Hospital, Stockholm, Sweden.
Source
Scand J Urol Nephrol. 1991;25(1):59-63
Date
1991
Language
English
Publication Type
Article
Keywords
Adult
Aged
Cause of Death
Comorbidity
Female
Humans
Kidney Failure, Chronic - mortality - therapy
Kidney Function Tests
Male
Middle Aged
Referral and Consultation - trends
Renal Dialysis - mortality - trends
Survival Rate
Sweden
Abstract
Patients accepted to chronic hemodialysis have changed. We analyzed these changes and survival, cause of death and other factors during 23 years at the Karolinska Hospital. Between 1965 and 1987, 274 patients were accepted: 60 are alive on dialysis, 75 died, 113 were transplanted, 25 sent to other units and one recovered renal function. The mean age increased from 44 to 55 years (p=0.001), the creatinine level at acceptance decreased from 1191 to 965 mumol/l (p = 0.001), the hemoglobin level rose from 70 to 85 g/l (p = 0.001) and the diastolic blood pressure decreased from 96 to 90 mmHg (p = 0.007). The number of co-morbid conditions increased from 1.2 to 1.4 (p less than 0.005). The diagnoses changed from over 90% primary renal disease to 20% systemic diseases such as nephrosclerosis and diabetes (p = 0.04). The chance of receiving a renal transplant decreased from 46 to 39% (p = 0.28). The transplanted patients were younger than the dialyzed patients 42 vs 47 years (p = 0.03) before 1980 and 49 vs. 56 years (p = 0.0001) after 1980. The cause of death changed. Withdrawal from dialysis increased from 5% of deaths before to 24% after 1980 (p = 0.047), cardiovascular deaths decreased from 85% to 55% (p = 0.01). Although the patients accepted for dialysis after 1980 had more serious renal disease and other degenerative diseases than those before, the mortality rate was reduced to only 1/4 to that before, in all age groups.(ABSTRACT TRUNCATED AT 250 WORDS)
PubMed ID
2047775 View in PubMed
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Clinical outcomes of elderly patients undergoing chronic peritoneal dialysis: experiences from one center and a review of the literature.

https://arctichealth.org/en/permalink/ahliterature160958
Source
Int Urol Nephrol. 2007;39(4):1295-302
Publication Type
Article
Date
2007
Author
Xiao Yang
Wei Fang
Jaitan Kothari
Mukesh Khandelwal
David Naimark
Sarbjit Vanita Jassal
Joanne M Bargman
Dimitrios G Oreopoulos
Author Affiliation
Peritoneal Dialysis Programme, Toronto Western Hospital, University Network and University of Toronto, 399 Bathurst Street, Toronto, Canada, M5T 2S8.
Source
Int Urol Nephrol. 2007;39(4):1295-302
Date
2007
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Female
Humans
Kidney Failure, Chronic - mortality - therapy
Male
Ontario - epidemiology
Peritoneal dialysis
Proportional Hazards Models
Retrospective Studies
Survival Analysis
Treatment Outcome
Abstract
The purpose of this study was to evaluate the outcome and to identify predictors of mortality in elderly patients on chronic peritoneal dialysis (CPD).
We retrospectively reviewed the charts of patients who started on CPD at the Division of Nephrology, University Health Network (UHN), Toronto, from 1 January 1994 to 31 December 2001. Patients were divided into three different age groups (/=75 years). Baseline variables included demographics, information on primary kidney disease, comorbidities when dialysis was first started, and initial biochemical data such as serum albumin, serum calcium (corrected for protein), phosphate, hemoglobin (Hb), total cholesterol, and triglyceride. The effects of these variables on survival were studied using a univariate procedure and then analyzed using multivariate Cox proportional hazards models in order to evaluate their independent relation to mortality.
This study included 358 patients, among whom 213 (59.5%) were /=75 years old. Mean actuarial (death-censored) technique survival for the overall study population was 72.4 months (95% confidence interval [CI]: 66.3-78.5); in the /=75 year-old groups mean survivals were 74.4, 62.0, and 64.5 months, respectively. The death-censored technique survival for the elderly patients was not statistically significantly different from that in young patients (P = 0.778). In the overall study population, the mean patient survival was 70.4 months (95% CI 64.2-76.6), while the mean survivals for the /=75 year-old groups were 82.3, 54.0, and 50.0 months, respectively. The overall survival rates at 12 months were 98%, 84%, and 85% for the /=75 year-old groups, respectively. Not surprisingly, the survival of elderly patients on CPD is shorter than that of younger patients (P = 0.000). There were no significant differences between the two elderly groups (P = 0.439). Mortality was predicted by lower initial serum total cholesterol and albumin as well as higher serum calcium levels.
Our study shows that elderly patients starting CPD had a death-censored technique survival comparable to that of younger patients. As expected, the survival of elderly patients on CPD was shorter than the survival of younger patients. Lower initial serum total cholesterol and albumin as well as higher initial serum calcium were associated with mortality in the elderly population. Our findings indicate that chronic peritoneal dialysis is a successful dialysis option for elderly patients with end stage renal disease. Measures to improve their nutritional state and achieve normalization of serum calcium might improve their survival.
PubMed ID
17922108 View in PubMed
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Clinical Practice Guidelines of the Canadian Society of Nephrology for the treatment of patients with chronic renal failure: a re-examination.

https://arctichealth.org/en/permalink/ahliterature185006
Source
Contrib Nephrol. 2003;(140):163-9
Publication Type
Article
Date
2003

Comparing mortality rates on CAPD/CCPD and hemodialysis. The Canadian experience: fact or fiction?

https://arctichealth.org/en/permalink/ahliterature203674
Source
Perit Dial Int. 1998 Sep-Oct;18(5):478-84
Publication Type
Article
Author
D E Schaubel
H I Morrison
S S Fenton
Author Affiliation
Laboratory Centre for Disease Control, Health Canada, Ottawa.
Source
Perit Dial Int. 1998 Sep-Oct;18(5):478-84
Language
English
Publication Type
Article
Keywords
Canada - epidemiology
Diabetic Nephropathies - mortality - therapy
Humans
Kidney Failure, Chronic - mortality - therapy
Peritoneal Dialysis - methods - mortality
Peritoneal Dialysis, Continuous Ambulatory - mortality
Registries - statistics & numerical data
Regression Analysis
Renal Dialysis - mortality
Time Factors
Abstract
To compare mortality rates on hemodialysis (HD) to rates on continuous ambulatory/cyclic peritoneal dialysis (CAPD/CCPD), to contrast our results with those of other recent investigations, and to discuss reasons for discrepancies.
Patient-specific data obtained from the Canadian Organ Replacement Register on patients initiating renal replacement therapy (RRT) between 1 January 1990 and 31 December 1995 (n = 14 483). Recent mortality comparisons of CAPD and HD.
Mortality rate ratio (RR) based on "as-treated" (AT) analysis incorporating treatment modality switches and adjusting for age, primary renal diagnosis, and comorbid conditions using Poisson regression. Hazard ratios (HR) were estimated using Cox regression and based on an "intent-to-treat" (ITT) analysis wherein patients were classified based on dialytic modality received on follow-up day 90.
Adjusted mortality rates were significantly decreased on CAPD/CCPD relative to HD [RR = 0.73, 95% confidence interval (CI) = (0.69, 0.77)] based on the AT analysis. Most of the protective effect of CAPD/CCPD was concentrated in the first 2 years of follow-up post-RRT initiation. Based on the ITT analysis, the estimated CAPD/ CCPD effect was greatly reduced, with HR = 0.93 (0.87, 0.99).
We provide further evidence that CAPD/CCPD is not an inferior dialytic modality to HD, particularly in the short term. Comparing mortality rates on CAPD/CCPD and HD is inherently difficult due to the potential for bias. Discrepancies between our results and those of previous investigations, and variability in findings among previous studies, relate to differences in clinical and demographic setting, patient populations, study design, statistical methods, and interaction between the dialytic modality effect and various other covariables.
Notes
Comment In: Perit Dial Int. 1998 Sep-Oct;18(5):5579848645
PubMed ID
9848625 View in PubMed
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Comparison of peritoneal dialysis practice patterns and outcomes between a Canadian and a Chinese centre.

https://arctichealth.org/en/permalink/ahliterature155196
Source
Nephrol Dial Transplant. 2008 Dec;23(12):4021-8
Publication Type
Article
Date
Dec-2008
Author
Wei Fang
Jiaqi Qian
Aiwu Lin
Fadel Rowaie
Zhaohui Ni
Qiang Yao
Joanne M Bargman
Dimitrios G Oreopoulos
Author Affiliation
Renal Division, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Source
Nephrol Dial Transplant. 2008 Dec;23(12):4021-8
Date
Dec-2008
Language
English
Publication Type
Article
Keywords
Adult
Aged
China - epidemiology
Female
Humans
Kaplan-Meier Estimate
Kidney Failure, Chronic - mortality - therapy
Male
Middle Aged
Ontario - epidemiology
Peritoneal Dialysis - adverse effects - methods - mortality - statistics & numerical data
Peritonitis - epidemiology - etiology
Physician's Practice Patterns
Proportional Hazards Models
Treatment Failure
Treatment Outcome
Abstract
Objective. We compared patient characteristics, dialysis practice patterns and outcomes of peritoneal dialysis (PD) patients between one Chinese centre and one Canadian centre to determine whether observed differences in demographics and practices are associated with patient and technique survival.
This study included all patients who started on PD between 1 January 2000 and 31 December 2004 at the University Health Network, University of Toronto, Canada and Renji Hospital, Shanghai Jiao Tong University School of Medicine, China. They were followed up from the date of PD initiation until death, cessation of PD, transfer to other centres or to the end of the study (31 December 2006).
We studied 496 patients, 256 from the Canadian centre and 240 from the Chinese centre. Canadian patients were older and more likely to have diabetes and cardiovascular comorbidities at the initiation of PD, while the Chinese patients had lower residual renal function (RRF). More Canadian patients were treated with APD, whereas all Chinese patients were on CAPD with a lower PD volume. Crude patient survival rates at 1, 2, 3 and 5 years were similar between the two centres: 90%, 79%, 72% and 61% for Canadian and 90%, 79%, 71% and 64% for Chinese patients, respectively. After adjustment for demographic and clinical variables, there is no significant difference in mortality between Chinese patients and Canadian patients. Age, cardiovascular disease, diabetes, RRF and serum albumin were independent predictors of patient survival. The death-censored technique survival rates were significantly lower among the Canadian patients compared to Chinese patients. Chinese patients showed a lower risk of technique failure (HR 0.491, 95% CI 0.269-0.898, P = 0.021) after adjustment for patient characteristics. Chinese centre, BMI, serum albumin and gender were independent predictors of technique survival. The average peritonitis rate was one episode every 36.1 patient-months in Canadian patients and one episode every 60.6 patient-months in their Chinese counterparts.
Patient characteristics, dialysis practice patterns and outcomes vary between Canadian and Chinese patients. The variability in patient outcomes between these two centres indicates that further improvements may be possible in both centres. We have identified several areas for improving outcomes.
PubMed ID
18790809 View in PubMed
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Continuous renal replacement therapy is associated with less chronic renal failure than intermittent haemodialysis after acute renal failure.

https://arctichealth.org/en/permalink/ahliterature78448
Source
Intensive Care Med. 2007 May;33(5):773-80
Publication Type
Article
Date
May-2007
Author
Bell Max
Granath Fredrik
Schön Staffan
Ekbom Anders
Martling Claes-Roland
Author Affiliation
Department of Anaesthesiology and Intensive Care, Karolinska University Hospital, 171 76, Solna, Stockholm, Sweden. max.bell@karolinska.se
Source
Intensive Care Med. 2007 May;33(5):773-80
Date
May-2007
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Female
Follow-Up Studies
Humans
Intensive Care Units
Kidney Failure, Acute - mortality - therapy
Kidney Failure, Chronic - mortality - therapy
Male
Middle Aged
Multicenter Studies
Registries
Renal Dialysis - methods
Renal Replacement Therapy - methods
Retrospective Studies
Survival Rate
Sweden
Abstract
OBJECTIVE: Acute renal failure can be treated with continuous renal replacement therapy (CRRT) or intermittent haemodialysis (IHD). Whether this choice affects renal recovery has been debated, since it has implications on quality of life and costs. Our objective was to determine the impact of CRRT and IHD on renal recovery. DESIGN: Nationwide retrospective cohort study between the years 1995 and 2004. Follow-up ranged between 3 months and 10 years. SETTING: Thirty-two Swedish intensive care units. PATIENTS AND PARTICIPANTS: Eligible subjects were adults treated in Swedish general intensive care units with RRT. A total of 2,642 patients from 32 ICUs were included. We then excluded patients with end-stage renal disease (252) and patients lacking a diagnosis in the in-patient register (188). Thus, 2,202 patients were studied. Follow-up was complete. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: The primary outcome was renal recovery. Secondarily we studied the mortality of the cohort. There were no differences between IHD and CRRT patients regarding baseline characteristics, such as age, sex and comorbidities. Of the 1,102 patients surviving 90 days after inclusion in the cohort, 944 (85.7%) were treated with CRRT and 158 (14.3%) were treated with IHD. Seventy-eight patients (8.3%; confidence interval, CI, 6.6-10.2), never recovered their renal function in the CRRT group. The proportion was significantly higher among IHD patients, where 26 subjects or 16.5% (CI 11.0-23.2) developed need for chronic dialysis. CONCLUSIONS: The use of CRRT is associated with better renal recovery than IHD, but mortality does not differ between the groups.
PubMed ID
17364165 View in PubMed
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Decline in glomerular filtration rate during pre-dialysis phase and survival on chronic renal replacement therapy.

https://arctichealth.org/en/permalink/ahliterature132501
Source
Nephrol Dial Transplant. 2012 Mar;27(3):1157-63
Publication Type
Article
Date
Mar-2012
Author
Mikko Haapio
Jaakko Helve
Pia Kurimo
Terje Forslund
Carola Grönhagen-Riska
Patrik Finne
Author Affiliation
Division of Nephrology, Helsinki University Central Hospital, Helsinki, Finland. mikko.haapio@helsinki.fi
Source
Nephrol Dial Transplant. 2012 Mar;27(3):1157-63
Date
Mar-2012
Language
English
Publication Type
Article
Keywords
Adult
Aged
Angiotensin-Converting Enzyme Inhibitors - therapeutic use
Cohort Studies
Comorbidity
Creatinine - blood
Female
Finland
Follow-Up Studies
Glomerular Filtration Rate
Humans
Kidney Failure, Chronic - mortality - therapy
Male
Middle Aged
Renal Dialysis - adverse effects
Renal Replacement Therapy - mortality
Risk
Risk factors
Survival Rate
Abstract
Estimated glomerular filtration rate (eGFR) is widely used in follow-up and assessment of patients before start of chronic renal replacement therapy (RRT). Reported data on impact of eGFR decline pattern during pre-dialysis phase on consequent survival on RRT are, however, non-existent.
Using the database of the Finnish Registry for Kidney Diseases, we conducted a cohort study of all incident adult patients (n = 457) entering chronic RRT in Finland in 1998, with follow-up until 31 December 2008. We included those (n = 319) with three serum creatinine measurements (at ~12 and 3 months and 1 to 2 weeks prior to RRT start) and calculated their slopes of eGFR using the modification of diet in renal disease formula. According to eGFR slopes (in mL/min/1.73m(2)/year), patients were divided into tertiles: most rapid (>8.5, n = 107), intermediate (3.4-8.5, n = 107) and slowest decline (
PubMed ID
21810761 View in PubMed
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45 records – page 1 of 5.