scholarly journals Citric Acid-Containing Dialysate and Survival Rate in the Dialysis Outcomes and Practice Patterns Study

Kidney360 ◽  
2021 ◽  
pp. 10.34067/KID.0006182020
Author(s):  
Pablo Ureña-Torres ◽  
Brian Bieber ◽  
Fitsum Guebre Egziabher ◽  
Rim Ossman ◽  
Michel Jadoul ◽  
...  
Keyword(s):  
Citric Acid ◽  
Practice Patterns ◽  
Cox Regression ◽  
Hemodialysis Patients ◽  
Hemodynamic Stability ◽  
Patient Demographics ◽  
Dependent Relationship ◽  
All Cause Mortality ◽  
Dialysis Outcomes ◽  
Dose Dependent

Background: Metabolic acidosis is a common threat for hemodialysis patients, managed by alkaline dialysate. The main base is bicarbonate, to which small amounts of acetic, citric, or hydrochloric acid are added. The first two ones are metabolized to bicarbonate, mostly by the liver. Citric acid-containing dialysate might improve dialysis efficiency, anticoagulation, calcification propensity score, and intradialytic hemodynamic stability. However, a recent report from the French dialysis registry suggested that this dialysate increases mortality risk. This prompted us to assess whether citric acid-containing bicarbonate-based dialysate was associated with mortality in the international Dialysis Outcomes and Practice Patterns Study (DOPPS). Methods: Detailed patient-based information on dialysate composition was collected in DOPPS phases 5 and 6 (2012 to 2017). Cox regression was used to model the association between baseline bicarbonate dialysate containing citric acid versus not containing citric acid and mortality among DOPPS country/phases where citric acid-containing dialysate was used. Results: Citrate-containing dialysate was most commonly used in Japan, Italy, and Belgium (25%, 25%, 21% of DOPPS phase 6 patients) and used in < 10% of patients in other countries. Among 11,306 patients in DOPPS country-phases with at least 15 patients using citrate-containing dialysate, patient demographics, comorbidities, and labs were similar among patients using (14%) vs. not using (86%) citrate-containing dialysate. After accounting for case mix, we did not observe a directional association between citric acid-containing dialysate use (any vs. none) and mortality [HR (95% CI) = 1.14 (0.97-1.34)], nor did we find evidence of a dose-dependent relationship when parameterizing the citrate concentration in the dialysate as 1, 2, and 3+ mEq/L. Conclusions: The use of citric acid-containing dialysate was not associated with greater risk of all-cause mortality in hemodialysis patients participating in DOPPS. Clinical indications for the use of citric acid-containing dialysate deserve further investigation.

scholarly journals Physical Function and Clinical Outcomes in Hemodialysis Patients: China Dialysis Outcomes and Practice Patterns Study

2021 ◽  
pp. 1-8
Author(s):  
Qingyu Niu ◽  
Xinju Zhao ◽  
Liangying Gan ◽  
Xinling Liang ◽  
Zhaohui Ni ◽  
...  
Keyword(s):  
Physical Function ◽  
Clinical Outcomes ◽  
Practice Patterns ◽  
Cox Regression ◽  
Demographic Data ◽  
Simple Method ◽  
Daily Dialysis ◽  
All Cause Mortality ◽  
Dialysis Outcomes ◽  
Climbing Stairs

Background: Hemodialysis (HD) patients usually have impaired physical function compared with the general population. Self-reported physical function is a simple method to implement in daily dialysis care. This study aimed to examine the association of self-reported physical function with clinical outcomes of HD patients. Methods: The Dialysis Outcomes and Practice Patterns Study (DOPPS) is a prospective cohort study. Data on 1,427 HD patients in China DOPPS5 were analyzed. Self-reported physical function was characterized by 2 items of “moderate activities limited level” and “climbing stairs limited level.” Demographic data, comorbidities, hospitalization, and death records were collected from patients’ records. Associations between physical function and outcomes were analyzed using COX regression models. Results: Compared to “limited a lot” in moderate activities, “limited a little” and “not limited at all” groups were associated with lower all-cause mortality after adjusted for covariates (HR: 0.652, 95% CI: 0.435–0.977, and HR: 0.472, 95% CI: 0.241–0.927, respectively). And, not limited in moderate activities was associated with lower risk of hospitalization than the “limited a lot” group after adjusted for covariates (HR: 0.747, 95% CI: 0.570–0.978). Meanwhile, compared to “limited a lot” in climbing stairs, “limited a little” and “not limited at all” groups were associated with lower all-cause mortality (HR: 0.574, 95% CI: 0.380–0.865 and HR: 0.472, 95% CI: 0.293–0.762, respectively) but not hospitalization after fully adjusted. Conclusion: Higher limited levels in self-reported physical function were associated with higher risk of all-cause mortality and hospitalization in HD patients.

MO792CONTEMPORARY MINERAL AND BONE DISORDER MARKERS AND TREATMENT AMONG HEMODIALYSIS PATIENTS IN THE EUROPEAN DIALYSIS OUTCOMES AND PRACTICE PATTERNS STUDY (DOPPS)*

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Brian Bieber ◽  
Indranil Dasgupta ◽  
Pieter Evenepoel ◽  
Stefan H Jacobson ◽  
Piergiorgio Messa ◽  
...  
Keyword(s):  
Vitamin D ◽  
Practice Patterns ◽  
Hemodialysis Patients ◽  
Serum Phosphorus ◽  
Active Vitamin ◽  
Mineral And Bone Disorder ◽  
Bone Disorder ◽  
Country Differences ◽  
Dialysis Outcomes ◽  
The Uk

Abstract Background and Aims Chronic kidney disease mineral and bone disorder (CKD-MBD) is characterized by abnormalities in serum calcium, phosphorus, and parathyroid hormone (PTH) and associated with morbidity and mortality. Previous publications from the Dialysis Outcomes and Practice Patterns Study (DOPPS) have demonstrated country differences in the prevalence and treatment of CKD-MBD among hemodialysis patients in participating European countries. We aim to compare the distribution of CKD-MBD related labs and treatments across countries in a contemporary population of European hemodialysis patients. Method DOPPS is an international prospective cohort study of hemodialysis patients ≥18 years of age. Patients are enrolled randomly from a representative sample of dialysis facilities within each nation at the start of each study phase. The current analysis includes n=1,701 patients from 91 facilities in the initial prevalent cross section of Europe DOPPS phase 7 (2019-present; Belgium, Germany, Italy, Spain, Sweden, UK). Results from Belgium should be considered preliminary as initial questionnaire completion is ongoing. Results The % of patients with a high PTH (&gt;600 pg/mL) ranged from 6% in Italy to 24% in the UK, with 12-17% having high PTH in all other countries. Mean serum total calcium ranged from 8.7 in Germany to 9.1 mg/dL in the UK (Table). Mean serum phosphorus varied from 4.5 in Belgium to 5.3 mg/dL in Germany. Dialysate calcium of 2.5 mEq/L was predominant in Germany, Sweden, and the UK while 3.0 mEq/L was the most common prescription in Belgium, Italy, and Spain. Calcimimetic prescription ranged from 13% in the UK to 32% in Spain. Etelcalcetide prescription ranged from 1% in the UK to 12% in Spain and 14% in Italy. Active vitamin D prescription ranged from 27% in Belgium to 75% in Sweden. Nearly all vitamin D prescriptions were administered intravenously in Spain versus about half in Italy; in all other countries, the route of active vitamin D administration was primarily oral. Patient age and dialysis vintage varied by country, potentially contributing to some of the observed country differences in MBD marker levels and treatment practices. Conclusion CKD-MBD related abnormalities in PTH, serum phosphorus and calcium remain common in European dialysis patients, with prevalence varying considerably by country. Substantial international variation in CKD-MBD treatments was also observed in prescription of vitamin D and calcimimetics. Uptake of the relatively new calcimimetic, etelcalcetide, varied considerably by country. A detailed understanding of the effect of treatment variation on CKD-MBD marker levels and patient outcomes is needed to provide important insights for the European HD community in optimizing management of secondary hyperparathyroidism.

Low Predialysis Plasma Calculated Osmolality Is Associated with Higher All-Cause Mortality: The Japanese Dialysis Outcomes and Practice Patterns Study (J-DOPPS)

Nephron ◽  
2020 ◽  
Vol 144 (3) ◽  
pp. 138-146
Author(s):  
Yasushi Tsujimoto ◽  
Yusuke Tsutsumi ◽  
Tsuyoshi Ohnishi ◽  
Miho Kimachi ◽  
Yosuke Yamamoto ◽  
...  
Keyword(s):  
Practice Patterns ◽  
All Cause Mortality ◽  
Dialysis Outcomes

Comparison of 24-hour and Office Pulse Wave Velocity for Prediction of Mortality in Hemodialysis Patients

2019 ◽  
Vol 49 (4) ◽  
pp. 317-327 ◽  
Author(s):  
Julia Matschkal ◽  
Christopher C. Mayer ◽  
Pantelis A. Sarafidis ◽  
Georg Lorenz ◽  
Matthias C. Braunisch ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Pulse Wave Velocity ◽  
Wave Velocity ◽  
Cardiovascular Mortality ◽  
Pulse Wave ◽  
Cox Regression ◽  
Hemodialysis Patients ◽  
Cox Regression Analysis ◽  
Kaplan Meier ◽  
All Cause Mortality

Background: Mortality in hemodialysis patients still remains unacceptably high. Enhanced arterial stiffness is a known cardiovascular risk factor, and pulse wave velocity (PWV) has proven to be a valid parameter to quantify risk. Recent studies showed controversial results regarding the prognostic significance of PWV for mortality in hemodialysis patients, which may be due to methodological issues, such as assessment of PWV in the office setting (Office-PWV). Method: This study cohort contains patients from the “Risk stratification in end-stage renal disease – the ISAR study,” a multicenter prospective longitudinal observatory cohort study. We examined and compared the predictive value of ambulatory 24-hour PWV (24 h-PWV) and Office-PWV on mortality in a total of 344 hemodialysis patients. The endpoints of the study were all-cause and cardiovascular mortality. Survival analysis included Kaplan-Meier estimates and Cox regression analysis. Results: During a follow-up of 36 months, a total of 89 patients died, 35 patients due to cardiovascular cause. Kaplan-Meier estimates for tertiles of 24 h-PWV and Office-PWV were similarly associated with mortality. In univariate Cox regression analysis, 24 h-PWV and Office-PWV were equivalent predictors for all-cause and cardiovascular mortality. After adjustment for common risk factors, only 24 h-PWV remained solely predictive for all-cause mortality (hazard ratio 2.51 [95% CI 1.31–4.81]; p = 0.004). Conclusions: Comparing both measurements, 24 h-PWV is an independent predictor for all-cause-mortality in hemodialysis patients beyond Office-PWV.

scholarly journals Cardiovascular Event Rates Among Hemodialysis Patients Across Geographical Regions—A Snapshot From The Dialysis Outcomes and Practice Patterns Study (DOPPS)

2019 ◽  
Vol 4 (6) ◽  
pp. 864-872 ◽  
Author(s):  
Heide A. Stirnadel-Farrant ◽  
Angelo Karaboyas ◽  
Borut Cizman ◽  
Brian A. Bieber ◽  
Lata Kler ◽  
...  
Keyword(s):  
Cardiovascular Event ◽  
Practice Patterns ◽  
Hemodialysis Patients ◽  
Geographical Regions ◽  
Dialysis Outcomes ◽  
Event Rates
Sign in / Sign up

Export Citation Format

Share Document