scholarly journals Study Protocol for ‘Patient Referral and Education Program prior to Renal Replacement Therapy (PREP-RRT)”:

2019 ◽  
Vol 2 ◽  
pp. 1-9
Author(s):  
Milda Saunders ◽  
Akilah King ◽  
Eric Robinson ◽  
Fanny Lopez ◽  
Michael Quinn ◽  
...  
Keyword(s):  
Renal Replacement Therapy ◽  
African Americans ◽  
Replacement Therapy ◽  
Education Program ◽  
Treatment Options ◽  
Self Care ◽  
Or Education ◽  
Patient Referral ◽  
Receive Treatment ◽  
Satisfaction With Education

Patients with advanced stages of chronic kidney disease (CKD), especially racial minorities, often do not receive treatment or education until specific symptoms begin to manifest. The Patient Referral and Education Program prior to Renal Replacement Therapy (PREP-RRT) study is intended to capture the perspective of African Americans receiving renal care and then tailor education for hospitalized patients who may not be well linked to the medical system. In the U.S., African Americans and other minorities are less likely to be seen by a nephrologist prior to dialysis and the lack of pre-dialysis care and education is associated with lower likelihood of pre-emptive transplant. The primary outcome for the PREP-RRT study will be change in patient knowledge, attitudes and behavior about CKD treatment options which will be assessed by the previously validated Kidney Knowledge Survey (KiKS). Secondary outcomes of interest are patient satisfaction with education, time-to-event for nephrology appointment, appearance at transplant center, likelihood of fistula, self-care dialysis at dialysis initiation, or documentation of patient decision not to initiate RRT. The PREP RRT intervention will identify, educate and motivate patients to increase CKD self-care and to improve communication and shared decision-making about RRT treatments among patients, their families and their providers.

Projecting demands for renal replacement therapy in the Northern Territory: a stochastic Markov model

2018 ◽  
Vol 42 (4) ◽  
pp. 380 ◽  
Author(s):  
Jiqiong You ◽  
Yuejen Zhao ◽  
Paul Lawton ◽  
Steven Guthridge ◽  
Stephen P. McDonald ◽  
...  
Keyword(s):  
Renal Replacement Therapy ◽  
Markov Model ◽  
Replacement Therapy ◽  
Management Practices ◽  
Markov Models ◽  
Self Care ◽  
Potential Effect ◽  
Northern Territory ◽  
Baseline Scenario ◽  
On Demand

Objective The aim of the present study was to evaluate the potential effects of different health intervention strategies on demand for renal replacement therapy (RRT) services in the Northern Territory (NT). Methods A Markov chain simulation model was developed to estimate demand for haemodialysis (HD) and kidney transplantation (Tx) over the next 10 years, based on RRT registry data between 2002 and 2013. Four policy-relevant scenarios were evaluated: (1) increased Tx; (2) increased self-care dialysis; (3) reduced incidence of end-stage kidney disease (ESKD); and (4) reduced mortality. Results There were 957 new cases of ESKD during the study period, with most patients being Indigenous people (85%). The median age was 50 years at onset and 57 years at death, 12 and 13 years younger respectively than Australian medians. The prevalence of RRT increased 5.6% annually, 20% higher than the national rate (4.7%). If current trends continue (baseline scenario), the demand for facility-based HD (FHD) would approach 100 000 treatments (95% confidence interval 75 000–121 000) in 2023, a 5% annual increase. Increasing Tx (0.3%), increasing self-care (5%) and reducing incidence (5%) each attenuate demand for FHD to ~70 000 annually by 2023. Conclusions The present study demonstrates the effects of changing service patterns to increase Tx, self-care and prevention, all of which will substantially attenuate the growth in FHD requirements in the NT. What is known about the topic? The burden of ESKD is projected to increase in the NT, with demand for FHD doubling every 15 years. Little is known about the potential effect of changes in health policy and clinical practice on demand. What does this paper add? This study assessed the usefulness of a stochastic Markov model to evaluate the effects of potential policy changes on FHD demand. What are the implications for practitioners? The scenarios simulated by the stochastic Markov models suggest that changes in current ESKD management practices would have a large effect on future demand for FHD.

scholarly journals Survival during Renal Replacement Therapy among African Americans Infected with HIV Type 1 in Urban Baltimore, Maryland

2007 ◽  
Vol 45 (12) ◽  
pp. 1625-1632 ◽  
Author(s):  
M. G. Atta ◽  
D. M. Fine ◽  
G. D. Kirk ◽  
S. H. Mehta ◽  
R. D. Moore ◽  
...  
Keyword(s):  
Renal Replacement Therapy ◽  
African Americans ◽  
Replacement Therapy ◽  
Hiv Type 1

Preparation for renal replacement therapy

2018 ◽  
Author(s):  
Muh Geot Wong ◽  
Bruce A. Cooper ◽  
Carol A. Pollock
Keyword(s):  
Chronic Kidney Disease ◽  
Renal Replacement Therapy ◽  
Kidney Disease ◽  
Replacement Therapy ◽  
Social Issues ◽  
Treatment Options ◽  
Multidisciplinary Education ◽  
Initiation Of Dialysis ◽  
Full Knowledge ◽  
The Individual

Although the primary aim of management in chronic kidney disease (CKD) is to prevent progression to stage 5 CKD, for many patients renal replacement therapy (RRT) is inevitable. Planning for the initiation of dialysis is aimed at ensuring that it takes place in a supported environment in which adverse events will be minimized, that the modality chosen is appropriate for the individual circumstances, and the patient has full knowledge of what RRT entails. Beginning dialysis inevitably involves medical, psychological, family, and social issues, and preparation for RRT is optimally managed by a team with appropriate expertise in these areas. Multidisciplinary education programmes that inform patients and their families about their disease and the treatment options are likely to result in patients starting dialysis in a planned and elective manner.

A validated LC-MS/MS method for the simultaneous quantification of the novel combination antibiotic, ceftolozane–tazobactam, in plasma (total and unbound), CSF, urine and renal replacement therapy effluent: application to pilot pharmacokinetic studies

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Suzanne L. Parker ◽  
Saurabh Pandey ◽  
Fekade B. Sime ◽  
Janine Stuart ◽  
Jeffrey Lipman ◽  
...  
Keyword(s):  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Matrix Effects ◽  
Treatment Options ◽  
World Health ◽  
Selected Reaction Monitoring ◽  
Pharmacokinetic Studies ◽  
Drug Resistant ◽  
Gram Negative ◽  
Simultaneous Quantification

AbstractObjectivesNovel treatment options for some carbapenem-resistant Gram-negative pathogens have been identified by the World Health Organization as being of the highest priority. Ceftolozane–tazobactam is a novel cephalosporin – beta-lactamase inhibitor combination antibiotic with potent bactericidal activity against the most difficult-to-treat multi-drug resistant and extensively drug resistant Gram-negative pathogens. This study aimed to develop and validate a liquid chromatography – tandem mass spectrometry method for the simultaneous quantification of ceftolozane and tazobactam in plasma (total and unbound), renal replacement therapy effluent (RRTE), cerebrospinal fluid (CSF) and urine.MethodsAnalytes were separated using mixed-mode chromatography with an intrinsically base-deactivated C18 column and a gradient mobile phase consisting of 0.1% formic acid, 10 mM ammonium formate and acetonitrile. The analytes and internal standards were detected using rapid ionisation switching between positive and negative modes with simultaneous selected reaction monitoring.ResultsA quadratic calibration was obtained for plasma (total and unbound), RRTE and CSF over the concentration range of 1–200 mg/L for ceftolozane and 0.5–100 mg/L for tazobactam, and for urine the concentration range of 10–2,000 mg/L for ceftolozane and 5–1,000 mg/L for tazobactam. For both ceftolozane and tazobactam, validation testing for matrix effects, precision and accuracy, specificity and stability were all within the acceptance criteria of ±15%.ConclusionsThis methodology was successfully applied to one pilot pharmacokinetic study in infected critically ill patients, including patients receiving renal replacement therapy, and one case study of a patient with ventriculitis, where all patients received ceftolozane–tazobactam.

Project of the Health Policy Program: Access to Vessels in Renal Replacement Therapy - Fistula First / Catheter Last

2020 ◽  
Vol 92 (1) ◽  
pp. 1-5
Author(s):  
Grzegorz Kubielas
Keyword(s):  
Health Care ◽  
Health Policy ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Vascular Access ◽  
Self Care ◽  
Care Organization ◽  
Arteriovenous Anastomosis ◽  
Number Of Patients ◽  
Policy Program

The number of patients with end-stage renal failure (ESRF) that require inclusion in the renal replacement therapy program (RRT) is steadily increasing. This fact caused an increase in vascular operations involving the production of vascular access. According to the current guidelines, the best and safest option for a patient with chronic kidney disease (CKD) is the early creation of arteriovenous fistula (AVF). An efficient vascular access to haemodialysis determines the procedure and directly affects the quality of life of a patient with CKD. The aim of this paper is to present the author's project of the health policy program „Vascular access in renal replacement therapy - fistula first / catheter last", the essence of which is to assess the practical effectiveness and develop an optimal model of CKD patient care organization qualified for the chronic RRT program. The target population of the program consists of all patients diagnosed with CKD, qualified for the RRT program. The basic measures of the program's effectiveness include: (1) reduction in the number of re-hospitalizations related to vascular access, (2) reduction in the number of complications associated with haemofiltration surgery, (3) reduction in general mortality among patients undergoing dialysis in a 12-month perspective, (4) increasing knowledge in the field of self-care and self-care of arteriovenous anastomosis, and (5) creating a register of vascular access in Poland. To sum up, health policy programme "Vascular access in renal replacement therapy - fistula first / catheter last" covering health care services provided in the scope and on the conditions specified in the regulations issued on the basis of article 31d of the Act of 27 August 2004 on health care benefits financed from public funds, is to check whether planned changes in the organization and delivery of services will improve the situation of patients with CKD eligible for chronic RRT and whether it will be effective the point of view of the health care system.

MO813ANALYSING TRANSITIONS IN THE INTEGRATED MODEL OF RENAL REPLACEMENT THERAPY IN A REGIONAL HEALTH SYSTEM

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Beatriz Gil-Casares Casanova ◽  
Jose Portoles ◽  
Paula López ◽  
Fernando Tornero Molina ◽  
Maria Marques Vidas ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Proportional Hazards ◽  
Treatment Options ◽  
Psychosocial Needs ◽  
Intention To Treat ◽  
Therapy Option ◽  
The Impact

Abstract Background and Aims Every year 83,000 Europeans and 6,500 Spanish CKD patients require dialysis or transplantation. The choice of renal replacement therapy (RRT) is an important decision that determines the quality of life and survival. A single therapy option might not be adequate across a patient’s entire lifespan and a majority of patients change from one RRT modality to another to adapt RRT to clinical and psychosocial needs. Transitions should be considered as an expected progression in the patient’s treatment options. In these circumstances, there are new questions about the best sequence of techniques. Method This observational study examined a cohort of all incident patients from the Madrid Registry of Renal Patients (REMER), who initiated RRT between January 2008 and December of 2018. This study used the proportional hazards models and competitive risk models to examine the impact of transitions between RRT modalities on survival. We performed an intention-to-treat (ITT) analysis, according to the initial RRT chosen and an as treated (AT) analysis, by RRT received (Only HD, Only PD, PD then HD or HD then PD). Results A total of 8,971 patients started RRT during this period in Madrid (6.6 Million population): 7,207 on hemodialysis (HD), 1,401 on peritoneal dialysis (PD) and 363 received a pre-emptive kidney transplantation (KTX). Incident HD-patients were older and had more comorbidities. They presented higher mortality (HD group 40.9% vs PD group 22.8% vs 8.3% KTX group, p <0.001) and less access to a transplant (HD group 30.4% vs DP group 51.6%; p <0.001). Transitions between dialysis techniques define different groups of patients with different clinical outcomes. Those who change from HD to PD do it earlier (66% in less than 6 months), are younger and behave like those treated only with PD. Those who change from PD to HD do so later (1.5 years on average), are older (61.6 vs 53.5 years) and present higher mortality and less access to kidney transplantation than the group who initiates in HD and transfer to PD. Survival analysis by competitive risks is essential for integrated RRT models, especially in groups such as PD patients, where 58.6% of the patients were considered as lost follow-up (received a KTX after during the first 2.5 years on PD). This analysis reflects how patients who change dialysis modality share more characteristics with the second technique than the original one. Conclusion Our data suggest that transitions between RRT-techniques describes different patients, who associate different risks, and should be analyzed in an integrated manner to define improvement actions. This approach should be incorporated into the analysis and repports of renal registries.

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