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Allen R. Nissenson

Bio: Allen R. Nissenson is an academic researcher from DaVita. The author has contributed to research in topics: Dialysis & Hemodialysis. The author has an hindex of 16, co-authored 32 publications receiving 1301 citations.

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TL;DR: Poor glycemic control appears associated incrementally with higher mortality in PD patients and the A1c-mortality association was modified by hemoglobin level such that higher all-cause mortality was evident only in nonanemic patients.
Abstract: Summary Background and objectives The optimal target for glycemic control has not been established for diabetic peritoneal dialysis (PD) patients. Design, setting, participants, & measurements We examined mortality-predictability of hemoglobin A1c random serum glucose in a contemporary cohort of diabetic PD patients treated in DaVita dialysis clinics July 2001 through June 2006 with follow-up through June 2007. Results We identified 2798 diabetic PD patients with A1c data. Serum glucose correlated with A1C (r = 0.51). Adjusted all-cause death hazard ratio and 95% confidence interval for baseline A1c increments of 7.0 to 7.9%, 8.0 to 8.9%, 9.0 to 9.9%, and ≥10%, compared with 6.0 to 6.9% (reference), were 1.13 (0.97 to 1.32), 1.05 (0.88 to 1.27), 1.06 (0.84 to 1.34), and 1.48 (1.18 to 1.86); and for time-averaged A1c values were 1.10 (0.96 to 1.27), 1.28 (1.07 to 1.53), 1.34 (1.05 to 1.70), and 1.81 (1.33 to 2.46), respectively. The A1c-mortality association was modified by hemoglobin level such that higher all-cause mortality was evident only in nonanemic patients. Similar but non-significant trends in cardiovascular death risk was found across A1c increments. Adjusted all-cause death HR for time-averaged blood glucose 150 to 199, 200 to 249, 250 to 299, and ≥300 mg/dl, compared with 60 to 99 mg/dl (reference), were 1.02 (0.70 to 1.47), 1.12 (0.77 to 1.63), 1.45 (0.97 to 2.18), and 2.10 (1.37 to 3.20), respectively. Conclusions Poor glycemic control appears associated incrementally with higher mortality in PD patients. Moderate to severe hyperglycemia is associated with higher death risk especially in certain subgroups.

113 citations

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TL;DR: Frequent in-center hemodialysis compared with conventional in- center hemodIALysis improved self-reported physical health and functioning but had no significant effect on objective physical performance.
Abstract: Summary Background and objectives Relatively little is known abouttheeffects of hemodialysis frequency on the disability of patients with ESRD. Design, setting, participants, & measurements This study examined changes in physical performance and selfreported physical health and functioning among subjects randomized to frequent (six times per week) compared withconventional(threetimesperweek)hemodialysisinboththeFrequentHemodialysisNetworkdaily(n=245) and nocturnal (n=87) trials. The main outcome measures were adjusted change in scores over 12 months on the short physical performance battery (SPPB), RAND 36-item health survey physical health composite (PHC), and physical functioning subscale (PF) based on the intention to treat principle. Results Overall scores for SPPB, PHC, and PF were poor relative to population norms and in line with other studies in ESRD. In the Daily Trial, subjects randomized to frequent compared with conventional in-center hemodialysis experienced no significant change in SPPB (adjusted mean change of 20.2060.19 versus 20.4160.21, P=0.45) but experienced significant improvement in PHC (3.460.8 versus 0.460.8, P=0.009) and a relatively large change in PF that did not reach statistical significance. In the Nocturnal Trial, there were no significant differences among subjects randomized to frequent compared with conventional hemodialysis in SPPB (adjusted mean change of 20.9260.44 versus 20.4160.43, P=0.41), PHC (2.761.4 versus 2.161.5, P=0.75), or PF (23.163.5 versus 1.163.6, P=0.40). Conclusions Frequent in-center hemodialysis compared with conventional in-center hemodialysis improved self-reported physical health and functioning but had no significant effect on objective physical performance. There were no significant effects of frequent nocturnal hemodialysis on the same physical metrics. Clin J Am Soc Nephrol 7: ccc–ccc, 2012. doi: 10.2215/CJN.10601011

98 citations

Journal ArticleDOI
TL;DR: Whereas in hemodialysis patients cumulatively high or low calcium levels are associated with higher death risk, subtle but meaningful interactions with phosphorus, PTH, paricalcitol dose and race exist.
Abstract: Background: The outcome-predictability of baseline and instantaneously changing serum calcium in hemodialysis patients has been examined. We investigated the mortality-predictabilit

82 citations


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TL;DR: Cardiovascular Disease in Dialysis Patients Tables: An Overview of Epidemiology of Cardiovascular disease in Children and Work Group Members and Foreword.

1,258 citations

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TL;DR: The 2019 update to the KDOQI Clinical Practice Guideline for Vascular Access is a comprehensive document intended to assist multidisciplinary practitioners care for chronic kidney disease patients and their vascular access.

858 citations

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TL;DR: Anemia is very common in CHF and its successful treatment is associated with a significant improvement in cardiac function, functional class, renal function and in a marked fall in the need for diuretics and hospitalization.

722 citations