Showing papers by "Friedrich K. Port published in 1996"

Predictors of Type of Vascular Access in Hemodialysis Patients

Abstract: Objective. —Complications from vascular access account for 15% of hospital admissions among US hemodialysis patients. Complications are less frequent with arteriovenous fistulas than with synthetic grafts. We assessed clinical and nonclinical predictors of whether patients with end-stage renal disease (ESRD) starting hemodialysis receive a fistula or graft. We also investigated changes in practice between 1986-1987 and 1990. Design. —Cross-sectional study. Setting. —United States hemodialysis population. Patients. —Random, national samples of ESRD patients who started hemodialysis in 1986-1987 (n=2741) or 1990 (n=1409) from United States Renal Data System Special Studies. Main Outcome Measure. —Type of permanent vascular access (arteriovenous fistula vs synthetic graft), analyzed using multivariate logistic regression. Results. —Clinical and demographic factors as well as socioeconomic status, region of residence, and year starting hemodialysis predicted the type of vascular access. Overall, 56% of patients had grafts 30 days after starting dialysis, but graft use increased from 51% in 1986-1987 to 65% in 1990 (adjusted odds ratio [AOR], 1.67for 1990 vs 1986-1987; 95% confidence interval [CI], 1.43-1.95; P P P Concclusions. —This national study documents large variations in the relative use of fistulas and grafts and a trend away from fistulas. The prevalence of comorbid conditions fails to explain these findings. Presentation and referral of patients early in the process of their ESRD, teaching surgeons to place fistulas, and training dialysis nurses to access fistulas may increase their use.

The effects of recombinant human erythropoietin on functional health and well-being in chronic dialysis patients.

Abstract: As a component of the open-label, multicenter National Cooperative Recombinant Human Erythropoietin (Epo) Study, the health-related quality-of-life effects of Epo therapy were assessed in 484 dialysis patients who had not previously been treated with Epo therapy (New-to-Epo) and 520 dialysis patients who were already receiving Epo therapy at the time of study enrollment (Old-to-Epo). Using scales from the Medical Outcomes Study 36-item Short Form Health Survey (SF-36), health-related quality of life was assessed on study enrollment (baseline) and at an average of 99 days follow-up. At baseline, SF-36 scores for Old- and New-to-Epo patients were well below those observed in the general population, reflecting substantial impairments in functional status and well-being among patients with chronic renal failure. Significant improvements from baseline to follow-up were observed among New-to-Epo patients in vitality, physical functioning, social functioning, mental health, looking after the home, social life, hobbies, and satisfaction with sexual activity (P < 0.05 for each). The mean improvements in hematocrit values among New-to-Epo and Old-to Epo patients were 4.6 and 0.3, respectively. At the time of follow-up, SF-36 scores for New-to-Epo patients were comparable with those observed among Old-to-Epo patients, whose scores did not change significantly from baseline to follow-up. Analysis of the relationship between Epo therapy, hematocrit values, and health-related quality of life suggest that some of the beneficial quality-of-life effects of Epo are mediated through a change in hematocrit level.

Gender discrepancies in living related renal transplant donors and recipients.

Abstract: Renal transplantation is the most successful treatment strategy for patients with ESRD to improve survival and quality of life. The study presented here examines the relationship of gender and living related (LR) transplantation donor and recipient rates in the United States. National data from the United States Renal Data System (USRDS) were used for this study. All LR transplants occurring between 1991 and 1993 among blacks and whites were included (N = 6193). Transplantation and donation rates for men and women were calculated. Poisson regression was used to calculate female/male transplantation and donation rate ratios. Overall, women were 10% less likely to receive a LR transplant than men (rate ratio [RR] = 0.90, P < 0.001). This gender difference increased over time from 1991 (Female/Male RR = 0.95, P = not significant [NS]) to 1993 (RR = 0.85, P < 0.001). In contrast, women were significantly more likely to donate a kidney than men (RR = 1.28, P < 0.001 and RR = 1.29, P < 0.001 among whites and blacks, respectively). Analyses by age subgroups revealed that only among ESRD patients aged 20 to 44 yr was the likelihood of receiving a LR kidney transplant equal for men and women. Higher donation rates among women compared with men were observed in all donor age and race subgroups except young blacks (aged 0 to 19 yr). Recipient gender appeared to influence donation rates. The female-to-male relative donation rates were higher when donations were to female, compared with male, recipients. This study of national data suggests an imbalance in LR donation and transplantation between men and women. Women are more likely to donate a kidney but are less likely to receive a LR transplant than men. Several potential explanatory factors are explored. These findings suggest a need for the development of gender-appropriate interventions to encourage donation among men and LR transplantation among women, to ultimately facilitate greater use of this ESRD treatment modality.

The study of outcomes for CAPD versus hemodialysis patients.

Abstract: ObjectiveTo discuss potential reasons for reported differences in the results of several recent studies comparing mortality risk among continuous ambulatory peritoneal dialysis (CAPD) and hemodialy...

Part B: Outcomes With ESRD Therapy: A Critical Overview from The United States

Abstract: Patient survival is a very basic but important outcome of any therapeutic intervention. In the case of end stage renal disease (ESRD), outcome studies have included several other outcomes such as quality of life indicators, morbidity measures (e.g., hospitalizations), length of time on a treatment modality (‘technique survival’) and survival with a functioning kidney allograft (graft survival). The establishment of regional and national registries has markedly facilitated the evaluation of these outcomes in actual practice rather than in the referral practice or related multicenter environment. This chapter will focus primarily on population-based patient survival studies using information from the United States Renal Data System (USRDS) and the Michigan Kidney Registry