Author
William F. Owen
Other affiliations: Tufts University
Bio: William F. Owen is an academic researcher from Brigham and Women's Hospital. The author has contributed to research in topics: Dialysis & Hemodialysis. The author has an hindex of 37, co-authored 67 publications receiving 19557 citations. Previous affiliations of William F. Owen include Tufts University.
Papers
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Journal Article•
TL;DR: In the early 1990s, the National Kidney Foundation (K/DOQI) developed a set of clinical practice guidelines to define chronic kidney disease and to classify stages in the progression of kidney disease.
10,265 citations
Journal Article•
University of Southern California1, United States Department of Veterans Affairs2, University of California, San Francisco3, Washington University in St. Louis4, Children's Memorial Hospital5, University of Kentucky6, Saint Louis University7, Mayo Clinic8, Indiana University – Purdue University Indianapolis9, University of California, Los Angeles10, University of Virginia11
2,609 citations
TL;DR: Low urea reduction ratios during dialysis are associated with increased odds ratios for death, and these risks are worsened by inadequate nutrition.
Abstract: Background Among patients with end-stage renal disease who are treated with hemodialysis, solute clearance during dialysis and nutritional adequacy are determinants of mortality. We determined the effects of reductions in blood urea nitrogen concentrations during dialysis and changes in serum albumin concentrations, as an indicator of nutritional status, on mortality in a large group of patients treated with hemodialysis. Methods We analyzed retrospectively the demographic characteristics, mortality rate, duration of hemodialysis, serum albumin concentration, and urea reduction ratio (defined as the percent reduction in blood urea nitrogen concentration during a single dialysis treatment) in 13,473 patients treated from October 1, 1990, through March 31, 1991. The risk of death was determined as a function of the urea reduction ratio and serum albumin concentration. Results As compared with patients with urea reduction ratios of 65 to 69 percent, patients with values below 60 percent had a higher risk of ...
1,357 citations
Journal Article•
Tufts University1, Wake Forest University2, Oregon Health & Science University3, Indiana University4, Albany College of Pharmacy and Health Sciences5, Rush University Medical Center6, Vanderbilt University7, East Carolina University8, University of Illinois at Chicago9, Beaumont Hospital10, Johns Hopkins University11, Cleveland Clinic12, University of Wisconsin-Madison13, University of Texas at Austin14, University of Pittsburgh15, Virginia Commonwealth University16, Texas Tech University Health Sciences Center17, National Institutes of Health18, University of Virginia19
TL;DR: The purpose of the Executive Summary is to provide a "stand-alone" summary of the background, scope, methods, and key recommendations, as well as the complete text of the guideline statements.
1,145 citations
TL;DR: Pulse pressure is associated with risk of death in a large, nationally representative sample of patients undergoing maintenance hemodialysis and the recognition of pulse pressure as an important correlate of mortality in patients receiving dialysis highlights the need to investigate the relationship between potential therapeutic implications of conduit vessel function and clinical outcomes in patients with end-stage renal disease.
Abstract: ContextAlthough increased blood pressure is associated with adverse outcomes
in the general population, elevated blood pressure is associated with decreased
mortality in patients with end-stage renal disease undergoing maintenance
hemodialysis. Recent investigations in the general population have demonstrated
the predictive utility of pulse pressure (systolic minus diastolic blood pressure),
a measure reflecting the pulsatile nature of the cardiac cycle.ObjectivesTo estimate the relationship between pulse pressure and mortality in
patients undergoing maintenance hemodialysis and to test our hypothesis that
an increasing pulse pressure would be associated with increased risk of death
up to 1 year despite the inverse relationship between conventional blood pressure
measures and mortality in patients with end-stage renal disease.Design, Setting, and PatientsRetrospective cohort investigation of patients with end-stage renal
disease undergoing maintenance hemodialysis at 782 hemodialysis facilities
throughout the United States. Of 44 069 eligible patients as of January
1, 1998, 37 069 with complete demographic data were included in the analyses
of clinical and laboratory data collected from October 1 through December
31, 1997. Patients were followed up through December 31, 1998.Main Outcome MeasuresThe primary study outcome was death at 1 year. A secondary outcome was
the magnitude of the pulse pressure.ResultsThe final patient cohort was similar to national averages with respect
to age, sex, race, and diabetic status. Mean (SD) pulse pressures before dialysis
were 75.0 (15.0) mm Hg and 66.9 (13.9) mm Hg after dialysis. By the end of
the 1-year follow-up, 5731 patients (18.4%) died. After adjusting for level
of systolic blood pressure, multivariable Cox proportional hazards modeling
showed a direct and consistent relationship between increasing pulse pressure
and increasing death risk. Each incremental elevation of 10 mm Hg in postdialysis
pulse pressure was associated with a 12% increase in the hazard for death
(hazard ratio, 1.12; 95% confidence interval, 1.06-1.18). Postdialysis systolic
blood pressure was inversely related to mortality with a 13% decreased hazard
for death for each incremental elevation of 10 mm Hg (hazard ratio, 0.87;
95% confidence interval, 0.84-0.90). In a multivariable linear regression
model, important variables directly associated with elevated pulse pressure
included age, diabetes, white race, female sex, and number of years receiving
dialysis (all P<.001).ConclusionsPulse pressure is associated with risk of death in a large, nationally
representative sample of patients undergoing maintenance hemodialysis. The
recognition of pulse pressure as an important correlate of mortality in patients
receiving dialysis highlights the need to investigate the relationship between
potential therapeutic implications of conduit vessel function and clinical
outcomes in patients with end-stage renal disease.
389 citations
Cited by
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TL;DR: The CKD-EPI creatinine equation is more accurate than the Modification of Diet in Renal Disease Study equation and could replace it for routine clinical use.
Abstract: The Modification of Diet in Renal Disease (MDRD) Study equation underestimates glomerular filtration rate (GFR) in patients with mild kidney disease. Levey and associates therefore developed and va...
18,691 citations
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TL;DR: The role of vitamin D in skeletal and nonskeletal health is considered and strategies for the prevention and treatment ofitamin D deficiency are suggested.
Abstract: Once foods in the United States were fortified with vitamin D, rickets appeared to have been conquered, and many considered major health problems from vitamin D deficiency resolved. But vitamin D deficiency is common. This review considers the role of vitamin D in skeletal and nonskeletal health and suggests strategies for the prevention and treatment of vitamin D deficiency.
11,849 citations
TL;DR: The longitudinal glomerular filtration rate was estimated among 1,120,295 adults within a large, integrated system of health care delivery in whom serum creatinine had been measured between 1996 and 2000 and who had not undergone dialysis or kidney transplantation.
Abstract: Background End-stage renal disease substantially increases the risks of death, cardiovascular disease, and use of specialized health care, but the effects of less severe kidney dysfunction on these outcomes are less well defined. Methods We estimated the longitudinal glomerular filtration rate (GFR) among 1,120,295 adults within a large, integrated system of health care delivery in whom serum creatinine had been measured between 1996 and 2000 and who had not undergone dialysis or kidney transplantation. We examined the multivariable association between the estimated GFR and the risks of death, cardiovascular events, and hospitalization. Results The median follow-up was 2.84 years, the mean age was 52 years, and 55 percent of the group were women. After adjustment, the risk of death increased as the GFR decreased below 60 ml per minute per 1.73 m2 of body-surface area: the adjusted hazard ratio for death was 1.2 with an estimated GFR of 45 to 59 ml per minute per 1.73 m2 (95 percent confidence interval, 1....
9,642 citations
TL;DR: A 2-day consensus conference on acute renal failure (ARF) in critically ill patients was organized by ADQI as discussed by the authors, where the authors sought to review the available evidence, make recommendations and delineate key questions for future studies.
Abstract: There is no consensus definition of acute renal failure (ARF) in critically ill patients. More than 30 different definitions have been used in the literature, creating much confusion and making comparisons difficult. Similarly, strong debate exists on the validity and clinical relevance of animal models of ARF; on choices of fluid management and of end-points for trials of new interventions in this field; and on how information technology can be used to assist this process. Accordingly, we sought to review the available evidence, make recommendations and delineate key questions for future studies. We undertook a systematic review of the literature using Medline and PubMed searches. We determined a list of key questions and convened a 2-day consensus conference to develop summary statements via a series of alternating breakout and plenary sessions. In these sessions, we identified supporting evidence and generated recommendations and/or directions for future research. We found sufficient consensus on 47 questions to allow the development of recommendations. Importantly, we were able to develop a consensus definition for ARF. In some cases it was also possible to issue useful consensus recommendations for future investigations. We present a summary of the findings. (Full versions of the six workgroups' findings are available on the internet at http://www.ADQI.net
) Despite limited data, broad areas of consensus exist for the physiological and clinical principles needed to guide the development of consensus recommendations for defining ARF, selection of animal models, methods of monitoring fluid therapy, choice of physiological and clinical end-points for trials, and the possible role of information technology.
6,072 citations
TL;DR: The data support the argument that magnesium supplementation improves the metabolic status in hypomagnesemic CKD patients with pre-diabetes and obesity.
Abstract: Background/Aims: Magnesium is an essential mineral for many metabolic functions. There is very little information on the effect of magnesium supplementation on me
4,639 citations