John Burkart - Academia.edu (original) (raw)
Papers by John Burkart
BMC Nephrology, 2021
Background Emory Dialysis serves an urban and predominantly African American population at its fo... more Background Emory Dialysis serves an urban and predominantly African American population at its four outpatient dialysis facilities. We describe COVID-19 infection control measures implemented and clinical characteristics of patients with COVID-19 in the Emory Dialysis facilities. Methods Implementation of COVID-19 infection procedures commenced in February 2020. Subsequently, COVID-19 preparedness assessments were conducted at each facility. Patients with COVID-19 from March 1–May 31, 2020 were included; with a follow-up period spanning March–June 30, 2020. Percentages of patients diagnosed with COVID-19 were calculated, and characteristics of COVID-19 patients were summarized as medians or percentage. Baseline characteristics of all patients receiving care at Emory Dialysis (i.e. Emory general dialysis population) were presented as medians and percentages. Results Of 751 dialysis patients, 23 (3.1%) were diagnosed with COVID-19. The median age was 67.0 years and 13 patients (56.6%)...
Journal of the American Society of Nephrology, 1995
A randomized, double-blind, placebo-controlled, multicenter trial was performed to assess the saf... more A randomized, double-blind, placebo-controlled, multicenter trial was performed to assess the safety and efficacy of subcutaneous recombinant erythropoietin (EPO) in peritoneal dialysis patients. Seventy-eight patients were randomized to receive EPO and 74 received placebo during the first 12 wk. After this, placebo patients with hematocrit less than 32% entered the EPO maintenance phase along with the initial EPO patients. Hematocrit rose significantly in the EPO group from 23.8 to 32% after 6 wk, and this was sustained at 33.7% at 12 wk. In the placebo group, the prestudy hematocrit was 23.8% as well, and no significant change in hematocrit occurred over 12 wk. Concomitant with the rise in hematocrit, transfusion requirements fell only in the EPO group. Eighty-eight percent of patients receiving EPO had their anemia ameliorated by Week 12 of the study. There was a wide range of dosage requirements during the maintenance phase, ranging from 8,000 U thrice weekly to 4,000 U every ot...
Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis, 1999
Objective To compare the efficacy of intraperitoneal (IP) and subcutaneous (SC) administration of... more Objective To compare the efficacy of intraperitoneal (IP) and subcutaneous (SC) administration of epoetin alfa in patients receiving peritoneal dialysis (PD). Design A 32-week prospective, randomized, cross-over experimental design. Setting Two university-based outpatient PD centers. Patients Twenty adult PD patients receiving stable doses of SC epoetin alfa enrolled in the study. Thirteen patients completed 32 weeks of follow-up. Intervention Patients were randomly assigned to receive either SC or IP epoetin alfa at the start of the study. Dose adjustments were made to maintain baseline hematocrit ± 3 percentage points. Following 16 weeks of treatment, patients crossed over to the other route of administration for an additional 16 weeks. Intraperitoneal epoetin alfa was administered into an empty peritoneal cavity for approximately 8 hours before resuming dialysis. End-of-study IP epoetin alfa doses required to maintain target hematocrit were given twice weekly ( n = 1), once weekl...
Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis, 2000
Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis, 2004
American journal of kidney diseases : the official journal of the National Kidney Foundation, 2016
The prevalence of cardiovascular disease, including cardiac arrhythmia, coronary artery disease, ... more The prevalence of cardiovascular disease, including cardiac arrhythmia, coronary artery disease, cardiomyopathy, and valvular heart disease, is higher in hemodialysis (HD) patients than in the US resident population. Cardiovascular disease is the leading cause of death in HD patients and the principal discharge diagnosis accompanying 1 in 4 hospital admissions. Furthermore, the rate of hospital admissions for either heart failure or fluid overload is persistently high despite widespread use of β-blockers and renin-angiotensin system inhibitors and attempts to manage fluid overload with ultrafiltration. An important predictor of cardiovascular mortality and morbidity in dialysis patients is left ventricular hypertrophy (LVH). LVH is an adaptive response to increased cardiac work, typically caused by combined pressure and volume overload, resulting in cardiomyocyte hypertrophy and increased intercellular matrix. In new dialysis patients, the prevalence of LVH is 75%. Regression of LVH...
Contributions to nephrology, 2012
Other than renal transplantation, the two major treatment options for patients with stage V kidne... more Other than renal transplantation, the two major treatment options for patients with stage V kidney disease are hemodialysis and peritoneal dialysis. Both therapies have advantages and disadvantages while there are obvious physical differences in the way they are delivered. In clinical practice, one typically uses one therapy at a time in patients. However, there are medical and patient lifestyle reasons why you may want to use both on a weekly basis. Early clinical experience with this approach has been encouraging. With emerging data suggesting that more frequent hemodialysis or slower ultrafiltration rates may be beneficial for the patient there are now even more compelling reasons to consider this approach. This paper reviews the published literature on combined modality therapy and suggests reasons why we may want to utilize combination therapy more often.
American journal of kidney diseases : the official journal of the National Kidney Foundation, 2003
American Journal of Kidney Diseases, 1990
Numerous cases of glomerular disease in sickle cell patients have been reported. Glomerular disea... more Numerous cases of glomerular disease in sickle cell patients have been reported. Glomerular disease in SC double heterozygotes has not been reported despite its equal prevalence in adults. We herein report a case of mesangiolytic glomerulopathy in a patient with SC disease.
Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis, 2012
BACKGROUND: Prophylactic gentamicin 0.1% cream has demonstrated efficacy in preventing both exit-... more BACKGROUND: Prophylactic gentamicin 0.1% cream has demonstrated efficacy in preventing both exit-site infection (ESI) and peritonitis attributable to gram-positive and gram-negative organisms; however, the effect of this practice on the gentamicin susceptibility patterns of bacterial pathogens isolated from such infections is unknown. We therefore examined the effect of a change in our prophylactic topical antibiotic exit-site protocol (from mupirocin 2% cream to gentamicin 0.1% cream) on infection rates and susceptibility patterns. METHODS: This retrospective observational cohort study examined two periods of time: before and after the change in exit-site protocol. Each period was 30 months in duration, with a 2-month implementation period between, during which patient data were excluded. Demographic, clinical, and microbiology data were collected for each patient and episode of infection. RESULTS: Overall, 377 patients were evaluated. In the mupirocin period (MUP), 145 infections ...
Dialysis & Transplantation, 2010
P eritoneal dialysis (PD) has been used as a chronic treatment for patients with end-stage renal ... more P eritoneal dialysis (PD) has been used as a chronic treatment for patients with end-stage renal disease (ESRD) since 1976. 1 In the United States, peak utilization occurred in 1993 when approximately 14.9% of patients were on PD. Since then, while the total number of patients on PD has been relatively stable, the increasing numbers of patients receiving dialytic care for ESRD has lead to a decline in the percentage of patients utilizing PD, to less than 8% in 2008. This is markedly different from the experience in other developed regions such as Mexico, Canada, New Zealand, Australia, and Hong Kong. 2 This article will explore the reasons for this, as well as the complex web of fi nancial, cultural, and medical practice differences between countries to consider what the future is for PD in the U.S. considering patient outcomes, utilization, and technological advances. Since becoming an attending nephrologist in 1984, I have treated many patients with PD, some for more than 15 years. At our university, I am the medical director of both a thriving center hemodialysis (CHD) unit and a robust home unit (offering both
Journal of the American Society of Nephrology, 1993
Hemodialysis patients often do not complete their full amount of time on dialysis and at times mi... more Hemodialysis patients often do not complete their full amount of time on dialysis and at times miss their hemodialysis treatments completely. However, neither the magnitude nor the potential reasons for this problem are known. The prevalence of unauthorized absences from hemodialysis sessions (no shows) and both the prevalence and reasons for early terminations from hemodialysis sessions (early sign-offs) were prospectively studied at a large hemodialysis unit in the southeastern United States. This unit provided a total of 31,212 hemodialysis sessions in a 12-month period to an average of 231 patients. There was a total of 2,108 early sign-offs (6.8 +/- 0.9%/mo) and 387 "no-shows" (1.2 +/- 0.2%/mo) during this 12-month period. The most common reasons for early sign-off were cramping (17.9%), followed by "feels bad or sick" (14.2%), personal business or errands (12.1%), lack of transportation later in the day (7.7%), and refusal to comply with the prescribed trea...
Nephrology news & issues, 2017
Peritoneal Dialysis International
long history, as of 2008 <8 % of prevalent ESRD patients in the United States are treated with... more long history, as of 2008 <8 % of prevalent ESRD patients in the United States are treated with PD, a modality mix that is significantly different from what is seen in other developed countries. Data are reviewed that suggest that the reasons for this seem to be caused by non–medical-related issues such as subtle differences in practice patterns and unintended financial considerations. Medical outcome date would seem to favor more utilization of PD. For instance, data from the USRDS suggested that the relative risk of death for PD versus center hemodialysis has been improving, tending to favor those on PD for longer and longer periods of time. Infectious complications have also been markedly reduced. It is anticipated that changes in government reimbursement, such as the bundling of dialysis-related services, will stimulate a renewed interest in home therapies. Currently most home dialysis units are small, and some have minimal clinical experience with PD. If trends in reimburseme...
American Journal of Hospice and Palliative Medicine®
Background: Patients with end-stage renal disease (ESRD) have a high burden of physical and psych... more Background: Patients with end-stage renal disease (ESRD) have a high burden of physical and psychological symptoms. Many remain unrecognized for long periods of time, particularly in older adults. The best strategy to monitor patient-reported outcome measures (PROMs) has not been identified. Objective: To assess the feasibility of implementing an iPad-based symptom assessment tool in older adults with ESRD on hemodialysis (HD). Methods: We designed an iPad application-delivery system for collecting electronic PROMs (ePROMs). Patient’s ≥60 years of age with ESRD on HD were recruited from a single outpatient dialysis unit. Feasibility was evaluated based on recruitment, retention, and the system usability score (SUS). Assessments were completed at baseline, 3 months, and 6 months after enrollment. ANOVA was used to assess longitudinal symptom variability. Results: Twenty-two patients (49% recruitment rate) were enrolled, with an 82% retention at 6 months. Mean age was 69.4 years (SD 6...
Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis
Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis
The International Society for Peritoneal Dialysis last published a guideline on prescribing perit... more The International Society for Peritoneal Dialysis last published a guideline on prescribing peritoneal dialysis (PD) in 2006. This focused on clearance of toxins and used a measure of waste product removal by dialysis using urea as an example. This guideline suggested that a specific quantity of small solute removal was needed to achieve dialysis 'adequacy'. It is now generally accepted, however, that the well-being of the person on dialysis is related to many different factors and not just removal of specific toxins. This guideline has been written with the focus on the person doing PD. It is proposed that dialysis delivery should be 'goal-directed'. This involves discussions between the person doing PD and the care team (shared decision-making) to establish care goals for dialysis delivery. The aims of these care goals are (1) to allow the person doing PD to achieve his/her own life goals and (2) to promote the provision of high-quality dialysis care by the dialysis team. Key recommendations 1. PD should be prescribed using shared decision-making between the person doing PD and the care team. The aim is to establish realistic care goals that (1) maintain quality of life for the person doing PD as much as possible by enabling them to meet their life goals, (2) minimize symptoms and treatment burden while (3) ensuring high-quality care is provided.
Peritoneal Dialysis International
Background Hospital readmissions are common among in- center hemodialysis patients, but little is... more Background Hospital readmissions are common among in- center hemodialysis patients, but little is known about read-missions among peritoneal dialysis (PD) patients. Using national administrative data, we aimed to examine the burden and correlates of hospital readmissions among U.S. PD patients. Methods Among 10,505 adult U.S. PD patients with an index admission (first admission after 120 days on dialysis) between 31 January 2011 and 30 November 2014, readmissions were defined as new hospital admissions within 30 days of index discharge. Multivariable logistic regression was used to obtain adjusted odds ratios (ORs) for readmission. Results Overall, 26.8% of index admissions were followed by a readmission. Readmitted patients were more likely to have congestive heart failure (31.0% vs 25.4%; p < 0.001) and peripheral arterial disease (11.6% vs 8.6%; p < 0.001) and had longer index admission length of stay (median = 4 vs 3 days; p < 0.001) than those who were not; age, sex, a...
Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association, Jan 25, 2017
Pulmonary edema is prevalent and may be a common cause of hospital readmissions in hemodialysis p... more Pulmonary edema is prevalent and may be a common cause of hospital readmissions in hemodialysis patients. We aimed to estimate the national burden of, and identify correlates of, readmissions related to pulmonary edema among hemodialysis patients. In this retrospective cohort study using national registry data, we identified prevalent US hemodialysis patients (n = 215 251) with index admissions while under Medicare primary coverage in 2011-13. We defined readmissions as admissions occurring within 30 days of the index discharge and pulmonary edema-related readmissions as readmissions with discharge diagnoses of fluid overload, heart failure or pulmonary edema. Multivariable logistic regression models were used to determine odds ratios (ORs) for pulmonary edema-related readmissions by patient and index admission characteristics. About one-quarter (23%) of index hospital admissions were followed by a readmission, with nearly half (44%) of the readmissions being associated with pulmona...
BMC Nephrology, 2021
Background Emory Dialysis serves an urban and predominantly African American population at its fo... more Background Emory Dialysis serves an urban and predominantly African American population at its four outpatient dialysis facilities. We describe COVID-19 infection control measures implemented and clinical characteristics of patients with COVID-19 in the Emory Dialysis facilities. Methods Implementation of COVID-19 infection procedures commenced in February 2020. Subsequently, COVID-19 preparedness assessments were conducted at each facility. Patients with COVID-19 from March 1–May 31, 2020 were included; with a follow-up period spanning March–June 30, 2020. Percentages of patients diagnosed with COVID-19 were calculated, and characteristics of COVID-19 patients were summarized as medians or percentage. Baseline characteristics of all patients receiving care at Emory Dialysis (i.e. Emory general dialysis population) were presented as medians and percentages. Results Of 751 dialysis patients, 23 (3.1%) were diagnosed with COVID-19. The median age was 67.0 years and 13 patients (56.6%)...
Journal of the American Society of Nephrology, 1995
A randomized, double-blind, placebo-controlled, multicenter trial was performed to assess the saf... more A randomized, double-blind, placebo-controlled, multicenter trial was performed to assess the safety and efficacy of subcutaneous recombinant erythropoietin (EPO) in peritoneal dialysis patients. Seventy-eight patients were randomized to receive EPO and 74 received placebo during the first 12 wk. After this, placebo patients with hematocrit less than 32% entered the EPO maintenance phase along with the initial EPO patients. Hematocrit rose significantly in the EPO group from 23.8 to 32% after 6 wk, and this was sustained at 33.7% at 12 wk. In the placebo group, the prestudy hematocrit was 23.8% as well, and no significant change in hematocrit occurred over 12 wk. Concomitant with the rise in hematocrit, transfusion requirements fell only in the EPO group. Eighty-eight percent of patients receiving EPO had their anemia ameliorated by Week 12 of the study. There was a wide range of dosage requirements during the maintenance phase, ranging from 8,000 U thrice weekly to 4,000 U every ot...
Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis, 1999
Objective To compare the efficacy of intraperitoneal (IP) and subcutaneous (SC) administration of... more Objective To compare the efficacy of intraperitoneal (IP) and subcutaneous (SC) administration of epoetin alfa in patients receiving peritoneal dialysis (PD). Design A 32-week prospective, randomized, cross-over experimental design. Setting Two university-based outpatient PD centers. Patients Twenty adult PD patients receiving stable doses of SC epoetin alfa enrolled in the study. Thirteen patients completed 32 weeks of follow-up. Intervention Patients were randomly assigned to receive either SC or IP epoetin alfa at the start of the study. Dose adjustments were made to maintain baseline hematocrit ± 3 percentage points. Following 16 weeks of treatment, patients crossed over to the other route of administration for an additional 16 weeks. Intraperitoneal epoetin alfa was administered into an empty peritoneal cavity for approximately 8 hours before resuming dialysis. End-of-study IP epoetin alfa doses required to maintain target hematocrit were given twice weekly ( n = 1), once weekl...
Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis, 2000
Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis, 2004
American journal of kidney diseases : the official journal of the National Kidney Foundation, 2016
The prevalence of cardiovascular disease, including cardiac arrhythmia, coronary artery disease, ... more The prevalence of cardiovascular disease, including cardiac arrhythmia, coronary artery disease, cardiomyopathy, and valvular heart disease, is higher in hemodialysis (HD) patients than in the US resident population. Cardiovascular disease is the leading cause of death in HD patients and the principal discharge diagnosis accompanying 1 in 4 hospital admissions. Furthermore, the rate of hospital admissions for either heart failure or fluid overload is persistently high despite widespread use of β-blockers and renin-angiotensin system inhibitors and attempts to manage fluid overload with ultrafiltration. An important predictor of cardiovascular mortality and morbidity in dialysis patients is left ventricular hypertrophy (LVH). LVH is an adaptive response to increased cardiac work, typically caused by combined pressure and volume overload, resulting in cardiomyocyte hypertrophy and increased intercellular matrix. In new dialysis patients, the prevalence of LVH is 75%. Regression of LVH...
Contributions to nephrology, 2012
Other than renal transplantation, the two major treatment options for patients with stage V kidne... more Other than renal transplantation, the two major treatment options for patients with stage V kidney disease are hemodialysis and peritoneal dialysis. Both therapies have advantages and disadvantages while there are obvious physical differences in the way they are delivered. In clinical practice, one typically uses one therapy at a time in patients. However, there are medical and patient lifestyle reasons why you may want to use both on a weekly basis. Early clinical experience with this approach has been encouraging. With emerging data suggesting that more frequent hemodialysis or slower ultrafiltration rates may be beneficial for the patient there are now even more compelling reasons to consider this approach. This paper reviews the published literature on combined modality therapy and suggests reasons why we may want to utilize combination therapy more often.
American journal of kidney diseases : the official journal of the National Kidney Foundation, 2003
American Journal of Kidney Diseases, 1990
Numerous cases of glomerular disease in sickle cell patients have been reported. Glomerular disea... more Numerous cases of glomerular disease in sickle cell patients have been reported. Glomerular disease in SC double heterozygotes has not been reported despite its equal prevalence in adults. We herein report a case of mesangiolytic glomerulopathy in a patient with SC disease.
Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis, 2012
BACKGROUND: Prophylactic gentamicin 0.1% cream has demonstrated efficacy in preventing both exit-... more BACKGROUND: Prophylactic gentamicin 0.1% cream has demonstrated efficacy in preventing both exit-site infection (ESI) and peritonitis attributable to gram-positive and gram-negative organisms; however, the effect of this practice on the gentamicin susceptibility patterns of bacterial pathogens isolated from such infections is unknown. We therefore examined the effect of a change in our prophylactic topical antibiotic exit-site protocol (from mupirocin 2% cream to gentamicin 0.1% cream) on infection rates and susceptibility patterns. METHODS: This retrospective observational cohort study examined two periods of time: before and after the change in exit-site protocol. Each period was 30 months in duration, with a 2-month implementation period between, during which patient data were excluded. Demographic, clinical, and microbiology data were collected for each patient and episode of infection. RESULTS: Overall, 377 patients were evaluated. In the mupirocin period (MUP), 145 infections ...
Dialysis & Transplantation, 2010
P eritoneal dialysis (PD) has been used as a chronic treatment for patients with end-stage renal ... more P eritoneal dialysis (PD) has been used as a chronic treatment for patients with end-stage renal disease (ESRD) since 1976. 1 In the United States, peak utilization occurred in 1993 when approximately 14.9% of patients were on PD. Since then, while the total number of patients on PD has been relatively stable, the increasing numbers of patients receiving dialytic care for ESRD has lead to a decline in the percentage of patients utilizing PD, to less than 8% in 2008. This is markedly different from the experience in other developed regions such as Mexico, Canada, New Zealand, Australia, and Hong Kong. 2 This article will explore the reasons for this, as well as the complex web of fi nancial, cultural, and medical practice differences between countries to consider what the future is for PD in the U.S. considering patient outcomes, utilization, and technological advances. Since becoming an attending nephrologist in 1984, I have treated many patients with PD, some for more than 15 years. At our university, I am the medical director of both a thriving center hemodialysis (CHD) unit and a robust home unit (offering both
Journal of the American Society of Nephrology, 1993
Hemodialysis patients often do not complete their full amount of time on dialysis and at times mi... more Hemodialysis patients often do not complete their full amount of time on dialysis and at times miss their hemodialysis treatments completely. However, neither the magnitude nor the potential reasons for this problem are known. The prevalence of unauthorized absences from hemodialysis sessions (no shows) and both the prevalence and reasons for early terminations from hemodialysis sessions (early sign-offs) were prospectively studied at a large hemodialysis unit in the southeastern United States. This unit provided a total of 31,212 hemodialysis sessions in a 12-month period to an average of 231 patients. There was a total of 2,108 early sign-offs (6.8 +/- 0.9%/mo) and 387 "no-shows" (1.2 +/- 0.2%/mo) during this 12-month period. The most common reasons for early sign-off were cramping (17.9%), followed by "feels bad or sick" (14.2%), personal business or errands (12.1%), lack of transportation later in the day (7.7%), and refusal to comply with the prescribed trea...
Nephrology news & issues, 2017
Peritoneal Dialysis International
long history, as of 2008 <8 % of prevalent ESRD patients in the United States are treated with... more long history, as of 2008 <8 % of prevalent ESRD patients in the United States are treated with PD, a modality mix that is significantly different from what is seen in other developed countries. Data are reviewed that suggest that the reasons for this seem to be caused by non–medical-related issues such as subtle differences in practice patterns and unintended financial considerations. Medical outcome date would seem to favor more utilization of PD. For instance, data from the USRDS suggested that the relative risk of death for PD versus center hemodialysis has been improving, tending to favor those on PD for longer and longer periods of time. Infectious complications have also been markedly reduced. It is anticipated that changes in government reimbursement, such as the bundling of dialysis-related services, will stimulate a renewed interest in home therapies. Currently most home dialysis units are small, and some have minimal clinical experience with PD. If trends in reimburseme...
American Journal of Hospice and Palliative Medicine®
Background: Patients with end-stage renal disease (ESRD) have a high burden of physical and psych... more Background: Patients with end-stage renal disease (ESRD) have a high burden of physical and psychological symptoms. Many remain unrecognized for long periods of time, particularly in older adults. The best strategy to monitor patient-reported outcome measures (PROMs) has not been identified. Objective: To assess the feasibility of implementing an iPad-based symptom assessment tool in older adults with ESRD on hemodialysis (HD). Methods: We designed an iPad application-delivery system for collecting electronic PROMs (ePROMs). Patient’s ≥60 years of age with ESRD on HD were recruited from a single outpatient dialysis unit. Feasibility was evaluated based on recruitment, retention, and the system usability score (SUS). Assessments were completed at baseline, 3 months, and 6 months after enrollment. ANOVA was used to assess longitudinal symptom variability. Results: Twenty-two patients (49% recruitment rate) were enrolled, with an 82% retention at 6 months. Mean age was 69.4 years (SD 6...
Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis
Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis
The International Society for Peritoneal Dialysis last published a guideline on prescribing perit... more The International Society for Peritoneal Dialysis last published a guideline on prescribing peritoneal dialysis (PD) in 2006. This focused on clearance of toxins and used a measure of waste product removal by dialysis using urea as an example. This guideline suggested that a specific quantity of small solute removal was needed to achieve dialysis 'adequacy'. It is now generally accepted, however, that the well-being of the person on dialysis is related to many different factors and not just removal of specific toxins. This guideline has been written with the focus on the person doing PD. It is proposed that dialysis delivery should be 'goal-directed'. This involves discussions between the person doing PD and the care team (shared decision-making) to establish care goals for dialysis delivery. The aims of these care goals are (1) to allow the person doing PD to achieve his/her own life goals and (2) to promote the provision of high-quality dialysis care by the dialysis team. Key recommendations 1. PD should be prescribed using shared decision-making between the person doing PD and the care team. The aim is to establish realistic care goals that (1) maintain quality of life for the person doing PD as much as possible by enabling them to meet their life goals, (2) minimize symptoms and treatment burden while (3) ensuring high-quality care is provided.
Peritoneal Dialysis International
Background Hospital readmissions are common among in- center hemodialysis patients, but little is... more Background Hospital readmissions are common among in- center hemodialysis patients, but little is known about read-missions among peritoneal dialysis (PD) patients. Using national administrative data, we aimed to examine the burden and correlates of hospital readmissions among U.S. PD patients. Methods Among 10,505 adult U.S. PD patients with an index admission (first admission after 120 days on dialysis) between 31 January 2011 and 30 November 2014, readmissions were defined as new hospital admissions within 30 days of index discharge. Multivariable logistic regression was used to obtain adjusted odds ratios (ORs) for readmission. Results Overall, 26.8% of index admissions were followed by a readmission. Readmitted patients were more likely to have congestive heart failure (31.0% vs 25.4%; p < 0.001) and peripheral arterial disease (11.6% vs 8.6%; p < 0.001) and had longer index admission length of stay (median = 4 vs 3 days; p < 0.001) than those who were not; age, sex, a...
Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association, Jan 25, 2017
Pulmonary edema is prevalent and may be a common cause of hospital readmissions in hemodialysis p... more Pulmonary edema is prevalent and may be a common cause of hospital readmissions in hemodialysis patients. We aimed to estimate the national burden of, and identify correlates of, readmissions related to pulmonary edema among hemodialysis patients. In this retrospective cohort study using national registry data, we identified prevalent US hemodialysis patients (n = 215 251) with index admissions while under Medicare primary coverage in 2011-13. We defined readmissions as admissions occurring within 30 days of the index discharge and pulmonary edema-related readmissions as readmissions with discharge diagnoses of fluid overload, heart failure or pulmonary edema. Multivariable logistic regression models were used to determine odds ratios (ORs) for pulmonary edema-related readmissions by patient and index admission characteristics. About one-quarter (23%) of index hospital admissions were followed by a readmission, with nearly half (44%) of the readmissions being associated with pulmona...