Wendy Bloembergen - Academia.edu (original) (raw)
Papers by Wendy Bloembergen
Journal of The American Society of Nephrology, Aug 1, 1995
Mortality rates associated with peritoneal dialysis (PD) have been found to be higher than those ... more Mortality rates associated with peritoneal dialysis (PD) have been found to be higher than those associated with hemodialysis (HD) among prevalent U.S. patients
Journal of The American Society of Nephrology, Nov 1, 1994
P atients treated for ESRD have a high mortality rate. Reports have shown that the risk of mortal... more P atients treated for ESRD have a high mortality rate. Reports have shown that the risk of mortality among patients treated for ESRD is higher for males than for females and for whites than for blacks. The U.S. Renal Data System (USRDS) has shown that 1-yr survival rates for ESRD patients incident during 40 30 20 10 Death Rate (per 100 patient years) 19.7 RR#{149}1.22 p'O.OOl'
PubMed, Apr 1, 1993
Patients who receive a kidney transplant that does not function immediately have more complicatio... more Patients who receive a kidney transplant that does not function immediately have more complications and decreased graft survival than patients whose allografts function immediately. To determine the causes of initial nonfunction (INF), the authors reviewed 188 consecutive cadaveric kidney transplants performed between 1985 and 1988 at the University Hospital, London, Ont. Data were collected on 16 putative risk factors for INF, which were divided into three categories: donor, recipient and technical. INF was defined as the need for dialysis within 7 days of transplantation. Forty-eight (26%) of the 188 allografts had INF, 6 of which never functioned. Univariate analysis identified five variables associated with increased risk of INF: no donor dopamine use, back-table flush, single-organ retrieval, exchanged kidney and prolonged cold ischemic time. Multivariate analysis, however, identified only three variables associated with INF: cerebrovascular accident as the cause of donor death, no donor dopamine use and single-organ retrieval. The authors recommend (a) low-dose dopamine therapy for all donors and (b) multiorgan retrieval to produce quality kidneys for transplantation.
Journal of the American Society of Nephrology, 1997
Withdrawal from dialysis has been a significant cause of mortality among dialysis patients, accou... more Withdrawal from dialysis has been a significant cause of mortality among dialysis patients, accounting for 6 to 22% of deaths. Since 1990, a new death notification form has allowed more detailed analyses of withdrawal from dialysis separate from causes of death. Using the U.S. Renal Data System data base, this study examined 116,829 deaths in adult patients from 1990 to 1995. Adjusted odds ratios were calculated for the risk of withdrawal using logistic regression. Adjustments included age at death, ethnicity, gender, cause of death, primary cause of end-stage renal disease, time on dialysis, and dialysis modality. In addition, odds ratios of withdrawal were calculated for deaths in patients who started dialysis after age 65. Death was preceded by withdrawal significantly more frequently in women than in men, more than twice as frequently in Caucasians than in African-Americans or Asians, and more frequently in older than in younger age groups. Patients who died of chronic diseases ...
Caries Research
Previous work has shown targeted fluorescent starch nanoparticles (TFSNs) can label the subsurfac... more Previous work has shown targeted fluorescent starch nanoparticles (TFSNs) can label the subsurface of carious lesions and assist dental professionals in the diagnostic process. In this study, we aimed to evaluate the potential of using artificial intelligence (AI) to detect and score carious lesions using the ICDAS in combination with fluorescent imaging following application of TFSNs on teeth with a range of lesion severities, using ICDAS-labeled images as the reference standard. A total of 130 extracted human teeth with ICDAS scores from 0 to 6 were selected by a calibrated cariologist according to ICDAS. Then, the same surface was imaged with a stereomicroscope under white-light illumination, and blue-light illumination with an orange filter following application of the TFSNs. Both sets of images were labeled by another blinded ICDAS-calibrated cariologist to demarcate lesion position and severity. Convolutional Neural Networks, state-of-the-art models in imaging AI, were trained...
Journal of the American Society of Nephrology, 1995
Measurements of hospitalization in the dialysis population are important because they provide ins... more Measurements of hospitalization in the dialysis population are important because they provide insight into the morbidity and the cost of treatment among dialysis patients. Prior comparisons of hospitalization for different dialysis modalities have had conflicting results. This study was designed to compare hospitalization for patients treated with peritoneal dialysis (PD) versus hemodialysis (HD) using the data from the U.S. Renal Data System 1993 Annual Data Report. The study population included all Medicare dialysis patients prevalent on January 1, 1988 through 1990. Patients were monitored to transplantation, death, or end of the calendar year for a total of 189,654 patient years. Hospital admission rates were computed from the total number of hospital admissions during the year divided by the total number of patient years at risk. Patients were classified by treatment modality (PD, HD), cause of ESRD (diabetes as a cause of ESRD versus all other causes), age (0 to 19, 20 to 44, ...
American Journal of Kidney Diseases, 2000
This national study compares waitlisting and transplantation rates by gender, race, and diabetes ... more This national study compares waitlisting and transplantation rates by gender, race, and diabetes and evaluates physiologic factors (panel-reactive antibodies [PRA], blood type, HLA matchability) and related practices (early and multiple waitlisting) as explanatory factors. This longitudinal study of the time to transplant waitlisting among 228,552 incident end-stage renal disease (ESRD) dialysis patients and to cadaveric transplantation among 46,164 waitlist dialysis patients (n ؍ 23,275 first cadaveric transplants) used US data for 1991 to 1997. Relative rates of waitlisting (RRWL) after ESRD onset and of cadaveric transplantation (RRTx) after waitlist (Cox proportional hazards models) were adjusted for age, race, sex, ESRD cause, region, and incidence/waitlist year. We found that women have an RRWL ؍ 0.84 (P < 0.0001) and RRTx ؍ 0.86 (P < 0.0001). PRA levels can explain the difference in the transplantation rate, because accounting for PRA gives an adjusted RRTx ؍ 0.98 (NS) for women. For blacks versus whites, the RRWL ؍ 0.59 (P < 0.0001) and RRTx ؍ 0.55 (P < 0.0001). However, the transplantation rate can only partly be explained by ABO types, rare HLA types, and early and multiple waitlisting (adjusted RRTx ؍ 0.67 [P < 0.0001]). For diabetes versus glomerulonephritis, the RRWL ؍ 0.52 (P < 0.0001) and RRTx ؍ 0.98 (NS). Older patients (40 to 59 years of age) are less likely to be waitlisted and to receive a transplant after waitlisting (RRWL ؍ 0.57 [P < 0.0001], RRTx ؍ 0.88 [P < 0.0001]) versus younger patients (ages 18 to 39 years). These results indicate substantial differences by age, sex, race, and diabetes in rates of waitlisting for transplantation and by age and race for transplantation after waitlisting. These differences by race were not explained by referral practices or the physiologic factors studied here.
American Journal of Kidney Diseases, 1999
• A number of studies have suggested that type of dialysis membrane is associated with difference... more • A number of studies have suggested that type of dialysis membrane is associated with differences in long-term outcome of patients undergoing hemodialysis, both in terms of morbidity and mortality. The purpose of this study was to determine the relationship of membrane type and specific causes of death. Data from the United States Renal Data System Case Mix Adequacy Study, a national random sample of hemodialysis patients who were alive on December 31, 1990, were used. Our study was limited to patients in this data set who were undergoing dialysis for at least 1 year (n ؍ 4,055). For the main analytic models, membrane type was classified into two categories: unmodified cellulose or MC/SYN (which combines modified cellulose [MC] and synthetic membranes [SYN]). The relationships of membrane type and major causes of mortality were analyzed using Cox proportional hazards models, which adjusted for multiple (21) covariates, including demographics, comorbidity, Kt/V, and other parameters. Patients were censored at transplantation or 60 days after a switch to peritoneal dialysis. Compared with patients dialyzed with unmodified cellulose membranes, the adjusted relative mortality risk (RR) from infection was 31% lower (RR ؍ 0.69; P ؍ 0.03) and from coronary artery disease was 26% lower (RR ؍ 0.74; P ؍ 0.07) for patients dialyzed with MC/SYN membranes. No statistically significant difference (all P G 0.1) was found in mortality risk from cerebrovascular disease (RR ؍ 1.08), other cardiac causes (RR ؍ 0.86), malignancy (RR ؍ 0.90), or other known causes (RR ؍ 0.82) between patients dialyzed with MC/SYN compared with unmodified cellulose membranes. These results offer support to reported experimental and observational clinical studies that have found that unmodified cellulose membranes may increase the risk for both infection and atherogenesis. Further studies are necessary to evaluate the possibility of confounding factors, compare more specific membrane types, and determine the pathophysiology linking membrane type to cause-specific mortality.
American Journal of Kidney Diseases, 1999
The role of predialysis blood pressure (BP) as a risk factor for the high mortality in chronic he... more The role of predialysis blood pressure (BP) as a risk factor for the high mortality in chronic hemodialysis (HD) patients has remained controversial. The objective of the current study was to further explore in a national random sample of 4,499 US hemodialysis patients any relationship of systolic or diastolic and predialysis or postdialysis BP with mortality, while considering subgroups of patients and controlling for other patient characteristics and comorbidities. The main finding of this study is the association of a low predialysis systolic BP with an elevated adjusted mortality risk (relative mortality risk [RR] ؍ 1.86 for systolic BP F 110, P F 0.0001). No association with an elevated mortality risk could be observed for predialysis systolic hypertension (RR ؍ 0.98 to 0.99, not significant [NS]), except for an elevated risk of cerebrovascular deaths. Postdialysis systolic BP was associated with an elevated mortality risk both for low and high BP levels as compared with midrange BP. Further evaluation of the elevated mortality risk associated with low predialysis systolic BP indicated similar patterns for both diabetic and nondiabetic subgroups and for patients with and without congestive heart failure (CHF) or coronary artery disease, although it was more pronounced among those with CHF. The level of predialysis fluid excess did not modify these results substantially. The findings from this historical prospective national study do not argue against the treatment of hypertension and suggest greater attention to postdialysis hypertension. The strikingly elevated mortality risk with low predialysis systolic BP suggests that low predialysis BP needs to be viewed with great concern and avoided where possible.
American Journal of Kidney Diseases, 1997
American Journal of Kidney Diseases, 1998
• Changes in the demographics and prescription of peritoneal dialysis (PD) during the past decade... more • Changes in the demographics and prescription of peritoneal dialysis (PD) during the past decade are reviewed using data from the United States and Canada. The number of patients in North America undergoing PD has increased markedly over the past decade, but the percentage of total chronic dialysis patients using the modality has remained relatively stable or decreased slightly during recent years. The average age of the patients undergoing PD has increased, and the percentage with diabetes has also increased. Comorbidity has otherwise remained relatively stable and tends to be significantly less than that in patients undergoing chronic hemodialysis (HD). The proportion of PD patients undergoing automated PD (APD) has increased markedly over the past decade and now includes more than one third of the PD patients in North America. The issue of adequacy of clearance achieved on PD has received a lot of attention over the past decade, and this is now being translated into changes in prescription. Patients undergoing continuous ambulatory PD (CAPD) are being prescribed larger dwell volumes, and more than one quarter use 2.5-L dwells or greater. A small number in the United States are being prescribed more than four exchanges a day, but this practice is more common in Canada. With regard to APD, the proportion of patients doing day dwells is now more than two thirds, and the average cycler dwell volumes have also increased. There are no baseline clearance data from a decade ago for comparative purposes, but it appears that clearances have increased in recent years. In general, more than 70% of the patients are achieving recommended clearance targets at the initiation of PD but, among prevalent US patients, the percentage achieving targets is in the range of 40% to 45%, reflecting a loss of residual renal function. In Canada, 60% to 70% of prevalent patients are achieving these targets. PD is a rapidly changing therapy at present. There have been dramatic and impressive improvements in prescription practices, but they need to change further if a higher proportion of patients is to achieve recommended clearance targets.
Journal of the American Society of Nephrology, 1995
Patients with ESRD treated with dialysis have a high mortality rate. Controversy exists as to whe... more Patients with ESRD treated with dialysis have a high mortality rate. Controversy exists as to whether this high mortality rate is affected by modality choice. The purpose of this epidemiologic study was to compare mortality in prevalent hemodialysis-treated (HD) and peritoneal dialysis-treated (PD) patients in a large national sample, adjusting for demographic characteristics. Data were obtained from the U.S. Renal Data System for patients prevalent on January 1 of the years 1987, 1988, and 1989, each with 1 yr of follow-up. Patients were censored at transplantation. Death rates per 100 patient years were compared between HD and PD, adjusting for age, race, gender, cause of ESRD (diabetes versus nondiabetes) and < 1 yr or > 1 yr of prior ESRD, by the use of Poisson regression. There were 42,372 deaths occurring over 170,700 patient years at risk. On average, prevalent patients treated with PD had a 19% higher adjusted mortality risk (relative risk (RR) = 1.19; P < 0.001) th...
American Journal of Kidney Diseases, 1995
Advances in Renal Replacement Therapy, 1996
Advances in renal replacement therapy, 1997
Cardiac abnormalities develop during chronic renal failure. The prevalence of ischemic heart dise... more Cardiac abnormalities develop during chronic renal failure. The prevalence of ischemic heart disease, cardiac failure, and left ventricular disorders is high among patients initiating end-stage renal disease (ESRD) therapy, and appears to be getting higher. Age, gender, race, diabetes, and possibly geographic location are predictive of the presence of several cardiac conditions. Cardiac morbidity after the initiation of ESRD therapy is high, and cardiac causes are the most common reported cause of death. Cardiac abnormalities present on starting dialysis contribute to this morbidity and mortality. In epidemiological studies, higher cardiac death rates have also been associated with dialysis rather than transplantation as mode of ESRD therapy, peritoneal rather than hemodialysis, lower dose of dialysis, and unmodified cellulose rather than modified cellulose/synthetic hemodialysis membranes.
Journal of the American Society of Nephrology : JASN, 2001
Despite the high prevalence of coronary artery disease (CAD) among patients with end-stage renal ... more Despite the high prevalence of coronary artery disease (CAD) among patients with end-stage renal disease (ESRD), few studies have identified clinical correlates using national data. The purpose of this study was to determine the prevalence and clinical associations of CAD in a national random sample of new ESRD in the United States in 1996/1997 (n = 4025). Data on demographic characteristics and comorbidities were obtained from the Dialysis Morbidity and Mortality Study, Wave 2. The principal outcome was CAD, defined as the presence of a previous history of CAD, myocardial infarction, or angina, coronary artery bypass surgery, coronary angioplasty, or abnormal coronary angiographic findings. Multivariate logistic regression analysis was used to assess the relationship of conventional factors and proposed uremic factors to the presence of CAD. CAD was present in 38% of patients. Of the total cohort, 17% had a history of myocardial infarction and 23% had angina. Several conventional r...
Nephrology and Urology in the Aged Patient, 1993
Over the past decade, the incidence of treated end-stage renal disease (ESRD) has increased rapid... more Over the past decade, the incidence of treated end-stage renal disease (ESRD) has increased rapidly in the U.S. [1] and in many other countries [2–6]. This rise has been greatest among the elderly (Figs. 1 and 2), who now have the highest incidence of ESRD. In the U.S., the median age of the overall ESRD population has increased from 55 years in 1980 to 61 years in 1990.
Journal of The American Society of Nephrology, Aug 1, 1995
Mortality rates associated with peritoneal dialysis (PD) have been found to be higher than those ... more Mortality rates associated with peritoneal dialysis (PD) have been found to be higher than those associated with hemodialysis (HD) among prevalent U.S. patients
Journal of The American Society of Nephrology, Nov 1, 1994
P atients treated for ESRD have a high mortality rate. Reports have shown that the risk of mortal... more P atients treated for ESRD have a high mortality rate. Reports have shown that the risk of mortality among patients treated for ESRD is higher for males than for females and for whites than for blacks. The U.S. Renal Data System (USRDS) has shown that 1-yr survival rates for ESRD patients incident during 40 30 20 10 Death Rate (per 100 patient years) 19.7 RR#{149}1.22 p'O.OOl'
PubMed, Apr 1, 1993
Patients who receive a kidney transplant that does not function immediately have more complicatio... more Patients who receive a kidney transplant that does not function immediately have more complications and decreased graft survival than patients whose allografts function immediately. To determine the causes of initial nonfunction (INF), the authors reviewed 188 consecutive cadaveric kidney transplants performed between 1985 and 1988 at the University Hospital, London, Ont. Data were collected on 16 putative risk factors for INF, which were divided into three categories: donor, recipient and technical. INF was defined as the need for dialysis within 7 days of transplantation. Forty-eight (26%) of the 188 allografts had INF, 6 of which never functioned. Univariate analysis identified five variables associated with increased risk of INF: no donor dopamine use, back-table flush, single-organ retrieval, exchanged kidney and prolonged cold ischemic time. Multivariate analysis, however, identified only three variables associated with INF: cerebrovascular accident as the cause of donor death, no donor dopamine use and single-organ retrieval. The authors recommend (a) low-dose dopamine therapy for all donors and (b) multiorgan retrieval to produce quality kidneys for transplantation.
Journal of the American Society of Nephrology, 1997
Withdrawal from dialysis has been a significant cause of mortality among dialysis patients, accou... more Withdrawal from dialysis has been a significant cause of mortality among dialysis patients, accounting for 6 to 22% of deaths. Since 1990, a new death notification form has allowed more detailed analyses of withdrawal from dialysis separate from causes of death. Using the U.S. Renal Data System data base, this study examined 116,829 deaths in adult patients from 1990 to 1995. Adjusted odds ratios were calculated for the risk of withdrawal using logistic regression. Adjustments included age at death, ethnicity, gender, cause of death, primary cause of end-stage renal disease, time on dialysis, and dialysis modality. In addition, odds ratios of withdrawal were calculated for deaths in patients who started dialysis after age 65. Death was preceded by withdrawal significantly more frequently in women than in men, more than twice as frequently in Caucasians than in African-Americans or Asians, and more frequently in older than in younger age groups. Patients who died of chronic diseases ...
Caries Research
Previous work has shown targeted fluorescent starch nanoparticles (TFSNs) can label the subsurfac... more Previous work has shown targeted fluorescent starch nanoparticles (TFSNs) can label the subsurface of carious lesions and assist dental professionals in the diagnostic process. In this study, we aimed to evaluate the potential of using artificial intelligence (AI) to detect and score carious lesions using the ICDAS in combination with fluorescent imaging following application of TFSNs on teeth with a range of lesion severities, using ICDAS-labeled images as the reference standard. A total of 130 extracted human teeth with ICDAS scores from 0 to 6 were selected by a calibrated cariologist according to ICDAS. Then, the same surface was imaged with a stereomicroscope under white-light illumination, and blue-light illumination with an orange filter following application of the TFSNs. Both sets of images were labeled by another blinded ICDAS-calibrated cariologist to demarcate lesion position and severity. Convolutional Neural Networks, state-of-the-art models in imaging AI, were trained...
Journal of the American Society of Nephrology, 1995
Measurements of hospitalization in the dialysis population are important because they provide ins... more Measurements of hospitalization in the dialysis population are important because they provide insight into the morbidity and the cost of treatment among dialysis patients. Prior comparisons of hospitalization for different dialysis modalities have had conflicting results. This study was designed to compare hospitalization for patients treated with peritoneal dialysis (PD) versus hemodialysis (HD) using the data from the U.S. Renal Data System 1993 Annual Data Report. The study population included all Medicare dialysis patients prevalent on January 1, 1988 through 1990. Patients were monitored to transplantation, death, or end of the calendar year for a total of 189,654 patient years. Hospital admission rates were computed from the total number of hospital admissions during the year divided by the total number of patient years at risk. Patients were classified by treatment modality (PD, HD), cause of ESRD (diabetes as a cause of ESRD versus all other causes), age (0 to 19, 20 to 44, ...
American Journal of Kidney Diseases, 2000
This national study compares waitlisting and transplantation rates by gender, race, and diabetes ... more This national study compares waitlisting and transplantation rates by gender, race, and diabetes and evaluates physiologic factors (panel-reactive antibodies [PRA], blood type, HLA matchability) and related practices (early and multiple waitlisting) as explanatory factors. This longitudinal study of the time to transplant waitlisting among 228,552 incident end-stage renal disease (ESRD) dialysis patients and to cadaveric transplantation among 46,164 waitlist dialysis patients (n ؍ 23,275 first cadaveric transplants) used US data for 1991 to 1997. Relative rates of waitlisting (RRWL) after ESRD onset and of cadaveric transplantation (RRTx) after waitlist (Cox proportional hazards models) were adjusted for age, race, sex, ESRD cause, region, and incidence/waitlist year. We found that women have an RRWL ؍ 0.84 (P < 0.0001) and RRTx ؍ 0.86 (P < 0.0001). PRA levels can explain the difference in the transplantation rate, because accounting for PRA gives an adjusted RRTx ؍ 0.98 (NS) for women. For blacks versus whites, the RRWL ؍ 0.59 (P < 0.0001) and RRTx ؍ 0.55 (P < 0.0001). However, the transplantation rate can only partly be explained by ABO types, rare HLA types, and early and multiple waitlisting (adjusted RRTx ؍ 0.67 [P < 0.0001]). For diabetes versus glomerulonephritis, the RRWL ؍ 0.52 (P < 0.0001) and RRTx ؍ 0.98 (NS). Older patients (40 to 59 years of age) are less likely to be waitlisted and to receive a transplant after waitlisting (RRWL ؍ 0.57 [P < 0.0001], RRTx ؍ 0.88 [P < 0.0001]) versus younger patients (ages 18 to 39 years). These results indicate substantial differences by age, sex, race, and diabetes in rates of waitlisting for transplantation and by age and race for transplantation after waitlisting. These differences by race were not explained by referral practices or the physiologic factors studied here.
American Journal of Kidney Diseases, 1999
• A number of studies have suggested that type of dialysis membrane is associated with difference... more • A number of studies have suggested that type of dialysis membrane is associated with differences in long-term outcome of patients undergoing hemodialysis, both in terms of morbidity and mortality. The purpose of this study was to determine the relationship of membrane type and specific causes of death. Data from the United States Renal Data System Case Mix Adequacy Study, a national random sample of hemodialysis patients who were alive on December 31, 1990, were used. Our study was limited to patients in this data set who were undergoing dialysis for at least 1 year (n ؍ 4,055). For the main analytic models, membrane type was classified into two categories: unmodified cellulose or MC/SYN (which combines modified cellulose [MC] and synthetic membranes [SYN]). The relationships of membrane type and major causes of mortality were analyzed using Cox proportional hazards models, which adjusted for multiple (21) covariates, including demographics, comorbidity, Kt/V, and other parameters. Patients were censored at transplantation or 60 days after a switch to peritoneal dialysis. Compared with patients dialyzed with unmodified cellulose membranes, the adjusted relative mortality risk (RR) from infection was 31% lower (RR ؍ 0.69; P ؍ 0.03) and from coronary artery disease was 26% lower (RR ؍ 0.74; P ؍ 0.07) for patients dialyzed with MC/SYN membranes. No statistically significant difference (all P G 0.1) was found in mortality risk from cerebrovascular disease (RR ؍ 1.08), other cardiac causes (RR ؍ 0.86), malignancy (RR ؍ 0.90), or other known causes (RR ؍ 0.82) between patients dialyzed with MC/SYN compared with unmodified cellulose membranes. These results offer support to reported experimental and observational clinical studies that have found that unmodified cellulose membranes may increase the risk for both infection and atherogenesis. Further studies are necessary to evaluate the possibility of confounding factors, compare more specific membrane types, and determine the pathophysiology linking membrane type to cause-specific mortality.
American Journal of Kidney Diseases, 1999
The role of predialysis blood pressure (BP) as a risk factor for the high mortality in chronic he... more The role of predialysis blood pressure (BP) as a risk factor for the high mortality in chronic hemodialysis (HD) patients has remained controversial. The objective of the current study was to further explore in a national random sample of 4,499 US hemodialysis patients any relationship of systolic or diastolic and predialysis or postdialysis BP with mortality, while considering subgroups of patients and controlling for other patient characteristics and comorbidities. The main finding of this study is the association of a low predialysis systolic BP with an elevated adjusted mortality risk (relative mortality risk [RR] ؍ 1.86 for systolic BP F 110, P F 0.0001). No association with an elevated mortality risk could be observed for predialysis systolic hypertension (RR ؍ 0.98 to 0.99, not significant [NS]), except for an elevated risk of cerebrovascular deaths. Postdialysis systolic BP was associated with an elevated mortality risk both for low and high BP levels as compared with midrange BP. Further evaluation of the elevated mortality risk associated with low predialysis systolic BP indicated similar patterns for both diabetic and nondiabetic subgroups and for patients with and without congestive heart failure (CHF) or coronary artery disease, although it was more pronounced among those with CHF. The level of predialysis fluid excess did not modify these results substantially. The findings from this historical prospective national study do not argue against the treatment of hypertension and suggest greater attention to postdialysis hypertension. The strikingly elevated mortality risk with low predialysis systolic BP suggests that low predialysis BP needs to be viewed with great concern and avoided where possible.
American Journal of Kidney Diseases, 1997
American Journal of Kidney Diseases, 1998
• Changes in the demographics and prescription of peritoneal dialysis (PD) during the past decade... more • Changes in the demographics and prescription of peritoneal dialysis (PD) during the past decade are reviewed using data from the United States and Canada. The number of patients in North America undergoing PD has increased markedly over the past decade, but the percentage of total chronic dialysis patients using the modality has remained relatively stable or decreased slightly during recent years. The average age of the patients undergoing PD has increased, and the percentage with diabetes has also increased. Comorbidity has otherwise remained relatively stable and tends to be significantly less than that in patients undergoing chronic hemodialysis (HD). The proportion of PD patients undergoing automated PD (APD) has increased markedly over the past decade and now includes more than one third of the PD patients in North America. The issue of adequacy of clearance achieved on PD has received a lot of attention over the past decade, and this is now being translated into changes in prescription. Patients undergoing continuous ambulatory PD (CAPD) are being prescribed larger dwell volumes, and more than one quarter use 2.5-L dwells or greater. A small number in the United States are being prescribed more than four exchanges a day, but this practice is more common in Canada. With regard to APD, the proportion of patients doing day dwells is now more than two thirds, and the average cycler dwell volumes have also increased. There are no baseline clearance data from a decade ago for comparative purposes, but it appears that clearances have increased in recent years. In general, more than 70% of the patients are achieving recommended clearance targets at the initiation of PD but, among prevalent US patients, the percentage achieving targets is in the range of 40% to 45%, reflecting a loss of residual renal function. In Canada, 60% to 70% of prevalent patients are achieving these targets. PD is a rapidly changing therapy at present. There have been dramatic and impressive improvements in prescription practices, but they need to change further if a higher proportion of patients is to achieve recommended clearance targets.
Journal of the American Society of Nephrology, 1995
Patients with ESRD treated with dialysis have a high mortality rate. Controversy exists as to whe... more Patients with ESRD treated with dialysis have a high mortality rate. Controversy exists as to whether this high mortality rate is affected by modality choice. The purpose of this epidemiologic study was to compare mortality in prevalent hemodialysis-treated (HD) and peritoneal dialysis-treated (PD) patients in a large national sample, adjusting for demographic characteristics. Data were obtained from the U.S. Renal Data System for patients prevalent on January 1 of the years 1987, 1988, and 1989, each with 1 yr of follow-up. Patients were censored at transplantation. Death rates per 100 patient years were compared between HD and PD, adjusting for age, race, gender, cause of ESRD (diabetes versus nondiabetes) and < 1 yr or > 1 yr of prior ESRD, by the use of Poisson regression. There were 42,372 deaths occurring over 170,700 patient years at risk. On average, prevalent patients treated with PD had a 19% higher adjusted mortality risk (relative risk (RR) = 1.19; P < 0.001) th...
American Journal of Kidney Diseases, 1995
Advances in Renal Replacement Therapy, 1996
Advances in renal replacement therapy, 1997
Cardiac abnormalities develop during chronic renal failure. The prevalence of ischemic heart dise... more Cardiac abnormalities develop during chronic renal failure. The prevalence of ischemic heart disease, cardiac failure, and left ventricular disorders is high among patients initiating end-stage renal disease (ESRD) therapy, and appears to be getting higher. Age, gender, race, diabetes, and possibly geographic location are predictive of the presence of several cardiac conditions. Cardiac morbidity after the initiation of ESRD therapy is high, and cardiac causes are the most common reported cause of death. Cardiac abnormalities present on starting dialysis contribute to this morbidity and mortality. In epidemiological studies, higher cardiac death rates have also been associated with dialysis rather than transplantation as mode of ESRD therapy, peritoneal rather than hemodialysis, lower dose of dialysis, and unmodified cellulose rather than modified cellulose/synthetic hemodialysis membranes.
Journal of the American Society of Nephrology : JASN, 2001
Despite the high prevalence of coronary artery disease (CAD) among patients with end-stage renal ... more Despite the high prevalence of coronary artery disease (CAD) among patients with end-stage renal disease (ESRD), few studies have identified clinical correlates using national data. The purpose of this study was to determine the prevalence and clinical associations of CAD in a national random sample of new ESRD in the United States in 1996/1997 (n = 4025). Data on demographic characteristics and comorbidities were obtained from the Dialysis Morbidity and Mortality Study, Wave 2. The principal outcome was CAD, defined as the presence of a previous history of CAD, myocardial infarction, or angina, coronary artery bypass surgery, coronary angioplasty, or abnormal coronary angiographic findings. Multivariate logistic regression analysis was used to assess the relationship of conventional factors and proposed uremic factors to the presence of CAD. CAD was present in 38% of patients. Of the total cohort, 17% had a history of myocardial infarction and 23% had angina. Several conventional r...
Nephrology and Urology in the Aged Patient, 1993
Over the past decade, the incidence of treated end-stage renal disease (ESRD) has increased rapid... more Over the past decade, the incidence of treated end-stage renal disease (ESRD) has increased rapidly in the U.S. [1] and in many other countries [2–6]. This rise has been greatest among the elderly (Figs. 1 and 2), who now have the highest incidence of ESRD. In the U.S., the median age of the overall ESRD population has increased from 55 years in 1980 to 61 years in 1990.