To examine new evidence linking expanded hemodialysis (HDx) using a medium cut-off (MCO) membrane with hospitalizations, hospital days, medication use, costs, and patient utility. This retrospective study utilized data from Renal Care Services medical records database in Colombia from 2017 to 2019.Clinics included had switched all patients from high flux hemodialysis (HD HF) to HDx and had at least a year of data on HD HF and HDx. Data included demographic characteristics, comorbidities, years on dialysis, hospitalizations, medication use, and quality of life measured by the 36 item and Short Form versions of the Kidney Disease Quality of Life survey at the start of HDx, and 1 year after HDx, which were mapped to EQ-5D utilities. Generalized linear models were run on the outcomes of interest with an indicator for being on HDx. Annual cost estimates were also constructed. The study included 81 patients. HDx was significantly associated with lower dosing of erythropoietin stimulating agents, iron, hypertension medications, and insulin. HDx was also significantly associated with lower hospital days per year (5.94 on HD vs. 4.41 on HDx) although not with the number of hospitalizations. Estimates of annual hospitalization costs were 23.9% lower using HDx and patient utilities did not appear to decline. HDx was statistically significantly associated with reduced hospitalization days and lower medication dosages. Furthermore, this preliminary analysis suggested potential for HDx being a dominant strategy in terms of costs and utility and should motivate future work with larger samples and better controls.

Background: The benefits of automated peritoneal dialysis (APD) have been established, but patient adherence to treatment remains a concern. Remote patient monitoring (RPM) programs are a potential solution; however, the cost implications are not well established. This study modeled, from the payer perspective, expected net costs and clinical consequences of a novel RPM program in Colombia. Methods: Amarkov model was used to project costs and clinical outcomes for APD patients with and without RPM. Clinical inputs were directly estimated from Renal Care Services data or taken from the literature. Dialysis costs were estimated from national fees. Inpatient costs were obtained from a recent Colombian study. The model projected overall direct costs and several clinical outcomes. Deterministic and probabilistic sensitivity analyses (DSA and PSA) were also conducted to characterize uncertainty in the results. Results: The model projected that the implementation of an RPM program costing US$35 per month in a cohort of 100 APD patients over 1 year would save US$121,233. The model also projected 31 additional months free of complications, 27 fewer hospitalizations, 518 fewer hospitalization days, and 6 fewer peritonitis episodes. In the DSA, results were most sensitive to hospitalization rates and days of hospitalization, but cost savings were robust. The PSA found there was a 91% chance for the RPM program to be cost saving. Conclusion: The results of the model suggest that RPM is cost-effective in APD patients which should be verified by a rigorous prospective cost analysis.

Introduction: Expanded hemodialysis (HDx) effectively removes large middle molecular uremic toxins (>25 kDa) while still retaining albumin, potentially reducing their adverse effects. We compare the clinical laboratory parameters, hospitalization rates, and medication use in a cohort of patients switched from high-flux HD to HDx. Methods: This is a multicenter, observational cohort study of 81 adult patients, across 3 clinics, with end-stage kidney disease (ESKD) on chronic hemodialysis (HD). Patients received high-flux HD for at least 1 year and then switched to HDx and were followed up for 1 year. Patients were excluded if they discontinued therapy, changed provider, underwent kidney transplant, recovered kidney function, or changed to peritoneal dialysis, another dialyzer, or renal clinic. Results: Twelve months after switching to HDx, the rate of hospitalization events per patient-year decreased from 0.77 (95% CI: 0.60–0.98, 61 events) to 0.71 (95% CI: 0.55–0.92, 57 events) (p = 0.6987). The hospital day rate per patient-year was significantly reduced from 5.94 days in the year prior to switching compared with 4.41 days after switching (p = 0.0001). The mean dose of erythropoiesis-stimulating agent (SC epoetin-α) and intravenous iron also significantly decreased (p = 0.0361 and p = 0.0003, respectively). Conclusion: Switching to HDx was associated with reductions in hospital day rate and medication use, suggesting HDx has the potential to reduce the burden of ESKD on patients and healthcare systems.

The results indicate that by replacing salmeterol/fluticasone or formoterol/budesonide with indacaterol, there are possible cost savings for the Colombian health care system. This was demonstrated by both cost-effectiveness and budget impact models.

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A 1 -A 3 1 8 A133 eficiaries who had a diagnosis of hypertension and CKD, aged 67 and above and continuously enrolled in Medicare Part D from 2008 to 2013 are included. Baseline characteristics examined using a two year lookback period. Adherence to ACEIs, ARBs and other blood pressure/ lipid lowering agents was measured using proportion of days covered (PDC). Multivariate Cox regression models were used to assess the association between medication adherence and progression to end stage renal disease (ESRD) and death. Results: A total of 115,769 hypertensive patients with CKD were included. Approximately 2.5% of them developed ESRD and 57.5% of them died during 2008-2013. Adherence to ACEIs and ARBs was associated with a significant decreased hazard of developing ESRD (Hazard Ratio: 0.29 95%CI [0.25-0.33] p< 0.0001; 0.49 95% CI [0.42, 0.57] p< 0.0001, respectively) after adjusting for demographic and clinical confounders. Patients with increased use of ACEIs and ARBs had reduced risk of death (Hazard Ratio: 0.76 95%CI [0.74-0.78] p< 0.0001; 0.64 95% CI [0.62, 0.66] p< 0.0001, respectively). Increased adherence to diuretics and statins were associated with lower ESRD and mortality risk, while calcium channel blockers and beta blockers were associated with increased ESRD risk and lower mortality risk. ConClusions: Increased adherence to ACEIs and ARBs for elderly patients diagnosed with hypertensive CKD is associated with delay in CKD progression and lower mortality risk. These findings could have significant implications for hypertension management in this population.

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4.89; I 2 =0%; 2 studies), complications (RR=0.37; 95%CI: 0.21, 0.65; I 2 = 0%; 2 studies), blood loss (mean difference= -1634.9ml; 95% CI: -2242.2ml, -1027.5ml; I 2 = 0%; 3 studies), and visual analogue scale (mean difference= -0.78; 95% CI: -1.50, -0.03; I 2 = 0%; 3 studies). Infection risk (RR=0.40; 95%CI: 0.09, 1.69; I 2 =0%; 2 studies), favorable change in cobb angle (mean difference= -0.38; 95% CI: -3.19, 2.43; I 2 =90.6%; 3 studies), and Oswestry Disability Index (mean difference= -3.45; 95% CI: -8.35, 1.45; I 2 =0%; 3 studies) were not significantly different between surgery types. Conclusions: Following a comprehensive pooling of the literature, this meta-analysis demonstrated that MIS was associated with better health and safety outcomes in adult patients with adult degenerative scoliosis compared to OS. Further studies are needed to allow for subgroup analyses and identification of specific patient populations who may benefit the most from MIS vs OS.