<b><i>Background:</i></b> Evidence suggests that online hemodiafiltration (OL-HDF) is associated with improved survival. Whether the dose-response relationship between convective volume and mortality may be confounded by selection bias or descends from practice patterns is not clear. We sought to evaluate the role of patients’ characteristics and practice patterns on OL-HDF dose and mortality in a large private dialysis network in the Republic of Russia. <b><i>Methods:</i></b> In this multicenter, historical cohort study, we included adult incident patients on OL-HDF with at least 90 days of survival on renal replacement therapy in centers belonging to the Russian Federation Fresenius Medical Care network (January 1, 2011, to December 31, 2016). We evaluated predictors and outcomes (survival) of substitution volume target achievement (<i>Q</i><sub>sub</sub> > 21 L/session). <b><i>Results:</i></b> Among 1,081 enrolled patients, the average <i>Q</i><sub>sub</sub> was 22.9 (±3.2) L/session; the mean ultrafiltration volume was 1.6 (±0.8) L/session. The mean age was 55.8 ± 13.2; 42% were woman. Most common comorbidities were congestive heart failure (39.7%) and peripheral vascular disease (21.7%). The average hemoglobin was 9.3 ± 1.3. The case-mix adjusted center effect accounted for 20% of variance in <i>Q</i><sub>sub</sub>. The top 10 most important variables associated with higher <i>Q</i><sub>sub</sub> were effective <i>Q</i><sub>b</sub>, serum protein, Charlson’s comorbidity index, hemoglobin, year of dialysis initiation (proxy of high <i>Q</i><sub>sub</sub> treatment policy in the clinic network), predialysis heart rate, serum bicarbonate, serum phosphate, age, serum sodium, and dry body weight. In addition, we found that the association of <i>Q</i><sub>b</sub> with <i>Q</i><sub>sub</sub> is moderated by year of enrollment, intradialytic weight gain, and coronary artery disease, whereas higher hemoglobin concentration moderated the relationship between treatment time and <i>Q</i><sub>sub</sub>. Finally, <i>Q</i><sub>sub</sub> between 21 and 25 L/session was associated with longer 5-year survival. <b><i>Conclusions:</i></b> Both center-dependent clinical practice standards and patient clinical conditions substantially contributed to the risk of low <i>Q</i><sub>sub</sub>. We confirmed previous evidence indicating better survival among patients with <i>Q</i><sub>sub</sub> ≥ 21 L/session.
© Коллектив авторов, 2014 г.Данные обследования 3442 человек были использованы для построения когортно-марковской модели оценки эффективности профилактики опасного и вредного потребления алкоголя на основе скрининга и краткосрочного вмешательства (СКСВ). Установлено, что в рамках пессимистичного сценария внедрение СКСВ в Российской Федерации будет ассоциировано с предотвращением ежегодных потерь в 18 716 лет, откорректированных на качество жизни (95% ДИ = 17 611-19 819), в случае более оптимистичного сце-нария эффективности СКСВ число предотвращенных потерь увеличивается до 564 618 лет (95% ДИ = 539 910-589 327). Данный эффект означает, что вмешательство будет давать на каждый вложенный во вме-шательство рубль от 5,92 рублей (95% ДИ = 5,57-6,27 рублей) до 179 рублей (95% ДИ = 171-186 руб-лей). Сравнение с другими профилактическими вмешательствами показывает, что СКСВ относится к группе стоимостно-эффективных вне зависимости от того, используется пессимистический или оптими-стичный сценарий эффекта.Ключевые слова: опасное и вредное потребление алкоголя, алкоголь-ассоциированные заболева -ния, стоимость-эффективность, DALY (количество потерянных лет жизни, откорректированных на инва-лидность).Based on the results of the screening of the 3442 persons Marcov-cohort model was used to estimate results of the preventive program based on the methodology of screening and brief intervention (SBI) to prevent harmful and hazardous alcohol consumption. It is found, that in case of pessimistic scenario introduction of SBI in Russian Federation will be associated with avoidance of 18 716 disability-adjusted life-years (DALY) (95% CI = 17 611-19 819), in case of more optimistic scenario effectiveness of SBI increase to 564 618 DALY (95% CI = 539 910-589 327). This means that economical effect will be from 5,92 rubles per each ruble invested in the SBI (95% CI = 5,57-6,27 rubles) to 179 rubles (95% CI = 171-186 rubles). Comparison to other preventive pro grams show, that SBI is a cost-effective intervention independent of the pessimistic or optimistic scenario used.
Aim. Of the study is to assess HIV prevalence in the vulnerable groups namely injecting drug users (IDU), sex workers (SW), and men who have sex with men (MSM) in some of the largest Russian regiоnal capitals mostly affected by HIV infection. Materials and methods. The study involved 3744 persons from vulnerable groups enrolled by respondent-driven sampling (RDS) or time-location sampling (TLS). The study was undertaken in seven regions of the Russian Federation: Moscow, St.-Petersburg, Yekaterinburg, Krasnoyarsk, Kemerovo, Tomsk and Perm. All participants were interviewed using specially designed questionnaire and then tested for HIV. The retrospective cohort method was applied to evaluate the number of new HIV cases among respondents. Results. HIV prevalence in IDUs ranged from 48.10% [95% confidence interval (CI)=42.20.54.10%] in Krasnoyarsk and 75.20% [95%CI=69.90.80.60%] in Kemerovo. HIV prevalence among sex workers varied from 2.32% [95%CI=0.49.4.17%] in St. Petersburg to 15.01% [95%CI=11.46.18.56%] in Perm. HIV prevalence among MSM ranged from 7.10% [95%CI=4.10.10.10%] in Moscow to 22.80% [95%CI=17.90.27.70%] in St.-Petersburg. Conclusion. The number of new HIV infections estimated by the retrospective cohort method indicated rapid spread of HIV infection among IDUs in all cities except St.-Petersburg, relatively high HIV growth rates among MSM ranging from 1.6% per year [95%CI=0.1... 3.1%] to 4.6% per year [95%CI=0.0... 11%] and 12.3% annual HIV growth rate [95%CI=0.0... 28.3%] among sex workers. Generally, the situation in the studied groups remained adverse and called for more intensive prevention activities in vulnerable populations.
С ердечно-сосудистые заболевания ( ССЗ) остаются важнейшей проблемой современного здравоохранения, несмотря на успехи медикаментозного и хирургического лечения. Поэтому эффективная терапия и профилактика этих заболеваний должна быть доступна как можно большему числу пациентов, желательно путем предоставления государственных гарантий цены препаратов и возможности получения их в рамках программ закупок лекарственных препаратов стационарами. Это означает, в частности, включение данных препаратов в список
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.