Mortality and hospitalization in haemodialysis patients in five European countries: results from the Dialysis Outcomes and Practice Patterns Study (DOPPS)

Rayner, Hugh; Pisoni, Ronald L.; Bommer, Juergen; Canaud, Bernard; Hecking, E; Locatelli, Francesco; Piera, L; Bragg‐Gresham, Jennifer L.; Feldman, Harold I.; Goodkin, David A.; Gillespie, Brenda W.; Wolfe, Robert A.; Held, Philip J.; Port, Friedrich K.

doi:10.1093/ndt/gfg483

Cited by 287 publications

(239 citation statements)

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“…Poor control of mineral metabolism is also associated with a higher risk for death, calcification of the coronary arteries and aorta, increased arterial stiffness, and cardiac valve calcification (8 -11,27). A recent report from a large international dialysis database demonstrated that among HD patients in five European countries, hospitalization rates for cardiovascular-related causes were as high as 26% (28). Because cinacalcet is not associated with elevations in calcium and phosphorus, treatment strategies that include cinacalcet may allow better achievement of the K/DOQI targets and possibly reduce complications associated with secondary HPT.…”

Section: Discussionmentioning

confidence: 99%

Cinacalcet HCl, an Oral Calcimimetic Agent for the Treatment of Secondary Hyperparathyroidism in Hemodialysis and Peritoneal Dialysis

Lindberg¹,

Culleton²,

Wong³

et al. 2005

Journal of the American Society of Nephrology

377

265

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Management of secondary hyperparathyroidism is challenging with traditional therapy. The calcimimetic cinacalcet HCl acts on the calcium-sensing receptor to increase its sensitivity to calcium, thereby reducing parathyroid hormone (PTH) secretion. This phase 3, multicenter, randomized, placebo-controlled, double-blind study evaluated the efficacy and safety of cinacalcet in hemodialysis (HD) and peritoneal dialysis (PD) patients with PTH >300 pg/ml despite traditional therapy. A total of 395 patients received once-daily oral cinacalcet (260 HD, 34 PD) or placebo (89 HD, 12 PD) titrated from 30 to 180 mg to achieve a target intact PTH (iPTH) level of <250 pg/ml. During a 10-wk efficacy assessment phase, cinacalcet was more effective than control for PTH reduction outcomes, including proportion of patients with mean iPTH levels <300 pg/ml (46 versus 9%), proportion of patients with >30% reduction in iPTH from baseline (65 versus 13%), and proportion of patients with >20, >40, or >50% reduction from baseline. Cinacalcet had comparable efficacy in HD and PD patients; 50% of PD patients achieved a mean iPTH <300 pg/ml. Cinacalcet also significantly reduced serum calcium, phosphorus, and Ca ؋ P levels compared with control treatment. The most common side effects, nausea and vomiting, were usually mild to moderate in severity and transient. Once-daily oral cinacalcet was effective in rapidly and safely reducing PTH, Ca ؋ P, calcium, and phosphorus levels in patients who received HD or PD. Cinacalcet offers a new therapeutic option for controlling secondary hyperparathyroidism in patients with chronic kidney disease on dialysis.

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Section: Discussionmentioning

confidence: 99%

Cinacalcet HCl, an Oral Calcimimetic Agent for the Treatment of Secondary Hyperparathyroidism in Hemodialysis and Peritoneal Dialysis

Lindberg¹,

Culleton²,

Wong³

et al. 2005

Journal of the American Society of Nephrology

377

265

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“…The use of tunneled or temporary catheters among prevalent patients also varies widely by country. 4 DOPPS has increased our understanding of these differences by studying facility practices at each stage of the pathway: patient presentation to a nephrologist, choice of access type, timing and performance of vascular access surgery, and access cannulation. 2,3,5 …”

Section: T He National Kidney Foundation'smentioning

confidence: 99%

“…3 As shown in Table 1, some European countries, in turn, have a much lower percentage of prevalent patients dialyzing via catheters. 3,4 …”

Section: Hemodialysis Catheter Usementioning

confidence: 99%

Vascular access results from the Dialysis Outcomes and Practice Patterns Study (DOPPS): Performance against Kidney Disease Outcomes Quality Initiative (K/DOQI) Clinical Practice Guidelines

Rayner

Besarab

Brown

et al. 2004

American Journal of Kidney Diseases

124

102

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• Background: The Kidney Disease Outcomes Quality Initiative Guidelines for Vascular Access in hemodialysis patients recommend native arteriovenous (AV) fistulae over AV grafts or catheters for permanent vascular access. They recommend letting fistulae mature >1 month before cannulation. Methods: The Dialysis Outcomes and Practice Patterns Study (DOPPS) provides an unparalleled means to examine vascular access practice patterns and guidelines internationally, with particular attention to associations with mortality risk. Results: Most patients in Europe and Japan dialyze through AV fistulae and very few use AV grafts; in the United States, more patients use grafts than fistulae. Patients who receive nephrologic care for over 30 days before starting dialysis have significantly higher chances of commencing via AV fistula. Medical directors of dialysis facilities in the United States commonly prefer grafts; in Europe and Japan, most prefer fistulae. In the United States, there is a relatively long average time between fistula creation and cannulation but significantly worse fistula survival than that seen in Europe. Tunneled catheters pose a higher mortality risk than permanent accesses and are associated with increased risk of failure of a subsequent fistula. The percentage of prevalent patients in the DOPPS countries using catheters has increased in recent years. DOPPS data suggest that performance in some countries falls short of practices achieved in other countries. AV fistula use is low in the United States but has been improving. The trend of increasing use of catheters in most countries is discouraging. Conclusion: The DOPPS will continue to monitor practice trends and explore whether greater application of guidelines will lead to fewer access complications and improved longevity for hemodialysis patients. Am J Kidney Dis 44(S2):S22-S26. © 2004 by the National Kidney Foundation, Inc. INDEX WORDS: Vascular access; arteriovenous fistula; graft; catheter; hemodialysis; end-stage renal disease; Dialysis Outcomes and Practice Patterns Study (DOPPS). T HE NATIONAL KIDNEY Foundation'sKidney Disease Outcomes Quality Initiative (K/DOQI) Clinical Practice Guidelines for Vascular Access, 2000, 1 Guideline 3, states that the preferred permanent vascular access for hemodialysis patients is a native arteriovenous (AV) fistula, ideally created at the wrist or, barring that possibility, at the elbow. Only if such an AV fistula cannot be established should an upperarm (brachio-basilic) AV fistula be created or an AV graft used. Guideline 29 1 sets goals of primary AV fistulae being constructed in at least 50% of all new kidney failure patients electing to receive hemodialysis as their initial form of renal replacement therapy and 40% of prevalent hemodialysis patients with a native AV fistula. Cuffed hemodialysis catheters are discouraged, and Guideline 30 1 sets a goal of less than 10% of chronic maintenance hemodialysis patients being maintained on catheters as their permanent hemodialysis access. In this context, chronic...

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“…Sin embargo, estos catéteres no están exentos de complicaciones y su duración es limitada, señalándose como principales complicaciones, infección, déficit de flujo sanguíneo, coagulaciones y trombosis 3,4 . La infección es la complicación más grave, por cuanto puede ocasionar bacteriemia y sepsis en los pacientes, originando un cuadro severo, siendo su frecuencia del 4 al 20 %, dependiendo de las series publicadas 5,6 . El déficit de flujo sanguíneo es una complicación frecuente, que puede comprometer la eficacia de la HD y sobre todo, supone uno de los problemas más importantes para enfermería en su manejo.…”

Section: Introductionunclassified

Estudio retrospectivo de las complicaciones de los catéteres temporales para hemodiálisis

Montero¹,

Abad²,

Cuesta³

et al. 2011

Rev Soc Esp Enferm Nefrol

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ResumenLos objetivos de este estudio fueron analizar la duración y las causas de retirada de los catéteres temporales para hemodiálisis Hemos estudiado 1409 catéteres que fueron implantados en 608 pacientes en hemodiálisis periódicas (60.9 ± 15.5 años, 341 mujeres (56%) y 267 hombres (44%). 280 (46%) pacientes recibieron 1 catéter y 144 (24%) 2 catéteres. Posteriormente se analizaron 546 catéteres retirados exclusivamente por complicaciones. La duración media de todos los catéteres (n=546) fue de 21±36 días. Las causas más frecuentes de retirada de catéteres por complicaciones fueron: 75% por déficit de flujo sanguíneo, 11% por infección, 6% por pérdida de sutura, 3% por oclusión, 3% por acodamiento. El déficit de flujo apareció a los 18 ± 34 días y la infección 29±50 días. La duración media de los catéteres implantados en el lado izquierdo fue 16±32 días y para el lado derecho 23±38 días (p<0.0001).Cuando analizamos la duración de los catéteres entre las distintas venas utilizadas, la duración media fue de 2 5.3±43 días para la yugular, 17.5±23 para la subclavia, y 11.9±10 días para la femoral, siendo las diferencias estadísticamente entre la yugularsubclavia y la vena femoral (p<0.05). Cuando comparamos la duración entre los de una sola luz frente a los de doble luz, en los catéteres retirados por complicaciones no se encuentran diferencias significativas (análisis multivariante).Podemos concluir, que la duración de los catéteres temporales colocados en vena yugular o subclavia y en el lado derecho, es significativamente superior a los colocados en vena femoral o lado izquierdo. No encontramos diferencias en la duración entre los catéteres de una o doble luz, al menos en nuestro estudio. pALABRAS CLAVE: -HEMODIáLISIS -ACCESOS VASCULARES -CATÉTERES TEMPORALES -COMPLICACIONESRetrospective study of the complications of temporary catheters for haemodialysis AbstractThe aim of this study was to analyze the duration and causes of removing complications for temporary catheters for haemodialysis.

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Mortality and hospitalization in haemodialysis patients in five European countries: results from the Dialysis Outcomes and Practice Patterns Study (DOPPS)

Abstract: The large differences in haemodialysis practice and outcomes in the Euro-DOPPS countries suggest opportunities for improvement in patient care.

Cited by 287 publications

References 20 publications

Cinacalcet HCl, an Oral Calcimimetic Agent for the Treatment of Secondary Hyperparathyroidism in Hemodialysis and Peritoneal Dialysis

Cinacalcet HCl, an Oral Calcimimetic Agent for the Treatment of Secondary Hyperparathyroidism in Hemodialysis and Peritoneal Dialysis

Vascular access results from the Dialysis Outcomes and Practice Patterns Study (DOPPS): Performance against Kidney Disease Outcomes Quality Initiative (K/DOQI) Clinical Practice Guidelines

Estudio retrospectivo de las complicaciones de los catéteres temporales para hemodiálisis

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