Peer Kidney Care Initiative 2014 Report: Dialysis Care and Outcomes in the United States

Weinhandl, Eric D.; Constantini, Edward; Everson, Susan; Gilbertson, David T.; Li, Suying; Solid, Craig A.; Anger, Michael; Bhat, J. Ganesh; DeOreo, Peter B.; Krishnan, Mahesh; Nissenson, Allen R.; Johnson, Dianna A.; İkizler, T. Alp; Maddux, Franklin W.; Sadler, John H.; Tyshler, Leanna; Parker, Thomas; Schiller, Brigitte; Smith, Barry H.; Lindenfeld, Stan; Collins, Allan J.

doi:10.1053/j.ajkd.2015.03.021

Cited by 23 publications

(43 citation statements)

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“…Commensurate with the singularly high mortality rate in incident dialysis patients, the HP2020 CKD-14.2 goal is to reduce the death rate within the first 3 months of dialysis initiation to 319.9 deaths per 1,000 patient-years (from the 2011 rate of 335.4 per 1000 patient-years). Figure 3 shows the early hazard of SCD (and other cause-specific mortality) at dialysis initiation (6).…”

Section: Scdmentioning

confidence: 99%

Arrhythmia and Sudden Death in Hemodialysis Patients

Charytan

Foley

McCullough

et al. 2016

Clinical Journal of the American Society of Nephrology

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Background Dialysis patients have high rates of cardiovascular morbidity and mortality, but data on arrhythmia burden, arrhythmia type, arrhythmia triggers, and the identity of terminal arrhythmias have historically been limited by an inability to monitor heart rhythm for prolonged periods.Objectives To investigate arrhythmia and its association with sudden death in dialysis-dependent ESRD, describe the potential for implantable devices to advance study of dialysis physiology, review the ethical implications of using implantable devices in clinical studies, and report on the protocol and baseline results of the Monitoring in Dialysis Study (MiD).Design, setting, participants, & measurements In this multicenter, interventional-observational, prospective cohort study, we placed implantable loop recorders in patients undergoing long-term hemodialysis. The proportion of patients experiencing clinically significant arrhythmias was the primary endpoint. For 6 months, we captured detailed data on the primary endpoint, symptomatic arrhythmias, other electrocardiographic variables, dialysis prescription, electrolytes, dialysis-related variables, and vital signs. We collected additional electrocardiographic data for up to 1 year.Results Overall, 66 patients underwent implantation in sites in the United States and India. Diabetes was present in 63.6% of patients, 12.1% were age $70 years, 69.7% were men, and 53.0% were black. Primary and secondary endpoint data are expected in 2016.Conclusions Cardiac arrhythmia is an important contributor to cardiovascular morbidity and mortality in dialysis patients, but available technology has previously limited the ability to estimate its true burden and triggers and to define terminal rhythms in sudden death. Use of implantable technology in observational studies raises complex issues but may greatly expand understanding of dialysis physiology. The use of implantable loop recorders in MiD is among the first examples of such a trial, and the results are expected to provide novel insights into the nature of arrhythmia in hemodialysis patients.

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Section: Scdmentioning

confidence: 99%

Arrhythmia and Sudden Death in Hemodialysis Patients

Charytan

Foley

McCullough

et al. 2016

Clinical Journal of the American Society of Nephrology

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“…Although longevity while undergoing dialysis has improved substantially over the past decade, major differences in ESRD incidence, hospitalization, and care remain. For example, although the ESRD incidence rate has stabilized in the United States as a whole (8), rates vary considerably by US Census region (12) and remain troublingly high in many areas. Figure 1 shows the standard United States health service areas, with the data smoothed using a Bayesian spatial hierarchical model, as has been done previously (13).…”

Section: Geographic Variation In Kidney Disease Care and Outcomesmentioning

confidence: 99%

Improving Outcomes in Patients Receiving Dialysis: The Peer Kidney Care Initiative

Wetmore

Gilbertson

Liu

et al. 2016

CJASN

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The past decade has witnessed a marked reduction in mortality rates among patients receiving maintenance dialysis. However, the reasons for this welcome development are uncertain, and greater understanding is needed to translate advances in care into additional survival gains. To fill important knowledge gaps and to enable dialysis provider organizations to learn from one another, with the aim of advancing patient care, the Peer Kidney Care Initiative (Peer) was created in 2014 by the chief medical officers of 14 United States dialysis provider organizations and the Chronic Disease Research Group. Areas of particular clinical importance were targeted to help shape the public health agenda in CKD and ESRD. Peer focuses on the effect of geographic variation on outcomes, the implications of seasonality for morbidity and mortality, the clinical significance of understudied disorders affecting dialysis patients, and the debate about how best to monitor and evaluate progress in care. In the realm of geovariation, Peer has provided key observations on regional variation in the rates of ESRD incidence, hospitalization, and pre-ESRD care. Regarding seasonality, Peer has reported on variation in both infectionrelated and non-infection-related hospitalizations, suggesting that ambient environmental conditions may affect a range of health outcomes in dialysis patients. Specific medical conditions that Peer highlights include Clostridium difficile infection, which has become strikingly more common in patients in the year after dialysis initiation, and chronic obstructive pulmonary disease, the treatments for which have the potential to contribute to sudden cardiac death. Finally, Peer challenges the nephrology community to consider alternatives to standardized mortality ratios in assessing progress in care, positing that close scrutiny of trends over time may be the most effective way to drive improvements in patient care.

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“…Although patients on dialysis were excluded from that study, experience at the level of the operative center and the individual physician would presumably have a spillover effect, conferring benefits to patients on dialysis undergoing PTX for SHPT. Third, another consideration is that patients on dialysis are living longer than ever before (23). The largest gains, as expected, are among the youngest patients, precisely those at highest risk of developing unremitting hyperparathyroidism.…”

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confidence: 94%

Parathyroidectomy: Complex Decisions about a Complex Procedure

Wetmore

2016

CJASN

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Peer Kidney Care Initiative 2014 Report: Dialysis Care and Outcomes in the United States

Cited by 23 publications

References 0 publications

Arrhythmia and Sudden Death in Hemodialysis Patients

Arrhythmia and Sudden Death in Hemodialysis Patients

Improving Outcomes in Patients Receiving Dialysis: The Peer Kidney Care Initiative

Parathyroidectomy: Complex Decisions about a Complex Procedure

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