United States Renal Data System 2008 Annual Data Report Abstract

Collins, Allan J.; Foley, Robert N.; Herzog, Charles A.; Chavers, Blanche M.; Gilbertson, David T.; Ishani, Areef; Kasiske, Bertram L.; Liu, Jiannong; Mau, Lih Wen; McBean, Marshall; Murray, Anne M.; Peter, Wendy L. St.; Guo, Haifeng; Li, Qi; Li, Shuling; Li, Suying; Peng, Yen‐Chun; Qiu, Yang; Roberts, Tricia; Skeans, M. A.; Snyder, Jon J.; Solid, Craig A.; Wang, Changchun; Weinhandl, Eric D.; Zaun, David; Arko, Cheryl; Chen, Shu‐Cheng; Dalleska, Frederick; Daniels, Frank; Dunning, Stephan; Ebben, James; Frazier, Eric; Hanzlik, Christopher; Johnson, Roger N.; Sheets, Daniel; Wang, Xinyue; Forrest, Beth; Constantini, Edward; Everson, Susan; Eggers, Paul W.; Agodoa, Lawrence Y.

doi:10.1053/j.ajkd.2008.10.005

Cited by 157 publications

(120 citation statements)

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“…More than 1 in 1000 persons requires hemodialysis for end-stage renal disease (ESRD) in the United States, and by the year 2020 more than 750,000 patients are expected to have ESRD [1]. Patients undergoing hemodialysis rely on large-bore arteriovenous conduits for renal replacement therapy, but hemodialysis accesses have finite patency.…”

Section: Introductionmentioning

confidence: 99%

“…Some studies have suggested that early angiography and prophylactic percutaneous transluminal angioplasty (PTA) reduce the incidence of access thrombosis [6][7][8], whereas others have found no benefit of an aggressive invasive approach [9][10][11][12]. Information about 1 Ocala Heart Institute, Munroe Regional Medical Center, Florida, Ocala 2 Saint-Luke's Mid America Heart Institute, Kansas City, Missouri the cost effectiveness of screening angiography and preventive angioplasty has been limited.…”

Section: Introductionmentioning

confidence: 99%

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Economic analysis of angiography and preemptive angioplasty to prevent hemodialysis‐access thrombosis

Bittl

Cohen²,

Seek

et al. 2009

Cathet Cardio Intervent

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Objectives: We sought to determine the economic value of early angiography and prophylactic angioplasty to prevent hemodialysis‐access thrombosis. Background: End stage renal disease consumes more than 6% of the Medicare budget. There is a need to understand the financial impact of each component of care. Methods: We conducted an observational economic analysis of a closed cohort of 818 hemodialysis patients, of whom 560 were referred for 1437 consecutive radiographic procedures during an 8‐year period. Patient‐level, bottom‐up microcosting methods provided supply and personnel costs before and after expansion of an angiographic referral program. Results: The rate of referral for malfunctioning but nonthrombosed hemodialysis accesses increased from 18.8 ± 8.8 to 48.3 ± 11.9 angiographic procedures per 100 patient‐years (P < 0.001), which was associated with a decline in access thrombosis from 27.6 to 22.0 events per 100 patient‐years (P = 0.029) and a net cost of $34,586 per 100 patient‐years. The incremental cost‐effectiveness ratio for invasive surveillance was $6,177 per thrombosis event avoided. The angiographic program expanded at the same time that the proportion of autogenous fistulas increased from 28.3% ± 11.3% to 59.7% ± 10.7% of total referrals (P = 0.0001). On multivariable logistic regression analysis, the expanded angiography program (P = 0.001) and the proportion of autogenous fistulas (P = 0.0001) were both independently associated with the reduction in access thrombosis. Conclusions: Given the incremental costs and the relatively modest benefits in preventing access thrombosis, preemptive angiographic management may represent a less efficient use of healthcare resources than increasing the number of patients with autogenous fistulas. © 2009 Wiley‐Liss, Inc.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Economic analysis of angiography and preemptive angioplasty to prevent hemodialysis‐access thrombosis

Bittl

Cohen²,

Seek

et al. 2009

Cathet Cardio Intervent

View full text Add to dashboard Cite

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“…Diabetes mellitus is the most important cause of ESRD in many countries [7]. Although survival of diabetic patients with ESRD has improved during the last years, it is still considerably worse than in nondiabetic ESRD patients [7].…”

Section: Diabetes Mellitusmentioning

confidence: 99%

“…Although survival of diabetic patients with ESRD has improved during the last years, it is still considerably worse than in nondiabetic ESRD patients [7]. Diabetic ESRD patients have various comorbidities.…”

Section: Diabetes Mellitusmentioning

confidence: 99%

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Cardiovascular events in chronic dialysis patients: emphasizing the importance of vascular disease prevention

et al. 2010

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Cardiovascular disease is the leading cause of death in both chronic kidney disease and peritoneal dialysis/hemodialysis patients. Vascular disease prevention in these patients is therefore important to reduce the incidence of cardiovascular events and the high morbidity and mortality. This Editorial discusses the traditional, (1) smoking, (2) dyslipidemia, (3) body mass index, (4) glycemic control and (5) blood pressure, and non-traditional, (1) anemia, (2) vitamin D/hyperparathyroidism, (3) calcium/phosphorus metabolism and (4) magnesium, risk factors in renal patients. Current evidence does not support routine statin use and antiplatelet medication to dialysis patients. Patient compliance and adherence to proposed measures could be essential to reduce cardiovascular events and mortality rates in this high-risk population.

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Blood Lead Level and Kidney Function in US Adolescents

Fadrowski¹

2010

Arch Intern Med

123

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Background Chronic, high-level lead exposure is a known risk factor for kidney disease. The effect of current low-level environmental lead exposure is less well known, particularly among children, a population generally free from kidney disease risk factors such as hypertension and diabetes mellitus. Therefore, in this study, we investigated the association between lead exposure and kidney function in a representative sample of US adolescents. Methods Participants included 769 adolescents aged 12 to 20 years for whom whole blood lead and serum cystatin C were measured in the Third National Health and Nutrition Examination Survey, conducted from 1988–1994. The association between blood lead level and level of kidney function (glomerular filtration rate [GFR]), determined by cystatin C–based and creatinine-based estimating equations, was examined. Results Median whole blood lead level was 1.5 μg/dL (to convert to micromoles per liter, multiply by 0.0483), and median cystatin C–estimated GFR was 112.9 mL/min/1.73 m2. Participants with lead levels in the highest quartile (≥3.0 μg/dL) had 6.6 mL/min/1.73 m2–lower estimated GFR (95% confidence interval, −0.7 to −12.6 mL/min/1.73 m2) compared with those in the first quartile (<1 μg/dL). A doubling of blood lead level was associated with a 2.9 mL/min/1.73 m2–lower estimated GFR (95% confidence interval, −0.7 to −5.0 mL/min/1.73 m2). Lead levels were also associated with lower creatinine-based estimated GFR levels, but the association was weaker than with cystatin C–based GFR and not statistically significant. Conclusions Higher blood lead levels in a range below the current Centers for Disease Control and Prevention–designated level of concern (10 μg/dL) were associated with lower estimated GFRs in a representative sample of US adolescents. This finding contributes to the increasing epidemiologic evidence indicating an adverse effect of low-level environmental lead exposure.

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United States Renal Data System 2008 Annual Data Report Abstract

Cited by 157 publications

References 0 publications

Economic analysis of angiography and preemptive angioplasty to prevent hemodialysis‐access thrombosis

Economic analysis of angiography and preemptive angioplasty to prevent hemodialysis‐access thrombosis

Cardiovascular events in chronic dialysis patients: emphasizing the importance of vascular disease prevention

Blood Lead Level and Kidney Function in US Adolescents

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