Dialysis world news


Interarm BP Differences Predict Cardiovascular Events in CKD Patients - Renal and Urology News
March 10, 2015

Increased interarm systolic blood pressure difference independently predicts cardiovascular (CV) events in patients with chronic kidney disease (CKD), according to a new study.

Borja Quiroga, MD, and colleagues at Hospital General Universitario Gregorio Marañón, in Madrid, Spain, prospectively studied 652 CKD patients with a mean age of 67 years. The study population had a mean follow-up period of 19 months. Of these patients, 136 (20.8%) had diabetes mellitus, 213 (32.6%) had a history of cardiovascular disease, and 327 (50.1%) had dyslipidemia. The interarm systolic blood pressure difference (IASBPD) was 10 mm Hg or greater in 184 patients (28.1%). The investigators noted that previous research has found a correlation between an IASBPD of 10 mm Hg or greater and CV risk factors in the general population and in patients with specific conditions such as vascular disease and diabetes mellitus.

Cardiovascular events occurred in 58 patients (8.5%). An IASBPD of 10 mm Hg or greater was associated with a significant 80% increased risk of CV events after adjusting for classical risk factors such as a history of CV disease, Dr. Quiroga's group reported online ahead of print in Nephrology Dialysis Transplantation.

“Our findings led us to hypothesize that patients with CKD can stratify their CV risk with regular monitoring of blood pressure,” the authors wrote. “In addition, patients with increased IASBPD should be considered at high risk of CV events, and probably intensive control and early treatment could improve their prognosis.”

The researchers explained that in most instances, a difference in BP between arms is due to subclinical atherosclerosis, but other possible causes include coarctation of the aorta, aortic aneurism, connective tissue disorders, vasculitis, and thoracic compression.

For the study, the investigators defined CV events as myocardial infarction, congestive heart failure and/or a left ventricular ejection fraction of less than 45%, ischemic or hemorrhagic cerebrovascular accident, peripheral vascular disease, and other ischemic conditions.

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Renal Ventures Management Highlights Kidney Awareness Month with Focus ... - Business Wire (press release)

LAKEWOOD, Colo.--(BUSINESS WIRE)--Renal Ventures Management (RVM), a leading provider of dialysis services for patients suffering from chronic kidney disease, continues its efforts to raise the standard of renal patient care during National Kidney Awareness Month. George R. Aronoff, M.D., M.S., F.A.C.P., Chief Medical Officer of Renal Ventures Management, said the company is continuing its focus on practical strategies and innovative programs to achieve continued and measureable care improvements.

“We’re operating in a challenging and dynamic environment of health care reform with a stronger focus than ever on achieving quality care and improved outcomes resulting in better coverage and reimbursement,” said Aronoff, who is speaking on several renal care topics in the coming months. “We’re meeting this challenge by rewriting the standards of care for renal patients through hands-on patient care, supporting clinical research and through our industry-leading programs.”

As CMO, Dr. Aronoff directs the RV Quality programs, including RV CARE, RV Kidney Care and RV TLC. According to the United States Renal Data System 2014 Annual Data Report and internal RVM data, these programs have successfully lowered hospitalization rates due to access infections and cardiovascular events for RVM patients to just 24 percent?less than half the national average. Additionally, the programs have helped lower the all-cause first-year mortality rate at RVM centers to just 2 percent compared with the national average of 35 percent. RVM is also the most successful national dialysis provider at transitioning patients from a temporary catheter to a permanent access port, which results in fewer hospitalizations, lower mortality rates and better quality of life.

In addition to his 30 years of experience in designing and performing clinical research in hemodialysis, peritoneal dialysis, transplant and CKD patients, Dr. Aronoff maintained an active clinical practice in chronic kidney disease, dialysis and transplantation. He is also a frequent lecturer on renal care innovation, quality standards and cost-effective delivery of services.

On Friday, March 20, 2015, Dr. Aronoff discusses the critical role of the medical director in the dialysis facility in “Practical Strategies for Medical Directors to Satisfy the Conditions for Coverage.” The talk is being delivered at the Renal Physicians Association annual meeting in Baltimore, Md.

On June 24, 2015, Dr. Aronoff presents “How Dialysis Really Gets Paid For,” focusing on the administrative, financial and regulatory issues of payment to Nephrologists and dialysis units for dialysis care. The presentation is being delivered during the American Society for Artificial Internal Organs annual meeting at the society’s Practical Outpatient Dialysis Short Course, designed to provide trainees and recent graduates in Nephrology with practical guidance to managing the real-world situations that arise in outpatient dialysis practice.

Earlier this year, Dr. Aronoff presented “Salt: Is It Really a Four Letter Word?” at the NKF of Florida Renal Professional Forum in February, discussing the impact of dietary sodium intake on patients with kidney disease. The program is designed specifically for renal social workers, dietitians, nurses and technicians.

From its groundbreaking educational programs to the continued research and development of advance treatment protocols for peritoneal dialysis patients, RVM continues to influence and re-shape the renal disease industry. RVM now operates 36 centers nationwide, with 20 of those centers providing peritoneal dialysis.

About Renal Ventures Management, LLC

Renal Ventures Management LLC is a leading provider of dialysis services in the U.S. The company partners with hospitals and physicians to provide patients suffering from chronic kidney failure with knowledgeable, compassionate and quality-focused care in comfortable clinic settings. For its hospital and nephrologist partners, Renal Ventures Management provides management expertise and patient-focused care operations which center around collaboration, quality and effectiveness. Headquartered in Lakewood, Colo., the company operates 35 dialysis partnerships and 25 inpatient service contracts in six states. They also operate seven infusion centers in two states treating patients with various autoimmune disorders and a vascular access center in Lafayette, Louisiana. For more information, visit www.renalventures.com.

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Fistula Use Increasing in U.S. Dialysis Population - Renal and Urology News
March 10, 2015

Still, approximately 70% of patients initiate dialysis with a catheter.

Fistula Use Increasing in U.S. Dialysis Population
The United States exhibited “intermediate” fistula and catheter use among 20 countries in 2012 to 2013, and the highest use of grafts.

Arteriovenous fistula (AVF) use increased from 24% in 1997 to 68% in 2013 in the U.S. hemodialysis (HD) population a new study finds. Over the same period, central venous catheter (CVC) use declined from 27% to 15%. These trends continued following the introduction of the prospective payment program for end-stage renal disease (ESRD) in 2011.

“It is clear that a culture devoted to improved vascular access, accelerated through the efforts of the CMS Fistula First Initiative, ESRD Networks, dialysis providers, and the NKF-KDOQI guidelines, has resulted in great gains for this very important facet of U.S. hemodialysis patient care,stated the research team led by Ronald L. Pisoni, PhD, of the Arbor Research Collaborative for Health in Ann Arbor, MI.

A few challenges remain, however. Among new patients, CVC use at hemodialysis initiation remained high at 70% (other national data report 80%), while AVF use, often considered the best option, remained low. Dialysis facilities in the United States likewise reported longer times to first AVF cannulation. Given the high rates of bacteremia, hospitalization, and mortality associated with CVC, the researchers suggest focusing additional efforts and incentives pre-dialysis to AVF.

For the study, the investigators studied patterns in vascular access use among 3,442 hemodialysis patients in the Dialysis Outcomes and Practice Patterns Study (DOPPS) Practice Monitor (DPM) in the U.S., as well as nearly 8,500 patients from 19 other countries. According to results published online ahead of print in the American Journal of Kidney Diseases, the United States exhibited “intermediate” AVF and CVC use among all 20 countries in 2012 to 2013, and the highest use of arteriovenous grafts (AVG).

Investigators also examined vascular access patterns by race. In 2013, AVG use was twice as high in black patients (26%) than others. Lower AVF use in black patients may be explained in part by recent study findings show that African-American males undergoing AV access surgery have significantly smaller median basilic and cephalic vein diameters.

Patient preferences may also play a role in vascular access patterns. The investigators asked patients to complete questionnaires, and while response was low, they received some interesting opinions: fewer female patients preferred an AV access; some patients preferred catheters to avoid large needles, needle sticks, and bleeding; and some were uniformed about the options in vascular access with their relative rates of infection.

Source
  1. Pisoni, RL, et al. AJKD; doi: 10.1053/j.ajkd.2014.12.014.

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Fistula Use Increasing in US Dialysis Population - Renal and Urology News
March 10, 2015

Still, approximately 70% of patients initiate dialysis with a catheter.

Fistula Use Increasing in U.S. Dialysis Population
The United States exhibited “intermediate” fistula and catheter use among 20 countries in 2012 to 2013, and the highest use of grafts.

Arteriovenous fistula (AVF) use increased from 24% in 1997 to 68% in 2013 in the U.S. hemodialysis (HD) population a new study finds. Over the same period, central venous catheter (CVC) use declined from 27% to 15%. These trends continued following the introduction of the prospective payment program for end-stage renal disease (ESRD) in 2011.

“It is clear that a culture devoted to improved vascular access, accelerated through the efforts of the CMS Fistula First Initiative, ESRD Networks, dialysis providers, and the NKF-KDOQI guidelines, has resulted in great gains for this very important facet of U.S. hemodialysis patient care,stated the research team led by Ronald L. Pisoni, PhD, of the University of Michigan in Ann Arbor.

A few challenges remain, however. Among new patients, CVC use at hemodialysis initiation remained high at 70% (other national data report 80%), while AVF use, often considered the best option, remained low. Dialysis facilities in the United States likewise reported longer times to first AVF cannulation. Given the high rates of bacteremia, hospitalization, and mortality associated with CVC, the researchers suggest focusing additional efforts and incentives pre-dialysis to AVF.

For the study, the investigators studied patterns in vascular access use among 3,442 hemodialysis patients in the Dialysis Outcomes and Practice Patterns Study (DOPPS) Practice Monitor (DPM) in the U.S., as well as nearly 8,500 patients from 19 other countries. According to results published online ahead of print in the American Journal of Kidney Diseases, the United States exhibited “intermediate” AVF and CVC use among all 20 countries in 2012 to 2013, and the highest use of arteriovenous grafts (AVG).

Investigators also examined vascular access patterns by race. In 2013, AVG use was twice as high in black patients (26%) than others. Lower AVF use in black patients may be explained in part by recent study findings show that African-American males undergoing AV access surgery have significantly smaller median basilic and cephalic vein diameters.

Patient preferences may also play a role in vascular access patterns. The investigators asked patients to complete questionnaires, and while response was low, they received some interesting opinions: fewer female patients preferred an AV access; some patients preferred catheters to avoid large needles, needle sticks, and bleeding; and some were uniformed about the options in vascular access with their relative rates of infection.

Source
  1. Pisoni, RL, et al. AJKD; doi: 10.1053/j.ajkd.2014.12.014.

...

 
Explore the Global dialysis market report: 2015 edition - WhaTech

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Complete report available athttp://www.marketreportsonline.com/401539.html.

End stage renal disease (ESRD) is the last stage of chronic kidney disease. This is the situation when kidney is functioning below 10% of their normal function and they can no longer support a person’s day to day life. The common causes of ESRD include high blood pressure, atherosclerosis, and genetic disorders. ESRD treatment is carried out either by dialysis or kidney transplant. The report analyzes the global and regional dialysis markets. Some of the factors driving the growth of dialysis market include: growing number of diabetic patients, increasing dialysis population and incidences of chronic and infectious diseases which has further increased the healthcare expenditure and pharmaceutical sales. Market dynamics like key trends and development, challenges and growth drivers are discussed in detail. The key players having the vicious competition with each other are: DaVita, Baxter, and Fresenius. These players are being profiled in the report along with their key financials and strategies for growth. http://www.marketreportsonline.com/contacts/purchase.php?name=401539. By combining SPSS Inc.’s data integration and analysis capabilities with our relevant findings, we have predicted the future growth of the market. We employed various significant variables that have an impact on this industry and created regression models with SPSS Base to determine the future direction of the industry. Before deploying the regression model, the relationship between several independent or predictor variables and the dependent variable was analyzed using standard SPSS output, including charts, tables and tests. Major points from Table of Contents (http://www.marketreportsonline.com/401539-toc.html) are listed below: List of Tables Stages of CKD Renoprotective Strategies for Slowing Progression of CKD Symptoms & Treatment of Renal Failure Advantages and Disadvantages of Dialysis Methods Total Spend per Patient per Year for US Dialysis Patients (2013) Regional Breakdown of Center Dialysis and Home Dialysis (2013) Competitors in North America Dialysis Market (2013) Competitors in EMEA Dialysis Market (2013) Competitors in Asia Pacific Dialysis Market (2013) Competitors in Latin America Dialysis Market (2013) Dependent & Independent Variables (2008–2013) Correlation Matrix Model Summary – Coefficient of Determination Regression Coefficients Output

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