Rapid fluid removal during dialysis is associated with cardiovascular morbidity and mortality

Jennifer E. Flythe,¹ Stephen E. Kimmel,² and Steven M. Brunelli¹

¹Renal Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA

²Cardiology Division, Department of Medicine, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA

PruMed Central: PMCID: PMC3091945

Abstract

Patients receiving hemodialysis have high rates of cardiovascular morbidity and mortality that may be related to the hemodynamic effects of rapid ultrafiltration. Here we tested whether higher dialytic ultrafiltration rates are associated with greater all-cause and cardiovascular mortality, and hospitalization for cardiovascular disease. We used data from the Hemodialysis Study, an almost-7-year randomized clinical trial of 1846 patients receiving thrice-weekly chronic dialysis. The ultrafiltration rates were divided into three categories: up to 10 ml/h/kg, 10–13 ml/h/kg, and over 13 ml/h/kg. Compared to ultrafiltration rates in the lowest group, rates in the highest were significantly associated with increased all-cause and cardiovascular-related mortality with adjusted hazard ratios of 1.59 and 1.71, respectively. Overall, ultrafiltration rates between 10–13 ml/h/kg were not associated with all-cause or cardiovascular mortality; however, they were significantly associated among participants with congestive heart failure. Cubic spline interpolation suggested that the risk of all-cause and cardiovascular mortality began to increase at ultrafiltration rates over 10 ml/h/kg regardless of the status of congestive heart failure. Hence, higher ultrafiltration rates in hemodialysis patients are associated with a greater risk of all-cause and cardiovascular death.

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Wishing All Our 

Hindu Brothers & Sisters

A Happy and Blessed Diwali

May the "True Light" prevail

Best and Warmest Regards

MalaysianKidneySPA

Inform family about pledges, organ donors told

The Star Online 24/10/2011

http://thestar.com.my/news/story.asp?file=/2011/10/24/nation/9760649&sec=nation

KUALA LUMPUR: Those who have pledged to be organ and tissue donors should inform their families to avoid “complications”.

Deputy Health Minister Datuk Rosnah Abdul Rashid Shirlin said that in most cases, family members of the deceased did not know of the pledge made.

“If they do not inform their next-of-kin, no one will know about it. If the family does not allow it, there is nothing that can be done,” she told reporters after launching the Bicara Hati programme in conjunction with Organ Donation Awareness Week 2011.

To create more awareness, she said the ministry had stepped up its campaigns and held forums, debates and health workshops through the “Young Doctors” programme.

Rosnah said donors should be hailed as community heroes and for upholding the 1Malaysia spirit.

She also paid tribute to family members who consented to the organ pledges.

Measuring the quality of end of life management in patients with advanced kidney disease: results from the pan-Thames renal audit group

1. Stephen P. McAdoo1, 
2. Edwina A. Brown1, 
3. Alistair M. Chesser2 
4. Ken Farrington3,
5. Emma M. Salisbury1 and 
6. on behalf of pan-Thames renal audit group

1. 1. ¹Imperial College Kidney and Transplant Institute, Hammersmith Hospital, London, UK
   2. ²Renal Department, Barts and the London NHS Trust, London, UK
   3. ³Lister Hospital Renal Unit, North Herts NHS Trust, Stevenage, UK
   Background. Despite a recent increased awareness of the need for quality End of Life (EOL) care for patients with advanced kidney disease, there is no established method for measuring or auditing outcomes relating to EOL care in this population.

   Methods. We designed a one-page proforma, which was used to collect data on various aspects of EOL care relating to all deaths of patients on dialysis and patients dying on specialist renal wards, over a predefined 8-week period in 10 hospitals in London and South–East England.

   Results. One hundred and thirty-eight deaths were recorded over the 8-week study period. The majority of patients (83%) were receiving maintenance haemodialysis prior to their terminal presentation. About 69% of deaths occurred during an in-patient hospital admission—of these, 36% were considered ‘unexpected’ and most quality markers of good EOL management were significantly less likely to be achieved in these patients, including use of palliative care strategies, good symptom control and overall quality of death. Thirty-six per cent of patients were from various ethnic minorities, and in this group, there was a trend towards lower use of palliative care pathways and lower rates of withdrawal from dialysis.

   Conclusions. This study confirms that it is possible to measure many important outcomes relating to quality of EOL care using a proforma completed at the time of death. Our findings suggest that many aspects of good EOL care are under-achieved in our region. This, in part, is due to a failure to recognize the worsening trajectory of the deteriorating patient, resulting in missed opportunities for EOL care planning and appropriate symptom control. Our observations suggest that there is a need for improved education and training in this area, particularly in detection of the dying patient, the value of advance care planning and the utility of tools such as the Liverpool Care Pathway.

No meds for unapproved ops

By WONG PEK MEI
pekmei@thestar.com.my

http://thestar.com.my/news/story.asp?file=/2011/10/17/nation/9711992&sec=nation

BANGI: Malaysians who travel abroad for organ transplants provided on commercial basis will not be allowed to get free supply of immunosuppressant drugs from Government hospitals, which costs between RM800 and RM1,000 per patient per month.

These drugs are used to inhibit or prevent activity of the immune system and to prevent the rejection of transplanted organs and tissues.

Health Minister Datuk Seri Liow Tiong Lai said the move, which takes effect from January, is to stop people from going overseas to get such treatment from unrecognised hospitals without the ministry's approval or knowledge.

He said many patients go for organ transplants at hospitals in foreign countries that are not recognised.

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57% rise in dialysis patients since 2006

The Star Online 12/10/2011

http://thestar.com.my/news/story.asp?file=/2011/10/12/parliament/9678055&sec=parliament

THE number of patients who had dialysis treatment rose by 56.7% from 14,946 patients in 2006 to 23,420 in 2010.

Deputy Health Minister Datuk Rosnah Abdul Rashid Shirlin said that of the total, 7,115 underwent treatment at government dialysis centres, 9,813 at private centres and 6,492 at centres run by non-governmental organisations (NGOs).

“In 2009, the number of patients with kidney failure who underwent dialysis nationwide was 21,543.

“Of the total, 7,103 underwent dialysis in government dialysis centres, 8,356 in private centres and 6,084 at centres run by NGOs,” she told Chong Eng (DAP-Bukit Mertajam).

Chong had asked for the number of kidney dialysis centres operated by the Government and private sectors as well as NGOs.

She had also asked for the number of patients receiving treatment at these centres each year for the past five years.

Rosnah said there were 181 government-operated dialysis centres, 297 private dialysis centres and 140 dialysis centres operated by NGOs last year.

She added that for Penang, there were 10 dialysis centres operated by the Government, 27 private dialysis centres and 20 operated by NGOs.

“The number of people seeking treatments at these centres is increasing yearly,” she said.

For listening pleasure....

Chinese are 50pc of organ donors since 1997

October 06, 2011

http://www.themalaysianinsider.com/malaysia/article/chinese-are-50pc-of-organ-donors-since-1997/ 

KUALA LUMPUR, Oct 6 — Out of 28 million Malaysians, only 181,534 persons became organ donors since 1997, with 55.29 per cent of them Chinese.

Organ Donation Action Committee chairman Tan Sri Lee Lam Thye told Bernama Online today that number only represents 0.64 per cent of the population.

In 2011 so far, 342 donors underwent successful transplant surgery — 33 of them cadaveric donors.

He said there were 14,037 patients on the wait list for organs, almost all of them (14,013) needing kidneys.

He was speaking at a press conference in conjunction with the 2011 National Organ Donation Awareness Week.

While the Chinese topped the number of donors in terms of race demographics, Indians were at 24.25 per cent and Malays, 17.64 per cent, said Lee.

But the Malay donors are increasing said Lee, with the 6,412 registered in 2011 up to September outstripping the 2010 total of 4,275.

The awareness campaign begins on October 16 and the health ministry is targeting those between the ages of 15 and 25.

Lee explained that early education was important, and that donors should inform their registration to their families.

The upcoming campaign is themed "1Malaysia 1Hope: Donate for Life", and will have walkathons, seminars, an Islamic forum entitled "Organ Donation" and the Friday sermon at the National Mosque will cover the subject.

Should there be an expanded role for palliative care in end-stage renal disease?

Kurella Tamura M, Cohen LM.

Source

Division of Nephrology, Stanford University School of Medicine and Geriatric Research and Education Clinical Center, Palo Alto Veterans Affairs Healthcare System, Palo Alto, California, USA. mktamura@stanford.edu

Curr Opin Nephrol Hypertens. 2010 Nov;19(6):556-60.

http://www.ncbi.nlm.nih.gov/pubmed/20644475

Abstract

PURPOSE OF REVIEW:

In this review, we outline the rationale for expanding the role of palliative care in end-stage renal disease (ESRD), describe the components of a palliative care model, and identify potential barriers in implementation.

RECENT FINDINGS:

Patients receiving chronic dialysis have reduced life expectancy and high rates of chronic pain, depression, cognitive impairment, and physical disability. Delivery of prognostic information and advance care planning are desired by patients, but occur infrequently. Furthermore, although hospice care is associated with improved symptom control and lower healthcare costs at the end of life, it is underutilized by the ESRD population, even among patients who withdraw from dialysis. A palliative care model incorporating communication of prognosis, advance care planning, symptom assessment and management, and timely hospice referral may improve quality of life and quality of dying. Resources and clinical practice guidelines are available to assist practitioners with incorporating palliative care into ESRD management.

SUMMARY:

There is a large unmet need to alleviate the physical, psychosocial, and existential suffering of patients with ESRD. More fully integrating palliative care into ESRD management by improving end-of-life care training, eliminating structural and financial barriers to hospice use, and identifying optimal methods to deliver palliative care are necessary if we are to successfully address the needs of an aging ESRD population.