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Damaged water pipe puts dialysis on hold Times of India Endless wait: On Monday, Mohammed Ahmed, a patient, told TOI: "I came here in the morning and was forced to wait for an entire day without treatment. My family was told the water pipe was damaged by infrastructure work, so dialysis has been suspended." Dialysis patients put to hardship NewsHub.org all 6 news articles »

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Hemodialysis

MedicalResearch.com Interview with:
Tanush Gupta, MD
Department of Medicine, Division of Cardiology
New York Medical College, NY

Medical Research: What is the background for this study? What are the main findings?

Dr.Gupta: There are approximately 600,000 prevalent cases of end stage renal disease (ESRD) in the United States. Cardiovascular disease is the leading cause of death in ESRD patients. Moreover, approximately 20% of these deaths due to cardiovascular disease are attributable to acute myocardial infarction (AMI). Multiple studies have shown that ESRD patients have poor short- and long-term survival after AMI relative to the general population. We analyzed the publicly available Nationwide Inpatient Sample (NIS) databases from 2003 to 2011 to examine the temporal trends in ST-elevation myocardial infarction (STEMI), use of mechanical revascularization for STEMI, and in-hospital outcomes in adult ESRD patients in the United States.

We found that from 2003 to 2011, whereas the number of acute myocardial infarction hospitalizations in ESRD patients increased from 13,322 to 20,552, there was a decline in the number of STEMI hospitalizations from 3,169 to 2,558. The use of percutaneous coronary intervention (PCI) for STEMI increased from 18.6% to 37.8%, whereas there was no significant change in the use of coronary artery bypass grafting. During the study period, in-hospital mortality in ESRD patients with STEMI increased from 22.3% to 25.3%. We also observed an increase in average hospital charges and a decrease in mean length of stay during the study period.

Medical Research: What should clinicians and patients take away from your report?

Dr.Gupta:: ESRD patients comprise a very sick sub-group of the overall STEMI population and are often managed sub-optimally with lower use of revascularization and proven medical therapies. In this analysis, although we observed favorable trends in the use of PCI and length of stay, there was a temporal increase in in-hospital mortality. The increasing trend in in-hospital mortality in ESRD patients with STEMI is worrisome and is in stark contrast to the trends in outcomes of STEMI in the general population, where in-hospital mortality has decreased dramatically in the modern era of reperfusion therapy.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr.Gupta:Reversal of the above mentioned adverse trends in in-hospital mortality in ESRD patients with STEMI should be the focus of future investigations.

Citation:

Gupta T, Harikrishnan P, Kolte D, Khera S, Subramanian KS, Mujib M, Masud A, Palaniswamy C, Sule S, Jain D, Ahmed A, Lanier GM, Cooper HA, Frishman WH, Bhatt DL, Fonarow GC, Panza JA, Aronow WS. Trends in Management and Outcomes of ST-Elevation Myocardial Infarction in Patients With End Stage Renal Disease in the United States. Am J Cardiol 2015;115:1033-1041.

MedicalResearch.com Interview with: Tanush Gupta, MD (2015). Heart Attack Carries Worse Prognosis In Dialysis Patients 

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Ontario Supporting New Satellite Dialysis Centre in Etobicoke

New Centre to Improve Access to Care for Patients with Kidney Disease

Ministry of Health and Long-Term Care

Ontario is supporting the construction of a new satellite dialysis centre that will enable patients in Etobicoke to receive dialysis services closer to home.

The new centre will be part of the Etobicoke General Hospital complex, which is part of the William Osler Health System. It will include 36 stations to provide vital pre-dialysis treatment and haemodialysis, which involves filtering blood. It will also provide home dialysis training through outpatient clinics.

This new centre will help relieve pressure on other dialysis programs at William Osler Health System and Humber River Hospital. Construction of the project is expected to begin in August 2016 and be completed one year later. 

Improving access to health care closer to home is part of the government's plan to build a better Ontario through its Patients First: Action Plan for Health Care, which is providing patients with faster access to the right care, better home and community care, the information they need to live healthy and a health care system that's sustainable for generations to come.

Quick Facts

• The Etobicoke satellite dialysis centre will have about 27,000 square feet of new space.
• Since 2003, our government has approved up to $1.88 billion towards capital projects at William Osler Health System.
• Our government has also approved $19 million toward planning and design costs for the Etobicoke General Hospital Phase 1 Patient Tower Project currently in planning.
• As one of Ontario’s largest community hospitals, William Osler Health System serves a population of over 1.3 million people living in one of the fastest growing and most culturally diverse regions of Canada.
• William Osler Health System is host to the Regional Chronic Kidney Disease Program for the Central West LHIN, one of 26 Regional Chronic Kidney Disease programs in Ontario and one of the fastest growing regional programs.

Additional Resources

• Patients First: Action Plan for Health Care
• Building Together, Ontario’s long-term infrastructure plan

Quotes

“This new satellite dialysis centre will help to ease a significant burden for patients suffering with kidney disease who will soon be able to access services closer to home. Today’s announcement demonstrates our government’s commitment to putting patients first, connecting them with quality services in the community.”

Dr. Eric Hoskins

Minister of Health and Long-Term Care

“Our government’s support for a new satellite dialysis centre will help ensure patients in Etobicoke continue to receive the kidney care they need closer to home. The William Osler Health System is an important part of our community, and this investment will help improve its dialysis programs.”

Dr. Shafiq Qaadri

MPP for Etobicoke North

“Etobicoke General Hospital’s new satellite dialysis centre will offer treatment closer to home for our renal patients and greater access to the services this community needs most. This investment is vital to our hospital and serves to create fundamental stepping stones that allow us to press forward with our exciting transformation.”

Matthew Anderson

President and CEO, William Osler Health System

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• Shae Greenfield

  Minister's Office

  416-325-5230

• For public inquiries call ServiceOntario, INFOline

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A protocol for urgent-start peritoneal dialysis results in less blood stream infections and appears to reduce mortality when compared to urgent-start hemodialysis, according to research presented at the National Kidney Foundation’s 2015 Spring Clinical Meetings in Dallas.

Most patients who present with end-stage renal disease in the emergency room are given urgent-start hemodialysis with a central venous catheter. However, researchers at the University of Southern California hypothesized that allowing patients the option of starting with peritoneal dialysis could improve long-range outcomes.

“In general, the overall outcomes for urgent-start PD patients are no different than patients who do traditional, planned PD and hemodialysis in terms of infection rates and outcomes,” said lead researcher Arshia Ghaffari, MD, Assistant Clinical Professor of Medicine, USC Division of Nephrology. “We were also surprised that we didn’t see the rate of complications we thought we would have in these urgent-start PD patients.”

Related articles:

The role for nursing in the increasing use of urgent peritoneal dialysis

PD takes a big jump in 2014, while HHD shows progress

To motivate patients on peritoneal dialysis, first motivate staff

Defining key elements in promoting peritoneal dialysis to patients

The research is based on 161 dialysis patients, of which 46 were urgent-start PD patients. Those who had urgent-start hemodialysis with a central venous catheter had a 43% higher hospitalization rate and had 4.3 times higher rates of adjusted catheter-related bacteremia, compared to urgent-start PD patients. There was also a statistically significant reduction in mortality for those on urgent-start PD compared to urgent-start hemodialysis with a central venous catheter.

“I worked at a county hospital where I regularly saw patients crashing into dialysis without a plan,” said Ghaffari. “Most are put on hemodialysis because there is infrastructure for that modality, but this research shows that urgent-start dialysis patients should be given a choice for their treatment.”

Urgent-start PD patients had similar rates of infection and hospitalization when compared to patients who had planned to go on hemodialysis or peritoneal dialysis.

“Many studies indicate better clinical outcomes for those on PD, and many PD patients report feeling better and having more energy for daily tasks,” said Kerry Willis, PhD, Chief Scientific Officer, National Kidney Foundation. “This new protocol appears to offer ESRD patients a safer dialysis choice, even in an urgent-start situation. It would be great to see this study replicated in other centers.”

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