Robert N Foley

..7, 2.0, 2.0, and 1.6 after 5 yr, respectively. Septicemia, which is associated with increased cardiovascular and death risk, has become more common in dialysis patients in the United States...

..Finally, comparisons are complicated by hazards ratios that vary over time, and time-segmented analysis is obligatory. Many types of analytical approaches are needed to begin to appreciate outcome disparities between dialysis therapies...

..Anaemia may not be an 'innocent bystander' in chronic disease; both components of the term 'anaemia of chronic disease' deserve attention...

..There has been explosive growth in observational studies and a heartening, if less dramatic, increase in risk factor intervention trials, suggesting that risk factor modification can lead to meaningful benefit...

..Smoking has received surprisingly little research attention in dialysis populations, a group at monumental cardiovascular risk...

..A large burden of cardiac disease and insensitive analytical approaches may go a long way toward explaining the reverse epidemiology of hypertension and survival in dialysis patients...

..Parathyroidectomy rates in U.S. hemodialysis patients increased between 1998 and 2002, a period in which the therapeutic armamentarium for preventing severe hyperparathyroidism expanded considerably...

..Although left ventricular hypertrophy (LVH) is a characteristic finding in hemodialysis (HD) populations, few risk factors for progressive LVH have been identified...

..The effects of different hemoglobin targets on blood transfusion requirements have not been well characterized, despite their relevance to clinical decision-making...

..A CKD screening approach targeting individuals 60 years and older or those with diabetes or hypertension likely would be useful from a public health standpoint...

..We aimed to determine the consequences associated with cumulative number of months below target haemoglobin concentrations...

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..Anemia also was associated with death in the year after new-onset CHF (adjusted hazard ratio, 1.28; P < .001). CONCLUSION: Anemia in the Medicare population is associated with the diagnosis and prognosis of new-onset CHF...

..Defining CKD using a single GFR threshold may be disadvantageous for minority populations because metabolic abnormalities are present at higher levels of GFR...

..It is logical to postulate that septicemia, a common macroinflammatory occurrence in dialysis patients, contributes to their large burden of cardiovascular disease...

..The aim of this study was to estimate the burden of CKD in patients with diabetes and examine the ability of serum creatinine and albuminuria to detect clinically meaningful CKD compared with estimated glomerular filtration rate (eGFR)...

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..On an absolute basis, however, the high death rates of patients with CKD may reflect accelerated rates of atherosclerotic vascular disease and congestive heart failure...

..These data suggest that increased use of peritoneal dialysis may benefit incident ESRD patients...

..The authors aimed to determine prevalence of parenteral iron administration and its contribution to exceeding hemoglobin target levels...

..This study describes cognitive impairment occurrence in a peritoneal dialysis cohort compared with a cohort without chronic kidney disease (CKD)...

..Temporal trends regarding the epidemiology of atherosclerotic renovascular disease (ARVD) in dialysis populations are poorly defined...

..Few data are available on kidney function in normal US adolescents. This study characterizes the distribution of kidney function measures and associated factors...

..The effects of different hemoglobin targets when using erythropoiesis-stimulating agents on quality of life are somewhat controversial, and predictors of change in quality of life in endstage renal disease have not been well characterized...

..We aimed to determine if time required to reach 11 g/dl was associated with increased risk of hospitalization or death among incident dialysis patients...

..Thus, the albumin-creatinine ratio and eGFR may be at least as efficient for survival-based clinical triage as most other classic risk factors...

..We aimed to determine whether such an association exists in community-dwelling young adults...

..4%; intermediate-intermediate (I-I), 6.0%; high-high (H-H), 2.3%; low-intermediate (L-I), 18.3%; intermediate-high (I-H), 31.7%, and low-high (L-H), 40.2%...

..8 in 2003). While time to recovery of prehospitalization hemoglobin levels remained constant year to year, epoetin doses and ERI did not, suggesting that optimum perihospitalization anemia management practices have yet to be determined...

..In conclusion, higher serum phosphorus levels, even within the normal range, may be a risk factor for coronary artery atherosclerosis in healthy young adults...

..This study aimed to estimate the magnitude of fluid overload treatment episodes for the Medicare hemodialysis population in hospital settings, including emergency departments...

..Hemoglobin levels in almost 90% of patients are in some degree of flux at any point in time, and the fluctuation is highly associated with clinical complications and provider practices...

..Cystatin C has recently emerged as a promising measure of GFR. To enable further insights into the evolution of CKD in the U.S. population, this study aimed to examine cystatin C levels in U.S. adults...

..76; P < 0.0001). CONCLUSION: In patients with persistently low hemoglobin values, optimizing urea clearance and a proactive approach to intravenous iron therapy may enhance epoetin responsiveness...

..Exceeding hemoglobin level targets has become widespread in the United States and is associated with changes in epoetin dosing practices...

..Our index performance was almost identical to the individual comorbid conditions regarding model fit, predictive ability, and effect on inference, and it outperformed the widely used Charlson Comorbidity Index...

..This study aimed to quantify diagnostic test characteristics of these measures for detecting metabolic abnormalities...

..Younger patients on long-term hemodialysis may be at a special risk. Parathyroidectomy risk increases stepwise with alterations in bone metabolism variables, suggesting that a single-threshold management approach may not be ideal...

..Hemoglobin levels in U.S. hemodialysis and peritoneal populations are similar. However, erythropoietin doses are dramatically higher in hemodialysis patients...

..Such assessment is needed to reduce the high burden of ESRD on national health-care systems, which can only be addressed by early screening and active treatment...

..Anemia is associated with each of these events...

..It has been suggested that cystatin C may be a superior measure of estimated glomerular filtration rate (eGFR) than creatinine-based methods. We aimed to assess the utility of cystatin C for clinical triage in community-based settings...

..1% of the population (26.3 million people based on the 2000 census) has CKD stages 1 to 4...

..To determine the prevalence of cardiovascular risk factors in the general population based on kidney function...

..We aimed to identify serum creatinine and eGFR thresholds of maximum sensitivity and specificity (Max(Sn+Sp)) for a composite outcome of coronary heart disease, stroke, and death...

..25 (95% confidence interval, 1.2546-1.2548). Anemia, a common association of CHF in elderly patients, is an antecedent association of increased societal medical expenditure...

..Studies addressing patterns and trends in red blood cell transfusion use in US hemodialysis patients surprisingly have received little attention in the last decade...

..Calcium-phosphate levels, linked to vascular dysfunction in chronic kidney disease, may represent novel risk factors for coronary heart disease, stroke, and death in community-dwelling adults...

..0212). CONCLUSIONS: Integrating factors predictive of anaemia improves overall prognostic discrimination. Propensity score adjustment refines the prognostic association of haemoglobin levels in haemodialysis patients...

..Public health programs, including the new Medicare chronic kidney disease education benefit, are needed to promote better care of patients who may need dialysis to reduce the high morbidity and mortality in the first year...

..It is not known whether sarcopenia is associated with levels of kidney function in community-dwelling adults...

..In addition, hemoglobin levels of >/=12 g/dL are associated with lower hospitalization rates in diabetic patients...

..As ESA doses have more than tripled in the USA since ESAs were introduced, we aimed to compare annual trends in cancer-specific mortality rates among incident maintenance hemodialysis patients...

..Long-term trend analyses are needed to determine whether morbidity and mortality rates change based on greater detection and treatment efforts...

..We aimed to determine the association between cardioprotective medications and a composite end point of cardiovascular events or death in an incident dialysis cohort...

..Parathyroidectomy rates in hemodialysis patients increased from 1992 to 2002, when medication choices to manage secondary hyperparathyroidism expanded...

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..The present paper focuses on the clinical epidemiology of major bacterial infections in dialysis patients, associations between bacterial infections and cardiovascular disease, and interventions aimed at averting these infections...

..Interventions that successfully prevent the development or progression of both conditions have the potential to substantially reduce global health care costs...

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..Given these problems, we hypothesized that a long interdialytic interval is associated with adverse events in patients receiving hemodialysis...

..The long-term prognostic associations of pre- and post-dialysis blood pressures, interdialytic weight gain, and antihypertensive use in hemodialysis patients are unclear...

..As dialysis patients are at vast cardiovascular risk, these findings suggest that aggressive treatment of hypertension should be the default approach, until large clinical trials show otherwise...

..Although recent studies suggest that hospitalization for major infections is much more common in nondialysis CKD than in the general population, the prognostic implications remain unexplored...

..Whereas the available evidence suggests that 11 g/dl is a reasonable lower bound for the hemoglobin target range, the upper bound remains to be defined and targets above 13 g/dl cannot be routinely recommended...

..Such agents include proteins and peptides that activate erythropoietin receptors, non-protein agents, and strategies with targets other than erythropoietin receptors...

..7% of total Medicare expenditures...

..The purpose of the present review was to examine existing research on temporal trends for CKD and treated end-stage renal disease (ESRD) in the United States...

..Lack of timely access to specialty care appears to limit optimal access...

..Several clinical trials have addressed the hypothesis that darbepoetin alfa can effectively treat renal anemia at dose frequencies of once per week, or less often, with positive outcomes...

..Although cognitive function in hemodialysis patients is believed to be best 24 hours after the dialysis session, the extent of variation during the dialysis cycle is unknown...

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..Patients with chronic kidney disease are at increased risk for cardiovascular disease, but the efficacy and safety of simvastatin and aspirin are unknown in this patient group...

..Ongoing studies should determine whether a physiologically targeted approach to anaemia management reduces the burden of cardiomyopathy in renal failure...

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..Long-bone fractures are common in patients receiving dialysis; their adverse prognostic implications may be linked to major cardiovascular and infectious events...

..Normalization of hemoglobin in incident hemodialysis patients does not have a beneficial effect on cardiac structure, compared with partial correction...

..Absolute cardiovascular risk exceeds that of renal replacement therapy. Renal revascularization is used selectively and shows inconsistent associations with cardiovascular outcomes, renal replacement therapy, and death...

..This study was undertaken to identify key patient characteristics for which the risk of death differs by dialysis modality...

..Although clinical experience suggests that pneumonia may occur frequently in dialysis patients, its clinical epidemiology in that group remains poorly defined...

..Minority women especially are at greater risk for ESRD than white women. Further studies are needed to determine whether earlier initiation of dialysis is a factor in higher ESRD incidence among minorities...

..This study reinforces the importance of intrarenal vascular and parenchymal disease in the etiology of renal dysfunction in ARVD...

..Patients with ARVD exhibit a high prevalence of cardiac morphologic and functional abnormalities at early stages of renal dysfunction. Such patients must be identified early in their disease course to allow risk factor modification...

..Whether this strategy, involving efficient surveillance, early detection, early intervention, and high Hb targets that are independent of the phase of CKD, actually reduces cardiac failure or death remains to be seen...

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