B J Manns

..This review discusses the epidemiology of sepsis, preclinical and clinical evidence supporting the use of rhAPC use, controversies about the evidence of efficacy in severe sepsis syndrome and cost-effectiveness data...

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..The impact of NHD on LV mass represents a clinically important outcome which will further elucidate the potential benefits of NHD and guide future clinical endpoint studies...

..The Prevention of Catheter Lumen Occlusion with rt-PA versus Heparin (PreCLOT) study will determine if use of weekly rt-PA, compared to regular heparin, as a catheter locking solution, will decrease the risk of catheter malfunction...

..We conducted a systematic review to summarize existing literature on trace element status in hemodialysis patients...

..This paper explains how ESRD care fits into the Canadian health care system, describes the epidemiology of ESRD in Canada, and offers economic explanations for international discrepancies...

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..Programs caring for patients with chronic medical conditions such as ESRD should examine how computer databases could assist in clinical care and improve the efficiency with which that care is delivered to their patients...

..In part, this is due to the intrusiveness of the treatment (hemodialysis or peritoneal dialysis) that is required. It is unclear whether hemodialysis or peritoneal dialysis is associated with a higher HRQOL...

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..01). Vascular access care is responsible for a significant proportion of health care costs in the first year of hemodialysis. These results support clinical practice guidelines that recommend preferential placement of a native fistula...

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..When compared to long-term dialysis as a therapy for ESRD, kidney transplantation increases survival, improves quality of life, and is cost saving...

..Living donor kidney transplantation has similar costs at 2 years compared with deceased donor transplantation. These results can be used by health care decision makers to inform strategies to increase donation...

..To determine the cost effectiveness of one-off population based screening for chronic kidney disease based on estimated glomerular filtration rate...

..Strategies aimed at slowing progression of kidney disease should consider underlying risk factors for progression and the negligible loss of kidney function that occurs in the majority of older adults...

..These data support expenditures on infection prevention and control programmes and further research into reducing the impact of these infections...

..The objective of this study was to evaluate the cost-effectiveness of routine use of high-resolution flow-cytometry cross-matching and solid-phase screening for all recipients of primary deceased donor kidney transplants...

..001). CONCLUSION: To maximize the efficiency with which care is provided to patients with ESRD, dialysis programs should encourage the use of home/self-care hemodialysis and peritoneal dialysis...

..Within each region we also determined whether distance from the closest transplant centre was associated with the likelihood of transplantation...

..Our objectives were to identify perceived advantages of SCD associated with increased odds of selecting SCD, and to evaluate the effect of an educational intervention on patients' perceptions of these advantages...

..There is some evidence to suggest that the modality of home nocturnal dialysis may offer improvements in clinical outcomes including quality of life, but further study of the cost effectiveness of this modality is required...

..The purpose of this study is to describe reasons in-center hemodialysis patients choose not to perform self-care dialysis and identify variables associated with a negative attitude toward self-care dialysis...

..Whether increasing dialysis adequacy in large patients not achieving KDOQI targets improves HRQL is unknown...

..We evaluated differences in survival and rate of renal transplantation among Aboriginal and white patients after initiation of dialysis...

..Before significant resources are invested in initiating nocturnal hemodialysis programs, further data on mortality and cardiovascular morbidity, preferably from randomized clinical trials, are required...

..Numerous barriers may impede the identification of, and transplantation from, living donors...

..Barriers to self-care PD are very common in the elderly ESRD population but home care assistance significantly increases the number of patients who can be safely offered PD...

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..Concerns about toxicity have led to more restrictive recommendations for ESA use; however, the incremental costs and benefits of such a strategy are unknown...

..Comparing outcomes of arteriovenous grafts and fistulas is challenging because the pathophysiology of access dysfunction and failure rate profiles differ by access type. Studying how risks vary over time may be important...

..Although proteinuria is also associated with adverse outcomes, it is not used to refine risk estimates of adverse events in this current system...

..We investigated whether patients receiving hemodialysis who live farther from their attending nephrologist are more likely to die than those who live closer...

..Few data guide the prescription of dialysate potassium (dK) in hemodialysis, which is usually prescribed empirically on the basis of predialysis serum potassium levels...

..Controversy exists regarding the optimal method of providing dialysis in critically ill patients with acute renal failure. We sought to determine the cost-effectiveness of treatment strategies...

..Whether modifying dialysis prescription to intensify small-solute clearance also leads to better phosphate clearance is unknown...

..CONCLUSION: Given their potential budgetary impact, future nephrology clinical practice guidelines should consider resource use, in addition to clinical data...

..Laboratory reporting of estimated glomerular filtration rate (GFR) has been widely implemented, with limited evaluation...

..Accurately identifying patients who are at risk for progressive disease is challenging. The extent to which histopathologic features improves prognostication is uncertain...

..The relative effectiveness and safety of sevelamer for treatment of hyperphosphataemia in dialysis patients is uncertain, as compared with calcium-based phosphate binders...

..Because of the high cost of ongoing dialysis, CRRT may still be an economically efficient treatment if it improves renal recovery among survivors; further study in this area is required...

..Acute renal failure requiring dialytic support is associated with a high risk of mortality and substantial morbidity...

..Patients were followed from the date of Qa measurement until death; follow-up was discontinued at loss to follow-up, kidney transplantation, or end of study...

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..Until such reporting occurs, clinicians will be left with uncertainty about the validity of RCTs that guide their clinical practice...

..The purpose of this study is to assess the validity of the Charlson index in incident dialysis patients and modify the index for use specifically in this patient population...

..5 to 10.5 g/dL. Aiming for hemoglobin targets in excess of 12.0 g/dL is associated with unfavorable cost-effectiveness ratios and should not be undertaken based on current data...

..This article highlights the need for randomized clinical trials and economic evaluations of therapies in critical care medicine for which the effect of the therapy on health outcomes and/or costs are unknown...

..Dialysis adequacy was significantly associated with HRQOL in hemodialysis patients. Controlled studies that examine the effect of increasing Kt/V on HRQOL are needed...

..Concern about primary fistula failure may contribute to the underuse of arteriovenous fistula. The objective of this study was to investigate the baseline clinical parameters associated with primary fistula success...

..We performed an economic evaluation, based on the results of a randomized clinical trial, to evaluate the economic implications of operative compared with nonoperative management of this fracture...

..Racial differences in health outcomes in general are well documented; however, few studies examined the impact of East Asian and Indo Asian race on choice of dialytic modality and survival among patients with end-stage renal disease (ESRD)...

..Until these inadequacies are resolved health-care providers will remain limited in their ability to make informed inferences about the validity of the studies upon which they base their clinical practice...

..The benefits of MDC and an assessment of their economic impact should be tested in a randomized, controlled trial...

..Consideration should be given to redefine "normal" hemoglobin values in the elderly. Clinical trials are also necessary to determine whether anemia correction improves quality or quantity of life in this population...

..We recently published an economic evaluation assessing the use of drug-eluting stents in patients undergoing percutaneous coronary intervention (PCI)...

..Due to the high prevalence of both CKD and NSAID use in older adults, we sought to determine the association between NSAID use and the progression of CKD in an elderly community-based cohort...

..The objective of this study was to combine systematic review and decision analytic techniques to determine the optimal treatment strategy for patients with locally advanced esophageal cancer...

..Sirolimus-eluting stents are more economically attractive for patients who are at higher risk of restenosis or at a high risk of death if a second revascularization procedure were to be required...

..Morbidity and mortality rates in hemodialysis patients remain excessive. Alterations in the delivery of dialysis may lead to improved patient outcomes...

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..INTERPRETATION: At present, CT colonography cannot be recommended as a primary means of population-based colorectal cancer screening in Canada...

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..We undertook an observational study to determine whether concealment of randomization or blinding was used in RCTs that failed to report these bias-reducing strategies...

..05). High-dose vitamin therapy significantly lowers, but does not normalize, MMA and tHcy levels. The MTHFR genotype, while influencing homocysteine levels, was not responsible for the majority of the elevation in plasma tHcy...

..We determined whether access to care differed between status Aboriginal people (Aboriginal people registered under the federal Indian Act) and non-Aboriginal people with chronic kidney disease...

..The nonmedical costs of colorectal cancer screening are unknown. However, they might influence screening uptake and impact the cost-effectiveness of colorectal cancer screening modalities...

..Several issues that decision-makers and providers may wish to consider when making such funding decisions are discussed...

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..Catheter-related infections cause morbidity and mortality in patients undergoing hemodialysis...