(Press-News.org) Patients on peritoneal dialysis (PD) typically have a higher early survival rate than patients on hemodialysis (HD). New data suggest that this difference may be explained by a higher risk of early deaths among patients undergoing HD with central venous catheters, according to a study appearing in an upcoming issue of the Journal of the American Society of Nephrology (JASN).
In a study that included more than 38,500 Canadian patients starting dialysis between 2001 and 2008, 63 percent started hemodialysis using a central catheter placed into one of the large veins. Seventeen percent started HD with an arteriovenous fistula (AVF) or arteriovenous graft (AVG)—surgically created access sites that reduce the rates of infection and other complications related to central catheters. The remaining 19 percent started on PD, in which dialysis is performed at home by the patient where metabolic wastes are eliminated by placing dialysis fluid into the abdomen.
Those patients who had an arteriovenous fistula or graft (AVF/AVG) when starting HD showed similar survival rates to the patients on peritoneal dialysis. "Our results emphasize the importance of predialysis care and education, and the need to avoid central venous catheter use in our HD patients," comments Jeffrey Perl, MD (St Michael's Hospital, Toronto).
During the first year, the risk of death for patients starting HD with a central catheter was 80 percent higher than for patients who started on PD. The risk of death in the first year for patients who started hemodialysis with an AVF/AVG was similar to that of the PD group.
In the five years after starting dialysis, the risk of death was still 20 percent higher in patients who started HD with a central catheter, compared to the PD group. The survival rate for patients who started HD with an AVF/AVG remained similar to that for patients who started on PD.
Some past studies have shown that patients on PD are at lower risk of death during the first year or two on dialysis, compared to patients on HD. "However, these studies have been heavily criticized for comparing 'apples to oranges,'" says Perl. "Their results may speak more towards the type of patients selected for PD over HD rather than a direct impact of PD versus HD itself on patient survival." He believes the new study provides a more fair, "apples to apples'' comparison of PD patients versus HD patients who have been "optimally prepared" with an AVF/AVG.
The study is limited by the fact it was an observational study, rather than a randomized controlled trial. Information on the type of access for HD use was obtained only at the time of dialysis initiation. Information on follow-up vascular access was not available, which would be useful to understand the contribution of the catheter versus other factors contributing to risk of death. There was no information on the reasons why patients started HD with a central catheter, or on whether they started dialysis in the hospital or as an outpatient.
###
Study co-authors were Ron Wald, MD CM MPH, Philip McFarlane, MD PhD (St Michael's Hospital), Joanne M Bargman, MD (University of Toronto), Edward Vonesh, PhD (Northwestern University, Chicago), Yingbo Na, MSc (The Canadian Organ Replacement Register, Toronto), S. Vanita Jassal, MD MSc (University of Toronto), and Louise Moist, MD MSc (University of Western Ontario).
Dr. Perl has received speaking honoraria from Amgen Canada and Baxter Healthcare Canada and holds an unrestricted educational fellowship from Baxter Healthcare Canada. Dr. McFarlane has received speaking honoraria from Biovail, Boehringer Ingelheim, Bristol Myers Squibb, GlaxoSmithKline, Merck, Novartis, and Sanofi-Aventis and has served on advisory boards for Amgen Canada, Baxter Healthcare Canada, Biovail, Boehringer Ingelheim, Bristol Myers Squibb, Fresenius, Merck Novartis, Ortho-Biotech, Sanofi-Aventis, and Schering. Dr. Wald has served on advisory boards for Amgen, Gilead and Fresenius Kabi and receives an unrestricted educational fellowship from Amgen. Dr. Bargman has served on advisory boards for Amgen, Takeda, and Hospira and has received speaking honoraria from Baxter Healthcare Canada, Amgen Canada, and Genzyme Canada. Dr. Vonesh has served as a consultant for Baxter Healthcare. Dr. Jassal has served on advisory boards for Amgen Canada and has received speaking honoraria from Baxter Healthcare Canada. Dr. Moist has served on advisory boards for Amgen Canada and Merck Frosst.
The article entitled, "Hemodialysis Vascular Access Modifies the Association between Dialysis Modality and Survival," will appear online at http://jasn.asnjournals.org/ on April 21, 2011 at 5:00 PM EDT, doi 10.1681/ASN.2010111155.
The American Society of Nephrology (ASN) does not offer medical advice. All content in ASN publications is for informational purposes only, and is not intended to cover all possible uses, directions, precautions, drug interactions, or adverse effects. This content should not be used during a medical emergency or for the diagnosis or treatment of any medical condition. Please consult your doctor or other qualified health care provider if you have any questions about a medical condition, or before taking any drug, changing your diet or commencing or discontinuing any course of treatment. Do not ignore or delay obtaining professional medical advice because of information accessed through ASN. Call 911 or your doctor for all medical emergencies.
Founded in 1966, and with more than 12,000 members, the American Society of Nephrology (ASN) leads the fight against kidney disease by educating health professionals, sharing new knowledge, advancing research, and advocating the highest quality care for patients.
Kidney disease coupled with heart disease common problem in elderly
2011-04-24
ELSE PRESS RELEASES FROM THIS DATE:
LateRooms.com - See A Hard Merciless Light in Madrid
2011-04-24
Madrid's Museo Nacional de Arte Reina Sofia is showing a collection of pictures from the worker-photography movement between 1926 and 1939.
A Hard Merciless Light will be on display until August 22nd 2011, displaying some fascinating examples of images used during that era in the press.
The installation explores how the partnership of photography and the leftist worker movement became intertwined and spread from humble beginnings in the Soviet Union to several other countries including the US and Spain.
In a statement, the organisers remarked: "The exhibition ...
Say hello to cheaper hydrogen fuel cells
2011-04-24
LOS ALAMOS, New Mexico, April 22, 2011—Los Alamos National Laboratory scientists have developed a way to avoid the use of expensive platinum in hydrogen fuel cells, the environmentally friendly devices that might replace current power sources in everything from personal data devices to automobiles.
In a paper published today in Science, Los Alamos researchers Gang Wu, Christina Johnston, and Piotr Zelenay, joined by researcher Karren More of Oak Ridge National Laboratory, describe the use of a platinum-free catalyst in the cathode of a hydrogen fuel cell. Eliminating ...
A new ending to an old 'tail'
2011-04-24
LA JOLLA, CA—In stark contrast to normal cells, which only divide a finite number of times before they enter into a permanent state of growth arrest or simply die, cancer cells never cease to proliferate. Now, scientists at the Salk Institute for Biological Studies have uncovered an important clue to one of the mechanisms underlying cancer cell immortality.
Their findings, published in the April 22, 2011 issue of Molecular Cell, reveal an unanticipated structure at chromosome ends, which could be a key ingredient in the biological "elixir of life," potentially making ...
Hotels-Paris.co.uk - Rembrandt and the Face of Jesus Unveiled in Paris
2011-04-24
A major new exhibition called Rembrandt and the Face of Jesus opened at Paris's Louvre art space on Thursday (April 21st).
The installation will be on show until July 18th 2011 and sees world-famous masterpiece The Pilgrims at Emmaus take centre stage.
Rembrandt Harmenszoon van Rijn - best known by his first name - painted it in the 17th century.
The picture will form the centrepiece for an installation that explores the way Jesus was represented in his art, as well as in the paintings of his students.
Tickets for the exhibition cost EUR11 (GBP9.75), or visitors ...
Bacteria interrupted: Disabling coordinated behavior and virulence gene expression
2011-04-24
New research reveals a strategy for disrupting the ability of bacteria to communicate and coordinate the expression of virulence factors. The study, published by Cell Press in the April 22nd issue of the journal Molecular Cell, may lead to the development of new antibacterial therapeutics.
Bacteria use a process called "quorum sensing" to synchronize group behaviors that promote pathogenesis. During the process of quorum sensing, bacteria communicate with one another via chemical signals called autoinducers. As the population increases, so do autoinducer concentrations. ...
LateRooms.com - Liverpool Showcases Like You've Never Been Away
2011-04-24
Like You've Never Been Away is a heart-warming project for which a photographer has tracked down the people who appeared in his photographs of Granby and Everton in 1975.
Paul Trevor was sent to the areas to record inner city deprivation and produced a collection of images showing the defiant nature with which the communities faced their problems.
In a statement, he described how he found everyone to be full of humour and energy at the time and decided to revisit the project and update the public on what the participants had done with themselves after he left.
Mr ...
Columbia engineering study links ozone hole to climate change all the way to the equator
2011-04-24
In a study to be published in the April 21st issue of Science magazine, researchers at Columbia University's School of Engineering and Applied Science report their findings that the ozone hole, which is located over the South Pole, has affected the entire circulation of the Southern Hemisphere all the way to the equator. While previous work has shown that the ozone hole is changing the atmospheric flow in the high latitudes, the Columbia Engineering paper, "Impact of Polar Ozone Depletion on Subtropical Precipitation," demonstrates that the ozone hole is able to influence ...
Giant tortoises show rewilding can work
2011-04-24
'Rewilding with taxon substitutes', the intentional introduction of exotic species to fulfil key functions in ecosystems following the loss of recently extinct species, is highly controversial, partly due to a lack of rigorous scientific studies.
In a paper published today in Current Biology, Christine Griffiths of Bristol's School of Biological Sciences and colleagues present the first empirical evidence that rewilding can work.
Exotic giant Aldabra tortoises, Aldabrachelys gigantea, were introduced to Ile aux Aigrettes, a 25-hectare island off Mauritius, in 2000 to ...
Hotels-Paris.co.uk - Visit Facteurs Factices in Paris for Peculiar Post Boxes
2011-04-24
An unusual exhibition of artwork from a tiny village in Loiret is being displayed at the Musee de la Poste in Paris.
Facteurs Factices shows off the many and varied post boxes in Saint-Martin-d'Abbat, which has become something of a traveller's curiosity due to the elaborate designs of the items.
One of them is made to look like a petrol pump, while another celebrates breakfast-time.
According to the organisers of the display, there are only 1,600 residents in the village, yet there are 220 unique post boxes.
Visitors to the Musee de la Poste can see pictures ...
In time for spring, biologist illuminates how seedlings regulate growth
2011-04-24
PROVIDENCE, R.I. [Brown University] — With seedlings and shoots still poking their leafy tops out of the soil, it's hard to read the newly published research of Brown University biologist Alison DeLong without musing that it provides a deeper understanding of what puts the spring in spring.
DeLong's paper, published in advance online April 21 in PLoS Genetics, reveals fertile new insights into the intricate network of proteins that controls plant growth and development, particularly at the seedling stage. But the research also runs deeper than the roots of any of the ...