Subject(s)
Databases, Factual , Kidney Diseases/epidemiology , Research Report , Databases, Factual/trends , Hospitalization , Humans , Kidney/physiology , Kidney Diseases/diagnosis , Kidney Diseases/therapy , Kidney Failure, Chronic/diagnosis , Kidney Failure, Chronic/epidemiology , Kidney Failure, Chronic/therapy , Research Report/trends , United States/epidemiologyABSTRACT
BACKGROUND: Acute myocardial infarction (AMI) is catastrophic for dialysis patients. This study set out to determine the clinical characteristics of dialysis patients hospitalized for AMI in the United States. METHODS AND RESULTS: This retrospective cohort study used data from the US Renal Data System (USRDS) database (n=1,285,177) and the third National Registry of Myocardial Infarction (NRMI 3) (n=537,444). AMI hospitalizations from April 1, 1998, through June 30, 2000, were identified using International Classification of Diseases, 9th edition, clinical modification, codes 410, 410.x, 410.x0, and 410.x1. The 9418 unique dialysis patients identified with AMI hospitalizations in the USRDS database were cross-matched with the NRMI registry, creating a cohort for analysis that consisted of 3049 matching patients. Clinical characteristics of dialysis and nondialysis (n=534,395) AMI patients were compared by use of the chi2 test. Of clinical significance, 44.8% of dialysis patients were diagnosed as not having acute coronary syndrome on admission, versus 21.2% of nondialysis patients; 44.4% presented with chest pain, versus 68.3% of nondialysis patients; and 19.1% had ST elevation, versus 35.9% of nondialysis patients. Cardiac arrest was twice as frequent for dialysis patients (11.0% versus 5.0%), and in-hospital death was nearly so (21.3% versus 11.7%). In a logistic regression model, the odds ratio for in-hospital death for dialysis versus nondialysis patients was 1.498 (95% CI, 1.340 to 1.674). CONCLUSIONS: Dialysis patients hospitalized for AMI differ strikingly from nondialysis patients, which possibly explains their poor outcomes. Intensive efforts for early, accurate recognition of AMI in dialysis patients are warranted.
Subject(s)
Kidney Failure, Chronic/epidemiology , Myocardial Infarction/epidemiology , Renal Dialysis , Adult , Aged , Aged, 80 and over , Cardiovascular Agents/therapeutic use , Cohort Studies , Comorbidity , Female , Hospital Mortality , Humans , Kidney Failure, Chronic/therapy , Male , Middle Aged , Myocardial Infarction/therapy , Myocardial Revascularization/statistics & numerical data , Registries/statistics & numerical data , Retrospective Studies , United States/epidemiologySubject(s)
Renal Insufficiency, Chronic , Health Expenditures , Hospitalization , Humans , Kidney Failure, Chronic/diagnosis , Kidney Failure, Chronic/economics , Kidney Failure, Chronic/epidemiology , Kidney Failure, Chronic/therapy , Medicare Part D , Renal Insufficiency, Chronic/diagnosis , Renal Insufficiency, Chronic/economics , Renal Insufficiency, Chronic/epidemiology , Renal Insufficiency, Chronic/therapy , United States/epidemiologySubject(s)
Health Expenditures/statistics & numerical data , Kidney Diseases , Societies, Medical , Annual Reports as Topic , Chronic Disease , Data Collection , Disease Management , Humans , Kidney Diseases/economics , Kidney Diseases/epidemiology , Kidney Diseases/therapy , United States/epidemiologySubject(s)
Kidney Failure, Chronic , Kidney Transplantation/statistics & numerical data , Renal Dialysis/statistics & numerical data , Humans , Kidney Failure, Chronic/economics , Kidney Failure, Chronic/epidemiology , Kidney Failure, Chronic/therapy , Kidney Transplantation/economics , Renal Dialysis/economics , United States/epidemiologySubject(s)
Kidney Diseases , Adult , Annual Reports as Topic , Child , Chronic Disease , Humans , Kidney Diseases/economics , Kidney Diseases/epidemiology , Kidney Failure, Chronic/economics , Kidney Failure, Chronic/epidemiology , Kidney Transplantation/statistics & numerical data , United States/epidemiologySubject(s)
Kidney Diseases/epidemiology , Kidney Failure, Chronic/epidemiology , Kidney Failure, Chronic/therapy , Kidney Transplantation/trends , Renal Dialysis/trends , Adolescent , Adult , Age Distribution , Aged , Cardiovascular Diseases/complications , Child , Chronic Disease , Data Collection , Diabetes Complications , Female , Health Expenditures/trends , Hospitalization/trends , Humans , Kidney Diseases/complications , Kidney Diseases/mortality , Kidney Diseases/therapy , Kidney Failure, Chronic/mortality , Kidney Transplantation/economics , Kidney Transplantation/statistics & numerical data , Male , Medicare/statistics & numerical data , Middle Aged , Morbidity/trends , Mortality/trends , Renal Dialysis/economics , Renal Dialysis/statistics & numerical data , United States/epidemiologySubject(s)
Kidney Failure, Chronic/epidemiology , Kidney Failure, Chronic/therapy , Adult , Annual Reports as Topic , Cardiovascular Diseases/complications , Child , Diabetes Complications , Female , Humans , Kidney Failure, Chronic/complications , Kidney Transplantation/statistics & numerical data , Male , Peritoneal Dialysis/statistics & numerical data , United States/epidemiologyABSTRACT
BACKGROUND AND OBJECTIVES: Cinacalcet was introduced in mid-2004 to treat secondary hyperparathyroidism in dialysis patients. We aimed to characterize adult patients who received cinacalcet prescriptions and to determine (1) dosage titration and effects on laboratory values, active intravenous vitamin D use, and phosphate binder prescriptions and (2) percentage who achieved National Kidney Foundation Kidney Disease Outcomes Quality Initiative targets for serum parathyroid hormone, calcium, and phosphorus and experienced biochemical adverse effects. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This observational study evaluated 45,487 prevalent patients from a dialysis organization database linked with the Centers for Medicare and Medicaid Services End-Stage Renal Disease database. Patient characteristics, laboratory values (albumin, parathyroid hormone, calcium, phosphorus), intravenous vitamin D, and oral medication (cinacalcet, phosphate binders) prescriptions were evaluated for cinacalcet patients. RESULTS: By June 2006, almost 32% of patients had received cinacalcet prescriptions. Mean baseline corrected calcium was 9.8 mg/dl and phosphorus was 6.3 mg/dl, and median parathyroid hormone was 577 pg/ml, versus 9.5 mg/dl, 5.3 mg/dl, and 215 pg/ml, respectively, for noncinacalcet patients. Patients with cinacalcet prescriptions for > or =6 mo had corrected calcium reduced by 4.2%, phosphorus by 7.0%, and parathyroid hormone by 29.9% by 12 mo. More cinacalcet patients attained Kidney Disease Outcomes Quality Initiative targets with less hyperparathyroidism, hypercalcemia, and hyperphosphatemia but more hypoparathyroidism and hypocalcemia. Over 12 mo, vitamin D use and use consistency increased, phosphate binder dosages increased, and mean cinacalcet daily dosage reached 55 mg. CONCLUSIONS: Patients with cinacalcet prescriptions exhibited more severe hyperparathyroidism and hyperphosphatemia than noncinacalcet patients. Positive effects were less dramatic than in Phase III clinical trials, possibly as a result of modest, slow dosage titration.
Subject(s)
Biomarkers/blood , Hyperparathyroidism, Secondary/drug therapy , Kidney Failure, Chronic/therapy , Naphthalenes/therapeutic use , Outcome and Process Assessment, Health Care , Practice Patterns, Physicians'/trends , Renal Dialysis , Adolescent , Adult , Calcium/blood , Centers for Medicare and Medicaid Services, U.S. , Cinacalcet , Databases as Topic , Drug Prescriptions , Drug Therapy, Combination , Drug Utilization , Drug Utilization Review , Female , Humans , Hyperparathyroidism, Secondary/blood , Hyperparathyroidism, Secondary/etiology , Kidney Failure, Chronic/complications , Male , Middle Aged , Naphthalenes/administration & dosage , Naphthalenes/adverse effects , Outcome and Process Assessment, Health Care/statistics & numerical data , Parathyroid Hormone/blood , Phosphorus/blood , Practice Guidelines as Topic , Renal Dialysis/adverse effects , Renal Dialysis/statistics & numerical data , Time Factors , Treatment Outcome , United States , Vitamin D/therapeutic use , Young AdultABSTRACT
Hospice is recognized for providing excellent end-of-life care but may be underused by dialysis patients. Hospice use and related outcomes were measured among dialysis patients, and factors that were associated with hospice use were identified. The 2-yr US Renal Data System dialysis patients who died between January 1, 2001, and December 31, 2002, and hospice claims from the Centers for Medicare & Medicaid Services were examined to measure prevalence, factors, and costs that were associated with dialysis withdrawal and hospice use. Of the 115,239 deceased patients, 21.8% withdrew from dialysis and 13.5% used hospice. Of those who withdrew, 41.9% used hospice. Failure to thrive was the most common reason for dialysis withdrawal (42.9%). On multivariable logistic regression analysis, factors that were significantly associated with hospice referral among patients who withdrew from dialysis were age, race, reason for withdrawal, ability to walk or transfer at dialysis initiation, and state of residence. Among patients who withdrew from dialysis and used hospice, median cost of per-patient care during the last week of life was $1858, compared with $4878 for nonhospice patients (P < 0.001); hospitalization costs accounted for most of that difference. Only 22.9% of dialysis hospice patients died in the hospital, compared with 69.0% of nonhospice patients (P < 0.001). A minority of dialysis patients use hospice, even among patients who withdrew from dialysis, whose death usually is certain. Increased hospice use may enable more dialysis patients to die at home, with substantial cost savings. Research regarding additional benefits of hospice care for dialysis patients is needed.