RESUMEN
OBJECTIVE: To compare healthcare costs in chronic kidney disease (CKD) stage 4 or 5 not on dialysis (estimated glomerular filtration rate <30â mL/min/1.73m2), peritoneal dialysis, haemodialysis and in transplanted patients with matched general population comparators. DESIGN: Population-based cohort study. SETTING: Swedish national healthcare system. PARTICIPANTS: Prevalent adult patients with CKD 4 or 5 (n=1046, mean age 68â years), on peritoneal dialysis (n=101; 64â years), on haemodialysis (n=460; 65â years) and with renal transplants (n=825; 52â years) were identified in Stockholm County clinical quality registers for renal disease on 1 January 2010. 5 general population comparators from the same county were matched to each patient by age, sex and index year. PRIMARY AND SECONDARY OUTCOME MEASURES: Annual healthcare costs in 2009 incurred through inpatient and hospital-based outpatient care and dispensed prescription drugs ascertained from nationwide healthcare registers. Secondary outcomes were annual number of hospital days and outpatient care visits. RESULTS: Patients on haemodialysis had the highest mean annual cost (87â 600), which was 1.49 (95% CI 1.38 to 1.60) times that observed in peritoneal dialysis (58â 600). The mean annual cost was considerably lower in transplanted patients (15â 500) and in the CKD group (9600). In patients on haemodialysis, outpatient care costs made up more than two-thirds (62â 500) of the total, while costs related to fluids ($29â 900) was the largest cost component in patients on peritoneal dialysis (51%). Compared with their matched general population comparators, the mean annual cost (95% CI) in patients on haemodialysis, peritoneal dialysis, transplanted patients and patients with CKD was 45 (39 to 51), 29 (22 to 37), 11 (10 to 13) and 4.0 (3.6 to 4.5) times higher, respectively. CONCLUSIONS: The mean annual costs were â¼50% higher in patients on haemodialysis than in those on peritoneal dialysis. Compared with the general population, costs were substantially elevated in all groups, from 4-fold in patients with CKD to 11, 29 and 45 times higher in transplanted patients and patients on peritoneal dialysis and haemodialysis, respectively.
Asunto(s)
Costos de la Atención en Salud , Trasplante de Riñón/economía , Diálisis Renal/economía , Insuficiencia Renal Crónica/economía , Adulto , Anciano , Atención Ambulatoria/economía , Estudios de Cohortes , Femenino , Tasa de Filtración Glomerular , Hospitalización/economía , Humanos , Fallo Renal Crónico/economía , Fallo Renal Crónico/terapia , Masculino , Persona de Mediana Edad , Programas Nacionales de Salud , Diálisis Peritoneal/economía , Sistema de Registros , Insuficiencia Renal Crónica/terapia , Terapia de Reemplazo Renal/economía , SueciaRESUMEN
OBJECTIVE: Chronic kidney disease is associated with inflammation, oxidative stress, malnutrition, poor oral health, and mouth dryness. The objective of this study was to evaluate effects of sea buckthorn oil (SBO) extract, which is rich in vitamins, phytochemicals, and polyunsaturated fatty acids, on oxidative stress, saliva production, and inflammation in hemodialysis patients. DESIGN SETTING AND SUBJECTS: This was a randomized, double-blinded, and placebo-controlled crossover study (2 × 8 weeks, 4-week washout). The study subjects were hemodialysis patients (n = 45) recruited from the Department of Renal Medicine at Karolinska University Hospital in Stockholm. INTERVENTION AND MAIN OUTCOME MEASURES: The patients received 4 capsules per day, each containing 500 mg of SBO or placebo, for 8 weeks. They were then crossed over to the other treatment after a 4-week washout period. Salivary gland biopsies, saliva, and blood samples were collected before and after each treatment period. Main outcomes were DNA breaks and oxidative DNA lesions in minor accessory salivary glands, salivary flow rates, and inflammation markers in blood (high-sensitivity C-reactive protein, antitrypsin, orosomucoid in plasma, leukocytes in blood). Blood markers including creatinine, urea in plasma, and hemoglobin in blood were investigated. RESULTS: The results showed no significant changes in DNA breaks, oxidative DNA lesions, salivary flow rates, or inflammation after SBO supplementation. However, plasma levels of phosphate and sodium increased and plasma levels of iron decreased. CONCLUSION: In conclusion, SBO supplementation as performed in this study did not protect against oxidative stress, nor improve oral health or inflammation status in hemodialysis patients.
Asunto(s)
Daño del ADN/efectos de los fármacos , Suplementos Dietéticos , Hippophae/química , Inflamación/tratamiento farmacológico , Salud Bucal , Diálisis Renal/efectos adversos , Anciano , Biomarcadores/sangre , Proteína C-Reactiva/análisis , Proteína C-Reactiva/metabolismo , Creatinina/sangre , Estudios Cruzados , Método Doble Ciego , Femenino , Humanos , Hierro/sangre , Masculino , Persona de Mediana Edad , Orosomucoide/análisis , Orosomucoide/metabolismo , Estrés Oxidativo/efectos de los fármacos , Fosfatos/sangre , Aceites de Plantas/administración & dosificación , Saliva/efectos de los fármacos , Saliva/metabolismo , Sodio/sangreRESUMEN
OBJECTIVE: Secondary hyperparathyroidism (SHPT) is a common problem among patients with chronic kidney disease (CKD) on haemodialysis. This study was conducted to assess the use, effectiveness and safety of intravenous paricalcitol in haemodialysis patients with various degrees of SHPT. MATERIAL AND METHODS: This observational, multicentre, prospective study was conducted in 14 Swedish dialysis centres from May 2007 to June 2008 and included 92 haemodialysis patients with a diagnosis of SHPT associated with CKD. The decision to initiate treatment with intravenous paricalcitol was made by the treating physician. No treatment algorithms were provided. RESULTS: Mean patient age was 64 years. Of the 92 patients included, 74 had an intact parathyroid hormone (iPTH) level of >300 pg/ml at baseline. Median iPTH was 584 pg/ml in patients with a baseline PTH of >300 pg/ml. During follow-up there was a decrease in iPTH to 323 pg/ml at 6 months (-45%, p < 0.0001). In parallel, there was a small increase in serum calcium, but serum phosphorus and the calcium × phosphorus product remained unchanged. CONCLUSIONS: This study showed that intravenous paricalcitol substantially and safely decreased iPTH in haemodialysis patients with a baseline iPTH above the Kidney Disease Outcomes Quality Initiative recommended target range (150-300 pg/ml) and had minimal impact on serum minerals.