Increasing the dialysis dose has failed to have an impact on the mortality of dialysis patients. In contrast, residual kidney function (RKF) has consistently been a potent predictor of improved ...survival for both hemodialysis and peritoneal dialysis patients. The benefits of RKF preservation challenge historical concepts of dialysis adequacy that have focused principally on achieving small-solute clearance targets. In this review, we highlight the evidence supporting the impact of RKF on survival and quality of life of dialysis patients and provide a mechanistic framework for this relationship. Current strategies to preserve RKF also are reviewed, emphasizing those used in patients treated with peritoneal dialysis.
Peritoneal dialysis (PD)-related peritonitis carries high morbidity for PD patients. Understanding the characteristics and risk factors for peritonitis can guide regional development of prevention ...strategies. We describe peritonitis rates and the associations of selected facility practices with peritonitis risk among countries participating in the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS).
Observational prospective cohort study.
7,051 adult PD patients in 209 facilities across 7 countries (Australia, New Zealand, Canada, Japan, Thailand, United Kingdom, United States).
Facility characteristics (census count, facility age, nurse to patient ratio) and selected facility practices (use of automated PD, use of icodextrin or biocompatible PD solutions, antibiotic prophylaxis strategies, duration of PD training).
Peritonitis rate (by country, overall and variation across facilities), microbiology patterns.
Poisson rate estimation, proportional rate models adjusted for selected patient case-mix variables.
2,272 peritonitis episodes were identified in 7,051 patients (crude rate, 0.28 episodes/patient-year). Facility peritonitis rates were variable within each country and exceeded 0.50/patient-year in 10% of facilities. Overall peritonitis rates, in episodes per patient-year, were 0.40 (95% CI, 0.36-0.46) in Thailand, 0.38 (95% CI, 0.32-0.46) in the United Kingdom, 0.35 (95% CI, 0.30-0.40) in Australia/New Zealand, 0.29 (95% CI, 0.26-0.32) in Canada, 0.27 (95% CI, 0.25-0.30) in Japan, and 0.26 (95% CI, 0.24-0.27) in the United States. The microbiology of peritonitis was similar across countries, except in Thailand, where Gram-negative infections and culture-negative peritonitis were more common. Facility size was positively associated with risk for peritonitis in Japan (rate ratio RR per 10 patients, 1.07; 95% CI, 1.04-1.09). Lower peritonitis risk was observed in facilities that had higher automated PD use (RR per 10 percentage points greater, 0.95; 95% CI, 0.91-1.00), facilities that used antibiotics at catheter insertion (RR, 0.83; 95% CI, 0.69-0.99), and facilities with PD training duration of 6 or more (vs <6) days (RR, 0.81; 95% CI, 0.68-0.96). Lower peritonitis risk was seen in facilities that used topical exit-site mupirocin or aminoglycoside ointment, but this association did not achieve conventional levels of statistical significance (RR, 0.79; 95% CI, 0.62-1.01).
Sampling variation, selection bias (rate estimates), and residual confounding (associations).
Important international differences exist in the risk for peritonitis that may result from varied and potentially modifiable treatment practices. These findings may inform future guidelines in potentially setting lower maximally acceptable peritonitis rates.
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Blindfolded Perl, Jeffrey M.
Common knowledge (New York, N.Y.),
01/2022, Volume:
28, Issue:
1
Journal Article
Peer reviewed
In a monograph-length contribution to the
symposium on contextualism, the journal's editor decontextualizes and then recontextualizes the medieval iconographic trope of Ecclesia and Synagoga in an ...effort to make plausible a news story about Pope Francis that received little coverage in the press. During 2015, the fiftieth anniversary of the Vatican II declaration
, Francis paid a surprise visit to a new statue in the United States, “Synagoga and Ecclesia in Our Time” by Joshua Koffman, as a sign of his endorsement of its radical reconsideration of a trope long associated with anti-Jewish sentiment in the Catholic Church. This article, which begins with a detailed analysis of Emeritus Pope Benedict XVI's essay on the
treatise
, deals primarily with twelfth- and thirteenth-century uses of the iconography. Special attention is paid to the Anagogical Window of the Royal Abbey of Saint-Denis and to the Ecclesia, Synagoga, and King Solomon statues on the south facade of Strasbourg Cathedral, in both of which is found previously overlooked evidence of philo-Semitic, rather than anti-Semitic, thinking on the part of the designers. The article concludes that contextualist scholars of medieval art have found what they expected to find and ignored contrary indications.
AbstractObjectiveTo determine the global capacity (availability, accessibility, quality, and affordability) to deliver kidney replacement therapy (dialysis and transplantation) and conservative ...kidney management.DesignInternational cross sectional survey.SettingInternational Society of Nephrology (ISN) survey of 182 countries from July to September 2018.ParticipantsKey stakeholders identified by ISN’s national and regional leaders.Main outcome measuresMarkers of national capacity to deliver core components of kidney replacement therapy and conservative kidney management.ResultsResponses were received from 160 (87.9%) of 182 countries, comprising 97.8% (7338.5 million of 7501.3 million) of the world’s population. A wide variation was found in capacity and structures for kidney replacement therapy and conservative kidney management—namely, funding mechanisms, health workforce, service delivery, and available technologies. Information on the prevalence of treated end stage kidney disease was available in 91 (42%) of 218 countries worldwide. Estimates varied more than 800-fold from 4 to 3392 per million population. Rwanda was the only low income country to report data on the prevalence of treated disease; 5 (<10%) of 53 African countries reported these data. Of 159 countries, 102 (64%) provided public funding for kidney replacement therapy. Sixty eight (43%) of 159 countries charged no fees at the point of care delivery and 34 (21%) made some charge. Haemodialysis was reported as available in 156 (100%) of 156 countries, peritoneal dialysis in 119 (76%) of 156 countries, and kidney transplantation in 114 (74%) of 155 countries. Dialysis and kidney transplantation were available to more than 50% of patients in only 108 (70%) and 45 (29%) of 154 countries that offered these services, respectively. Conservative kidney management was available in 124 (81%) of 154 countries. Worldwide, the median number of nephrologists was 9.96 per million population, which varied with income level.ConclusionsThese comprehensive data show the capacity of countries (including low income countries) to provide optimal care for patients with end stage kidney disease. They demonstrate substantial variability in the burden of such disease and capacity for kidney replacement therapy and conservative kidney management, which have implications for policy.
Full text
Available for:
BFBNIB, CMK, NMLJ, NUK, PNG, SAZU, UL, UM, UPUK
The coronavirus disease 2019 (COVID-19) pandemic, technological advancements, regulatory waivers, and user acceptance have converged to boost telehealth activities. Due to the state of emergency, ...regulatory waivers in the United States have made it possible for providers to deliver and bill for services across state lines for new and established patients through Health Insurance Portability and Accountability Act (HIPAA)- and non–HIPAA-compliant platforms with home as the originating site and without geographic restrictions. Platforms have been developed or purchased to perform videoconferencing, and interdisciplinary dialysis teams have adapted to perform virtual visits. Telehealth experiences and challenges encountered by dialysis providers, clinicians, nurses, and patients have exposed health care disparities in areas such as access to care, bandwidth connectivity, availability of devices to perform telehealth, and socioeconomic and language barriers. Future directions in telehealth use, quality measures, and research in telehealth use need to be explored. Telehealth during the public health emergency has changed the practice of health care, with the post–COVID-19 world unlikely to resemble the prior era. The future impact of telehealth in patient care in the United States remains to be seen, especially in the context of the Advancing American Kidney Health Initiative.
Abstract Background Sodium polystyrene sulfonate (Kayexalate; Sanofi-Aventis, Paris, France) is a cation-exchange resin routinely used in the management of hyperkalemia. However, its use has been ...associated with colonic necrosis and other fatal gastrointestinal adverse events. Although the addition of sorbitol to sodium polystyrene sulfonate preparations was previously believed to be the cause of gastrointestinal injury, recent reports have suggested that sodium polystyrene sulfonate itself may be toxic. Our objective was to systematically review case reports of adverse gastrointestinal events associated with sodium polystyrene sulfonate use. Methods MEDLINE (1948 to July 2011), EMBASE (1980 to July 2011), Cochrane Central Register of Controlled Trials (CENTRAL) (1993 to July 27, 2011), bibliographies of identified articles, and websites of relevant drug agencies and professional associations in the United States and Canada were reviewed to identify eligible reports of adverse gastrointestinal events associated with sodium polystyrene sulfonate use. Causality criteria of the World Health Organization causality assessment system were applied to each report. Results Thirty reports describing 58 cases (41 preparations containing sorbitol and 17 preparations without sorbitol) of adverse events were identified. The colon was the most common site of injury (n = 44; 76%), and transmural necrosis (n = 36; 62%) was the most common histopathologic lesion reported. Mortality was reported in 33% of these cases due to gastrointestinal injury. Conclusions Sodium polystyrene sulfonate use, both with and without sorbitol, may be associated with fatal gastrointestinal injury. Physicians must be cognizant of the risk of these adverse events when prescribing this therapy for the management of hyperkalemia.
Beyond Xenophilia Perl, Jeffrey M.
Common knowledge (New York, N.Y.),
01/2020, Volume:
26, Issue:
1
Journal Article
Peer reviewed
This essay, by the editor of
, responds to a piece by Dionigi Albera that, in turn, responds to Jeffrey Perl’s introduction, published in May 2017, to
’s multipart symposium on xenophilia. Albera ...argues that the ambivalence that Perl observes in many instances of xenophilia needs genealogical explanation, and Albera turns for this purpose to analysis of the relationship between Aphrodite and Ares in Greco-Roman mythology. In the present piece, Perl extends that exploration in analysis of a series of images in which the gods of love and war, along with their illegimate children Eros and Phobos (or
and
), are given comical and often vulgar treatment by artists ranging from Botticelli and Mantegna, in the fifteenth century; to Titian, Veronese, and Tintoretto, in the sixteenth; to Rubens, Jan Bruegel the Elder, and Poussin, in the seventeenth; to Lagrenée, in the eighteenth; to David and Guillemot, in the nineteenth; to Jeff Koons in our own day. Perl and Albera agree with these artists that the antithetical pair, Aphrodite and Ares, have a fully logical, if furtive relationship in mythology, iconography, and psychology. The idealization to which the comic images respond—that when warriors make love, there is no warfare—is laughed, again and again, out of court. But Perl’s concern, unlike Albera’s, is that this cynicism on the part of artists and advanced intellectuals means that, despite their ostensible preference for peace over conflict, they will always find cause to undermine every effort to make way for peace.
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