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Who's on duty at the "end" in ESRD?

August 17, 2010

FEATURED SEARCH: end stage renal disease

Perhaps you already saw this healthcare quality study in JAMA, based on records of more than 41,000 patients with end-stage renal disease (ESRD). It shows wide regional variations on how quickly ESRD patients begin dialysis, whether or not they ever stop, and what happens as they reach the end of life. In general, nephrologists don't seem to focus much on the quality of ESRD patients' life outside the dialysis clinic or on their wishes about treatment. That's still up to primary care, until someone issues better guidelines—and even afterward. A recent review of care for chronic kidney disease clearly places the onus for education and patient dialogue on primary care doctors.

RESULT: Regional Variation in Health Care Intensity and Treatment Practices for End-stage Renal Disease in Older Adult
JAMA | Jul 14, 2010

RESULT: Chronic Kidney Disease in Primary Care
Journal of the American Board of Family Medicine | Jul 1, 2010

There is progress in understanding the issues that face ESRD patients as their disease progresses. Hong Kong specialists report that systolic dysfunction is a strong predictor of sudden cardiac death, which is common in ESRD. Apparently ever more ESRD patients are having coronary bypass, despite substantial comorbidities and a mortality risk three times higher than average, and doctors at Brigham & Women's in Boston have created an algorithm to predict which patients with chronic kidney disease are likely to survive the procedure.

RESULT: Sudden Cardiac Death in End-Stage Renal Disease Patients: A 5-Year Prospective Analysis
Hypertension | Aug 1, 2010

RESULT: Perioperative outcomes among patients with end-stage renal disease following coronary artery bypass surgery in the USA
Nephrology Dialysis Transplantation | Jul 1, 2010

RESULT: Long and short-term outcomes following coronary artery bypass grafting in patients with and without chronic kidney disease
Nephrology Dialysis Transplantation | Jun 15, 2010

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Search: stem cell transplantation for multiple sclerosis

Despite high hopes, for the moment it seems that hematopoietic stem cell transplants are not a promising intervention for multiple sclerosis.

RESULT: Neuroinflammation and demyelination in multiple sclerosis after allogeneic hematopoietic stem cell transplantation
Archives of Neurology | Jun 1, 2010

Search: prostate cancer

Because there's still no very good way to predict which early prostate cancers will be aggressive, screening with PSA has failed its mandate, according to the editorial below, which urges watchful waiting rather than intervention in most cases—including many "treatment failures" (biochemical recurrences after surgery or radiation). The editorial responds to recent studies in Archives that document with solid data the adage that most men die with, not of, prostate cancer and show that many men who have relatively low-risk PSA levels are getting aggressive treatment with no compelling benefit.

RESULT: Prostate Cancer: Doing Less Might Be More
Archives of Internal Medicine | Aug 9, 2010

 

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