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The study examines the effect of limiting the intake of phosphorus-containing food additives on serum phosphorus levels among patients with end-stage renal disease. Findings suggest educating patients to avoid phosphorus-containing food additives leads to modest improvements in hyperphosphatemia.

A study aims to determine the impact of informing resource-poor rural populations about entitled health and social services in India. The results concluded that informing the population enhanced delivery of health and social care services.

Quality improvement efforts may eliminate some disparities in medical care among different ethnic groups but not others. In a study of 58,700 patients with kidney failure who received dialysis, 87% of white patients and 84% of black patients received an adequate dose in 2000. In 1993, those figures were 46% and 36%, respectively. However, blacks and women were less likely to be treated for anemia than white men in both time periods.

It may not be a good idea to pay people to donate an organ such as a kidney while they are still alive. A survey of 305 people who had sold a kidney in India found that most experienced a decline in their health after the surgery and the money they received in exchange did not improve their standard of living. Seventy-nine percent said they would not recommend selling a kidney.

Doctors may be able to lower mortality rates in US dialysis patients by using a fistula or graft rather than a catheter, treating the patient more often, and increasing the duration of dialysis. US dialysis patients have the highest mortality rates in the industrialized world., Context Mortality rates among US hemodialysis patients are the highest in the industrialized world at 23% per year. Measures of dialysis dose (Kt/V) correspond strongly with survival and are inadequate in one sixth of patients. Inadequate dialysis is also associated with increased hospitalizations and high inpatient costs. Our previous work identified 3 barriers to adequate hemodialysis: dialysis underprescription, catheter use, and shortened treatment time. Objective To determine the effect of a tailored intervention on adequacy of hemodialysis. Design and Setting Community-based randomized controlled trial with recruitment from April 1999 to June 2000 at 29 hemodialysis facilities in northeast Ohio. Participants Forty-four nephrologists and their 169 randomly selected adult patients receiving inadequate hemodialysis. Intervention Nephrologists were randomly assigned to an intervention (n=21) or control (n=23) group. For patients in the intervention group (n=85), depending on the barrier(s) present, a study coordinator gave nephrologists recommendations about optimizing dialysis prescriptions, expedited conversion of catheters to surgically created grafts or fistulas, and educated patients about the importance of compliance with treatment time. Patients in the control group (n=84) continued to receive usual care. Main Outcome Measures Changes in Kt/V and specific barriers after 6 months. Results At baseline, intervention and control patients had similar Kt/V measurements, specific barriers, and demographic and medical characteristics. After 6 months, intervention patients had 2-fold larger increases in Kt/V compared with control patients (+0.20 vs +0.10; P Conclusions An intervention tailored to patient-specific barriers resulted in increased hemodialysis dose. Extending this approach to the 33000 persons in the United States receiving inadequate hemodialysis may substantially enhance patient survival, diminish hospitalizations, and decrease inpatient expenditures.

Background. Without family caregivers, many frail elders who live at home would require nursing home care. However, providing care to frail elders requires a large time commitment that may interfere with the caregiver's ability to work. Our goal was to determine the patient and caregiver characteristics associated with the reduction of employment hours in caregivers of frail elders. Methods. This was a cross-sectional study of 2806 patients (mean age 78, 73% women, 29% African American, 12% Hispanic, 54% with dementia) with at least one potentially working caregiver (defined as one who is either currently employed or who would have been employed if they had not been providing care) and their 4592 potentially working caregivers. Patients were enrollees at 11 sites of the Program of All-Inclusive Care for the Elderly (PACE). Social workers interviewed patients and caregivers at the time of PACE enrollment. Caregivers were asked if they had reduced the hours they worked or had stopped working to care for the patient. Nurses interviewed patients and caregivers to assess independence in activities of daily living (ADLs) and the presence of behavioral disturbances. Comorbid conditions were assessed by physicians during enrollment examinations. Results. A total of 604 (22%) of the 2806 patients had at least one caregiver who either reduced the number of hours they worked or quit working to care for the patient. Patient characteristics independently associated with a caregiver reducing hours or quitting work were ethnicity (odds ratio [OR] = 1.42, 95% confidence interval [CI] 1.14-1.78 for African American; OR = 1.90, 95% CI 1.43-2.52 for Hispanic), ADL function below the median (OR = 1.76, 95% CI 1.44-2.15), a diagnosis of dementia (OR = 1.68, 95% CI = 1.31-2.17 if associated with a behavioral disturbance; OR = 1.31, 95% CI 1.06-1.63 if not associated with a behavioral disturbance), or a history of stroke (OR = 1.42, 95% CI 1.16-1.73). After controlling for these patient characteristics, caregiver characteristics associated with reducing work hours included being the daughter or daughter-in-law of the patient (OR = 1.69, 95% CI 1.37-2.08) and living with the patient (OR = 4.66, 95% CI 3.65-5.95 if no other caregiver lived at home, OR = 2.53, 95% CI 2.03-3.14 if another caregiver lived at home). Conclusions. Many caregivers reduce the number of hours they work to care for frail elderly relatives. The burden of reduced employment is more likely to be incurred by the families of ethnic minorities and of patients with specific clinical characteristics. Daughters and caregivers who live with the patient are more likely to reduce work hours than other caregivers. Future research should examine the impact of lost caregiver employment on patients' families and the ways in which the societal responsibility of caring for frail elders can be equitably shared.

Background: Failure of a previously transplanted kidney is a common cause of end-stage renal disease (ESRD) and represents 5% of incident dialysis patients in the United States. Patients with native kidney failure ESRD (Nat-ESRD) who receive predialysis care from a nephrologist have better outcomes in the first 12 months on dialysis than those who don't. Because many patients with a failed kidney transplant ESRD (Tx-ESRD) receive care from nephrologists, they would also be expected to have good dialysis outcomes. We sought to compare the quality metrics of Tx-ESRD patients and Nat-ESRD patients during the first 12 months of hemodialysis.Methods: We used data from the United States Renal Data System to identify hemodialysis patients who began treatment between May 2012 and December 2013 and who received nephrology care prior to starting hemodialysis. Quality metrics by quarter for the first 12 months of treatment were dichotomized according to practice guidelines to determine the percentage of patients in each quarter who met quality of care goals.Results: Compared to Nat-ESRD (n = 96,063) patients, Tx-ESRD (n = 5,528) patients had 10-19% lower rates of at goal hemoglobin levels, 6-12% lower rates of at goal serum phosphorus, and 3-11% lower rates of at goal albumin levels. Compared to Nat-ESRD patients, -Tx-ESRD patients had a 6% higher rate of fistula use in the first quarter but a 3-7% lower rate in subsequent quarters.Conclusions: Tx-ESRD patients have worse quality metrics related to anemia, phosphorus, albumin, and vascular access compared to Nat-ESRD patients. Nephrology care for patients with Tx-ESRD should be improved to address these quality metrics gaps. [ABSTRACT FROM AUTHOR]

Dialysis patients in Germany and Japan are much less likely to have advance directives than American dialysis patients. Researchers surveyed 72 American nephrologists, 87 German nephrologists and 73 Japanese nephrologists. The American nephrologists had stopped dialysis for 5% of their patients, while the German nephrologists had withdrawn only 1.6% of their patients and the Japanese nephrologists only 0.7% of their patients. Only 0.3% of Japanese and German patients had advance directives compared to 30% of the American dialysis patients.