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Conservative kidney management practice patterns in The United States: A ckdopps analysis [Meeting Abstract]

Scherer, J S; Muenz, D G; Bieber, B; Stengel, B; Masud, T; Robinson, B M; Pecoits-Filho, R; Goldfeld, K S; Chodosh, J; Charytan, D M
Background: Conservative kidney management (CKM) of kidney failure is an important treatment option for many patients. However, its availability in the United States (US) is not well described. We describe CKM resources and provider practice patterns in US Chronic Kidney Disease (CKD) clinics.
Method(s): Cross sectional analysis of provider surveys (n=22) from unique clinics in the US from the CKD Outcomes and Practice Patterns Study (CKDopps) collected between 2014-2017.
Result(s): Only eight (36%) providers reported involving palliative care in planning for and educating patients about kidney failure. A majority (59%) were extremely comfortable discussing CKM and nearly 100% typically discussed CKM as a treatment option. Nearly all (95%) reported their clinics had the ability to routinely deliver CKM, but only one had a CKM protocol or guideline, and none offered a specific CKM clinic. Most providers said their clinics used the word conservative to describe CKM, with 24% choosing palliative or supportive terminology. Regardless of involvement of PC, most providers estimated that 5% of their patients with or approaching kidney failure were managed with CKM. Patient preference, functional status, frailty, and comorbidities were the most important factors influencing provider decisions in contemplating the suitability of CKM for patients. (Figure 1)
Conclusion(s): Most providers report feeling comfortable discussing CKM, yet almost no clinics report resources or dedicated infrastructure for CKM delivery. Despite reported high frequency of discussing CKM, few patients were described as choosing this treatment pathway. Factors that influence consideration of CKM are consistent with elements that generally influence well-informed geriatric and end-of-life care. Efforts to improve assessment of those elements may allow for more informed recommendations of CKM
ISSN: 1533-3450
CID: 5179742

Lower transferrin saturation (TSAT) index is associated with an anemia-independent risk of increased mortality in non-dialysis (ND) CKD patients [Meeting Abstract]

Guedes, M H; Muenz, D G; Zee, J; Bieber, B; Wachter, S; Stengel, B; Massy, Z; Reichel, H; Charytan, D M; Wong, M M; Pisoni, R L; Robinson, B M; Pecoits-Filho, R
Background: Iron Deficiency (ID), defined by a TSAT index <20 %, is present in approximately half of ND-CKD patients, varying little by CKD stage. Distinct from approaches in conditions such as heart failure, the importance of iron reserves and the basis for iron therapy in CKD has focused primarily on supporting effective erythropoiesis. A comprehensive approach and design to estimate the impact of ID, independently from hemoglobin (Hb) levels, on mortality risk has not been explored in ND-CKD until the present.
Method(s): 5144 patients from Brazil (N=294), France (N=2227), the US (N=494), and Germany (N=2129) enrolled in the Chronic Kidney Disease Outcomes and Practice Patterns Study (CKDopps) from 2013-2019 with available TSAT were included in the analysis. We categorized patients by first available TSAT at enrollment. Hb measurements at same time as TSAT were used. Cox models were used to estimate hazard ratios (HR) of TSAT on mortality, censored at start of dialysis or kidney transplantation. Models were progressively adjusted for confounders, including demographics, comorbidities, inflammation surrogates, treatment with erythropoietin stimulating-agents and Hb.
Result(s): Sample characteristics were: 59% male; 45% diabetes; and mean (SD) age 69 (13) years, eGFR 28 (11) mL/min, Hb 12 (2) g/dL, TSAT 24 (2) %, ferritin 196 (214) ng/dL. TSAT levels below 25% were progressively associated with higher mortality risk, while patients with TSAT greater than 45% tended to have higher risks for mortality (Figure).
Conclusion(s): ID, as measured by the TSAT index, is associated with higher risk of all-cause mortality in ND-CKD patients, even after extensive adjustments for clinical, demographic and biochemical confounders, including Hb levels. Interventional studies evaluating the impact of iron supplementation and alternative targets on clinical outcomes in ND-CKD patients are needed to better inform ID management strategies
ISSN: 1533-3450
CID: 4752642

Trigger point injections

Chapter by: Bieber, Benjamin; Ryan, Devon
in: Spinal disorders and treatments : the NYU-HJD comprehensive textbook by Errico, Thomas J; Cheriyan, Thomas; Varlotta, Gerard P [Eds]
New Delhi : Jaypee Brothers, 2015
pp. 200-204
ISBN: 9351524957
CID: 2709252