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Christopher R Blagg

Publications and source records attributed to Christopher R Blagg.

15 recordsLinked to original sources
PubMed2006

Home haemodialysis-international trends and variation.

BACKGROUND: Home haemodialysis (HD) has the best patient outcomes and is the most cost-effective of any dialysis modality, but its use has been declining in many countries. METHODS: Point prevalence rates of different dialysis modalities and transplantation were obtained from national and regional registries for the most recent available year (2001-03) for 21 high-income and 12 middle-income countries. Relationships with median age and prevalence of diabetic nephropathy, healthcare expenditure and population density were assessed. Long-term trends in the use of home HD during the last two to four decades were obtained for seven countries. RESULTS: The prevalence of home HD varies from 0 to 58.4 per million population, and varies between countries, more than any other renal replacement therapy (RRT) modality. There is a positive association between the use of peritoneal dialysis and home HD (Spearman's rho = 0.531, P = 0.013), but no correlation with transplantation prevalence. There is a negative correlation with median age of the renal replacement population (rho = -0.552, P = 0.018). There is no association with prevalence of diabetic nephropathy, healthcare expenditure or population density. Temporal trends in home HD prevalence are dramatically different in different countries, with several countries expanding its use in the last few years. CONCLUSION: The use of home HD varies dramatically between and within countries. The variation cannot be explained by the variation in the use of other RRT modalities, nor by prevalence of diabetic nephropathy, national wealth or population density. The inverse correlation with median age is difficult to explain. Significant expansion of home HD is likely to be possible in most countries, and will be increasingly important as the impressive results of more frequent HD gain credence.

Health Services Needs and Demand↗
PubMed2006

Comparison of survival between short-daily hemodialysis and conventional hemodialysis using the standardized mortality ratio.

More frequent hemodialysis (5 or more times weekly, both short during the day and long overnight) has been shown to improve patient well-being, reduce symptoms during and between treatments, and have beneficial effects on clinical outcomes. Because of the relatively small patient sample sizes, there are little or no data on mortality from any single study at this time. This study compares survival in 117 U.S. patients treated by short-daily hemodialysis in 2003 and 2004, with patients reported in the 2003 data from the United States Renal Data System (USRDS). Expected mortality was calculated from the USRDS and compared with observed actual mortality. The standardized mortality ratio (SMR) was used to adjust for differences in patient age, sex, race, and cause of renal failure. The SMR for the short-daily hemodialysis patients was 0.39, statistically significantly better (p < 0.005) than data from the overall U.S. population of hemodialysis patients and indicating that daily hemodialysis patients had a 61% better survival. Patients treated by short-daily hemodialysis have a better survival rate than comparable populations treated by conventional hemodialysis.

Adult↗
PubMed2006

Daily dialyses decrease plasma levels of brain natriuretic peptide (BNP), a biomarker of left ventricular dysfunction.

Brain natriuretic peptide or B-type natriuretic peptide (BNP) is a sensitive marker of heart disease. Plasma levels of BNP increase in left ventricular failure and determination of plasma BNP has become a useful tool in the diagnosis of heart failure. Hemodialysis (HD) patients may have elevated plasma levels of BNP, particularly predialysis, that correlate with echocardiographic signs of left ventricular dysfunction. High BNP levels are also a strong predictor of mortality in both nonrenal and HD patients. We studied plasma BNP levels in patients who changed from conventional thrice-weekly dialysis to daily dialysis 6 times a week while maintaining a total weekly time on dialysis of 12 hr. Twelve HD patients, mean age 55 years, had 4 hr of conventional thrice-weekly treatment for 4 weeks. Predialysis and postdialysis blood samples were obtained at the last dialysis. Patients were then dialyzed for 2 hr, 6 times weekly, for 4 weeks (daily dialysis). Again, predialysis and postdialysis blood samples were collected at the last HD. Brain natriuretic peptide plasma concentrations were determined by immunoradiometric assay. Predialysis BNP levels decreased from 194+/-51 ng/L (68+/-19 pmol/L; mean+SE) during thrice-weekly HD to 113+/-45 ng/L (41+/-18 pmol/L; p = 0.001) after 4 weeks on daily dialysis. With thrice-weekly HD, predialysis BNP levels were higher than postdialysis levels: 120+/-26 ng/L (39+/-8 pmol/L; p = 0.059). With daily dialysis, predialysis BNP levels did not differ significantly from postdialysis levels. Elevated predialysis plasma levels of BNP, considered sensitive and early markers of left ventricular dysfunction, decreased when patients were changed from conventional thrice-weekly HD to daily dialysis maintaining total hours of dialysis per week constant. Given the accumulated evidence that BNP is a biomarker of left ventricular dysfunction and can be used for risk stratification and guidance in pharmacotherapy of heart failure, daily dialysis appears to lead to less cardiac distress.

Adult↗
PubMed2005

Home haemodialysis: 'home, home, sweet, sweet home!'.

Home haemodialysis was first developed 40 years ago as a means of treating more patients with the limited funds then available. It soon became obvious that the treatment worked well and subsequent studies and experience have confirmed that it improves both mortality and morbidity and provides the best quality of life and other benefits for dialysis patients. The present review describes the history of the development of home haemodialysis in Seattle and elsewhere and the lessons learned about its benefits in the early days, which are just as relevant today. The advantages and disadvantages are discussed, as are the issues of which patients are candidates for this treatment and what is required of a home haemodialysis training and support programme. The decline in use of home haemodialysis in the USA and elsewhere is described and the actions that may already be beginning to reverse this trend. The role of home haemodialysis in giving the opportunity for longer hours of dialysis three times a week or on alternate nights is important. There is discussion of the relationship of home haemodialysis and peritoneal dialysis and its important future role as the means to enable treatment with more frequent short daily and long nightly haemodialysis.

Canada↗
PubMed2004

Early clinical, quality-of-life, and biochemical changes of "daily hemodialysis" (6 dialyses per week).

BACKGROUND: Advantages associated with an increased frequency of hemodialysis have been reported previously. However, previous studies were either small or not controlled and did not detail early clinical, biochemical, quality-of-life, urea kinetic, and dynamic changes when patients switched from a conventional (3 times/wk) dialysis regimen to "daily" (6 times/wk) dialysis therapy when total weekly dialysis time was unchanged. METHODS: A prospective sequential study with 21 patients as their own controls was performed. A 4-week period of conventional thrice-weekly dialysis (N = 240 treatments) was followed immediately by a 4-week period of daily (ie, 6 times/wk) dialysis (N = 480 treatments), in which each treatment was half the length of a conventional dialysis treatment session. Clinical parameters and symptoms during and between dialysis treatments were graded, and urea-related parameters, blood chemistry results, and nutritional data were determined. RESULTS: Within 4 weeks of switching to this daily dialysis regimen, there were improvements in blood pressure, dialysis "unphysiology," intradialytic and interdialytic symptoms, and urea kinetics and dynamics. There were fewer machine alarms and less need for nursing interventions during dialysis. Nutrition and quality of life began to improve. There was no increase in blood access complications and no significant changes in blood chemistry results, hematologic parameters, or use of medications. CONCLUSION: In this short-term study, daily dialysis appears to be a safe, better, and more physiological method to deliver dialysis care to patients with end-stage renal disease.

Adult↗
PubMedDate not supplied

Blood access and daily hemodialysis: clinical experience and review of the literature.

The present authors studied longevity and complications with fistulae, grafts, and central venous catheters in 23 patients on daily hemodialysis for a total of 409 patient months (mean 18 +/- 10 months) and 9,209 dialyses. Fourteen patients had fistulae, five had grafts, and four had catheters. These required one, one, and two replacements respectively during a total observation time of 254, 105, and 50 patient months. Fistulae required 0.05 replacements per year vs. 0.11 replacements per year for grafts and 0.48 replacements per year for catheters (p = 0.042, fistulae vs. other accesses). Cumulative survival at 15 months was 100% for fistulae, 80% for grafts, and 20% for catheters, and at 3 years it was 80% for fistulae and grafts. No catheter survived beyond 15 months (p = 0.041). Twenty-seven events required hospitalization or an outpatient intervention. Fistulae had 0.52 events per patient year, grafts 1.37 events per patient year, and catheters 1.44 events per patient year (p = 0.080, fistulae vs. other accesses). Patients with fistulae reported more problems between dialyses, these occurring on 3.2% of the observation days compared with 0.2% for grafts and 0.4% for catheters (p < 0.0001). Eighty-five percent of these problems were pain and redness at the access site. During dialysis, there were more problems with catheters (9.1% vs. fistulae 2.7% and grafts 0.9%, p < 0.0001). Complications and survival data were similar to those reported with daily hemodialysis by others and better than data from reports of access problems with conventional three times weekly hemodialysis. In conclusion, daily hemodialysis does not adversely affect the usual types of blood access. Survival was best and need for intervention was least with fistulae and worst with catheters. Grafts, when functioning, had fewer problems both between and during dialyses.

Adult↗
PubMedDate not supplied

The Aksys personal hemodialysis system.

The Aksys personal hemodialysis system empowers patients to dialyze where, when, and how they want. It allows them to easily do the best dialysis--daily hemodialysis--in the safest place--at home--by simplifying operation (almost anyone can do it), doing the drudgery work of dialysis (the patient is the master, not the slave of the dialysis machine, giving patients their lives back), needing no bulky disposables (patients have their homes back), reducing emergencies during dialysis, and performing immediate fluid resuscitation on demand.

Clinical Trials as Topic↗
PubMedDate not supplied

Belding Hibbard Scribner, the individual: a brief biography.

The paper gives a short biography of Belding Hibbard Scribner (1921-2003) and discusses his contribution to therapy of renal disease. A particular emphasis is given to peritoneal dialysis, the Teflon shunt and the first out-hospital dialysis unit.

History, 20th Century↗