Hemodialysis clinical practice guidelines for the Canadian Society of Nephrology.
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Adult↗
Biomedical subjects
Steven D Soroka
Publications and source records attributed to Steven D Soroka.
The marginal cost of satellite versus in-center hemodialysis.
BACKGROUND: Despite increasing numbers of patients receiving hemodialysis in satellite units (SHD), the economic aspects have not been widely explored. A cost analysis of SHD and in-center hemodialysis (ICHD) from a societal perspective was performed to establish the efficiencies associated with shifting resources and patients from ICHD to SHD. METHODS: Costs were classified as fixed or variable and placed into categories. The resources for operating a SHD unit are the sum of two components: total fixed costs (TFC) and average variable cost (AVC) times SHD patient volume (Q). Using the TFC of a specific-sized SHD unit and the difference in AVC between ICHD and SHD the number of patients needed (Q) in the SHD unit for financial viability was determined. The formula TFC = (AVC(ICHD) - AVC(SHD)) X Q was used to determine the number of patients (Q) needed in a specific-sized SHD unit such that the yearly cost of SHD treatment would be the same as ICHD treatment. RESULTS: Our results show that SHD fixed costs can be fully offset if the volume of SHD patients is seven per year in a six-station unit. SHD costs were lower for nursing and physician fees. Therefore, ICHD care variable costs were $11,374 more per patient year. SHD patients would also have lower travel costs, a mean cost saving of $12,364 per year. CONCLUSION: SHD can result in significant savings both to the health-care system and to patients. Using the cost categories and formula presented, the number of patients needed in a specific-sized satellite unit to realize cost savings was determined for our program. We found that these savings can offset the fixed investment needed to operate a SHD unit at modest patient volumes.
Ambulatory Care Facilities↗
HealthInfoCDA: Case Composition Using Electronic Health Record Data Sources.
HealthInfoCDA denotes a health informatics educational intervention for learning about the clinical process through use of the Clinical Document Architecture (CDA). We hypothesize those common standards for an electronic health record can provide content for a case base for learning how to make decisions. The medical record provides a shared context to coordinate delivery of healthcare and is a boundary object that satisfies the informational requirement of multiple communities of practice. This study transforms clinical narrative in three knowledge-rich modalities: case write-up, patient record and online desk reference to develop a case base of experiential clinical knowledge useful for medical and health informatics education. Our ultimate purpose is to aggregate concepts into knowledge elements for case-based teaching.
Biomedical Research↗
Randomized, controlled trial of darbepoetin alfa for the treatment of anemia in hemodialysis patients.
BACKGROUND: Darbepoetin alfa (Aranesp; Amgen, Thousand Oaks, CA) is a new erythropoiesis-stimulating protein with a threefold longer terminal half-life than recombinant human erythropoietin (epoetin) in patients with chronic kidney disease (CKD). The purpose of this randomized, double-blind, noninferiority study is to determine whether darbepoetin alfa is as effective as epoetin for the treatment of anemia in hemodialysis patients when administered at a reduced dosing frequency. METHODS: Patients receiving epoetin therapy were randomized to continue epoetin administered intravenously (IV) three times weekly (n = 338) or change to darbepoetin alfa administered IV once weekly (n = 169). The dose of darbepoetin alfa or epoetin was individually titrated to maintain hemoglobin concentrations within -1.0 to +1.5 g/dL (-10 to +15 g/L) of patients' baseline values and within a range of 9.0 to 13.0 g/dL (90 to 130 g/L) for up to 28 weeks (20-week dose-titration period followed by an 8-week evaluation period). The primary end point was change in hemoglobin level between baseline and the evaluation period (weeks 21 to 28). RESULTS: Mean changes in hemoglobin levels from baseline to the evaluation period were 0.24 +/- 0.10 (SE) g/dL (2.4 +/- 1.0 g/L) in the darbepoetin alfa group and 0.11 +/- 0.07 g/dL (1.1 +/- 0.7 g/L) in the epoetin group, a difference of 0.13 g/dL (95% confidence interval [CI], -0.08 +/- 0.33 [1.3 g/L; 95% CI, -0.8 to 3.3]). This difference was not statistically significant or clinically relevant despite the reduced frequency of darbepoetin alfa administration. The safety profile of darbepoetin alfa was similar to that of epoetin, and no antibody formation to either treatment was detected. CONCLUSION: These results show that darbepoetin alfa maintains hemoglobin concentrations as effectively and safely as epoetin in patients with CKD, but with a reduced dosing frequency.
Adult↗