| 1. |
- Ghani, Zartashia, et al.
(author)
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The effect of peritoneal dialysis on labor market outcomes compared with institutional hemodialysis
- 2019
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In: Peritoneal Dialysis International. - : SAGE Publications. - 1718-4304 .- 0896-8608. ; 39:1, s. 59-65
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Journal article (peer-reviewed)abstract
- BACKGROUND: The aim of this study is to compare the impact of peritoneal dialysis (PD) and institutional hemodialysis (IHD), the 2 most common dialysis modalities, on employment, work income, and disability pension in Sweden.METHODS: Included in this study were 4,734 patients in IHD and PD, aged 20 - 60 years, starting treatment in Sweden during 1995 - 2012, and surviving the first year of dialysis therapy. Both "intention to treat" and "on treatment" analyses were performed by including transplant patients into the former and censoring them at the date of transplant in the latter analysis. A reduced bias treatment effect of PD vs IHD on labor market outcomes was esti-mated while accounting for non-random selection into treatment.RESULTS: Peritoneal dialysis was found to be associated with a 4-percentage-point increased probability of employment compared with IHD in the "on treatment" analysis. Also, PD was associated with a reduced disability pension by 6 percentage points, as well as increased work income (EUR 3,477 for employed) compared with IHD during the first year of treatment. The "intention to treat" analysis tended to give higher effect sizes compared with "on treatment."CONCLUSIONS: The results indicate that PD is associated with a treatment advantage over IHD in terms of increased employment, work income, and reduced disability pension in the Swedish popu-lation after controlling for non-random selection into treatment.
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| 2. |
- Helgesson, Gert, et al.
(author)
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Ethical aspects of diagnosis and interventions for children with fetal alcohol Spectrum disorder (FASD) and their families
- 2018
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In: BMC Medical Ethics. - : BIOMED CENTRAL LTD. - 1472-6939. ; 19
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Journal article (peer-reviewed)abstract
- Background: Fetal alcohol spectrum disorders (FASD) is an umbrella term covering several conditions for which alcohol consumption during pregnancy is taken to play a causal role. The benefit of individuals being identified with a condition within FASD remains controversial. The objective of the present study was to identify ethical aspects and consequences of diagnostics, interventions, and family support in relation to FASD.Methods: Ethical aspects relating to diagnostics, interventions, and family support regarding FASD were compiled and discussed, drawing on a series of discussions with experts in the field, published literature, and medical ethicists.Results: Several advantages and disadvantages in regards of obtaining a diagnosis or description of the condition were identified. For instance, it provides an explanation and potential preparedness for not yet encountered difficulties, which may play an essential role in acquiring much needed help and support from health care, school, and the socia ! services. There are no interventions specifically evaluated for FASD conditions, but training programs and family support for conditions with symptoms overlapping with FASD, e.g. ADHD, autism, and intellectual disability, are likely to be relevant. Stigmatization, blame, and guilt are potential downsides. There might also be unfortunate prioritization if individuals with equal needs are treated differently depending on whether or not they meet the criteria for a specific condition. Conclusions: The value for the concerned individuals of obtaining a FASD-related description of their condition - for instance, in terms of wellbeing - is not established. Nor is it established that allocating resources based, on whether individuals fulfil FASD-related criteria is justified, compared to allocations directed to the most prominent specific needs.
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| 3. |
- Rydell, Helena, et al.
(author)
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Fewer hospitalizations and prolonged technique survival with home hemodialysis- a matched cohort study from the Swedish Renal Registry
- 2019
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In: BMC Nephrology. - : Springer Science and Business Media LLC. - 1471-2369. ; 20:1
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Journal article (peer-reviewed)abstract
- Background: Patients on home hemodialysis (HHD) exhibit superior survival compared with patients on institutional hemodialysis (IHD) and peritoneal dialysis (PD). There is a sparsity of reports comparing morbidity between HHD and IHD or PD and none in a European population. The aim of this study is to compare morbidity between modalities in a Swedish population. Methods: The Swedish Renal Registry was used to retrieve patients starting on HHD, IHD or PD. Patients were matched according to sex, age, comorbidity and start date. The Swedish Inpatient Registry was used to determine comorbidity before starting renal replacement therapy (RRT) and hospital admissions during RRT. Dialysis technique survival was compared between HHD and PD. Results: RRT was initiated with HHD for 152 patients; these were matched with 608 patients with IHD and 456 with PD. Patients with HHD had significantly lower annual admission rate and number of days in hospital. (median 1.7 admissions; 12 days) compared with IHD (2.2; 14) and PD (2.8; 20). The annual admission rate was significantly lower for patients with HHD compared with IHD for cardiovascular diagnoses and compared with PD for infectious disease diagnoses. Dialysis technique survival was significantly longer with HHD compared with PD. Conclusions: Patients choosing HHD as initial RRT spend less time in hospital compared with patients on IHD and PD and they were more likely than PD patients, to remain on their initial modality. These advantages, in combination with better survival and higher likelihood of renal transplantation, are important incentives for promoting the use of HHD.
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| 4. |
- Rydell, Helena, et al.
(author)
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Home- or Institutional Hemodialysis? - a Matched Pair-Cohort Study Comparing Survival and Some Modifiable Factors Related to Survival
- 2016
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In: Kidney & Blood Pressure Research. - : S. Karger AG. - 1420-4096 .- 1423-0143. ; 41:4, s. 392-401
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Journal article (peer-reviewed)abstract
- Background/Aims: Survival for dialysis patients is poor. Earlier studies have shown better survival in home-hemodialysis (HHD). The aims of this study are to compare survival for matched patients with HHD and institutional hemodialysis (IHD) and to elucidate the effect on factors related to survival such as hyperphosphatemia, fluid overload and anemia. Methods: In this retrospective, observational study, incident patients starting HHD and IHD were matched according to sex, age, comorbidity and date of start. Survival analysis was performed both as ”intention to treat” including renal transplantation and ”on treatment” with censoring at the date of transplantation. Dialysis doses, laboratory parameters and prescriptions of medications were compared. Results: After matching, 41 pairs of patients, with HHD and IHD, were included. Survival among HHD patients was longer compared with IHD, median survival being 17.3 and 13.0 years (p=0.016), respectively. The “on treatment” analysis, also favoured HHD (p=0.015). HHD patients had lower phosphate, 1.5 mmol/L compared with 2.1 mmol/L (p
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| 5. |
- Rydell, Helena, et al.
(author)
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Improved long-term survival with home hemodialysis compared with institutional hemodialysis and peritoneal dialysis : A matched cohort study
- 2019
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In: BMC Nephrology. - : Springer Science and Business Media LLC. - 1471-2369. ; 20:1
-
Journal article (peer-reviewed)abstract
- Background: The survival rate for dialysis patients is poor. Previous studies have shown improved survival with home hemodialysis (HHD), but this could be due to patient selection, since HHD patients tend to be younger and healthier. The aim of the present study is to analyse the long-term effects of HHD on patient survival and on subsequent renal transplantation, compared with institutional hemodialysis (IHD) and peritoneal dialysis (PD), taking age and comorbidity into account. Methods: Patients starting HHD as initial renal replacement therapy (RRT) were matched with patients on IHD or PD, according to gender, age, Charlson Comorbidity Index and start date of RRT, using the Swedish Renal Registry from 1991 to 2012. Survival analyses were performed as intention-to-treat (disregarding changes in RRT) and per-protocol (as on initial RRT). Results: A total of 152 patients with HHD as initial RRT were matched with 608 IHD and 456 PD patients, respectively. Median survival was longer for HHD in intention-to-treat analyses: 18.5 years compared with 11.9 for IHD (p < 0.001) and 15.0 for PD (p = 0.002). The difference remained significant in per-protocol analyses omitting the contribution of subsequent transplantation. Patients on HHD were more likely to receive a renal transplant compared with IHD and PD, although treatment modality did not affect subsequent graft survival (p > 0.05). Conclusion: HHD as initial RRT showed improved long-term patient survival compared with IHD and PD. This survival advantage persisted after matching and adjusting for a higher transplantation rate. Dialysis modality had no impact on subsequent graft survival.
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| 6. |
- Rydell, Helena
(author)
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Long-term prognosis with home hemodialysis. A comparison with other renal replacement therapies.
- 2018
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Doctoral thesis (other academic/artistic)abstract
- Background: The annual mortality for patients on dialysis is high even if it has decreased from 30 % in 1991 to 18 % in 2016. It is mainly caused by an increased cardiovascular and infectious morbidity. Previous studies have reported improved survival for patients with home hemodialysis (HHD). However, patients starting HHD are younger and healthier compared to patients starting other dialysis modalities. The aims of this thesis are to investigate the survival of Swedish patients starting with HHD as initial RRT, to analyse the major non-modifiable factors predicting survival and to study whether there is a benefit beyond patient selection in patient survival, health care utilization and subsequent renal graft survival for patients starting HHD compared with patients starting IHD or PD. An additional aim is to compare the effect on some modifiable risk factors between HHD and IHD. Methods:The studies in this thesis are retrospective observational studies based on data from patient records in study I and II and data from Swedish Renal Registry and the Swedish Inpatient Registry in study III and IV. In study I patients starting HHD at Lund University hospital 1971-1998 were included. In study II patients starting HHD at Lund University hospital 1983-2002 were matched with patients starting IHD at Malmö General Hospital. In study III and IV, all Swedish patients starting HHD during 1991-2012 were matched with patients starting IHD and PD. Matching was performed according to sex, age, Davies Comorbidity Index in study II, Charlson comorbidity index in study III-IV and date of start of dialysis, Results:The annual mortality for patients starting HHD in Lund was 4.9 %. Age, comorbidity and decade of start of HHD had a significant impact on survival. For patients younger than 60 years without comorbidies, subsequent renal transplantations did not have a significant impact on survival. (Study I)Patients starting HHD have a significant superior median survival, 18.5 years, compared with patients starting IHD, 11.9 years, or PD, 15.0 years (Study III).Patients starting HHD have less health care consumption measured as hospital admissions compared with IHD and PD. This advantage is partly caused by less admissions with cardiovascular diagnoses compared IHD and less admissions with infectious disease diagnoses and longer dialysis technique survival compared with PD. (Study IV).There was no significant difference in subsequent renal graft surival after HHD compared to IHD or PD (Study III). Contributing modifiable factors to the improved prognosis for patients on HHD are less prescribed antihypertensives and diuretics, as indirect measures of improved fluid balance, and lower phosphate levels, compared to patients on IHD. (Study II)Conclusion: Patients starting HHD as initial RRT exhibit an improved long-term prognosis beyond differences in patient selection, a superior survival and less health care utilization, compared with patients starting IHD or PD. The results of this thesis are strong incentives for increased use of HHD for patients on maintenance dialysis.
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| 7. |
- Zhang, Ye, et al.
(author)
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Socioeconomic inequalities in the kidney transplantation process : A registry-based study in Sweden
- 2018
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In: Transplant Direct. - 2373-8731. ; 4:2
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Journal article (peer-reviewed)abstract
- Background. Few studies have examined the association between individual-level socioeconomic status and access to kidney transplantation. This study aims to investigate the association between predialysis income and education, and access to (i) the kidney waitlist (first listing), and (ii) kidney transplantation conditional on waitlist placement. Adjustment will be made for a number of medical and nonmedical factors. Methods. The Swedish Renal Register was linked to national registers for adult patients in Sweden who started dialysis during 1995 to 2013. We employed Cox proportional hazards models. Results. Nineteen per cent of patients were placed on the waitlist. Once on the waitlist, 80% received kidney transplantation. After adjusting for covariates,patients in the highest income quintile were found to have higher access to both the waitlist (hazard ratio [HR], 1.73; 95% confidence interval [CI], 1.53-1.96) and kidney transplantation (HR, 1.33; 95% CI, 1.16-1.53) compared with patients in the lowest incomequintile. Patients with higher education also had better access to the waitlist and kidney transplantation (HR, 2.16; 95% CI, 1.94-2.40; and HR, 1.16; 95% CI, 1.03-1.30, respectively) compared with patients with mandatory education. Conclusions. Socioeconomic status-related inequalities exist with regard to both access to the waitlist, and kidney transplantation conditional on listing. However, the former inequality is substantially larger and is therefore expected to contribute more to societal inequalities. Further studies are needed to explore the potential mechanisms and strategies to reduce these inequalities.
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