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  1. Article ; Online: Precision medicine approach to dialysis including incremental and decremental dialysis regimens.

    Murea, Mariana

    Current opinion in nephrology and hypertension

    2020  Volume 30, Issue 1, Page(s) 85–92

    Abstract: Purpose of review: Conventional standardization of haemodialysis for treatment of end-stage kidney disease (ESKD) is predicated upon the fixed construct of one disease stage and one patient category. Increasingly recognized are subgroups of patients for ...

    Abstract Purpose of review: Conventional standardization of haemodialysis for treatment of end-stage kidney disease (ESKD) is predicated upon the fixed construct of one disease stage and one patient category. Increasingly recognized are subgroups of patients for whom less-intensive haemodialysis, such as incremental or decremental haemodialysis, could be employed.
    Recent findings: Almost 30% of patients with incident ESKD have clinical and residual kidney function (RFK) parameters that could accommodate less-intensive haemodialysis. In one study, patients with incident ESKD and substantial RKF treated with low-dose haemodialysis had similar mortality rate as those treated with standard-dose haemodialysis, adding to the evidence that endogenous kidney function -- when present -- can complement less-intensive haemodialysis schedules. Hazards related to incremental haemodialysis include insidious development of fluid overload and higher rates of fluid removal. Finally, deintensification of haemodialysis treatment could be employed in patients with ESKD who seek conservative care.
    Summary: A shift in approach to ESKD from a dichotomous frame -- disease presence versus absence -- to stages of dialysis-dependent kidney disease, each stage associated with attuned haemodialysis intensity, has been proposed. Haemodialysis standardization and personalization -- often considered mutually exclusive -- can be combined in incremental haemodialysis. Data from ongoing and future randomized clinical trials, comparing less-intensive with standard haemodialysis schedules, are required to change practice.
    MeSH term(s) Conservative Treatment/methods ; Disease Progression ; Humans ; Kidney Failure, Chronic/classification ; Kidney Failure, Chronic/diagnosis ; Kidney Failure, Chronic/therapy ; Patient Selection ; Precision Medicine ; Renal Dialysis/methods ; Renal Dialysis/standards
    Language English
    Publishing date 2020-11-04
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't ; Review
    ZDB-ID 1151092-4
    ISSN 1473-6543 ; 1535-3842 ; 1062-4813 ; 1062-4821
    ISSN (online) 1473-6543 ; 1535-3842
    ISSN 1062-4813 ; 1062-4821
    DOI 10.1097/MNH.0000000000000667
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    Zs.A 3686: Show issues Location:
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  2. Article ; Online: The Hemodialysis Prescription: Past, Present, and Future.

    Murea, Mariana / Sirich, Tammy L

    Kidney360

    2023  Volume 4, Issue 7, Page(s) 990–993

    MeSH term(s) Humans ; Renal Dialysis ; Kidney Failure, Chronic/therapy ; Prescriptions
    Language English
    Publishing date 2023-05-31
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
    ISSN 2641-7650
    ISSN (online) 2641-7650
    DOI 10.34067/KID.0000000000000164
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  3. Article: The reasons for comparative effectiveness clinical trials of arteriovenous fistula versus graft strategy in older adults on hemodialysis with a catheter.

    Murea, Mariana / Allon, Michael

    Clinical nephrology

    2023  Volume 100, Issue 6, Page(s) 243–248

    Abstract: Clinicians and patients are guided by observational studies to make one of the most consequential decisions for patients with advanced kidney disease: the selection of the "right" hemodialysis vascular access. More than a decade ago, a call for ... ...

    Abstract Clinicians and patients are guided by observational studies to make one of the most consequential decisions for patients with advanced kidney disease: the selection of the "right" hemodialysis vascular access. More than a decade ago, a call for randomized clinical trials was made to equitably compare clinical outcomes between arteriovenous (AV) fistulas (AVFs) and AV grafts (AVGs). Mounting evidence suggests that trade-offs between AVF- and AVGrelated outcomes are context dependent. In this article, we summarize four streams of evidence that collectively underpin the burden of equipoise between the two types of AV access in older adults with comorbidities who are on hemodialysis with a central venous catheter.
    MeSH term(s) Aged ; Humans ; Arteriovenous Fistula ; Arteriovenous Shunt, Surgical/adverse effects ; Central Venous Catheters ; Graft Occlusion, Vascular ; Kidney Failure, Chronic/therapy ; Renal Dialysis ; Retrospective Studies ; Treatment Outcome ; Vascular Patency ; Clinical Trials as Topic
    Language English
    Publishing date 2023-10-24
    Publishing country Germany
    Document type Journal Article
    ZDB-ID 185101-9
    ISSN 0301-0430
    ISSN 0301-0430
    DOI 10.5414/CN111227
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    Zs.A 873: Show issues Location:
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  4. Article: Incremental dialysis: two complementary views.

    Casino, Debaters Francesco Gaetano / Murea, Mariana / Floege, Moderators Jürgen / Zoccali, Carmine

    Clinical kidney journal

    2024  Volume 17, Issue 2, Page(s) sfae020

    Abstract: Franco Casino and Mariana Murea discuss today's knowledge about the 'incremental dialysis' concept ... standardize the practical aspects of this approach. Mariana Murea objects that most of the evidence gathered ...

    Abstract Franco Casino and Mariana Murea discuss today's knowledge about the 'incremental dialysis' concept. Franco Casino frames the problem by saying that, in the presence of substantial residual kidney function, kidney replacement therapy can begin with low doses and/or frequencies, to be gradually increased to compensate for any subsequent losses of residual kidney function, keeping the total clearance above the minimum levels of adequacy. He remarks that studies so far have documented that this approach is safe. He recognizes that adequate randomized controlled trials (RCTs) are necessary to confirm the safety and simplify and standardize the practical aspects of this approach. Mariana Murea objects that most of the evidence gathered so far primarily derives from retrospective and observational studies, which can be influenced by socioeconomic constraints. She argues for the need for RCTs to provide compelling empirical evidence on the efficacy of incremental dialysis. Nephrologists are still reluctant to adopt this approach for various reasons, including unfamiliarity with the method, lack of practical guidance and financial disincentives. Several countries have ongoing or planned RCTs comparing incremental dialysis with conventional dialysis. These trials can shift the haemodialysis paradigm if they validate the safety and effectiveness of this approach. The moderators believe that the results of ongoing trials must be carefully interpreted, and further validation may be needed across different patient populations or healthcare settings. The ultimate goal is to gather robust evidence that could lead to widespread adoption of incremental haemodialysis, optimizing treatment, reducing overtreatment, preserving resources and improving patients' quality of life.
    Language English
    Publishing date 2024-02-05
    Publishing country England
    Document type Journal Article
    ZDB-ID 2655800-2
    ISSN 2048-8513 ; 2048-8505
    ISSN (online) 2048-8513
    ISSN 2048-8505
    DOI 10.1093/ckj/sfae020
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    Zs.A 6587: Show issues Location:
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  5. Article ; Online: Starting chronic hemodialysis twice weekly: when less is more.

    Murea, Mariana / Kalantar-Zadeh, Kamyar

    Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association

    2022  Volume 37, Issue 12, Page(s) 2297–2299

    MeSH term(s) Humans ; Renal Dialysis ; Peritoneal Dialysis
    Language English
    Publishing date 2022-09-09
    Publishing country England
    Document type Editorial ; Comment
    ZDB-ID 90594-x
    ISSN 1460-2385 ; 0931-0509
    ISSN (online) 1460-2385
    ISSN 0931-0509
    DOI 10.1093/ndt/gfac261
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    Zs.A 2198: Show issues Location:
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    Zs.MO 329: Show issues

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  6. Article ; Online: On the path to individualizing care with incremental-start hemodialysis.

    Murea, Mariana / Lin, Eugene / Torreggiani, Massimo

    Journal of nephrology

    2023  Volume 36, Issue 6, Page(s) 1505–1508

    MeSH term(s) Humans ; Renal Dialysis ; Kidney ; Kidney Failure, Chronic/diagnosis ; Kidney Failure, Chronic/therapy
    Language English
    Publishing date 2023-06-07
    Publishing country Italy
    Document type Editorial
    ZDB-ID 1093991-x
    ISSN 1724-6059 ; 1120-3625 ; 1121-8428
    ISSN (online) 1724-6059
    ISSN 1120-3625 ; 1121-8428
    DOI 10.1007/s40620-023-01689-7
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    Zs.A 3369: Show issues Location:
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  7. Article ; Online: New Frontiers in Vascular Access Practice: From Standardized to Patient-tailored Care and Shared Decision Making.

    Murea, Mariana / Woo, Karen

    Kidney360

    2021  Volume 2, Issue 8, Page(s) 1380–1389

    Abstract: Vascular access planning is critical in the management of patients with advanced kidney disease who elect for hemodialysis for RRT. Policies put in place more than two decades ago attempted to standardize vascular access care around the model of optimal, ...

    Abstract Vascular access planning is critical in the management of patients with advanced kidney disease who elect for hemodialysis for RRT. Policies put in place more than two decades ago attempted to standardize vascular access care around the model of optimal, namely arteriovenous fistula, and least preferred, namely central venous catheter, type of access. This homogenized approach to vascular access care emerged ineffective in the increasingly heterogeneous and complex dialysis population. The most recent vascular access guidelines acknowledge the limitations of standardized care and encourage tailoring vascular access care on the basis of patient and disease characteristics. In this article, we discuss available literature in support of patient-tailored access care on the basis of differences in vascular access outcomes by biologic and social factors-age, sex, and race. Further, we draw attention to the overlooked dimension of patient-reported preferences and shared decision making in the practice of vascular access planning. We discuss milestones to overcome as requisite steps to implement effective shared decision making in vascular access care. Finally, we take into consideration local practice cofactors as major players in vascular access fate. We conclude that a personalized approach to hemodialysis vascular access will require dynamic care specifically relevant to the individual on the basis of biologic factors, fluctuating clinical needs, values, and preferences.
    MeSH term(s) Arteriovenous Fistula ; Central Venous Catheters ; Decision Making, Shared ; Humans ; Patient Preference ; Renal Dialysis/methods
    Language English
    Publishing date 2021-06-15
    Publishing country United States
    Document type Journal Article ; Review ; Research Support, N.I.H., Extramural
    ISSN 2641-7650
    ISSN (online) 2641-7650
    DOI 10.34067/KID.0002882021
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  8. Article ; Online: Incremental and Twice-Weekly Hemodialysis Program in Practice.

    Murea, Mariana / Kalantar-Zadeh, Kamyar

    Clinical journal of the American Society of Nephrology : CJASN

    2020  Volume 16, Issue 1, Page(s) 147–149

    MeSH term(s) Disease Progression ; Health Policy ; Humans ; Kidney/physiopathology ; Patient Selection ; Renal Dialysis/methods ; Renal Insufficiency, Chronic/physiopathology ; Renal Insufficiency, Chronic/therapy ; Time Factors
    Language English
    Publishing date 2020-09-22
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
    ZDB-ID 2226665-3
    ISSN 1555-905X ; 1555-9041
    ISSN (online) 1555-905X
    ISSN 1555-9041
    DOI 10.2215/CJN.04170320
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    Zs.A 6584: Show issues Location:
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  9. Article ; Online: Bioinformatics Analysis Reveals a Shared Pathway for Common Forms of Adult Nephrotic Syndrome.

    Li, DengFeng / Liu, Liang / Murea, Mariana / Freedman, Barry I / Ma, Lijun

    Kidney360

    2023  Volume 4, Issue 4, Page(s) e515–e524

    MeSH term(s) Humans ; Adult ; Nephrotic Syndrome/diagnosis ; Nephrotic Syndrome/genetics ; Computational Biology
    Language English
    Publishing date 2023-02-10
    Publishing country United States
    Document type Journal Article
    ISSN 2641-7650
    ISSN (online) 2641-7650
    DOI 10.34067/KID.0000000000000074
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  10. Article ; Online: Shared decision-making in hemodialysis vascular access practice.

    Murea, Mariana / Grey, Carl R / Lok, Charmaine E

    Kidney international

    2021  Volume 100, Issue 4, Page(s) 799–808

    Abstract: Shared decision-making (SDM) is a process of collaborative deliberation in the dyadic patient-physician interaction whereby physicians inform the patients about the pros and cons of all available treatment options and reach an agreement with the patients ...

    Abstract Shared decision-making (SDM) is a process of collaborative deliberation in the dyadic patient-physician interaction whereby physicians inform the patients about the pros and cons of all available treatment options and reach an agreement with the patients on their preferred treatment plan. In hemodialysis vascular access practice, SDM advocates a deliberative approach based on the existence of reasonable alternatives-that is, arteriovenous fistula, arteriovenous graft, and central venous catheter-so that patients are able to form and share preferences about access options. In spite of its ethical imperative, SDM is not broadly applied in hemodialysis vascular access planning. Physicians and surgeons commonly deliver prescriptive fistula-centered recommendations concerning the approach to vascular access care. This paternalistic approach has been shaped by directions from long-held clinical practice guidelines and is reinforced by financial payment models linked with the prevalence of arteriovenous fistula in patients on hemodialysis. Awareness is growing that what may have initially seemed a medically and surgically appropriate approach might not always be focused on each individual's goals of care. Clinician's recommendations for vascular access often do not sufficiently consider the uncertainty surrounding the potential benefits of the decision or the cumulative impact of the decision on patient's quality of life. In the evolving health care landscape, it is time for the practice of hemodialysis vascular access to shift from a hierarchical doctor-patient approach to patient-centered care. In this article we review the current state of vascular access practice, present arguments why SDM is necessary in vascular access planning, review barriers and potential solutions to SDM implementation, and discuss future research contingent on an effective system of physician-patient participative decision-making in hemodialysis vascular access practice.
    MeSH term(s) Central Venous Catheters ; Decision Making, Shared ; Humans ; Patient Participation ; Quality of Life ; Renal Dialysis/adverse effects
    Language English
    Publishing date 2021-07-08
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Review
    ZDB-ID 120573-0
    ISSN 1523-1755 ; 0085-2538
    ISSN (online) 1523-1755
    ISSN 0085-2538
    DOI 10.1016/j.kint.2021.05.041
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