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  1. Article ; Online: Midodrine Is an Effective Therapy for Resistant Intradialytic Hypotension: CON.

    Husarek, Kathryn / Brunelli, Steven M

    Kidney360

    2023  Volume 4, Issue 3, Page(s) 302–305

    MeSH term(s) Humans ; Midodrine/therapeutic use ; Hypotension/drug therapy ; Hypotension/etiology ; Renal Dialysis/adverse effects
    Chemical Substances Midodrine (6YE7PBM15H)
    Language English
    Publishing date 2023-03-30
    Publishing country United States
    Document type Journal Article
    ISSN 2641-7650
    ISSN (online) 2641-7650
    DOI 10.34067/KID.0007422021
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  2. Article ; Online: Use of prescription drug claims data to identify lipid-lowering medication exposure in pharmacoepidemiology studies: potential pitfalls.

    Brunelli, Steven M

    Pharmacoepidemiology and drug safety

    2016  Volume 25, Issue 7, Page(s) 844–846

    Language English
    Publishing date 2016-07
    Publishing country England
    Document type Journal Article
    ZDB-ID 1099748-9
    ISSN 1099-1557 ; 1053-8569
    ISSN (online) 1099-1557
    ISSN 1053-8569
    DOI 10.1002/pds.4017
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    Zs.A 3395: Show issues Location:
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  3. Article ; Online: The Precision of Standardized Hospitalization, Readmission, and Mortality Ratios for Dialysis Facilities.

    Brunelli, Steven M / Walker, Adam G

    American journal of kidney diseases : the official journal of the National Kidney Foundation

    2017  Volume 71, Issue 2, Page(s) 291–294

    MeSH term(s) Hospital Mortality/trends ; Hospitalization/trends ; Humans ; Patient Readmission/trends ; Reference Standards ; Renal Dialysis/mortality ; Renal Dialysis/trends
    Language English
    Publishing date 2017-11-20
    Publishing country United States
    Document type Letter
    ZDB-ID 604539-x
    ISSN 1523-6838 ; 0272-6386
    ISSN (online) 1523-6838
    ISSN 0272-6386
    DOI 10.1053/j.ajkd.2017.09.006
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  4. Article ; Online: Predicting hospitalizations for patients with chronic kidney disease.

    Karpinski, Steph / Sibbel, Scott / Gray, Kathryn / Walker, Adam G / Luo, Jiacong / Colson, Carey / Stebbins, Juliana / Brunelli, Steven M

    The American journal of managed care

    2023  Volume 29, Issue 9, Page(s) e262–e266

    Abstract: Objectives: Patients with chronic kidney disease (CKD) are at higher risk of being admitted to the hospital than the general population. Hospitalizations in patients with CKD are associated with higher medical costs and increased morbidity and mortality. ...

    Abstract Objectives: Patients with chronic kidney disease (CKD) are at higher risk of being admitted to the hospital than the general population. Hospitalizations in patients with CKD are associated with higher medical costs and increased morbidity and mortality. Identification of patients with CKD who are at greatest risk of hospitalization may hold promise to improve clinical outcomes and enable judicious allocation of health care resources.
    Study design: Retrospective, observational cohort study.
    Methods: Medicare Part A and Part B claims from calendar years 2017 and 2018 from 50,000 unique patients with a diagnosis of stage 3 to 5 CKD were used for this study. Data were split into training (n = 40,000) and test (n = 10,000) sets. A variety of model types were built to predict all-cause hospitalization within 90 days.
    Results: The final model was a gradient-boosting machine with 399 input terms. The model demonstrated good ability to discriminate (area under the curve [AUC] for the receiver operating characteristic curve = 0.73), which was stable when tested in the test set (AUC = 0.73). The positive predictive value in the test set was 0.306, 0.240, and 0.216 at the 10%, 20%, and 30% thresholds, respectively. The sensitivity in the test set was 0.288, 0.453, and 0.609 at the 10%, 20%, and 30% thresholds, respectively.
    Conclusions: We developed an algorithm that uses medical claims to identify Medicare patients with CKD stages 3 to 5 who are at highest risk of being hospitalized in the near term. This algorithm could be used as a decision support tool for clinical programs focusing on management of patient populations with CKD.
    MeSH term(s) Aged ; United States ; Humans ; Medicare ; Retrospective Studies ; Hospitalization ; Hospitals ; Renal Insufficiency, Chronic/diagnosis ; Renal Insufficiency, Chronic/therapy
    Language English
    Publishing date 2023-09-01
    Publishing country United States
    Document type Observational Study ; Journal Article
    ZDB-ID 2035781-3
    ISSN 1936-2692 ; 1088-0224 ; 1096-1860
    ISSN (online) 1936-2692
    ISSN 1088-0224 ; 1096-1860
    DOI 10.37765/ajmc.2023.89428
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  5. Article ; Online: Use of incremental peritoneal dialysis: impact on clinical outcomes and quality of life measure.

    Naljayan, Mihran / Hunt, Abigail / McKeon, Katherine / Marlowe, Gilbert / Schreiber, Martin J / Brunelli, Steven M / Tentori, Francesca

    Journal of nephrology

    2023  Volume 36, Issue 7, Page(s) 1897–1905

    Abstract: Background: Incremental peritoneal dialysis (PD) can be defined as a PD prescription that is less than the standard, full dose prescription and is typically used for patients initiating PD with residual kidney function. It has been suggested that use of ...

    Abstract Background: Incremental peritoneal dialysis (PD) can be defined as a PD prescription that is less than the standard, full dose prescription and is typically used for patients initiating PD with residual kidney function. It has been suggested that use of incremental peritoneal dialysis may help preserve residual kidney function and may offer better quality of life due to the lower treatment burden, however published evidence is limited. In this study we assessed the associations between incremental peritoneal dialysis use and both clinical outcomes and quality of life measures in a large cohort of incident peritoneal dialysis patients in the US.
    Methods: We considered adult patients initiating peritoneal dialysis between 31 July, 2015 and 31 May, 2019 within a single dialysis organization. Patients with body weight < 40 kg, amputation, or an estimated glomerular filtration rate > 20 mL/min during the first 4 weeks on peritoneal dialysis were excluded. Patients were assigned to exposure groups based on peritoneal dialysis prescription during dialysis weeks 5-8. Incremental peritoneal dialysis was defined by treatment frequency, number of exchanges/day, and exchange volume (for continuous ambulatory peritoneal dialysis patients) or by treatment frequency and presence/absence of last fill (for automated peritoneal dialysis patients). Analyses were performed separately for continuous ambulatory peritoneal dialysis and automated peritoneal dialysis. For each analysis, incremental peritoneal dialysis patients were propensity score matched to eligible full-dose peritoneal dialysis patients. Patients were followed for a maximum of 12 months until censoring for loss to follow-up or study end. Outcomes were compared using Poisson models (mortality, hospitalization, peritoneal dialysis discontinuation), linear mixed models (estimated glomerular filtration rate), and paired t tests (KDQOL domain scores).
    Results: Among continuous ambulatory peritoneal dialysis patients, compared to full-dose peritoneal dialysis, incremental peritoneal dialysis use was associated with better KDQOL scores on 3 domains: physical composite score (42.5 vs 37.7, p = 0.03), burden of kidney disease (60.2 vs 45.6, p = 0.003), effects of kidney disease (79.4 vs 72.3, p = 0.05). Hospitalization and mortality rates were numerically lower (0.77 vs 1.12 admits/pt-year, p = 0.09 and 5.0 vs 10.2 deaths/100 pt-years, p = 0.22), while no associations were found with estimated glomerular filtration rate or peritoneal dialysis discontinuation rate. Use of incremental peritoneal dialysis was not associated with any discernable effects on outcomes in automated peritoneal dialysis patients.
    Conclusion: These results suggest that there may be benefits of using incremental PD in the context of continuous ambulatory peritoneal dialysis, particularly with respect to quality of life as a prescription strategy when initiating peritoneal dialysis. While no significant benefits of incremental peritoneal dialysis were detected among patients initiating automated peritoneal dialysis, no detrimental effects of using incremental schedules were observed for either peritoneal dialysis type.
    MeSH term(s) Adult ; Humans ; Quality of Life ; Kidney Failure, Chronic/diagnosis ; Kidney Failure, Chronic/therapy ; Peritoneal Dialysis/adverse effects ; Peritoneal Dialysis/methods ; Peritoneal Dialysis, Continuous Ambulatory/methods ; Kidney Diseases/therapy
    Language English
    Publishing date 2023-08-29
    Publishing country Italy
    Document type Journal Article
    ZDB-ID 1093991-x
    ISSN 1724-6059 ; 1120-3625 ; 1121-8428
    ISSN (online) 1724-6059
    ISSN 1120-3625 ; 1121-8428
    DOI 10.1007/s40620-023-01703-y
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  6. Article ; Online: In reply to 'More evidence needed before lower dialysate sodium concentrations can be recommended'.

    Weiner, Daniel E / Brunelli, Steven M

    American journal of kidney diseases : the official journal of the National Kidney Foundation

    2015  Volume 65, Issue 3, Page(s) 520

    MeSH term(s) Extracellular Fluid/physiology ; Fluid Therapy/standards ; Humans ; Physician's Role ; Renal Dialysis/standards
    Language English
    Publishing date 2015-03
    Publishing country United States
    Document type Comment ; Letter
    ZDB-ID 604539-x
    ISSN 1523-6838 ; 0272-6386
    ISSN (online) 1523-6838
    ISSN 0272-6386
    DOI 10.1053/j.ajkd.2014.12.011
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  7. Article ; Online: Utilization of Home Dialysis and Permanent Vascular Access at Dialysis Initiation Following a Structured CKD Education Program.

    Mckeon, Katherine / Sibbel, Scott / Brunelli, Steven M / Matheson, Erin / Lefeber, Nick / Epps, Meghan / Tentori, Francesca

    Kidney medicine

    2022  Volume 4, Issue 7, Page(s) 100490

    Abstract: Rationale & objective: Treatment options for kidney failure are complex, and the majority of patients transitioning to dialysis lack important information about treatment options and are not prepared to make informed decisions about their care. ... ...

    Abstract Rationale & objective: Treatment options for kidney failure are complex, and the majority of patients transitioning to dialysis lack important information about treatment options and are not prepared to make informed decisions about their care. Correspondingly, the majority of patients who start dialysis default to in-center hemodialysis using a central venous catheter for vascular access as the initial modality; furthermore, hospital admissions, mortality, and infections are exceedingly common over the first few months.
    Study design: Matched retrospective cohort study.
    Setting & patients: 2,398 adult patients with chronic kidney disease (CKD) who attended a structured CKD education program and pair-matched control patients who did not receive education before starting dialysis between January 2018 and June 2019.
    Exposure: CKD education attendance documented from 2 months (60 days)-3 years before dialysis initiation. CKD education consisted of a 1-time, 90-minute, inperson or virtual class.
    Outcome: Primary outcomes were dialysis modality and vascular access type on the first day of dialysis (day 0) and at day 90 after dialysis initiation. Secondary outcomes included hospitalizations and deaths during the first year of receiving dialysis.
    Analytical approach: Generalized linear models were used to compare outcomes between patients receiving CKD education and controls.
    Results: Compared with controls, CKD education patients were more frequently receiving home dialysis (38.5% vs 12.6%,
    Limitations: Bias and confounding cannot fully be accounted for in an observational study. Analyses only included patients with commercial and Medicare insurance who received CKD care before dialysis initiation and may not be generalizable to other patient populations.
    Conclusions: Our findings indicate that attending a CKD education class before starting dialysis resulted in positive clinical outcomes, including reduction in hospitalization and mortality rates. Broad implementation of structured CKD education may result in more patients choosing home dialysis as their first treatment option and reduce the risk of adverse outcomes in the crucial early period after dialysis initiation.
    Language English
    Publishing date 2022-05-27
    Publishing country United States
    Document type Journal Article
    ISSN 2590-0595
    ISSN (online) 2590-0595
    DOI 10.1016/j.xkme.2022.100490
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  8. Article ; Online: Measuring patient survival on hemodialysis.

    Brunelli, Steven M

    Journal of the American Society of Nephrology : JASN

    2009  Volume 20, Issue 9, Page(s) 1866–1867

    MeSH term(s) Humans ; Kidney Failure, Chronic/mortality ; Kidney Failure, Chronic/therapy ; Renal Dialysis/mortality
    Language English
    Publishing date 2009-09
    Publishing country United States
    Document type Comment ; Editorial
    ZDB-ID 1085942-1
    ISSN 1533-3450 ; 1046-6673
    ISSN (online) 1533-3450
    ISSN 1046-6673
    DOI 10.1681/ASN.2009070689
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  9. Article ; Online: Blood pressure variability among chronic dialysis patients: recent advances in knowledge.

    Flythe, Jennifer E / Brunelli, Steven M

    Current opinion in nephrology and hypertension

    2015  Volume 24, Issue 2, Page(s) 163–169

    Abstract: Purpose of review: This review focuses on recent evidence linking blood pressure variability (BPV) to adverse clinical outcomes in the chronic hemodialysis patient population.: Recent findings: BPV is an increasingly recognized poor prognostic factor ...

    Abstract Purpose of review: This review focuses on recent evidence linking blood pressure variability (BPV) to adverse clinical outcomes in the chronic hemodialysis patient population.
    Recent findings: BPV is an increasingly recognized poor prognostic factor in the general population. A growing body of evidence suggests that both short-term and long-term BPV are associated with adverse events among chronic dialysis patients. Over the last 18 months, several studies have linked long-term BPV (considered dialysis treatment to dialysis treatment) to all-cause and cardiovascular morbidity and mortality. Similar results have been demonstrated for short-term (considered as intradialytic) BPV and clinical outcomes. Further studies substantiating these findings and examining potential BPV mitigation strategies are needed. Additionally, a BPV metric that is easily calculated and tracked in the clinical setting is necessary before BPV can become a routine component of clinical monitoring.
    Summary: Recent observational data demonstrate an association between short-term and long-term BPV and adverse outcomes among chronic hemodialysis patients. Further research is needed to identify strategies that mitigate this risk and to translate these findings into clinical practice.
    MeSH term(s) Animals ; Blood Pressure/physiology ; Blood Pressure Determination/methods ; Cardiovascular Diseases/physiopathology ; Cardiovascular Diseases/therapy ; Humans ; Renal Dialysis/adverse effects ; Risk Assessment ; Time
    Language English
    Publishing date 2015-03
    Publishing country England
    Document type Journal Article ; 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.0000000000000107
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  10. Article ; Online: Blood pressure variability and dialysis: variability may not always be the spice of life.

    Flythe, Jennifer E / Brunelli, Steven M

    Journal of the American Society of Nephrology : JASN

    2014  Volume 25, Issue 4, Page(s) 650–653

    MeSH term(s) Female ; Humans ; Male ; Renal Dialysis ; Systole
    Language English
    Publishing date 2014-01-02
    Publishing country United States
    Document type Editorial ; Research Support, N.I.H., Extramural ; Comment
    ZDB-ID 1085942-1
    ISSN 1533-3450 ; 1046-6673
    ISSN (online) 1533-3450
    ISSN 1046-6673
    DOI 10.1681/ASN.2013111237
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