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  1. Article ; Online: Ultrafiltration rate in conventional hemodialysis: Where are the limits and what are the consequences?

    Slinin, Yelena / Babu, Megha / Ishani, Areef

    Seminars in dialysis

    2018  Volume 31, Issue 6, Page(s) 544–550

    Abstract: Background: Ultrafiltration rate (UFR) has attracted attention as a modifiable aspect of volume management.: Objective: The objective of this review is to summarize the evidence that links UFR to patient outcomes and discuss UFR cut-offs proposed, ... ...

    Abstract Background: Ultrafiltration rate (UFR) has attracted attention as a modifiable aspect of volume management.
    Objective: The objective of this review is to summarize the evidence that links UFR to patient outcomes and discuss UFR cut-offs proposed, and discuss possible consequences of adapting UFR as a quality metric.
    Results: Higher UFRs has been associated with younger age, longer dialysis vintage, greater prevalence of comorbidities, higher Kt/V, lower weight, greater interdialytic weight gain, lower residual renal function, and shorter treatment times. Many of the characteristics associated with high UFRs have also been independently associated with poor patient outcomes. Four observational studies have assessed the association between UFR and patient mortality. All of them reported an association between higher UFR and greater patient mortality, though the studies differed in their definition of UFR, follow-up, and adjustment for confounding. Evidence for the association between higher UFR and potential mediations of the mortality association, such as interdialytic hypotension, cardiac remodeling, and cardiovascular events was less consistent. There was a graded association between higher UFRs and all-cause mortality; no definitive cut-off for acceptable UFR can be established based on the current evidence. Targeting UFR in isolation might result in volume expansion and worsening patient outcomes. Residual confounding likely contributed to the findings of the observational studies. No randomized controlled trials addressed the questions.
    Conclusion: Evidence supporting UFR limits is weak and confounded. Randomized controlled trials are needed before UFR can be used as a quality of care indicator.
    MeSH term(s) Female ; Hemodiafiltration/adverse effects ; Hemodiafiltration/methods ; Hemodiafiltration/mortality ; Humans ; Kidney Failure, Chronic/mortality ; Kidney Failure, Chronic/therapy ; Male ; Quality Improvement ; Risk Factors ; Survival Rate ; Treatment Outcome
    Language English
    Publishing date 2018-06-08
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 1028193-9
    ISSN 1525-139X ; 0894-0959
    ISSN (online) 1525-139X
    ISSN 0894-0959
    DOI 10.1111/sdi.12717
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  2. Article ; Online: What drives early dialysis initiation and how do we optimize timing of RRT?

    Slinin, Yelena / Ishani, Areef

    Clinical journal of the American Society of Nephrology : CJASN

    2014  Volume 9, Issue 10, Page(s) 1671–1673

    MeSH term(s) Female ; Glomerular Filtration Rate ; Health Facilities ; Healthcare Disparities ; Humans ; Kidney/physiopathology ; Kidney Failure, Chronic/therapy ; Male ; Renal Dialysis ; Residence Characteristics ; Time-to-Treatment
    Language English
    Publishing date 2014-09-23
    Publishing country United States
    Document type Editorial ; Comment
    ZDB-ID 2226665-3
    ISSN 1555-905X ; 1555-9041
    ISSN (online) 1555-905X
    ISSN 1555-9041
    DOI 10.2215/CJN.08350814
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  3. Article ; Online: Dialysis bundling and small dialysis organizations: a call for close monitoring.

    Slinin, Yelena / Ishani, Areef

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

    2013  Volume 61, Issue 6, Page(s) 858–860

    MeSH term(s) Ambulatory Care Facilities/economics ; Female ; Humans ; Kidney Failure, Chronic/economics ; Male ; Medicare/economics ; Prospective Payment System/economics ; Renal Dialysis/economics
    Language English
    Publishing date 2013-06
    Publishing country United States
    Document type Comment ; Editorial
    ZDB-ID 604539-x
    ISSN 1523-6838 ; 0272-6386
    ISSN (online) 1523-6838
    ISSN 0272-6386
    DOI 10.1053/j.ajkd.2013.03.005
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  4. Article ; Online: Kidney-Metabolic Factors Associated with Cognitive Impairment in Chronic Kidney Disease: A Pilot Study.

    Murray, Anne M / Slinin, Yelena / Tupper, David E / Pederson, Sarah L / Davey, Cynthia / Gilbertson, David T / Drawz, Paul / Mello, Ryan / Hart, Allyson / Johansen, Kirsten L / Reule, Scott / Rossom, Rebecca / Knopman, David S

    American journal of nephrology

    2022  Volume 53, Issue 6, Page(s) 435–445

    Abstract: Introduction: The associations of kidney-metabolic biomarkers with cognitive impairment (CI) beyond the estimated glomerular filtration rate (eGFR, in mL/min/1.73 m2) and albuminuria levels are not well understood. In exploratory analysis, our objective ...

    Abstract Introduction: The associations of kidney-metabolic biomarkers with cognitive impairment (CI) beyond the estimated glomerular filtration rate (eGFR, in mL/min/1.73 m2) and albuminuria levels are not well understood. In exploratory analysis, our objective was to determine the extent that three kidney-metabolic factors, previously proposed as mechanisms of CI and commonly abnormal in chronic kidney disease (CKD), were associated with prevalent CI in CKD participants, adjusted for kidney function measures.
    Methods: The study cohort included community-dwelling individuals aged ≥45 years with CKD (eGFR <60), not requiring dialysis, recruited from four health systems. We examined the serum biomarkers bicarbonate (CO2), TNFαR1, and cholesterol as primary exposures. A structured neuropsychological battery conducted by trained staff measured global and domain-specific cognitive performance. Logistic regression analyses estimated the cross-sectional associations between kidney-metabolic measures and global and cognitive domain-specific moderate/severe (Mod/Sev) CI, adjusted for the eGFR, urinary albumin-creatinine ratio (UACR, mg/g), demographics, comorbid conditions, and other kidney-metabolic biomarkers commonly abnormal in CKD.
    Results: Among 436 CKD participants with mean age 70 years, 16% were Black, the mean eGFR was 34, and the median [IQR] UACR was 49 [0.0, 378] mg/g. In adjusted models, increased TNFαR1 was associated with global Mod/Sev CI (odds ratio [95% confidence interval] = 1.40 [1.02, 1.93]; p = 0.04); low bicarbonate (CO2 <20 mEq/L) with Mod/Sev memory impairment (3.04 [1.09, 8.47]; p = 0.03), and each 10-mg/dL lower cholesterol was associated with Mod/Sev executive function/processing speed impairment (1.12 [1.02, 1.23]; p = 0.02). However, after adjustment for multiple comparisons, these associations were no longer significant nor were any other kidney-metabolic factors significant for any CI classification.
    Conclusion: In exploratory analyses in a CKD population, three kidney-metabolic factors were associated with CI, but after adjustment for multiple comparisons, were no longer significant. Future studies in larger CKD populations are needed to assess these potential risk factors for CI.
    MeSH term(s) Aged ; Albuminuria/epidemiology ; Bicarbonates ; Carbon Dioxide ; Cognitive Dysfunction/epidemiology ; Cognitive Dysfunction/etiology ; Cross-Sectional Studies ; Glomerular Filtration Rate ; Humans ; Kidney ; Pilot Projects ; Renal Insufficiency, Chronic ; Risk Factors
    Chemical Substances Bicarbonates ; Carbon Dioxide (142M471B3J)
    Language English
    Publishing date 2022-04-28
    Publishing country Switzerland
    Document type Journal Article ; Research Support, Non-U.S. Gov't ; Research Support, N.I.H., Extramural
    ZDB-ID 604540-6
    ISSN 1421-9670 ; 0250-8095
    ISSN (online) 1421-9670
    ISSN 0250-8095
    DOI 10.1159/000524166
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  5. Book ; Online: Comparative effectiveness of home-based kidney dialysis versus in-center or other outpatient kidney dialysis locations

    Ishani, Areef / Slinin, Yelena

    a systematic review

    (Evidence-based synthesis program)

    2015  

    Abstract: Home-based dialysis (defined for this review as in-home hemodialysis [HHD] or peritoneal dialysis [PD] outside of a dialysis facility) may offer advantages over in-center hemodialysis (HD), including patient convenience, expanded capacity for VA to ... ...

    Title variant Home- based versus in-center dialysis
    Institution United States. / Department of Veterans Affairs.
    Quality Enhancement Research Initiative (U.S.),
    Minneapolis VA Health Care System (U.S.). / VA Evidence Synthesis Program,
    Author's details prepared for, Department of Veterans Affairs, Veterans Health Administration, Quality Enhancement Research Initiative, Health Services Research & Development Service ; prepared by, Evidence-based Synthesis Program (ESP) Center, Minneapolis VA Medical Center ; principal investigator, Areef Ishani, Yelena Slinin ; co-investigators, Nancy Greer, Timothy J. Wilt ; research associates, Roderick MacDonald, Joseph Messana, Indulis Rutks
    Series title Evidence-based synthesis program
    Abstract Home-based dialysis (defined for this review as in-home hemodialysis [HHD] or peritoneal dialysis [PD] outside of a dialysis facility) may offer advantages over in-center hemodialysis (HD), including patient convenience, expanded capacity for VA to deliver fully integrated care to Veterans with end-stage renal disease (ESRD), a reduction in fee-basis costs associated with dialysis, and potentially improved patient quality of life and blood pressure control with greater survival and fewer hospitalizations. As the number of patients requiring renal replacement therapy (RRT) increases, there is need for a current review of the benefits and harms of home-based dialysis (HHD or PD) versus in-center HD, the benefits and harms of different home-based dialysis modalities, and the predictors of successful home-based dialysis to allow VA to better serve patient needs. We reviewed the evidence from studies of adults with chronic kidney disease requiring dialysis and comparing home-based and in-center HD. Due to between-country differences in health care systems, we focused our review on studies most relevant to the VA, ie, those from North America, Europe, or Australia/New Zealand.
    MeSH term(s) Renal Dialysis ; Hemodialysis, Home ; Ambulatory Care ; Treatment Outcome ; Comparative Effectiveness Research ; Evidence-Based Medicine
    Keywords United States
    Language English
    Size 1 online resource (1 PDF file (iv, 164 pages))
    Document type Book ; Online
    Database Catalogue of the US National Library of Medicine (NLM)

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  6. Article ; Online: Cerebral blood flow characteristics following hemodialysis initiation in older adults: A prospective longitudinal pilot study using arterial spin labeling imaging.

    Li, Xiufeng / Slinin, Yelena X / Zhang, Lin / Dengel, Donald R / Tupper, David / Metzger, Gregory J / Murray, Anne M

    NeuroImage. Clinical

    2020  Volume 28, Page(s) 102434

    Abstract: Purpose: To investigate cerebral blood flow (CBF) characteristics before and after hemodialysis initiation and their longitudinal associations with global cognitive function in older adults.: Methods: A cohort of 17 older end-stage renal disease ... ...

    Abstract Purpose: To investigate cerebral blood flow (CBF) characteristics before and after hemodialysis initiation and their longitudinal associations with global cognitive function in older adults.
    Methods: A cohort of 17 older end-stage renal disease patients anticipating standard thrice-weekly hemodialysis and a group of 11 age- and sex-matched healthy control volunteers were recruited for brain perfusion imaging studies using arterial spin labeling. Hemodialysis patients participated in a prospective longitudinal study using brain magnetic resonance imaging and global cognitive assessment using the Modified Mini-Mental State Examination (3MS) at two time points: baseline, 2.9 ± 0.9 months before, and follow-up, 6.4 ± 2.4 months after hemodialysis initiation. Healthy controls were imaged once using the same protocol. CBF analyses were performed globally in grey and white matter and regionally in the hippocampus and orbitofrontal cortex. Covariate-adjusted linear mixed-effects models were used for statistical analyses (significance: p < 0.05; marginal significance: p < 0.1).
    Results: At baseline, global and regional CBF was significantly higher in hemodialysis patients than in healthy controls. However, after approximately 6 months of hemodialysis, CBF declined substantially in hemodialysis patients, and became comparable to those in healthy controls. Specifically, in the hemodialysis patients, CBF declined non-significantly globally for grey and white matter and significantly regionally in the hippocampus and orbitofrontal cortex. Marginally significant associations were observed between 3MS scores and regional CBF measurements in the hippocampus and orbitofrontal cortex at baseline and follow-up, and between longitudinal changes.
    Conclusion: The significant decline in CBF after hemodialysis initiation and the observed association between longitudinal changes in regional CBF and 3MS scores suggest that decreased brain perfusion may contribute to the observed cognitive decline.
    MeSH term(s) Aged ; Brain ; Cerebrovascular Circulation ; Cognition ; Humans ; Longitudinal Studies ; Magnetic Resonance Imaging ; Pilot Projects ; Prospective Studies ; Renal Dialysis ; Spin Labels
    Chemical Substances Spin Labels
    Language English
    Publishing date 2020-09-15
    Publishing country Netherlands
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
    ZDB-ID 2701571-3
    ISSN 2213-1582 ; 2213-1582
    ISSN (online) 2213-1582
    ISSN 2213-1582
    DOI 10.1016/j.nicl.2020.102434
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  7. Article ; Online: Cerebral blood flow characteristics following hemodialysis initiation in older adults

    Xiufeng Li / Yelena X. Slinin / Lin Zhang / Donald R. Dengel / David Tupper / Gregory J. Metzger / Anne M. Murray

    NeuroImage: Clinical, Vol 28, Iss , Pp 102434- (2020)

    A prospective longitudinal pilot study using arterial spin labeling imaging

    2020  

    Abstract: Purpose: To investigate cerebral blood flow (CBF) characteristics before and after hemodialysis initiation and their longitudinal associations with global cognitive function in older adults. Methods: A cohort of 17 older end-stage renal disease patients ... ...

    Abstract Purpose: To investigate cerebral blood flow (CBF) characteristics before and after hemodialysis initiation and their longitudinal associations with global cognitive function in older adults. Methods: A cohort of 17 older end-stage renal disease patients anticipating standard thrice-weekly hemodialysis and a group of 11 age- and sex-matched healthy control volunteers were recruited for brain perfusion imaging studies using arterial spin labeling. Hemodialysis patients participated in a prospective longitudinal study using brain magnetic resonance imaging and global cognitive assessment using the Modified Mini-Mental State Examination (3MS) at two time points: baseline, 2.9 ± 0.9 months before, and follow-up, 6.4 ± 2.4 months after hemodialysis initiation. Healthy controls were imaged once using the same protocol. CBF analyses were performed globally in grey and white matter and regionally in the hippocampus and orbitofrontal cortex. Covariate-adjusted linear mixed-effects models were used for statistical analyses (significance: p < 0.05; marginal significance: p < 0.1). Results: At baseline, global and regional CBF was significantly higher in hemodialysis patients than in healthy controls. However, after approximately 6 months of hemodialysis, CBF declined substantially in hemodialysis patients, and became comparable to those in healthy controls. Specifically, in the hemodialysis patients, CBF declined non-significantly globally for grey and white matter and significantly regionally in the hippocampus and orbitofrontal cortex. Marginally significant associations were observed between 3MS scores and regional CBF measurements in the hippocampus and orbitofrontal cortex at baseline and follow-up, and between longitudinal changes. Conclusion: The significant decline in CBF after hemodialysis initiation and the observed association between longitudinal changes in regional CBF and 3MS scores suggest that decreased brain perfusion may contribute to the observed cognitive decline.
    Keywords Arterial spin labeling (ASL) ; Perfusion or cerebral blood flow (CBF) ; End-stage renal disease (ESRD) ; Hemodialysis ; Magnetic resonance imaging (MRI) ; Computer applications to medicine. Medical informatics ; R858-859.7 ; Neurology. Diseases of the nervous system ; RC346-429
    Subject code 610
    Language English
    Publishing date 2020-01-01T00:00:00Z
    Publisher Elsevier
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  8. Article ; Online: Serum phosphate and cognitive function in older men.

    Slinin, Yelena / Vo, Tien / Taylor, Brent C / Murray, Anne M / Schousboe, John / Langsetmo, Lisa / Ensrud, Kristine

    International journal of geriatric psychiatry

    2017  Volume 33, Issue 1, Page(s) 159–166

    Abstract: Objective: Determine whether serum phosphate is associated with concurrent cognitive impairment and subsequent cognitive decline in older men independent of demographic covariates and atherosclerotic risk factors.: Methods: In a prospective study of ... ...

    Abstract Objective: Determine whether serum phosphate is associated with concurrent cognitive impairment and subsequent cognitive decline in older men independent of demographic covariates and atherosclerotic risk factors.
    Methods: In a prospective study of 5529 men enrolled in the Osteoporotic Fractures in Men study, we measured baseline serum phosphate, baseline cognitive function, and change in cognitive function between baseline and follow-up exams an average of 4.6 years later using the Modified Mini-Mental State (3MS) Examination and Trails B.
    Results: There was no association between serum phosphate and odds of cognitive impairment as assessed by baseline 3MS score or risk of cognitive decline as assessed by longitudinal change in 3MS score. Higher baseline serum phosphate was associated with higher odds of poor executive function as assessed by Trails B with fully adjusted odds ratios 1.12 (95% confidence interval: 0.83-1.52), 1.31 (0.97-1.77), and 1.45 (1.08-1.94) for men in the second, third, and fourth versus the bottom quartile (referent group) of serum phosphate (p-trend 0.007). However, higher phosphate level was not associated with risk of decline in executive function as assessed by longitudinal change in Trails B score with fully adjusted odds ratios 0.94 (95% confidence interval 0.69-1.28), 0.96 (0.70-1.32), and 1.21 (0.89-1.66) for men in the second, third, and fourth versus the bottom quartile (referent group) of serum phosphate (p-trend 0.22).
    Conclusions: Higher serum phosphate in older men was associated with a higher likelihood of poor executive function, but not with impaired global cognitive function or decline in executive or global cognition. Copyright © 2017 John Wiley & Sons, Ltd.
    MeSH term(s) Aged ; Aged, 80 and over ; Cognition/physiology ; Cognition Disorders/blood ; Cognition Disorders/physiopathology ; Executive Function ; Female ; Humans ; Male ; Odds Ratio ; Phosphates/blood ; Prospective Studies ; Risk Factors
    Chemical Substances Phosphates
    Language English
    Publishing date 2017-03-22
    Publishing country England
    Document type Journal Article
    ZDB-ID 806736-3
    ISSN 1099-1166 ; 0885-6230
    ISSN (online) 1099-1166
    ISSN 0885-6230
    DOI 10.1002/gps.4699
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  9. Article ; Online: Long-term Outcomes of Living Kidney Donation.

    Slinin, Yelena / Brasure, Michelle / Eidman, Keith / Bydash, Jason / Maripuri, Saugar / Carlyle, Maureen / Ishani, Areef / Wilt, Timothy J

    Transplantation

    2016  Volume 100, Issue 6, Page(s) 1371–1386

    Abstract: Background: In an effort to improve outcomes associated with living kidney donation, the Kidney Diseases Improving Global Outcomes (KDIGO) assembled a Work Group to develop comprehensive guidelines addressing the evaluation and care of living kidney ... ...

    Abstract Background: In an effort to improve outcomes associated with living kidney donation, the Kidney Diseases Improving Global Outcomes (KDIGO) assembled a Work Group to develop comprehensive guidelines addressing the evaluation and care of living kidney donors. We conducted this systematic review to inform guideline development.
    Methods: We searched Ovid Medline, Ovid Embase, and the Cochrane Library to identify systematic reviews, randomized controlled trials, and observational studies published through September of 2014 and consulted the KDIGO Expert Work Group. We extracted data from systematic reviews and observational studies with sample size over 100 and mean follow-up time of at least 5 years. Studies had to have an adequate comparison group that excludes subjects with contraindications to kidney donation.
    Results: For the long-term donor outcomes, we extracted 5 systematic reviews and 40 observational studies. Moderate grade evidence reveals an association between living kidney donation and greater risk of end-stage renal disease. This association is true for donors of all races with African American donors sustaining the greatest increase in absolute risk. We found very low grade evidence that kidney donation is associated with lower kidney function, proteinuria, hypertension, and psychosocial outcomes. Consistent evidence from 3 studies reveals that donors are at higher risk for preeclampsia and gestational hypertension with postdonation pregnancies and compared with healthy matched nondonors.
    Conclusions: Living kidney donation appears to be associated with a small absolute increase in risk of end-stage renal disease, hypertension, and pregnancy complications, such as preeclampsia and gestational hypertension.
    Language English
    Publishing date 2016-06
    Publishing country United States
    Document type Journal Article
    ZDB-ID 208424-7
    ISSN 1534-6080 ; 0041-1337
    ISSN (online) 1534-6080
    ISSN 0041-1337
    DOI 10.1097/TP.0000000000001252
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  10. Article ; Online: Cystatin C and Objectively Measured Mobility 10 Years Later in Older Women.

    Ensrud, Kristine E / Lui, Li-Yung / Cawthon, Peggy / Fredman, Lisa / Slinin, Yelena / Hillier, Teresa / Cauley, Jane / Canales, Muna

    The journals of gerontology. Series A, Biological sciences and medical sciences

    2016  Volume 71, Issue 11, Page(s) 1472–1475

    Abstract: Background: Serum biomarkers predicting physical performance in late life are uncertain. We tested the hypotheses that lower serum cystatin C (cysC) in older women is associated with good mobility 10 years later.: Methods: We conducted a longitudinal ...

    Abstract Background: Serum biomarkers predicting physical performance in late life are uncertain. We tested the hypotheses that lower serum cystatin C (cysC) in older women is associated with good mobility 10 years later.
    Methods: We conducted a longitudinal analysis of a prospective cohort of 1,384 women attending Year 10 and Year 20 examinations of the Study of Osteoporotic Fractures. Serum cysC was measured using Year 10 frozen serum specimens. Year 20 mobility was ascertained by the Short Physical Performance Battery; scores of 10-12 indicated good mobility.
    Results: At Year 20, mean age was 87.5 years and 364 women (26.3%) had good mobility. After adjustment for age, race, education, health status, diabetes, cardiovascular disease, and body mass index, lower cysC at Year 10 was associated with a higher likelihood of good mobility at Year 20. Compared with quartile (Q) 4 of cysC (referent group), odds ratios (95% confidence interval) were 1.52 (1.02-2.25) for Q3, 1.93 (1.32-2.84) for Q2 and 1.80 (1.21-2.67) for Q1 (p trend across Qs .003). The association was only modestly attenuated after further adjustment for mobility as assessed by a modified Short Physical Performance Battery at Year 10 (p trend .02) or consideration of potential biologic mediators including Year 10 levels of serum 25-hydroxyvitamin D, interleukin 6, and cytokine soluble receptors (p trend .04).
    Conclusions: Lower cysC in older women is independently associated with good mobility 10 years later and may be a biomarker for successful aging as manifested by preservation of lower extremity performance in late life.
    Language English
    Publishing date 2016-03-09
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1223643-3
    ISSN 1758-535X ; 1079-5006
    ISSN (online) 1758-535X
    ISSN 1079-5006
    DOI 10.1093/gerona/glw037
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