What did we learn from the 1989 Dallas Morbidity and Mortality Meeting? Alan R. Hull, MD A teaching hospital of Harvard Medical School.

Slides:

Advertisements

Similar presentations

ANZDATA Registry Annual Report 2013 STOCK AND FLOW CHAPTER 1.

Advertisements

Chronic Uremic Acidosis Nutritional Effects 2 Hypoalbuminemia Osteomalacia (bone mineral loss) Decreased muscle mass Increased incidence of morbidity and.

Urgent-Start Peritoneal Dialysis Cathy Wilson-Bates, RN, CDN, CPDN.

Renal Replacement Therapy: What the PCP Needs to Know.

UK Renal Registry 15th Annual Report Figure One year death rate per 1,000 patient years by UK country and age group for prevalent dialysis.

End Stage Kidney Disease Treatment Modalities Australia New Zealand Dec 2012 Prepared by Debbie Fortnum Kidney Health Australia Data courtesy of ANZDATA.

Prof. Dr. Willem Kollf (1911 Leyden Netherland) -Emeritus Prof. Dr. Internal Diseases,Surgery, Bioenergy, Specialist.UTAH 39 th EDTA Congress Copenhag.

Inpatient Palliative Care: What is it and Why it’s Important Lyra Sihra MD Associate Medical Director Gentiva Hospice.

STUDY DESIGN CASE SERIES AND CROSS-SECTIONAL

Groupe de recherche PRIMUS. Time to Insulin Initiation in Diabetic Patients: A Quebec Population-Based Analysis Present by: Shabnam Asghari M.D. Ph.D.

Dialysis Facility Compare Valarie Ashby Co-Managing Director UM-KECC.

Summary of the 2012 ERA-EDTA Registry Annual Report Amsterdam, the Netherlands, 2014.

Gerard Dou, The Dropsical Woman, 1663, Louvre, Paris Peer Report: Dialysis Care & Outcomes in the U.S., 2014 Executive Summary.

MiPCT Palliative Care and Advance Care Planning 2014 Phil Rodgers, MD, Presenter

Health Disparities & Resources: Connecting the Community to Care Robert Gilchick, MD, MPH, FACPM Director, Child and Adolescent Health Program and Policy.

© ANZDATA Registry Method and Location of Dialysis 1453 (30%) 632 (13%) 1317 (27%) 1335 (27%) Number of Patients Australia 31-Dec-96.

| 1| 1Peer Report: Dialysis Care & Outcomes in the U.S., 2014 | Mortality Peer Report: Dialysis Care & Outcomes in the U.S., 2014 Mortality.

Creating an Oligopoly in the Treatment of End Stage Renal Disease and the Subsequent Impact on Home Hemodialysis Therapies in the United States John D.

CHRONIC KIDNEY DISEASE National Healthcare Quality and Disparities Report Chartbook on Effective Treatment.

Chapter 29 Improving Physician Decisions. Supplement 15 Improving Physician Decisions.

Care at Home How to Survey Home Training and Support with the New ESRD CfCs Teri Spencer and Kelly Frank.

DVT & PE: How early can I mobilize a patient ??

Looking at Frailty Through a New Lens John Strandmark, M.D. ©AAHCM.

Survival after graft failure Dr Lynsey Webb Registrar UK Renal Registry UK Renal Registry 2011 Annual Audit Meeting.

Natividad Medical Center Board of Trustees February 1, 2013 Financial Statements For December 31,

USRDS 1999 Point Prevalence Counts by Modality, Data Source, and Year, Count (1000s) Year Center Hemo Functioning Transplant PD Home Hemo Facility.

STOCK AND FLOW CHAPTER 1. © ANZDATA Registry Figure 1.1 Prevalent Patients (Number Per Million Population at 31st December)

Summary of the 2013 ERA-EDTA Registry Annual Report Amsterdam, the Netherlands, 2015.

ESRD: State of the Art and Charting the Challenges for the Future Beth Israel Deaconess and Harvard Medical School April 23 – 26, 2009 A teaching hospital.

Blair Grace Kylie Hurst Stephen McDonald CHAPTER 1 STOCK AND FLOW 2012 Annual Report—35th Edition ANZDATA Registry Annual Report 2012.

© ANZDATA Registry Stock and Flow of CAPD Patients Australia Number of Patients 1504 Patients * (Data to 30 Sept) Extrapolated.

ESRD Prognoses James Heaf. This Power Point presentation belongs to the Danish Renal Registry, which owns the copyright. It can be freely used.

2016 Annual Data Report, Vol 2, ESRD, Ch 13

World Kidney Day 2016: Kidney Disease & Children

The Burden of Malaria at the Pothawira Clinic Malawi, Africa

McCullough PA, Chan CT, Weinhandl ED, Burkart JM, Bakris GL

Prevalence (pmp) of Renal Replacement Therapy

UK Renal Registry 10th Annual Report 2007

The HEMO Study Hemodialysis (HEMO) Study Reference

Figure 3.1 First-year mortality rates in incident dialysis patients, by incident year & month Patients aged 18 years or older. Peer Report Dialysis.

Volume 68, Pages S46-S52 (August 2005)

Summary of the 2013 ERA-EDTA Registry Annual Report

December 31st point prevalent counts by modality figure 3.1

McCullough PA, Chan CT, Weinhandl ED, Burkart JM, Bakris GL

UK Renal Registry 9th Annual Report 2006

UK Renal Registry 10th Annual Report 2007

2019 Health Plan ASU is a self-insured health plan. Employees and ASU pay premiums into the plan, and those premiums are used to pay claims, administrative.

End-stage renal disease in developing countries

Number of dialysis & transplant units figure 10.1

METHOD AND LOCATION OF DIALYSIS CHAPTER 4.

CHAPTER 1 All Renal Replacement Therapy In Malaysia

Both cardiovascular and non-cardiovascular diseases are important causes of death in dialysis patients: A comparison with the general population Minako.

Anne M. Butler, PhD, Andrew F. Olshan, PhD, Abhijit V

Outcomes with dual RAAS inhibition with an ACE inhibitor and ARB vs standard therapy in patients on hemodialysis with CHF standard therapy in patients.

A Nursing Perspective on Improving Outcomes for Patients With Hemophilia.

Name of Hospital Presenter: Consultant Physician: Presentation Date:

Iain C. Macdougall, MD American Journal of Kidney Diseases

David C. Mendelssohn, MD, FRCPC, Jay B. Wish, MD

Volume 68, Pages S46-S52 (August 2005)

ANZDATA Registry 41st Annual Report Highlights of End Stage Kidney Disease in Australia and New Zealand Data to 31-Dec-2017.

Baseline Demographic Characteristics of Adults With Diagnosed Heart Failure and Eligible to Receive Lipid-Lowering Therapy Alan S. Go, et al.

Volume 66, Issue 5, Pages (November 2004)

Peter A. McCullough, MD, MPH, Christopher T. Chan, MD, Eric D

Kaplan–Meier curve for technique survival censored for death, transplantation, and program exit for patient choice for all individuals commencing home.

Renal replacement therapy in Latin America

American Journal of Kidney Diseases

Worldwide incidence of ESRD figure 12.1, per million population

Douglas E. Schaubel, Howard I. Morrison, Stanley S.A. Fenton

Mary B. Leonard, Lynn A. Donaldson, Martin Ho, Denis F. Geary

My PAH Patient.

Presentation transcript:

What did we learn from the 1989 Dallas Morbidity and Mortality Meeting? Alan R. Hull, MD A teaching hospital of Harvard Medical School

3 Questions proposed for the Dallas Meeting Is the mortality rate in the U.S. actually higher than other “industrialized” countries? Has the mortality rate in the U.S. been increasing? Can the differences between the countries be accounted for by the prescription and delivery of dialysis or the demographics/incidence rate of the patients?

A teaching hospital of Harvard Medical School The Requested Format for the Dallas Meeting Yearly acceptance rate (Incidence) Prevalence rate for the calendar year GROSS MORTALITY –Definition: deaths during the calendar year over the mid year census

A teaching hospital of Harvard Medical School 1987 – 88 Comparison of Registries RegistryIncidence*Prevalence*Transplant*Gross Mortality (%) Canada FRG France Japan137671<28.8 U.S (Current) 151 (360) 403 (1200) Australia *PMP/Y

A teaching hospital of Harvard Medical School

Summary of the Dallas Meeting The U.S. did have a higher mortality rate –Higher incidence rate Mortality rate was increasing over the previous 4 years ( ) Multiple theories –Most prevalent theory = prescription and delivery of dialysis

A teaching hospital of Harvard Medical School Contemporary Provocations and Final 3 Questions (1) Why do you support the current thrice weekly in-center hemodialysis system for your patients? The Bevan Story –Is it possible that the dialysis providers are following Bevan’s lead and the “gold” is the Medical Director’s fee? –A true story

A teaching hospital of Harvard Medical School Contemporary Provocations and Final 3 Questions (2) Is it possible, although you are the patient’s physician, that you are subjecting them to a treatment that you would not accept yourself - nor have your immediate family undertake?

A teaching hospital of Harvard Medical School Provocation: Therapies and Outcomes Possible Therapies –CAPD –CCPD –Conventional In Center –Nocturnal In Center –Conventional HHD –Nocturnal HHD –Short Daily HHD –Transplant Living Cadaveric –Palliative Therapies Stratified by Outcomes –Transplantation –Nocturnal HHD –Nocturnal In-center and Short Daily HHD –Conventional HHD –CAPD and CCPD –Conventional In Center –Palliative