This is a handout I gave out to an under-grad stats class (where I was a guest lecturer) where I attempted to use a real life situation to impress upon the students the importance of statistics. I then went through six published journal articles relating to this topic to show them how to make a rational decision based on the current literature and statistics available on ESRD to show them how to come to an "evidence based" decision.
Statistics: So What?
Case Study for Kidney Failure Treatment Options Using Statistics as a Guide
Presenter: Eli Lazovsky, MPH
Date: June 14, 2011–06–14
For: HTC Statistics Class
You are advising a friend who has ESRD/Kidney Failure about his/her treatment options. What would you suggest to them as a rational course of action. Remember, there is not necessarily only 1 correct option. Be able to back up (using statistics) whatever you decide to advise your friend. Your friend isn’t so proficient in statistics so (s)he is relying on what you learned in your statistics class to help out.
What is your recommendation to your friend. Focus on what decision correlates with the following goal: Increase Life Expectancy
Diagnosis: ESRD
Treatment Options:
A. do nothing
B. dialysis
C. transplant
B. Dialysis
1. hemodialysis
2. peritoneal dialysis
Type of Access Point for the hemodialysis
1. AVF
2. AGF
3. Catheter
Frequency of Hemodialysis
1. 3 times a week
2. 6 times a week
C. Transplant
1. Before starting dialysis
2. After starting dialysis
Status of Organ Donor
1. Deceased Donor/Cadaver Organ
2. Live Donor
Type of Organ
1. Ideal Organ
2. Marginal Organ
Friday, June 17, 2011
Monday, June 6, 2011
Treatment Modalities for ESRD Patients: How to Increase Life Expectancy
A person who has kidney failure, or ESRD, should be cognizant that the choices s(he) and their physician make regarding their care will effect their life expectancy.
For example, a study comparing Dialysis treatment in Italy and the U.S. points out that in 2006, the annual mortality rate for people with ESRD in Italy was 11.2+/-.6 compared to 24% in the U.S. A link to the abstract of the article can be found here.
The authors write, in part, that "[t]he following may explain the low mortality for ESRD patients in Italy: low prevalence of diabetes, high use of AV fistulae, delivery of care by nephrologists beginning in pre-ESRD stages, their involvement in placement of dialysis vascular access, and their physical presence requirement during dialysis sessions."
Keep in mind, as of 2006, only 38.6% of dialysis patients had AV fistulas compared to approximately 82% of dialysis patients in Italy (figures taken from the study cited above). Recent data is much more encouraging. As of December 2010, in the U.S., 57.5% of hemodialysis patients had AV Fistulas. See here.
AV fistulas are associated with lower infection rates compare to people with AV grafts and thus better long term outcomes for the patient.
A Veterans Administration study linked to here also found that people on hemodialysis who had AV fistulas lived on average about 3 months longer compared to people with AV grafts.
The bottom line is by studying the various manners of treatment for ESRD both domestically and internationally, ESRD best-practices guidelines can be fashioned to increase the life expectancy and the quality of life for people on dialysis.
For example, a study comparing Dialysis treatment in Italy and the U.S. points out that in 2006, the annual mortality rate for people with ESRD in Italy was 11.2+/-.6 compared to 24% in the U.S. A link to the abstract of the article can be found here.
The authors write, in part, that "[t]he following may explain the low mortality for ESRD patients in Italy: low prevalence of diabetes, high use of AV fistulae, delivery of care by nephrologists beginning in pre-ESRD stages, their involvement in placement of dialysis vascular access, and their physical presence requirement during dialysis sessions."
Keep in mind, as of 2006, only 38.6% of dialysis patients had AV fistulas compared to approximately 82% of dialysis patients in Italy (figures taken from the study cited above). Recent data is much more encouraging. As of December 2010, in the U.S., 57.5% of hemodialysis patients had AV Fistulas. See here.
AV fistulas are associated with lower infection rates compare to people with AV grafts and thus better long term outcomes for the patient.
A Veterans Administration study linked to here also found that people on hemodialysis who had AV fistulas lived on average about 3 months longer compared to people with AV grafts.
The bottom line is by studying the various manners of treatment for ESRD both domestically and internationally, ESRD best-practices guidelines can be fashioned to increase the life expectancy and the quality of life for people on dialysis.
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