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E W Boeschoten

Publications and source records attributed to E W Boeschoten.

At least 19 recordsLinked to original sources
PubMed2002

Validation of the KDQOL-SF: a dialysis-targeted health measure.

BACKGROUND: In evaluations of dialysis therapy, an assessment of health-related quality of life (HRQOL) is often important. The aim of this study was to determine the basic psychometric properties, reliability and validity of the short form of the KDQOL i.e. the KDQOL-SF, a dialysis-targeted instrument, and to assess its ability to detect changes over time. METHODS: In a prospective cohort study (Netherlands Cooperative Study on the Adequacy of Dialysis, NECOSAD), all new adult ESRD patients in 32 different Dutch centers were consecutively enrolled. Demographic, clinical and HRQOL data were obtained 3 and 12 months after the start of chronic dialysis therapy. RESULTS: The reliability of the KDQOL-SF was supported by test results that were above the recommended minimal values. Validity of KDQOL-SF was confirmed by the hypothesized positive correlations of the overall health rating and renal function, and by the negative correlations between the number of comorbidities and dialysis dose. Moreover, dialysis-targeted dimensions were more sensitive in detecting relevant differences pertaining to kidney diseases than generic dimensions. The KDQOL-SF was able to detect clinical changes over time. CONCLUSIONS: The psychometric properties of the KDQOL-SF were good, and the different dialysis-targeted dimensions were informative with a high reliability and validity. These results support the application of the KDQOL-SF in studies evaluating dialysis therapy.

Female↗
PubMed2001

When to initiate dialysis: effect of proposed US guidelines on survival.

BACKGROUND: Recent guidelines from the US National Kidney Foundation Dialysis Outcomes Quality Initiative recommend an earlier start of dialysis treatment than has been common practice. Their implementation would have a substantial effect on patients' daily lives and would increase costs. The guidelines are largely opinion-based, because evidence is still lacking. METHODS: As part of a prospective multicentre study in the Netherlands, we included, between January, 1997, and May, 1999, all new patients with end-stage renal disease, for whom data were available on residual renal function 0-4 weeks before the start of dialysis. We recorded date of death or censoring until August, 2000. FINDINGS: 94 (37%) of 253 patients started dialysis treatment later than recommended by the US guideline. There was an increased mortality risk for these patients compared with those who started dialysis on time, although it was not significant (adjusted hazard ratio 1.66 [95% CI 0.95-2.89]). The adjusted difference in estimated survival time after 3 years on dialysis treatment was 2.5 months (1.1-4.0) in favour of timely starters. Conversely, the average delay in dialysis initiation for late starters, the extra time free of dialysis, was at least 4.1 months. INTERPRETATION: Although we observed a gain in survival time with a timely start of dialysis, it is probably a reflection of initiating dialysis earlier in the disease. We question the benefit of putting this guideline into daily practice, given the current clinical evidence and the effects it would have on patients and dialysis resources.

Comorbidity↗
PubMed2001

What happens to patients starting dialysis in the Netherlands?

BACKGROUND: despite improvements in dialysis technology, publications around 1990 showed increasing mortality rates in dialysis patients. The Dialysis Group of the Netherlands initiated the Netherlands Cooperative Study on the Adequacy of Dialysis (NECOSAD) to investigate the association of patient and therapy characteristics with outcome. METHODS: 250 patients were included in this prospective multicentre study 3 months after the start of dialysis. We used Cox regression to predict mortality and technique failure and repeated measures analysis of variance to study the time course of continuous parameters. RESULTS: there were considerable differences in patient populations among dialysis centres. Patient survival was 76% at 2 years. Technique survival was higher in haemodialysis. Hospitalisation decreased from 25 days between 3 and 12 months to 19 days per patient year in the third year. Residual renal function decreased at a similar rate in both modalities, but blood pressure tended to increase in females receiving peritoneal dialysis. Outcome was predominantly dependent on patient characteristics. CONCLUSIONS: In the light of the increasing age of patients starting dialysis, increasing mortality can be expected. Furthermore, if outcome is to play a role in the quality assessment of dialysis centres, it is essential to know the characteristics of their patient populations.

Age Factors↗
PubMed2000

Predictors of poor outcome in chronic dialysis patients: The Netherlands Cooperative Study on the Adequacy of Dialysis. The NECOSAD Study Group.

In a prospective cohort study, we constructed a composite index of poor outcome that incorporates survival, morbidity, and quality of life (QL). We identified baseline patient and treatment characteristics that predicted poor outcome 1 year after the start of chronic dialysis. Outcome was classified as poor if a patient had died or if at least two of the following criteria were present: (1) 30 days or greater of hospitalization per year, (2) serum albumin level of 30 g/L or less or a malnutrition index score of 11 or greater, (3) a 36-item Medical Outcomes Study (MOS)-Short Form Health Survey Questionnaire (SF-36) physical summary QL score of 2 or more SDs less than the general population mean score, and (4) an SF-36 mental summary QL score of 2 or more SDs less than the general population mean score. Multivariate logistic regression analysis was used to identify independent predictors of poor outcome. Of 250 included patients, 189 were assessable with respect to poor outcome. Of these patients, 47 (25%) were classified as poor. A baseline presence of comorbidity, serum albumin level of 30 g/L or less, physical or mental QL score 2 or more SDs less than the general population mean score, and, to a lesser extent, residual glomerular filtration rate of 2.5 mL/min/1.73 m(2) or less were independently associated with a greater risk for poor outcome. A post hoc analysis indicated a mean arterial blood pressure greater than 107 mm Hg was predictive of poor outcome in patients undergoing peritoneal dialysis. In conclusion, our prognostic model provides a useful tool to identify chronic dialysis patients at risk for poor health status. Strategies aimed at preserving residual renal function, controlling blood pressure, monitoring QL, and consequently giving psychosocial support may reduce the risk for poor outcome.

Adult↗
PubMed1999

Mortality and technique failure in patients starting chronic peritoneal dialysis: results of The Netherlands Cooperative Study on the Adequacy of Dialysis. NECOSAD Study Group.

BACKGROUND: Recent studies have shown an association between small solute clearance and patient survival. Thus far, little attention has been paid to the potential effects of fluid overload. The aim of this study was to determine the relative importance of baseline patient and treatment characteristics to mortality and technique failure in patients starting peritoneal dialysis. METHODS: One hundred and eighteen consecutive new patients were included in this prospective multicenter cohort study. Cox proportional hazards regression was used to predict mortality and technique failure. RESULTS: There were 33 deaths and 44 technique failures. The two-year patient survival was 77%, and the two-year technique survival was 64%. Age, systolic blood pressure, and the absolute quantity of small solutes removed at baseline were independent predictors of mortality. A one-year increase in age was associated with a relative risk (RR) of death of 1.05 (95% CI, 1.01 to 1.09) and a 10 mm Hg rise in systolic blood pressure, with a RR of 1.42 (95% CI, 1.17 to 1.73). The removal of 1 mmol/week/1.73 m2 of urinary and dialysate creatinine was associated with a RR of death of 0.95 (95% CI, 0.92 to 0.98) and 0.93 (95% CI, 0.89 to 0.98). The removal of urea had a similar association with the RR of death. Predictors for technique failure were urine volume, peritoneal ultrafiltration, and systolic blood pressure. CONCLUSIONS: Dialysate solute removal was an independent predictor of mortality. The association between systolic blood pressure and mortality shows that the maintenance of fluid balance and the removal of small solutes deserve equal attention.

Blood Pressure↗
PubMed1999

Quality of life over time in dialysis: the Netherlands Cooperative Study on the Adequacy of Dialysis. NECOSAD Study Group.

BACKGROUND: Information on the longitudinal quality of life (QL) of patients treated by different dialysis modalities is lacking. Therefore, we performed a prospective cohort study on the QL over time in hemodialysis (HD) and peritoneal dialysis (PD) patients. METHODS: New chronic dialysis patients from 13 Dutch dialysis centers were consecutively included. The patients' self-assessment of QL was measured with the SF-36 form at 3, 6, 12, and 18 months after the start of dialysis treatment. RESULTS: Out of 230 patients who completed the QL questionnaire at least once, 139 patients stayed on their initial dialysis modality, 26 patients switched dialysis modality, 35 patients were transplanted, 28 patients died, and two patients had a recovery of renal function. The QL of patients who died during the study period was considerably worse at baseline and worsened at a faster rate than in the other patient groups. In patients who stayed on their initial dialysis modality, the physical QL decreased over time, whereas the mental QL tended to remain stable. After an adjustment for the initial value of QL and comorbidity, a consistently favorable effect of HD on physical QL over time was found compared with PD, whereas mental QL values remained similar. Parameters of adequacy of dialysis were not associated with QL over time. CONCLUSION: This prospective cohort study shows that physical QL over time in HD patients is better than in PD patients.

Aged↗
PubMed1999

Dialysis in The Netherlands: the clinical condition of new patients put into a European perspective. NECOSAD Study Group. Netherlands Cooperative Study on the Adequacy of Dialysis phase 1.

BACKGROUND: The unadjusted annual mortality rate among prevalent Dutch dialysis patients increased from 1981 to 1992. Part of this increase may be attributed to the ageing of the dialysis population, but hardly any data were available on other important prognostic features of new Dutch dialysis patients, such as co-morbidity and other aspects of their clinical condition. The aim of the present study was to obtain these data and to put them into a European perspective. METHODS: Two hundred and fifty consecutive new patients were included in this prospective multi-centre study. Data were collected 3 months after start of dialysis. Multivariate linear regression analysis was used to explain the variability of parameters of nutritional state and blood pressure. RESULTS: Mean age was 57 years, co-morbid conditions were present in 51%, diabetes mellitus in 18%, and cardiovascular disease in 28%. Decreased protein intake was related to diminished residual renal function. Our patients did not have more co-morbidity than Dutch patients participating in a European study some years earlier. Comparison with other studies was complicated by the use of different definitions of co-morbidity and of selected patient populations. CONCLUSIONS: Despite the fact that Dutch dialysis patients have become older and the incidence of diabetic nephropathy has increased, no conclusions could be drawn on a concomitant increase in co-morbidity. This patient group may serve as a reference population to study future changes in patient case-mix within the Netherlands. Furthermore, the use of common international definitions of co-morbidity is needed to be able to make comparisons of survival data.

Activities of Daily Living↗
PubMed1999

Physical symptoms and quality of life in patients on chronic dialysis: results of The Netherlands Cooperative Study on Adequacy of Dialysis (NECOSAD)

BACKGROUND: So far, little attention has been paid to the value of dialysis adequacy for patients' quality of life (QL). Therefore we studied the impact of demographic, clinical, and dialysis characteristics on physical symptoms and perceived QL. METHODS: The study population consisted of 120 incident chronic haemodialysis (HD) and 106 peritoneal dialysis (PD) patients, starting dialysis treatment in 13 Dutch centres. Data were collected 3 months after the start of dialysis. Nine physical symptoms were assessed with a self-administered questionnaire. Patient's self-assessment of QL was measured with the 36-item MOS Short Form (SF-36). RESULTS: The most common symptoms in HD and PD were fatigue (respectively 82 and 87%) and itching (73 and 68%). In HD only a medium to high comorbidity--age risk index was associated with greater symptom burden. In PD also a lower percentage lean body mass, a lower rGFR, and past episodes of underhydration were associated with greater symptom burden. The explained variance by these variables was only 12% in HD and 21% in PD. However, greater symptom burden explained a substantial additional amount of impaired physical and mental QL on top of demographics and clinical status. Dialysis variables were associated neither with symptoms nor with QL. CONCLUSION: Symptom burden can be explained to a limited extent by demographic and clinical variables and not by dialysis characteristics. Addition of symptom burden to the other variables makes it possible to explain one-third of perceived QL. This underlines the importance of symptom reduction in order to improve patient's QL.

Adult↗
PubMed1999

Estimation of residual glomerular filtration rate and renal Kt/Vurea from creatinine clearance in end-stage renal disease patients. The Netherlands Cooperative Study on the Adequacy of Dialysis.

Residual glomerular filtration rate (rGFR) and renal Kt/Vurea are important parameters in clinical practice and in cohort studies. The calculation of these parameters requires analysis of urea in a 24-hour urine collection and in a simultaneously obtained plasma sample. In clinical practice, urea clearance is not always determined, but creatinine clearance usually is. The aim of the present study was to assess how well rGFR and renal Kt/Vurea can be estimated from creatinine clearance in end-stage renal disease (ESRD) patients. Of new Dutch ESRD patients, 365 were consecutively included in this study at the start of their chronic dialysis treatment. The estimation models were based on a random sample of two-thirds of the patients; the models were validated on the remaining one-third. We built models for pre-dialysis and peritoneal dialysis (PD) patients together (pre + PD group), and separate models for hemodialysis (HD) patients. Mean measured rGFR of pre + PD patients in the validation group was 6.3 mL/minute. The limits of agreement (LoAs) between estimated and measured rGFR were within -1.5 and +1.5. Mean measured rGFR in HD patients was 3.1 mL/minute (LoAs: -0.3 and +0.3). These relatively small limits of agreement reveal that, should urea clearance be missing, rGFR can be estimated by a formula in which creatinine clearance and 24-hour urine production are included. The estimation of renal Kt/Vurea from creatinine clearance was less precise.

Creatinine↗
PubMed1999

Reliability of the 7-point subjective global assessment scale in assessing nutritional status of dialysis patients.

Subjective global assessment (SGA) is a method to score nutritional status in a standardized way. The original 3-point scale has been replaced by a 7-point scale. The reliability of the latter scale has never been tested. We therefore assessed inter-observer and intra-observer reliability. Furthermore, we examined the relationship of SGA with other objective nutritional parameters. In 13 hemodialysis and 9 peritoneal dialysis patients, two nurses assessed SGA. They re-examined the same patients two weeks later. Anthropometric measurements and blood samples were taken at the first assessment. According to SGA, 2 patients (9%) were classified as severely malnourished, 6 (27%) as mildly malnourished, and 14 (64%) as well nourished. The 7-point SGA scale showed fair inter-observer reliability [intraclass correlation (ICC) = 0.72] and good intra-observer reliability (ICC = 0.88). A strong correlation was present between the 7-point SGA scale and body mass index (BMI) (r = 0.79, p < 0.001), % fat (r = 0.77, p < 0.001), and mid arm circumference (r = 0.71, p < 0.001). Lower correlations were found with mid arm muscle circumference and serum albumin. With respect to biochemical markers, the strongest relationship was found with prealbumin (r = 0.60, p = 0.004). We conclude that the 7-point SGA scale is a valid and reliable tool to assess nutritional status among end-stage renal disease patients. We suggest that one observer or a select group of observers perform the assessments to gain maximum benefit from the reliability of the SGA instrument.

Anthropometry↗
PubMed1997

Quality of life in patients on chronic dialysis: self-assessment 3 months after the start of treatment. The Necosad Study Group.

The aim of the present multicenter study was to assess quality of life of Dutch dialysis patients 3 months after the start of chronic dialysis treatment. The quality of life was compared with the quality of life of a general population sample, and the impact of demographic, clinical, renal function, and dialysis characteristics on patients' quality of life was studied. New end-stage renal disease (ESRD) patients who were started on chronic hemodialysis or peritoneal dialysis in 13 dialysis centers in The Netherlands were consecutively included. Patients' self-assessment of quality of life was measured by the SF-36, a 36-item Short Form Health Survey Questionnaire encompassing eight dimensions: physical functioning, social functioning, role-functioning physical, role-functioning emotional, mental health, vitality, bodily pain, and general health perceptions. One hundred twenty hemodialysis and 106 peritoneal dialysis patients completed the SF-36. Quality of life of hemodialysis and peritoneal dialysis patients was substantially impaired in comparison to the general population sample, particularly with respect to role-functioning physical and general health perceptions. Mean role-functioning physical and general health perceptions scores of the hemodialysis patients corresponded with the lowest scoring 8% and 12%, respectively, of the reference group. Mean role-functioning physical and general health perceptions scores of the peritoneal dialysis patients corresponded with the lowest scoring 10% and 12%, respectively, of the reference group. Hemodialysis patients showed lower levels of quality of life than peritoneal dialysis patients on physical functioning, role-functioning emotional, mental health, and pain. However, on the multivariate level, we could only demonstrate an impact of dialysis modality on mental health. A higher number of comorbid conditions, a lower hemoglobin level, and a lower residual renal function were independently related to poorer quality of life. The variability of the SF-36 scores explained by selected demographic, clinical, renal function, and dialysis characteristics was highest for physical functioning (29.7%). Explained variability of the other SF-36 dimensions ranged from 6.9% for general health perceptions to 15.4% for vitality. We conclude that quality of life of new ESRD patients is substantially impaired. Comorbid conditions, hemoglobin, and residual renal function could explain poor quality of life only to a limited extent. Further research exploring determinants and indices of quality of life in ESRD patients is warranted. From a clinical perspective, we may conclude that quality of life should be considered in the monitoring of dialysis patients.

Adolescent↗
PubMed1996

Impaired initial cell reaction in CAPD-related peritonitis.

Our objective was to determine the incidence of peritonitis episodes with an impaired initial cell reaction (IICR:neutrophil number < 100 x 10(6)/L) over a period of ten years, and to find possible explanations for this unusual presentation of peritonitis. A retrospective review of the files of continuous ambulatory peritoneal dialysis (CAPD) patients included in the CAPD program 1984 and 1993 was done. Analysis of cytokine and prostanoid patterns during four peritonitis episodes with an IICR was compared to 12 episodes with a normal initial cell reaction (NICR). Dialysate cell numbers and immunoeffector characteristics of peritoneal cells were compared in 7 IICR patients in a stable situation and a control group of 70 stable CAPD patients. The setting was a CAPD unit in the Academic Medical Center in Amsterdam. Thirty-five CAPD patients who had one or more peritonitis episodes with an IICR and a control group of 249 CAPD patients were included in the study. The incidence of peritonitis with an IICR was 6%. These episodes occurred more than once in 51% of the patients who presented with IICR. In 72% the cell reaction was only delayed: a cell number exceeding 100 x 10(6)/L was reached later. Staphylococcus aureus was significantly more frequently the causative microorganism compared to all peritonitis episodes (PE) that occurred during the study period. Patients with IICR had lower dialysate cell counts in a stable situation, compared to a control group (p < 0.01). This was caused by a lower number of macrophages and CD4 positive lymphocytes. The phagocytosis capacity of the macrophages appeared to be normal. In a comparison of four PE with an IICR and 12 episodes with an NICR, the tumor necrosis factor-alpha (TNF-alpha) response was similar and occurred on day 1, also pointing to normally functioning macrophages. However, the maximal appearance rates of interleukin-6 (IL-6) and IL-8 occurred later in the episodes with IICR compared to NICR (day 2 vs day 1, p < 0.05). No differences were found in vasodilating prostaglandins, mesothelial cell markers (cancer antigen 125, phospholipids, hyaluronan), and mesothelial cell numbers in the stable situation nor during peritonitis. Peritonitis can present as abdominal pain in the absence of a cloudy dialysate. In some of the patients this presentation occurred more than once. This impaired, most often delayed, cell reaction was associated with a delayed secondary cytokine response. As IL-6 and IL-8 can be synthesized by mesothelial cells, this suggests an impaired functioning mesothelium. This could not be confirmed, however, by a lower number of mesothelial cells in effluent or lower dialysate levels of mesothelial cell markers.

Adolescent↗
PubMed1994

A prospective study of peritoneal transport in CAPD patients.

A prospective two year follow-up study of the functional characteristics of the peritoneal membrane was conducted in 61 CAPD patients. Peritoneal transport of solutes, calculated by mass transfer area coefficients for urea and creatinine, peritoneal clearances for proteins, percentage of absorption of glucose, as well as net ultrafiltration were measured every four months. After five months on CAPD a decrease was found for the transport of most solutes (P < 0.05, mean values, ml/min/1.73 m2): urea 18.1 to 16.2, creatinine 9.5 to 8.4, IgG 0.049 to 0.040 and alpha 2-macroglobulin 0.020 to 0.015, as well as for the absorption of glucose (57.9 to 53.2%, P < 0.05). Net ultrafiltration increased simultaneously from 44.6 to 100.5 ml/4 hr/1.73 m2, P < 0.05. From five months to two years on CAPD a significant increase in the transport of all solutes except alpha 2-macroglobulin was found, as well as a decrease in net ultrafiltration. Peritoneal transport at the end of the study was not significantly different from the starting values. Our findings indicate an initial effect of CAPD itself on peritoneal transport, probably due to the recent start of the treatment. Baseline values were reached after five months on CAPD. Thereafter a gradual increase in peritoneal solute transport occurred during two years of treatment. This can be explained by an increase in the effective peritoneal surface area.

Adult↗
PubMed1994

The effect of serum albumin at the start of continuous ambulatory peritoneal dialysis treatment on patient survival.

OBJECTIVE: To analyze the effect of serum albumin using immunoturbidimetry, demographic, biochemical, and kinetic factors on survival of continuous ambulatory peritoneal dialysis (CAPD) patients. DESIGN: A review of prospectively collected data in a 2-year follow-up study of peritoneal transport kinetics. SETTING: University medical center. PARTICIPANTS: Sixty-one patients, evaluated within 3 months after the start of CAPD. MAIN OUTCOME MEASURES: Covariables used in the survival analysis were plasma urea, and creatinine, albumin, hemoglobin, mass transfer area coefficient of creatinine, peritoneal albumin clearance, 4-hour peritoneal albumin loss, net ultrafiltration, age, blood pressure, body mass index, difference between actual and ideal bodyweight, and presence or absence of systemic disease. RESULTS: Overall survival was 64% at 2 years. Median serum albumin was 30.9 g/L, range 18.1-43.9 g/L. Patients with a serum albumin below the median had a lower survival rate than those higher than the median (2-year survival 49% vs 79%, p = 0.01). Using the Cox model, survival was related to systemic disease (p = 0.004), age (p = 0.02), hemoglobin (p = 0.03), and serum albumin (p = 0.1). CONCLUSIONS: The results confirm the strength of serum albumin as predictor of survival. However, in this study serum albumin merely reflected the presence of a systemic disease, which was the most important risk factor for patient survival.

Comorbidity↗
PubMed1993

Acute pancreatitis during CAPD in The Netherlands.

Acute pancreatitis in patients on CAPD treatment is an infrequent, but serious complication. We studied the records of all CAPD patients with acute pancreatitis in the Netherlands from 1979 until May 1992. The incidence of acute pancreatitis during CAPD treatment was 0.46 per 100 treatment-years. In all patients at least one risk factor was present. Hypercalcaemia was the most frequently observed risk factor in our patients. The clinical picture consisted of abdominal pain and vomiting, with normal temperature and normal peristalsis. Plasma amylase was elevated in 18 episodes. Dialysate amylase concentrations exceeded 100 U/l in seven of ten episodes. The dialysate could either be clear, haemorrhagic, or cloudy. Positive dialysate cultures were found in five patients, in most cases with skin flora. No direct correlation with the pancreatitis could be established. Mortality was 58%. Continuation of CAPD or transfer to haemodialysis had no apparent effect on the outcome, but the best prognosis was found in patients with a persistently clear dialysate.

Acute Disease↗