Most Read Articles
01 Dec 2020
Tetanus toxoid 5 Lf, diphtheria toxoid 2 Lf, pertussis toxoid 2.5 mcg, filamentous haemagglutinin 5 mcg, fimbriae types 2 and 3 5 mcg, pertactin 3 mcg
Dr. Hsu Li Yang, Dr. Tan Thuan Tong, Dr. Andrea Kwa, 08 Jan 2021
Antimicrobial resistance has become increasingly dire as the rapid emergence of drug resistance, especially gram-negative pathogens, has outpaced the development of new antibiotics. At a recent virtual symposium, Dr Hsu Li Yang, Vice Dean (Global Health) and Programme Leader (Infectious Diseases), NUS Saw Swee Hock School of Public Health, presented epidemiological data on multidrug-resistant (MDR) gram-negative bacteria (GNB) in Asia, while Dr Tan Thuan Tong, Head and Senior Consultant, Department of Infectious Diseases, Singapore General Hospital (SGH), focused on the role of ceftazidime-avibactam in MDR GNB infections. Dr Andrea Kwa, Assistant Director of Research, Department of Pharmacy, SGH, joined the panel in an interactive fireside chat, to discuss challenges, practical considerations, and solutions in MDR gram-negative infections. This Pfizer-sponsored symposium was chaired by Dr Ng Shin Yi, Head and Senior Consultant of Surgical Intensive Care, SGH.
Jairia Dela Cruz, 4 days ago
Spending too much time sitting cannot be good for the body, and rising to one's feet breaks up such a behaviour and yields small, but meaningful, reductions in certain cardiovascular disease (CVD) risk factors, according to the results of a meta-analysis.
4 days ago
Use of thyroid hormone therapy does not seem to protect older adults with subclinical hypothyroidism against mortality, but it appears to confer survival benefits to those aged <65 years, results of a study have shown.

Early initiation of peritoneal dialysis detrimental to elderly but not young patients

05 Jan 2021

Starting elderly patients on peritoneal dialysis (PD) early, when estimated glomerular filtration rate (eGFR) is at ≥7.5 mL/min/1.73 m2, appears to do more harm than good, contributing to an increased risk of death, according to a study. Among younger patients, on the other hand, early commencement of PD neither improves clinical outcomes nor negatively influences survival.

The study included 2,133 patients receiving PD, of whom 1,803 were young (<65 years old; mean age, 42.6 years; 61.1 percent male) and 330 were elderly (≥65 years old; mean age, 71.2 years; 51.5 percent male).

Over a median follow-up of 43.6 months, 334 patients (18.5 percent) died, 288 (16.0 percent) were transferred to permanent hemodialysis (HD), and 494 (27.4 percent) received kidney transplantations in the young group.

The respective cumulative patient survival rates at years 1 and 5 were 98 percent and 77 percent in the early-start PD subgroup, 98 percent and 81 percent in the mid-start subgroup, and 98 percent and 82 percent in the late-start subgroup (p=0.008). The CV mortality rates at years 1 and 5 were 1 percent and 11 percent, 1 percent and 10 percent, and 1 percent and 10 percent in the early-, mid- and late-start PD subgroups, respectively (p=0.176).

In the elderly group, on the other hand, there were 222 (67.3 percent) deaths, 40 (12.1 percent) transfers to permanent HD, and three (0.9 percent) kidney transplantation recorded over a median follow-up of 37.2 months.

The respective cumulative patient survival rates at years 1 and 5 were 80 percent and 28 percent in the early-start PD subgroup, 82 percent and 32 percent in the mid-start subgroup, and 91 percent and 41 percent in the late-start subgroup (p=0.024). The CV mortality rates at years 1 and 5 were 3 percent and 56 percent, 11 percent and 47 percent, and 4 percent and 34 percent in the early-, mid- and late-start PD subgroups, respectively (p=0.176).

Multivariable Cox analysis showed no differences in the overall and CV mortality risks across the PD subgroups among young patients.

However, among elderly patients, early initiation of PD therapy conferred a risk increase for all-cause death (hazard ratio [HR], 1.54, 95 percent confidence interval [CI], 1.06–2.25) and CV death (HR, 2.07, 95 percent CI, 1.24–3.48) compared with late initiation. Overall or CV mortality was similar in the mid- and late-start subgroups.

Digital Edition
Asia's trusted medical magazine for healthcare professionals. Get your MIMS Doctor - Malaysia digital copy today!
Sign In To Download
Editor's Recommendations
Most Read Articles
01 Dec 2020
Tetanus toxoid 5 Lf, diphtheria toxoid 2 Lf, pertussis toxoid 2.5 mcg, filamentous haemagglutinin 5 mcg, fimbriae types 2 and 3 5 mcg, pertactin 3 mcg
Dr. Hsu Li Yang, Dr. Tan Thuan Tong, Dr. Andrea Kwa, 08 Jan 2021
Antimicrobial resistance has become increasingly dire as the rapid emergence of drug resistance, especially gram-negative pathogens, has outpaced the development of new antibiotics. At a recent virtual symposium, Dr Hsu Li Yang, Vice Dean (Global Health) and Programme Leader (Infectious Diseases), NUS Saw Swee Hock School of Public Health, presented epidemiological data on multidrug-resistant (MDR) gram-negative bacteria (GNB) in Asia, while Dr Tan Thuan Tong, Head and Senior Consultant, Department of Infectious Diseases, Singapore General Hospital (SGH), focused on the role of ceftazidime-avibactam in MDR GNB infections. Dr Andrea Kwa, Assistant Director of Research, Department of Pharmacy, SGH, joined the panel in an interactive fireside chat, to discuss challenges, practical considerations, and solutions in MDR gram-negative infections. This Pfizer-sponsored symposium was chaired by Dr Ng Shin Yi, Head and Senior Consultant of Surgical Intensive Care, SGH.
Jairia Dela Cruz, 4 days ago
Spending too much time sitting cannot be good for the body, and rising to one's feet breaks up such a behaviour and yields small, but meaningful, reductions in certain cardiovascular disease (CVD) risk factors, according to the results of a meta-analysis.
4 days ago
Use of thyroid hormone therapy does not seem to protect older adults with subclinical hypothyroidism against mortality, but it appears to confer survival benefits to those aged <65 years, results of a study have shown.