PMID- 29644070
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220317
IS  - 2048-8505 (Print)
IS  - 2048-8513 (Electronic)
IS  - 2048-8505 (Linking)
VI  - 11
IP  - 2
DP  - 2018 Apr
TI  - Intravenous drug users who require dialysis: causes of renal failure and 
      outcomes.
PG  - 270-274
LID - 10.1093/ckj/sfx090 [doi]
AB  - BACKGROUND: Intravenous drug use is associated with progressive kidney disease of 
      several aetiologies. It is associated with behavioural and lifestyle 
      characteristics that make the provision of renal replacement therapies (RRTs) 
      challenging. We observed that patients who use intravenous drugs [people who 
      inject drugs (PWID)] present late to renal services and struggle to engage with 
      treatment. We describe the experience of a UK centre providing renal services to 
      a mixed city and rural population. METHODS: A review of electronic patient 
      records (2003-16) was performed to identify patients actively using intravenous 
      drugs at the time of dialysis initiation. Descriptive statistics were used to 
      describe aetiology, treatment, complications and prognosis. RESULTS: Twenty-three 
      patients were identified; 15 had a biopsy-proven diagnosis of AA amyloidosis. The 
      median time from presentation to dialysis initiation was 47 days [interquartile 
      range (IQR) 8-147.5]. Hepatitis C infection, venous thromboembolism and mental 
      health disorders were common comorbidities. Eight patients attempted peritoneal 
      dialysis; all failed after a median of 30 days (IQR 21.75-83). One-year survival 
      was 65% (95% confidence interval 42-80), significantly lower than 2013 UK renal 
      registry statistics for incident haemodialysis patients <65 years of age (94.2%). 
      CONCLUSIONS: PWID who develop end-stage kidney disease in our region 
      predominantly have AA amyloidosis. Most present late to renal services and have 
      poor outcomes on all forms of RRT. Rates of transplantation are low. Management 
      challenges include coexisting alcohol and mental health problems, low 
      socio-economic status, contamination of intravenous dialysis access and chaotic 
      lifestyles. Multidisciplinary management with enhanced social support may be 
      beneficial in improving outcomes for this patient group.
FAU - Scott, Jemima K
AU  - Scott JK
AD  - Richard Bright Renal Service, North Bristol NHS Trust, UK.
FAU - Taylor, Dominic M
AU  - Taylor DM
AUID- ORCID: 0000-0002-1362-2146
AD  - Richard Bright Renal Service, North Bristol NHS Trust, UK.
FAU - Dudley, Chris R K
AU  - Dudley CRK
AD  - Richard Bright Renal Service, North Bristol NHS Trust, UK.
LA  - eng
PT  - Journal Article
DEP - 20170831
PL  - England
TA  - Clin Kidney J
JT  - Clinical kidney journal
JID - 101579321
PMC - PMC5887625
OTO - NOTNLM
OT  - ESRD
OT  - amyloidosis
OT  - dialysis
OT  - hepatitis C
OT  - survival analysis
OT  - vascular access
EDAT- 2018/04/13 06:00
MHDA- 2018/04/13 06:01
PMCR- 2017/08/31
CRDT- 2018/04/13 06:00
PHST- 2017/05/19 00:00 [received]
PHST- 2017/07/13 00:00 [accepted]
PHST- 2018/04/13 06:00 [entrez]
PHST- 2018/04/13 06:00 [pubmed]
PHST- 2018/04/13 06:01 [medline]
PHST- 2017/08/31 00:00 [pmc-release]
AID - sfx090 [pii]
AID - 10.1093/ckj/sfx090 [doi]
PST - ppublish
SO  - Clin Kidney J. 2018 Apr;11(2):270-274. doi: 10.1093/ckj/sfx090. Epub 2017 Aug 31.