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DESIGN We introduced a long-term care facility (LTCF) infectious disease (ID) consultation service (LID service) that provides on-site consultations to residents of a Veterans Affairs (VA) LTCF. We determined the impact of the LID service on antimicrobial use and Clostridium difficile infections at the LTCF. SETTING A 160-bed VA LTCF. METHODS Systemic(More)
BACKGROUND The purpose of this study is to evaluate serum bicarbonate level as a risk factor for renal outcomes, cardiovascular events, and mortality in patients with chronic kidney disease (CKD). STUDY DESIGN Observational cohort study. SETTING & PARTICIPANTS 3,939 participants with CKD stages 2-4 who enrolled in the Chronic Renal Insufficiency Cohort(More)
BACKGROUND/AIMS Low heart rate variability (HRV) is a risk factor for adverse outcomes in the general population. We aimed to determine the factors associated with HRV and evaluate the association between low HRV and clinical outcomes in patients with chronic kidney disease (CKD). METHODS A 10-second electrocardiogram was obtained at baseline in the(More)
The development of proliferative podocytopathies has been linked to ligation of tumor necrosis factor receptor 2 (TNFR2) expressed on the renal parenchyma; however, the TNFR2-positive cells within the kidney responsible for podocyte injury are unknown. We detected de novo expression of TNFR2 on podocytes before hyperplastic injury in crescentic(More)
OBJECTIVES To develop and validate a model to predict 1-year risk of end-stage renal disease (ESRD) in elderly subjects with advanced chronic kidney disease (CKD). DESIGN Retrospective. SETTING Veterans Affairs Medical Center. PARTICIPANTS Individuals aged 65 and older with CKD with an estimated glomerular filtration rate (eGFR) less than 30 mL/min(More)
Early identification of chronic kidney disease (CKD) provides an opportunity to implement therapies to improve kidney function and slow progression. The goal of this article is to review established and developing clinical therapies directed at slowing progression. The importance of controlling blood pressure will be discussed along with the target blood(More)
BACKGROUND Adherence to hypertension guidelines in the outpatient setting is low. OBJECTIVE To evaluate adherence to JNC VII guidelines in nursing home patients. DESIGN Data were obtained from the 2004 National Nursing Home Survey (NNHS), a nationally representative sample of US nursing homes. Patients with hypertension were identified using ICD-9(More)
OBJECTIVES To determine whether elderly adults with a low glomerular filtration rate (GFR) are at risk for anemia, hyperkalemia, acidosis, and hyperphosphatemia. DESIGN Retrospective study. SETTING Veterans Affairs Medical Center. PARTICIPANTS Thirteen thousand eight hundred seventy-four veterans aged 65 and older with chronic kidney disease (CKD) and(More)
BACKGROUND Primary care providers do not routinely follow guidelines for the care of patients with chronic kidney disease (CKD). Multidisciplinary efforts may improve care for patients with chronic disease. Pharmacist based interventions have effectively improved management of hypertension. We performed a pragmatic, randomized, controlled trial to evaluate(More)