Graham Abra

All Publications

• Bundle Fix?: We Need an Act of Congress. Journal of the American Society of Nephrology : JASN Abra, G., Shah, A. D. 2025

  View details for DOI 10.1681/ASN.0000000664

  View details for PubMedID 39951354

• Description and outcomes of a staff-assisted peritoneal dialysis program in the United States. Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis Hussein, W. F., Chen, S., Bennett, P. N., Atwal, J., Abra, G., Weinhandl, E., Zheng, S., Pravoverov, L., Schiller, B. 2024: 8968608241259607

  Abstract

  Staff-assisted peritoneal dialysis (PD) can help overcome barriers to self-care but is not yet available in the United States (US). We developed and implemented a staff-assisted PD program that fits within current regulatory and cost restraints in the US healthcare environment.Patient care technicians (PCTs) were trained on PD procedures and troubleshooting common problems. The program expanded from two centers in August 2020 to sixteen by October 2022. We described the logistic elements of program delivery, and patient and treatment outcomes for patients discharged by end of April 2023, with a cohort follow up until October 2023.A total of 121 patients were referred to the program. The most common indications for referral were physical function limitations, cognitive impairment, and psychosocial challenges. Staff assistance was provided for 73 patients. Mean age was 72 (standard deviation 14) years. A total of 604 visits were delivered, with a median 5 (interquartile range [IQR] 3-10, range: 1-49) visits per patient. Median duration of assistance was 8 (IQR: 2-21, range: 1-84) days. Assistance was most frequently needed for PD treatment setup and for observing and directing the technique. No peritonitis events or exit-site infections were reported. Sixty-eight patients (93%) were discharged on PD without staff assistance. The 6- and 12-month survival of PD without assistance was 71% and 57%, respectively.Staff-assisted PD for limited time periods is operationally feasible with PCTs in the US and can support transitioning and maintaining patients on PD.ClinicalTrials.gov Identifier: NCT04319185.

  View details for DOI 10.1177/08968608241259607

  View details for PubMedID 38881397

• Assisted peritoneal dialysis: Position paper for the ISPD. Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis Oliver, M. J., Abra, G., Béchade, C., Brown, E. A., Sanchez-Escuredo, A., Johnson, D. W., Guedes, A. M., Graham, J., Fernandes, N., Jha, V., Kabbali, N., Knananjubach, T., Kam-Tao Li, P., Lundström, U. H., Salenger, P., Lobbedez, T. 2024: 8968608241246447

  View details for DOI 10.1177/08968608241246447

  View details for PubMedID 38712887

• Exploring Preconceptions as Barriers to Peritoneal Dialysis Eligibility: A Global Scenario-Based Survey of Kidney Care Physicians. Kidney international reports Shah, N., Bennett, P. N., Cho, Y., Leibowitz, S., Abra, G., Kanjanabuch, T., Baharani, J. 2024; 9 (4): 941-950

  Abstract

  Despite the growing number of patients requiring kidney replacement therapy (KRT), peritoneal dialysis (PD) is underutilized globally. A contributory factor may be clinician myths about its use. The aim of this study was to explore perceptions about PD initiation by clinicians according to various physical, social, and clinical characteristics of patients.An online global survey (in English and Thai) was administered to ascertain nephrologists' and nephrology trainees' decisions on recommending PD as a treatment modality.A total of 645 participants (522 nephrologists and 123 trainees; 56% male) from 54 countries (66% from high-income countries [HICs], 22% from upper middle-income countries [UMICs], 12% from lower middle-income countries, and 1% from low-income countries [LICs]) completed the survey. Of the respondents, 81% identified as attending physicians or consultants, and 19% identified as trainees or other. PD was recommended for most scenarios, including repeated exposures to heavy lifting, swimming (especially in a private pool and ocean), among patients with cirrhosis or cognitive impairment with available support, and those living with a pet if a physical separation can be achieved during PD. Certain abdominal surgeries were more acceptable to proceed with PD (hysterectomy, 90%) compared to others (hemicolectomy, 45%). Similar variation was noted for different types of stomas (nephrostomies, 74%; suprapubic catheters, 53%; and ileostomies, 27%).The probability of recommending PD in various scenarios was greater among clinicians from HICs, larger units, and consultants with more clinical experience. There is a disparity in recommending PD across various clinical scenarios driven by experience, unit-level characteristics, and region of practice. Globally, evidence-informed education is warranted to rectify misconceptions to enable greater PD uptake.

  View details for DOI 10.1016/j.ekir.2024.01.041

  View details for PubMedID 38765569

  View details for PubMedCentralID PMC11101779

• Home-Based Dialysis: A Primer for the Internist. Annual review of medicine Rope, R., Ryan, E., Weinhandl, E. D., Abra, G. E. 2023

  Abstract

  Home-based dialysis modalities offer both clinical and practical advantages to patients. The use of the home-based modalities, peritoneal dialysis and home hemodialysis, has been increasing over the past decade after a long period of decline. Given the increasing frequency of use of these types of dialysis, it is important for clinicians to be familiar with how these types of dialysis are performed and key clinical aspects of care related to their use in patients with end-stage kidney disease. Expected final online publication date for the Annual Review of Medicine, Volume 75 is January 2024. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

  View details for DOI 10.1146/annurev-med-050922-051415

  View details for PubMedID 38039393

• Predicting transfer to haemodialysis using the peritoneal dialysis surprise question. Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis Anwaar, A., Liu, S., Montez-Rath, M., Neilsen, H., Sun, S., Abra, G., Schiller, B., Hussein, W. F. 2023: 8968608231214143

  Abstract

  People on peritoneal dialysis (PD) at risk of transfer to haemodialysis (HD) need support to remain on PD or ensure a safe transition to HD. Simple point-of-care risk stratification tools are needed to direct limited dialysis centre resources. In this study, we evaluated the utility of collecting clinicians' identification of patients at high risk of transfer to HD using a single point of care question.In this prospective observational study, we included 1275 patients undergoing PD in 35 home dialysis programmes. We modified the palliative care 'surprise question' (SQ) by asking the registered nurse and treating nephrologist: 'Would you be surprised if this patient transferred to HD in the next six months?' A 'yes' or 'no' answer indicated low and high risk, respectively. We subsequently followed patient outcomes for 6 months. Cox regression model estimated the hazard ratio (HR) of transfer to HD.Patients' mean age was 59 ± 16 years, 41% were female and the median PD vintage was 20 months (interquartile range: 9-40). Responses were received from nurses for 1123 patients, indicating 169 (15%) as high risk and 954 (85%) as low risk. Over the next 6 months, transfer to HD occurred in 18 (11%) versus 29 (3%) of the high and low-risk groups, respectively (HR: 3.92, 95% confidence interval (CI): 2.17-7.05). Nephrologist responses were obtained for 692 patients, with 118 (17%) and 574 (83%) identified as high and low risk, respectively. Transfer to HD was observed in 14 (12%) of the high-risk group and 14 (2%) of the low-risk group (HR: 5.56, 95% CI: 2.65-11.67). Patients in the high-risk group experienced higher rates of death and hospitalisation than low-risk patients, with peritonitis events being similar between the two groups.The PDSQ is a simple point of care tool that can help identify patients at high risk of transfer to HD and other poor clinical outcomes.

  View details for DOI 10.1177/08968608231214143

  View details for PubMedID 38017608

• Patient-Centered Home Hemodialysis: Approaches and Prescription. Clinical journal of the American Society of Nephrology : CJASN El Shamy, O., Abra, G., Chan, C. 2023

  Abstract

  Writing a home hemodialysis (HD) prescription is a complex, multifactorial process that requires the incorporation of patient values, preferences, and lifestyle. Knowledge of the different options available in terms of home HD modality (conventional, nocturnal, short daily, and alternate nightly) is also important when customizing a prescription. Finally, an understanding of the different home HD machines currently approved for use at home, their different attributes and limitations help guide providers when formulating their prescriptions. In this review article, we set out to address these different aspects to help guide providers in providing a patient-centered home HD approach.

  View details for DOI 10.2215/CJN.0000000000000292

  View details for PubMedID 37639246

• Setting Up Home Dialysis Programs: Now and In the Future. Clinical journal of the American Society of Nephrology : CJASN Abra, G. E., Weinhandl, E. D., Hussein, W. F. 2023

  Abstract

  Home dialysis utilization has been growing in the United States over the past decade but still lags behind similar socioeconomic nations. More than half of dialysis facilities in the United States either are not licensed to offer home dialysis or, despite a license, have no patients dialyzing at home and many programs have a relatively small census. Multiple stakeholders including patients, healthcare providers and payers have identified increased home dialysis use as in important goal. In order to realize these goals nephrologists and kidney care professions need a sound understanding of the key considerations in home dialysis center operation. In this review, we outline the core domains required to set up and operate a home dialysis program in the United States now and in the future.

  View details for DOI 10.2215/CJN.0000000000000284

  View details for PubMedID 37603364

• Peritoneal Dialysis-Related Drain Pain and Patient and Treatment Characteristics: Findings From the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS). American journal of kidney diseases : the official journal of the National Kidney Foundation Aga, Z., McCullough, K., Pisoni, R. L., Zhao, J., Fukasawa, M., Oh, K., Wilson, S., Abra, G., Gupta, N., Kanjanabuch, T., Figueiredo, A. E., Perl, J., PDOPPS Steering Committee Members, Johnson, D., Kawanishi, H., Kim, Y., Davies, S., Bernardo, A., Robinson, B., Shen, J. 2023

  View details for DOI 10.1053/j.ajkd.2023.04.005

  View details for PubMedID 37393052

• The Implementation of a Virtual Home Dialysis Mentoring Program for Nephrologists. Kidney360 Abra, G., Poyan Mehr, A., Chan, C. T., Schiller, B. 2022; 3 (4): 734-736

  Abstract

  Virtual home dialysis physician mentorship is feasible.In total, 53% of participants perceived the program would change the perspective of participants on prescribing home dialysis.More research is needed to ascertain the effect of virtual mentorship on home dialysis incidence and attrition rates in a wider audience.

  View details for DOI 10.34067/KID.0000202022

  View details for PubMedID 35721601

  View details for PubMedCentralID PMC9136906

• SARS-CoV-2 Booster Vaccine Response among Patients Receiving Dialysis. Clinical journal of the American Society of Nephrology : CJASN Garcia, P., Han, J., Montez-Rath, M., Sun, S., Shang, T., Parsonnet, J., Chertow, G., Anand, S., Schiller, B., Abra, G. 2022

  Abstract

  N/A.

  View details for DOI 10.2215/CJN.00890122

  View details for PubMedID 35383042

• Implementation of a Staff-Assisted Peritoneal Dialysis Program in the United States: A Feasibility Study. Clinical journal of the American Society of Nephrology : CJASN Hussein, W. F., Bennett, P. N., Anwaar, A., Atwal, J., Legg, V., Abra, G., Zheng, S., Pravoverov, L., Schiller, B. 2022

  View details for DOI 10.2215/CJN.00940122

  View details for PubMedID 35383044

• COVID19 Vaccine Type and Humoral Immune Response in Patients Receiving Dialysis. Journal of the American Society of Nephrology : JASN Garcia, P., Anand, S., Han, J., Montez-Rath, M., Sun, S., Shang, T., Parsonnet, J., Chertow, G., Schiller, B., Abra, G. 2021

  View details for DOI 10.1681/ASN.2021070936

  View details for PubMedID 34645698

• Integrating Patient Activation Into Dialysis Care. American journal of kidney diseases : the official journal of the National Kidney Foundation Hussein, W. F., Bennett, P. N., Abra, G., Watson, E., Schiller, B. 2021

  Abstract

  Patient activation, the measure of patients' readiness and willingness to manage their own health care, is low among people on in-center hemodialysis (HD), exacerbated by how passively patients receive care. In our pursuit of person-centered care and value-based medicine, enabling patients to take a more active role in their care can lead to healthy behaviors, with subsequent reductions in individual burden and costs to the healthcare system. To improve patient activation, we need to embrace a "patient-first" approach and combine it with ways to equip patients to thrive with self-management. This requires changes in the training of the healthcare team, as well as changes in the delivery care models, promoting interventions such as health coaching and peer mentoring, while leveraging technology to enable self-access to records, self-monitoring, and communication with providers. We also need healthcare policies that encourage a focus on patient-identified goals, including more attention to patient-reported outcomes. In this article, we review the current status of patient activation in dialysis patients, outline some of the available interventions, and propose steps to change the dynamics of the current system to move towards a more active role for patients in their care.

  View details for DOI 10.1053/j.ajkd.2021.07.015

  View details for PubMedID 34461165

• Pulling the goalie: What the United States and the world can learn from Canada about growing home dialysis. Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis Abra, G., Weinhandl, E. D. 2021: 8968608211034696

  View details for DOI 10.1177/08968608211034696

  View details for PubMedID 34323152

• Systematic Review of Early Immune Response to SARS-CoV-2 Vaccination Among Patients with Chronic Kidney Disease. Kidney international reports Carr, E. J., Kronbichler, A., Graham-Brown, M., Abra, G., Argyropoulos, C., Harper, L., Lerma, E. V., Suri, R. S., Topf, J., Willicombe, M., Hiremath, S. 2021

  Abstract

  Introduction: The effects of the coronavirus disease 19 (COVID-19) pandemic in particular affect those with chronic kidney disease (CKD), who commonly have defects in humoral and cellular immunity, and the efficacy of vaccinations against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is uncertain.Methods: To inform public health and clinical practice, we synthesized published studies and preprints evaluating surrogate measures of immunity after SARS-CoV-2 vaccination in patients with CKD including those receiving dialysis or with a kidney transplant.Results: We found 35 studies (28 published, 7 preprints), sample size from 23 to 1140 patients, and follow-up from one week to 1 month after vaccination. 17 of the 35 studies enrolled a control group. In the 22 studies of patients receiving dialysis, the development of antibodies was observed in 18 to 53% after one dose, and in 70 to 96% after two doses of mRNA vaccine. In the 14 studies of transplant recipients, 3% to 59% mounted detectable humoral or cellular responses after 2 doses of mRNA vaccine. After vaccination, there are a few reported cases of relapse or de novo glomerulonephritis, and acute transplant rejection suggesting ongoing surveillance is important.Conclusion: Studies are needed to better evaluate the effectiveness of SARS-CoV-2 vaccination in these populations. Rigorous surveillance for long-term adverse effects in patients with autoimmune disease and transplant recipients is required. For transplant recipients and those with suboptimal immune responses, alternate vaccination platforms and strategies should be considered. As additional data arise, the NephJC COVID-19 page will be updated (http://www.nephjc.com/news/covid-vaccine).

  View details for DOI 10.1016/j.ekir.2021.06.027

  View details for PubMedID 34250319

• The Use of Virtual Physician Mentoring to Enhance Home Dialysis Knowledge and Uptake. Nephrology (Carlton, Vic.) Ashley, J., Abra, G., Schiller, B., Bennett, P. N., Mehr, A. P., Bargman, J. M., Chan, C. T. 2021

  Abstract

  Home dialysis therapies are flexible kidney replacement strategies with documented clinical benefits. While the incidence of end-stage kidney disease continues to increase globally, the use of home dialysis remains low in most developed countries. Multiple barriers to providing home dialysis have been noted in the published literature. Amongst known challenges, gaps in clinician knowledge are potentially addressable with a focused education strategy. Recent national surveys in the United States and Australia have highlighted the need for enhanced home dialysis knowledge especially among nephrologists who have recently completed training. Traditional in-person continuing professional educational programs have had modest success in promoting home dialysis and are limited by scale and the present global COVID-19 pandemic. We hypothesize that the use of a "Hub and Spoke" model of virtual home dialysis mentorship for nephrologists based on project ECHO would support home dialysis growth. We review the home dialysis literature, known educational gaps and plausible educational interventions to address current limitations in physician education. This article is protected by copyright. All rights reserved.

  View details for DOI 10.1111/nep.13867

  View details for PubMedID 33634548

• Peritoneal Dialysis Following Left Ventricular Assist Device Placement and Kidney Recovery: A Case Report Kidney Medicine Ajuria, M., Franz, D. D., Morris III, J. T., Abra, G., Hussein, W. F. 2021; 3 (3): 438-441

  View details for DOI 10.1016/j.xkme.2020.12.009

• Self-care training using the Tablo hemodialysis system. Hemodialysis international. International Symposium on Home Hemodialysis Plumb, T. J., Alvarez, L., Ross, D. L., Lee, J. J., Mulhern, J. G., Bell, J. L., Abra, G. E., Prichard, S. S., Chertow, G. M., Aragon, M. A. 2020

  Abstract

  INTRODUCTION: Recently published results of the investigational device exemption (IDE) trial using the Tablo hemodialysis system confirmed its safety and efficacy for home dialysis. This manuscript reports additional data from the Tablo IDE study on the training time required to be competent in self-care, the degree of dependence on health care workers and caregivers after training was complete, and participants' assessment of the ease-of-use of Tablo.METHODS: We collected data on the time required to set up concentrates and the Tablo cartridge prior to treatment initiation. We asked participants to rate system setup, treatment, and takedown on a Likert scale from 1 (very difficult) to 5 (very simple) and if they had required any assistance with any aspect of treatment over the prior 7days. In a subgroup of 15 participants, we recorded the number of training sessions required to be deemed competent to do self-care dialysis.FINDINGS: Eighteen men and 10 women with a mean age of 52.6years completed the study. Thirteen had previous self-care experience using a different dialysis system. Mean set up times for the concentrates and cartridge were 1.1 and 10.0minutes, respectively. Participants with or without previous self-care experience had similar set-up times. The mean ease-of-use score was 4.5 or higher on a scale from 1 to 5 during the in-home phase. Sixty-five percent required no assistance at home and on average required fewer than four training sessions to be competent in managing their treatments. Results were similar for participants with or without previous self-care experience.CONCLUSIONS: Participants in the Tablo IDE trial were able to quickly learn and manage hemodialysis treatments in the home, found Tablo easy to use, and were generally independent in performing hemodialysis.

  View details for DOI 10.1111/hdi.12890

  View details for PubMedID 33047477

• Outcomes Among Patients With Left Ventricular Assist Devices Receiving Maintenance Outpatient Hemodialysis: A Case Series. American journal of kidney diseases : the official journal of the National Kidney Foundation Franz, D. D., Hussein, W. F., Abra, G., Diskin, C. D., Duggal, V., Teuteberg, J. J., Chang, T. I., Schiller, B. 2020

  Abstract

  RATIONALE & OBJECTIVE: The incidence of left ventricular assist device (LVAD) implantation as destination therapy for heart failure is increasing and kidney failure requiring maintenance hemodialysis is a common complication. As little is known about the safety or efficacy of outpatient hemodialysis among patients with LVADs, this study sought to describe their clinical course.STUDY DESIGN: Case series of patients with a LVAD undergoing maintenance outpatient hemodialysis whose clinical data were obtained from an electronic medical record.SETTING & PARTICIPANTS: Adults who received an LVAD, survived to hospital discharge, and were subsequently treated with maintenance hemodialysis by a non-profit dialysis provider between 2011 and 2019.RESULTS: Eleven patients were included. Six had a known prior history of chronic kidney disease. Patients underwent outpatient hemodialysis for a mean duration of 165.2 days (range 31-542) during which they were treated with 544 total dialysis sessions. Six of these sessions were stopped early due to dialysis-related adverse events (1.1%). Over 80% of follow-up time was spent out of hospital, however, 54.5% of patients were rehospitalized within one month of starting outpatient hemodialysis. The most common reason for hospitalization was infection (32.1%), followed by hypervolemia (14.3%), and cerebrovascular accident (CVA) or transient ischemic attack (TIA) (10.7%). Four patients recovered kidney function, one underwent combined heart and kidney transplantation, two continued treatment, two died, and two were lost to follow-up.LIMITATIONS: Retrospective design, small number of cases, and lack of complete follow-up data.CONCLUSIONS: Approximately half of the patients with complete follow-up either recovered kidney function or underwent combined heart and kidney transplantation. This case series demonstrates that outpatient hemodialysis centers, in partnership with LVAD treatment teams, can successfully provide hemodialysis to patients on LVAD support.

  View details for DOI 10.1053/j.ajkd.2020.04.018

  View details for PubMedID 32711070

• Myelin bodies in LMX1B-associated nephropathy: potential for misdiagnosis. Pediatric nephrology (Berlin, Germany) Lei, L., Oh, G., Sutherland, S., Abra, G., Higgins, J., Sibley, R., Troxell, M., Kambham, N. 2020

  Abstract

  BACKGROUND: Myelin figures, or zebra bodies, seen on electron microscopy were historically considered pathognomonic of Fabry disease, a rare lysosomal storage disorder caused by alpha-galactosidase A deficiency and associated with X-linked recessive mode of inheritance. More recently, iatrogenic phospholipidosis has emerged as an important alternate cause of myelin figures in the kidney.METHODS: We report two families with autosomal dominant nephropathy presenting with proteinuria and microscopic hematuria, and the kidney biopsies were notable for the presence of myelin figures and zebra bodies.RESULTS: Laboratory and genetic work-up for Fabry disease was negative. Genetic testing in both families revealed the same heterozygous missense mutation in LMX1B (C.737G>A, p.Arg246Gln). LMX1B mutations are known to cause nail-patella syndrome, featuring dysplastic nails and patella with or without nephropathy, as well as isolated LMX1B-associated nephropathy in the absence of extrarenal manifestations.CONCLUSIONS: LMX1B mutation-associated nephropathy should be considered in hereditary cases of proteinuria and/or hematuria, even in the absence of unique glomerular basement membrane changes indicative of nail-patella syndrome. In addition, LMX1B mutation should be included in the differential diagnosis of myelin figures and zebra bodies on kidney biopsy, so as to avoid a misdiagnosis.

  View details for DOI 10.1007/s00467-020-04564-w

  View details for PubMedID 32356190

• Public policy and programs - Missing links in growing home dialysis in the United States. Seminars in dialysis Abra, G. n., Schiller, B. n. 2020

  Abstract

  Patients with end-stage kidney disease (ESKD) require dialysis or a kidney transplant for survival and over 760 000 patients now benefit from these therapies in the United States. Dialysis in the United States in the late 1960s and early 1970s was often done in the home. After the advent of Medicare coverage for ESKD in 1972 and the subsequent easier access to center based hemodialysis, the use of home modalities dramatically declined. This stands in contrast to home dialysis uptake in other industrialized healthcare systems where both peritoneal dialysis and home hemodialysis are more frequently used. Characteristics unique to the US healthcare system as well as the cultures of providers (physicians and dialysis providers) and recipients of ESKD care are hypothesized as the main reasons for observed differences in home dialysis use. To address these issues, the Centers for Medicare and Medicaid Services have recently proposed new payment programs under an Executive Order from the President of the United States, with the explicit goal of increasing the number of patients using home dialysis. This perspective outlines policy opportunities and programs with a proven track record of home dialysis growth in other countries or hypothesized promise based on identified barriers and needs.

  View details for DOI 10.1111/sdi.12850

  View details for PubMedID 31943408

• Use of a gentamicin-citrate lock leads to lower catheter-related bloodstream infection rates and reduced cost of care in hemodialysis patients. Hemodialysis international. International Symposium on Home Hemodialysis Hussein, W. F., Gomez, N. n., Sun, S. J., Yu, J. n., Yang, F. n., Ajuria, M. n., Abra, G. E., Schiller, B. n. 2020

  Abstract

  Central venous catheters (CVC) are a major contributor to infections in hemodialysis (HD) patients, leading to high morbidity and mortality. Gentamicin-citrate (GC) lock is used as standard of care at centers belonging to a mid-size dialysis organization. Four outpatient HD centers acquired by the organization continued to use heparin for catheter locks for a period of time before converting to the provider's standard of using GC lock.In this retrospective observational study, we included patients receiving HD by CVC at these four centers. We report rates of CVC-related bloodstream infections (CVC-BSI) during the heparin lock and the GC lock periods; crude rate ratios and adjusted rate ratios using Cox survival analyses adjusting for potential confounders; microbiology patterns; safety signals (gentamicin resistance, hospitalizations and deaths); and financial impact on payer.A total of 220 and 281 patients used tunneled CVCs, accounting for 25,245 and 44,550 catheter days in the heparin and the GC lock periods, respectively. CVC-BSI event rates were 66% lower in the GC lock period (CVC-BSI event rate: 0.20 per 1000 catheter-days) than the heparin lock period (rate: 0.59 per 1000 catheter days); rate ratio 0.34 (95% confidence interval (CI) 0.15-0.78, P = 0.01). In the fully adjusted multivariable Cox model, use of GC lock was associated with 70% reduction in CVC-BSI events (HR 0.30, 95% CI 0.12-0.72, P = 0.01). No increased risk of gentamicin resistance, hospitalizations, or death associated with use of GC lock were observed. Use of GC lock was associated with an estimated saving of $1533 (95% CI: $259-$4882) per patient per year.Use of GC lock led to significant reductions in CVC-BSIs with no signal for harm, and is associated with significant cost savings in dialysis care.

  View details for DOI 10.1111/hdi.12880

  View details for PubMedID 33006269

• Update and review of renal artery stenosis. Disease-a-month : DM Colbert, G. B., Abra, G. n., Lerma, E. V. 2020: 101118

  View details for DOI 10.1016/j.disamonth.2020.101118

  View details for PubMedID 33303204

• Safety and efficacy of the Tablo hemodialysis system for in-center and home hemodialysis. Hemodialysis international. International Symposium on Home Hemodialysis Plumb, T. J., Alvarez, L., Ross, D. L., Lee, J. J., Mulhern, J. G., Bell, J. L., Abra, G., Prichard, S. S., Chertow, G. M., Aragon, M. A. 2019

  Abstract

  INTRODUCTION: Home hemodialysis remains underutilized despite observational data indicating more favorable outcomes with home compared with in-center hemodialysis. The Tablo Hemodialysis system is designed to be easy to learn and use and to facilitate adoption of home hemodialysis. The objective of the current investigational device exemption (IDE) study was to evaluate the safety and efficacy of Tablo managed in-center by health care professionals and in-home by patients and/or caregivers.METHODS: A prospective, multicenter, open-label, crossover trial comparing in-center and in-home hemodialysis using Tablo. There were 4 treatment periods during which hemodialysis was prescribed 4 times per week: 1-week Run-In, 8-week In-Center, 4-week Transition, and 8-week In-Home. The primary efficacy endpoint was weekly standard Kt/Vurea ≥2.1. The secondary efficacy endpoint was delivery of ultrafiltration (UF) within 10% of prescribed UF. We collected safety and usability data.FINDINGS: Thirty participants enrolled and 28 completed all trial periods. Adherence to the protocol requirement of 4 treatments per week was 96% in-center and 99% in-home. The average prescribed and delivered session lengths were 3.4hours for both the In-Center and the In-Home periods. The primary efficacy endpoint for the intention-to-treat cohort was achieved in 199/200 (99.5%) of measurements during the In-Center period and 168/171 (98.3%) In-Home. The average weekly standard Kt/Vurea was 2.8 in both periods. The secondary efficacy UF endpoint was achieved in the ITT cohort in 94% in both in-center and in-home. Two prespecified adverse events (AEs) occurred during the In-Center period and 6 in the In-Home period. None of the AEs were deemed by investigators as related to Tablo. The median resolution time of alarms was 8seconds in-center and 5seconds in-home.CONCLUSION: Primary and secondary efficacy and safety endpoints were achieved during both In-Center and In-Home trial periods. This study confirms that Tablo is safe and effective for home hemodialysis use.

  View details for DOI 10.1111/hdi.12795

  View details for PubMedID 31697042

• The effect of blood flow rate on dialysis recovery time in patients undergoing maintenance hemodialysis: A prospective, parallel-group, randomized controlled trial HEMODIALYSIS INTERNATIONAL Duggal, V., Hussein, W. F., Reiterman, M., Sun, S. J., Abra, G. E., Schiller, B. 2019; 23 (2): 223–29

  View details for DOI 10.1111/hdi.12741

  View details for Web of Science ID 000465412100020

• Timing of initiation of dialysis: time for a new direction? CURRENT OPINION IN NEPHROLOGY AND HYPERTENSION Abra, G., Tamura, M. K. 2012; 21 (3): 329-333

  Abstract

  The past 15 years have seen tremendous growth in the initiation of dialysis at higher levels of kidney function in the setting of mixed evidence and at great societal economic cost. We review recent data on the early dialysis initiation trend, the clinical and economic impact of early dialysis initiation and the future implications for the management of advanced chronic kidney disease (CKD).The percentage of patients who initiate dialysis with an estimated glomerular filtration rate (eGFR) above 10  ml/min/1.73m(2) is now greater than 50%, including 20% who initiate with an eGFR above 15 ml/min/1.73m(2). The drivers behind these findings are probably diverse but recent literature does not seem to support a higher symptom burden among the ageing CKD population as the major cause. The Initiating Dialysis Early And Late (IDEAL) trial provides guidance on the safety of waiting for symptoms or lower levels of estimated glomerular filtration rate prior to beginning dialysis. In addition, economic analyses based on the IDEAL and US Renal Data System findings suggest that significant cost savings could be achieved by reversing the early initiation trend.These findings should help clinicians and policy makers looking to rein in costs while maintaining the quality of CKD care.

  View details for DOI 10.1097/MNH.0b013e328351c244

  View details for Web of Science ID 000302769500014

  View details for PubMedID 22388556

  View details for PubMedCentralID PMC3458516

• Reversible hepatic and lipid abnormalities with nonprescription anabolic-androgenic steroid use in 2 HIV-infected men CLINICAL INFECTIOUS DISEASES Abra, G. E., Lonergan, J. T. 2006; 42 (1): 151-152

  View details for Web of Science ID 000233698900030

  View details for PubMedID 16323106

• The Peritoneal Dialysis Transfer Set Replacement Procedure. Nephrology nursing journal : journal of the American Nephrology Nurses' Association Funes, I. n., Velasquez, K. n., Doss-McQuitty, S. n., Hussein, W. F., Abra, G. n., Anantiyo, P. n., Bennett, P. N., Schiller, B. n. ; 47 (4): 343–46

  Abstract

  Peritoneal dialysis transfer sets (extension lines) are replaced every six to nine months to minimize peritoneal dialysis catheter complications. The aim of this study was to compare a revised non-bag transfer set exchange procedure with the standard bag exchange procedure on nursing time, costs, and safety. Thirty-three people were randomized to two groups - a standard bag exchange procedure group (n = 16) and a non-bag transfer set exchange procedure group (n = 17). The standard bag exchange procedure took a median of 32 minutes (interquartile range [IQR] 25 to 38 minutes) compared to the non-bag transfer set exchange procedure of 6 minutes (IQR 4 to 8 minutes) (p Ò 0.0001). There was one episode of peritonitis in each group within the 72-hour follow-up period. The average cost of the non-bag transfer set exchange procedure was $24.54 lower, a 37% cost reduction. This study has shown the revised non-bag transfer set replacement procedure appears to be safe, consume less participant and staff time, and decreases costs.

  View details for PubMedID 32830940