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Carrero JJ, Hecking M, Ulasi I, Sola L, Thomas B. Chronic Kidney Disease, Gender, and Access to Care: A Global Perspective. Semin Nephrol 2018; 37:296-308. [PMID: 28532558 DOI: 10.1016/j.semnephrol.2017.02.009] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Little is known regarding the ways in which chronic kidney disease (CKD) prevalence and progression differ between the sexes. Still less is known regarding how social disparities between men and women may affect access to care for CKD. In this review, we briefly describe biological sex differences, noting how these differences currently do not influence CKD management recommendations. We then describe what is known within the published literature regarding differences in CKD epidemiology between sexes; namely prevalence, progression, and access to treatment throughout the major world regions. We highlight that health care expenditure and social gender disparities ultimately may determine whether women have equitable access to care for CKD and end-stage kidney disease. Among many high- and low-income settings, women more often donate and are less likely to receive kidney transplants when compared with men. Research is needed urgently to elucidate the reasons behind these disparities, as well as to develop CKD treatment strategies tailored to women's unique health care needs.
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Affiliation(s)
- Juan-Jesus Carrero
- Division of Kidney Medicine, Karolinska Institute, Solna, Stockholm, Sweden.
| | - Manfred Hecking
- Medizinische Universität Wien, Universitätsklinik für Innere Medizin III, Klinische Abteilung für Nephrologie und Dialyse, Wein, Austria
| | - Ifeoma Ulasi
- Department of Medicine, College of Medicine, University of Nigeria, Nsukka, Nigeria
| | - Laura Sola
- División Epidemiologia, Ministerio de Salud, Departamento Medicina Preventiva y Social, Universidad de la República, Montevideo, Uruguay
| | - Bernadette Thomas
- Department of Global Health, University of Washington, Seattle, WA, USA
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52
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Balkau B, Metzger M, Andreelli F, Frimat L, Speyer E, Combe C, Laville M, Jacquelinet C, Briançon S, Ayav C, Massy Z, Pisoni RL, Stengel B, Fouque D. Impact of sex and glucose-lowering treatments on hypoglycaemic symptoms in people with type 2 diabetes and chronic kidney disease. The French Chronic Kidney Disease - Renal Epidemiology and Information Network (CKD-REIN) Study. DIABETES & METABOLISM 2018; 45:175-183. [PMID: 29706470 DOI: 10.1016/j.diabet.2018.03.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2017] [Revised: 02/27/2018] [Accepted: 03/27/2018] [Indexed: 12/15/2022]
Abstract
AIM To describe current practices of glucose-lowering treatments in people with diabetes and chronic kidney disease (CKD), the associated glucose control and hypoglycaemic symptoms, with an emphasis on sex differences. METHODS Among the 3033 patients with CKD stages 3-5 recruited into the French CKD-REIN study, 645 men and 288 women had type 2 diabetes and were treated by glucose-lowering drugs. RESULTS Overall, 31% were treated only with insulin, 28% with combinations of insulin and another drug, 42% with non-insulin glucose-lowering drugs. In CKD stage 3, 40% of patients used metformin, 12% at stages 4&5, similar for men and women; in CKD stage 3, 53% used insulin, similar for men and women, but at stages 4&5, 59% of men and 77% of women used insulin. Patients were reasonably well controlled, with a median HbA1c of 7.1% (54mmol/mol) in men, 7.4% (57mmol/mol) in women (P=0.0003). Hypoglycaemic symptoms were reported by 40% of men and 59% of women; they were not associated with the estimated glomerular filtration rate, nor with albuminuria or with HbA1c in multivariable analyses, but they were more frequent in people treated with insulin, particularly with fast-acting and pre-mixed insulins. CONCLUSION Glucose-lowering treatment, HbA1c and hypoglycaemic symptoms were sex dependent. Metformin use was similar in men and women, but unexpectedly low in CKD stage 3; its use could be encouraged rather than resorting to insulin. Hypoglycaemic symptoms were frequent and need to be more closely monitored, with appropriate patient-education, especially in women.
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Affiliation(s)
- B Balkau
- CESP Centre for Research in Epidemiology and Population Health, Univ Paris-Saclay, Univ Paris Sud, UVSQ, UMRS 1018, Villejuif, France
| | - M Metzger
- CESP Centre for Research in Epidemiology and Population Health, Univ Paris-Saclay, Univ Paris Sud, UVSQ, UMRS 1018, Villejuif, France
| | - F Andreelli
- Diabetology, CHU Pitié-Salpétrière, APHP, Paris, France
| | - L Frimat
- Lorraine Univ, Paris-Descartes Univ, Apemac, EA 4360, Nancy, France; Nephrology Department, CHU de Nancy, Vandoeuvre-lès-Nancy, France
| | - E Speyer
- CESP Centre for Research in Epidemiology and Population Health, Univ Paris-Saclay, Univ Paris Sud, UVSQ, UMRS 1018, Villejuif, France
| | - C Combe
- Service de Néphrologie Transplantation Dialyse Aphérèse, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France; Inserm, U1026, Univ Bordeaux Segalen, Bordeaux, France
| | - M Laville
- Department of Nephrology, Centre Hospitalier Lyon Sud, Univ Lyon, UCBL, Carmen, Pierre-Bénite, France
| | - C Jacquelinet
- CESP Centre for Research in Epidemiology and Population Health, Univ Paris-Saclay, Univ Paris Sud, UVSQ, UMRS 1018, Villejuif, France; Agence de la Biomédecine, Saint-Denis, France
| | - S Briançon
- Inserm CIC-1433, CHRU Nancy, Clinical Epidemiology, Vandoeuvre-lès-Nancy, France
| | - C Ayav
- Inserm CIC-1433, CHRU Nancy, Clinical Epidemiology, Vandoeuvre-lès-Nancy, France
| | - Z Massy
- CESP Centre for Research in Epidemiology and Population Health, Univ Paris-Saclay, Univ Paris Sud, UVSQ, UMRS 1018, Villejuif, France; Nephrology Department, CHU Ambroise Paré, Boulogne, France
| | - R L Pisoni
- Arbor Research Collaborative for Health, Ann Arbor, MI, United States
| | - B Stengel
- CESP Centre for Research in Epidemiology and Population Health, Univ Paris-Saclay, Univ Paris Sud, UVSQ, UMRS 1018, Villejuif, France.
| | - D Fouque
- Department of Nephrology, Centre Hospitalier Lyon Sud, Univ Lyon, UCBL, Carmen, Pierre-Bénite, France
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Lucena ADF, Magro CZ, Proença MCDC, Pires AUB, Moraes VM, Aliti GB. Validation of the nursing interventions and activities for patients on hemodialytic therapy. ACTA ACUST UNITED AC 2018. [PMID: 29538608 DOI: 10.1590/1983-1447.2017.03.66789] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To validate interventions and nursing activities proposed by the Nursing Interventions Classification for patients with acute renal failure or acute chronic renal disease in hemodialysis therapy with the Excess Fluid Volume and Risk for Imbalanced Fluid Volume nursing diagnoses. METHODS Validation of content with 19 expert nurses from a university hospital. The data collection was made from September to November 2011 through instruments that contained the interventions and nursing activities in study. The data analysis considered the average of scores obtained in the validation process. RESULTS The Fluid Management was validated as a priority intervention (mean ≥ 0.8), with eight main activities for the Excess Fluid Volume nursing diagnosis and eight for the Risk for Imbalanced Fluid Volume nursing diagnosis. CONCLUSION The validated intervation of the Fluid Management enables the monitoring of the hydric balance and facilitates the prevention of complications, which are important activities in the nursing care of the patients in hemodialysis therapy.
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Affiliation(s)
- Amália de Fátima Lucena
- Universidade Federal do Rio Grande do Sul (UFRGS), Escola de Enfermagem. Porto Alegre, Rio Grande do Sul, Brasil
| | - Cecília Zys Magro
- Universidade Federal do Rio Grande do Sul (UFRGS), Escola de Enfermagem. Porto Alegre, Rio Grande do Sul, Brasil
| | - Maria Conceição da Costa Proença
- Hospital de Clínicas de Porto Alegre (HCPA), Serviço de Enfermagem Cardiovascular, Nefrologia e Imagem, Unidade de Hemodiálise. Porto Alegre, Rio Grande do Sul, Brasil
| | - Ananda Ughini Bertoldo Pires
- Universidade Federal do Rio Grande do Sul (UFRGS), Escola de Enfermagem. Porto Alegre, Rio Grande do Sul, Brasil
| | - Vítor Monteiro Moraes
- Universidade Federal do Rio Grande do Sul (UFRGS), Escola de Enfermagem. Porto Alegre, Rio Grande do Sul, Brasil
| | - Graziella Badin Aliti
- Universidade Federal do Rio Grande do Sul (UFRGS), Escola de Enfermagem. Porto Alegre, Rio Grande do Sul, Brasil
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Eder S, Leierer J, Kerschbaum J, Rosivall L, Wiecek A, de Zeeuw D, Mark PB, Heinze G, Rossing P, Heerspink HL, Mayer G. A Prospective Cohort Study in Patients with Type 2 Diabetes Mellitus for Validation of Biomarkers (PROVALID) - Study Design and Baseline Characteristics. Kidney Blood Press Res 2018; 43:181-190. [PMID: 29466797 DOI: 10.1159/000487500] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 02/08/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS The prevalence of diabetes mellitus type 2 and kidney disease in these patients varies widely between European countries. METHODS In addition to store bio-samples the "Prospective cohort study in patients with type 2 diabetes mellitus for validation of biomarkers" collects information on history, physical status, laboratory measurements and medication in 4000 patients with diabetes mellitus type 2, being taken care of at the primary level of healthcare in 5 European countries (Austria, Hungary, Netherlands, Poland and Scotland). Next to comparing the rate of loss of eGFR between the countries, a further objective of the PROVALID study is to determine the 5-year cumulative incidence of renal and cardiovascular outcomes. RESULTS The mean age of the population recruited is 62.9±10 years, 54.6% are male and the mean BMI is 30.9±5.4 kg/m2. Metabolic control (median HBA1c 6.8 % (6.2; 7.5)) is achieved via administration of metformin in 67.4% of the patients and insulin in 30.3%. Median systolic and diastolic blood pressure at recruitment is 135 (125; 146) and 80 (72; 85) mmHg, 65.4% of subjects received RAAS blocking agents. Mean eGFR is 80.7±29.2 ml/min/1.73m2 and median baseline albumin/creatinine ratio 8.3 mg (IQR: 3.8 and 25.1). CONCLUSION PROVALID will provide information on incidence and progression of renal and cardiovascular disease and therapy in patients with type 2 diabetes mellitus in different European countries. Thus, in contrast to many other cohort studies we will be able to associate national clinical practise pattern with outcome in this highly vulnerable patient population.
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Affiliation(s)
- Susanne Eder
- Department of Internal Medicine IV (Nephrology and Hypertension), Medical University Innsbruck, Innsbruck, Austria
| | - Johannes Leierer
- Department of Internal Medicine IV (Nephrology and Hypertension), Medical University Innsbruck, Innsbruck, Austria
| | - Julia Kerschbaum
- Department of Internal Medicine IV (Nephrology and Hypertension), Medical University Innsbruck, Innsbruck, Austria
| | - Laszlo Rosivall
- International Nephrology Research and Training Center, Institute of Pathophysiology, Semmelweis University, Budapest, Hungary
| | - Andrzej Wiecek
- Department of Nephrology, Endocrinology and Metabolic Diseases, Medical University of Silesia, Katowice, Poland
| | - Dick de Zeeuw
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Patrick B Mark
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Georg Heinze
- Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University Vienna, Vienna, Austria
| | - Peter Rossing
- Novo Nordisk Foundation Center for Basic Metabolic Research, Metabolism Center, University of Copenhagen, Copenhagen, Denmark
| | - Hiddo L Heerspink
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Gert Mayer
- Department of Internal Medicine IV (Nephrology and Hypertension), Medical University Innsbruck, Innsbruck, Austria
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Mahmood U, Healy HG, Kark A, Cameron A, Wang Z, Abeysekera R, Hoy WE. Spectrum (characteristics) of patients with chronic kidney disease (CKD) with increasing age in a major metropolitan renal service. BMC Nephrol 2017; 18:372. [PMID: 29282014 PMCID: PMC5745771 DOI: 10.1186/s12882-017-0781-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Accepted: 12/07/2017] [Indexed: 11/26/2022] Open
Abstract
Background Aim of our study is to describe, in people with CKD, the demographic and clinical characteristics and outcomes with increasing age. The prevalence of CKD in Western populations, where longevity is the norm, is about 10–15%, but how age influence different characteristics of patients with CKD is largely not known. Methods One thousand two hundred sixty-five patients enrolled in the CKD.QLD registry at the Royal Brisbane and Women’s Hospital were grouped according to age at consent i.e. <35, 35–44, 45–54, 55–64, 65–74, 75–84, 85+ years age groups, and were followed till start of renal replacement therapy (RRT), death, discharge or the censor date of September 2015. Results Age ranged from 17.6 to 98.5 years with medians of 70.1 and 69.9 years for males and females respectively: 7% were <35 years of age, with the majority (63%) >65 years old. The leading renal diagnoses changed from genetic real disease (GRD) and glomerulonephritis (GN) in the younger patients to renovascular disease (RVD) and hypertension (HTN) in older patients. With increasing age, there were often multiple renal disease diagnoses, more advanced stages of CKD, greater number of comorbidities, more frequent and more costly hospitalizations, and higher death rates. The rates of initiation of renal replacement therapy (RRT) rose from 4.5 per 100 person years in those age < 35 years to a maximum of 5.5 per 100 person years in 45–54 years age group and were lowest, at 0.5 per 100 person years in those >85 years. Mortality rates increased by age group from 1.3 to 17.0 per 100 person years in 35–44 year and 85+ year age groups respectively. Rates of hospitalization, length of stay and cost progressively increased from the youngest to eldest groups. Patients with diabetic nephropathy had highest incidence rate of RRT and death. The proportion of patients who lost more than 5mls/min/1.73m2 of eGFR during at least 12 months follow up increased from 13.3% in the youngest age group to 29.2% in the eldest. Conclusion This is the first comprehensive view, with no exclusions, of CKD patients seen in a public renal specialty referral practice, in Australia. The age distribution of patients encompasses the whole of adult life, with a broader range and higher median value than patients receiving RRT. Health status ranged from a single system (renal) disease in young adults through, with advancing age, renal impairment as a component of, or accompanying multisystem diseases, to demands and complexities of support of frail or elderly people approaching end of life. This great spectrum demands a broad understanding and capacity of renal health care providers, and dictates a need for a wider scope of health services provision incorporating multiple models of care.
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Affiliation(s)
- Usman Mahmood
- Kidney Health Services, Metro North Hospital and Health Service, Royal Brisbane & Women's Hospital, Brisbane, QLD, Australia. .,NHMRC CKD.CRE & CKD.QLD, Brisbane, QLD, Australia. .,Toowoomba Hospital, Toowoomba, QLD, Australia.
| | - Helen G Healy
- Kidney Health Services, Metro North Hospital and Health Service, Royal Brisbane & Women's Hospital, Brisbane, QLD, Australia.,NHMRC CKD.CRE & CKD.QLD, Brisbane, QLD, Australia
| | - Adrian Kark
- Kidney Health Services, Metro North Hospital and Health Service, Royal Brisbane & Women's Hospital, Brisbane, QLD, Australia.,NHMRC CKD.CRE & CKD.QLD, Brisbane, QLD, Australia
| | - Anne Cameron
- Kidney Health Services, Metro North Hospital and Health Service, Royal Brisbane & Women's Hospital, Brisbane, QLD, Australia.,NHMRC CKD.CRE & CKD.QLD, Brisbane, QLD, Australia.,Centre for Chronic Disease, University of Queensland, Brisbane, Australia
| | - Zaimin Wang
- NHMRC CKD.CRE & CKD.QLD, Brisbane, QLD, Australia.,Centre for Chronic Disease, University of Queensland, Brisbane, Australia
| | - Rajitha Abeysekera
- Kidney Health Services, Metro North Hospital and Health Service, Royal Brisbane & Women's Hospital, Brisbane, QLD, Australia.,NHMRC CKD.CRE & CKD.QLD, Brisbane, QLD, Australia
| | - Wendy E Hoy
- NHMRC CKD.CRE & CKD.QLD, Brisbane, QLD, Australia.,Centre for Chronic Disease, University of Queensland, Brisbane, Australia
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Jean G, Daugas É, Roth H, Drueke T, Bouchet JL, Hannedouche T, London G, Fouque D. [Management of bone and mineral metabolism disorders before the dialysis stage remains still perfectible. Data from the French Phosphorus and Calcium Survey Photo-Graphe]. Nephrol Ther 2017; 13:470-478. [PMID: 28843391 DOI: 10.1016/j.nephro.2017.02.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 01/27/2017] [Accepted: 02/01/2017] [Indexed: 11/19/2022]
Abstract
Only limited data is available on the management of the chronic kidney disease-associated bone and mineral metabolism disorder (CKD-MBD) in the pre-dialysis stages of CKD in France. A better knowledge of current management habits could lead to an improvement in the implementation of international recommendations (KDIGO). The 3rd version of the French Phosphorus and Calcium Survey Photo-Graphe (Sanofi) included a cohort of CKD stages 4 and 5 patients, whose aim was to examine the prevalence of CKD-MBD and the quality of its management in patients under the care of 62 nephrologists from over 20 geographical regions in France. The study started in October 2011, i.e. one year after patient enrollment. We examined in particular the percentage of patients presenting with laboratory parameter abnormalities indicative of CKD-MBD who were not receiving adequate treatment. A total of 456 patients with CKD stage 4 and 154 with CKD stage 5 were studied. Their mean age was 72.9±14.2 years, and male/female ratio was 58/42. KDIGO targets of serum PTH for CKD stages 4 and 5 were not achieved in respectively 80 and 84% of the patients, for serum calcium in 8 and 22% and for serum phosphate in 12 and 46%. As a potential explanation, insufficient therapy was estimated to account for respectively 45 and 60% of insufficiently controlled secondary hyperparathyroidism, and for 36% of persistent hyperphosphatemia in stage 5. It should be noted that 55.5 and 57.5% of patients were receiving native vitamin D. In this national observatory, the management of CKD-MBD stages 4 and 5 appears suboptimal, especially as regards the control of secondary hyperparathyroidism, which remained untreated in nearly 50% of the patients. Hyperphosphatemia was also common and inadequately controlled in CKD stage 5. To improve the management of CKD-MBD, nephrologists need to be more aware of the importance of aiming for recommended laboratory targets and how this can be achieved.
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Affiliation(s)
- Guillaume Jean
- NephroCare Tassin-Charcot, 7, avenue du Maréchal-Foch, 69110 Sainte-Foy-lès-Lyon, France.
| | - Éric Daugas
- Service de néphrologie, université Paris-Diderot, Inserm U1149, hôpital Bichat, DHU FIRE, AP-HP, 75877 Paris, France
| | - Hubert Roth
- Centre de recherche en nutrition humaine Rhône-Alpes, Inserm U1055-bioénergétique, université J. Fourier, CHU de Grenoble, 38100 Grenoble, France
| | - Tilman Drueke
- Inserm unit 1018, CESP, université de Paris-Sud, université de Paris-Île-de-France Ouest, 94800 Villejuif, France
| | - Jean-Louis Bouchet
- Centre de traitement des maladies rénales Saint-Augustin, 33000 Bordeaux, France
| | - Thierry Hannedouche
- Service de néphrologie, faculté de médecine, hôpitaux universitaires de Strasbourg, 67091 Strasbourg, France
| | | | - Denis Fouque
- Département de néphrologie, université de Lyon, CENS, hôpital Lyon-Sud, 69495 Lyon, France
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Alencar de Pinho N, Coscas R, Metzger M, Labeeuw M, Ayav C, Jacquelinet C, Massy ZA, Stengel B. Predictors of nonfunctional arteriovenous access at hemodialysis initiation and timing of access creation: A registry-based study. PLoS One 2017; 12:e0181254. [PMID: 28749967 PMCID: PMC5531527 DOI: 10.1371/journal.pone.0181254] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 06/28/2017] [Indexed: 12/21/2022] Open
Abstract
Determinants of nonfunctional arteriovenous (AV) access, including timing of AV access creation, have not been sufficiently described. We studied 29 945 patients who had predialysis AV access placement and were included in the French REIN registry from 2005 through 2013. AV access was considered nonfunctional when dialysis began with a catheter. We estimated crude and adjusted odds ratio (OR) with 95% confidence intervals (CI) of nonfunctional versus functional AV access associated with case-mix, facility characteristics, and timing of AV access creation. Analyses were stratified by dialysis start condition (planned or as an emergency) and comorbidity profile. Overall, 18% patients had nonfunctional AV access at hemodialysis initiation. In the group with planned dialysis start, female gender (OR 1.43, 95% CI 1.32–1.56), diabetes (OR 1.28, 95% CI 1.15–1.44), and a higher number of cardiovascular comorbidities (OR 1.27, 95% CI 1.09–1.49, and 1.31, 1.05–1.64, for 3 and >3 cardiovascular comorbidities versus none, respectively) were independent predictors of nonfunctional AV access. A higher percentage of AV access creation at the region level was associated with a lower rate of nonfunctional AV access (OR 0.98, 95% CI 0.98–0.99 per 1% increase). The odds of nonfunctional AV access decreased as time from creation to hemodialysis initiation increased up to 3 months in nondiabetic patients with fewer than 2 cardiovascular comorbidities and 6 months in patients with diabetes or 2 or more such comorbidities. In conclusion, both patient characteristics and clinical practices may play a role in successful AV access use at hemodialysis initiation. Adjusting the timing of AV access creation to patients’ comorbidity profiles may improve functional AV access rates.
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Affiliation(s)
- Natalia Alencar de Pinho
- Renal and Cardiovascular Epidemiology Team, CESP, INSERM U1018, Paris-Sud Univ, UVSQ, Paris Saclay University,Villejuif, France
- * E-mail:
| | - Raphael Coscas
- Renal and Cardiovascular Epidemiology Team, CESP, INSERM U1018, Paris-Sud Univ, UVSQ, Paris Saclay University,Villejuif, France
- Division of Vascular Surgery, Ambroise Paré University Hospital, AP-HP, Boulogne-Billancourt, France
| | - Marie Metzger
- Renal and Cardiovascular Epidemiology Team, CESP, INSERM U1018, Paris-Sud Univ, UVSQ, Paris Saclay University,Villejuif, France
| | | | - Carole Ayav
- Epidémiologie et Evaluations Cliniques, Pôle S2R, CHRU Nancy, Nancy, France
- CIC-1433 Epidémiologie Clinique, Inserm, Nancy, France
| | | | - Ziad A. Massy
- Renal and Cardiovascular Epidemiology Team, CESP, INSERM U1018, Paris-Sud Univ, UVSQ, Paris Saclay University,Villejuif, France
- Division of Nephrology, Ambroise Paré University Hospital, AP-HP, Boulogne-Billancourt, France
| | - Bénédicte Stengel
- Renal and Cardiovascular Epidemiology Team, CESP, INSERM U1018, Paris-Sud Univ, UVSQ, Paris Saclay University,Villejuif, France
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58
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Tuppin P, Cuerq A, Torre S, Couchoud C, Fagot-Campagna A. Prise en charge des patients avant l’initiation d’un traitement de suppléance de l’insuffisance rénale chronique terminale en 2013 en France. Nephrol Ther 2017; 13:76-86. [DOI: 10.1016/j.nephro.2016.07.446] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 07/06/2016] [Accepted: 07/06/2016] [Indexed: 11/17/2022]
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Kumar V, Yadav AK, Gang S, John O, Modi GK, Ojha JP, Pandey R, Parameswaran S, Prasad N, Sahay M, Varughese S, Baid-Agarwal S, Jha V. Indian chronic kidney disease study: Design and methods. Nephrology (Carlton) 2017; 22:273-278. [DOI: 10.1111/nep.12789] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 03/23/2016] [Accepted: 03/24/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Vivek Kumar
- Department of Nephrology; Post Graduate Institute of Medical Education and Research; Chandigarh India
| | - Ashok Kumar Yadav
- Department of Nephrology; Post Graduate Institute of Medical Education and Research; Chandigarh India
| | - Sishir Gang
- Muljibhai Patel Urological Hospital; Nadiad India
| | - Oommen John
- George Institute for Global Health; New Delhi India
| | - Gopesh K Modi
- Samarpan Kidney Institute and Research Center; Bhopal India
| | - Jai Prakash Ojha
- Department of Nephrology, Institute of Medical Science; Banaras Hindu University; Varanasi India
| | - Rajendra Pandey
- Department of Nephrology; Institute of Post Graduate Medical Education & Research; Kolkata India
| | - Sreejith Parameswaran
- Department of Nephrology; Jawaharlal Institute of Postgraduate Medical Education & Research; Pondicherry India
| | - Narayan Prasad
- Department of Nephrology; Sanjay Gandhi Postgraduate Institute of Medical Science; Lucknow India
| | - Manisha Sahay
- Department of Nephrology; Osmania Medical College, Osmania General Hospital; Hyderabad India
| | | | - Seema Baid-Agarwal
- Department of Nephrology and Transplant Center; Sahlgrenska University Hospital; Gothenburg Sweden
| | - Vivekanand Jha
- Department of Nephrology; Post Graduate Institute of Medical Education and Research; Chandigarh India
- George Institute for Global Health; New Delhi India
- University of Oxford; Oxford UK
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Massol J, Janin G, Bachot C, Gousset C, Deville GSC, Chalopin JM. Pilot non dialysis chronic renal insufficiency study (P-ND-CRIS): a pilot study of an open prospective hospital-based French cohort. BMC Nephrol 2017; 18:46. [PMID: 28143424 PMCID: PMC5286676 DOI: 10.1186/s12882-017-0463-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Accepted: 01/26/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Before establishing a prospective cohort, an initial pilot study is recommended. However, there are no precise guidelines on this subject. This paper reports the findings of a French regional pilot study carried out in three nephrology departments, before realizing a major prospective Non Dialysis Chronic Renal Insufficiency study (ND-CRIS). METHODS We carried out an internal pilot study. The objectives of this pilot study were to validate the feasibility (regulatory approval, providing patients with information, availability of variables, refusal rate of eligible patients) and quality criteria (missing data, rate of patients lost to follow-up, characteristics of the patients included and non-included eligible patients, quality control of the data gathered) and estimate the human resources necessary (number of clinical research associates required). RESULTS The authorizations obtained (CCTIRS - CNIL) and the contracts signed with hospitals have fulfilled the regulatory requirements. After validating the information on the study provided to patients, 1849 of them were included in three centres (university hospital, intercommunal hospital, town hospital) between April 2012 and September 2015. The low refusal rate (51 patients) and the characteristics of non-included patients have confirmed the benefit for patients of participating in the study and provide evidence of the feasibility and representativeness of the population studied. The lack of missing data on the variables studied, the quality of the data analyzed and the low number of patients lost to follow-up are evidence of the quality of the study. By taking into account the time spent by CRAs to enter data and to travel, as well as the annual patient numbers in each hospital, we estimate that five CRAs will be required in total. CONCLUSION With no specific guidelines on how to realize a pilot study before implementing a major prospective cohort, we considered it pertinent to report our experience of P-ND-CRIS. This experience confirms that i) feasibility, ii) quality of data and iii) evaluating the resources required must be validated before carrying out a large prospective cohort study such as ND-CRIS.
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Affiliation(s)
- Jacques Massol
- Institut PHISQUARE, 20, rue Saint Saëns, 75015, Paris, France.
| | - Gérard Janin
- Centre Hospitalier de Mâcon, 350, boulevard Escande, 71018, Mâcon, Cedex, France
| | - Camille Bachot
- Institut PHISQUARE, 20, rue Saint Saëns, 75015, Paris, France
| | | | | | - Jean-Marc Chalopin
- Nephrology, CHRU de Besançon, Hôpital Jean Minjoz, 3, boulevard Alexandre Fleming, 25030, Besançon, France
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Dienemann T, Fujii N, Orlandi P, Nessel L, Furth SL, Hoy WE, Matsuo S, Mayer G, Methven S, Schaefer F, Schaeffner ES, Solá L, Stengel B, Wanner C, Zhang L, Levin A, Eckardt KU, Feldman HI. International Network of Chronic Kidney Disease cohort studies (iNET-CKD): a global network of chronic kidney disease cohorts. BMC Nephrol 2016; 17:121. [PMID: 27590182 PMCID: PMC5010740 DOI: 10.1186/s12882-016-0335-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 08/17/2016] [Indexed: 01/13/2023] Open
Abstract
Background Chronic kidney disease (CKD) is a global health burden, yet it is still underrepresented within public health agendas in many countries. Studies focusing on the natural history of CKD are challenging to design and conduct, because of the long time-course of disease progression, a wide variation in etiologies, and a large amount of clinical variability among individuals with CKD. With the difference in health-related behaviors, healthcare delivery, genetics, and environmental exposures, this variability is greater across countries than within one locale and may not be captured effectively in a single study. Methods Studies were invited to join the network. Prerequisites for membership included: 1) observational designs with a priori hypotheses and defined study objectives, patient-level information, prospective data acquisition and collection of bio-samples, all focused on predialysis CKD patients; 2) target sample sizes of 1,000 patients for adult cohorts and 300 for pediatric cohorts; and 3) minimum follow-up of three years. Participating studies were surveyed regarding design, data, and biosample resources. Results Twelve prospective cohort studies and two registries covering 21 countries were included. Participants age ranges from >2 to >70 years at inclusion, CKD severity ranges from stage 2 to stage 5. Patient data and biosamples (not available in the registry studies) are measured yearly or biennially. Many studies included multiple ethnicities; cohort size ranges from 400 to more than 13,000 participants. Studies’ areas of emphasis all include but are not limited to renal outcomes, such as progression to ESRD and death. Conclusions iNET-CKD (International Network of CKD cohort studies) was established, to promote collaborative research, foster exchange of expertise, and create opportunities for research training. Participating studies have many commonalities that will facilitate comparative research; however, we also observed substantial differences. The diversity we observed across studies within this network will be able to be leveraged to identify genetic, behavioral, and health services factors associated with the course of CKD. With an emerging infrastructure to facilitate interactions among the investigators of iNET-CKD and a broadly defined research agenda, we are confident that there will be great opportunity for productive collaborative investigations involving cohorts of individuals with CKD. Electronic supplementary material The online version of this article (doi:10.1186/s12882-016-0335-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Thomas Dienemann
- Department of Nephrology and Hypertension, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Naohiko Fujii
- Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Paula Orlandi
- Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Lisa Nessel
- Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Susan L Furth
- Division of Pediatric Nephrology, Children's Hospital of Philadelphia, Philadelphia, USA
| | - Wendy E Hoy
- Centre for Chronic Disease, School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Seiichi Matsuo
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Gert Mayer
- Nephrology and Hypertension, Innsbruck Medical University, Innsbruck, Austria
| | - Shona Methven
- School of Clinical Sciences, University of Bristol, Southmead Hospital, Westbury-on-Trym, Bristol, UK
| | - Franz Schaefer
- Division of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, University of Heidelberg, Heidelberg, Germany
| | - Elke S Schaeffner
- Institute of Public Health, Charite University Medicine, Berlin, Germany
| | - Laura Solá
- Directora Division Epidemiologia, DIGESA-Ministerio Salud Publica, Montevideo, Uruguay
| | - Bénédicte Stengel
- Université Paris-Saclay, Univ Paris-Sud, UVSQ, CESP, Centre for Research in Epidemiology and Population Health, Inserm, F-CRIN-INI-CRCT, Villejuif, France
| | - Christoph Wanner
- Department of Internal Medicine I, Division of Nephrology, University of Würzburg, Würzburg, Germany
| | - Luxia Zhang
- Renal Division, Department of Medicine, Peking University First Hospital, Peking University Institute of Nephrology, Beijing, China
| | - Adeera Levin
- Division of Nephrology, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Kai-Uwe Eckardt
- Department of Nephrology and Hypertension, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Harold I Feldman
- Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA. .,Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA.
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Manjarres L, Sanchez P, Cabezas MC, Fornasini M, Freire V, Albert A. Budget impact of secondary hyperparathyroidism treatment in chronic kidney disease in an Ecuadorian social security hospital. BMC Health Serv Res 2016; 16:443. [PMID: 27566059 PMCID: PMC5002117 DOI: 10.1186/s12913-016-1671-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Accepted: 08/15/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) is a disorder with high morbidity and mortality worldwide whose complications generate multiple costs. In Ecuador, only a few healthcare institutions have implemented management protocols aimed to reduce costs and to improve the quality of life of patients. The aim of this study is to evaluate the short-term (1-year) and long-term (5-year) costs and savings in the management of secondary hyperparathyroidism (SHPT) of hemodialyzed CKD patients by comparing calcitriol and paricalcitol in a large social security hospital in Quito, Ecuador. METHODS The estimation model assessed the resources used in the management of SHPT by comparing prospectively the cost savings within 1-year and 5-year time horizon with calcitriol and paricalcitol. Hospitalization, erythropoietin (EPO), treatment doses, intravenous iron consumption, and medical supplies were estimated according international references, based on the initial parathormone level (iPTH) of patients. The Ecuadorian National Reference costs (2014-2015) and institutional costs were used to calculate treatment costs. A statistical sensitivity analysis was also performed. RESULTS The study was based on data from 354 patients of whom 147 (41.4 %) had a value of iPTH in the range 300-600 pg/ml, 45 (12.8 %) in the range 601-800 pg/ml, and 162 (45.7 %) over 800 pg/ml. The 1-year estimated costs per patient for calcitriol and paricalcitol, respectively, were: medication, 63.88 USD and 1,123.44 USD; EPO, 19,522.95 USD and 16,478 USD; intravenous iron 143.21 USD and 187.76 USD. Yearly hospitalization costs per patient were 11,647.99 USD with calcitriol and 8,019.41 USD with paricalcitol. Total yearly costs per patient amounted to 31,378.02 USD with calcitriol and 25,809.50 USD with paricalcitol. Total savings using paricalcitol were 5,568.52 USD per patient compared with calcitriol. The 5-year cumulative medication costs were 319 USD for calcitriol and 2,403 USD for paricalcitol; EPO with calcitriol was 97,615 USD and with paricalcitol 82,394 USD; intravenous iron with calcitriol was 716 USD and paricalcitol 939 USD. Hospitalization costs for patients with calcitriol and paricalcitol were 43,095 USD and 62,595 USD, respectively. Total savings using paricalcitol amounted 32,414 USD per patient compared with calcitriol. CONCLUSIONS Paricalcitol use generated more cost savings than calcitriol after 1 and 5 years.
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Affiliation(s)
- Luis Manjarres
- Nephrology Service, Carlos Andrade Marin Hospital, Quito, Ecuador
| | - Pilar Sanchez
- Nephrology Service, Carlos Andrade Marin Hospital, Quito, Ecuador
| | - María C Cabezas
- Medical School, Pontifical Catholic University of Ecuador, Quito, Ecuador. .,Health & Research Services, Quito, Ecuador.
| | - Marco Fornasini
- Translational Research Center, Universidad de las Américas (UDLA), Quito, Ecuador
| | - Valeria Freire
- Medical School, Pontifical Catholic University of Ecuador, Quito, Ecuador
| | - Adelin Albert
- Public Health Department, University of Liège, Liège, Belgium
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Massol J, Janin G, Bachot C, Gousset C, Sainte-Claire Deville G, Chalopin JM. The Non-Dialysis Chronic Renal Insufficiency study (ND-CRIS): an open prospective hospital-based cohort study in France. BMC Nephrol 2016; 17:92. [PMID: 27448596 PMCID: PMC4957911 DOI: 10.1186/s12882-016-0307-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 06/22/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) amounts to a heavy burden for health services. There is no long-running epidemiological tool for CKD before dialysis. We here present the protocol for a cohort of patients with "non-dialysis" CKD receiving care in the Bourgogne-Franche-Comté region of France. The aim of this cohort was to periodically describe the characteristics of patients included and their care provision, to analyse evolution in care and patients' kidney function outcomes. METHODS The ND-CRIS cohort is prevalent and incident. Patients are included in the cohort if over 18, with a glomerula filtration rate (GFR) <60 ml/min/1.73 m2, non-dialysed, informed on the research and not having opposed it, and followed by a nephrologist in one of the 9 centres in the region, (3 pilot centres joined by 6 others in 2015). All the patients are followed up, with varying time lapses according to the degree of GFR deterioration. Data is collected by clinical research assistants (CRAs) using a dedicated computerised case-report form (CRF). Professional practices are assessed using indicators defined by the French Health Authority. The follow-up of patients included should enable assessment of the evolution of their GFR and co-morbidities. The periodic descriptions should give insight into evolution in epidemiological terms. DISCUSSION The ND-CRIS meets a need in epidemiological tools in France for CKD. The cohort does claim to be representative, of ND-CKD patients receiving care from nephrologists. The open and incident nature of the cohort and the number of patients included in the ND-CRIS should provide answers to questions that cannot be answered by smaller solely prevalent cohorts. The numbers of patients included over the study period (2391 patients in 3 centres in 3 years) suggests that the figure of 5000 patients should be reached by 2017. The participation of nephrologists and the rate of inclusions point to the feasibility of the implementation of this cohort. Beyond the information to be found in the CRFs, this cohort should also enable ad hoc studies, in particular in the area of pharmaco-epidemiology, and it could later serve as a research platform and as a public health surveillance tool.
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Affiliation(s)
- Jacques Massol
- />Institut PHISQUARE, 20, rue Saint Saëns, 75015 Paris, France
| | - Gérard Janin
- />Centre Hospitalier de Mâcon, 350, boulevard Escande, 71018 Mâcon Cedex, France
| | - Camille Bachot
- />Institut PHISQUARE, 20, rue Saint Saëns, 75015 Paris, France
| | | | | | - Jean-Marc Chalopin
- />Department of Nephrology, CHRU de Besançon, Hôpital Jean Minjoz, 3, boulevard Alexandre Fleming, 25030 Besançon, France
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Pedersen L, Jensen JB, Wogensen L, Munk OL, Jessen N, Frøkiær J, Jakobsen S. Renal PET-imaging with (11)C-metformin in a transgenic mouse model for chronic kidney disease. EJNMMI Res 2016; 6:54. [PMID: 27339044 PMCID: PMC4919269 DOI: 10.1186/s13550-016-0211-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 06/16/2016] [Indexed: 01/09/2023] Open
Abstract
Background Organic cation transporters (OCTs) in the renal proximal tubule are important for the excretion of both exo- and endogenous compounds, and chronic kidney disease (CKD) alter the expression of OCT. Metformin is a well-known substrate for OCT, and recently, we demonstrated that positron emission tomography (PET) with 11C-labelled metformin (11C-metformin) is a promising approach to evaluate the function of OCT. The aim of this study is therefore to examine renal pharmacokinetics of 11C-metformin and expression of OCTs in a transgenic (RenTGF-β1) mouse model of CKD. Methods Age- and sex-matched RenTGF-β1 (Tg) and wildtype (WT) mice were used (5–8/group). Animals received an iv bolus of 11C-metformin followed by 90-min dynamic PET and MRI scan. PET data were analysed using a one-tissue compartment model. Renal protein abundance of OCT2 (by Western blot) as well as OCT1, OCT2, and MATE1 messenger RNA (mRNA) (by RT-PCR) was examined. Results Protein expression of the basolateral uptake transporter OCT2 was 1.5-fold lower in Tg mice compared to WT mice while OCT1 and MATE1 mRNA expression did not differ between the two groups. The influx rate constant of 11C-metformin in renal cortex (K1) was 2.2-fold lower in transgenic mice whereas the backflux rate constant (k2) was similar in the two groups, consistent with protein expression. Total body clearance (TBC) correlated within each group linearly with K1. Conclusions In conclusion, this study demonstrates that both renal OCT2 expression and 11C-metformin uptake are reduced in CKD mice. This potentially makes 11C-metformin valuable as a PET probe to evaluate kidney function.
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Affiliation(s)
- Lea Pedersen
- Research Laboratory for Biochemical Pathology, Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Jonas Brorson Jensen
- Research Laboratory for Biochemical Pathology, Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Nuclear Medicine & PET Center, Aarhus University Hospital, DK-8000, Aarhus C, Denmark
| | - Lise Wogensen
- Research Laboratory for Biochemical Pathology, Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Ole Lajord Munk
- Department of Nuclear Medicine & PET Center, Aarhus University Hospital, DK-8000, Aarhus C, Denmark
| | - Niels Jessen
- Research Laboratory for Biochemical Pathology, Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Jørgen Frøkiær
- Department of Nuclear Medicine & PET Center, Aarhus University Hospital, DK-8000, Aarhus C, Denmark
| | - Steen Jakobsen
- Department of Nuclear Medicine & PET Center, Aarhus University Hospital, DK-8000, Aarhus C, Denmark.
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Li L, Liang W, Ye T, Chen Z, Zuo X, Du X, Qian K, Zhang C, Hu X, Li J, Wang L, Ma Z, Yao Y. The Association between Nutritional Markers and Biochemical Parameters and Residual Renal Function in Peritoneal Dialysis Patients. PLoS One 2016; 11:e0156423. [PMID: 27258403 PMCID: PMC4892617 DOI: 10.1371/journal.pone.0156423] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 05/14/2016] [Indexed: 11/18/2022] Open
Abstract
Residual renal function (RRF) is an important prognostic factor for peritoneal dialysis patients as it influences the quality of life and mortality. This study was conducted to explore the potential factors correlated with RRF. A cross-sectional study was conducted by recruiting 155 patients with residual GFR more than 1mL/min per 1.73m2 at the initiation of peritoneal dialysis. We collected the demographic characteristics, nutritional markers and biochemical parameters of all participants, and analyzed the correlation between these variables and residual GFR as well. The odds ratio of RRF loss associated with each of the nutritional markers and biochemical parameters were estimated by logistic regression model. The residual GFR was negatively correlated with serum phosphate (ORQ3 = 2.67, 95%CI: 1.03-6.92; ORQ4 = 3.45, 95%CI: 1.35-9.04), magnesium (ORQ4 = 3.77, 95%CI: 1.48-3.63), and creatinine (ORQ3 = 2.93, 95%CI: 1.09-7.88; ORQ4 = 8.64 95%CI: 2.79-26.78), while positively associated with normalized protein catabolic rate (ORQ3 = 0.24, 95%CI: 0.09-0.65; ORQ4 = 0.11, 95%CI: 0.03-0.35), 24 hours urine volume(ORQ1 = 22.87, 95%CI: 2.76-189.24; ORQ3 = 0.08, 95%CI: 0.02-0.28) and serum chlorine concentrations (ORQ1 = 5.34, 95%CI: 1.94-14.68; ORQ4 = 0.28, 95%CI: 0.09-0.85), respectively. Our study suggested that the nutritional markers and biochemical parameters, though not all, but at least in part were closely correlated with RRF in peritoneal dialysis patients.
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Affiliation(s)
- Li Li
- Department of Clinical Nutrition, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wangqun Liang
- Department of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ting Ye
- Department of Clinical Nutrition, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhenyan Chen
- Department of Clinical Nutrition, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xuezhi Zuo
- Department of Clinical Nutrition, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiang Du
- Department of Clinical Nutrition, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kun Qian
- Department of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chunxiu Zhang
- Department of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiangrong Hu
- Department of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Junhua Li
- Department of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Le Wang
- Department of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zufu Ma
- Department of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- * E-mail: (YY); (ZM)
| | - Ying Yao
- Department of Clinical Nutrition, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Department of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- * E-mail: (YY); (ZM)
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Mariani L, Stengel B, Combe C, Massy ZA, Reichel H, Fliser D, Pecoits-Filho R, Lopes AA, Yamagata K, Wada T, Wong MMY, Speyer E, Port FK, Pisoni RL, Robinson BM. The CKD Outcomes and Practice Patterns Study (CKDopps): Rationale and Methods. Am J Kidney Dis 2016; 68:402-13. [PMID: 27113505 DOI: 10.1053/j.ajkd.2016.03.414] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 03/09/2016] [Indexed: 01/01/2023]
Abstract
BACKGROUND Minimizing clinical complications in patients with advanced chronic kidney disease (CKD) and improving the transition to dialysis therapy and transplantation represents a challenge, requiring reliable evidence regarding the effects of CKD care on outcomes. STUDY DESIGN The CKD Outcomes and Practice Patterns Study (CKDopps) is a new international prospective cohort study designed to describe and evaluate variation in nephrologist-led CKD practices. SETTING & PARTICIPANTS CKDopps is underway in Brazil, France, Germany, Japan, and the United States. Diverse national samples of nephrology clinics are being recruited based on random selection stratified by geographic region and clinic characteristics. CKDopps aims to enroll 12,200 non-dialysis-dependent patients with CKD (75% and 25% with estimated glomerular filtration rates < 30 and 30-<60mL/min/1.73m(2), respectively) to be followed up for 3 to 5 years. PREDICTORS Demographic, comorbid condition, laboratory, and treatment-related variables are collected at 6-month intervals; patient-reported data are collected annually and more frequently near the transition to end-stage kidney disease; nephrologist practice surveys are collected annually. OUTCOMES Outcomes include mortality, end-stage kidney disease, other clinical events (eg, acute kidney injury, hospitalizations, infections, cardiovascular events, and transplant wait-listing), and patient-reported outcomes. RESULTS For the targeted sample size of 12,200 patients and 160 clinics, CKDopps has 80% power to detect HRs of 1.31 for mortality and 1.19 for mortality or transition to end-stage kidney disease. LIMITATIONS CKDopps does not capture care provided in settings outside nephrology clinics (eg, primary care) or patients with CKD not receiving medical care. CONCLUSIONS CKDopps is designed to characterize nephrology clinic practice variation and identify practices associated with better outcomes, with particular focus on advanced CKD, transition to end-stage kidney disease, and the patient experience. Because data will be collected during routine clinical care in real-world practice, analyses may yield practical readily implementable findings. CKDopps aims to establish a multinational infrastructure for research, collaboration, and ancillary investigation. Additional countries are encouraged to join.
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Affiliation(s)
- Laura Mariani
- Arbor Research Collaborative for Health, Ann Arbor, MI; University of Michigan, Ann Arbor, MI.
| | - Bénédicte Stengel
- University Paris-Saclay, University Paris-Sud, UVSQ, CESP, Centre for Research in Epidemiology and Population Health, Inserm UMR1018, F-CRIN-INI-CRCT, Villejuif, France
| | - Christian Combe
- Service de Néphrologie Transplantation Dialyse, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France; Inserm, U1026, Universitaire Bordeaux, Bordeaux, France
| | - Ziad A Massy
- University Paris-Saclay, University Paris-Sud, UVSQ, CESP, Centre for Research in Epidemiology and Population Health, Inserm UMR1018, F-CRIN-INI-CRCT, Villejuif, France; Division of Nephrology, Ambroise Paré University Hospital, APHP, University of Paris Ouest-Versailles-St-Quentin-en-Yvelines (UVSQ), Boulogne-Billancourt/Paris, France
| | | | - Danilo Fliser
- Internal Medicine IV - Renal and Hypertensive Diseases, Saarland University Medical Centre, Homburg/Saar, Germany
| | | | - Antonio A Lopes
- Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, BA, Brazil
| | | | - Takashi Wada
- Department of Nephrology and Laboratory Medicine, Kanazawa University, Kanazawa, Japan
| | | | - Elodie Speyer
- Arbor Research Collaborative for Health, Ann Arbor, MI
| | - Friedrich K Port
- Arbor Research Collaborative for Health, Ann Arbor, MI; University of Michigan, Ann Arbor, MI
| | | | - Bruce M Robinson
- Arbor Research Collaborative for Health, Ann Arbor, MI; University of Michigan, Ann Arbor, MI
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Stengel B, Combe C, Jacquelinet C, Briançon S, Fouque D, Laville M, Frimat L, Pascal C, Herpe YÉ, Morel P, Deleuze JF, Schanstra JP, Pisoni RL, Robinson BM, Massy ZA. Cohorte française Chronic Kidney Disease–Réseau Épidémiologie et Information en Néphrologie (CKD-REIN) : mieux connaître la maladie rénale chronique. Nephrol Ther 2016; 12 Suppl 1:S49-56. [DOI: 10.1016/j.nephro.2016.01.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Jankowski J, Schanstra JP, Mischak H. Body fluid peptide and protein signatures in diabetic kidney diseases. Nephrol Dial Transplant 2016. [PMID: 26209737 DOI: 10.1093/ndt/gfv091] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Body fluid protein-based biomarkers carry the hope of improving patient management in diabetes by enabling more accurate and earlier detection of diabetic kidney disease (DKD), but also of defining the most suitable therapeutic targets. We present the data on some of the best studied individual protein markers in body fluids and conclude that their potential in clinical application for assessing DKD is moderate. Proteome-based approaches aiming at the identification of panels of body fluid biomarkers might be a valid alternative. We discuss the past (first) clinical proteomics studies in DKD, stressing their drawbacks but also the lessons that could be learned from them, as well as the more recent studies that have a potential for actual clinical implementation. We also highlight relevant issues and current problems associated with clinical proteomics from discovery towards application, and give suggestions for solutions that may help guiding proteomic studies, thereby removing some of the current hurdles for implementation of potentially beneficial results.
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Affiliation(s)
- Joachim Jankowski
- Universitätsklinikum RWTH Aachen, Institute of Molecular Cardiovascular Research, Aachen, Germany
| | - Joost P Schanstra
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1048, Institute of Cardiovascular and Metabolic Disease, Toulouse, France Université Toulouse III Paul-Sabatier, Toulouse, France
| | - Harald Mischak
- Mosaiques Diagnostics & Therapeutics, Hannover, Germany BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, Faculty of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
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Shah B, Kirpalani A, Sunder S, Gupta A, Khanna U, Chafekar D, Tan LP, Sirivongs D, Pahari D, Nath G, Ikizler TA. A prospective, multi-centre, observational study to examine kidney disease progression in adults with chronic kidney disease - CKDOD - Study design and preliminary results. BMC Nephrol 2015; 16:215. [PMID: 26696239 PMCID: PMC4687357 DOI: 10.1186/s12882-015-0191-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 11/24/2015] [Indexed: 11/29/2022] Open
Abstract
Background The objective of this article is to describe the organisation of an international, clinical registry, the Chronic Kidney Disease Observational Database (CKDOD), the processes of enrolling patients and entering data and preliminary results to date. Design The Chronic Kidney Disease Observational Database (CKDOD) is designed to assess the association between different factors with a known influence on chronic kidney disease (CKD) progression as well as treatment strategies such as dietary modifications, blood pressure control and pharmacological interventions in Asian countries (India, China, Malaysia and Thailand). The only inclusion criterion is the presence of CKD stage 2 or higher as defined by the KDIGO guidelines. Demographic and clinical information are collected by a standardised electronic questionnaire, available in English and Chinese. The data are transferred to the CKDOD database either by e-mail or via web access. All data are checked for consistency and missing values. Collection of data started in September 2011 and by April 2015, data on 1323 individual patients had been submitted. The mean age at inclusion was 57 ± 14 years, 67 % were male and 36 % were diabetic. The baseline estimated glomerular filtration rate was 26 ml/min/1.73 m2. Of all enrolled patients, 324 (24 %) received ketoanalogue supplementation during at least one recorded visit. Discussion The CKDOD is a very large and comprehensive data repository, currently focused in subjects recruited from Asia. The database is expected to provide important long-term information on CKD progression, nutritional and metabolic derangements that accompany CKD progression and treatment strategies to ameliorate progression and complications of CKD. Trial Registration Clinical Trial Registry – India: CTRI/2012/06/002743; 25th July 2012 Electronic supplementary material The online version of this article (doi:10.1186/s12882-015-0191-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | - Sham Sunder
- Department of Nephrology, RML (Ram Manohar Lohiya) hospital, New Delhi, India.
| | | | | | | | - Li Ping Tan
- University Malaya Medical Centre, Renal unit, Faculty of Medicine, Kuala Lumpur, Malaysia.
| | - Dhavee Sirivongs
- Department of Medicine, Khon Kaen Medical School, Khon Kaen City, Thailand.
| | - Dilip Pahari
- Dr. Medica Institute of Kidney Diseases, Kolkata, India.
| | - Gokul Nath
- Department of Nephrology, St. John's Medical College & Hospital, Bangalore, India.
| | - Talat Alp Ikizler
- Vanderbilt University Medical Center, Division of Nephrology, 1161 21st Avenue South, S-3223 Medical Center North, Nashville, TN, 37232-2372, USA.
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Mariani LH, Kretzler M. Pro: 'The usefulness of biomarkers in glomerular diseases'. The problem: moving from syndrome to mechanism--individual patient variability in disease presentation, course and response to therapy. Nephrol Dial Transplant 2015; 30:892-8. [PMID: 25994659 DOI: 10.1093/ndt/gfv108] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
The diagnosis and treatment decisions in glomerular disease are principally based on renal pathology and nonspecific clinical laboratory measurements such as serum creatinine and urine protein. Using these classification approaches, patients have marked variability in rate of progression and response to therapy, exposing a significant number of patients to toxicity without benefit. Additionally, clinical trials are at risk of not being able to detect an efficacious therapy in relevant subgroups as patients with shared clinical-pathologic diagnoses have heterogeneous underlying pathobiology. To change this treatment paradigm, biomarkers that reflect the molecular mechanisms underlying the clinical-pathologic diagnoses are needed. Recent progress to identify such biomarkers has been aided by advances in molecular profiling, large-scale data generation and multi-scalar data integration, including prospectively collected clinical data. This article reviews the evolving success stories in glomerular disease biomarkers across the genotype-phenotype continuum and highlights opportunities to transition to precision medicine in glomerular disease.
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Affiliation(s)
- Laura H Mariani
- Department of Internal Medicine/Nephrology, University of Michigan, Ann Arbor, MI, USA Arbor Research Collaborative for Health, Ann Arbor, MI, USA
| | - Matthias Kretzler
- Department of Internal Medicine/Nephrology, University of Michigan, Ann Arbor, MI, USA Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI, USA
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Breit M, Weinberger KM. Metabolic biomarkers for chronic kidney disease. Arch Biochem Biophys 2015; 589:62-80. [PMID: 26235490 DOI: 10.1016/j.abb.2015.07.018] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 07/11/2015] [Accepted: 07/26/2015] [Indexed: 01/28/2023]
Abstract
Chronic kidney disease (CKD) is an increasingly recognized burden for patients and health care systems with high (and growing) global incidence and prevalence, significant mortality, and disproportionately high treatment costs. Yet, the available diagnostic tools are either impractical in clinical routine or have serious shortcomings impeding a well-informed disease management although optimized treatment strategies with proven benefits for the patients have become available. Advances in bioanalytical technologies have facilitated studies that identified genomic, proteomic, and metabolic biomarker candidates, and confirmed some of them in independent cohorts. This review summarizes the CKD-related markers discovered so far, and focuses on compounds and pathways, for which there is quantitative data, substantiating evidence from translational research, and a mechanistic understanding of the processes involved. Also, multiparametric marker panels have been suggested that showed promising diagnostic and prognostic performance in initial analyses although the data basis from prospective trials is very limited. Large-scale studies, however, are underway and will provide the information for validating a set of parameters and discarding others. Finally, the path from clinical research to a routine application is discussed, focusing on potential obstacles such as the use of mass spectrometry, and the feasibility of obtaining regulatory approval for targeted metabolomics assays.
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Affiliation(s)
- Marc Breit
- Research Group for Clinical Bioinformatics, Institute of Electrical and Biomedical Engineering (IEBE), University for Health Sciences, Medical Informatics and Technology (UMIT), 6060 Hall in Tirol, Austria
| | - Klaus M Weinberger
- Research Group for Clinical Bioinformatics, Institute of Electrical and Biomedical Engineering (IEBE), University for Health Sciences, Medical Informatics and Technology (UMIT), 6060 Hall in Tirol, Austria; sAnalytiCo Ltd., Forsyth House, Cromac Square, Belfast BT2 8LA, United Kingdom.
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Integration, Networking, and Global Biobanking in the Age of New Biology. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2015; 864:1-9. [DOI: 10.1007/978-3-319-20579-3_1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Combe C, Rigothier C, Chauveau P. Evidence-based choice of dialysis technique in diabetics with end-stage kidney disease: half a loaf is better than no bread. Nephrol Dial Transplant 2014; 30:160-2. [PMID: 25523448 DOI: 10.1093/ndt/gfu390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Christian Combe
- Service de Néphrologie Transplantation Dialyse, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France Unité INSERM 1026 Bioingénierie tissulaire, Université de Bordeaux, Bordeaux, France
| | - Claire Rigothier
- Service de Néphrologie Transplantation Dialyse, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France Unité INSERM 1026 Bioingénierie tissulaire, Université de Bordeaux, Bordeaux, France
| | - Philippe Chauveau
- Service de Néphrologie Transplantation Dialyse, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France AURAD Aquitaine, Gradignan, France
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Tampe D, Zeisberg M. Potential approaches to reverse or repair renal fibrosis. Nat Rev Nephrol 2014; 10:226-37. [DOI: 10.1038/nrneph.2014.14] [Citation(s) in RCA: 136] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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