A call to action on World Kidney Day, 8 March 2007

The comparative effectiveness of statin therapy in selected chronic diseases compared with the remaining population

Background

Total cholesterol (TC) concentration is the most commonly used measure of statin efficacy in the UK. This study aimed to evaluate the effectiveness of statins in lowering TC, cardiovascular events (CV) and mortality five common chronic diseases (chronic obstructive pulmonary disease (COPD), osteoarthritis (OA), rheumatoid arthritis (RA), chronic kidney disease (CKD), and diabetes mellitus (DM)) and to compare effectiveness with the rest of the population not recorded as having these diseases.

Methods

A population-based cohort study was conducted in Tayside population who had at least two TC measurements between 1993 and 2007. There were 12,140 patients with chronic diseases and 9,481 patients in the rest of the population not recorded as having these chronic diseases. The main outcomes were TC change from baseline, CV events and all-cause mortality.

Results

Statin-associated TC reductions varied from 15% to 28% with baseline value of between 5.1 and 5.9 mmol/L in the primary prevention (PP) and from 7% to 23% with baseline value of 4.5 to 5.2 mmol/L in the secondary prevention (SP) among chronic diseases patients. In the rest of the population, TC reductions with statins were 31% in PP and 28% in SP with baselines of 6.3 mmol/L and 5.3 mmol/L, respectively (test of heterogeneity with chronic disease groups: p < 0.001). A notional reduction of 0.5 mmol/L in TC predicted variable reductions in incident CV events of 30% in RA, 19% in CKD, and 20% in DM, and recurrent CV events by 62% in COPD, 16% in CKD, and 19% in DM. The corresponding figures for the rest of population were 12% for incident CV events and 17% for the recurrent CV events, respectively. Risk reductions for all-cause mortality varied from 20% to 36% in PP and from 18% to 40% in SP, except in OA or RA patients in the chronic diseases and 11% in PP and 16% in the rest of population (test of heterogeneity: p > 0.05).

Conclusions

The effectiveness of statins in common chronic diseases varied. With the exception of diabetes, statins tends to be less effective in patients with the chronic diseases compared with the rest of the study population. Changes in TC with statins appear not to correlate well with the changes in cardiovascular events and all-cause mortality.

Clinical application of antibody microarray in chronic kidney disease: How far to go?

Chronic kidney disease (CKD) that affects about 10% of the adult population has been shown as a worldwide public health problem in recent years. Both basic and clinical investigations have identified complex disease-associated protein networks involved in the pathophysiologic processes of CKD. The traditional single-assay approach and proteomic analysis of those related proteins have given birth to a steadily increasing panel of molecules that may have the potential to serve as biomarkers for CKD. However, both approaches suffered from some shortcomings from a technological point of view. Antibody microarray (AbM) is characterized by high sensitivity, specificity, and quantitative ability for a particular set of known proteins. However, its application in CKD has been very limited so far. The objective of this review, therefore, is to address the potential applications of AbM in studying of CKD. We will briefly discuss the proteins involved in the development of CKD, future directions in which AbM approaches would probably display its potential and also some key issues that need to be considered in application of this novel technique.

An analysis of media coverage on the prevention and early detection of CKD in Australia

News media raise public awareness about health and can influence public policy agenda. Recently, nephrologists have sought to make prevention and early detection of chronic kidney disease (CKD) a health care priority. We assessed the extent and manner in which Australian television news and newspapers cover CKD prevention or early detection. Electronic news databases for print media and television programs were searched (May 2005 to March 2007) for items referring to CKD prevention or early detection. We analyzed all relevant items for spokespeople, main news frame, focus of responsibility, proposed solutions, and trigger/reason for publication. Of 2,439 newspaper articles and 10,430 television broadcasts retrieved, only 214 articles (8.77%) and 7 broadcasts (0.06%) were eligible. Kidney transplantation dominated CKD-related news. Lay person or high-profile advocates were virtually absent. Risks of cardiovascular disease and mortality conferred by CKD were not emphasized by news reports; instead, CKD received peripheral mention as a secondary consequence of diabetes or obesity. Few reports cited the economic consequences of CKD. The media focused on lifestyle causes and solutions, whereas nonlifestyle causes and screening and prevention strategies were rarely mentioned. Kidney health professionals need to actively engage with the media in efforts to amplify desired messages on CKD prevention or early detection. Medical journals, research institutions, universities, hospitals, and advocacy groups should issue press releases that highlight newsworthy aspects of this topic. Extending news media coverage can help exert an influence on health policies and agenda setting and increase public awareness to improve prevention and early detection of CKD.

Community-partnered approaches to enhance chronic kidney disease awareness, prevention, and early intervention

There is a need to increase community involvement in addressing the growing burden of chronic kidney disease (CKD). Community-partnered participatory research (CPPR) is a collaborative approach that equitably involves academic, community, and professional partners in research, and the development of shared goals and of interventional programs to attain these goals. We present a case study of the processes, strategies, and activities concerning the interface of World Kidney Day goals and community-academic partnerships using a CPPR model focused on CKD. We show that CPPR methods can be used to (1) bring together community and academic leaders around goal sharing and research agenda development, (2) convene a community/professional conference aimed at knowledge transfer and data collection among partners, and (3) develop workgroups from a diverse group of participants to collaborate in community partnered strategies to reduce the burden of CKD. Participants included health care professionals, patients, faith-based professionals, government employees and officials, academics, caregivers, and community members. Follow-up workgroups developed action plans to address shared concerns. Using CPPR practices and principles, we were able to incorporate World Kidney Day objectives with community-derived goals to develop a community-partnered infrastructure, shared objectives, and workgroups to reduce the burden of chronic kidney disease.