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Chen DC, Lees JS, Lu K, Scherzer R, Rutherford E, Mark PB, Kanaya AM, Shlipak MG, Estrella MM. Differential Associations of Cystatin C Versus Creatinine-Based Kidney Function With Risks of Cardiovascular Event and Mortality Among South Asian Individuals in the UK Biobank. J Am Heart Assoc 2023; 12:e027079. [PMID: 36695320 PMCID: PMC9973614 DOI: 10.1161/jaha.122.027079] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 12/09/2022] [Indexed: 01/26/2023]
Abstract
Background South Asian individuals have increased cardiovascular disease and mortality risks. Reliance on creatinine- rather than cystatin C-based estimated glomerular filtration rate (eGFRcys) may underestimate the cardiovascular disease risk associated with chronic kidney disease. Methods and Results Among 7738 South Asian UK BioBank participants without prevalent heart failure (HF) or atherosclerotic cardiovascular disease, we investigated associations of 4 eGFRcys and creatinine-based estimated glomerular filtration rate categories (<45, 45-59, 60-89, and ≥90 mL/min per 1.73 m2) with risks of all-cause mortality, incident HF, and incident atherosclerotic cardiovascular disease. The mean age was 53±8 years; 4085 (53%) were women. Compared with creatinine, cystatin C identified triple the number of participants with estimated glomerular filtration <45 (n=35 versus n=113) and 6 times the number with estimated glomerular filtration 45 to 59 (n=80 versus n=481). After multivariable adjustment, the eGFRcys 45 to 59 category was associated with higher risks of mortality (hazard ratio [HR], 2.38 [95% CI, 1.55-3.65]) and incident HF (sub-HR [sHR], 1.87 [95% CI, 1.09-3.22]) versus the eGFRcys ≥90 category; the creatinine-based estimated glomerular filtration rate 45 to 59 category had no significant associations with outcomes. Of the 7623 participants with creatinine-based estimated glomerular filtration rate ≥60, 498 (6.5%) were reclassified into eGFRcys <60 categories. Participants who were reclassified as having eGFRcys <45 had higher risks of mortality (HR, 4.88 [95% CI, 2.56-9.31]), incident HF (sHR, 4.96 [95% CI, 2.21-11.16]), and incident atherosclerotic cardiovascular disease (sHR, 2.29 [95% CI, 1.14-4.61]) versus those with eGFRcys ≥90; those reclassified as having eGFRcys 45 to 59 had double the mortality risk (HR, 2.25 [95% CI, 1.45-3.51]). Conclusions Among South Asian individuals, cystatin C identified a high-risk chronic kidney disease population that was not detected by creatinine and enhanced estimated glomerular filtration rate-based risk stratification for mortality, incident HF, and incident atherosclerotic cardiovascular disease.
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Affiliation(s)
- Debbie C. Chen
- Division of Nephrology, Department of MedicineUniversity of California, San FranciscoSan FranciscoCA
- Kidney Health Research CollaborativeSan Francisco VA Medical Center & University of California, San FranciscoSan FranciscoCA
- Genentech, Inc.South San FranciscoCA
| | - Jennifer S. Lees
- Institute of Cardiovascular and Medical SciencesUniversity of GlasgowUnited Kingdom
- Glasgow Renal and Transplant UnitQueen Elizabeth University HospitalGlasgowUnited Kingdom
| | - Kaiwei Lu
- Kidney Health Research CollaborativeSan Francisco VA Medical Center & University of California, San FranciscoSan FranciscoCA
- Department of Medicine, San Francisco VA Health Care SystemSan FranciscoCA
| | - Rebecca Scherzer
- Kidney Health Research CollaborativeSan Francisco VA Medical Center & University of California, San FranciscoSan FranciscoCA
- Department of Medicine, San Francisco VA Health Care SystemSan FranciscoCA
| | - Elaine Rutherford
- Institute of Cardiovascular and Medical SciencesUniversity of GlasgowUnited Kingdom
- Renal Unit, Mountainhall Treatment Centre, NHS Dumfries and GallowayDumfriesUnited Kingdom
| | - Patrick B. Mark
- Institute of Cardiovascular and Medical SciencesUniversity of GlasgowUnited Kingdom
- Glasgow Renal and Transplant UnitQueen Elizabeth University HospitalGlasgowUnited Kingdom
| | - Alka M. Kanaya
- Department Epidemiology and BiostatisticsUniversity of California, San FranciscoSan FranciscoCA
- Department of MedicineUniversity of California, San FranciscoSan FranciscoCA
| | - Michael G. Shlipak
- Kidney Health Research CollaborativeSan Francisco VA Medical Center & University of California, San FranciscoSan FranciscoCA
- Department of Medicine, San Francisco VA Health Care SystemSan FranciscoCA
- Department Epidemiology and BiostatisticsUniversity of California, San FranciscoSan FranciscoCA
| | - Michelle M. Estrella
- Division of Nephrology, Department of MedicineUniversity of California, San FranciscoSan FranciscoCA
- Kidney Health Research CollaborativeSan Francisco VA Medical Center & University of California, San FranciscoSan FranciscoCA
- Department of Medicine, San Francisco VA Health Care SystemSan FranciscoCA
- Division of Nephrology, Department of Medicine, San Francisco VA Health Care SystemSan FranciscoCA
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Evidence-Based Decision Making 6: Administrative Databases as Secondary Data Source for Epidemiologic and Health Service Research. Methods Mol Biol 2021. [PMID: 33871860 DOI: 10.1007/978-1-0716-1138-8_26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
Abstract
Health-care systems require reliable information on which to base health-care planning and make decisions, as well as to evaluate their policy impact. Administrative data, predominantly captured for non-research purposes, provide important information about health services use, expenditures, and clinical outcomes and may be used to assess quality of care. With increased digitalization and accessibility of administrative databases, this data is more readily available for health service research purposes, aiding evidence-based decision making. This chapter discusses the utility of administrative data for population-based studies of health and health care.
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Wu J, Duan SW, Yang HT, Deng YY, Li W, He YN, Ni ZH, Zhan YL, Lin S, Guo ZY, Zhu J, Fang JA, Liu XS, Wang LH, Wang R, Wang NS, Cheng XH, He LQ, Luo P, Sun SR, Sun JF, Yin AP, Jiang GR, Chen HY, Liu WH, Lin HL, Liang M, Ma L, Chen M, Song LQ, Chen J, Zhu Q, Xing CY, Li Y, Gao JN, Li RS, Li Y, Zhang H, Lu Y, Zhou QL, Fu JZ, He Q, Cai GY, Chen XM. Efficacy and safety of Shenyankangfu Tablet, a Chinese patent medicine, for primary glomerulonephritis: A multicenter randomized controlled trial. JOURNAL OF INTEGRATIVE MEDICINE-JIM 2021; 19:111-119. [PMID: 33589406 DOI: 10.1016/j.joim.2021.01.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 12/16/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Shenyankangfu Tablet (SYKFT) is a Chinese patent medicine that has been used widely to decrease proteinuria and the progression of chronic kidney disease. OBJECTIVE This trial compared the efficacy and safety of SYKFT, for the control of proteinuria in primary glomerulonephritis patients, against the standard drug, losartan potassium. DESIGN, SETTING, PARTICIPANTS AND INTERVENTION This was a multicenter, double-blind, randomized, controlled clinical trial. Primary glomerulonephritis patients, aged 18-70 years, with blood pressure ≤ 140/90 mmHg, estimated glomerular filtration rate (eGFR) ≥ 45 mL/min per 1.73 m2, and 24-hour proteinuria level of 0.5-3.0 g, were recruited in 41 hospitals across 19 provinces in China and were randomly divided into five groups: SYKFT, losartan potassium 50 mg or 100 mg, SYKFT plus losartan potassium 50 mg or 100 mg. MAIN OUTCOME MEASURES The primary outcome was change in the 24-hour proteinuria level, after 48 weeks of treatment. RESULTS A total of 735 participants were enrolled. The percent decline of urine protein quantification in the SYKFT group after 48 weeks was 8.78% ± 2.56% (P = 0.006) more than that in the losartan 50 mg group, which was 0.51% ± 2.54% (P = 1.000) less than that in the losartan 100 mg group. Compared with the losartan potassium 50 mg group, the SYKFT plus losartan potassium 50 mg group had a 13.39% ± 2.49% (P < 0.001) greater reduction in urine protein level. Compared with the losartan potassium 100 mg group, the SYKFT plus losartan potassium 100 mg group had a 9.77% ± 2.52% (P = 0.001) greater reduction in urine protein. With a superiority threshold of 15%, neither was statistically significant. eGFR, serum creatinine and serum albumin from the baseline did not change statistically significant. The average change in TCM syndrome score between the patients who took SYKFT (-3.00 [-6.00, -2.00]) and who did not take SYKFT (-2.00 [-5.00, 0]) was statistically significant (P = 0.003). No obvious adverse reactions were observed in any group. CONCLUSION SYKFT decreased the proteinuria and improved the TCM syndrome scores of primary glomerulonephritis patients, with no change in the rate of decrease in the eGFR. SYKFT plus losartan potassium therapy decreased proteinuria more than losartan potassium therapy alone. TRIAL REGISTRATION NUMBER NCT02063100 on ClinicalTrials.gov.
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Affiliation(s)
- Jie Wu
- Department of Nephrology, Chinese People's Liberation Army General Hospital, Chinese People's Liberation Army Institute of Nephrology, State Key Laboratory of Kidney Diseases (2011DAV00088), National Clinical Research Center for Kidney Diseases, Beijing 100853, China
| | - Shu-Wei Duan
- Department of Nephrology, Chinese People's Liberation Army General Hospital, Chinese People's Liberation Army Institute of Nephrology, State Key Laboratory of Kidney Diseases (2011DAV00088), National Clinical Research Center for Kidney Diseases, Beijing 100853, China
| | - Hong-Tao Yang
- Department of Nephrology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin 300192, China
| | - Yue-Yi Deng
- Department of Nephrology, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
| | - Wei Li
- Department of Nephrology, Shandong University of Traditional Chinese Medicine Affiliated Hospital, Jinan 250011, Shandong Province, China
| | - Ya-Ni He
- Department of Nephrology, Daping Hospital, Army Medical University, Chongqing 400042, China
| | - Zhao-Hui Ni
- Department of Nephrology, Renji Hospital, Shanghai Jiao Tong University, Shanghai 200127, China
| | - Yong-Li Zhan
- Department of Nephrology, Guang'anmen Hospital, China Academy of Traditional Chinese Medical Sciences, Beijing 100053, China
| | - Shan Lin
- Department of Nephrology, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Zhi-Yong Guo
- Department of Nephrology, Changhai Hospital of Shanghai, Naval Medical University, Shanghai 200433, China
| | - Jun Zhu
- Department of Nephrology, West China Hospital, Chengdu 610083, Sichuan Province, China
| | - Jing-Ai Fang
- Department of Nephrology, First Affiliated Hospital of Shanxi Medical University, Taiyuan 030001, Shanxi Province, China
| | - Xu-Sheng Liu
- Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou 510120, Guangdong Province, China
| | - Li-Hua Wang
- Department of Nephrology, Shanxi Medical University Second Affiliated Hospital, Taiyuan 030001, Shanxi Province, China
| | - Rong Wang
- Department of Nephrology, Shandong Provincial Hospital, Jinan 250021, Shandong Province, China
| | - Nian-Song Wang
- Department of Nephrology and Rheumatology, Affiliated Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai 200233, China
| | - Xiao-Hong Cheng
- Department of Nephrology, Shaanxi Traditional Chinese Medicine Hospital, Xi'an 710003, Shaanxi Province, China
| | - Li-Qun He
- Department of Nephrology, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200021, China
| | - Ping Luo
- Department of Nephrology, Jilin University Second Hospital, Changchun 130041, Jilin Province, China
| | - Shi-Ren Sun
- Department of Nephrology, Xijing Hospital, Air Force Military Medical University, Xi'an 710032, Shaanxi Province, China
| | - Ji-Feng Sun
- Department of Nephrology, Tangdu Hospital, Air Force Military Medical University, Xi'an 710038, Shaanxi Province, China
| | - Ai-Ping Yin
- Department of Nephrology, the First Affiliated Hospital of Xi'an Jiao Tong University, Xi'an 710061, Shaanxi Province, China
| | - Geng-Ru Jiang
- Department of Nephrology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
| | - Hong-Yu Chen
- Department of Nephrology, Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou 310007, Zhejiang Province, China
| | - Wen-Hu Liu
- Department of Nephrology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Hong-Li Lin
- Department of Nephrology, the First Affiliated Hospital of Dalian Medical University, Dalian 116011, Liaoning Province, China
| | - Meng Liang
- Department of Nephrology, the 174th Hospital of the People's Liberation Army, Xiamen 361003, Fujian Province, China
| | - Lu Ma
- Department of Nephrology, 281th Hospital of Chinese People's Liberation Army, Qinhuangdao 066100, Hebei Province, China
| | - Ming Chen
- Department of Nephrology, Teaching Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu 610075, Sichuan Province, China
| | - Li-Qun Song
- Department of Nephrology, First Affiliated Hospital, Heilongjiang University of Chinese Medicine, Harbin 150040, Heilongjiang Province, China
| | - Jian Chen
- Department of Nephrology, 900th Hospital of the Joint Logistics Team of the Chinese People's Liberation Army, Fuzhou 350001, Fujian Province, China
| | - Qing Zhu
- Department of Nephrology, Henan Provincial People's Hospital, Zhengzhou 450003, Henan Province, China
| | - Chang-Ying Xing
- Department of Nephrology, Jiangsu Province Hospital, Nanjing 210029, Jiangsu Province, China
| | - Yun Li
- Department of Nephrology, Jiangxi Provincial People's Hospital, Nanchang 330006, Jiangxi Province, China
| | - Ji-Ning Gao
- Department of Nephrology, Shanxi Hospital of Integrated Traditional and Western Medicine, Taiyuan 030001, Shanxi Province, China
| | - Rong-Shan Li
- Department of Nephrology, Shanxi Provincial People's Hospital, Taiyuan 030012, Shanxi Province, China
| | - Ying Li
- Department of Nephrology, the Third Hospital of Hebei Medical University, Shijiazhuang 050051, Hebei Province, China
| | - Hao Zhang
- Department of Nephrology, the Third Xiangya Hospital of Central South University, Changsha 410000, Hunan Province, China
| | - Ying Lu
- Department of Nephrology, Tongde Hospital of Zhejiang Province, Hangzhou 310012, Zhejiang Province, China
| | - Qiao-Ling Zhou
- Department of Nephrology, Xiangya Hospital of Central South University, Changsha 410008, Hunan Province, China
| | - Jun-Zhou Fu
- Department of Nephrology, Guangzhou First People's Hospital, Guangzhou 510180, Guangdong Province, China
| | - Qiang He
- Department of Nephrology, Zhejiang Provincial People's Hospital, Hangzhou 310014, Zhejiang Province, China
| | - Guang-Yan Cai
- Department of Nephrology, Chinese People's Liberation Army General Hospital, Chinese People's Liberation Army Institute of Nephrology, State Key Laboratory of Kidney Diseases (2011DAV00088), National Clinical Research Center for Kidney Diseases, Beijing 100853, China.
| | - Xiang-Mei Chen
- Department of Nephrology, Chinese People's Liberation Army General Hospital, Chinese People's Liberation Army Institute of Nephrology, State Key Laboratory of Kidney Diseases (2011DAV00088), National Clinical Research Center for Kidney Diseases, Beijing 100853, China.
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Hounkpatin HO, Fraser SDS, Honney R, Dreyer G, Brettle A, Roderick PJ. Ethnic minority disparities in progression and mortality of pre-dialysis chronic kidney disease: a systematic scoping review. BMC Nephrol 2020; 21:217. [PMID: 32517714 PMCID: PMC7282112 DOI: 10.1186/s12882-020-01852-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 05/12/2020] [Indexed: 01/13/2023] Open
Abstract
Background There are a growing number of studies on ethnic differences in progression and mortality for pre-dialysis chronic kidney disease (CKD), but this literature has yet to be synthesised, particularly for studies on mortality. Methods This scoping review synthesized existing literature on ethnic differences in progression and mortality for adults with pre-dialysis CKD, explored factors contributing to these differences, and identified gaps in the literature. A comprehensive search strategy using search terms for ethnicity and CKD was taken to identify potentially relevant studies. Nine databases were searched from 1992 to June 2017, with an updated search in February 2020. Results 8059 articles were identified and screened. Fifty-five studies (2 systematic review, 7 non-systematic reviews, and 46 individual studies) were included in this review. Most were US studies and compared African-American/Afro-Caribbean and Caucasian populations, and fewer studies assessed outcomes for Hispanics and Asians. Most studies reported higher risk of CKD progression in Afro-Caribbean/African-Americans, Hispanics, and Asians, lower risk of mortality for Asians, and mixed findings on risk of mortality for Afro-Caribbean/African-Americans and Hispanics, compared to Caucasians. Biological factors such as hypertension, diabetes, and cardiovascular disease contributed to increased risk of progression for ethnic minorities but did not increase risk of mortality in these groups. Conclusions Higher rates of renal replacement therapy among ethnic minorities may be partly due to increased risk of progression and reduced mortality in these groups. The review identifies gaps in the literature and highlights a need for a more structured approach by researchers that would allow higher confidence in single studies and better harmonization of data across studies to advance our understanding of CKD progression and mortality.
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Affiliation(s)
- Hilda O Hounkpatin
- School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, South Academic Block, University of Southampton, Southampton General Hospital, Tremona Road, Room AC18 Level C, Southampton, SO16 6YD, UK.
| | - Simon D S Fraser
- School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, South Academic Block, University of Southampton, Southampton General Hospital, Tremona Road, Room AC18 Level C, Southampton, SO16 6YD, UK
| | - Rory Honney
- School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, South Academic Block, University of Southampton, Southampton General Hospital, Tremona Road, Room AC18 Level C, Southampton, SO16 6YD, UK
| | - Gavin Dreyer
- Department of Nephrology, Barts Health NHS Trust, London, UK
| | - Alison Brettle
- School of Nursing, Midwifery, Social Work and Social Sciences, University of Salford, Rm 1.47, Mary Seacole Building, Frederick Road, Salford, M6 6PU, UK
| | - Paul J Roderick
- School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, South Academic Block, University of Southampton, Southampton General Hospital, Tremona Road, Room AC18 Level C, Southampton, SO16 6YD, UK
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Eastwood SV, Chaturvedi N, Sattar N, Welsh PI, Hughes AD, Tillin T. Impact of Kidney Function on Cardiovascular Risk and Mortality: A Comparison of South Asian and European Cohorts. Am J Nephrol 2019; 50:425-433. [PMID: 31665726 DOI: 10.1159/000503873] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 09/30/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND Evidence is limited on ethnic differences in associations between kidney function markers and mortality or cardiovascular disease (CVD). METHODS Baseline cross-sectional analysis and longitudinal follow-up study of a UK population-based cohort of 1,116 Europeans and 1,104 South Asians of predominantly Indian descent, age 52 ± 7 years at baseline (1988-1991). Kidney function was estimated using Cystatin C and creatinine-based chronic kidney disease (CKD) Epidemiology Collaboration estimated glomerular filtration rate (eGFR) equations, and urinary albumin-creatinine ratio (ACR). Mortality was captured at 27 years, and incident CVD at 22 years, from death certification, medical records and participant report. Longitudinal associations between eGFR/ACR and mortality/incident CVD were examined using Cox models. RESULTS eGFRcys was lower and ACR higher in South Asians than Europeans. eGFRcys and -eGFRcreat were more strongly associated with outcomes in Europeans than South Asians. Conversely, associations between ACR and outcomes were greater in South Asians than Europeans, for example, for CVD mortality: HRs (95% CI) adjusted for CVD risk factors and ACR/eGFRcys as appropriate, p for ethnicity interaction: eGFRcys: Europeans: 0.76 (0.62-0.92), South Asians: 0.92 (0.78-1.07), p = 0.05, eGFRcreat: Europeans 0.81 (0.67-0.99), South Asians 1.18 (0.97-1.41), p = 0.002, ACR: -Europeans: 1.24 (1.08-1.42), South Asians: 1.39 (1.25-1.57), p= 0.23. Addition of all CKD measures to a standard CVD risk factor model modestly improved prediction capability in -Europeans; in South Asians only ACR contributed to improvement. CONCLUSIONS Strong associations between ACR and outcomes in South Asians of predominantly Indian origin, and null associations for eGFRcys and eGFRcreat, suggest that ACR may have greater utility in CVD risk prediction in South Asians. Further work is needed to validate these -findings.
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Affiliation(s)
- Sophie V Eastwood
- Institute of Cardiovascular Science, University College London, London, United Kingdom,
| | - Nishi Chaturvedi
- Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Paul I Welsh
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Alun D Hughes
- Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Therese Tillin
- Institute of Cardiovascular Science, University College London, London, United Kingdom
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Waheed A, Djurdjev O, Dong J, Gill J, Barbour S. Validation of Self-Reported Race in a Canadian Provincial Renal Administrative Database. Can J Kidney Health Dis 2019; 6:2054358119859528. [PMID: 31308951 PMCID: PMC6604118 DOI: 10.1177/2054358119859528] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Accepted: 05/20/2019] [Indexed: 11/18/2022] Open
Abstract
Background: Administrative data are commonly used to study clinical outcomes in renal
disease. Race is an important determinant of renal health delivery and
outcomes in Canada but is not validated in most administrative data, and the
correlation with census-based definitions of race is unknown. Objectives: Validation of self-reported race (SRR) in a Canadian provincial renal
administrative database (Patient Records and Outcome Management Information
System [PROMIS]) and comparison with the Canadian census categories of
race. Design: Prospective patient survey study to validate SRR in PROMIS. Setting: British Columbia, Canada. Patients: Adult patients registered in PROMIS. Measurements: Survey SRR was used as gold standard to validate SRR in PROMIS. Self-reported
race in PROMIS was compared with census race categories. Methods: This is a cross-sectional telephone survey of a random sample of all adults
in PROMIS conducted between February 2016 and November 2016. Responders
selected a race category from PROMIS and from the Canadian census.
Sensitivity (Sn) and specificity (Sp) were calculated with 95% confidence
intervals (CIs). Results: A total of 21 039 patients met inclusion criteria, 1677 were selected for the
survey and 637 participated (38% response rate). There were no differences
between the PROMIS, sampled, and responder populations. PROMIS SRR had an
accuracy of 95.3% (95% CI: 94.2%-97.0%) when validated against the survey
SRR with Sn and Sp ≥90% in all race groups except in Aboriginals (Sn 87.5%).
The positive and negative predictive values were ≥95%, except in very low
and high–prevalence groups, respectively. The Canadian census had an
accuracy of 95.7% (95% CI: 94.4%-97.6%) when validated against PROMIS SRR
with Sn and Sp ≥90%. The results did not differ in subgroups based on age,
sex, birth outside Canada, or renal group (glomerulonephritis, chronic
kidney disease, hemodialysis, peritoneal dialysis, transplant recipients, or
live donors). Limitations: Analysis of minority groups and lower prevalence groups is limited by sample
size. Results may not be generalizable to other administrative
databases. Conclusions: We have shown high accuracy of PROMIS SRR that validates its use in the
secondary analysis of administrative data for research. There is high
correlation between PROMIS and census race categories which allows linkage
with other data sources that use census-based definitions of race.
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Affiliation(s)
- Aiza Waheed
- The University of British Columbia, Vancouver, Canada
| | | | | | - Jagbir Gill
- The University of British Columbia, Vancouver, Canada.,BC Provincial Renal Agency, Vancouver, Canada
| | - Sean Barbour
- The University of British Columbia, Vancouver, Canada.,BC Provincial Renal Agency, Vancouver, Canada
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Wu J, Jia J, Li Z, Pan H, Wang A, Guo X, Wu S, Zhao X. Association of estimated glomerular filtration rate and proteinuria with all-cause mortality in community-based population in China: A Result from Kailuan Study. Sci Rep 2018; 8:2157. [PMID: 29391563 PMCID: PMC5794900 DOI: 10.1038/s41598-018-20554-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 01/18/2018] [Indexed: 01/05/2023] Open
Abstract
This study was based on 95391 participants (18-98 years old) from the Kailuan study, which assessed all-cause mortality in a community-based population in northern China according to estimated glomerular filtration rate (eGFR) by the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula and proteinuria estimated from urine dipstick results. Data were analysed based on Cox proportional hazards models with adjustment for relevant confounders, and the results were expressed as hazard ratios (HRs) with 95% confidence intervals (CIs). During eight years of follow-up, a total of 6024 participants died. The two indicators, eGFR < 45 ml/min/1.73 m2 and the presence of proteinuria, were independently associated with all-cause mortality. Compared with eGFR ≥45 ml/min/1.73 m2 with negative proteinuria, HRs of all-cause mortality were 1.26 (95% CI 1.10-1.44) for eGFR < 45 ml/min/1.73 m2 without proteinuria, 1.95 (1.78-2.14) for eGFR ≥45 ml/min/1.73 m2 with proteinuria, and 2.63 (2.14-3.23) for eGFR < 45 ml/min/1.73 m2 with proteinuria. The all-cause mortality risk of eGFR and/or proteinuria was much higher in females than in males (P for interaction < 0.01). In conclusion, both severely decreased eGFR and proteinuria are independent predictors of all-cause mortality in the general northern Chinese population. A combination of severely decreased eGFR and proteinuria increases the risk of all-cause mortality, which is even over 5-fold higher in females.
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Affiliation(s)
- Jianwei Wu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Jiaokun Jia
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Zhaoxia Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Hua Pan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Anxin Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Xiuhua Guo
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China. .,Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China.
| | - Shouling Wu
- Department of Cardiology, Kailuan Hospital, Hebei United University, Tangshan, China.
| | - Xingquan Zhao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China. .,China National Clinical Research Center for Neurological Diseases, Beijing, China. .,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China. .,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China.
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Khan YH, Sarriff A, Adnan AS, Khan AH, Mallhi TH, Jummaat F. Progression and outcomes of non-dialysis dependent chronic kidney disease patients: A single center longitudinal follow-up study. Nephrology (Carlton) 2017; 22:25-34. [PMID: 26718476 DOI: 10.1111/nep.12713] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 12/21/2015] [Accepted: 12/26/2015] [Indexed: 01/02/2023]
Abstract
AIM Despite increase global prevalence of End stage renal disease (ESRD) and subsequent need for renal replacement therapy (RRT), relatively little is known about disease progression and prognosis of earlier stages of CKD. Current study was conducted to examine rate of CKD progression, predictors of ESRD and death. METHODS A total 621 patients with estimated glomerular filtration rate (eGFR) of 15-59ml/min/1.73m2 (CKD stage 3 & 4) were selected and followed up for 10 years or until ESRD or death, whichever occurred first. Subjects who did not meet inclusion criteria were excluded (n=1474). RESULTS Annual cumulative decline in eGFR was 3.01±0.40 ml/min/1.73m2 . Overall disease progression was observed in 60% patients while 18% died. Among patients with CKD stage 3, 21% progressed to stage 4, 10% to stage 5ND (non-dialysis) and 31% to RRT while mortality was observed in 16% patients. On the other hand, 8% patients with CKD stage 4 progressed to stage 5ND, 31% to RRT and mortality was observed in 24% cases. Patients with CVD, higher systolic blood pressure, elevated phosphate levels, heavy proteinuria, microscopic hematuria and use of diuretics were more likely to develop ESRD. Advancing age, low eGFR, low systolic blood pressure, low hemoglobin and baseline diabetes were found to be significant predictors of mortality while being female reduced risk of mortality. CONCLUSION Our data suggest that, in this CKD cohort, patients were more likely to develop ESRD than death. Prime importance should be given to mild forms of CKD to retard and even reverse CKD progression.
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Affiliation(s)
- Yusra Habib Khan
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, University Sains Malaysia, Penang, 11800, Malaysia.,Chronic Kidney Disease Resource Centre, School of Medical Sciences, Health Campus, University Sains Malaysia, Kubang Kerain, 16150, Kelantan, Malaysia
| | - Azmi Sarriff
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, University Sains Malaysia, Penang, 11800, Malaysia
| | - Azreen Syazril Adnan
- Chronic Kidney Disease Resource Centre, School of Medical Sciences, Health Campus, University Sains Malaysia, Kubang Kerain, 16150, Kelantan, Malaysia
| | - Amer Hayat Khan
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, University Sains Malaysia, Penang, 11800, Malaysia
| | - Tauqeer Hussain Mallhi
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, University Sains Malaysia, Penang, 11800, Malaysia.,Chronic Kidney Disease Resource Centre, School of Medical Sciences, Health Campus, University Sains Malaysia, Kubang Kerain, 16150, Kelantan, Malaysia
| | - Fauziah Jummaat
- Department of Obstetrics and Gynecology, School of Medical Sciences, Health Campus University Sains Malaysia, Kubang Kerain, 16150, Kelantan, Malaysia
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Lin X, Zeng XZ, Ai J. The Glomerular Filtration Rate (GFR) at Dialysis Initiation and Mortality in Chronic Kidney Disease (CKD) in East Asian Populations: A Meta-analysis. Intern Med 2016; 55:3097-3104. [PMID: 27803401 PMCID: PMC5140856 DOI: 10.2169/internalmedicine.55.6520] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Accepted: 02/24/2016] [Indexed: 11/06/2022] Open
Abstract
Objective The impact of dialysis initiation on survival is still somewhat controversial. Given that race or ethnicity has been observed to be a predictor of mortality and the rate of progression of chronic kidney disease, we conducted a meta-analysis to investigate the effect of early vs. late dialysis initiation on mortality in East Asian populations. Methods All eligible cohort studies of target were selected from the MEDLINE (PubMed), EMBASE, The Cochrane Library and the Clinical Trials Registry databases from inception to October 2014. The data were extracted with all-cause mortality rates as the primary outcome, and pooled adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated. Results Ten studies examined the association between early vs. late dialysis initiation and mortality. Compared to late dialysis initiation, patients who received early dialysis initiation had a higher overall mortality risk (adjusted HR, 1.36; 95% CI, 1.0-1.85; p<0.05) in East Asian populations. In a subgroup analysis, baseline characteristic differences (adjusted HR, 2.0; 95%CI, 1.56-2.57; p<0.001), initial dialysis modalities (adjusted HR, 2.12; 95% CI, 1.72-2.62; p<0.001) and follow up duration (adjusted HR, 1.59; 95% CI, 1.19-2.12; p=0.002), demonstrated that the association between early dialysis initiation and mortality were significant. Conclusion A higher glomerular filtration rate (early) at the initiation of dialysis is associated with a higher all-cause mortality risk in East Asian populations.
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Affiliation(s)
- Xin Lin
- Department of Nephrology, People's Hospital of Guizhou Province, China
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10
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Misra S, Khosla A, Allred J, Harmsen WS, Textor SC, McKusick MA. Mortality and Renal Replacement Therapy after Renal Artery Stent Placement for Atherosclerotic Renovascular Disease. J Vasc Interv Radiol 2016; 27:1215-24. [PMID: 27296703 DOI: 10.1016/j.jvir.2016.05.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 04/29/2016] [Accepted: 05/01/2016] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To identify risk factors for progression to renal replacement therapy (RRT) and all-cause mortality in patients who underwent renal artery (RA) stent placement for atherosclerotic renal artery stenosis (RAS). MATERIALS AND METHODS A retrospective study from June 1996 to June 2009 identified 1,052 patients who underwent RA stent placement. Glomerular filtration rate at time of RA stent placement was estimated from serum creatinine level and divided into chronic kidney disease (CKD) stages 1-5. Univariate and multivariable Cox proportional hazards models were used to determine which factors were associated with each endpoint. RESULTS Times to progression to all-cause mortality and RRT were similar for CKD stages 1/2/3A and served as the reference group. In multivariable analysis, high-grade proteinuria (P < .001) and higher CKD stage (5 vs 1/2/3A [P < .001], 4 vs 1/2/3A [P < .001], 3B vs 1/2/3A [P = .02]) remained independently associated with increased risk of progression to RRT. Angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (ACEI/ARB) use was associated with decreased risk of progression to RRT (P = .03). Higher CKD stage (5 vs 1/2/3A [P < .001], 4 vs 1/2/3A [P = .004]), carotid artery disease (P < .001), diabetes mellitus (P = .002), and high-grade proteinuria (P < .001) remained independently associated with all-cause mortality. Statin use was associated with decreased risk of all-cause mortality (P < .001). CONCLUSIONS Patients with atherosclerotic RAS who undergo RA stent placement and have high-grade proteinuria and CKD stage 3B/4/5 have increased risk of progression to RRT. Patients with high-grade proteinuria, CKD stage 3B/4/5, carotid artery disease, or diabetes have increased risk for all-cause mortality after renal artery stent placement. Patients receiving ACEI/ARBs have a decreased risk of progression to RRT, and patients receiving statins have a decreased risk of all-cause mortality.
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Affiliation(s)
- Sanjay Misra
- Vascular and Interventional Radiology Translational Laboratory, Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905.
| | - Ankaj Khosla
- Vascular and Interventional Radiology Translational Laboratory, Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - Jake Allred
- Vascular and Interventional Radiology Translational Laboratory, Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - William S Harmsen
- Vascular and Interventional Radiology Translational Laboratory, Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - Stephen C Textor
- Division of Nephrology and Hypertension, Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - Michael A McKusick
- Division of Vascular and Interventional Radiology, Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
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11
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Ethnic Differences in Prevalence of Peripheral Artery Disease in Patients Undergoing Hemodialysis. J Racial Ethn Health Disparities 2016; 2:275-9. [PMID: 26863457 DOI: 10.1007/s40615-014-0066-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Revised: 10/14/2014] [Accepted: 10/24/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Hemodialysis patients experience poor outcomes associated with the presence of atherosclerosis, particularly lower-extremity peripheral artery disease (PAD). Prevalence of PAD is known to vary between ethnic groups; however, no information on ethnic-specific PAD prevalence in a hemodialysis cohort is available. METHODS Data from the Canadian Kidney Dialysis Cohort Study was used in a secondary analysis of 1293 adults starting hemodialysis in three major Canadian centres. PAD diagnosis was determined through structured interview and supplemented by clinical record. Ethnicity was self-reported. RESULTS Overall PAD prevalence was 19.1 % with no significant difference between ethnic groups. Ethnic differences observed in diabetes prevalence in the full hemodialysis group were not present in the subset of PAD patients. CONCLUSIONS The prevalence of PAD in patients undergoing hemodialysis is high, however we found no apparent ethnic differences in prevalence between ethnic groups.
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Morton RL, Schlackow I, Mihaylova B, Staplin ND, Gray A, Cass A. The impact of social disadvantage in moderate-to-severe chronic kidney disease: an equity-focused systematic review*. Nephrol Dial Transplant 2015; 31:46-56. [DOI: 10.1093/ndt/gfu394] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 11/28/2014] [Indexed: 11/12/2022] Open
Abstract
Abstract
It is unclear whether a social gradient in health outcomes exists for people with moderate-to-severe chronic kidney disease (CKD). We critically review the literature for evidence of social gradients in health and investigate the ‘suitability’ of statistical analyses in the primary studies. In this equity-focused systematic review among adults with moderate-to-severe CKD, factors of disadvantage included gender, race/ethnicity, religion, education, socio-economic status or social capital, occupation and place of residence. Outcomes included access to healthcare, kidney disease progression, cardiovascular events, all-cause mortality and suitability of analyses. Twenty-four studies in the pre-dialysis population and 34 in the dialysis population representing 8.9 million people from 10 countries were included. In methodologically suitable studies among pre-dialysis patients, a significant social gradient was observed in access to healthcare for those with no health insurance and no home ownership. Low income and no home ownership were associated with higher cardiovascular event rates and higher mortality [HR 1.94, 95% confidence interval (CI) 1.27–2.98; HR 1.28, 95% CI 1.04–1.58], respectively. In methodologically suitable studies among dialysis patients, females, ethnic minorities, those with low education, no health insurance, low occupational level or no home ownership were significantly less likely to access cardiovascular healthcare than their more advantaged dialysis counterparts. Low education level and geographic remoteness were associated with higher cardiovascular event rates and higher mortality (HR 1.54, 95% CI 1.01–2.35; HR 1.21, 95% CI 1.08–1.37), respectively. Socially disadvantaged pre-dialysis and dialysis patients experience poorer access to specialist cardiovascular health services, and higher rates of cardiovascular events and mortality than their more advantaged counterparts.
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Affiliation(s)
- Rachael Lisa Morton
- School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Iryna Schlackow
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Borislava Mihaylova
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Natalie Dawn Staplin
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Alastair Gray
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Alan Cass
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
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13
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Vejakama P, Ingsathit A, Attia J, Thakkinstian A. Epidemiological study of chronic kidney disease progression: a large-scale population-based cohort study. Medicine (Baltimore) 2015; 94:e475. [PMID: 25634196 PMCID: PMC4602951 DOI: 10.1097/md.0000000000000475] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
The prognostic information about CKD progression, particularly for GFR categories 1 and 2, is still limited. This cohort was therefore conducted to determine the CKD progression using a competing risk approach. We conducted a retrospective cohort study linking community health screening with hospitals and death registry data in a province of Thailand, from 1997 to 2011. A competing risk model was applied by treating death as a competing risk factor to estimate 2-, 5-, and 10-year probability of kidney failure and median time for CKD progression from lower to higher GFR category. There were 17,074 non-diabetic and 15,032 diabetic CKD subjects. Diabetic subjects progressed more rapidly through GFR categories with the median times for CKD progression from GFR categories G1 to G2, G2 to G3a, G3a to G3b, G3b to G4, and G4 to G5 of 4.4, 6.1, 4.9, 6.3, and 9.0 years, respectively. Non-diabetic subjects took longer to progress with the corresponding median time of 9.4, 14.0, 11.0, 13.8, and >14.3 years. After adjusting for confounders, diabetic subjects were 49% (cause-specific hazard ratio ((c)HR) = 1.49, 95% CI: 1.37, 1.62) more likely to develop kidney failure than non-diabetic subjects. Albuminuria categories A3 and A2 were, respectively, 3.40 (95% CI: 3.07, 3.76) and 1.71 (95% CI: 1.53, 1.92) higher risk of kidney failure when compared to A1. For each albumin category, death rate increased as albuminuria increased particularly in diabetic subjects, which was approximately 2 times higher in A3 compared to A1. Considering GFR category, it gradually increased from G1 to G4 and sharply increased from G4 to G5 in both non-diabetic and diabetic subjects. This study has quantified CKD progression in an Asian population within ordinary practice. Diabetic subjects progress through GFR and albuminuria categories and reach kidney failure about twice as rapidly as non-diabetic subjects.
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Affiliation(s)
- Phisitt Vejakama
- From the Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok (PV, AI, AT); Department of Medicine, Bundarik Hospital, Bundarik District, Ubon Ratchathani Province, Thailand (PV); and Centre for Clinical Epidemiology and Biostatistics, School of Medicine and Public Health, University of Newcastle, and Hunter Medical Research Institute, Newcastle, NSW, Australia (JA)
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Chowdhury TT, Hemmelgarn B. Evidence-based decision-making 6: Utilization of administrative databases for health services research. Methods Mol Biol 2015; 1281:469-84. [PMID: 25694328 DOI: 10.1007/978-1-4939-2428-8_28] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Health-care systems require reliable information on which to base health-care planning and make decisions, as well as to evaluate their policy impact. Administrative data provide important information about health services use, expenditures, clinical outcomes, and may be used to assess quality of care. With increased digitalization and accessibility of administrative databases, these data are more readily available for health service research purposes, aiding evidence-based decision-making. This chapter discusses the utility of administrative data for population-based studies of health and health care.
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15
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Kou J, Wu J, Yang HT, He YN, Fang JA, Deng YY, Xie YS, Nie LF, Lin HL, Cai GY, Chen XM. Efficacy and safety of Shenyankangfu tablets for primary glomerulonephritis: study protocol for a randomized controlled trial. Trials 2014; 15:479. [PMID: 25480673 PMCID: PMC4289030 DOI: 10.1186/1745-6215-15-479] [Citation(s) in RCA: 5] [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: 06/16/2014] [Accepted: 11/17/2014] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Chronic kidney disease is a common disease. Most chronic kidney diseases evolve from primary glomerulonephritis. Proteinuria is an independent risk factor for the progression of chronic kidney disease. The general consensus is that therapy administered to decrease proteinuria should include steroids and/or immunosuppressants, angiotensin-converting enzyme inhibitors, and angiotensin II receptor blockers. However, the side effects of, and adverse reactions to, these agents reduce the benefits to patients. In addition, the cost of these drugs is relatively high. Therefore, identification of inexpensive and effective drugs to decrease proteinuria is urgently needed. Shenyankangfu tablets have been a widely applied Chinese patent medicine for many years to decrease proteinuria. However, there is a lack of research-derived data regarding the clinical use. Therefore, we designed the present randomized controlled clinical trial to compare the efficacy and safety of Shenyankangfu tablets versus losartan potassium for control of proteinuria in patients with primary glomerulonephritis. METHODS/DESIGN This study will be a multicenter, prospective, double-blind, double-dummy, randomized controlled clinical trial. We will enroll 720 patients diagnosed with primary glomerulonephritis. The eligible patients will be randomly divided into the following groups at a 1:1:1:1:1 ratio: Shenyankangfu tablets group, losartan potassium 50 mg group, losartan potassium 100 mg group, Shenyankangfu tablets + losartan potassium 50 mg group, and Shenyankangfu tablets + losartan potassium 100 mg group. All groups will be followed up for 48 weeks; follow-up visits will be performed, at weeks 0, 4, 8, 12, 24, 36, and 48. The primary efficacy outcome will be the post-treatment change in the 24-hour proteinuria level, and the secondary efficacy outcomes will be the post-treatment changes in the serum creatinine level, estimated glomerular filtration rate, traditional Chinese medicine syndrome score, and serum albumin level. DISCUSSION The results of this trial will provide solid data for use in evidence-based medicine with respect to the efficacy and safety of Shenyankangfu tablets for control of proteinuria in patients with primary glomerulonephritis compared to those of losartan potassium. Moreover, we infer that therapy comprising Shenyankangfu tablets + losartan potassium can decrease proteinuria to a larger extent than Shenyankangfu tablets or losartan potassium can alone. TRIAL REGISTRATION This trial was registered on 12 February 2014 at ClinicalTrials.gov (ID number NCT02063100).
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Affiliation(s)
- Jia Kou
- />Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center of Kidney Diseases, 28 Fuxing Road, Haidian District, Beijing, 100853 China
| | - Jie Wu
- />Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center of Kidney Diseases, 28 Fuxing Road, Haidian District, Beijing, 100853 China
| | - Hong-tao Yang
- />Department of Nephrology, The First Affiliated Hospital of Tianjin University of TCM, 314 West Anshan Road, Nankai District, Tianjin, 300193 China
| | - Ya-ni He
- />Department of Nephrology, Daping Hospital, The Third Military Medical University, 10 Changjiangzhilu Daping, Yuzhong District, Chongqing, 400042 China
| | - Jing-ai Fang
- />Department of Nephrology, First Hospital of Shanxi Medical University, 85 liberation Road, Taiyuan, Shanxi Province 030001 China
| | - Yue-yi Deng
- />Department of Nephrology, Longhua Hospital of Shanghai University of TCM, 725 South Wanping Road, Shanghai, 200032 China
| | - Yuan-sheng Xie
- />Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center of Kidney Diseases, 28 Fuxing Road, Haidian District, Beijing, 100853 China
| | - Li-fang Nie
- />Department of Nephrology, Xiyuan Hospital CACMS, 1 Xiyuan Playground, Haidian District, Beijing, 100091 China
| | - Hong-li Lin
- />Department of Nephrology, The First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Road, Zhongshan District, Dalian, Liaoning Province 116011 China
| | - Guang-yan Cai
- />Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center of Kidney Diseases, 28 Fuxing Road, Haidian District, Beijing, 100853 China
| | - Xiang-mei Chen
- />Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center of Kidney Diseases, 28 Fuxing Road, Haidian District, Beijing, 100853 China
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Wen CP, Matsushita K, Coresh J, Iseki K, Islam M, Katz R, McClellan W, Peralta CA, Wang H, de Zeeuw D, Astor BC, Gansevoort RT, Levey AS, Levin A. Relative risks of chronic kidney disease for mortality and end-stage renal disease across races are similar. Kidney Int 2014; 86:819-27. [PMID: 24522492 PMCID: PMC4048178 DOI: 10.1038/ki.2013.553] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Revised: 10/23/2013] [Accepted: 11/21/2013] [Indexed: 02/08/2023]
Abstract
Some suggest race-specific cutpoints for kidney measures to define and stage chronic kidney disease (CKD), but evidence for race-specific clinical impact is limited. To address this issue, we compared hazard ratios of estimated glomerular filtration rates (eGFR) and albuminuria across races using meta-regression in 1.1 million adults (75% Asians, 21% Whites, and 4% Blacks) from 45 cohorts. Results came mainly from 25 general population cohorts comprising 0.9 million individuals. The associations of lower eGFR and higher albuminuria with mortality and end-stage renal disease (ESRD) were largely similar across races. For example, in Asians, Whites, and Blacks, the adjusted hazard ratios (95% confidence interval) for eGFR 45-59 versus 90-104 ml/min per 1.73 m(2) were 1.3 (1.2-1.3), 1.1 (1.0-1.2), and 1.3 (1.1-1.7) for all-cause mortality, 1.6 (1.5-1.7), 1.4 (1.2-1.7), and 1.4 (0.7-2.9) for cardiovascular mortality, and 27.6 (11.1-68.7), 11.2 (6.0-20.9), and 4.1 (2.2-7.5) for ESRD, respectively. The corresponding hazard ratios for urine albumin-to-creatinine ratio 30-299 mg/g or dipstick 1+ versus an albumin-to-creatinine ratio under 10 or dipstick negative were 1.6 (1.4-1.8), 1.7 (1.5-1.9), and 1.8 (1.7-2.1) for all-cause mortality, 1.7 (1.4-2.0), 1.8 (1.5-2.1), and 2.8 (2.2-3.6) for cardiovascular mortality, and 7.4 (2.0-27.6), 4.0 (2.8-5.9), and 5.6 (3.4-9.2) for ESRD, respectively. Thus, the relative mortality or ESRD risks of lower eGFR and higher albuminuria were largely similar among three major races, supporting similar clinical approach to CKD definition and staging, across races.
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Affiliation(s)
- Chi-Pang Wen
- Institute of Population Science, National Health Research Institutes, Zhunan, Taiwan
- China Medical University Hospital, Taichung, Taiwan
| | - Kunihiro Matsushita
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Josef Coresh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kunitoshi Iseki
- Dialysis Unit, University Hospital of The Ryukyus, Nishihara, Okinawa, Japan
| | - Muhammad Islam
- Department of Community Health Sciences, The Aga Khan University, Karachi, Pakistan
| | - Ronit Katz
- Department of Biostatistics, University of Washington, Seattle, Washington, USA
| | - William McClellan
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Carmen A Peralta
- Division of Nephrology, University of California, San Francisco, California, USA
| | - HaiYan Wang
- Renal Division, Department of Medicine, Peking University First Hospital, Institute of Nephrology, Peking University, Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China
| | - Dick de Zeeuw
- Department of Clinical Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Brad C Astor
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
- Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Ron T Gansevoort
- Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Andrew S Levey
- Division of Nephrology, Tufts Medical Center, Boston, Massachusetts, USA
| | - Adeera Levin
- Division of Nephrology UBC, St. Pauls Hospital, Vancouver, British Columbia, Canada
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17
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Lee J, An JN, Hwang JH, Kim YL, Kang SW, Yang CW, Kim NH, Oh YK, Lim CS, Kim YS, Lee JP. Effect of dialysis initiation timing on clinical outcomes: a propensity-matched analysis of a prospective cohort study in Korea. PLoS One 2014; 9:e105532. [PMID: 25137235 PMCID: PMC4138196 DOI: 10.1371/journal.pone.0105532] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2014] [Accepted: 07/23/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Controversy persists regarding the appropriate initiation timing of renal replacement therapy for patients with end-stage renal disease. We evaluated the effect of dialysis initiation timing on clinical outcomes. Initiation times were classified according to glomerular filtration rate (GFR). METHODS We enrolled a total of 1691 adult patients who started dialysis between August 2008 and March 2013 in a multi-center, prospective cohort study at the Clinical Research Center for End Stage Renal Disease in the Republic of Korea. The patients were classified into the early-start group or the late-start group according to the mean estimated GFR value, which was 7.37 ml/min/1.73 m2. The primary outcome was patient survival, and the secondary outcomes were hospitalization, cardiovascular events, vascular access complications, change of dialysis modality, and peritonitis. The two groups were compared before and after matching with propensity scores. RESULTS Before propensity score matching, the early-start group had a poor survival rate (P<0.001). Hospitalization, cardiovascular events, vascular access complications, changes in dialysis modality, and peritonitis were not different between the groups. A total of 854 patients (427 in each group) were selected by propensity score matching. After matching, neither patient survival nor any of the other outcomes differed between groups. CONCLUSIONS There was no clinical benefit after adjustment by propensity scores comparing early versus late initiation of dialysis.
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Affiliation(s)
- Jeonghwan Lee
- Department of Internal Medicine, Hallym University Hangang Sacred Heart Hospital, Seoul, Korea
- Clinical Research Center for End Stage Renal Disease (CRC for ESRD), Daegu, Korea
| | - Jung Nam An
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Jin Ho Hwang
- Department of Internal Medicine, Chung-Ang University Medical Center, Seoul, Korea
| | - Yong-Lim Kim
- Clinical Research Center for End Stage Renal Disease (CRC for ESRD), Daegu, Korea
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - Shin-Wook Kang
- Clinical Research Center for End Stage Renal Disease (CRC for ESRD), Daegu, Korea
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Chul Woo Yang
- Clinical Research Center for End Stage Renal Disease (CRC for ESRD), Daegu, Korea
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Nam-Ho Kim
- Clinical Research Center for End Stage Renal Disease (CRC for ESRD), Daegu, Korea
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Yun Kyu Oh
- Clinical Research Center for End Stage Renal Disease (CRC for ESRD), Daegu, Korea
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Chun Soo Lim
- Clinical Research Center for End Stage Renal Disease (CRC for ESRD), Daegu, Korea
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Yon Su Kim
- Clinical Research Center for End Stage Renal Disease (CRC for ESRD), Daegu, Korea
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jung Pyo Lee
- Clinical Research Center for End Stage Renal Disease (CRC for ESRD), Daegu, Korea
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
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Phillips LA, Phillips BM, Meran S, Russell J, Zouwail S, Riley SG, Phillips AO. The long-term impact of eGFR reporting on referral patterns. Eur J Intern Med 2014; 25:97-101. [PMID: 23993052 DOI: 10.1016/j.ejim.2013.08.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Revised: 07/29/2013] [Accepted: 08/02/2013] [Indexed: 11/17/2022]
Abstract
BACKGROUND The prognostic significance of CKD has driven the widespread introduction of automated estimated glomerular filtration rate (eGFR) reporting, and the incorporation of CKD in the revised Quality Outcomes Framework (QOF) of the General Medical Services (GMS) contract in the U.K. AIMS To assess the long-term impact of the introduction of these two initiatives, on patient referral numbers to a nephrology service. METHODS Data was collected on the numbers and basic characteristics of all new patients referred from April 2005 to March 2011, to one NHS Health Board. RESULTS Introduction of eGFR reporting and CKD QOF domains was associated with a significant increase in the number of referrals, which was sustained. The initiatives also led to a sustained increase in the mean age of the patients at referral, predominantly due to an increase in the age of female patients referred. There was also an increase in the proportion of female patients referred. In the immediate aftermath of the introduction of change there was a transient decrease in the average eGFR at referral, a decrease in age of patients referred with an eGFR <15ml/min and an increase in the eGFR of patients >70yrs of age. CONCLUSIONS The data demonstrates significant and sustained increase in numbers of referrals. In the short term this was associated with a reduction in referral of elderly patients with stage 5 CKD and an increase in elderly patients with mild renal impairment. In the longer term we saw an increase in referral of an older female population.
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Affiliation(s)
- L A Phillips
- Institute of Nephrology, Cardiff University School of Medicine, Cardiff, UK
| | - B M Phillips
- Institute of Nephrology, Cardiff University School of Medicine, Cardiff, UK
| | - S Meran
- Institute of Nephrology, Cardiff University School of Medicine, Cardiff, UK
| | - J Russell
- Institute of Nephrology, Cardiff University School of Medicine, Cardiff, UK
| | - S Zouwail
- Department of Biochemistry and Immunology, Cardiff and Vale University Health Board, University Hospital of Wales, Cardiff, UK; Department of Medical Biochemistry, School of Medicine, Alexandria University, Egypt
| | - S G Riley
- Institute of Nephrology, Cardiff University School of Medicine, Cardiff, UK
| | - A O Phillips
- Institute of Nephrology, Cardiff University School of Medicine, Cardiff, UK.
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Incremental prognostic information from kidney function in patients with new onset coronary heart disease. Am Heart J 2014; 167:86-92. [PMID: 24332146 DOI: 10.1016/j.ahj.2013.10.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Accepted: 10/12/2013] [Indexed: 11/20/2022]
Abstract
BACKGROUND Prognostic factors are usually evaluated by their statistical significance rather than by their clinical utility. Risk reclassification measures the extent to which a novel marker adds useful information to a prognostic model. The extent to which estimated glomerular filtration rate (eGFR) adds information about prognosis among patients with coronary heart disease is uncertain. METHODS We studied patients in an integrated health care delivery system with newly diagnosed coronary heart disease. We developed a model of the risk of death over 2 years of follow-up and then added eGFR to the model and measured changes in C-index, net reclassification improvement, and integrated discrimination improvement. RESULTS Almost half of the 31,533 study patients had reduced eGFR (<60 mL/min per 1.73 m(2)). Mortality was significantly higher among patients who had lower levels of eGFR, even after adjustment for baseline characteristics (P < .0001). The addition of eGFR to the prognostic model increased the C-index from 0.837 to 0.843, the net reclassification improvement by 3.2% (P < .0001), and integrated discrimination improvement by 1.3% (P = .007). CONCLUSION Estimated glomerular filtration rate is an informative prognostic factor among patients with incident coronary heart disease, independent of other clinical characteristics.
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Jesky M, Lambert A, Burden ACF, Cockwell P. The impact of chronic kidney disease and cardiovascular comorbidity on mortality in a multiethnic population: a retrospective cohort study. BMJ Open 2013; 3:e003458. [PMID: 24302500 PMCID: PMC3855607 DOI: 10.1136/bmjopen-2013-003458] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To assess the impact of chronic kidney disease (CKD) and cardiovascular comorbidity on mortality in a multiethnic primary care population. DESIGN Retrospective cohort study. SETTING Inner-city primary care trust in West Midlands, UK. PARTICIPANTS Individuals aged 40 years and older, of South Asian, black or white ethnicity, registered with a general practice and with their kidney function checked within the last 12 months (n=31 254). OUTCOME MEASURE All-cause mortality. RESULTS Reduced estimated glomerular filtration rate, higher albuminuria, older age, white ethnicity (vs South Asian or black ethnicity) and increasing cardiovascular comorbidities were independent determinants of a higher mortality risk. In the multivariate model including comorbidities and kidney function, the HR for mortality for South Asians was 0.697 (95% CI 0.56 to 0.868, p=0.001) and for blacks it was 0.533 (95% CI 0.403 to 0.704, p<0.001) compared to whites. CONCLUSIONS The HR for death is lower for South Asian and black individuals compared to white individuals. This is, in part, independent of age, gender, socioeconomic status, kidney function and comorbidities. Risk of death is higher in individuals with CKD and with a higher cumulative cardiovascular comorbidity.
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Affiliation(s)
- Mark Jesky
- Department of Renal Medicine, Queen Elizabeth Hospital Birmingham, Birmingham, UK
- Division of Infection and Immunity, University of Birmingham, Birmingham, UK
| | - Amanda Lambert
- Public Health Intelligence, Birmingham City Council, Birmingham, UK
| | - A C Felix Burden
- Sandwell and West Birmingham Clinical Commissioning Group, Birmingham, UK
| | - Paul Cockwell
- Department of Renal Medicine, Queen Elizabeth Hospital Birmingham, Birmingham, UK
- Division of Infection and Immunity, University of Birmingham, Birmingham, UK
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