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Kaur N, Mahapatra HS, Pursnani L, B M, Singh M, Gupta YP. Longitudinal Assessment of Health-Related Quality of Life in Three Different Hyperphosphatemia Management Groups of Stage III and IV Chronic Kidney Disease Patients. Indian J Nephrol 2024; 34:119-128. [PMID: 38681013 PMCID: PMC11044664 DOI: 10.4103/ijn.ijn_6_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 03/13/2023] [Indexed: 05/01/2024] Open
Abstract
Introduction Health-related quality of life (HRQoL) has emerged as an important outcome measure inpatients with CKD. The lack of prospective studies on HRQoL and its relation with hyperphosphatemia control measures among pre-dialysis patients necessitated the need for this study. Methods This is a prospective, randomized, controlled, open-labelled studythat was conducted for one year on 120 CKD stages III and IV patients divided equally into three groups: Group 1, in which patients under went dietary phosphorus modification; Group 2, in which they were administered calcium-based phosphate binders; and Group 3, in which they were administered non-calcium-based phosphate binders. Patients were assessed for HRQoL, fibroblast growth factor 23 (FGF 23), intact parathyroid hormone (iPTH), phosphorus, and nutritional status, and dietary phosphorus control strategies at 0, 6, and 12 months. HRQoL was measured by using the 36-item Short Form Survey (SF-36) that included a physical component score (PCS) and mental component score (MCS). The scores is ranging from 0 to 100. Higher scores indicate better health status. Usingthe two-wayand one-way repeated measure ANOVA, we analyzed equality of group means, time intervals, and interactions. Results At baseline, the mean PCS and MCS were equal in three groups. PCS improved significantly (P < 0.00) from baseline to one year in all the three groups: ingroup 1, the PCS score was 66.5 ± 13.5to 75.1 ± 9.76; in group 2, it was 68.9 ± 11.80 to 77.2 ± 7.50; and in group 3, it was 66.2 ± 12.16 to 73.8 ± 9.27. Initially, MCS declined substantially on the sixth month but recovered afterone year. Multiple regression analysis in 13 associated parameters yielded R2 of 13.7% and 18.1% in PCS and MCS, respectively, indicating little contribution of various parameters. Conclusion There has been a significant positive change in PCSs in three hyperphosphatemia management groups over a period of 12 months. Among the three study groups, the incremental changes in PCS and MCS scores were insignificant.
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Affiliation(s)
- Navjot Kaur
- Department of Nephrology, ABVIMS, Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Himansu S. Mahapatra
- Department of Nephrology, ABVIMS, Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Lalit Pursnani
- Department of Nephrology, ABVIMS, Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Muthukumar B
- Department of Nephrology, ABVIMS, Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Mansi Singh
- Department of Nephrology, ABVIMS, Dr. Ram Manohar Lohia Hospital, New Delhi, India
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Tran TXM, Jung SY, Lee EG, Cho H, Kim NY, Shim S, Kim HY, Kang D, Cho J, Lee E, Chang Y, Cho H. Health-related quality of life in long-term early-stage breast cancer survivors compared to general population in Korea. J Cancer Surviv 2023:10.1007/s11764-023-01482-2. [PMID: 37999857 DOI: 10.1007/s11764-023-01482-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 10/06/2023] [Indexed: 11/25/2023]
Abstract
PURPOSE This study assessed health-related quality of life (HRQoL) of long-term breast cancer (BC) survivors diagnosed at early stages and compare with cancer-free, age-matched women. METHODS The study population included BC survivors diagnosed with ductal carcinoma in situ (DCIS) or breast cancer stages I-II, who had undergone lumpectomy/mastectomy, with time since diagnosis ranging from 9 to 16 years. Survey was conducted at two tertiary hospitals in 2020. Data for cancer-free female controls was randomly drawn from a population-based survey and age-, education-matched with 1 case: 3 controls ratio. Self-reported HRQoL was assessed using EQ-5D with five dimentions. EQ-5D utility index score was calculated. Difference in EQ-5D score was evaluated using the Tobit regression model with adjustment for other covariates. RESULTS Of 273 survivors. 88% and 12% underwent mastectomy and lumpectomy, respectively. The mean (standard deviation, SD) age at survey was 57.3 (8.5) years old. BC survivors reported significantly more problems performing daily activities (11% vs. 5%, p < 0.001), pain/discomfort (46% vs. 23%, p < 0.001), and anxious/depressed feelings (44% vs. 8%, p < 0.001) relative to the controls. Difference in EQ-5D score between BC survivors and the general population was higher in older age groups. The overall EQ-5D score of BC survivors was statistically lower than that of the control subjects (adjusted [Formula: see text]=0.117, p < 0.001). CONCLUSION Long-term BC survivors who survived beyond ten years post-diagnosis experience more pain, anxiety, and distress, leading to an overall poorer HRQoL. IMPLICATIONS FOR CANCER SURVIVORS This study suggest the importance of follow-up care, particularly focusing on pain, anxiety, and distress management to enhance the HRQoL of long-term BC survivors.
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Affiliation(s)
- Thi Xuan Mai Tran
- Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, 10408, Republic of Korea
| | - So-Youn Jung
- Center for Breast Cancer, National Cancer Center, Goyang, 10408, Republic of Korea
| | - Eun-Gyeong Lee
- Center for Breast Cancer, National Cancer Center, Goyang, 10408, Republic of Korea
| | - Heeyoun Cho
- Division of Cancer Control and Policy, National Cancer Control Institute, National Cancer Center, 323 Ilsan-Ro, Ilsandong-Gu, Goyang-Si, Goyang, Gyeonggi-Do, 10408, Republic of Korea
| | - Na Yeon Kim
- Cancer Education Center, Samsung Comprehensive Cancer Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06351, Republic of Korea
| | - Sungkeun Shim
- Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06351, Republic of Korea
| | - Ho Young Kim
- Cancer Education Center, Samsung Comprehensive Cancer Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06351, Republic of Korea
| | - Danbee Kang
- Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06351, Republic of Korea
- Department of Clinical Research Design & Evaluation, SAIHST, Sungkyunkwan University, Seoul, 06351, Republic of Korea
| | - Juhee Cho
- Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06351, Republic of Korea
- Department of Clinical Research Design & Evaluation, SAIHST, Sungkyunkwan University, Seoul, 06351, Republic of Korea
| | - Eunsook Lee
- Center for Breast Cancer, National Cancer Center, Goyang, 10408, Republic of Korea
- Department of Cancer Biomedical Science, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, 10408, Republic of Korea
| | - Yoonjung Chang
- Division of Cancer Control and Policy, National Cancer Control Institute, National Cancer Center, 323 Ilsan-Ro, Ilsandong-Gu, Goyang-Si, Goyang, Gyeonggi-Do, 10408, Republic of Korea.
- Department of Cancer AI and Digital Health, Graduate School of Cancer Science and Policy, National Cancer Center, 323 Ilsan-Ro, Ilsandong-Gu, Goyang-Si, Goyang, Gyeonggi-Do, 10408, Republic of Korea.
| | - Hyunsoon Cho
- Department of Cancer AI and Digital Health, Graduate School of Cancer Science and Policy, National Cancer Center, 323 Ilsan-Ro, Ilsandong-Gu, Goyang-Si, Goyang, Gyeonggi-Do, 10408, Republic of Korea.
- Integrated Biostatistics Branch, Division of Cancer Data Science, Research Institute, National Cancer Center, Goyang, Republic of Korea.
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Tran TXM, Jung SY, Lee EG, Cho H, Cho J, Lee E, Chang YJ, Cho H. Long-term trajectory of postoperative health-related quality of life in young breast cancer patients: a 15-year follow-up study. J Cancer Surviv 2023; 17:1416-1426. [PMID: 35279800 DOI: 10.1007/s11764-022-01165-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 01/07/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE Breast cancer (BC) patients often experience various long-term sequelae due to aggressive treatment. We analyzed and illustrated long-term trajectory during different phases of treatment and survivorship. METHODS Data were obtained from a cohort of 298 BC patients diagnosed between 2004 and 2006 and were followed up until 2020. We measured HRQoL using EORTC QLQ-C30, QLQ-BR23, and EuroQoL-5D questionnaires and conducted eight assessments right after initial diagnosis, during treatment, post-treatment, and during survivorship phases. Linear mixed model was used to assess changes in HRQoL. Overall HRQoL measured by EQ-5D index of long-term BC survivors were further compared with that of the age-matched general population. RESULTS Of 298 participants, 246 women survived and 124 participated in the long-term follow-up survey (LTFU). Overall, HRQoL functions deteriorated during treatment but gradually improved between 1- and 3-year post-diagnosis and stabilized over LTFU measure. Significant recovery was observed in physical, role, emotional, social functions, and future perspectives (p < 0.05). Treatment-related acute symptoms were reported in the first year but diminished afterward, and treatment-related financial difficulties lessened. At LTFU, BC survivors reported a high level of insomnia, fatigue, and pain and appeared to have poorer overall HRQoL than the general population (mean difference, EQ-5D index: 0.073, p < 0.001). CONCLUSIONS Through 15-year survivorship, BC survivors showed improvement in many aspects of HRQoL. However, some inferior aspects remain relevant for long-term survivors. Ongoing supportive programs concentrating on pain management, persistent cancer-related fatigue, and sleeping problems might aid enhance their HRQoL.
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Affiliation(s)
- Thi Xuan Mai Tran
- Department of Cancer Control and Population Health, National Cancer Center Graduate School of Cancer Science and Policy, National Cancer Center, 10408, Goyang, Republic of Korea
| | - So-Youn Jung
- Center for Breast Cancer, Research Institute and Hospital, National Cancer Center, Goyang, 10408, Republic of Korea
| | - Eun-Gyeong Lee
- Center for Breast Cancer, Research Institute and Hospital, National Cancer Center, Goyang, 10408, Republic of Korea
| | - Heeyoun Cho
- Division of Cancer Control and Policy, National Cancer Control Institute, National Cancer Center, Goyang, 10408, Republic of Korea
| | - Juhee Cho
- Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, 06351, Republic of Korea
| | - Eunsook Lee
- Center for Breast Cancer, Research Institute and Hospital, National Cancer Center, Goyang, 10408, Republic of Korea
- Department of Cancer Biomedical Science, National Cancer Center Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, 10408, Republic of Korea
| | - Yoon Jung Chang
- Department of Cancer Control and Population Health, National Cancer Center Graduate School of Cancer Science and Policy, National Cancer Center, 10408, Goyang, Republic of Korea.
- Division of Cancer Control and Policy, National Cancer Control Institute, National Cancer Center, Goyang, 10408, Republic of Korea.
| | - Hyunsoon Cho
- Department of Cancer Control and Population Health, National Cancer Center Graduate School of Cancer Science and Policy, National Cancer Center, 10408, Goyang, Republic of Korea.
- Division of Cancer Registration and Surveillance, National Cancer Control Institute, National Cancer Center, Goyang, 10408, Republic of Korea.
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Swartling O, Evans M, Larsson P, Perri G, Yarbakht D, Al-Kamil H, Gilg S, Holmberg M, Sparrelid E, Ghorbani P. Preoperative chronic kidney disease and complications after pancreatoduodenectomy: a retrospective cohort study. ANZ J Surg 2023; 93:2492-2498. [PMID: 37654154 DOI: 10.1111/ans.18677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 08/01/2023] [Accepted: 08/17/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND Chronic kidney disease is a prevalent condition in surgical patients. Possible associations with increased postoperative morbidity and mortality have not been clearly demonstrated in patients undergoing pancreatoduodenectomy. The aim of this study was to assess the risk of postoperative complications in patients with reduced kidney function undergoing pancreatoduodenectomy. METHODS All patients undergoing pancreatoduodenectomy at Karolinska University Hospital between 2008 and 2019 were retrospectively included. The variable of interest was chronic kidney disease, based on preoperative estimated glomerular filtration rate measurements. Unadjusted and adjusted logistic regression analyses were performed for standardized postoperative complications. RESULTS A total of 971 patients were included in the study, of whom 92 (10%) had an estimated glomerular filtration rate < 60 mL/min/1.73m2 , equivalent to chronic kidney disease Stage 3a or worse. Patients with chronic kidney disease had a higher odds of longer hospital stay (adjusted odds ratio 1.58, 95% confidence interval 1.00-2.50) and postoperative weight increase (adjusted odds ratio 2.02, 1.14-3.56). A 10 unit increase of preoperative estimated glomerular filtration rate was associated to lower odds of intensive care unit admission (adjusted odds ratio 0.81, 0.69-0.95), delayed gastric emptying (adjusted odds ratio 0.90, 0.81-0.99), and post-operative pancreatic fistula (adjusted odds ratio 0.83, 0.74-0.94). CONCLUSION Patients undergoing pancreatoduodenectomy with decreased preoperative kidney function are more likely to experience major postoperative complications, and also postoperative weight increase. Preoperative kidney function assessment is important in risk stratification before pancreatoduodenectomies.
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Affiliation(s)
- Oskar Swartling
- Clinical Epidemiology Division, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Marie Evans
- Renal Unit, Department of Clinical Sciences, Interventions and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Patrik Larsson
- Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
- Division of Surgery, Department of Clinical Sciences, Interventions and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Giampaolo Perri
- Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
- Division of Surgery, Department of Clinical Sciences, Interventions and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Danial Yarbakht
- Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Hussein Al-Kamil
- Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Stefan Gilg
- Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
- Division of Surgery, Department of Clinical Sciences, Interventions and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Marcus Holmberg
- Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
- Division of Surgery, Department of Clinical Sciences, Interventions and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Ernesto Sparrelid
- Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
- Division of Surgery, Department of Clinical Sciences, Interventions and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Poya Ghorbani
- Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
- Division of Surgery, Department of Clinical Sciences, Interventions and Technology, Karolinska Institutet, Stockholm, Sweden
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Lee DY, Han SY, Lee K, Lee Y, Phan L, Mansur RB, Rosenblat JD, McIntyre RS. Association of a low protein diet with depressive symptoms and poor health-related quality of life in CKD. J Psychiatr Res 2023; 161:282-288. [PMID: 36947959 DOI: 10.1016/j.jpsychires.2023.02.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 02/14/2023] [Accepted: 02/22/2023] [Indexed: 03/24/2023]
Abstract
OBJECTIVES A low protein diet (LPD) for chronic kidney disease (CKD) is a core dietary therapy to slow CKD progression. A study showed depressive symptoms are more common in populations with an LPD. In this cross-sectional study, we evaluated depressive symptoms and health-related quality of life (HRQOL) in patients with CKD. METHODS A total of 571 CKD patients were enrolled in this study. The LPD was defined with dietary protein intake ≤0.8 g/kg/day. We divided the CKD into mild CKD and advanced CKD according to severity, as well as diabetic kidney disease (DKD) and non-DKD according to DM. The logistic regression analysis was performed to evaluate the association between an LPD and depressive symptoms as well as HRQOL in CKD patients and each subgroup. RESULTS An LPD had significantly higher unadjusted Odds Ratio (OR) (1.81, [95% for Confidence Interval (CI), 1.18-2.76]) and multivariate-adjusted OR (1.80, [1.15-2.81]) for depressive symptoms. Moreover, an LPD showed significantly higher unadjusted OR (2.08, 1.44-3.01]) and multivariate OR (2.04, [1.38-3.02]) for poor HRQOL. In DKD subgroups, an LPD had a significant increase in unadjusted OR (2.00, [1.12-3.57]) and multivariate OR (1.99, [1.01-3.44]) for depressive symptoms. The advanced CKD group also showed that an LPD had significantly higher unadjusted OR (1.97, [1.13-3.42]) and multivariate OR (2.03, [1.12-3.73]) for depressive symptoms. CONCLUSIONS An LPD for CKD patients was significantly associated with depressive symptoms and poor HRQOL. Subgroup analysis indicated that DKD and advanced CKD are more predisposed to depressive symptoms and poor HRQOL.
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Affiliation(s)
- Dong-Young Lee
- Department of Internal Medicine, Veterans Healthcare Service Medical Center, Seoul, Republic of Korea
| | - Sang Youb Han
- Department of Internal Medicine, Inje University College of Medicine, Ilsan-Paik Hospital, Goyang, Gyeonggi, Republic of Korea
| | - Kangbaek Lee
- Yonsei Miso Dental Clinic, Seongnam, Gyeonggi, Republic of Korea
| | - Young Lee
- Veterans Medical Research Institute, Veterans Healthcare Service Medical Center, Seoul, Republic of Korea
| | - Lee Phan
- Department of Psychiatry, University of Toronto, Ontario, Canada
| | - Rodrigo B Mansur
- Mood Disorders Psychopharmacology Unit, Poul Hansen Family Centre for Depression, University of Health Network, Toronto, Ontario, Canada; Braxia Health, Mississauga, Ontario, Canada; Department of Psychiatry, University of Toronto, Ontario, Canada
| | - Joshua D Rosenblat
- Mood Disorders Psychopharmacology Unit, Poul Hansen Family Centre for Depression, University of Health Network, Toronto, Ontario, Canada; Braxia Health, Mississauga, Ontario, Canada; Department of Psychiatry, University of Toronto, Ontario, Canada
| | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit, Poul Hansen Family Centre for Depression, University of Health Network, Toronto, Ontario, Canada; Braxia Health, Mississauga, Ontario, Canada; Department of Psychiatry, University of Toronto, Ontario, Canada.
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Busa I, Ordóñez-Mena JM, Yang Y, Wolstenholme J, Petrou S, Taylor CJ, O’Callaghan CA, Fraser SDS, Taal MW, McManus RJ, Hirst JA, Hobbs FDR. Quality of life in older adults with chronic kidney disease and transient changes in renal function: Findings from the Oxford Renal cohort. PLoS One 2022; 17:e0275572. [PMID: 36240168 PMCID: PMC9565742 DOI: 10.1371/journal.pone.0275572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 09/19/2022] [Indexed: 11/07/2022] Open
Abstract
Background Quality of life (QoL) is an important measure of disease burden and general health perception. The relationship between early chronic kidney disease (CKD) and QoL remains poorly understood. The Oxford Renal Study (OxRen) cohort comprises 1063 adults aged ≥60 years from UK primary care practices screened for early CKD, grouped according to existing or screen-detected CKD diagnoses, or biochemistry results indicative of reduced renal function (referred to as transient estimated glomerular filtration rate (eGFR) reduction). Objectives This study aimed to compare QoL in participants known to have CKD at recruitment to those identified as having CKD through a screening programme. Methods Health profile data and multi-attribute utility scores were reported for two generic questionnaires: 5-level EuroQol-5 Dimension (EQ-5D-5L) and ICEpop CAPability measure for Adults (ICECAP-A). QoL was compared between patients with existing and screen-detected CKD; those with transient eGFR reduction served as the reference group in univariable and multivariable linear regression. Results Mean and standard deviation utility scores were not significantly different between the subgroups for EQ-5D-5L (screen-detected:0.785±0.156, n = 480, transient:0.779±0.157, n = 261, existing CKD:0.763±0.171, n = 322, p = 0.216) or ICECAP-A (screen-detected:0.909±0.094, transient:0.904±0.110, existing CKD:0.894±0.115, p = 0.200). Age, smoking status, and number of comorbidities were identified as independent predictors of QoL in this cohort. Conclusion QoL of participants with existing CKD diagnoses was not significantly different from those with screen-detected CKD or transient eGFR reduction and was similar to UK mean scores for the same age, suggesting that patient burden of early CKD is minor. Moreover, CKD-related comorbidities contribute more significantly to disease burden in earlier stages of CKD than renal function per se. Larger prospective studies are required to define the relationship between QoL and CKD progression more precisely. These data also confirm the essentially asymptomatic nature of CKD, implying that routine screening or case finding are required to diagnose it.
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Affiliation(s)
- Isabella Busa
- University of Oxford Medical School, Osler House, John Radcliffe Hospital, Oxford, United Kingdom
- * E-mail:
| | - José M. Ordóñez-Mena
- Nuffield Department of Primary Care Health Science, University of Oxford, Oxford, United Kingdom
- National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Yaling Yang
- Nuffield Department of Primary Care Health Science, University of Oxford, Oxford, United Kingdom
- National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Jane Wolstenholme
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Stavros Petrou
- Nuffield Department of Primary Care Health Science, University of Oxford, Oxford, United Kingdom
| | - Clare J. Taylor
- Nuffield Department of Primary Care Health Science, University of Oxford, Oxford, United Kingdom
| | | | - Simon D. S. Fraser
- School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Maarten W. Taal
- Centre for Kidney Research and Innovation, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Richard J. McManus
- Nuffield Department of Primary Care Health Science, University of Oxford, Oxford, United Kingdom
| | - Jennifer A. Hirst
- Nuffield Department of Primary Care Health Science, University of Oxford, Oxford, United Kingdom
- National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - F. D. Richard Hobbs
- Nuffield Department of Primary Care Health Science, University of Oxford, Oxford, United Kingdom
- National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
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Swartling O, Yang Y, Clase CM, Fu EL, Hecking M, Hödlmoser S, Trolle-Lagerros Y, Evans M, Carrero JJ. Sex Differences in the Recognition, Monitoring, and Management of CKD in Health Care: An Observational Cohort Study. J Am Soc Nephrol 2022; 33:1903-1914. [PMID: 35906075 PMCID: PMC9528319 DOI: 10.1681/asn.2022030373] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 06/09/2022] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION Reported sex differences in the etiology, population prevalence, progression rates, and health outcomes of people with CKD may be explained by differences in health care. METHODS We evaluated sex as the variable of interest in a health care-based study of adults (n=227,847) with at least one outpatient eGFR<60 ml/min per 1.73 m2 measurement denoting probable CKD in Stockholm from 2009 to 2017. We calculated the odds ratios for diagnosis of CKD and provision of RASi and statins at inclusion, and hazard ratios for CKD diagnosis, visiting a nephrologist, or monitoring creatinine and albuminuria during follow-up. RESULTS We identified 227,847 subjects, of whom 126,289 were women (55%). At inclusion, women had lower odds of having received a diagnostic code for CKD and were less likely to have received RASi and statins, despite having guideline-recommended indications. In time-to-event analyses, women were less likely to have received a CKD diagnosis (HR, 0.43; 95% CI, 0.42 to 0.45) and visited a nephrologist (HR, 0.46; 95% CI, 0.43 to 0.48) regardless of disease severity, presence of albuminuria, or criteria for referral. Women were also less likely to undergo monitoring of creatinine or albuminuria, including those with diabetes or hypertension. These differences remained after adjustment for comorbidities, albuminuria, and highest educational achievement, and among subjects with confirmed CKD at retesting. Although in absolute terms all nephrology-care indicators gradually improved over time, the observed sex gap persisted. CONCLUSIONS There were profound sex differences in the detection, recognition, monitoring, referrals, and management of CKD. The disparity was also observed in people at high risk and among those who had guideline-recommended indications. PODCAST This article contains a podcast at https://www.asn-online.org/media/podcast/JASN/2022_10_11_JASN2022030373.mp3.
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Affiliation(s)
- Oskar Swartling
- Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden
| | - Yuanhang Yang
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Catherine M. Clase
- Departments of Medicine and Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Edouard L. Fu
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Manfred Hecking
- Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Sebastian Hödlmoser
- Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
- Department of Epidemiology, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Ylva Trolle-Lagerros
- Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden
- Center for Obesity, Academic Specialist Center, Stockholm Health Services, Stockholm, Sweden
| | - Marie Evans
- Department of Clinical Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Juan J. Carrero
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Division of Nephrology, Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
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Understanding health problems in people with extremely low health-related quality of life in Korea. Sci Rep 2022; 12:4037. [PMID: 35260609 PMCID: PMC8904781 DOI: 10.1038/s41598-022-07528-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 02/07/2022] [Indexed: 11/08/2022] Open
Abstract
Little is known about patients reporting extremely poor health-related quality of life (HRQoL). This study targeted population with inferior HRQoL and examined their problems experienced with HRQoL dimensions, and impacts of different morbidities on these problems. Data were obtained from a population-based survey in Korea. HRQoL was measured by EQ-5D questionnaire and low-HRQoL population was defined as individuals whose EQ-5D utility score was among the lowest 5% of total survey population. Logistic regression models were used to evaluate the impact of fifteen morbidities on HRQoL dimensions. Of 2976 low-HRQoL participants, females and low socioeconomic individuals were predominant. They experienced significantly more problems in all dimensions, with pain/discomfort, and mobility as the most frequently reported problems. Problems in HRQoL dimensions diverged according to diseases. Individuals with arthritis experienced more difficulties with mobility (aOR 2.62, 95% CI 1.77–3.87) and pain/discomfort (aOR 2.86, 95% CI 1.78–4.60). Stroke patients experienced more problems in self-care (aOR 2.24, 95% CI 1.59–3.15) and usual activities (aOR 1.87, 95% CI 1.11–3.14). Having two or more diseases was associated with worse outcomes in usual activities and increased risk of depression. Thus, efforts to improve status of low-HRQoL should be customized to fulfil unmet needs corresponding to various diseases, and depression prevention is needed for those with multimorbidity status.
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Brazzelli M, Aucott L, Aceves-Martins M, Robertson C, Jacobsen E, Imamura M, Poobalan A, Manson P, Scotland G, Kaye C, Sawhney S, Boyers D. Biomarkers for assessing acute kidney injury for people who are being considered for admission to critical care: a systematic review and cost-effectiveness analysis. Health Technol Assess 2022; 26:1-286. [PMID: 35115079 PMCID: PMC8859769 DOI: 10.3310/ugez4120] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Acute kidney injury is a serious complication that occurs in the context of an acute critical illness or during a postoperative period. Earlier detection of acute kidney injury may facilitate strategies to preserve renal function, prevent further disease progression and reduce mortality. Acute kidney injury diagnosis relies on a rise in serum creatinine levels and/or fall in urine output; however, creatinine is an imperfect marker of kidney function. There is interest in the performance of novel biomarkers used in conjunction with existing clinical assessment, such as NephroCheck® (Astute Medical, Inc., San Diego, CA, USA), ARCHITECT® urine neutrophil gelatinase-associated lipocalin (NGAL) (Abbott Laboratories, Abbott Park, IL, USA), and urine and plasma BioPorto NGAL (BioPorto Diagnostics A/S, Hellerup, Denmark) immunoassays. If reliable, these biomarkers may enable earlier identification of acute kidney injury and enhance management of those with a modifiable disease course. OBJECTIVE The objective was to evaluate the role of biomarkers for assessing acute kidney injury in critically ill patients who are considered for admission to critical care. DATA SOURCES Major electronic databases, conference abstracts and ongoing studies were searched up to June 2019, with no date restrictions. MEDLINE, EMBASE, Health Technology Assessment Database, Cumulative Index to Nursing and Allied Health Literature, Cochrane Central Register of Controlled Trials, Web of Science, World Health Organization Global Index Medicus, EU Clinical Trials Register, International Clinical Trials Registry Platform and ClinicalTrials.gov were searched. REVIEW METHODS A systematic review and meta-analysis were conducted to evaluate the performance of novel biomarkers for the detection of acute kidney injury and prediction of other relevant clinical outcomes. Random-effects models were adopted to combine evidence. A decision tree was developed to evaluate costs and quality-adjusted life-years accrued as a result of changes in short-term outcomes (up to 90 days), and a Markov model was used to extrapolate results over a lifetime time horizon. RESULTS A total of 56 studies (17,967 participants), mainly prospective cohort studies, were selected for inclusion. No studies addressing the clinical impact of the use of biomarkers on patient outcomes, compared with standard care, were identified. The main sources of bias across studies were a lack of information on blinding and the optimal threshold for NGAL. For prediction studies, the reporting of statistical details was limited. Although the meta-analyses results showed the potential ability of these biomarkers to detect and predict acute kidney injury, there were limited data to establish any causal link with longer-term health outcomes and there were considerable clinical differences across studies. Cost-effectiveness results were highly uncertain, largely speculative and should be interpreted with caution in the light of the limited evidence base. To illustrate the current uncertainty, 15 scenario analyses were undertaken. Incremental quality-adjusted life-years were very low across all scenarios, ranging from positive to negative increments. Incremental costs were also small, in general, with some scenarios generating cost savings with tests dominant over standard care (cost savings with quality-adjusted life-year gains). However, other scenarios generated results whereby the candidate tests were more costly with fewer quality-adjusted life-years, and were thus dominated by standard care. Therefore, it was not possible to determine a plausible base-case incremental cost-effectiveness ratio for the tests, compared with standard care. LIMITATIONS Clinical effectiveness and cost-effectiveness results were hampered by the considerable heterogeneity across identified studies. Economic model predictions should also be interpreted cautiously because of the unknown impact of NGAL-guided treatment, and uncertain causal links between changes in acute kidney injury status and changes in health outcomes. CONCLUSIONS Current evidence is insufficient to make a full appraisal of the role and economic value of these biomarkers and to determine whether or not they provide cost-effective improvements in the clinical outcomes of acute kidney injury patients. FUTURE WORK Future studies should evaluate the targeted use of biomarkers among specific patient populations and the clinical impact of their routine use on patient outcomes and management. STUDY REGISTRATION This study is registered as PROSPERO CRD42019147039. FUNDING This project was funded by the National Institute for Health Research (NIHR) Evidence Synthesis programme and will be published in full in Health Technology Assessment; Vol. 26, No. 7. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Miriam Brazzelli
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Lorna Aucott
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | | | - Clare Robertson
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Elisabet Jacobsen
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - Mari Imamura
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Amudha Poobalan
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Paul Manson
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Graham Scotland
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - Callum Kaye
- Anaesthetics and Intensive Care Medicine, NHS Grampian, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Simon Sawhney
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Dwayne Boyers
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
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10
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Hockham C, Bao L, Tiku A, Badve SV, Bello AK, Jardine MJ, Jha V, Toyama T, Woodward M, Jun M. OUP accepted manuscript. Clin Kidney J 2022; 15:1144-1151. [PMID: 35664281 PMCID: PMC9155252 DOI: 10.1093/ckj/sfac030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Indexed: 11/20/2022] Open
Abstract
Background Previous reports on the prevalence of chronic kidney disease (CKD) in Asia have suggested important sex disparities but have been inconsistent in nature. We sought to synthesize available sex-disaggregated CKD prevalence data in Asia to quantify sex disparities in the region. Methods We systematically searched MEDLINE and Embase for observational studies involving ≥500 adults who reported sex-disaggregated CKD prevalence data in any of the 26 countries in East, Southeast and South Asia. For each study we calculated the female:male prevalence ratio (PR), with a ratio >1 indicating a higher female prevalence. For each country, log-transformed PRs were pooled using random effects meta-analysis. These were then combined using a fixed effects model, weighting by population size, to estimate a pooled PR for each of East, Southeast and South Asia and Asia overall. Results Sex-disaggregated data were available from 171 cohorts, spanning 15 countries and comprising 2 550 169 females and 2 595 299 males. Most studies (75.4%) came from East Asia (China, Taiwan, Japan and South Korea). Across Asia, CKD prevalence was higher in females {pooled prevalence 13.0% [95% confidence interval (CI) 11.3–14.9]} compared with males [pooled prevalence 12.1% (95% CI 10.3–14.1)], with a pooled PR of 1.07 (95% CI 0.99–1.17). Substantial heterogeneity was observed between countries. The pooled PRs for East, Southeast and South Asia were 1.11 (95% CI 1.02–1.21), 1.09 (0.88–1.36) and 1.03 (0.87–1.22), respectively. Conclusions Current evidence suggests considerable between-country and -region heterogeneity in the female:male PR of CKD. However, there remains a large part of the region where data on sex-specific CKD prevalence are absent or limited. Country-level assessment of the differential burden of CKD in females and males is needed to define locally relevant policies that address the needs of both sexes.
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Affiliation(s)
| | - Lexia Bao
- George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
- University of British Columbia, Vancouver, BC, Canada
| | - Anushree Tiku
- George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Sunil V Badve
- George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
- Department of Renal Medicine, St George Hospital, Sydney, NSW, Australia
| | - Aminu K Bello
- Division of Nephrology, University of Alberta, Edmonton, AB, Canada
| | - Meg J Jardine
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
- Concord Repatriation General Hospital, Sydney, NSW, Australia
| | - Vivekanand Jha
- George Institute for Global Health, School of Public Health, Imperial College London, London, UK
- George Institute for Global Health, University of New South Wales International, New Delhi, India
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - Tadashi Toyama
- Department of Nephrology, Kanazawa University, Kanazawa, Japan
| | - Mark Woodward
- George Institute for Global Health, School of Public Health, Imperial College London, London, UK
- George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Min Jun
- George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
- Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
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11
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You HS, Shin SJ, Kim J, Kang HT. Statin Use and Incidence of Chronic Kidney Disease in Hypercholesterolemia Patients with Normal Renal Function. Am J Nephrol 2021; 52:940-948. [PMID: 34864729 DOI: 10.1159/000520532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 10/23/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Dyslipidemia is a known risk factor for chronic kidney disease (CKD). The effects of statins on CKD have already been studied in patients with CKD; however, data on the general population are limited. This study aimed to determine the relationship between statin use and the incidence of CKD in patients with hypercholesterolemia having normal renal function. METHODS A total of 7,856 participants aged 40-79 years at baseline (2009-2010) were included in the final analyses. The participants were divided into statin users (n = 4,168) and statin nonusers (n = 3,668), according to the statin usage. The Cox proportional hazard regression model was used to evaluate the adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) for CKD. RESULTS The median follow-up duration was 5.8 years. A total of 543 cases of CKD (285 cases in males and 258 cases in females) occurred during the study period. The estimated cumulative incidence of CKD was significantly different between male statin nonusers and users (p < 0.001), while it was not statistically significant between female statin nonusers and users (p = 0.126). Compared with statin nonusers, the fully adjusted HRs (95% CIs) for CKD in statin users were 1.014 (0.773-1.330) in males and 1.117 (0.843-1.481) in females. CONCLUSION Dyslipidemia is an obvious risk factor for CKD; however, statin use in patients with hypercholesterolemia having normal renal function does not demonstrate a clear relationship with the incidence of CKD.
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Affiliation(s)
- Hyo-Sun You
- Department of Family Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Sang-Jun Shin
- Department of Information and Statistics, Chungbuk National University, Cheongju, Republic of Korea
| | - Joungyoun Kim
- College of Nursing, Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, Republic of Korea
| | - Hee-Taik Kang
- Department of Family Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea
- Department of Family Medicine, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
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12
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Chronic Kidney Disease on Health-Related Quality of Life in Patients with Diabetes Mellitus: A National Representative Study. J Clin Med 2021; 10:jcm10204639. [PMID: 34682762 PMCID: PMC8540120 DOI: 10.3390/jcm10204639] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 09/29/2021] [Accepted: 10/06/2021] [Indexed: 12/30/2022] Open
Abstract
Importance: With an increasing prevalence of diabetes mellitus (DM) and comorbid chronic kidney disease (CKD), health-related quality of life (HRQoL) in patients with DM and CKD needs to be better understood. Objective: To investigate the association between the severity of CKD on HRQoL in DM patients. Design: A cross-sectional study of a nationally representative population-based survey, the Korea National Health and Nutrition Examination Survey (KNHANES). Setting: Data collected between 2007 and 2018 from the KNHANES. Participants: Adult participants with DM who completed the self-administered European Quality of Life Questionnaire Five Dimension (EQ-5D) questionnaire (n = 7243). Exposures: CKD stages defined by the Kidney Disease Improving Global System (KDIGO) staging system. Main Outcomes and Measures: We estimated the odds ratios (ORs) and 95% confidence intervals (CIs) of the presence of having problems in the 5 dimensions (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression) of EQ-5D by CKD stage after adjusting for socio-demographic parameters and comorbid conditions. In addition, the EQ-5D index, reflecting the overall health status, was compared across CKD stages. Results: Among 7243 participants (mean (standard error) age 58.2 (0.2) 56.9% male), 24.0% (n = 1768) had CKD and 8.6% (n = 775) had stage 3–5 CKD. Pain/discomfort was the most common problem (30.5%) among patients with DM. Participants with more advanced CKD were more likely to experience problems in all dimensions of EQ-5D except the anxiety/depression dimension. In particular, compared to those without CKD, the adjusted ORs (95% CI) for any problem in the usual activities dimension was 1.65 (1.30, 2.10) in CKD stage 3 and 4.23 (2.07, 8.67) in CKD stage 4–5. Moreover, participants with stage 3 (−0.016 (−0.029, −0.003)) and stage 4–5 CKD (−0.088 (−0.129, −0.048)) had significantly lower EQ-5D index than those without CKD. However, compared with no CKD, CKD stage 1–2 was not significantly associated with having any problem in any dimensions. Conclusions and Relevance: In this nationally representative study, patients with DM had a high prevalence of self-reported poor HRQoL and the prevalence increased with more advanced stages of CKD. Therefore, assessment of HRQoL and interventions are necessary at early stages of CKD in DM patients.
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13
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Evangelidis N, Sautenet B, Madero M, Tong A, Ashuntantang G, Sanabria LC, de Boer IH, Fung S, Gallego D, Levey AS, Levin A, Lorca E, Okpechi IG, Rossignol P, Sola L, Usherwood T, Wheeler DC, Cho Y, Howell M, Guha C, Scholes-Robertson N, Widders K, Gonzalez AM, Teixeira-Pinto A, Viecelli AK, Bernier-Jean A, Anumudu S, Dunn L, Wilkie M, Craig JC. Standardised Outcomes in Nephrology - Chronic Kidney Disease (SONG-CKD): a protocol for establishing a core outcome set for adults with chronic kidney disease who do not require kidney replacement therapy. Trials 2021; 22:612. [PMID: 34503563 PMCID: PMC8427149 DOI: 10.1186/s13063-021-05574-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 08/27/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Globally, over 1.2 million people die from chronic kidney disease (CKD) every year. Patients with CKD are up to 10 times more likely to die prematurely than progress to kidney failure requiring kidney replacement therapy. The burden of symptoms and impaired quality of life in CKD may be compounded by comorbidities and treatment side effects. However, patient-important outcomes remain inconsistently and infrequently reported in trials in patients with CKD, which can limit evidence-informed decision-making. The Standardised Outcomes in Nephrology - Chronic Kidney Disease (SONG-CKD) aims to establish a consensus-based core outcome set for trials in patients with CKD not yet requiring kidney replacement therapy to ensure outcomes of relevance to patients, caregivers and health professionals are consistently reported in trials. METHODS SONG-CKD involves four phases: a systematic review to identify outcomes (domains and measures) that have been reported in randomised controlled trials involving adults with CKD who do not require kidney replacement therapy; stakeholder key informant interviews with health professionals involved in the care of adults with CKD to ascertain their views on establishing core outcomes in CKD; an international two-round online Delphi survey with patients, caregivers, clinicians, researchers, policy makers and industry representatives to obtain consensus on critically important outcome domains; and stakeholder consensus workshops to review and finalise the set of core outcome domains for trials in CKD. DISCUSSION Establishing a core outcome set to be reported in trials in patients with CKD will enhance the relevance, transparency and impact of research to improve the lives of people with CKD. TRIAL REGISTRATION Not applicable. This study is registered with the Core Outcome Measures in Effectiveness Trials (COMET) database: http://www.comet-initiative.org/Studies/Details/1653 .
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Affiliation(s)
- Nicole Evangelidis
- Sydney School of Public Health, The University of Sydney, Sydney, Australia. .,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Sydney, Australia.
| | - Benedicte Sautenet
- Department of Nephrology, CHU Tours, INSERM SPHERE U1246, University of Tours, University of Nantes, Tours, France
| | - Magdalena Madero
- Division of Nephrology, Department of Medicine, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - Allison Tong
- Sydney School of Public Health, The University of Sydney, Sydney, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Sydney, Australia
| | - Gloria Ashuntantang
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
| | - Laura Cortes Sanabria
- Unidad de Investigación Médica en Enfermedades Renales, Hospital de Especialidades, CMNO, IMSS, Guadalajara, Mexico
| | - Ian H de Boer
- Department of Medicine, Kidney Research Institute, University of Washington, Seattle, Washington, USA
| | - Samuel Fung
- Division of Nephrology, Department of Medicine & Geriatrics, Princess Margaret Hospital, Hong Kong, Hong Kong
| | - Daniel Gallego
- Federacion Nacional ALCER (Spanish Kidney Patient's Federation), Madrid, Spain
| | - Andrew S Levey
- Division of Nephrology, Tufts Medical Center, Boston, MA, USA
| | - Adeera Levin
- Division of Nephrology, University of British Columbia, Vancouver, Canada
| | - Eduardo Lorca
- Department of Nephrology, Hospital Salvador, Santiago, Chile
| | - Ikechi G Okpechi
- Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa.,Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Patrick Rossignol
- Université de Lorraine, Inserm, Centre d'Investigations Clinique 1433 and Inserm U1116; CHRU Nancy; F-CRIN INI-CRCT, Nancy, France
| | - Laura Sola
- Dialysis Unit, CASMU-IAMPP, Montevideo, Uruguay
| | - Tim Usherwood
- The University of Sydney, Westmead Clinical School, Westmead, NSW, Australia.,The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | | | - Yeoungjee Cho
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia.,Australasian Kidney Trials Network, Centre for Health Services Research, University of Queensland, Brisbane, QLD, Australia.,Translational Research Institute, Brisbane, QLD, Australia
| | - Martin Howell
- Sydney School of Public Health, The University of Sydney, Sydney, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Sydney, Australia
| | - Chandana Guha
- Sydney School of Public Health, The University of Sydney, Sydney, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Sydney, Australia
| | - Nicole Scholes-Robertson
- Sydney School of Public Health, The University of Sydney, Sydney, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Sydney, Australia
| | - Katherine Widders
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Sydney, Australia
| | - Andrea Matus Gonzalez
- Sydney School of Public Health, The University of Sydney, Sydney, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Sydney, Australia
| | - Armando Teixeira-Pinto
- Sydney School of Public Health, The University of Sydney, Sydney, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Sydney, Australia
| | - Andrea K Viecelli
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia.,Australasian Kidney Trials Network, Centre for Health Services Research, University of Queensland, Brisbane, QLD, Australia
| | - Amelie Bernier-Jean
- Sydney School of Public Health, The University of Sydney, Sydney, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Sydney, Australia
| | - Samaya Anumudu
- Selzman Institute for Kidney Health, Section of Nephrology, Baylor College of Medicine, Houston, TX, USA
| | - Louese Dunn
- Sheffield Kidney Institute, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Martin Wilkie
- Sheffield Kidney Institute, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Jonathan C Craig
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
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14
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Amir N, Tong A, McCarthy H, Howell M. Trajectories of quality of life in chronic kidney disease: a novel perspective of disease progression. Nephrol Dial Transplant 2021; 36:1563-1565. [PMID: 33508092 DOI: 10.1093/ndt/gfab006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 01/06/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Noa Amir
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia.,Centre for Kidney Research, Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Allison Tong
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia.,Centre for Kidney Research, Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Hugh McCarthy
- Centre for Kidney Research, Children's Hospital at Westmead, Sydney, NSW, Australia.,Discipline of Paediatrics and Child Health, University of Sydney, Sydney, Australia
| | - Martin Howell
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia.,Centre for Kidney Research, Children's Hospital at Westmead, Sydney, NSW, Australia
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15
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Perera R, Stevens R, Aronson JK, Banerjee A, Evans J, Feakins BG, Fleming S, Glasziou P, Heneghan C, Hobbs FDR, Jones L, Kurtinecz M, Lasserson DS, Locock L, McLellan J, Mihaylova B, O’Callaghan CA, Oke JL, Pidduck N, Plüddemann A, Roberts N, Schlackow I, Shine B, Simons CL, Taylor CJ, Taylor KS, Verbakel JY, Bankhead C. Long-term monitoring in primary care for chronic kidney disease and chronic heart failure: a multi-method research programme. PROGRAMME GRANTS FOR APPLIED RESEARCH 2021. [DOI: 10.3310/pgfar09100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background
Long-term monitoring is important in chronic condition management. Despite considerable costs of monitoring, there is no or poor evidence on how, what and when to monitor. The aim of this study was to improve understanding, methods, evidence base and practice of clinical monitoring in primary care, focusing on two areas: chronic kidney disease and chronic heart failure.
Objectives
The research questions were as follows: does the choice of test affect better care while being affordable to the NHS? Can the number of tests used to manage individuals with early-stage kidney disease, and hence the costs, be reduced? Is it possible to monitor heart failure using a simple blood test? Can this be done using a rapid test in a general practitioner consultation? Would changes in the management of these conditions be acceptable to patients and carers?
Design
Various study designs were employed, including cohort, feasibility study, Clinical Practice Research Datalink analysis, seven systematic reviews, two qualitative studies, one cost-effectiveness analysis and one cost recommendation.
Setting
This study was set in UK primary care.
Data sources
Data were collected from study participants and sourced from UK general practice and hospital electronic health records, and worldwide literature.
Participants
The participants were NHS patients (Clinical Practice Research Datalink: 4.5 million patients), chronic kidney disease and chronic heart failure patients managed in primary care (including 750 participants in the cohort study) and primary care health professionals.
Interventions
The interventions were monitoring with blood and urine tests (for chronic kidney disease) and monitoring with blood tests and weight measurement (for chronic heart failure).
Main outcome measures
The main outcomes were the frequency, accuracy, utility, acceptability, costs and cost-effectiveness of monitoring.
Results
Chronic kidney disease: serum creatinine testing has increased steadily since 1997, with most results being normal (83% in 2013). Increases in tests of creatinine and proteinuria correspond to their introduction as indicators in the Quality and Outcomes Framework. The Chronic Kidney Disease Epidemiology Collaboration equation had 2.7% greater accuracy (95% confidence interval 1.6% to 3.8%) than the Modification of Diet in Renal Disease equation for estimating glomerular filtration rate. Estimated annual transition rates to the next chronic kidney disease stage are ≈ 2% for people with normal urine albumin, 3–5% for people with microalbuminuria (3–30 mg/mmol) and 3–12% for people with macroalbuminuria (> 30 mg/mmol). Variability in estimated glomerular filtration rate-creatinine leads to misclassification of chronic kidney disease stage in 12–15% of tests in primary care. Glycaemic-control and lipid-modifying drugs are associated with a 6% (95% confidence interval 2% to 10%) and 4% (95% confidence interval 0% to 8%) improvement in renal function, respectively. Neither estimated glomerular filtration rate-creatinine nor estimated glomerular filtration rate-Cystatin C have utility in predicting rate of kidney function change. Patients viewed phrases such as ‘kidney damage’ or ‘kidney failure’ as frightening, and the term ‘chronic’ was misinterpreted as serious. Diagnosis of asymptomatic conditions (chronic kidney disease) was difficult to understand, and primary care professionals often did not use ‘chronic kidney disease’ when managing patients at early stages. General practitioners relied on Clinical Commissioning Group or Quality and Outcomes Framework alerts rather than National Institute for Health and Care Excellence guidance for information. Cost-effectiveness modelling did not demonstrate a tangible benefit of monitoring kidney function to guide preventative treatments, except for individuals with an estimated glomerular filtration rate of 60–90 ml/minute/1.73 m2, aged < 70 years and without cardiovascular disease, where monitoring every 3–4 years to guide cardiovascular prevention may be cost-effective. Chronic heart failure: natriuretic peptide-guided treatment could reduce all-cause mortality by 13% and heart failure admission by 20%. Implementing natriuretic peptide-guided treatment is likely to require predefined protocols, stringent natriuretic peptide targets, relative targets and being located in a specialist heart failure setting. Remote monitoring can reduce all-cause mortality and heart failure hospitalisation, and could improve quality of life. Diagnostic accuracy of point-of-care N-terminal prohormone of B-type natriuretic peptide (sensitivity, 0.99; specificity, 0.60) was better than point-of-care B-type natriuretic peptide (sensitivity, 0.95; specificity, 0.57). Within-person variation estimates for B-type natriuretic peptide and weight were as follows: coefficient of variation, 46% and coefficient of variation, 1.2%, respectively. Point-of-care N-terminal prohormone of B-type natriuretic peptide within-person variability over 12 months was 881 pg/ml (95% confidence interval 380 to 1382 pg/ml), whereas between-person variability was 1972 pg/ml (95% confidence interval 1525 to 2791 pg/ml). For individuals, monitoring provided reassurance; future changes, such as increased testing, would be acceptable. Point-of-care testing in general practice surgeries was perceived positively, reducing waiting time and anxiety. Community heart failure nurses had greater knowledge of National Institute for Health and Care Excellence guidance than general practitioners and practice nurses. Health-care professionals believed that the cost of natriuretic peptide tests in routine monitoring would outweigh potential benefits. The review of cost-effectiveness studies suggests that natriuretic peptide-guided treatment is cost-effective in specialist settings, but with no evidence for its value in primary care settings.
Limitations
No randomised controlled trial evidence was generated. The pathways to the benefit of monitoring chronic kidney disease were unclear.
Conclusions
It is difficult to ascribe quantifiable benefits to monitoring chronic kidney disease, because monitoring is unlikely to change treatment, especially in chronic kidney disease stages G3 and G4. New approaches to monitoring chronic heart failure, such as point-of-care natriuretic peptide tests in general practice, show promise if high within-test variability can be overcome.
Future work
The following future work is recommended: improve general practitioner–patient communication of early-stage renal function decline, and identify strategies to reduce the variability of natriuretic peptide.
Study registration
This study is registered as PROSPERO CRD42015017501, CRD42019134922 and CRD42016046902.
Funding
This project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 9, No. 10. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Rafael Perera
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Richard Stevens
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Jeffrey K Aronson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Amitava Banerjee
- Institute of Health Informatics, University College London, London, UK
| | - Julie Evans
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Benjamin G Feakins
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Susannah Fleming
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Paul Glasziou
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences & Medicine, Bond University, Gold Coast, QLD, Australia
| | - Carl Heneghan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - FD Richard Hobbs
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Louise Jones
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Milena Kurtinecz
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Daniel S Lasserson
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Louise Locock
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Julie McLellan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Borislava Mihaylova
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Institute of Population Health Sciences, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | | | - Jason L Oke
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Nicola Pidduck
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Annette Plüddemann
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Nia Roberts
- Bodleian Health Care Libraries, Knowledge Centre, University of Oxford, Oxford, UK
| | - Iryna Schlackow
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Brian Shine
- Department of Clinical Biochemistry, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Claire L Simons
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Clare J Taylor
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Kathryn S Taylor
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Jan Y Verbakel
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
- National Institute for Health Research (NIHR) Community Healthcare MedTech and In Vitro Diagnostics Co-operative (MIC), Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Clare Bankhead
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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16
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Krishnan A, Teixeira-Pinto A, Lim WH, Howard K, Chapman JR, Castells A, Roger SD, Bourke MJ, Macaskill P, Williams G, Lok CE, Diekmann F, Cross N, Sen S, Allen RDM, Chadban SJ, Pollock CA, Turner R, Tong A, Yang JYH, Williams N, Au E, Kieu A, James L, Francis A, Wong G, Craig JC. Health-Related Quality of Life in People Across the Spectrum of CKD. Kidney Int Rep 2020; 5:2264-2274. [PMID: 33305120 PMCID: PMC7710842 DOI: 10.1016/j.ekir.2020.09.028] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 09/08/2020] [Indexed: 11/30/2022] Open
Abstract
Introduction People with chronic kidney disease (CKD) experience reduced quality of life (QoL) because of the high symptom and treatment burden. Limited data exist on the factors associated with overall and domain-specific QoL across all CKD stages. Methods Using data from a prospective, multinational study (Australia, New Zealand, Canada, and Spain) in 1696 participants with CKD, we measured overall and domain-specific QoL (pain, self-care, activity, mobility, anxiety/depression) using the EuroQoL, 5 dimension, 3 level. Multivariable linear regression and logistic modeling were used to determine factors associated with overall and domain-specific QoL. Results QoL for patients with CKD stages 3 to 5 (n = 787; mean, 0.81; SD, 0.20) was higher than in patients on dialysis (n = 415; mean, 0.76; SD, 0.24) but lower than in kidney transplant recipients (n = 494; mean, 0.84; SD, 0.21). Factors associated with reduced overall QoL (β [95% confidence intervals]) included being on dialysis (compared with CKD stages 3–5: –0.06 [–0.08 to –0.03]), female sex (–0.03 [–0.05 to –0.006]), lower educational attainment (– 0.04 [–0.06 to –0.02), lacking a partner (–0.04 [–0.06 to –0.02]), having diabetes (–0.05 [–0.07 to –0.02]), history of stroke (–0.09 [–0.13 to –0.05]), cardiovascular disease (–0.06 [–0.08 to –0.03]), and cancer (–0.03 [–0.06 to –0.009]). Pain (43%) and anxiety/depression (30%) were the most commonly affected domains, with dialysis patients reporting decrements in all 5 domains. Predictors for domain-specific QoL included being on dialysis, presence of comorbidities, lower education, female sex, and lack of a partner. Conclusions Being on dialysis, women with CKD, those with multiple comorbidities, lack of a partner, and lower educational attainment were associated with lower QoL across all stages of CKD.
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Affiliation(s)
- Anoushka Krishnan
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, Australia
| | - Armando Teixeira-Pinto
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Wai H Lim
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, Australia
| | - Kirsten Howard
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Jeremy R Chapman
- Centre for Transplant and Renal Research, Westmead Hospital, Westmead, Australia
| | - Antoni Castells
- Gastroenterology Department, Hospital Clinic, University of Barcelona, IDIBAPS, CIBEREHD, Barcelona, Spain
| | - Simon D Roger
- Department of Renal Medicine, Gosford Hospital, Gosford, Australia
| | - Michael J Bourke
- Department of Gastroenterology, Westmead Hospital, Westmead, Australia
| | - Petra Macaskill
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Gabrielle Williams
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Charmaine E Lok
- Department of Medicine, University Health Network-Toronto General Hospital, Toronto, Ontario, Canada
| | - Fritz Diekmann
- Department of Nephrology and Kidney Transplantation, Hospital Clínic, Barcelona, Spain
| | - Nicholas Cross
- Department of Nephrology and Kidney Transplantation, Christchurch Hospital and Otago University, Christchurch, New Zealand
| | - Shaundeep Sen
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Department of Renal Medicine, Concord Repatriation General Hospital, Concord, Australia
| | - Richard D M Allen
- Department of Renal Medicine, Royal Prince Alfred Hospital, and Charles Perkins Centre, The University of Sydney, Sydney, Australia
| | - Steven J Chadban
- Department of Renal Medicine, Royal Prince Alfred Hospital, and Charles Perkins Centre, The University of Sydney, Sydney, Australia
| | - Carol A Pollock
- Department of Medicine, Northern Clinical School, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Robin Turner
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Biostatistics Unit, Dunedin School of Medicine, University of Otago, Christchurch, New Zealand
| | - Allison Tong
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Jean Y H Yang
- School of Mathematics and Statistics, The University of Sydney, Sydney, Australia
| | - Narelle Williams
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Eric Au
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Anh Kieu
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Laura James
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Anna Francis
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Germaine Wong
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Centre for Transplant and Renal Research, Westmead Hospital, Westmead, Australia
| | - Jonathan C Craig
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
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17
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Kim YT, Chung HJ, Park BR, Kim YY, Lee JH, Kang DR, Kim JY, Lee MY, Lee JY. Risk of Cardiovascular Disease and Chronic Kidney Disease According to 2017 Blood Pressure Categories in Diabetes Mellitus. Hypertension 2020; 76:766-775. [PMID: 32755407 DOI: 10.1161/hypertensionaha.120.15320] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The association between blood pressure (BP) defined by the 2017 American College of Cardiology/American Heart Association Hypertension Clinical Practice Guidelines with cardiovascular disease (CVD) and chronic kidney disease in patients with diabetes mellitus remains unclear. This study used the National Health Insurance Database of Korea that has health information of 8 922 940 persons who were screened from 2009 to 2014. We determined the BP status of 490 352 diabetes mellitus: level 1 (systolic <120 mm Hg and diastolic <80 mm Hg), level 2 (systolic 120-129 mm Hg and diastolic <80 mm Hg), level 3 (systolic 130-139 mm Hg or diastolic 80-89 mm Hg), and level 4 (systolic ≥140 mm Hg or diastolic ≥90 mm Hg). Over a mean follow-up of 5 years, 6508 CVD events (1.3%), 14 318 cases of chronic kidney disease development (2.9%), 9094 cerebrovascular events (2.0%), and 1150 CVD mortalities (0.2%) occurred. Compared with people with BP levels 1, the adjusted hazard ratios for CVD in people with BP levels 2, 3, and 4 were 1.07 (95% CI, 0.98-1.16), 1.12 (95% CI, 1.04-1.20), and 1.17 (95% CI, 1.08-1.26), respectively. There were also increased risks of chronic kidney disease (1.18 [95% CI, 1.12-1.24] and 1.22 [95% CI, 1.15-1.29]), cerebrovascular disease (1.21 [95% CI, 1.14-1.29] and 1.52 [95% CI, 1.42-1.63]), and CVD mortality (1.31 [95% CI, 1.09-1.56] and 1.91 [95% CI, 1.58-2.32]) among subjects with BP levels 3 and 4 compared with those with BP level 1. These findings provide evidence supporting the 2017 American College of Cardiology/American Heart Association Hypertension Clinical Practice Guidelines for BP targets in diabetes mellitus patients.
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Affiliation(s)
- Yong Tae Kim
- From the Department of Internal Medicine (Y.T.K., H.J.C., Y.Y.K., J.-Y.K., M.Y.L., J.Y.L.), Yonsei University Wonju College of Medicine, Korea
| | - Hyung Joon Chung
- From the Department of Internal Medicine (Y.T.K., H.J.C., Y.Y.K., J.-Y.K., M.Y.L., J.Y.L.), Yonsei University Wonju College of Medicine, Korea
| | - Bo Ram Park
- Big Data Department, National Health Insurance Service, Wonju, Korea (B.R.P., Y.Y.K.)
| | - Yeon Yong Kim
- From the Department of Internal Medicine (Y.T.K., H.J.C., Y.Y.K., J.-Y.K., M.Y.L., J.Y.L.), Yonsei University Wonju College of Medicine, Korea.,Big Data Department, National Health Insurance Service, Wonju, Korea (B.R.P., Y.Y.K.)
| | - Jun Hyeok Lee
- Department of Biostatistics (J.H.L.), Yonsei University Wonju College of Medicine, Korea
| | - Dae Ryong Kang
- Department of Precision Medicine (D.R.K.), Yonsei University Wonju College of Medicine, Korea
| | - Jang-Young Kim
- From the Department of Internal Medicine (Y.T.K., H.J.C., Y.Y.K., J.-Y.K., M.Y.L., J.Y.L.), Yonsei University Wonju College of Medicine, Korea
| | - Mi Young Lee
- From the Department of Internal Medicine (Y.T.K., H.J.C., Y.Y.K., J.-Y.K., M.Y.L., J.Y.L.), Yonsei University Wonju College of Medicine, Korea
| | - Jun Young Lee
- From the Department of Internal Medicine (Y.T.K., H.J.C., Y.Y.K., J.-Y.K., M.Y.L., J.Y.L.), Yonsei University Wonju College of Medicine, Korea
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18
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Ishigami J, Sang Y, Grams ME, Coresh J, Chang A, Matsushita K. Effectiveness of Influenza Vaccination Among Older Adults Across Kidney Function: Pooled Analysis of 2005-2006 Through 2014-2015 Influenza Seasons. Am J Kidney Dis 2020; 75:887-896. [DOI: 10.1053/j.ajkd.2019.09.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 09/02/2019] [Indexed: 02/07/2023]
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19
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van Haalen H, Jackson J, Spinowitz B, Milligan G, Moon R. Impact of chronic kidney disease and anemia on health-related quality of life and work productivity: analysis of multinational real-world data. BMC Nephrol 2020; 21:88. [PMID: 32143582 PMCID: PMC7060645 DOI: 10.1186/s12882-020-01746-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 02/27/2020] [Indexed: 12/18/2022] Open
Abstract
Background Reductions in health-related quality of life (HRQoL) in patients with chronic kidney disease (CKD) are thought to be exacerbated by the low hemoglobin (Hb) levels that define anemia, a common complication of CKD. The current analysis evaluated the impact of anemia on HRQoL and work productivity in patients with non-dialysis dependent and dialysis-dependent CKD using real-world data. Methods Data were collected in France, Germany, Italy, Spain, the UK, the USA and China in 2012–2018 in the Adelphi Real World Disease Specific Programme™ for CKD, a large, cross-sectional, survey of physicians and their patients. Patients completed three patient-reported outcomes (PRO) instruments: the EuroQol 5-Dimension 3-level (EQ-5D-3 L), the Kidney Disease Quality of Life (KDQOL-36) instrument and the Work Productivity and Activity Impairment questionnaire. PROs were assessed by CKD stage and Hb levels, and regression analyses were performed with CKD stage and Hb level as independent variables and PROs as outcome variables, while adjusting for age, sex, CKD stage, comorbidities and cardiovascular risk. Results Overall, 5276 patients participated in the survey, including 28% stage 4 and 36% dialysis patients. Patients with lower Hb levels more often reported problems/issues on all EQ-5D-3 L domains (p < 0.0001). Regression analyses showed significant associations between lower Hb levels and the probability of low (< 0.8) EQ-5D-3 L utility scores (p < 0.0001) and low visual analog scale scores (p < 0.05), indicating poorer health status. Associations were seen even when adjusting for CKD stage and other potential confounding factors. Significant associations were observed between Hb level and the 12-Item Short-Form Health Survey (SF-12) Physical Component Summary, SF-12 Mental Component Summary and the three KDQOL-36 subscales (all p < 0.0001), and were confirmed using linear regression analyses adjusting for CKD stage and other potential confounders. Numerically greater work productivity losses and greater activity impairment were observed with lower Hb levels. Conclusions Lower Hb levels worsen the impact of CKD on HRQoL, and are associated with lower work productivity in patients with CKD. Assessment and treatment of anemia should be recognized as a key component of integral CKD management throughout all stages of the disease.
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Affiliation(s)
| | | | - Bruce Spinowitz
- Division of Nephrology, New York Presbyterian Queens, Flushing, NY, USA
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20
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Jo MW, Lee HJ, Ryu DR, Park J, Ock M, Kim SH. Estimation of population-based utility weights for health states of chronic kidney disease, dialysis and kidney transplantation. Nephrology (Carlton) 2020; 25:544-550. [PMID: 32026549 DOI: 10.1111/nep.13700] [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: 09/25/2019] [Revised: 01/12/2020] [Accepted: 01/14/2020] [Indexed: 11/28/2022]
Abstract
AIM This study aimed to determine the utility of chronic kidney disease (CKD)-related health states in the Korean general population by using the standard gamble (SG) method. METHODS Seven hypothetical CKD-related health states were developed and revised based on previous publications. Data from 242 individuals from the Korean general population were obtained via computer-assisted personal interviews and used to evaluate the CKD-related health states by using the visual analogue scale (VAS) and SG methods. Mean and median utility values were calculated for each health state. To assess the reliability of the valuation, some samples were retested and evaluated using intraclass correlation coefficients (ICC). RESULTS In all health states, the utility weights from SG were higher than those from VAS. The difference in utility values between the two valuation methods ranged from 0.258 to 0.308. The utility value of CKD grade 3 was the highest and that of peritoneal dialysis (PD) was the lowest. The utility weights tended to decrease in accordance with the progression of CKD. CKD grade 3 was assigned a SG utility value of 0.878, whereas PD was assigned 0.507. The SG utility values of predialysis end-stage renal disease, haemodialysis, kidney transplantation (KT), and post-KT recovery states were 0.666, 0.547, 0.748 and 0.827, respectively. The mean ICC (SD) at the individual level was 0.746 (0.281) for the SG scores. CONCLUSION Our results could be used to measure the burden of kidney disease or to evaluate the economic efficiency of CKD-related interventions.
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Affiliation(s)
- Min-Woo Jo
- Department of Preventive Medicine, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hyeon-Jeong Lee
- Division of Healthcare Technology Assessment Research, National Evidence-based Healthcare Collaborating Agency, Seoul, Republic of Korea
| | - Dong-Ryeol Ryu
- Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Jongha Park
- Division of Nephrology, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Minsu Ock
- Department of Preventive Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Seon-Ha Kim
- Department of Nursing, Dankook University, Cheonan, Republic of Korea
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21
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Chronic kidney disease attenuates the impact of obesity on quality of life. Sci Rep 2020; 10:2375. [PMID: 32047200 PMCID: PMC7012880 DOI: 10.1038/s41598-020-59382-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 01/27/2020] [Indexed: 12/14/2022] Open
Abstract
The impact of obesity on health-related quality of life (HRQoL) in chronic kidney disease (CKD) population has not been elucidated, despite the impairment of HRQoL in the obese among general population. We hypothesized that the impact of obesity on HRQoL might be confounded by impaired renal function in CKD population, and that CKD would attenuate the impact of obesity on HRQoL. To compare the impact of obesity on HRQoL according to kidney function, 17,001 subjects from Korea National Health and Nutrition Examination Survey (2008–2011) were categorized by estimated glomerular filtration rate (eGFR), as follows: group 1, eGFR ≥ 90 mL/min/1.73 m2; group 2, eGFR of 60–89 mL/min/1.73 m2; group 3, eGFR < 60 mL/min/1.73 m2. The association between obesity parameters (body mass index, waist circumference and, truncal fat mass) and HRQoL parameters (EQ-5D index and EQ-VAS) were cross-sectionally analyzed. Despite robust correlations between obesity parameters and low EQ-5D index or EQ-VAS in general population, no significant association was observed in group 3 population. Impact of obesity on HRQoL in CKD population was only limitedly observed in the mobility domain of EQ-5D, as mobility limitation was associated with increased body mass index or waist circumference regardless of kidney function. Therefore, the impact of obesity on HRQoL seems significantly attenuated in CKD population, suggesting that the risk of obesity should not be over-estimated in patients with CKD, especially with respect to HRQoL.
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22
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Modi GK, Yadav AK, Ghosh A, Kamboj K, Kaur P, Kumar V, Bhansali S, Prasad N, Sahay M, Parameswaran S, Varughese S, Gang S, Singh S, Sircar D, Gopalakrishnan N, Jaryal A, Vikrant S, Baid-Agrawal S, Jha V. Nonmedical Factors and Health-Related Quality of Life in CKD in India. Clin J Am Soc Nephrol 2020; 15:191-199. [PMID: 32001488 PMCID: PMC7015100 DOI: 10.2215/cjn.06510619] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 11/07/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Patient-reported outcomes have gained prominence in the management of chronic noncommunicable diseases. Measurement of health-related quality of life is being increasingly incorporated into medical decision making and health care delivery processes. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS The Indian Chronic Kidney Disease Study is a prospective cohort of participants with mild to moderate CKD. Baseline health-related quality of life scores, determined by the standardized Kidney Disease Quality of Life 36 item instrument, are presented for the inception cohort (n=2919). Scores are presented on five subscales: mental component summary, physical component summary, burden, effect of kidney disease, and symptom and problems; each is scored 0-100. The associations of socioeconomic and clinical parameters with the five subscale scores and lower quality of life (defined as subscale score <1 SD of the sample mean) were examined. The main socioeconomic factors studied were sex, education, occupation, and income. The key medical factors studied were age, eGFR, diabetes, hypertension, and albuminuria. RESULTS The mean (SD) subscale scores were physical component summary score, 43±9; mental component summary score, 48±10; burden, 61±33; effects, 87±13; and symptoms, 90±20. Among the socioeconomic variables, women, lower education, and lower income were negatively associated with reduced scores across all subscales. For instance, the respective β-coefficients (SD) for association with the physical component summary subscale were -2.6 (-3.4 to -1.8), -1.5 (-2.2 to -0.7), and -1.6 (-2.7 to -0.5). Medical factors had inconsistent or no association with subscale scores. The quality of life scores also displayed regional variations. CONCLUSIONS In this first of its kind analysis from India, predominantly socioeconomic factors were associated with quality of life scores in patients with CKD.
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Affiliation(s)
- Gopesh K Modi
- Nephrology, Samarpan Kidney Institute and Research Center, Bhopal, India
| | - Ashok K Yadav
- Departments of Experimental Medicine and Biotechnology and
| | - Arpita Ghosh
- George Institute for Global Health, University of New South Wales, New Delhi, India
| | - Kajal Kamboj
- Nephrology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Prabhjot Kaur
- Nephrology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vivek Kumar
- Nephrology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Shobhit Bhansali
- Nephrology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Narayan Prasad
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Manisha Sahay
- Department of Nephrology, Osmania Medical College, Osmania General Hospital, Hyderabad, India
| | - Sreejith Parameswaran
- Department of Nephrology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | | | - Sishir Gang
- Department of Nephrology, Muljibhai Patel Urological Hospital, Nadiad, India
| | - Shivendra Singh
- Department of Nephrology, Institute of Medical Science, Banaras Hindu University, Varanasi, India
| | - Dipankar Sircar
- Department of Nephrology, Institute of Post Graduate Medical Education and Research, Kolkata, India
| | | | - Ajay Jaryal
- Department of Nephrology, Indira Gandhi Medical College, Shimla, India
| | - Sanjay Vikrant
- Department of Nephrology, Indira Gandhi Medical College, Shimla, India
| | - Seema Baid-Agrawal
- Department of Nephrology and Transplant Center, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
| | - Vivekanand Jha
- George Institute for Global Health, University of New South Wales, New Delhi, India; .,Manipal Academy of Higher Education, Manipal, Karnataka, India; and.,University of Oxford, Oxford, United Kingdom
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23
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Ishigami J, Padula WV, Grams ME, Chang AR, Jaar B, Gansevoort RT, Bridges JF, Kovesdy CP, Uchida S, Coresh J, Matsushita K. Cost-effectiveness of Pneumococcal Vaccination Among Patients With CKD in the United States. Am J Kidney Dis 2019; 74:23-35. [DOI: 10.1053/j.ajkd.2019.01.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Accepted: 01/12/2019] [Indexed: 11/11/2022]
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24
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Viggiano D, Wagner CA, Blankestijn PJ, Bruchfeld A, Fliser D, Fouque D, Frische S, Gesualdo L, Gutiérrez E, Goumenos D, Hoorn EJ, Eckardt KU, Knauß S, König M, Malyszko J, Massy Z, Nitsch D, Pesce F, Rychlík I, Soler MJ, Spasovski G, Stevens KI, Trepiccione F, Wanner C, Wiecek A, Zoccali C, Unwin R, Capasso G. Mild cognitive impairment and kidney disease: clinical aspects. Nephrol Dial Transplant 2019; 35:10-17. [PMID: 31071220 DOI: 10.1093/ndt/gfz051] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 02/21/2019] [Indexed: 02/06/2023] Open
Affiliation(s)
- Davide Viggiano
- Department of Translational Medical Sciences, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Carsten A Wagner
- Institute of Physiology, University of Zurich, Winterthurerstrasse 190, CH-8057, Zurich, Switzerland and National Center of Competence in Research (NCCR) Kidney CH, Switzerland
| | - Peter J Blankestijn
- Department of Nephrology, University Medical Center, Utrecht, The Netherlands
| | - Annette Bruchfeld
- Department of Renal Medicine, CLINTEC, Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden
| | - Danilo Fliser
- Department of Internal Medicine IV-Nephrology and Hypertension, Saarland University Medical Centre, Homburg, Germany
| | - Denis Fouque
- Department of Nephrology, Dialysis, Nutrition, Centre Hospitalier Lyon Sud, Université de Lyon, F-69495 Pierre Bénite Cedex, France
| | | | - Loreto Gesualdo
- Division of Nephrology, Azienda Ospedaliero-Universitaria Policlinico, Bari and University 'Aldo Moro' of Bari, Bari, Italy
| | - Eugenio Gutiérrez
- Department of Clinical Medicine, Center of Functionally Integrative Neuroscience, University of Aarhus, Aarhus, Denmark
| | | | - Ewout J Hoorn
- Department of Internal Medicine, Division of Nephrology and Transplantation, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Kai-Uwe Eckardt
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Samuel Knauß
- Klinik für Neurologie mit Experimenteller Neurologie, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Berlin, Germany
| | - Maximilian König
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Jolanta Malyszko
- Department of Nephrology, Dialysis and Internal Medicine, Warsaw Medical University, Warsaw, Poland
| | - Ziad Massy
- Division of Nephrology, Ambroise Paré Hospital, APHP, Paris-Ile-de-France-West University (UVSQ), Boulogne Billancourt/Paris, INSERM U1018 Team5, Villejuif, France
| | - Dorothea Nitsch
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Francesco Pesce
- Division of Nephrology, Azienda Ospedaliero-Universitaria Policlinico, Bari and University 'Aldo Moro' of Bari, Bari, Italy
| | - Ivan Rychlík
- First Department of Internal Medicine, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Maria Jose Soler
- Department of Nephrology, Hospital Universitari Vall d'Hebron, Nephrology Research Group, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - Goce Spasovski
- Department of Nephrology, Medical Faculty, University of Skopje, Skopje, Former Yugoslav, Republic of Macedonia
| | - Kathryn I Stevens
- Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, UK
| | - Francesco Trepiccione
- Department of Translational Medical Sciences, University of Campania 'Luigi Vanvitelli', Naples, Italy.,Department of Genetic and Translational Medicine, Biogem, Ariano Irpino, Italy
| | - Christoph Wanner
- Department of Medicine, Division of Nephrology, University Hospital, Wuerzburg, Germany
| | - Andrzej Wiecek
- Department of Nephrology, Transplantation and Internal Medicine, Medical University of Silesia, Katowice, Poland
| | | | - Robert Unwin
- Centre for Nephrology, University College London (UCL), Royal Free Campus, London, UK.,AstraZeneca IMED ECD CVRM R&D, Gothenburg, Sweden
| | - Giovambattista Capasso
- Department of Translational Medical Sciences, University of Campania 'Luigi Vanvitelli', Naples, Italy.,Department of Genetic and Translational Medicine, Biogem, Ariano Irpino, Italy
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25
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Ryu J, Yoon SR, An WS, Kim OY. Relationship between Nutrition Intake and Estimated Glomerular Filtration Rate in Korean Adults (30-65 years) from the Korea National Health and Nutrition Examination Survey 2013-2014. Clin Nutr Res 2018; 7:102-111. [PMID: 29713618 PMCID: PMC5921327 DOI: 10.7762/cnr.2018.7.2.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Revised: 04/09/2018] [Accepted: 04/09/2018] [Indexed: 11/19/2022] Open
Abstract
This study aimed to examine the relationship between nutrition intake and estimated glomerular filtration rate (eGFR) indicating kidney function in Korean individuals without diabetes or cardiovascular disease. Study participants from the Korea National Health and Nutrition Examination Survey 2013–2014 (n = 4,378, 30–65 years) were classified by their eGFR levels (mL/min/1.732 m2): ≥ 120 (n = 299), 119–105 (n = 789), 104–90 (n = 1,578), 89–60 (n = 1,685), < 60 (n = 27). After adjusted for confounding factors (age, sex, cigarette smoking, alcohol drinking, total caloric intake [TCI], income status, education level, body mass index, and physical activity), blood pressure, low-density lipoprotein (LDL) cholesterol, aspartate aminotransferase, alanine aminotransferase, blood urea nitrogen, creatinine, fasting glucose, and glycated hemoglobin were higher, and high density lipoprotein cholesterol levels were lower in participants with lower eGFR levels than those with higher eGFR levels. n-3 fatty acid (FA) and n-6 FA (% of TCI/day) intake were also significantly higher in participants with higher eGFR levels than in those with lower eGFR levels. Based on the above results, participants were subdivided into 3 groups according to n-6 FA intake levels (Q1: ≥ 2.93%, n = 1,462; Q2: 2.92%–1.88%, n = 1,463; Q3: < 1.88%, n = 1,453). People consuming higher n-6 FAs, particularly the Q1 group showed higher eGFR levels and lower levels of LDL cholesterol and creatinine. In conclusion, higher intake of n-6 FAs within the range of dietary reference may be beneficial to maintain healthy kidney function.
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Affiliation(s)
- Jihye Ryu
- Department of Food Science and Nutrition, Brain Busan 21 Project, Dong-A University, Busan 49315, Korea.,Department of Nutrition Management, Dong-A University Hospital, Busan 49201, Korea
| | - So Ra Yoon
- Department of Food Science and Nutrition, Brain Busan 21 Project, Dong-A University, Busan 49315, Korea
| | - Won Suk An
- Department of Internal Medicine, Dong-A University College of Medicine, Busan 49201, Korea
| | - Oh Yoen Kim
- Department of Food Science and Nutrition, Brain Busan 21 Project, Dong-A University, Busan 49315, Korea
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26
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Lee SW. Potential Role of Psychosocial Factors on Health-Related Quality of Life in Hemodialysis Patients. J Korean Med Sci 2018; 33:e121. [PMID: 29607638 PMCID: PMC5879043 DOI: 10.3346/jkms.2018.33.e121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 03/28/2018] [Indexed: 11/20/2022] Open
Affiliation(s)
- Sung Woo Lee
- Division of Nephrology, Department of Internal Medicine, Eulji General Hospital, Eulji University, Seoul, Korea.
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27
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Webster AC, Nagler EV, Morton RL, Masson P. Chronic Kidney Disease. Lancet 2017; 389:1238-1252. [PMID: 27887750 DOI: 10.1016/s0140-6736(16)32064-5] [Citation(s) in RCA: 2004] [Impact Index Per Article: 286.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 06/29/2016] [Accepted: 07/19/2016] [Indexed: 02/08/2023]
Abstract
The definition and classification of chronic kidney disease (CKD) have evolved over time, but current international guidelines define this condition as decreased kidney function shown by glomerular filtration rate (GFR) of less than 60 mL/min per 1·73 m2, or markers of kidney damage, or both, of at least 3 months duration, regardless of the underlying cause. Diabetes and hypertension are the main causes of CKD in all high-income and middle-income countries, and also in many low-income countries. Incidence, prevalence, and progression of CKD also vary within countries by ethnicity and social determinants of health, possibly through epigenetic influence. Many people are asymptomatic or have non-specific symptoms such as lethargy, itch, or loss of appetite. Diagnosis is commonly made after chance findings from screening tests (urinary dipstick or blood tests), or when symptoms become severe. The best available indicator of overall kidney function is GFR, which is measured either via exogenous markers (eg, DTPA, iohexol), or estimated using equations. Presence of proteinuria is associated with increased risk of progression of CKD and death. Kidney biopsy samples can show definitive evidence of CKD, through common changes such as glomerular sclerosis, tubular atrophy, and interstitial fibrosis. Complications include anaemia due to reduced production of erythropoietin by the kidney; reduced red blood cell survival and iron deficiency; and mineral bone disease caused by disturbed vitamin D, calcium, and phosphate metabolism. People with CKD are five to ten times more likely to die prematurely than they are to progress to end stage kidney disease. This increased risk of death rises exponentially as kidney function worsens and is largely attributable to death from cardiovascular disease, although cancer incidence and mortality are also increased. Health-related quality of life is substantially lower for people with CKD than for the general population, and falls as GFR declines. Interventions targeting specific symptoms, or aimed at supporting educational or lifestyle considerations, make a positive difference to people living with CKD. Inequity in access to services for this disease disproportionally affects disadvantaged populations, and health service provision to incentivise early intervention over provision of care only for advanced CKD is still evolving in many countries.
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Affiliation(s)
- Angela C Webster
- Sydney School of Public Health, University of Sydney, NSW, Australia; Centre for Transplant and Renal research, Westmead Hospital, Westmead, NSW, Australia.
| | - Evi V Nagler
- Renal Section, Department of Internal Medicine, Ghent University Hospital, Ghent, Belgium
| | - Rachael L Morton
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia
| | - Philip Masson
- Department of Renal Medicine, Royal Infirmary of Edinburgh, Edinburgh, Scotland, UK
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28
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Park JI, Baek H, Kim BR, Jung HH. Comparison of urine dipstick and albumin:creatinine ratio for chronic kidney disease screening: A population-based study. PLoS One 2017; 12:e0171106. [PMID: 28151999 PMCID: PMC5289498 DOI: 10.1371/journal.pone.0171106] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 01/16/2017] [Indexed: 01/20/2023] Open
Abstract
Chronic kidney disease (CKD) is usually diagnosed using the estimated glomerular filtration rate (eGFR) or kidney damage markers. The urine dipstick test is a widely used screening tool for albuminuria, a CKD marker. Although the urine albumin:creatinine ratio (ACR) has advantages over the dipstick test in sensitivity and quantification of levels, the two methods have not been compared in the general population. A total of 20,759 adults with urinalysis data in the Korea National Health and Nutrition Examination Survey 2011–2014 were examined. CKD risk categories were created using a combination of eGFR and albuminuria. Albuminuria was defined using an ACR cutoff of 30 mg/g or 300 mg/g and a urine dipstick cutoff of trace or 1+. The EQ-5D index was used for the health outcome. Prevalence estimates of ACR ≥30 mg/g and >300 mg/g vs dipstick ≥trace and ≥1+ in adults aged ≥20 years were 7.2% and 0.9% vs 9.1% and 1.2%, respectively. For ACR ≥30 mg/g detection, the sensitivity, specificity, and positive/negative predictive values of dipstick ≥trace were 43.6%, 93.6%, 34.6%, and 95.5%, respectively. When risk categories created based on dipstick cutoffs were compared with those based on ACR cutoffs, 10.4% of the total population was reclassified to different risk categories, with only 3.9% reclassified to the same CKD category. Akaike information criterion values were lower, and non-fatal disease burdens of CKD were larger, in models predicting EQ-5D index using ACR-based categories compared to those using dipstick-based categories, even after adjusting for confounders. In conclusion, the urine dipstick test had poor sensitivity and high false-discovery rates for ACR ≥30 mg/g detection, and classified a large number of individuals into different CKD risk categories compared with ACR-based categories. Therefore, ACR assessments in CKD screening appear beneficial for a more accurate prediction of worse quality of life.
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Affiliation(s)
- Ji In Park
- Department of Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Gangwon-do, South Korea
| | - Hyunjeong Baek
- Department of Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Gangwon-do, South Korea
| | - Bo Ra Kim
- Department of Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Gangwon-do, South Korea
| | - Hae Hyuk Jung
- Department of Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Gangwon-do, South Korea
- * E-mail:
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29
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Abstract
The purpose of the present study was to investigate the association between the number of natural teeth and measures of kidney dysfunction, such as urinary albumin/creatinine ratio (ACR) and estimated glomerular filtration (eGFR) rate, using nationally representative data.The data used were from the Korea National Health and Nutrition Examination Survey with cross-sectional design, which was conducted between 2011 and 2012; the sample analyzed in this study consisted of a total of 10,388 respondents, each of whom was 19 years or older and had no missing outcome variables. The association between the number of natural teeth and kidney function was assessed by multiple logistic regression and model was adjusted for age, sex, waist conference, smoking, drinking, exercise, education, income, frequency of tooth brushing per day, diabetes, metabolic syndrome, urinary ACR, and eGFR.The mean age, body mass index, and waist circumference were significantly higher among those with lower kidney function (urinary ACR ≥30 mg/g and eGFR <60 mL/min/1.73m). Urinary ACR and eGFR were associated with loss of natural teeth. As urinary ACR increased, the number of natural teeth decreased accordingly. Conversely, the number of natural teeth increased with an increase in eGFR.This study showed that the number of natural teeth is inversely associated with the presence of kidney disease. Severity of tooth loss may be considered an independent risk indicator for kidney disease among Koreans. More epidemiological studies are warranted to investigate the role of tooth loss in kidney disease, to confirm this relationship and to test possible underlying mechanisms.
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Affiliation(s)
- Hye Min Choi
- Department of Internal Medicine, Seonam University Myongji Hospital, Goyang, Gyeonggi-do
| | | | | | - Jun-Beom Park
- Department of Periodontics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Correspondence: Jun-Beom Park, Department of Periodontics, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea (e-mail: )
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30
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Wyld ML, Chadban SJ, Morton RL. Improving Our Understanding of Quality of Life in CKD. Am J Kidney Dis 2016; 67:820-1. [DOI: 10.1053/j.ajkd.2016.03.412] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 03/10/2016] [Indexed: 11/11/2022]
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