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Gallagher A, Smyth B, Jha V. Climate Change, Heat-Related Acute Kidney Disease, and the Need for Action. Am J Kidney Dis 2023; 81:501-503. [PMID: 36759239 DOI: 10.1053/j.ajkd.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 11/13/2022] [Indexed: 02/10/2023]
Affiliation(s)
- Alex Gallagher
- Department of Renal Medicine, St George Hospital, Kogarah, Australia; NHMRC Clinical Trials Centre, University of Sydney, Camperdown, Australia
| | - Brendan Smyth
- Department of Renal Medicine, St George Hospital, Kogarah, Australia; NHMRC Clinical Trials Centre, University of Sydney, Camperdown, Australia.
| | - Vivekanand Jha
- The George Institute for Global Health, New Delhi, India; School of Public Health, Imperial College London, London, United Kingdom; Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
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Smyth B, Trongtrakul K, Haber A, Talbot B, Hawley C, Perkovic V, Woodward M, Jardine M. Inequities in the global representation of sites participating in large, multicentre dialysis trials: a systematic review. BMJ Glob Health 2019; 4:e001940. [PMID: 31799004 PMCID: PMC6861095 DOI: 10.1136/bmjgh-2019-001940] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 10/18/2019] [Accepted: 10/19/2019] [Indexed: 11/23/2022] Open
Abstract
Background The number of dialysis recipients is growing worldwide, making it important that the full range of patient populations are represented in randomised trials. As trial recruitment has not previously been examined at a global level, we compared the location of trial sites recruiting to large multicentre randomised controlled trials (RCTs) in dialysis to the global distribution of dialysis recipients. Methods A systematic review (2007–2016) was conducted to identify RCTs enrolling ≥100 dialysis patients from ≥2 sites. The number and location of sites were extracted from manuscripts and trial registration. The proportion of sites from each International Society of Nephrology global region was divided by the proportion of the global dialysis population in that region to determine a ‘representation index’ (RI), where 1.0 indicated that the number of sites was proportionate to the number of dialysis recipients in that region. Results We identified 180 RCTs, recruiting from 6172 sites in 54 countries. Eastern and Central Europe had the highest RI at 2.45. Other well-represented regions were Western Europe (2.20), North America (2.06), and Russia and newly independent states (1.36). Africa had the lowest RI at 0.05, followed by South Asia (0.08), Latin America (0.15), Middle East (0.27), North-East Asia (0.41), and South-East Asia and Oceania (0.62). Conclusions Regions of the world with growing numbers of dialysis patients are poorly represented in large, multicentre RCTs. Efforts to boost trial participation in these regions are required to ensure that generalisable and relevant information is available to local healthcare providers.
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Affiliation(s)
- Brendan Smyth
- Renal and Metabolic Division, The George Institute for Global Health and University of New South Wales, Sydney, New South Wales, Australia.,Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Konlawij Trongtrakul
- Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Anna Haber
- Chelsea and Westminster Hospital, London, UK
| | - B Talbot
- Renal and Metabolic Division, The George Institute for Global Health and University of New South Wales, Sydney, New South Wales, Australia
| | - Carmel Hawley
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Vlado Perkovic
- Renal and Metabolic Division, The George Institute for Global Health and University of New South Wales, Sydney, New South Wales, Australia
| | - Mark Woodward
- The George Institute for Global Health, University of Oxford, Oxford, UK.,Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Meg Jardine
- Renal and Metabolic Division, The George Institute for Global Health and University of New South Wales, Sydney, New South Wales, Australia.,Department of Renal Medicine, Concord Repatriation General Hospital, Concord, New South Wales, Australia
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