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Renberg M, Hertzberg D, Rimes-Stigare C, Hallqvist L, Bell M. Advanced chronic kidney disease after surgery and the contribution of acute kidney disease: a national observational cohort study. Br J Anaesth 2024; 132:1238-1247. [PMID: 38553313 DOI: 10.1016/j.bja.2024.02.024] [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: 12/19/2023] [Revised: 01/23/2024] [Accepted: 02/21/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Limited knowledge exists regarding long-term renal outcomes after noncardiac surgery. This study investigated the incidence of, and risk factors for, developing advanced chronic kidney disease (CKD) and major adverse kidney events within 1 yr of surgery in a nationwide cohort. METHODS Adults without renal dysfunction before noncardiac surgery in Sweden were included between 2007 and 2013 in this observational multicentre cohort study. We analysed data from a national surgical database linked to several national and quality outcome registries. Associations of perioperative risk factors with advanced CKD (estimated glomerular filtration rate [eGFR] <30 ml min-1 1.73 m-2) and major adverse kidney events within 1 yr (MAKE365, comprising eGFR <30 ml min-1 1.73 m-2, chronic dialysis, death) were quantified. RESULTS Of 237,124 patients, 1597 (0.67%) developed advanced CKD and 16,789 (7.1%) developed MAKE365. Risk factors for advanced CKD included higher ASA physical status, urological surgery, extended surgical duration, prolonged postoperative hospital stay, repeated surgery, and postoperative use of renin-angiotensin-aldosterone system blockers. Advanced acute kidney disease (AKD) (eGFR <30 ml min-1 1.73 m-2 within 90 postoperative days) occurred in 1661 (0.70%) patients and was associated with advanced CKD (subdistribution hazard ratio [SHR] 44.5, 95% confidence interval [CI] 38.7-51.1) and MAKE365 (hazard ratio [HR] 6.60, 95% CI 6.07-7.17). Among patients with advanced AKD after surgery 36% developed advanced CKD at 1 yr after surgery and 51% developed MAKE365. CONCLUSIONS Advanced CKD within 1 yr after surgery is uncommon but clinically important in patients without preoperative renal dysfunction. Advanced AKD after surgery constitutes a major risk factor for advanced CKD and MAKE365.
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Affiliation(s)
- Mårten Renberg
- Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden; Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
| | - Daniel Hertzberg
- Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden; Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Claire Rimes-Stigare
- Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden; Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Linn Hallqvist
- Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden; Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Max Bell
- Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden; Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
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Wahood W, Takahashi E, Rajan D, Misra S. National Trends in Complications of Vascular Access for Hemodialysis and Analysis of Racial Disparities Among Patients With End-Stage Renal Disease in the Inpatient Setting. Kidney Int Rep 2023; 8:1162-1169. [PMID: 37284686 PMCID: PMC10239770 DOI: 10.1016/j.ekir.2023.03.001] [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: 11/16/2022] [Revised: 01/31/2023] [Accepted: 03/06/2023] [Indexed: 04/04/2023] Open
Abstract
Introduction The aim of this study is to assess the trends in access-related complications, as well as the impact of race on these complications, among admitted patients with end-stage kidney disease (ESKD) receiving hemodialysis. Methods A retrospective cohort study between 2005 and 2018 was performed using the National Inpatient Sample (NIS). Hospitalizations involving ESKD and hemodialysis were identified. There were 9,246,553 total admissions involving ESKD and hemodialysis, of which 1,167,886 (12.6%) had complications. Trends in complications were assessed and compared among races. Results There was a decreasing trend in rates of mechanical (trend: -0.05% per year; P < 0.001), inflammatory or infectious (-0.48%; P < 0.001), and other (-0.19%; P < 0.001) complications from 2005 to 2018. Non-White patients had a greater magnitude in the decrease in trends in rates of complications compared to White patients (-0.69% per year vs. -0.57%; P < 0.001). Compared to the White patients, Black patients (odds ratio [OR]: 1.26; P < 0.001) and those of the other races (OR: 1.11; P < 0.001) had higher odds of complications. These differences were also statistically significant among lower socioeconomic classes (75 percentile vs. 0-25 percentile: P = 0.009) and within southern states (vs. Northeast: P < 0.001). Conclusion Although there was an overall decrease in the trends of dialysis-associated complications requiring hospitalization among ESKD patients receiving hemodialysis, non-White patients have higher odds of complications compared to White patients. The findings in this study emphasize the need for more equitable care for hemodialysis patients.
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Affiliation(s)
- Waseem Wahood
- Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, Davie, Florida, USA
| | - Edwin Takahashi
- Department of Interventional Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Dheeraj Rajan
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Sanjay Misra
- Department of Interventional Radiology, Mayo Clinic, Rochester, Minnesota, USA
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De Luca L, Dovizio M, Sangiorgi D, Perrone V, Degli Esposti L. Incidence and Predictors of Switching and Dose Change of Direct Oral Anticoagulants among Elderly Patients with Nonvalvular Atrial Fibrillation: A 5-Year Analysis of a Large Administrative Database. J Clin Med 2023; 12:jcm12062379. [PMID: 36983380 PMCID: PMC10056372 DOI: 10.3390/jcm12062379] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 03/09/2023] [Accepted: 03/17/2023] [Indexed: 03/30/2023] Open
Abstract
In the last decade, novel oral anticoagulants (NOACs) have emerged as prominent therapeutic options in non-valvular atrial fibrillation (NVAF). We analysed the clinical burden and the switching rate between all available NOACs, and their dosage change over a period of 5 years in a representative population of patients with NVAF aged between 70 and 75 years. Methods and Results: This is a retrospective observational study on administrative databases, covering approximately 6.2 million health-assisted individuals by the Italian National Health System (around 11% of the entire Italian residents). Out of 4640 NVAF patients treated with NOACs and aged 70-75 years in 2017, 3772 (81.3%) patients were still in treatment with NOAC up to 2021 and among them, 3389 (73.0%) patients remained in treatment with the same NOAC during 2017-2021. In fact, 10.2% of patients switched NOAC type and 10.3% changed the dose of the same NOAC. Overall, after switching, the dabigatran and rivaroxaban groups lost, respectively, 13.5% and 2.8% of patients, while apixaban and edoxaban resulted in a relative percentage increase of 6.8% and 44.6% of patients, respectively. By a logistic regression analysis, the treatment with rivaroxaban, apixaban, and edoxaban (respect to dabigatran) was associated with a significant risk reduction of switch of 57%, 68%, and 44%, respectively. On the other hand, several features of high risk were associated with dose reduction. Conclusions. In our 5-year analysis of a large administrative database, a switching among NOACs or a change in NOAC dosages occurred in around 20% of elderly patients with NVAF. The type of NOAC was associated with a high switching rate, while several characteristics of high risk resulted as predictors of dose reduction of NOACs. Moreover, a worsening trend of clinical conditions occurred in patients maintaining the same NOAC treatment across 2017-2021.
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Affiliation(s)
- Leonardo De Luca
- Department of Cardio-Thoracic-Vascular Sciences, A.O. San Camillo-Forlanini, 00151 Rome, Italy
- Department of Cardio-Thoracic and Vascular Medicine and Surgery, U.O.C. Cardiologia, Azienda Ospedaliera San Camillo-Forlanini Circonvallazione Gianicolense, 87, 00152 Roma, Italy
- UniCamillus-Saint Camillus International, University of Health Sciences, 00131 Rome, Italy
| | - Melania Dovizio
- CliCon S.r.l. Società Benefit, Health, Economics & Outcomes Research, 40137 Bologna, Italy
| | - Diego Sangiorgi
- CliCon S.r.l. Società Benefit, Health, Economics & Outcomes Research, 40137 Bologna, Italy
| | - Valentina Perrone
- CliCon S.r.l. Società Benefit, Health, Economics & Outcomes Research, 40137 Bologna, Italy
| | - Luca Degli Esposti
- CliCon S.r.l. Società Benefit, Health, Economics & Outcomes Research, 40137 Bologna, Italy
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Sörling A, Nordberg P, Hofmann R, Häbel H, Svensson P. Association between chronic kidney disease, obesity, cardiometabolic risk factors, and severe COVID-19 outcomes. Kidney Int Rep 2023; 8:775-784. [PMID: 36685734 PMCID: PMC9840229 DOI: 10.1016/j.ekir.2023.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 12/01/2022] [Accepted: 01/09/2023] [Indexed: 01/15/2023] Open
Abstract
Introduction Chronic kidney disease (CKD) is a risk factor for acquiring severe Coronavirus disease 2019 (COVID-19) but underlying mechanisms are unknown. We aimed to study the risk associated with CKD for severe COVID-19-outcomes in relation to BMI and diabetes, since they are common risk factors both for CKD and severe COVID-19. Methods This nationwide case-control study with data from mandatory national registries included 4684 patients admitted to the intensive care units (ICUs) requiring mechanical ventilation (cases) and 46840 population-based controls matched by age, sex and district of residency. Logistic regression was used to calculate odds ratios (ORs) with 95% confidence intervals (CIs) for associations between severe COVID -19 and exposures with adjustment for confounders, in subgroups by BMI, and matched by type 2 diabetes. Results The median age was 64 years and 27.7% were female. CKD was observed in 5.4% of the cases and 1.5% of the controls whereas 1.9% and 0.3% had end-stage CKD, respectively. CKD was associated with severe COVID-19 (OR 2.20 [95% CI, 1.85-2.62]), continuous renal replacement therapy at ICU (OR 7.36 [95% CI 5.39-10.05]), and death any time after ICU admission (OR 2.51 [95% CI 1.96-3.22]). The risk associated with CKD for severe COVID-19 did not differ significantly by weight but was higher in non-diabetics (OR, 2.76 [95% CI 2.15-3.55]) than in diabetics (OR, 1.88 [95% CI 1.37-2.59]). Conclusion CKD, especially end-stage CKD, is an important risk factor for severe COVID-19 and death after ICU-admission also in patients with normal BMI and without type 2 diabetes.
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Affiliation(s)
- Annika Sörling
- Department of Cardiology, Södersjukhuset, Stockholm, Sweden,Correspondence: Annika Sörling, Department of Cardiology, Södersjukhuset, Sjukhusbacken 10, SE 118 83 Stockholm, Sweden
| | - Per Nordberg
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden,Function Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
| | - Robin Hofmann
- Department of Cardiology, Södersjukhuset, Stockholm, Sweden,Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Henrike Häbel
- Division of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Per Svensson
- Department of Cardiology, Södersjukhuset, Stockholm, Sweden,Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
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García Rodríguez LA, Ruigómez A, Schink T, Voss A, Smits E, Swart KMA, Balabanova Y, Suzart-Woischnik K, Brobert G, Herings RMC. Safety and effectiveness of rivaroxaban for prevention of stroke in patients with nonvalvular atrial fibrillation: analysis of routine clinical data from four countries. Expert Opin Drug Saf 2023; 22:493-500. [PMID: 36795067 DOI: 10.1080/14740338.2023.2181334] [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: 08/08/2022] [Accepted: 01/16/2023] [Indexed: 02/17/2023]
Abstract
BACKGROUND The safety and effectiveness of rivaroxaban versus vitamin K antagonists (standard of care [SOC]) for stroke prevention in patients with nonvalvular atrial fibrillation (NVAF) was evaluated in Europe. RESEARCH DESIGN AND METHODS Observational studies were conducted in the UK, the Netherlands, Germany, and Sweden. Primary safety outcomes were hospitalization for intracranial hemorrhage, gastrointestinal bleeding, or urogenital bleeding among new users of rivaroxaban and SOC with NVAF; outcomes were analyzed using cohort (rivaroxaban or SOC use) and nested case-control designs (current vs nonuse). Statistical analyses comparing rivaroxaban and SOC cohorts were not performed. RESULTS Overall, 162,919 rivaroxaban users and 177,758 SOC users were identified. In the cohort analysis, incidence ranges for rivaroxaban users were 0.25-0.63 events per 100 person-years for intracranial bleeding, 0.49-1.72 for gastrointestinal bleeding, and 0.27-0.54 for urogenital bleeding. Corresponding ranges for SOC users were 0.30-0.80, 0.30-1.42, and 0.24-0.42, respectively. In the nested case-control analysis, current SOC use generally presented a greater risk of bleeding outcomes than nonuse. Rivaroxaban use (vs nonuse) was associated with a higher risk of gastrointestinal bleeding, but a similar risk of intracranial or urogenital bleeding, in most countries. Ischemic stroke incidence ranged from 0.31 to 1.52 events per 100 person-years for rivaroxaban users. CONCLUSIONS Incidences of intracranial bleeding were generally lower with rivaroxaban than with SOC, whereas incidences of gastrointestinal and urogenital bleeding were generally higher. The safety profile of rivaroxaban for NVAF in routine practice is consistent with findings from randomized controlled trials and other studies.
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Affiliation(s)
| | - Ana Ruigómez
- Centre for Pharmacoepidemiological Research (CEIFE), Madrid, Spain
| | - Tania Schink
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Annemarie Voss
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Elisabeth Smits
- PHARMO Institute for Drug Outcomes Research, Utrecht, Netherlands
| | - Karin M A Swart
- PHARMO Institute for Drug Outcomes Research, Utrecht, Netherlands
| | - Yanina Balabanova
- Medical Affairs & Pharmacovigilance, Pharmaceuticals, Bayer AG, Leverkusen, Germany
| | | | | | - Ron M C Herings
- PHARMO Institute for Drug Outcomes Research, Utrecht, Netherlands
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6
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Huang TY, Rodriguez-Watson C, Wang T, Calhoun SR, Marshall J, Burk J, Nam YH, Mendelsohn AB, Jamal-Allial A, Greenlee RT, Selvan M, Pawloski PA, McMahill Walraven CN, Rai A, Toh S, Brown JS. Using the IMEDS distributed database for epidemiological studies in type 2 diabetes mellitus. BMJ Open Diabetes Res Care 2022; 10:10/6/e002916. [PMID: 36535702 PMCID: PMC9764656 DOI: 10.1136/bmjdrc-2022-002916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 11/09/2022] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION This study aimed to assess data relevancy and data quality of the Innovation in Medical Evidence Development and Surveillance System Distributed Database (IMEDS-DD) for diabetes research and to evaluate comparability of its type 2 diabetes cohort to the general type 2 diabetes population. RESEARCH DESIGN AND METHODS A retrospective study was conducted using the IMEDS-DD. Eligible members were adults with a medical encounter between April 1, 2018 and March 31, 2019 (index period). Type 2 diabetes and co-existing conditions were determined using all data available from April 1, 2016 to the most recent encounter within the index period. Type 2 diabetes patient characteristics, comorbidities and hemoglobin A1c (HbA1c) values were summarized and compared with those reported in national benchmarks and literature. RESULTS Type 2 diabetes prevalence was 12.6% in the IMEDS-DD. Of 4 14 672 patients with type 2 diabetes, 52.8% were male, and the mean age was 65.0 (SD 13.3) years. Common comorbidities included hypertension (84.5%), hyperlipidemia (82.8%), obesity (45.3%), and cardiovascular disease (44.7%). Moderate-to-severe chronic kidney disease was observed in 20.2% patients. The most commonly used antihyperglycemic agents included metformin (35.7%), sulfonylureas (14.8%), and insulin (9.9%). Less than one-half (48.9%) had an HbA1c value recorded. These findings demonstrated the notable similarity in patient characteristics between type 2 diabetes populations identified within the IMEDS-DD and other large databases. CONCLUSIONS Despite the limitations related to HbA1c data, our findings indicate that the IMEDS-DD contains robust information on key data elements to conduct pharmacoepidemiological studies in diabetes, including member demographic and clinical characteristics and health services utilization.
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Affiliation(s)
- Ting-Ying Huang
- Department of Population Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Carla Rodriguez-Watson
- Reagan-Udall Foundation for the Food and Drug Administration, Washington, District of Columbia, USA
| | - Tongtong Wang
- Epidemiology, Merck & Co, Inc, Rahway, New Jersey, USA
| | | | - James Marshall
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
| | - Jillian Burk
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
| | - Young Hee Nam
- Department of Population Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Aaron B Mendelsohn
- Department of Population Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | | | | | - Mano Selvan
- Humana Healthcare Research, Louisville, Kentucky, USA
| | | | | | - Ashish Rai
- Department of Population Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Sengwee Toh
- Department of Population Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Jeffery S Brown
- Department of Population Medicine, Harvard Medical School, Boston, Massachusetts, USA
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Carrero JJ, Elinder CG. The Stockholm CREAtinine Measurements (SCREAM) project: Fostering improvements in chronic kidney disease care. J Intern Med 2022; 291:254-268. [PMID: 35028991 DOI: 10.1111/joim.13418] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
SCREAM (Stockholm CREAtinine Measurements project) was initiated in 2010 in collaboration with the healthcare provider of Stockholm County healthcare to quantify potential medication errors, estimate the burden of chronic kidney disease (CKD) and to illustrate the value of incorporating measures of kidney function into the medical decision process. Because most patients are unaware of their CKD and diagnoses are seldom issued, SCREAM took advantage of the commonness of serum/plasma creatinine testing, which can be used to estimate the glomerular filtration rate (eGFR) and classify the stage of CKD severity. SCREAM is periodically updated, and at present contains healthcare information of all residents in Stockholm region during 2006-2019 (about 3 million people), enriched with a broad range of laboratory measurements for those in whom creatinine or albuminuria has been measured (about 1.8 million people). This health information was linked with national administrative and quality registries via the unique personal identification number of each Swedish citizen, conforming the richest characterization in Sweden of the population's journey through health and disease. This review discusses the context of its creation, strengths and weakness, key findings and plans for the future. We summarize our findings related to the burden of CKD in Sweden, its adverse health risks (such as risk of infections, cancer or dementia) and how underlying kidney function alters the risk-benefit ratio of common medications. Results have had clinical impact and demonstrate the importance of population-based research in the spectrum of clinical research to improve health.
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Affiliation(s)
- Juan Jesus Carrero
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Carl Gustaf Elinder
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
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Takeuchi M, Shinkawa K, Yanagita M, Kawakami K. Prevalence, recognition and management of chronic kidney disease in Japan: population-based estimate using a healthcare database with routine health checkup data. Clin Kidney J 2021; 14:2197-2202. [PMID: 34676073 PMCID: PMC8528067 DOI: 10.1093/ckj/sfab016] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 01/11/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND We aimed to update information on the prevalence of chronic kidney disease (CKD) in Japan. We also explored whether CKD was properly recognized and managed. METHODS We used data from annual health checkups in 2017, compiling records for 5 million persons. These included laboratory results and were linked to healthcare utilization records via personal identifiers. CKD was defined as an estimated glomerular filtration rate <60 mL/min/1.73 m2. The prevalence was compared with that in 2005. Healthcare utilization, including laboratory tests, disease coding and medication for comorbid diabetes mellitus (DM) and hypertension (HT), was used as an indicator for the recognition and management of CKD. RESULTS Of the 761 565 records [median age 46 years (interquartile range 50-62)], CKD was found in 50 091 persons; the crude and age-adjusted prevalences were 63.1 and 71.8 per 1000 persons, respectively. CKD prevalence was significantly higher in 2017 than in 2005, with an increase of 14.1 per 1000 persons. Among persons with CKD, >95% sought medical services and 64.6% received laboratory tests within 180 days of the checkup. However, the diagnostic code suggestive of CKD was recorded in only 23.2% of patients and prescriptions for DM and HT were found in 31.2% (1590/5096) and 36.7% (8081/22 019) of comorbid persons, respectively. CONCLUSIONS The prevalence of CKD in Japan has increased over the past decade. However, recognition of CKD is likely suboptimal and there is room to improve the management of comorbid DM and HT.
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Affiliation(s)
- Masato Takeuchi
- Department of Pharmacoepidemiology, Graduate School
of Medicine, Kyoto University, Kyoto, Japan
| | - Kanna Shinkawa
- Department of Pharmacoepidemiology, Graduate School
of Medicine, Kyoto University, Kyoto, Japan
- Department of Nephrology, Graduate School of
Medicine, Kyoto University, Kyoto, Japan
| | - Motoko Yanagita
- Department of Nephrology, Graduate School of
Medicine, Kyoto University, Kyoto, Japan
- Institute for the Advanced Study of Human Biology
(WPI-ASHBi), Kyoto University, Kyoto, Japan
| | - Koji Kawakami
- Department of Pharmacoepidemiology, Graduate School
of Medicine, Kyoto University, Kyoto, Japan
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Roy L, Zappitelli M, White-Guay B, Lafrance JP, Dorais M, Perreault S. Agreement Between Administrative Database and Medical Chart Review for the Prediction of Chronic Kidney Disease G category. Can J Kidney Health Dis 2020; 7:2054358120959908. [PMID: 33101698 PMCID: PMC7549183 DOI: 10.1177/2054358120959908] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 08/12/2020] [Indexed: 01/13/2023] Open
Abstract
Background Chronic kidney disease (CKD) is a major health issue and cardiovascular risk factor. Validity assessment of administrative data for the detection of CKD in research for drug benefit and risk using real-world data is important. Existing algorithms have limitations and we need to develop new algorithms using administrative data, giving the importance of drug benefit/risk ratio in real world. Objective The aim of this study was to validate a predictive algorithm for CKD GFR category 4-5 (eGFR < 30 mL/min/1.73 m2 but not receiving dialysis or CKD G4-5ND) using the administrative databases of the province of Quebec relative to estimated glomerular filtration rate (eGFR) as a reference standard. Design This is a retrospective cohort study using chart collection and administrative databases. Setting The study was conducted in a community outpatient medical clinic and pre-dialysis outpatient clinic in downtown Montreal and rural area. Patients Patient medical files with at least 2 serum creatinine measures (up to 1 year apart) between September 1, 2013, and June 30, 2015, were reviewed consecutively (going back in time from the day we started the study). We excluded patients with end-stage renal disease on dialysis. The study was started in September 2013. Measurement Glomerular filtration rate was estimated using the CKD Epidemiological Collaboration (CKD-EPI) from each patient's file. Several algorithms were developed using 3 administrative databases with different combinations of physician claims (diagnostics and number of visits) and hospital discharge data in the 5 years prior to the cohort entry, as well as specific drug use and medical intervention in preparation for dialysis in the 2 years prior to the cohort entry. Methods Chart data were used to assess eGFR. The validity of various algorithms for detection of CKD groups was assessed with sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Results A total of 434 medical files were reviewed; mean age of patients was 74.2 ± 10.6 years, and 83% were older than 65 years. Sensitivity of algorithm #3 (diagnosis within 2-5 years and/or specific drug use within 2 years and nephrologist visit ≥4 within 2-5 years) in identification of CKD G4-5ND ranged from 82.5% to 89.0%, specificity from 97.1% to 98.9% with PPV and NPV ranging from 94.5% to 97.7% and 91.1% to 94.2%, respectively. The subsequent subgroup analysis (diabetes, hypertension, and <65 and ≥65 years) and also the comparisons of predicted prevalence in a cohort of older adults relative to published data emphasized the accuracy of our algorithm for patients with severe CKD (CKD G4-5ND). Limitations Our cohort comprised mostly older adults, and results may not be generalizable to all adults. Participants with CKD without 2 serum creatinine measurements up to 1 year apart were excluded. Conclusions The case definition of severe CKD G4-5ND derived from an algorithm using diagnosis code, drug use, and nephrologist visits from administrative databases is a valid algorithm compared with medical chart reviews in older adults.
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Affiliation(s)
- Louise Roy
- Faculty of Medicine, University of Montreal, University of Montreal Hospital Center, QC, Canada
| | - Michael Zappitelli
- Faculty of Medicine, Department of Pediatrics, Pediatric Nephrology, Toronto Hospital for Sick Children, University of Toronto, ON, Canada
| | | | - Jean-Philippe Lafrance
- Faculty of Medicine, Department of Pharmacology and Physiology, University of Montreal, QC, Canada
| | - Marc Dorais
- StatSciences Inc., Notre-Dame-de-l'Île-Perrot, QC, Canada
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10
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Matan D, Löfström U, Corovic Cabrera C, Eriksson B, Ekström M, Hage C, Ljunggren G, Lyngå P, Wallén H, Knudsen Malmqvist K, Linde C, Persson H. Reorganization of heart failure management and improved outcome - the 4D HF Project. SCAND CARDIOVASC J 2020; 55:1-8. [PMID: 32969284 DOI: 10.1080/14017431.2020.1820075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Heart failure (HF) management is suboptimal in Sweden despite available evidence-based guidelines. To improve HF treatment, a comprehensive HF management program (4D project) was implemented in the Stockholm County (>2.1 million inhabitants). Design. A standardized care program centralized at five hospital-based HF clinics was implemented in 2014-2017. We registered from 2012 to 2017: (1) numbers of referrals and visits to HF clinics, (2) numbers of hospital admitted patients per million inhabitants, (3) dispensed HF medications after admission, and (4) covariate-adjusted 1-year all-cause mortality or HF readmission. Results. Yearly visits to the five HF outpatient clinics increased 3.4 times from 3,372 to 11,527. Dispensed HF drug prescriptions increased, in particular, for readmitted patients, compared to 2012 (p<.0001). Total number of hospital admitted HF patients as well as new-onset or readmitted HF patients decreased by 16, 13, and 20%, respectively (p < .0001). The combined 1-year mortality or HF readmission over the period was 48% (n = 17,124/35,880) and improved per year (HR 0.98 [0.97-0.99], p < .001) from 2012. Conclusion. A comprehensive standardized care HF management program including expanded HF clinics was associated with improved evidence-based medication, reduced HF hospitalization, and improvement of the combined outcome of 1-year mortality or HF readmission in Stockholm.
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Affiliation(s)
- Dmitri Matan
- Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden.,Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Ulrika Löfström
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Medicine, Capio St. Göran Hospital, Stockholm, Sweden
| | - Carin Corovic Cabrera
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden.,Department of Cardiology, Södersjukhuset, Stockholm, Sweden.,Department of Cardiology, South General Hospital, Stockholm, Sweden
| | - Björn Eriksson
- Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden.,Gustavsberg Academic Health Care Center, Stockholm, Sweden
| | - Mattias Ekström
- Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden.,Department of Cardiology, Danderyd University Hospital, Stockholm, Sweden
| | - Camilla Hage
- Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden.,Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Gunnar Ljunggren
- Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden.,Public Health Care Services Committee Administration, Stockholm County Council, Stockholm, Sweden
| | - Patrik Lyngå
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden.,Department of Cardiology, South General Hospital, Stockholm, Sweden
| | - Håkan Wallén
- Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden.,Department of Cardiology, Danderyd University Hospital, Stockholm, Sweden
| | - Karin Knudsen Malmqvist
- Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden.,Department of Cardiology, Danderyd University Hospital, Stockholm, Sweden
| | - Cecilia Linde
- Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden.,Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Hans Persson
- Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden.,Department of Cardiology, Danderyd University Hospital, Stockholm, Sweden
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11
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Miao B, Sood N, Bunz TJ, Coleman CI. Rivaroxaban versus apixaban in non-valvular atrial fibrillation patients with end-stage renal disease or receiving dialysis. Eur J Haematol 2020; 104:328-335. [PMID: 31925840 DOI: 10.1111/ejh.13383] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 01/06/2020] [Accepted: 01/07/2020] [Indexed: 01/11/2023]
Abstract
OBJECTIVES We sought to evaluate the effectiveness and safety of rivaroxaban vs apixaban in non-valvular atrial fibrillation (NVAF) patients with end-stage renal disease (ESRD) and/or receiving dialysis in routine practice. METHODS Using US MarketScan claims data from January 1, 2014, to December 31, 2017, we identified new-users of rivaroxaban or apixaban during 2015 with at least 12 months of insurance coverage prior to oral anticoagulant (OAC) initiation. Differences in baseline covariates between cohorts were adjusted using inverse probability-of-treatment weighting based on propensity scores. Patients were followed for stroke or systemic embolism (SSE) or major bleeding hospitalizations. Cox proportion hazards regression was used to compare rivaroxaban and apixaban. Analyses stratified by age, sex, CHA2DS2-VASc score, prior stroke, prior bleed, diabetes, and reduced OAC dose were performed. RESULTS We identified 787 rivaroxaban and 1836 apixaban users. Median (25, 75% range) age = 70 (61, 79), CHA2DS2-VASc score = 3 (2, 4), and follow-up = 0.87 (0.38, 1.56) years. No differences in the risks of SSE (HR = 1.18, 95% CI = 0.53-2.63), ischemic stroke (HR = 1.12, 95%CI = 0.45-2.76), or major bleeding (HR = 1.00, 95% CI = 0.63-1.58) were observed. No significant interactions were observed upon subgroup analysis. CONCLUSION In NVAF patients with ESRD and/or receiving dialysis, rivaroxaban and apixaban were associated with similar risks of SSE and major bleeding.
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Affiliation(s)
- Benjamin Miao
- University of Connecticut School of Pharmacy, Storrs, CT, USA.,Hartford Hospital Evidence-Based Practice Center, Hartford, CT, USA
| | - Nitesh Sood
- Arrhythmia Services, Southcoast Health, Fall River, MA, USA
| | - Thomas J Bunz
- Division of Pharmacoepidemiology, New England Health Analytics LLC, Granby, CT, USA
| | - Craig I Coleman
- University of Connecticut School of Pharmacy, Storrs, CT, USA.,Hartford Hospital Evidence-Based Practice Center, Hartford, CT, USA
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12
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Marino C, Ferraro PM, Bargagli M, Cascini S, Agabiti N, Gambaro G, Davoli M. Prevalence of chronic kidney disease in the Lazio region, Italy: a classification algorithm based on health information systems. BMC Nephrol 2020; 21:23. [PMID: 31992222 PMCID: PMC6986004 DOI: 10.1186/s12882-020-1689-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 01/14/2020] [Indexed: 01/13/2023] Open
Abstract
Background Estimating CKD prevalence is difficult. Information on CKD prevalence is rather scanty in Italy and available figures come from surveys in selected geographical areas. Administrative data have been already demonstrated to be an effective tool in estimating the epidemiological burden of diseases, however there is limited experience in literature as far as CKD is concerned. Methods The aim of this study is to develop an algorithm based on regional Health Administrative Databases to identify individuals with CKD and provide estimates of disease prevalence in Lazio Region (Italy); about 5.500.000 inhabitants in 2017. A population-level analysis based on a record-linkage strategy using data from Health Administrative Databases has been applied in Lazio Region. CKD cases were identified between January 1, 2012 and December 31, 2017 using Outpatient Specialist Service Information System, Hospital Discharge Registry, Ticket Exemption Registry and Drug Dispensing Registry. Age-specific and standardized prevalence rates were calculated by gender. CKD cases were classified as higher and lower severity. Results The algorithm identified 99,457 individuals with CKD (mean age 71 years, 55.8% males). The exclusive contributions of each regional source used were: 35,047 (35.2%) from Outpatient Specialist Service Information System, 27,778 (27.9%) from Hospital Discharge Registry, 4143 (4.2%) from Ticket Exemption Registry and 463 (0.5%) from Drug Dispensing Registry; 5.1% of cases were found in all databases. The standardized prevalence rate at December 31, 2017 was 1.76, 2.06% for males and 1.50% for females. The prevalence increased with age, rising from 0.33% (age 0–18) up to 14.18% (age 85+) among males and from 0.25% up to 8.18% among females. The proportion of CKD individuals with lower severity disease was 78.7% in both genders. Conclusions The proposed algorithm represents a novel tool to monitor the burden of CKD disease, that can be used by the regional government to guide the development and implementation of evidence-based pathways of care for CKD patients. The high prevalence of people with CKD of lower severity should be carefully considered in order to promote diagnosis and optimal management at early stages.
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Affiliation(s)
- Claudia Marino
- Department of Epidemiology Lazio Regional Health Service, Via Cristoforo Colombo, 112, 00147, Roma, Italy.
| | - Pietro Manuel Ferraro
- U.O.C. Nefrologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli, 8, 00168, Roma, Italy.,Università Cattolica del Sacro Cuore, Roma, Largo Francesco Vito, 1, 00168, Roma, Italy
| | - Matteo Bargagli
- U.O.C. Nefrologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli, 8, 00168, Roma, Italy.,Università Cattolica del Sacro Cuore, Roma, Largo Francesco Vito, 1, 00168, Roma, Italy
| | - Silvia Cascini
- Department of Epidemiology Lazio Regional Health Service, Via Cristoforo Colombo, 112, 00147, Roma, Italy
| | - Nera Agabiti
- Department of Epidemiology Lazio Regional Health Service, Via Cristoforo Colombo, 112, 00147, Roma, Italy
| | - Giovanni Gambaro
- Department of Medicine, Renal Unit, Division of Nephrology and Dialysis, University of Verona, Piazzale Ludovico Antonio Scuro 10, 37134, Verona, Italy
| | - Marina Davoli
- Department of Epidemiology Lazio Regional Health Service, Via Cristoforo Colombo, 112, 00147, Roma, Italy
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