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Wang T, Ji D, Stürmer T, Ismail S, Dong S, Shen P, Lin H, Shi L, Guan X, Xu Y. The Effect of Sodium Glucose Cotransporter-2 Inhibitors on Hemoglobin A1c Variability and Acute Kidney Injury: A Causal Mediation Analysis. Pharmacoepidemiol Drug Saf 2024; 33:e5876. [PMID: 39090775 DOI: 10.1002/pds.5876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 06/30/2024] [Accepted: 07/02/2024] [Indexed: 08/04/2024]
Abstract
PURPOSE The role of lower hemoglobin A1c (HbA1c) variability in the effect of sodium glucose cotransporter-2 inhibitors (SGLT2i) on acute kidney injury (AKI) remains unclear. We compared AKI risk between SGLT2i and dipeptidyl peptidase 4 inhibitors (DPP4i) initiators. Additionally, we aimed to explore the extent to which SGLT2i's influence on AKI risk is mediated by reducing long-term HbA1c variability. METHODS Using 2018-2022 year data in Yinzhou Regional Health Care Database, we included adult, type 2 diabetes patients who were new users of SGLT2i or DPP4i. The effect of SGLT2i versus DPP4i on AKI, HbA1c variability, and AKI through HbA1c variability was compared using inverse probability of treatment weighted Cox proportional hazards models, median regression models, and causal mediation analysis. RESULTS With a median follow-up of 1.76 years, 19 717 adults (for SGLT2i, n = 6008; for DPP4i, n = 13 709) with type 2 diabetes were included. The adjusted hazard ratio for SGLT2i versus DPP4i was 0.79 (95% confidence interval [CI] 0.64-0.98) for AKI. The adjusted differences in median HbA1c variability score (HVS) and HbA1c reduction were -16.67% (95% CI: -27.71% to -5.62%) and -1.98% (95% CI: -14.34% to 10.38%), respectively. Furthermore, lower AKI risk associated with SGLT2i was moderately mediated (22.77%) through HVS. The results remained consistent across various subgroups and sensitivity analyses. CONCLUSIONS Compared to DPP4i, lower AKI risk associated with SGLT2i is moderately mediated through HbA1c variability. These findings enhance our understanding of the effect of SGLT2i on AKI and underscore the importance of considering HbA1c variability in diabetes treatment and management.
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Affiliation(s)
- Tiansheng Wang
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Dongze Ji
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University Health Science Center, Beijing, China
| | - Til Stürmer
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Sherin Ismail
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Shujie Dong
- Department of Pharmacy, Peking University Third Hospital, Beijing, China
| | - Peng Shen
- Department of Chronic Disease and Health Promotion, Yinzhou District Center for Disease Control and Prevention, Ningbo, China
| | - Hongbo Lin
- Department of Chronic Disease and Health Promotion, Yinzhou District Center for Disease Control and Prevention, Ningbo, China
| | - Luwen Shi
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University Health Science Center, Beijing, China
- International Research Center for Medicinal Administration, Peking University, Beijing, China
| | - Xiaodong Guan
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University Health Science Center, Beijing, China
- International Research Center for Medicinal Administration, Peking University, Beijing, China
| | - Yang Xu
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University Health Science Center, Beijing, China
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Jensen SK, Rasmussen TB, Jacobsen BH, Heide-Jørgensen U, Sawhney S, Gammelager H, Birn H, Johnsen SP, Christiansen CF. Regional variation in incidence and prognosis of acute kidney injury. Nephrol Dial Transplant 2024; 39:1171-1180. [PMID: 38140955 DOI: 10.1093/ndt/gfad267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Examining regional variation in acute kidney injury (AKI) and associated outcomes may reveal inequalities and possibilities for optimization of the quality of care. Using the Danish medical databases, we examined regional variation in the incidence, follow-up and prognosis of AKI in Denmark. METHODS Patients with one or more AKI episodes in 2017 were identified using population-based creatinine measurements covering all Danish residents. Crude and sex-and-age-standardized incidence rates of AKI were estimated using census statistics for each municipality. Adjusted hazard ratios (aHR) of chronic kidney disease (CKD), all-cause death, biochemical follow-up and outpatient contact with a nephrology department after AKI were estimated across geographical regions and categories of municipalities, accounting for differences in demographics, comorbidities, medication use, lifestyle and social factors, and baseline kidney function. RESULTS We identified 63 382 AKI episodes in 58 356 adults in 2017. The regional standardized AKI incidence rates ranged from 12.9 to 14.9 per 1000 person-years. Compared with the Capital Region of Denmark, the aHRs across regions ranged from 1.04 to 1.25 for CKD, from 0.97 to 1.04 for all-cause death, from 1.09 to 1.15 for biochemical follow-up and from 1.08 to 1.49 for outpatient contact with a nephrology department after AKI. Similar variations were found across municipality categories. CONCLUSIONS Within the uniform Danish healthcare system, we found modest regional variation in AKI incidence. The mortality after AKI was similar; however, CKD, biochemical follow-up and nephrology follow-up after AKI varied across regions and municipality categories.
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Affiliation(s)
- Simon Kok Jensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Thomas Bøjer Rasmussen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Bjarke Hejlskov Jacobsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Uffe Heide-Jørgensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Simon Sawhney
- Aberdeen Centre for Health Data Science, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
- NHS Grampian, Aberdeen, UK
| | - Henrik Gammelager
- Department of Intensive Care Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Henrik Birn
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Søren Paaske Johnsen
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Christian Fynbo Christiansen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Gregoriano C, Hauser S, Schuetz P, Mueller B, Segerer S, Kutz A. Evaluation of health care utilisation and mortality in medical hospitalisations with multimorbidity and kidney disease, according to frailty: a nationwide cohort study. Swiss Med Wkly 2024; 154:3400. [PMID: 38980660 DOI: 10.57187/s.3400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 04/10/2024] [Indexed: 07/10/2024] Open
Abstract
INTRODUCTION The impact of impaired kidney function on healthcare use among medical hospitalisations with multimorbidity and frailty is incompletely understood. In this study, we assessed the prevalence of acute kidney injury (AKI) and chronic kidney disease (CKD) among multimorbid medical hospitalisations in Switzerland and explored the associations of kidney disease with in-hospital outcomes across different frailty strata. METHODS This observational study analysed nationwide hospitalisation records from 1 January 2012 to 31 December 2020. We included adults (age ≥18 years) with underlying multimorbidity hospitalised in a medical ward. The study population consisted of hospitalisations with AKI, CKD or no kidney disease (reference group), and was stratified by three frailty levels (non-frail, pre-frail, frail). Main outcomes were in-hospital mortality, intensive care unit (ICU) treatment, length of stay (LOS) and all-cause 30-day readmission. We estimated multivariable adjusted odds ratios (OR) and changes in percentage of log-transformed continuous outcomes with 95% confidence intervals (CI). RESULTS Among 2,651,501 medical hospitalisations with multimorbidity, 198,870 had a diagnosis of AKI (7.5%), 452,990 a diagnosis of CKD (17.1%) and 1,999,641 (75.4%) no kidney disease. For the reference group, the risk of in-hospital mortality was 4.4%, for the AKI group 14.4% (adjusted odds ratio [aOR] 2.56 [95% CI 2.52-2.61]) and for the CKD group 5.9% (aOR 0.98 [95% CI 0.96-0.99]), while prevalence of ICU treatment was, respectively, 10.5%, 21.8% (aOR 2.39 [95% CI 2.36-2.43]) and 9.3% (aOR 1.01 [95% CI 1.00-1.02]). Median LOS was 5 days (interquartile range [IQR] 2.0-9.0) in hospitalisations without kidney disease, 9 days (IQR 5.0-15.0) (adjusted change [%] 67.13% [95% CI 66.18-68.08%]) in those with AKI and 7 days (IQR 4.0-12.0) (adjusted change [%] 18.94% [95% CI 18.52-19.36%]) in those with CKD. The prevalence of 30-day readmission was, respectively, 13.3%, 13.7% (aOR 1.21 [95% CI 1.19-1.23]) and 14.8% (aOR 1.26 [95% CI 1.25-1.28]). In general, the frequency of adverse outcomes increased with the severity of frailty. CONCLUSION In medical hospitalisations with multimorbidity, the presence of AKI or CKD was associated with substantial additional hospitalisations and healthcare utilisation across all frailty strata. This information is of major importance for cost estimates and should stimulate discussion on reimbursement.
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Chen M, Ding N, Grams ME, Matsushita K, Ishigami J. Cigarette Smoking and Risk of Hospitalization With Acute Kidney Injury: The Atherosclerosis Risk in Communities (ARIC) Study. Am J Kidney Dis 2024; 83:794-802.e1. [PMID: 38070588 PMCID: PMC11116070 DOI: 10.1053/j.ajkd.2023.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 09/04/2023] [Accepted: 10/29/2023] [Indexed: 02/02/2024]
Abstract
RATIONALE & OBJECTIVE Smoking is a modifiable risk factor for various adverse events. However, little is known about the association of smoking with the incidence of acute kidney injury (AKI) in the general population. This study investigated the association of cigarette smoking with the risk of AKI. STUDY DESIGN Prospective observational study. SETTING & PARTICIPANTS 14,571 participants (mean age 55±6 years, 55% women, and 25% Black participants) from the ARIC study visit 1 (1987-1989) followed through December 31, 2019. EXPOSURE Smoking parameters (status, duration, pack-years, intensity, and years since cessation). OUTCOME Incident hospitalization with AKI, defined by a hospital discharge with a diagnostic code relevant to AKI. ANALYTICAL APPROACH Multivariable Cox regression models. RESULTS Over a median follow-up period of 26.3 years, 2,984 participants had an incident hospitalization with AKI. Current and former smokers had a significantly higher risk of AKI compared to never smokers after adjusting for potential confounders (HR, 2.22 [95% CI, 2.02-2.45] and 1.12 [1.02-1.23], respectively). A dose-response association was consistently seen for each of smoking duration, pack-years, and intensity with AKI (eg, HR, 1.19 [95% CI, 1.16-1.22] per 10 years of smoking). When years since cessation were considered as a time-varying exposure, the risk of AKI associated with smoking compared with current smokers began to decrease after 10 years, and became similar to never smokers at 30 years (HR for≥30 years, 1.07 [95% CI, 0.97-1.20] vs never smokers). LIMITATIONS Self-reported smoking measurements and missing outpatient AKI cases. CONCLUSIONS In a community-based cohort, all smoking parameters were robustly associated with the risk of AKI. Smoking cessation was associated with decreased risk of AKI, although the excess risk lasted up to 30 years. Our study supports the importance of preventing smoking initiation and promoting smoking cessation for the risk of AKI. PLAIN-LANGUAGE SUMMARY Smoking is a behavior that is associated with many negative health effects. It is not well understood how smoking relates to the occurrence of acute kidney injury (AKI) in the community. In this study, we looked at data from a group of 14,571 adults who were followed for 26 years to see how different aspects of smoking (such as whether someone smoked, how long they smoked for, how many cigarettes they smoked per day, and whether they quit smoking) were related to AKI. We found that smoking was strongly linked to an increased risk of AKI. This risk decreased after 5-10 years of quitting smoking, but the excess risk lasted up to 30 years. This study shows the importance of preventing people from starting smoking and to encourage smokers to quit to reduce their risk of AKI.
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Affiliation(s)
- Mengkun Chen
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Ning Ding
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Morgan E Grams
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Division of Precision of Medicine, Department of Medicine, Grossman School of Medicine, New York University, New York, New York
| | - Kunihiro Matsushita
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Junichi Ishigami
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
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Sawhney S, Ball W, Bell S, Black C, Christiansen CF, Heide-Jørgensen U, Jensen SK, Lambourg E, Ronksley PE, Tan Z, Tonelli M, James MT. Recovery of kidney function after acute kidney disease-a multi-cohort analysis. Nephrol Dial Transplant 2024; 39:426-435. [PMID: 37573145 PMCID: PMC10899778 DOI: 10.1093/ndt/gfad180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Indexed: 08/14/2023] Open
Abstract
BACKGROUND There are no consensus definitions for evaluating kidney function recovery after acute kidney injury (AKI) and acute kidney disease (AKD), nor is it clear how recovery varies across populations and clinical subsets. We present a federated analysis of four population-based cohorts from Canada, Denmark and Scotland, 2011-18. METHODS We identified incident AKD defined by serum creatinine changes within 48 h, 7 days and 90 days based on KDIGO AKI and AKD criteria. Separately, we applied changes up to 365 days to address widely used e-alert implementations that extend beyond the KDIGO AKI and AKD timeframes. Kidney recovery was based on resolution of AKD and a subsequent creatinine measurement below 1.2× baseline. We evaluated transitions between non-recovery, recovery and death up to 1 year; within age, sex and comorbidity subgroups; between subset AKD definitions; and across cohorts. RESULTS There were 464 868 incident cases, median age 67-75 years. At 1 year, results were consistent across cohorts, with pooled mortalities for creatinine changes within 48 h, 7 days, 90 days and 365 days (and 95% confidence interval) of 40% (34%-45%), 40% (34%-46%), 37% (31%-42%) and 22% (16%-29%) respectively, and non-recovery of kidney function of 19% (15%-23%), 30% (24%-35%), 25% (21%-29%) and 37% (30%-43%), respectively. Recovery by 14 and 90 days was frequently not sustained at 1 year. Older males and those with heart failure or cancer were more likely to die than to experience sustained non-recovery, whereas the converse was true for younger females and those with diabetes. CONCLUSION Consistently across multiple cohorts, based on 1-year mortality and non-recovery, KDIGO AKD (up to 90 days) is at least prognostically similar to KDIGO AKI (7 days), and covers more people. Outcomes associated with AKD vary by age, sex and comorbidities such that older males are more likely to die, and younger females are less likely to recover.
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Affiliation(s)
- Simon Sawhney
- Aberdeen Centre for Health Data Science, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
- Department of Renal Medicine, NHS Grampian, Aberdeen, UK
| | - William Ball
- Aberdeen Centre for Health Data Science, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Samira Bell
- Division of Population Health and Genomics, University of Dundee, Dundee, UK
| | - Corri Black
- Aberdeen Centre for Health Data Science, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
- Department of Renal Medicine, NHS Grampian, Aberdeen, UK
| | - Christian F Christiansen
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Uffe Heide-Jørgensen
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Simon K Jensen
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Emilie Lambourg
- Division of Population Health and Genomics, University of Dundee, Dundee, UK
| | - Paul E Ronksley
- Department of Community Health Sciences, O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Zhi Tan
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Marcello Tonelli
- Department of Community Health Sciences, O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Matthew T James
- Department of Community Health Sciences, O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Chinzowu T, Chyou TY, Nishtala PS. Antibiotic-Associated Acute Kidney Injury Among Older Adults: A Case-Crossover Study. Clin Drug Investig 2024; 44:131-139. [PMID: 38170348 DOI: 10.1007/s40261-023-01339-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND AND OBJECTIVES Drug-related acute kidney injury is quite common in older adults. The associated drugs, including antibiotics, are often co-prescribed. The objective of this study was to ascertain antibiotic-associated acute kidney injury (AKI) in older adults aged 65 years or above in New Zealand using a case-crossover study design. METHODS The International Statistical Classification of Diseases and Related Health Problems, tenth revision, Australian modification code N17.x was used to identify all individuals aged 65 years and above with a diagnosis of incident AKI on admission between 1 January 2005 and 31 December 2020, from the New Zealand National Minimum Data Set. A case-crossover cohort for antibiotic exposures, with a 3 day case period and two 30 day washout periods, summed up to a 66 day study period, was created. Using conditional logistic regression, the changed odds of AKI due to exposure to an antibiotic was calculated as matched odds ratios and their 95% confidence intervals. RESULTS A total of 2399 incident cases of AKI were identified between 2005 and 2020 among older adults. The adjusted odds of consuming sulfamethoxazole/trimethoprim antibiotic during the case period was 3.57 times (95% CI 2.86-4.46) higher than the reference period among the incident AKI cases. Fluoroquinolone utilization was also associated with incident AKI (adjusted OR = 2.56; 95% CI 1.90-3.46). CONCLUSION The potential of sulfamethoxazole/trimethoprim and fluoroquinolones to be associated with AKI raises the significant need for vigilant prescribing of these antibiotics in older adults.
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Affiliation(s)
| | - Te-Yuan Chyou
- Department of Biochemistry, University of Otago, Dunedin, New Zealand
| | - Prasad S Nishtala
- Department of Life Sciences, University of Bath, Bath, BA2 7AY, UK
- Centre for Therapeutic Innovation, University of Bath, Bath, UK
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Andresen K, Hinojosa-Campos M, Podmore B, Drysdale M, Qizilbash N, Cunnington M. Validity of Routine Health Data To Identify Safety Outcomes of Interest For Covid-19 Vaccines and Therapeutics in the Context of the Emerging Pandemic: A Comprehensive Literature Review. Drug Healthc Patient Saf 2024; 16:1-17. [PMID: 38192299 PMCID: PMC10771726 DOI: 10.2147/dhps.s415292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 08/15/2023] [Indexed: 01/10/2024] Open
Abstract
Introduction Regulatory guidance encourages transparent reporting of information on the quality and validity of electronic health record data being used to generate real-world benefit-risk evidence for vaccines and therapeutics. We aimed to provide an overview of the availability of validated diagnostic algorithms for selected safety endpoints for Coronavirus disease 2019 (COVID-19) vaccines and therapeutics in the context of the emerging pandemic prior to December 2020. Methods We reviewed the literature up to December 2020 to identify validation studies for various safety events of interest, including myocardial infarction, arrhythmia, myocarditis, acute cardiac injury, vasculitis/vasculopathy, venous thromboembolism, stroke, respiratory distress syndrome (RDS), pneumonitis, cytokine release syndrome (CRS), multiple organ dysfunction syndrome, and renal failure. We included studies published between 2015 and 2020 that were considered high quality assessed with QUADAS and that reported positive predictive values (PPVs). Results Out of 43 identified studies, we found that diagnostic algorithms for cardiovascular outcomes were supported by the highest number of validation studies (n=17). Accurate algorithms are available for myocardial infarction (median PPV 80%; IQR 22%), arrhythmia (PPV range >70%), venous thromboembolism (median PPV: 73%) and ischaemic stroke (PPV range ≥85%). We found a lack of validation studies for less common respiratory and cardiac safety outcomes of interest (eg, pneumonitis and myocarditis), as well as for COVID-specific complications (CRS, RDS). Conclusion There is a need for better understanding of barriers to conducting validation studies, including data governance restrictions. Regulatory guidance should promote embedding validation within real-world EHR research used for decision-making.
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Affiliation(s)
- Kirsty Andresen
- OXON Epidemiology, London, UK
- London School of Hygiene and Tropical Medicine, London, UK
| | | | - Bélène Podmore
- OXON Epidemiology, London, UK
- London School of Hygiene and Tropical Medicine, London, UK
- OXON Epidemiology, Madrid, Spain
| | | | - Nawab Qizilbash
- OXON Epidemiology, London, UK
- London School of Hygiene and Tropical Medicine, London, UK
- OXON Epidemiology, Madrid, Spain
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Ohlmeier C, Schuchhardt J, Bauer C, Brinker M, Kong SX, Scott C, Vaitsiakhovich T. Risk of chronic kidney disease in patients with acute kidney injury following a major surgery: a US claims database analysis. Clin Kidney J 2023; 16:2461-2471. [PMID: 38046015 PMCID: PMC10689184 DOI: 10.1093/ckj/sfad148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Indexed: 12/05/2023] Open
Abstract
Background Acute kidney injury (AKI) is a common complication after major surgery. This study assessed the risk of developing or worsening of chronic kidney disease (CKD) and other clinical outcomes in patients experiencing AKI after major surgery. Methods This retrospective observational study used Optum's de-identified Clinformatics Data Mart Database to investigate cardiorenal outcomes in adult patients at the first AKI event following major surgery. The primary outcome was CKD stage ≥3; secondary outcomes included myocardial infarction (MI), stroke, heart failure, all-cause hospitalization, end-stage kidney disease, need for dialysis or kidney transplant and composite measures. Follow-up was up to 3 years. Additionally, the effect of intercurrent events on the risk of clinical outcomes was assessed. Results Of the included patients (N = 31 252), most were male (61.9%) and White (68.9%), with a median age of 72 years (interquartile range 64-79). The event rates were 25.5 events/100 patient-years (PY) for CKD stage ≥3, 3.1 events/100 PY for end-stage kidney disease, 3.0 events/100 PY for dialysis and 0.1 events/100 PY for kidney transplants. Additionally, there were 6.9 events/100 PY for MI, 8.7 events/100 PY for stroke and 49.8 events/100 PY for all-cause hospitalization during follow-up. Patients with AKI relapses as intercurrent events were more likely to develop CKD stage ≥3 than those with just one AKI event after major surgery. Conclusion This analysis demonstrated that patients experiencing AKI following major surgery are at high risk of developing severe CKD or worsening of pre-existing CKD and other cardiorenal clinical outcomes such as MI and stroke.
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Affiliation(s)
- Christoph Ohlmeier
- Medical Affairs & Pharmacovigilance, Pharmaceuticals, Bayer AG, Berlin, Germany
| | | | | | - Meike Brinker
- Research & Development, Pharmaceuticals, Bayer AG, Wuppertal, Germany
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Bikbov B, Fortino I, Leoni O, Nobili A, Tettamanti M. Burden of Acute Kidney Injury among Adult Hospital Patients in the Italian Lombardy Region: A 20-Year Real-World Data Analysis. Nephron Clin Pract 2023; 147:599-607. [PMID: 37231958 DOI: 10.1159/000530919] [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: 09/05/2022] [Accepted: 04/05/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Acute kidney injury (AKI) is a frequent condition, with persistent shortage of large-scale epidemiological studies. We analyzed the population-wide healthcare system of the Italian Lombardy region over the 2000-2019 period, and evaluated AKI incidence, mortality, and related healthcare resource utilization and cost in all citizens 40 years and older. METHODS The retrospective cohort analysis of an administrative claims database that routinely collects information about healthcare provision in a high-income region with 10 million citizens. Over 20 years, AKI was identified in 84,384 hospital discharge records by the International Classification of Diseases 9th Revision codes (mean age 77.4 ± 11.6 years, 52.5% were males). RESULTS From 2000 to 2019, the AKI rates per 100,000 population changed from 32.9 to 90.5 for incidence, from 4.7 to 11.9 for mortality, and from 32.3 to 44.1 for years of life lost (YLLs), respectively. In-hospital mortality changed slightly (14.2% and 13.2%, respectively), while 30-day mortality decreased from 21.5% to 17.4%, respectively. Incidence rates increased with age and were higher in males, and varied almost four-fold between provinces. The median hospitalization cost was €4,014 (IQR: 3,652; 4,134), and the annual cost of treatment risen from €5.2 million in 2000 to €22.9 million in 2019. Hemodialysis was administered in 7.4% of hospitalizations. Over the total study period the cumulative AKI burden accounted for 11,420 in-hospital deaths, 63,370.8 YLLs, and €329 million of direct cost. CONCLUSIONS This real-world analysis demonstrates the high burden of AKI with prominent geographical differences that require further implementation of preventive and diagnostic actions.
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Affiliation(s)
- Boris Bikbov
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | | | | | | | - Mauro Tettamanti
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
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Lee W, Wu X, Heo S, Kim JM, Fong KC, Son JY, Sabath MB, Trisovic A, Braun D, Park JY, Kim YC, Lee JP, Schwartz J, Kim H, Dominici F, Al-Aly Z, Bell ML. Air Pollution and Acute Kidney Injury in the U.S. Medicare Population: A Longitudinal Cohort Study. ENVIRONMENTAL HEALTH PERSPECTIVES 2023; 131:47008. [PMID: 37036790 PMCID: PMC10084931 DOI: 10.1289/ehp10729] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 02/14/2023] [Accepted: 02/23/2023] [Indexed: 05/09/2023]
Abstract
BACKGROUND Recent studies have reported the association between air pollution exposure and reduced kidney function. However, it is unclear whether air pollution is associated with an increased risk of acute kidney injury (AKI). OBJECTIVES To address this gap in knowledge, we investigated the effect estimates of long-term exposures to fine particulate matter [PM ≤ 2.5 μ m in aerodynamic diameter (PM 2.5 )], nitrogen dioxide (NO 2 ), and ozone (O 3 ) on the risk of first hospital admission for AKI using nationwide Medicare data. METHODS This nationwide population-based longitudinal cohort study included 61,300,754 beneficiaries enrolled in Medicare Part A fee-for-service (FFS) who were ≥ 65 years of age and resided in the continental United States from the years 2000 through 2016. We applied Cox-equivalent Poisson models to estimate the association between air pollution and first hospital admission for AKI. RESULTS Exposure to PM 2.5 , NO 2 , and O 3 was associated with increased risk for first hospital admission for AKI, with hazard ratios (HRs) of 1.17 (95% CI: 1.16, 1.19) for a 5 - μ g / m 3 increase in PM 2.5 , 1.12 (95% CI: 1.11, 1.13) for a 10 -ppb increase in NO 2 , and 1.03 (95% CI: 1.02, 1.04) for a 10 -ppb increase in summer-period O 3 (June to September). The associations persisted at annual exposures lower than the current National Ambient Air Quality Standard. DISCUSSION This study found an association between exposures to air pollution and the risk of the first hospital admission with AKI, and this association persisted even at low concentrations of air pollution. Our findings provide beneficial implications for public health policies and air pollution guidelines to alleviate health care expenditures and the disease burden attributable to AKI. https://doi.org/10.1289/EHP10729.
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Affiliation(s)
- Whanhee Lee
- School of Biomedical Convergence Engineering, Pusan National University, Yangsan, Republic of Korea
| | - Xiao Wu
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Seulkee Heo
- Yale School of the Environment, Yale University, New Haven, Connecticut, USA
| | - Joyce Mary Kim
- Department of Environmental Medicine, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Kelvin C. Fong
- Yale School of the Environment, Yale University, New Haven, Connecticut, USA
| | - Ji-Young Son
- Yale School of the Environment, Yale University, New Haven, Connecticut, USA
| | - Matthew Benjamin Sabath
- Faculty of Arts and Sciences Research Computing Department, Harvard University, Boston, Massachusetts, USA
| | - Ana Trisovic
- Department of Data Science, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Department of Biostatistics, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| | - Danielle Braun
- Department of Data Science, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Department of Biostatistics, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| | - Jae Yoon Park
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Republic of Korea
- Department of Internal Medicine, Dongguk University College of Medicine, Republic of Korea
| | - Yong Chul Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jung Pyo Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Republic of Korea
| | - Joel Schwartz
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Ho Kim
- Department of Public Health Science, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
- Institute for Sustainable Development, Graduate School of Public Health, Seoul National University, Republic of Korea
| | - Francesca Dominici
- Department of Data Science, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Department of Biostatistics, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| | - Ziyad Al-Aly
- Nephrology Section, Medicine Service, Veterans Affairs Saint Louis Health Care System, Saint Louis, Missouri, USA
- Department of Medicine, Washington University School of Medicine, Saint Louis, Missouri, USA
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA
- Institute for Public Health, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Michelle L. Bell
- Yale School of the Environment, Yale University, New Haven, Connecticut, USA
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Lee W, Heo S, Stewart R, Wu X, Fong KC, Son JY, Sabath B, Braun D, Park JY, Kim YC, Lee JP, Schwartz J, Kim H, Dominici F, Bell ML. Associations between greenness and kidney disease in Massachusetts: The US Medicare longitudinal cohort study. ENVIRONMENT INTERNATIONAL 2023; 173:107844. [PMID: 36841189 DOI: 10.1016/j.envint.2023.107844] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 01/22/2023] [Accepted: 02/19/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Recent studies have identified the association of environmental stressors with reduced kidney function and the development of kidney disease. While residential greenness has been linked to many health benefits, the association between residential greenness and the development of kidney disease is not clear. We aimed to investigate the association between residential greenness and the development of kidney disease. METHODS We performed a longitudinal population-based cohort study including all fee-for-service Medicare Part A beneficiaries (aged 65 years or older) in Massachusetts (2000-2016). We assessed greenness with the annual average Enhanced Vegetation Index (EVI) based on residential ZIP codes of beneficiaries. We applied Cox-equivalent Poisson models to estimate the association between EVI and first hospital admission for total kidney disease, chronic kidney disease (CKD), and acute kidney injury (AKI), separately. RESULTS Data for 1,462,949 beneficiaries who resided in a total of 644 ZIP codes were analyzed. The total person-years of follow-up for total kidney disease, CKD, and AKI were 9.8, 10.9, and 10.8 million person-years, respectively. For a 0.1 increase in annual EVI, the hazard ratios (HRs) were 0.95 (95% CI: 0.93 to 0.97) for the first hospital admission for total kidney disease, and the association was more prominent for AKI (HR: 0.94 with 95% CI: 0.92 to 0.97) than CKD (HR: 0.98 with 95% CI: 0.95-1.01]). The estimated effects of EVI on kidney disease were generally more evident in White beneficiaries and those residing in metropolitan areas compared to the overall population. CONCLUSIONS This study found that higher levels of annual residential greenness were associated with a lower risk of the first hospital admission for kidney diseases. Results are consistent with the hypothesis that higher residential greenness benefits kidney patients.
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Affiliation(s)
- Whanhee Lee
- School of Biomedical Convergence Engineering, College of Information and Biomedical Engineering, Pusan National University, Yangsan, Republic of Korea.
| | - Seulkee Heo
- Yale School of the Environment, Yale University, New Haven, CT, USA
| | - Rory Stewart
- Yale School of the Environment, Yale University, New Haven, CT, USA
| | - Xiao Wu
- Department of Biostatistics, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Kelvin C Fong
- Yale School of the Environment, Yale University, New Haven, CT, USA
| | - Ji-Young Son
- Yale School of the Environment, Yale University, New Haven, CT, USA
| | - Benjamin Sabath
- Faculty of Arts and Sciences Research Computing Department, Harvard University, Boston, MA, USA
| | - Danielle Braun
- Department of Biostatistics, Harvard T H Chan School of Public Health, Boston, MA, USA; Department of Data Science, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Jae Yoon Park
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Republic of Korea; Department of Internal Medicine, Dongguk University College of Medicine, Republic of Korea
| | - Yong Chul Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jung Pyo Lee
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Republic of Korea
| | - Joel Schwartz
- Department of Environmental Health, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Ho Kim
- Department of Public Health Science, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea; Institute for Sustainable Development, Graduate School of Public Health, Seoul National University, Republic of Korea
| | - Francesca Dominici
- Department of Biostatistics, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Michelle L Bell
- Yale School of the Environment, Yale University, New Haven, CT, USA
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12
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Carrero JJ, Fu EL, Vestergaard SV, Jensen SK, Gasparini A, Mahalingasivam V, Bell S, Birn H, Heide-Jørgensen U, Clase CM, Cleary F, Coresh J, Dekker FW, Gansevoort RT, Hemmelgarn BR, Jager KJ, Jafar TH, Kovesdy CP, Sood MM, Stengel B, Christiansen CF, Iwagami M, Nitsch D. Defining measures of kidney function in observational studies using routine health care data: methodological and reporting considerations. Kidney Int 2023; 103:53-69. [PMID: 36280224 DOI: 10.1016/j.kint.2022.09.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 08/31/2022] [Accepted: 09/09/2022] [Indexed: 11/06/2022]
Abstract
The availability of electronic health records and access to a large number of routine measurements of serum creatinine and urinary albumin enhance the possibilities for epidemiologic research in kidney disease. However, the frequency of health care use and laboratory testing is determined by health status and indication, imposing certain challenges when identifying patients with kidney injury or disease, when using markers of kidney function as covariates, or when evaluating kidney outcomes. Depending on the specific research question, this may influence the interpretation, generalizability, and/or validity of study results. This review illustrates the heterogeneity of working definitions of kidney disease in the scientific literature and discusses advantages and limitations of the most commonly used approaches using 3 examples. We summarize ways to identify and overcome possible biases and conclude by proposing a framework for reporting definitions of exposures and outcomes in studies of kidney disease using routinely collected health care data.
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Affiliation(s)
- Juan Jesus Carrero
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden.
| | - Edouard L Fu
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden; Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA; Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Søren V Vestergaard
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Simon Kok Jensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Alessandro Gasparini
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| | - Viyaasan Mahalingasivam
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Samira Bell
- Division of Population Health and Genomics, University of Dundee, Dundee, UK
| | - Henrik Birn
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Biomedicine, Aarhus University, Aarhus, Denmark; Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Uffe Heide-Jørgensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Catherine M Clase
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Department of Health Research and Methodology, McMaster University, Hamilton, Ontario, Canada
| | - Faye Cleary
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Josef Coresh
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Friedo W Dekker
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Ron T Gansevoort
- Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | | | - Kitty J Jager
- ERA Registry, Amsterdam UMC location University of Amsterdam, Medical Informatics, Meibergdreef, Amsterdam, Netherlands; Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
| | - Tazeen H Jafar
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - Csaba P Kovesdy
- Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Manish M Sood
- Department of Medicine, the Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Bénédicte Stengel
- CESP (Center for Research in Epidemiology and Population Health), Clinical Epidemiology Team, University Paris-Saclay, University Versailles-Saint Quentin, Inserm U1018, Villejuif, France
| | - Christian F Christiansen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Masao Iwagami
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK; Department of Health Services Research, University of Tsukuba, Ibaraki, Japan
| | - Dorothea Nitsch
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK; Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; UK Renal Registry, UK Kidney Association, Bristol, UK.
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13
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Harmonization of epidemiology of acute kidney injury and acute kidney disease produces comparable findings across four geographic populations. Kidney Int 2022; 101:1271-1281. [DOI: 10.1016/j.kint.2022.02.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 01/25/2022] [Accepted: 02/18/2022] [Indexed: 12/24/2022]
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Humbert-Droz M, Mukherjee P, Gevaert O. Strategies to Address the Lack of Labeled Data for Supervised Machine Learning Training With Electronic Health Records: Case Study for the Extraction of Symptoms From Clinical Notes. JMIR Med Inform 2022; 10:e32903. [PMID: 35285805 PMCID: PMC8961340 DOI: 10.2196/32903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 11/12/2021] [Accepted: 12/16/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Automated extraction of symptoms from clinical notes is a challenging task owing to the multidimensional nature of symptom description. The availability of labeled training data is extremely limited owing to the nature of the data containing protected health information. Natural language processing and machine learning to process clinical text for such a task have great potential. However, supervised machine learning requires a great amount of labeled data to train a model, which is at the origin of the main bottleneck in model development. OBJECTIVE The aim of this study is to address the lack of labeled data by proposing 2 alternatives to manual labeling for the generation of training labels for supervised machine learning with English clinical text. We aim to demonstrate that using lower-quality labels for training leads to good classification results. METHODS We addressed the lack of labels with 2 strategies. The first approach took advantage of the structured part of electronic health records and used diagnosis codes (International Classification of Disease-10th revision) to derive training labels. The second approach used weak supervision and data programming principles to derive training labels. We propose to apply the developed framework to the extraction of symptom information from outpatient visit progress notes of patients with cardiovascular diseases. RESULTS We used >500,000 notes for training our classification model with International Classification of Disease-10th revision codes as labels and >800,000 notes for training using labels derived from weak supervision. We show that the dependence between prevalence and recall becomes flat provided a sufficiently large training set is used (>500,000 documents). We further demonstrate that using weak labels for training rather than the electronic health record codes derived from the patient encounter leads to an overall improved recall score (10% improvement, on average). Finally, the external validation of our models shows excellent predictive performance and transferability, with an overall increase of 20% in the recall score. CONCLUSIONS This work demonstrates the power of using a weak labeling pipeline to annotate and extract symptom mentions in clinical text, with the prospects to facilitate symptom information integration for a downstream clinical task such as clinical decision support.
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Affiliation(s)
- Marie Humbert-Droz
- Stanford Center for Biomedical Informatics Research, Department of Medicine, Stanford University, Stanford, CA, United States
| | - Pritam Mukherjee
- Stanford Center for Biomedical Informatics Research, Department of Medicine, Stanford University, Stanford, CA, United States
| | - Olivier Gevaert
- Stanford Center for Biomedical Informatics Research, Department of Medicine, Stanford University, Stanford, CA, United States
- Department of Biomedical Data Science, Stanford University, Stanford, CA, United States
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15
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Dialysis attendance patterns and health care utilisation of Aboriginal patients attending dialysis services in urban, rural and remote locations. BMC Health Serv Res 2022; 22:251. [PMID: 35209888 PMCID: PMC8867655 DOI: 10.1186/s12913-022-07628-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 02/09/2022] [Indexed: 12/26/2022] Open
Abstract
Background Aboriginal people in the Northern Territory (NT) suffer the heaviest burden of kidney failure in Australia with most living in remote areas at time of dialysis commencement. As there are few dialysis services in remote areas, many Aboriginal people are required to relocate often permanently, to access treatment. Missing dialysis treatments is not uncommon amongst Aboriginal patients but the relationship between location of dialysis service and dialysis attendance (and subsequent hospital use) has not been explored to date. Aim To examine the relationships between location of dialysis service, dialysis attendance patterns and downstream health service use (overnight hospital admissions, emergency department presentations) among Aboriginal patients in the NT. Methods Using linked hospital and dialysis registry datasets we analysed health service activity for 896 Aboriginal maintenance dialysis patients in the NT between 2008 and 2014. Multivariate linear regression and negative binomial regression analyses explored the associations between dialysis location, dialysis attendance and health service use. Results We found missing two or more dialysis treatments per month was more likely for Aboriginal people attending urban services and this was associated with a two-fold increase in the rate of hospital admissions and more than three-fold increase in ED presentations. However, we found higher dialysis attendance and lower health service utilisation for those receiving care in rural and remote settings. When adjusted for age, time on dialysis, region, comorbidities and residence pre-treatment, among Aboriginal people from remote areas, those dialysing in remote areas had lower rates of hospitalisations (IRR 0.56; P < 0.001) when compared to those who relocated and dialysed in urban areas. Conclusion There is a clear relationship between the provision and uptake of dialysis services in urban, rural and remote areas in the NT and subsequent broader health service utilisation. Our study suggests that the low dialysis attendance associated with relocation and care in urban models for Aboriginal people can potentially be ameliorated by access to rural and remote models and this warrants a rethinking of service delivery policy. If providers are to deliver effective and equitable services, the full range of intended and unintended consequences of a dialysis location should be incorporated into planning decisions. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07628-9.
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16
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Lee W, Wu X, Heo S, Fong KC, Son JY, Sabath MB, Braun D, Park JY, Kim YC, Lee JP, Schwartz J, Kim H, Dominici F, Bell M. Associations between long term air pollution exposure and first hospital admission for kidney and total urinary system diseases in the US Medicare population: nationwide longitudinal cohort study. BMJ MEDICINE 2022; 1:e000009. [PMID: 36936557 PMCID: PMC10012859 DOI: 10.1136/bmjmed-2021-000009] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 03/21/2022] [Indexed: 11/04/2022]
Abstract
Objective To estimate the associations between long term exposure to air pollution and the first hospital admission related to kidney and total urinary system diseases. Design Nationwide longitudinal cohort study. Setting Data were collected from the Medicare fee-for-service for beneficiaries living in 34 849 zip codes across the continental United States from 2000 to 2016. Exposure variables were annual averages of traffic related pollutants (fine particles (PM2.5) and nitrogen dioxide (NO2)) that were assigned according to the zip code of residence of each beneficiary with the use of validated and published hybrid ensemble prediction models. Participants All beneficiaries aged 65 years or older who were enrolled in Medicare part A fee-for-service (n=61 097 767). Primary and secondary outcome measures First hospital admission with diagnosis codes for total kidney and urinary system disease or chronic kidney disease (CKD), analyzed separately. Results The average annual concentrations of air pollution were 9.8 µg/m3 for PM2.5 and 18.9 ppb for NO2. The total number of first admissions related to total kidney and urinary system disease and CKD were around 19.0 million and 5.9 million, respectively (2000-16). For total kidney and urinary system disease, hazard ratios were 1.076 (95% confidence interval 1.071 to 1.081) for a 5 µg/m3 increase in PM2.5 and 1.040 (1.036 to 1.043) for a 10 ppb increase in NO2. For CKD, hazard ratios were 1.106 (1.097 to 1.115) for a 5 µg/m3 increase in PM2.5 and 1.013 (1.008 to 1.019) for a 10 ppb increase in NO2. These positive associations between PM2.5 and kidney outcomes persisted at concentrations below national health based air quality standards. Conclusions The findings suggest that higher annual air pollution levels were associated with increased risk of first hospital admission related to diseases of the kidney and urinary system or CKD in the Medicare population.
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Affiliation(s)
- Whanhee Lee
- School of the Environment, Yale University, New Haven, CT, USA
- Department of Environmental Medicine, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
- Institute of Ewha-SCL for Environmental Health (IESEH), Seoul, Republic of Korea
| | - Xiao Wu
- Department of Biostatistics, Harvard University T H Chan School of Public Health, Boston, MA, USA
| | - Seulkee Heo
- School of the Environment, Yale University, New Haven, CT, USA
| | - Kelvin C Fong
- School of the Environment, Yale University, New Haven, CT, USA
| | - Ji-Young Son
- School of the Environment, Yale University, New Haven, CT, USA
| | | | - Danielle Braun
- Harvard University T H Chan School of Public Health, Boston, MA, USA
- Department of Data Science, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Jae Yoon Park
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Gyeonggi-do, Republic of Korea
- Department of Internal Medicine, Dongguk University College of Medicine, Goyang, Gyeonggi-do, Republic of Korea
| | - Yong Chul Kim
- Department of Internal Medicine, Seoul National University Hospital, Jongno-gu, Seoul, Republic of Korea
| | - Jung Pyo Lee
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Joel Schwartz
- Environmental Health, Harvard University T H Chan School of Public Health, Boston, MA, USA
| | - Ho Kim
- Graduate School of Public Health, Seoul National University, Gwanak-gu, Seoul, Republic of Korea
- Institute for Sustainable Development, Graduate School of Public Health, Seoul, Republic of Korea
| | - Francesca Dominici
- Department of Biostatistics, Harvard University T H Chan School of Public Health, Boston, MA, USA
| | - Michelle Bell
- School of the Environment, Yale University, New Haven, CT, USA
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Alkabbani W, Zongo A, Minhas-Sandhu JK, Eurich DT, Shah BR, Alsabbagh MW, Gamble JM. Renal effectiveness and safety of the sodium-glucose cotransporter-2 inhibitors: a population-based cohort study. BMJ Open Diabetes Res Care 2021; 9:9/2/e002496. [PMID: 34906925 PMCID: PMC8671915 DOI: 10.1136/bmjdrc-2021-002496] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 11/23/2021] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION To assess the comparative effectiveness and safety of renal-related outcomes associated with sodium-glucose cotransporter-2 inhibitors (SGLT2-i) initiation among patients with type 2 diabetes using real-world data. RESEARCH DESIGN AND METHODS We conducted a population-based cohort study using administrative healthcare data from Alberta (AB), Canada and primary care data from the Clinical Practice Research Datalink (CPRD), UK. From a cohort of new metformin users, we identified initiators of a SGLT2-i or dipeptidyl peptidase-4 inhibitor (DPP4-i) between January 1, 2014 and March 30, 2018 (AB) or between January 1, 2013 and November 29, 2018 (CPRD). Initiators of an SGLT2-i or DPP4-i were followed until death, disenrolment, therapy discontinuation, or study end date. The effectiveness outcome was renal disease progression, defined as a composite of new-onset macroalbuminuria, serum creatinine doubling with estimated glomerular filtration rate of ≤45 mL/min/1.73 m2, renal replacement therapy, hospital admission or death from renal causes. The safety outcome was hospitalization due to acute kidney injury (AKI). We adjusted for confounding using high-dimensional propensity score matching and estimated HRs using Cox proportional hazards regression. Aggregate data from each database were combined by random-effects meta-analysis. RESULTS Among the 29 465 included patients (20 564 AB, 8901 CPRD), 37.5% were new SGLT2-i users in AB and 21.3% in CPRD. Compared with DPP4 initiators, SGLT2-i initiators were associated with a reduced risk of renal disease progression (pooled HR 0.79, 95% CI 0.62 to 1.00); however, there was no significant difference in the risk of AKI (pooled HR 0.89, 95% CI 0.58 to 1.36). These findings were consistent with other exposure definitions and antidiabetic comparators. CONCLUSIONS Our findings support a renoprotective effect of SGLT2-i without an increased risk of AKI, compared with clinically relevant active comparators.
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Affiliation(s)
- Wajd Alkabbani
- School of Pharmacy, University of Waterloo, Kitchener, Ontario, Canada
| | - Arsene Zongo
- Faculté de pharmacie, Université Laval, Laval, Quebec, Canada
- CHU de Québec-Université Laval Research Center, Québec City, Québec, Canada
| | - Jasjeet K Minhas-Sandhu
- School of Pharmacy, University of Waterloo, Kitchener, Ontario, Canada
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Dean T Eurich
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Baiju R Shah
- Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Androgen deprivation therapy and acute kidney injury in patients with prostate cancer undergoing definitive radiotherapy. Prostate Cancer Prostatic Dis 2021:10.1038/s41391-021-00415-3. [PMID: 34811501 DOI: 10.1038/s41391-021-00415-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 06/12/2021] [Accepted: 06/22/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Androgen deprivation therapy (ADT) is frequently utilized in conjunction with radiotherapy (RT) in the definitive management of prostate cancer. Prior studies have suggested an association between ADT use and acute kidney injury (AKI), however, these included heterogeneous populations undergoing a variety of treatments and relied on billing codes to ascertain the incidence of AKI. METHODS We analyzed a cohort of 27,868 veterans undergoing definitive RT + /- ADT for prostate cancer between 2001 and 2015 using the Veterans Affairs Informatics and Computing Infrastructure (VINCI). Exposure was defined as use of ADT within one year of diagnosis. The primary outcome was AKI, defined by an increase in serum creatinine to at least 1.5 times the baseline value. AKIs were classified as mild, moderate, or severe in accordance with international guidelines. A multivariate competing risks model was used to account for demographic and oncologic factors as well as medications and procedures known to influence the risk of AKI. RESULTS Most (n = 18,754) men received RT alone; 9,114 men received RT + ADT. The incidence of AKI at two years after diagnosis was 10.5% in the RT + ADT group and 7.9% in the RT group (Gray's test p < 0.01). Multivariate analysis confirmed ADT usage was associated with an increased risk for any AKI (SHR = 1.24, 95% CI = 1.14-1.36, p < 0.01). ADT was also associated with an increased risk of mild AKI (SHR = 1.13, 95% CI = 1.01-1.27, p = 0.04) and moderate AKI (SHR = 1.45, 95% CI = 1.20-1.76, p < 0.01), though not severe AKI (SHR = 1.33, 95% CI = 0.93-1.91, p = 0.11). CONCLUSIONS Our findings confirm that use of ADT is associated with an increased risk of AKI in patients undergoing definitive RT for prostate cancer. Clinicians should be alert to the potential for renal dysfunction in this population.
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Savino M, Plumb L, Casula A, Evans K, Wong E, Kolhe N, Medcalf JF, Nitsch D. Acute kidney injury identification for pharmacoepidemiologic studies: Use of laboratory electronic acute kidney injury alerts versus electronic health records in Hospital Episode Statistics. Pharmacoepidemiol Drug Saf 2021; 30:1687-1695. [PMID: 34418198 DOI: 10.1002/pds.5347] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 06/30/2021] [Accepted: 08/16/2021] [Indexed: 01/17/2023]
Abstract
PURPOSE A laboratory-based acute kidney injury (AKI) electronic-alert (e-alert) system, with e-alerts sent to the UK Renal Registry (UKRR) and collated in a master patient index (MPI), has recently been implemented in England. The aim of this study was to determine the degree of correspondence between the UKRR-MPI and AKI International Classification Disease-10 (ICD-10) N17 coding in Hospital Episode Statistics (HES) and whether hospital N17 coding correlated with 30-day mortality and emergency re-admission after AKI. METHODS AKI e-alerts in people aged ≥18 years, collated in the UKRR-MPI during 2017, were linked to HES data to identify a hospitalised AKI population. Multivariable logistic regression was used to analyse associations between absence/presence of N17 codes and clinicodemographic features. Correlation of the percentage coded with N17 and 30-day mortality and emergency re-admission after AKI were calculated at hospital level. RESULTS In 2017, there were 301 540 adult episodes of hospitalised AKI in England. AKI severity was positively associated with coding in HES, with a high degree of inter-hospital variability-AKI stage 1 mean of 48.2% [SD 14.0], versus AKI stage 3 mean of 83.3% [SD 7.3]. N17 coding in HES depended on demographic features, especially age (18-29 years vs. ≥85 years OR 0.22, 95% CI 0.21-0.23), as well as sex and ethnicity. There was no evidence of association between the proportion of episodes coded for AKI with short-term AKI outcomes. CONCLUSION Coding of AKI in HES is influenced by many factors that result in an underestimation of AKI. Using e-alerts to triangulate the true incidence of AKI could provide a better understanding of the factors that affect hospital coding, potentially leading to improved coding, patient care and pharmacoepidemiologic research.
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Affiliation(s)
| | - Lucy Plumb
- UK Renal Registry, Bristol, UK.,Population Health Sciences, University of Bristol Medical School, Bristol, UK
| | | | | | | | | | - James F Medcalf
- UK Renal Registry, Bristol, UK.,Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.,Leicester General Hospital, Leicester, UK
| | - Dorothea Nitsch
- UK Renal Registry, Bristol, UK.,London School of Hygiene and Tropical Medicine, London, UK.,Royal Free London NHS Foundation Trust, London, UK
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20
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Guthrie G, Guthrie B, Walker H, James MT, Selby NM, Tonelli M, Bell S. Developing an AKI Consensus Definition for Database Research: Findings From a Scoping Review and Expert Opinion Using a Delphi Process. Am J Kidney Dis 2021; 79:488-496.e1. [PMID: 34298142 DOI: 10.1053/j.ajkd.2021.05.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 05/12/2021] [Indexed: 12/18/2022]
Abstract
RATIONALE & OBJECTIVE The KDIGO (Kidney Disease: Improving Global Outcomes) definition of acute kidney injury (AKI) is frequently used in studies to examine the epidemiology of AKI. This definition is variably interpreted and applied to routinely collected health care data. The aim of this study was to examine this variation and to achieve consensus in how AKI should be defined for research using routinely collected health care data. SOURCES OF EVIDENCE AND STUDY DESIGN Scoping review via searching Medline and EMBASE for studies using health care data to examine AKI by using the KDIGO creatinine-based definition. An international panel of experts formed to participate in a modified Delphi process to attempt to generate consensus about how AKI should be defined when using routinely collected laboratory data. CHARTING METHODS AND ANALYTICAL APPROACH The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) extension for scoping reviews was followed. For the Delphi process, 2 rounds of questions were distributed via internet-based questionnaires to all participants with a prespecified cutoff of 75% agreement used to define consensus. RESULTS The scoping review found 174 studies that met the inclusion criteria. The KDIGO definition was inconsistently applied, and the methods for application were poorly described. We found 58 (33%) of papers did not provide a definition of how the baseline creatinine value was determined, and only 34 (20%) defined recovery of kidney function. Of 55 invitees to the Delphi process, 35 respondents participated in round 1, and 25 participated in round 2. Some consensus was achieved in areas related to how to define the baseline creatinine value, which patients should be excluded from analysis of routinely collected laboratory data, and how persistent chronic kidney disease or nonrecovery of AKI should be defined. LIMITATIONS The Delphi panel members predominantly came from the United Kingdom, the United States, and Canada, and there were low response rates for some questions in round 1. CONCLUSIONS The current methods for defining AKI using routinely collected data are inconsistent and poorly described in the available literature. Experts could not achieve consensus for many aspects of defining AKI and describing its sequelae. The KDIGO guidelines should be extended to include a standardized definition for how AKI should be defined when using routinely collected data.
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Affiliation(s)
- Greg Guthrie
- Renal Unit, Ninewells Hospital, Dundee, United Kingdom
| | - Bruce Guthrie
- Advanced Care Research Centre, Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, United Kingdom
| | - Heather Walker
- Renal Unit, Ninewells Hospital, Dundee, United Kingdom; Division of Population Health and Genomics, Medical Research Institute, University of Dundee, Dundee, United Kingdom
| | - Matthew T James
- Division of Nephrology, Department of Medicine, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Nicholas M Selby
- Centre for Kidney Research and Innovation, Academic Unit for Translational Medical Sciences, School of Medicine (Royal Derby Hospital Campus), University of Nottingham, Nottingham, United Kingdom
| | - Marcello Tonelli
- Division of Nephrology, Department of Medicine, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Samira Bell
- Renal Unit, Ninewells Hospital, Dundee, United Kingdom; Division of Population Health and Genomics, Medical Research Institute, University of Dundee, Dundee, United Kingdom.
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21
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Marquez-Exposito L, Tejedor-Santamaria L, Santos-Sanchez L, Valentijn FA, Cantero-Navarro E, Rayego-Mateos S, Rodrigues-Diez RR, Tejera-Muñoz A, Marchant V, Sanz AB, Ortiz A, Goldschmeding R, Ruiz-Ortega M. Acute Kidney Injury is Aggravated in Aged Mice by the Exacerbation of Proinflammatory Processes. Front Pharmacol 2021; 12:662020. [PMID: 34239439 PMCID: PMC8258347 DOI: 10.3389/fphar.2021.662020] [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: 01/31/2021] [Accepted: 06/03/2021] [Indexed: 12/11/2022] Open
Abstract
Acute kidney injury (AKI) is more frequent in elderly patients. Mechanisms contributing to AKI (tubular cell death, inflammatory cell infiltration, impaired mitochondrial function, and prolonged cell-cycle arrest) have been linked to cellular senescence, a process implicated in regeneration failure and progression to fibrosis. However, the molecular and pathological basis of the age-related increase in AKI incidence is not completely understood. To explore these mechanisms, experimental AKI was induced by folic acid (FA) administration in young (3-months-old) and old (1-year-old) mice, and kidneys were evaluated in the early phase of AKI, at 48 h. Tubular damage score, KIM-1 expression, the recruitment of infiltrating immune cells (mainly neutrophils and macrophages) and proinflammatory gene expression were higher in AKI kidneys of old than of young mice. Tubular cell death in FA-AKI involves several pathways, such as regulated necrosis and apoptosis. Ferroptosis and necroptosis cell-death pathways were upregulated in old AKI kidneys. In contrast, caspase-3 activation was only found in young but not in old mice. Moreover, the antiapoptotic factor BCL-xL was significantly overexpressed in old, injured kidneys, suggesting an age-related apoptosis suppression. AKI kidneys displayed evidence of cellular senescence, such as increased levels of cyclin dependent kinase inhibitors p16ink4a and p21cip1, and of the DNA damage response marker γH2AX. Furthermore, p21cip1 mRNA expression and nuclear staining for p21cip1 and γH2AX were higher in old than in young FA-AKI mice, as well as the expression of senescence-associated secretory phenotype (SASP) components (Il-6, Tgfb1, Ctgf, and Serpine1). Interestingly, some infiltrating immune cells were p21 or γH2AX positive, suggesting that molecular senescence in the immune cells (“immunosenescence”) are involved in the increased severity of AKI in old mice. In contrast, expression of renal protective factors was dramatically downregulated in old AKI mice, including the antiaging factor Klotho and the mitochondrial biogenesis driver PGC-1α. In conclusion, aging resulted in more severe AKI after the exposure to toxic compounds. This increased toxicity may be related to magnification of proinflammatory-related pathways in older mice, including a switch to a proinflammatory cell death (necroptosis) instead of apoptosis, and overactivation of cellular senescence of resident renal cells and infiltrating inflammatory cells.
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Affiliation(s)
- Laura Marquez-Exposito
- Cellular Biology in Renal Diseases Laboratory, IIS-Fundación Jiménez Díaz, Universidad Autónoma Madrid, Madrid, Spain.,Red de Investigación Renal (REDinREN), Madrid, Spain
| | - Lucia Tejedor-Santamaria
- Cellular Biology in Renal Diseases Laboratory, IIS-Fundación Jiménez Díaz, Universidad Autónoma Madrid, Madrid, Spain.,Red de Investigación Renal (REDinREN), Madrid, Spain
| | - Laura Santos-Sanchez
- Cellular Biology in Renal Diseases Laboratory, IIS-Fundación Jiménez Díaz, Universidad Autónoma Madrid, Madrid, Spain.,Red de Investigación Renal (REDinREN), Madrid, Spain
| | - Floris A Valentijn
- Department of Pathology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Elena Cantero-Navarro
- Cellular Biology in Renal Diseases Laboratory, IIS-Fundación Jiménez Díaz, Universidad Autónoma Madrid, Madrid, Spain.,Red de Investigación Renal (REDinREN), Madrid, Spain
| | - Sandra Rayego-Mateos
- Cellular Biology in Renal Diseases Laboratory, IIS-Fundación Jiménez Díaz, Universidad Autónoma Madrid, Madrid, Spain.,Red de Investigación Renal (REDinREN), Madrid, Spain
| | - Raul R Rodrigues-Diez
- Cellular Biology in Renal Diseases Laboratory, IIS-Fundación Jiménez Díaz, Universidad Autónoma Madrid, Madrid, Spain.,Red de Investigación Renal (REDinREN), Madrid, Spain
| | - Antonio Tejera-Muñoz
- Cellular Biology in Renal Diseases Laboratory, IIS-Fundación Jiménez Díaz, Universidad Autónoma Madrid, Madrid, Spain.,Red de Investigación Renal (REDinREN), Madrid, Spain
| | - Vanessa Marchant
- Cellular Biology in Renal Diseases Laboratory, IIS-Fundación Jiménez Díaz, Universidad Autónoma Madrid, Madrid, Spain.,Red de Investigación Renal (REDinREN), Madrid, Spain
| | - Ana B Sanz
- Red de Investigación Renal (REDinREN), Madrid, Spain.,Division of Nephrology and Hypertension, IIS-Fundación Jiménez Díaz-Universidad Autónoma Madrid, Madrid, Spain
| | - Alberto Ortiz
- Red de Investigación Renal (REDinREN), Madrid, Spain.,Division of Nephrology and Hypertension, IIS-Fundación Jiménez Díaz-Universidad Autónoma Madrid, Madrid, Spain
| | - Roel Goldschmeding
- Department of Pathology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Marta Ruiz-Ortega
- Cellular Biology in Renal Diseases Laboratory, IIS-Fundación Jiménez Díaz, Universidad Autónoma Madrid, Madrid, Spain.,Red de Investigación Renal (REDinREN), Madrid, Spain
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22
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Tain YL, Kuo HC, Hsu CN. Changing trends in dialysis modalities utilization and mortality in children, adolescents and young adults with acute kidney injury, 2010-2017. Sci Rep 2021; 11:11887. [PMID: 34088938 PMCID: PMC8178371 DOI: 10.1038/s41598-021-91171-w] [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] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 05/07/2021] [Indexed: 11/09/2022] Open
Abstract
The aim of the study was to assess trends in the relative use of dialysis modalities in the hospital-based pediatric cohort and to determine risk factors associated with in-hospital morality among pediatric patients receiving dialysis for acute kidney injury (AKI). Patients aged < 20 years who received dialysis between 2010 and 2017 were identified from electronic health records databases of a Taiwan's healthcare delivery system. The annual uses of intermittent hemodialysis (HD), continuous and automated peritoneal dialysis (PD) and continuous kidney replacement therapy (CKRT) were assessed using Cochran-Armitage Tests for trend. Among patients who received their first dialysis as inpatients for AKI, a multivariate logistic regression model was employed to assess mortality risks associated with dialysis modalities, patient demographics, complexity of baseline chronic disease, and healthcare service use during their hospital stays. Kidney dialysis was performed 37.9 per patient per year over the study period. Intermittent hemodialysis (HD) (73.3%) was the most frequently used dialysis modality. In the inpatient setting, the relative annual use of CKRT increased over the study period, while HD use concomitantly declined (P < 0.0001). The overall in-hospital mortality rate after dialysis for AKI was 33.6%, which remained steady over time (P = 0.2411). Patients aged < 2 years [adjusted odds ratio: (aOR) 3.36; 95% confidence interval (CI) 1.34-8.93] and greater vasoactive regimen use (aOR: 17.1; 95% CI: 5.3-55.21) were significantly associated with dialysis-related mortality. Overall treatment modality used for dialysis in pediatric patients increased slowly in the study period, and HD and CRKT modality uses largely evolved in the inpatient setting. Younger ages and use of more vasoactive medication regimens were independently associated with increased early mortality in patients on AKI-dialysis.
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Affiliation(s)
- You-Lin Tain
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung, 833, Taiwan
| | - Hsiao-Ching Kuo
- Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, 833, Taiwan
| | - Chien-Ning Hsu
- Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, 833, Taiwan.
- School of Pharmacy, Kaohsiung Medical University, Kaohsiung, 807, Taiwan.
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23
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Sohaney R, Heung M. Care of the Survivor of Critical Illness and Acute Kidney Injury: A Multidisciplinary Approach. Adv Chronic Kidney Dis 2021; 28:105-113. [PMID: 34389131 DOI: 10.1053/j.ackd.2021.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 10/19/2020] [Accepted: 01/04/2021] [Indexed: 11/11/2022]
Abstract
Acute kidney injury (AKI) is a common complication of critical illness and is associated with adverse short- and long-term health consequences. Survivors of critical illness and AKI experience poor kidney, cardiovascular and quality of life outcomes, along with increased mortality. Yet, many patients surviving AKI are unaware that there is a problem with their kidney health, and post-AKI nephrology follow-up occurs at very low rates. Although there is a paucity of evidence-based studies to guide post-AKI care, attention to risk factors such as hypertension and albuminuria are requisite. There are several ongoing or planned studies which are expected to help inform specific management in the future. Until then, a multidisciplinary approach is warranted to address areas such as quality of life, physical rehabilitation, dietary modifications, and medication reconciliation.
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24
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Hapca S, Siddiqui MK, Kwan RS, Lim M, Matthew S, Doney AS, Pearson ER, Palmer CN, Bell S. The Relationship between AKI and CKD in Patients with Type 2 Diabetes: An Observational Cohort Study. J Am Soc Nephrol 2021; 32:138-150. [PMID: 32948670 PMCID: PMC7894655 DOI: 10.1681/asn.2020030323] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 07/27/2020] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND There are few observational studies evaluating the risk of AKI in people with type 2 diabetes, and even fewer simultaneously investigating AKI and CKD in this population. This limits understanding of the interplay between AKI and CKD in people with type 2 diabetes compared with the nondiabetic population. METHODS In this retrospective, cohort study of participants with or without type 2 diabetes, we used electronic healthcare records to evaluate rates of AKI and various statistical methods to determine their relationship to CKD status and further renal function decline. RESULTS We followed the cohort of 16,700 participants (9417 with type 2 diabetes and 7283 controls without diabetes) for a median of 8.2 years. Those with diabetes were more likely than controls to develop AKI (48.6% versus 17.2%, respectively) and have preexisting CKD or CKD that developed during follow-up (46.3% versus 17.2%, respectively). In the absence of CKD, the AKI rate among people with diabetes was nearly five times that of controls (121.5 versus 24.6 per 1000 person-years). Among participants with CKD, AKI rate in people with diabetes was more than twice that of controls (384.8 versus 180.0 per 1000 person-years after CKD diagnostic date, and 109.3 versus 47.4 per 1000 person-years before CKD onset in those developing CKD after recruitment). Decline in eGFR slope before AKI episodes was steeper in people with diabetes versus controls. After AKI episodes, decline in eGFR slope became steeper in people without diabetes, but not among those with diabetes and preexisting CKD. CONCLUSIONS Patients with diabetes have significantly higher rates of AKI compared with patients without diabetes, and this remains true for individuals with preexisting CKD.
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Affiliation(s)
- Simona Hapca
- Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, United Kingdom,Division of Computing Science and Mathematics, University of Stirling, Stirling, United Kingdom
| | - Moneeza K. Siddiqui
- Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, United Kingdom
| | - Ryan S.Y. Kwan
- Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, United Kingdom
| | - Michelle Lim
- Renal Unit, Ninewells Hospital, Dundee, United Kingdom
| | - Shona Matthew
- Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, United Kingdom
| | - Alex S.F. Doney
- Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, United Kingdom
| | - Ewan R. Pearson
- Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, United Kingdom
| | - Colin N.A. Palmer
- Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, United Kingdom
| | - Samira Bell
- Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, United Kingdom,Renal Unit, Ninewells Hospital, Dundee, United Kingdom
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25
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Howard SJ, Elvey R, Ohrnberger J, Turner AJ, Anselmi L, Martindale AM, Blakeman T. Post-discharge care following acute kidney injury: quality improvement in primary care. BMJ Open Qual 2020; 9:e000891. [PMID: 33328317 PMCID: PMC7745694 DOI: 10.1136/bmjoq-2019-000891] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 10/27/2020] [Accepted: 11/03/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Over the past decade, targeting acute kidney injury (AKI) has become a priority to improve patient safety and health outcomes. Illness complicated by AKI is common and is associated with adverse outcomes including high rates of unplanned hospital readmission. Through national patient safety directives, NHS England has mandated the implementation of an AKI clinical decision support system in hospitals. In order to improve care following AKI, hospitals have also been incentivised to improve discharge summaries and general practices are recommended to establish registers of people who have had an episode of illness complicated by AKI. However, to date, there is limited evidence surrounding the development and impact of interventions following AKI. DESIGN We conducted a quality improvement project in primary care aiming to improve the management of patients following an episode of hospital care complicated by AKI. All 31 general practices within a single NHS Clinical Commissioning Group were incentivised by a locally commissioned service to engage in audit and feedback, education training and to develop an action plan at each practice to improve management of AKI. RESULTS AKI coding in general practice increased from 28% of cases in 2015/2016 to 50% in 2017/2018. Coding of AKI was associated with significant improvements in downstream patient management in terms of conducting a medication review within 1 month of hospital discharge, monitoring kidney function within 3 months and providing written information about AKI to patients. However, there was no effect on unplanned hospitalisation and mortality. CONCLUSION The findings suggest that the quality improvement intervention successfully engaged a primary care workforce in AKI-related care, but that a higher intensity intervention is likely to be required to improve health outcomes. Development of a real-time audit tool is necessary to better understand and minimise the impact of the high mortality rate following AKI.
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Affiliation(s)
- Susan J Howard
- NIHR Applied Research Collaboration Greater Manchester (ARC-GM), Health Innovation Manchester, Manchester, UK
| | - Rebecca Elvey
- NIHR Applied Research Collaboration Greater Manchester (ARC-GM), Health Innovation Manchester, Manchester, UK
- Centre for Primary Care and Health Services Research, Division of Population Health, Health Services Research and Primary Care; School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK, The University of Manchester, Manchester, UK
| | - Julius Ohrnberger
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Alex J Turner
- Health Organisation, Policy and Economics (HOPE) group, Centre for Primary Care and Health Services Research, The University of Manchester, Manchester, UK
| | - Laura Anselmi
- Health Organisation, Policy and Economics (HOPE) group, Centre for Primary Care and Health Services Research, The University of Manchester, Manchester, UK
| | - Anne-Marie Martindale
- NIHR Applied Research Collaboration Greater Manchester (ARC-GM), Health Innovation Manchester, Manchester, UK
- Centre for Primary Care and Health Services Research, Division of Population Health, Health Services Research and Primary Care; School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK, The University of Manchester, Manchester, UK
| | - Tom Blakeman
- NIHR Applied Research Collaboration Greater Manchester (ARC-GM), Health Innovation Manchester, Manchester, UK
- Centre for Primary Care and Health Services Research, Division of Population Health, Health Services Research and Primary Care; School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK, The University of Manchester, Manchester, UK
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26
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Elvey R, Howard SJ, Martindale AM, Blakeman T. Implementing post-discharge care following acute kidney injury in England: a single-centre qualitative evaluation. BMJ Open 2020; 10:e036077. [PMID: 32792434 PMCID: PMC7430404 DOI: 10.1136/bmjopen-2019-036077] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 02/28/2020] [Accepted: 05/17/2020] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVES We sought to understand the factors influencing the implementation of a primary care intervention to improve post-discharge care following acute kidney injury (AKI). DESIGN Qualitative study using semi-structured interviews and thematic analysis. SETTING General practices in one Clinical Commissioning Group area in England. PARTICIPANTS A total of 18 healthcare staff took part in interviews. Participants were practice pharmacists, general practitioners, practice managers and administrators involved in implementing the intervention. RESULTS We identified three main factors influencing implementation: differentiation of the new intervention from other practice work; development of skill mix and communication across organisations. Overall, post-AKI processes of care were deemed straightforward to embed into existing practice. However, it was also important to separate the intervention from other work in general practice. Dedicating staff time to proactively identify AKI on discharge summaries and to coordinate the provision of care enabled implementation of the intervention. The post-AKI intervention provided an opportunity for practice pharmacists to expand their primary care role. Working in a new setting also brought challenges; time to develop trusting relationships including an understanding of boundaries of clinical expertise influenced pharmacists' roles. Unclear and inconsistent information on discharge summaries contributed to concerns about additional work in primary care. CONCLUSIONS The research highlights challenges around post-discharge management in the primary care context. Coordination and communication were key factors for improving follow-up care following AKI. Further consideration is required to understand patient experiences of the interface between secondary and primary care. The issues pertaining to discharge care following AKI are relevant to practitioners and commissioners as they work to improve transitions of care for vulnerable patient populations.
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Affiliation(s)
- Rebecca Elvey
- Centre for Primary Care and Health Services Research, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, The University of Manchester, Manchester, UK
- NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Greater Manchester, Salford Royal NHS Foundation Trust, Salford, UK
- Manchester Academic Health Science Centre (MAHSC), Manchester, UK
| | - Susan J Howard
- NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Greater Manchester, Salford Royal NHS Foundation Trust, Salford, UK
| | - Anne-Marie Martindale
- Centre for Primary Care and Health Services Research, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, The University of Manchester, Manchester, UK
- NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Greater Manchester, Salford Royal NHS Foundation Trust, Salford, UK
- Manchester Academic Health Science Centre (MAHSC), Manchester, UK
| | - Thomas Blakeman
- Centre for Primary Care and Health Services Research, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, The University of Manchester, Manchester, UK
- NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Greater Manchester, Salford Royal NHS Foundation Trust, Salford, UK
- Manchester Academic Health Science Centre (MAHSC), Manchester, UK
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27
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Guthrie GD, Bell S. Deprivation and kidney disease-a predictor of poor outcomes. Clin Kidney J 2020; 13:128-132. [PMID: 32297882 PMCID: PMC7147306 DOI: 10.1093/ckj/sfz151] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 09/20/2019] [Indexed: 01/05/2023] Open
Abstract
There is a growing body of evidence for the role of deprivation in a broad spectrum of diseases including renal disease. Deprivation has been demonstrated to be associated with poorer outcomes across a range of renal diseases including acute kidney injury (AKI), chronic kidney disease and transplantation. In this issue of Clinical Kidney Journal, Hounkpatin et al. describe the association of socioeconomic deprivation with incidence, mortality and resolution of AKI in a large UK cohort. Investigating deprivation as a factor influencing either incidence or outcome of disease is challenging due to variations in measures of deprivation used and other confounding factors that may be contributing to the observed differences. In this editorial, we review the current literature examining the role of deprivation in renal disease.
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Affiliation(s)
| | - Samira Bell
- Renal Unit, Ninewells Hospital Dundee, Dundee, UK
- Division of Population Health and Genomic, School of Medicine, University of Dundee, Dundee, UK
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