1
|
Chittinandana P, Gojaseni P, Chuasuwan A, Singprasert R, Chailimpamontree W, Chittinandana A. Major adverse kidney events in multidisciplinary chronic kidney disease care compared with usual outpatient care: a propensity score matched analysis. J Nephrol 2024:10.1007/s40620-024-01994-9. [PMID: 38940998 DOI: 10.1007/s40620-024-01994-9] [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: 02/15/2024] [Accepted: 05/20/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND Chronic kidney disease (CKD) is a public health problem worldwide. Multidisciplinary care has been recommended in clinical practice to delay disease progression and minimize complications. However, the effectiveness of multidisciplinary care on major adverse kidney events in CKD patients is still inconclusive. METHODS We conducted a cohort study in patients with CKD stages G3b to 4 who were followed up at Bhumibol Adulyadej Hospital from 2014 to 2020. Propensity score matching by age, sex, CKD staging, Diabetes Mellitus (DM), blood pressure and rate of estimated Glomerular Filtration Rate (eGFR) decline before inclusion between patients in multidisciplinary CKD care (MDC) and usual outpatient care (UOC) was performed. The primary outcome was a composite of cardiovascular or renal mortality, 40% eGFR decline and initiation of long-term kidney replacement therapy. RESULTS After 1:1 propensity score matching, 822 patients were included. Mean age was 70.9 years, 64% had diabetes. During the mean follow-up of 3.3 years, rate of reaching the primary endpoint was lower in the multidisciplinary CKD care group than in the usual outpatient care group (24.1% vs. 38.9%; hazard ratio [HR], 0.66; 95% confidence interval [CI], 0.52-0.86; P = 0.002). The multidisciplinary CKD care group benefited more than the usual outpatient care group with regard to 40% eGFR decline (21.7% vs. 35.0%; HR, 0.67; 95%CI 0.52-0.88; P = 0.004), all-cause mortality (8.5% vs. 19.5%; HR, 0.60; 95%CI 0.40-0.90; P = 0.014), non-cardiovascular death (6.1% vs. 15.1%; HR, 0.56; 95%CI 0.35-0.90; P = 0.015) and hospitalizations per year (1.0 ± 1.5 vs. 1.6 ± 2.0; P < 0.001). According to subgroup analysis, diabetes mellitus patients benefited the most from multidisciplinary CKD care. CONCLUSIONS In a tertiary care hospital, multidisciplinary CKD care showed benefits over usual outpatient care on kidney outcomes in patients with CKD stages G3b and 4. The benefit was enhanced in DM patients.
Collapse
Affiliation(s)
- Palita Chittinandana
- Division of Nephrology, Department of Medicine, Bhumibol Adulyadej Hospital, Royal Thai Air Force, Bangkok, Thailand
| | - Pongsathorn Gojaseni
- Division of Nephrology, Department of Medicine, Bhumibol Adulyadej Hospital, Royal Thai Air Force, Bangkok, Thailand.
| | - Anan Chuasuwan
- Division of Nephrology, Department of Medicine, Bhumibol Adulyadej Hospital, Royal Thai Air Force, Bangkok, Thailand
| | - Rattinan Singprasert
- Division of Nephrology, Department of Medicine, Bhumibol Adulyadej Hospital, Royal Thai Air Force, Bangkok, Thailand
| | - Worawon Chailimpamontree
- Division of Nephrology, Department of Medicine, Bhumibol Adulyadej Hospital, Royal Thai Air Force, Bangkok, Thailand
| | - Anutra Chittinandana
- Division of Nephrology, Department of Medicine, Bhumibol Adulyadej Hospital, Royal Thai Air Force, Bangkok, Thailand
| |
Collapse
|
2
|
Chao CT, Wu MY, Hung KY, Wu MS, Liang JC. Interprofessional Differences in Multidimensional Self-Efficacy Associated With Professional Performance in Nephrology During Case-Based Learning. Kidney Int Rep 2024; 9:877-887. [PMID: 38765585 PMCID: PMC11101767 DOI: 10.1016/j.ekir.2024.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 01/04/2024] [Accepted: 01/08/2024] [Indexed: 05/22/2024] Open
Abstract
Introduction Postgraduate medical education assumes rising importance in the rapidly advancing field of medicine. Case-based learning (CBL), a learner-centered pedagogy employing clinical cases to improve decision-making, is widely embraced in postgraduate medical education, including nephrology. Studies suggest that learning self-efficacy (SE) was closely associated with learning motivation and academic performance; however, very few studies examined this association in postgraduate nephrology education. None evaluated whether there were interprofessional differences concerning such association. Methods In 2022, we prospectively enrolled physicians and nurses participating in chronic kidney disease (CKD) care from institutions around Taiwan. They completed the Professional Medical Learning Self-efficacy (PMLS) questionnaire after attending >1 CBL session involving CKD care. We undertook confirmatory factor analysis (CFA), followed by structural equation modeling (SEM) to evaluate associations between 5 dimensions of learning SE (conceptual understanding [CU], higher-order cognitive skills [HC], practical work [PW], everyday application [EA], and medical science communication [MSC]) and their professional SE in nephrology according to participants' medical professions. Results A total of 513 healthcare providers were surveyed. The convergent and construct validity of our questionnaire were satisfied after analyses. We found that better perceived professional performance in the form of higher professional SE in nephrology was significantly associated with all 5 dimensions of learning SE among physicians and nurses. Only CU and PW were significantly associated with physicians' professional performance; whereas among nurses, only HC and MSC were significantly associated. Conclusion We showed that learning SE was an important determinant of nephrology professional performance. Different medical professions posed influences on major SE dimensions.
Collapse
Affiliation(s)
- Chia-Ter Chao
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Division of Nephrology, Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
- Division of Nephrology, Department of Internal Medicine, Min-Sheng General Hospital, Taoyuan City, Taiwan
- Center of faculty development, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Mei-Yi Wu
- Division of Nephrology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- TMU-Research Center of Urology and Kidney (TMU-RCUK), Taipei Medical University, Taipei, Taiwan
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Kuan-Yu Hung
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Division of Nephrology, Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
- Division of Nephrology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Mai-Szu Wu
- Division of Nephrology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- TMU-Research Center of Urology and Kidney (TMU-RCUK), Taipei Medical University, Taipei, Taiwan
| | - Jyh-Chong Liang
- Program of Learning Sciences and Institute for Research Excellence in Learning Sciences, National Taiwan Normal University, Taiwan
| |
Collapse
|
3
|
Hayashi A, Mizuno K, Shinkawa K, Sakoda K, Yoshida S, Takeuchi M, Yanagita M, Kawakami K. Effect of multidisciplinary care on diabetic kidney disease: a retrospective cohort study. BMC Nephrol 2024; 25:114. [PMID: 38528482 DOI: 10.1186/s12882-024-03550-w] [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: 10/11/2023] [Accepted: 03/18/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND Diabetic kidney disease (DKD) is the most common disease among patients requiring dialysis for the first time in Japan. Multidisciplinary care (MDC) may prevent the progression of kidney failure. However, the effectiveness and timing of MDC to preserve kidney function in patients with DKD is unclear. Therefore, the aim of this study was to investigate whether MDC for patients with DKD affects the preservation of kidney function as well as the timing of MDC in clinical practice. METHODS In this retrospective cohort study, we identified patients with type 2 diabetes mellitus and DKD from April 2012 to January 2020 using a nationwide Japanese healthcare record database. The fee code for medical guidance to prevent dialysis in patients with diabetes was used to distinguish between the MDC and non-MDC groups. The primary outcome was a 40% decline in the estimated glomerular filtration rate, and secondary outcomes were death, hospitalization, permanent dialysis, kidney failure with replacement therapy, and emergency temporary catheterization. Propensity score matching was performed, and Kaplan-Meier and multivariable Cox regression analyses were performed. RESULTS Overall, 9,804 eligible patients met the inclusion criteria, of whom 5,614 were matched for the main analysis: 1,039 in the MDC group, and 4,575 in the non-MDC group. The primary outcome did not differ between the groups (hazard ratio: 1.18, [95% confidence interval: 0.99-1.41], P = 0.07). The groups also did not differ in terms of the secondary outcomes. Most patients with DKD received their first MDC guidance within 1 month of diagnosis, but most received guidance only once per year. CONCLUSIONS Although we could not demonstrate the effectiveness of MDC on kidney function in patients with DKD, we clarified the characteristics of such patients assigned the fee code for medical guidance to prevent dialysis related to diabetes.
Collapse
Affiliation(s)
- Ayano Hayashi
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshida-Konoe-Cho, Sakyo-Ku, Kyoto, 606-8501, Japan
- Department of Nephrology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kayoko Mizuno
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshida-Konoe-Cho, Sakyo-Ku, Kyoto, 606-8501, Japan
| | - Kanna Shinkawa
- Department of Nephrology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kazunori Sakoda
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshida-Konoe-Cho, Sakyo-Ku, Kyoto, 606-8501, Japan
- Department of Nephrology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Satomi Yoshida
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshida-Konoe-Cho, Sakyo-Ku, Kyoto, 606-8501, Japan.
| | - Masato Takeuchi
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshida-Konoe-Cho, Sakyo-Ku, Kyoto, 606-8501, Japan
- Graduate School of Public Health, Shizuoka Graduate University of Public Health, Shizuoka, Japan
| | - Motoko Yanagita
- Department of Nephrology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Institute for the Advanced Study of Human Biology (WPI-ASHBi), Kyoto University, Kyoto, Japan
| | - Koji Kawakami
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshida-Konoe-Cho, Sakyo-Ku, Kyoto, 606-8501, Japan
| |
Collapse
|
4
|
Tsai MY, Huang YC, Cheng BC, Chin CY, Hsu YT, Lee WC. Prevalence and varieties of complementary and alternative medicine usage among individuals with pre-dialysis chronic kidney disease in Taiwan: an investigative cross-sectional analysis. BMC Complement Med Ther 2024; 24:11. [PMID: 38167149 PMCID: PMC10759758 DOI: 10.1186/s12906-023-04311-2] [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: 06/11/2023] [Accepted: 12/12/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Complementary and alternative medicine (CAM) is frequently used in the general population, yet only limited data are available regarding the prevalence of these medications in patients with chronic kidney disease (CKD). Hence, our study aimed to explore the prevalence and types of CAM in Taiwanese patients with CKD. METHODS A cross-sectional questionnaire survey was conducted by face-to-face interview of 275 pre-dialysis patients without dialysis treatment or kidney transplant at an outpatient nephrology clinic in Taiwan from March 2021 to June 2023. The study outcomes were the prevalence of CAM, CAM types, reasons for using CAM, and sources of information about CAM. RESULTS Overall, 128 patients (46.5%) were using CAM, but no significant differences from non-CAM users in the various CKD stages (p = 0.156) were found. CAM usage was high in the age range of 20-60 years and duration of CKD ≤ 5 years (p < 0.05). The most commonly used type of CAM was nutritional approaches (79.7%), followed by other complementary health approaches (26.6%). The most commonly utilized modalities of CAM were vitamins and minerals (38.3%), and only 27.1% of patients disclosed their CAM use to their physicians. The most common sources of information about CAM were family and friends, cited by 66% of the participants. Health promotion and a proactive attitude were reported by 40% of users as the reasons for using CAM. CONCLUSIONS The present study provides data on the CAM usage among CKD patients and adds to the increasing evidence on CAM use. Because some of these practices have safety concerns, better education from healthcare providers on the risks and benefits of CAM therapy is needed by CKD patients.
Collapse
Affiliation(s)
- Ming-Yen Tsai
- Department of Chinese Medicine, Kaohsiung Chang Gung Memorial Hospital and, Chang Gung University College of Medicine, No. 123 Dapi Rd., Niaosong Dist., Kaohsiung, 83301, Taiwan.
| | - Yu-Chuen Huang
- Department of Medical Research, China Medical University Hospital and School of Chinese Medicine, China Medical University, Taichung, 41354, Taiwan
| | - Ben-Chung Cheng
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, 83301, Taiwan
| | - Chieh-Ying Chin
- Department of Chinese Medicine, Kaohsiung Chang Gung Memorial Hospital and, Chang Gung University College of Medicine, No. 123 Dapi Rd., Niaosong Dist., Kaohsiung, 83301, Taiwan
- Department of Nursing, MeiHo University, Pingtung, 912009, Taiwan
- Kaohsiung Municipal Feng Shan Hospital-Under the management of Chang Gung Medical Foundation, Kaohsiung, 830025, Taiwan
| | - Yung-Tang Hsu
- Department of Chinese Medicine, Kaohsiung Chang Gung Memorial Hospital and, Chang Gung University College of Medicine, No. 123 Dapi Rd., Niaosong Dist., Kaohsiung, 83301, Taiwan
| | - Wen-Chin Lee
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, 83301, Taiwan.
| |
Collapse
|
5
|
Huang PY, Hsieh YH, Ting YH, Lee CC, Tsai JP. Ellagic acid ameliorates renal fibrogenesis by blocking epithelial-to-mesenchymal transition. Tzu Chi Med J 2024; 36:59-66. [PMID: 38406569 PMCID: PMC10887343 DOI: 10.4103/tcmj.tcmj_106_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/05/2023] [Accepted: 08/18/2023] [Indexed: 02/27/2024] Open
Abstract
Objectives Ellagic acid (EA), a kind of polyphenol found in numerous fruits and vegetables, has anti-inflammatory, anti-apoptotic, anti-oxidant, and anti-fibrotic effects against a variety of diseases, but its role in mediating renal fibrogenesis remains unknown. Materials and Methods We used an in vivo mouse unilateral ureteral obstruction (UUO) model and an in vitro model with HK-2 cell lines treated with EA and transforming growth factor β1 (TGF-β1). The expression of epithelial-to-mesenchymal transition (EMT)-related proteins of UUO mice was examined using immunohistochemical staining. Liver function and renal function were evaluated using biochemical testing. Western blot analysis was used to determine the proteins related to EMT, and MTT assay was used to determine cell viability. Results In UUO mice fed EA, both microscopical examination with immunohistochemical staining and western blotting protein analysis showed reduced expression of fibrotic (α-SMA, fibronectin, and collagen I)- and EMT (vimentin and N-cadherin)-related proteins, compared with sham control. In HK-2 cells treated with TGF-β1, EA decreased motility as well as expression of α-SMA, collagen-I, fibronectin, N-cadherin, and vimentin. Conclusion EA reduced the progression of the morphological transformations and concomitantly suppressed the expression of fibrotic- and EMT-related proteins in vitro and in vivo. These findings improved our understanding of the role of EA in suppressing renal fibrogenesis and demonstrated the promising role EA may play in the management of chronic kidney disease.
Collapse
Affiliation(s)
- Po-Yu Huang
- Division of Nephrology, Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Yi-Hsien Hsieh
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Yi-Hsuan Ting
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Chu-Che Lee
- Department of Medicine Research, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
| | - Jen-Pi Tsai
- Division of Nephrology, Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| |
Collapse
|
6
|
Juan YH, Yu YL, Tsai YP, Lee CC, Chen YS, Ting YH, Tsai JP, Hsieh YH. Alpha-mangostin alleviate renal interstitial fibrosis via suppression of TGF-β1/Smad/ERK signaling axis in vitro and in vivo. Biochem Pharmacol 2023; 218:115935. [PMID: 37989414 DOI: 10.1016/j.bcp.2023.115935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 11/15/2023] [Accepted: 11/16/2023] [Indexed: 11/23/2023]
Abstract
α-mangostin (α-MG), a natural derivative of coumarin, exhibits anti-inflammatory, antioxidant and anti-fibrotic effects. This study aimed to determine the effect of α-MG treatment in mediating the process of renal interstitial fibrosis. We found that α-MG could alleviate tubule-interstitial damage and decrease fibrotic (α-smooth muscle actin [α-SMA], fibronectin, and collagen I), and epithelial-mesenchymal transition (EMT) protein (N-cadherin, Snail, Slug, TGF-β1 and vimentin) expression in unilateral ureteral obstruction (UUO) mice with chronic kidney disease. α-MG significantly decreased motility as well as inhibited expression of fibrotic- and EMT-related proteins in TGF-β1-induced HK2 cells. To clarify the molecular mechanisms of α-MG in reducing renal interstitial fibrosis, we used a MEK inhibitor (U0126) or Smad inhibitor (SB431542) cotreatment with α-MG. This is the first study is to demonstrate the antifibrotic effects of α-MG by targeting the TGF-β1/ERK/Smad-mediated EMT signaling pathway, is even more effective against renal interstitial fibrosis.
Collapse
Affiliation(s)
- Ying-Hsu Juan
- Department of Chinese Medicine, Dalin Tzu Chi hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Chiayi, Taiwan; School of Post-Baccalaureate Chinese Medicine, Tzu Chi University, Hualien City, Taiwan
| | - Yung-Luen Yu
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan; Ph.D. Program for Translational Medicine, China Medical University, Taichung, Taiwan; Institute of Translational Medicine and New Drug Development, Taichung, Taiwan; Drug Development Center, Research Center for Cancer Biology, China Medical University, Taichung, Taiwan; Center for Molecular Medicine, China Medical University Hospital, Taichung, Taiwan; Department of Medical Laboratory Science and Biotechnology, Asia University, Taichung, Taiwan
| | - Yuan-Pei Tsai
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Chu-Che Lee
- Department of Medicine Research, Buddhist Dalin Tzu Chi Hospital, Chiayi, Taiwan
| | - Yong-Syuan Chen
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Yi-Hsuan Ting
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Jen-Pi Tsai
- School of Medicine, Tzu Chi University, Hualien City, Taiwan; Division of Nephrology, Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan.
| | - Yi-Hsien Hsieh
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan.
| |
Collapse
|
7
|
Molnar AO, Nash DM, Emblem J, Bota S, McArthur E, Luo B, Liu Y, Garg AX, Blake PG, Brimble KS. Patient Care Gaps Prior to Maintenance Dialysis Initiation: A Population-Based Retrospective Study. Can J Kidney Health Dis 2023; 10:20543581231212134. [PMID: 38020481 PMCID: PMC10657522 DOI: 10.1177/20543581231212134] [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: 07/12/2023] [Accepted: 09/19/2023] [Indexed: 12/01/2023] Open
Abstract
Background Guidelines in Ontario, Canada, recommend timely referral for multidisciplinary kidney care to facilitate planned dialysis initiation. Many patients do not receive recommended multidisciplinary kidney care prior to dialysis. Objective To better understand why this gap in pre-dialysis care exists, we conducted a study to describe the pathways by which patients initiate maintenance dialysis. Design A retrospective cohort study. Setting Population-based, using health care administrative databases from Ontario, Canada. Patients Adults initiating maintenance dialysis from April 2016 to March 2019. Measurements and methods Patients were grouped based on whether they received recommended multidisciplinary kidney care prior to dialysis initiation (at least 1 year of care with at least 2 visits). For those who did not receive recommended care, we grouped patients as having no identified care gap or into the following groups: (1) lack of timely chronic kidney disease (CKD) screening, (2) late nephrology referral (<1 year), or (3) late or no referral for multidisciplinary kidney care among patients followed by a nephrologist for at least 1 year. Results A total of 9216 patients were included with a mean (standard deviation) age of 66 (15) years, and 61.5% were male. Of the total, 896 (9.7%) patients died, 7671 (83.2%) remained on dialysis at 90 days, and 649 (7.0%) had stopped dialysis due to kidney function recovery within 90 days. Of the 9216 patients, 5434 (59%) had not received recommended multidisciplinary kidney care. Among those without recommended care, there were 2251 (41.4%) patients with no identified care gaps, 1351 (24.9%) patients with a lack of timely CKD screening, 359 (6.6%) patients with late nephrology referral, and 1473 (27.1%) patients with late or no referral for multidisciplinary kidney care. Limitations We could not determine if patients were referred but declined multidisciplinary kidney care. Conclusions More than half of patients had not received recommended multidisciplinary kidney care. Many patients experienced an acute decline in kidney function, which may not be preventable, but in others, there were missed opportunities for CKD screening or early referral to nephrology, or at the level of nephrology practice for early referral for multidisciplinary care. This work could be used to inform policies aimed at improving increased uptake of multidisciplinary kidney care prior to dialysis.
Collapse
Affiliation(s)
- Amber O. Molnar
- Division of Nephrology, Department of Medicine, McMaster University, Hamilton, ON, Canada
- St. Joseph’s Hospital, Hamilton, ON, Canada
- ICES, ON, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Danielle M. Nash
- ICES, ON, Canada
- Lawson Health Research Institute, London Health Sciences Centre, ON, Canada
| | | | - Sarah Bota
- ICES, ON, Canada
- Lawson Health Research Institute, London Health Sciences Centre, ON, Canada
| | - Eric McArthur
- ICES, ON, Canada
- Lawson Health Research Institute, London Health Sciences Centre, ON, Canada
| | - Bin Luo
- ICES, ON, Canada
- Lawson Health Research Institute, London Health Sciences Centre, ON, Canada
| | - Yaqing Liu
- Ontario Renal Network, Ontario Health, Toronto, Canada
| | - Amit X. Garg
- ICES, ON, Canada
- Lawson Health Research Institute, London Health Sciences Centre, ON, Canada
- Division of Nephrology, Department of Medicine, Western University, London, ON, Canada
| | - Peter G. Blake
- Lawson Health Research Institute, London Health Sciences Centre, ON, Canada
- Ontario Renal Network, Ontario Health, Toronto, Canada
- Division of Nephrology, Department of Medicine, Western University, London, ON, Canada
| | - K. Scott Brimble
- Division of Nephrology, Department of Medicine, McMaster University, Hamilton, ON, Canada
- St. Joseph’s Hospital, Hamilton, ON, Canada
- Ontario Renal Network, Ontario Health, Toronto, Canada
| |
Collapse
|
8
|
Terasaka Y, Takahashi H, Amano K, Fujisaki K, Kita S, Kato K, Nakayama K, Yamashita Y, Nakamura S, Anzai K. Change in Liver Fibrosis Associates with Progress of Diabetic Nephropathy in Patients with Nonalcoholic Fatty Liver Disease. Nutrients 2023; 15:3248. [PMID: 37513666 PMCID: PMC10386534 DOI: 10.3390/nu15143248] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 07/17/2023] [Accepted: 07/19/2023] [Indexed: 07/30/2023] Open
Abstract
Diabetic nephropathy (DN) is a major complication of diabetes. Nonalcoholic fatty liver disease (NAFLD) is common in diabetes, and liver fibrosis is a prognostic risk factor for NAFLD. The interaction between DN and liver fibrosis in NAFLD remains unclear. In 189 patients with DN and NAFLD who received an education course about diabetic nephropathy, liver fibrosis was evaluated using the fibrosis-4 (FIB-4) index. The association between the outcome of DN and changes in liver fibrosis was examined. The FIB-4 index was maintained at the baseline level in patients with improved DN, while it was increased in other patients. The ΔFIB-4 index was positively correlated with changes in albuminuria and proteinuria (ρ = 0.22, p = 0.004). In a multivariate analysis, changes in albuminuria and proteinuria were associated with the ΔFIB-4 index (p = 0.002). Patients with a progressive FIB-4 index category from baseline to 5 years showed a lower event-free survival rate after 5 years than patients with an improved FIB-4 index category (p = 0.037). The outcome of DN is associated with changes in liver fibrosis in patients with diabetes, NAFLD and DN. Developing a preventive and therapeutic approach for these conditions is required.
Collapse
Affiliation(s)
- Yoshiko Terasaka
- Department of Internal Medicine, Division of Metabolism and Endocrinology, Faculty of Medicine, Saga University, Saga 849-8501, Japan
- Internal Medicine, Heiwadai Hospital, Miyazaki 880-0034, Japan
| | - Hirokazu Takahashi
- Department of Internal Medicine, Division of Metabolism and Endocrinology, Faculty of Medicine, Saga University, Saga 849-8501, Japan
- Liver Center, Saga University Hospital, Faculty of Medicine, Saga University, Saga 849-8501, Japan
| | - Kazushi Amano
- Internal Medicine, Heiwadai Hospital, Miyazaki 880-0034, Japan
| | - Koshiro Fujisaki
- Internal Medicine, Heiwadai Hospital, Miyazaki 880-0034, Japan
- Fujisaki Clinic, Kagoshima 891-0141, Japan
| | - Shotaro Kita
- Internal Medicine, Heiwadai Hospital, Miyazaki 880-0034, Japan
| | - Kaori Kato
- Internal Medicine, Heiwadai Hospital, Miyazaki 880-0034, Japan
- Ryutokukai Medical Corp, Tsuruta Hospital, Miyazaki 881-0016, Japan
| | - Koujin Nakayama
- Internal Medicine, Heiwadai Hospital, Miyazaki 880-0034, Japan
| | - Yuko Yamashita
- Internal Medicine, Heiwadai Hospital, Miyazaki 880-0034, Japan
| | - Shuji Nakamura
- Internal Medicine, Heiwadai Hospital, Miyazaki 880-0034, Japan
| | - Keizo Anzai
- Department of Internal Medicine, Division of Metabolism and Endocrinology, Faculty of Medicine, Saga University, Saga 849-8501, Japan
| |
Collapse
|
9
|
Abe M, Hatta T, Imamura Y, Sakurada T, Kaname S. Inpatient multidisciplinary care can prevent deterioration of renal function in patients with chronic kidney disease: a nationwide cohort study. Front Endocrinol (Lausanne) 2023; 14:1180477. [PMID: 37409235 PMCID: PMC10319111 DOI: 10.3389/fendo.2023.1180477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 05/24/2023] [Indexed: 07/07/2023] Open
Abstract
Background Multidisciplinary care is necessary to prevent worsening renal function and all-cause mortality in patients with chronic kidney disease (CKD) but has mostly been investigated in the outpatient setting. In this study, we evaluated the outcome of multidisciplinary care for CKD according to whether it was provided in an outpatient or inpatient setting. Methods This nationwide, multicenter, retrospective, observational study included 2954 Japanese patients with CKD stage 3-5 who received multidisciplinary care in 2015-2019. Patients were divided into two groups: an inpatient group and an outpatient group, according to the delivery of multidisciplinary care. The primary composite endpoint was the initiation of renal replacement therapy (RRT) and all-cause mortality, and the secondary endpoints were the annual decline in the estimated glomerular filtration rate (ΔeGFR) and the changes in proteinuria between the two groups. Results Multidisciplinary care was provided on an inpatient basis in 59.7% and on an outpatient basis in 40.3%. The mean number of health care professionals involved in multidisciplinary care was 4.5 in the inpatient group and 2.6 in the outpatient group (P < 0.0001). After adjustment for confounders, the hazard ratio of the primary composite endpoint was significantly lower in the inpatient group than in the outpatient group (0.71, 95% confidence interval 0.60-0.85, P = 0.0001). In both groups, the mean annual ΔeGFR was significantly improved, and proteinuria significantly decreased 24 months after the initiation of multidisciplinary care. Conclusion Multidisciplinary care may significantly slow deterioration of eGFR and reduce proteinuria in patients with CKD and be more effective in terms of reducing initiation of RRT and all-cause mortality when provided on an inpatient basis.
Collapse
Affiliation(s)
- Masanori Abe
- The Committee of the Evaluation and Dissemination for Certified Kidney Disease Educator, Japan Kidney Association, Tokyo, Japan
- Division of Nephrology, Hypertension and Endocrinology, Department of Internal Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Tsuguru Hatta
- The Committee of the Evaluation and Dissemination for Certified Kidney Disease Educator, Japan Kidney Association, Tokyo, Japan
- Department of Medicine, Hatta Medical Clinic, Kyoto, Japan
| | - Yoshihiko Imamura
- The Committee of the Evaluation and Dissemination for Certified Kidney Disease Educator, Japan Kidney Association, Tokyo, Japan
- Department of Nephrology, Nissan Tamagawa Hospital, Tokyo, Japan
| | - Tsutomu Sakurada
- The Committee of the Evaluation and Dissemination for Certified Kidney Disease Educator, Japan Kidney Association, Tokyo, Japan
- Department of Nephrology and Hypertension, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Shinya Kaname
- The Committee of the Evaluation and Dissemination for Certified Kidney Disease Educator, Japan Kidney Association, Tokyo, Japan
- Department of Nephrology and Rheumatology, Kyorin University School of Medicine, Tokyo, Japan
| |
Collapse
|
10
|
Abe M, Hatta T, Imamura Y, Sakurada T, Kaname S. Effectiveness and current status of multidisciplinary care for patients with chronic kidney disease in Japan: a nationwide multicenter cohort study. Clin Exp Nephrol 2023; 27:528-541. [PMID: 37002509 DOI: 10.1007/s10157-023-02338-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 03/04/2023] [Indexed: 04/03/2023]
Abstract
Abstract
Background
Multidisciplinary care is well established in clinical practice, but its effectiveness in patients with chronic kidney disease (CKD) remains unclear. The aim of this study was to determine whether multidisciplinary care could help to avoid worsening kidney function in patients with CKD.
Methods
This nationwide study had a multicenter retrospective observational design and included 3015 Japanese patients with CKD stage 3–5 who received multidisciplinary care. We assessed the annual decrease in estimated glomerular filtration rate (ΔeGFR) and urinary protein in the 12 months before and 24 months after the start of multidisciplinary care. All-cause mortality and initiation of renal replacement therapy were investigated according to baseline characteristics.
Results
Most of the patients had CKD stage 3b or higher and a median eGFR of 23.5 mL/min/1.73 m2. The multidisciplinary care teams consisted of health care professionals from an average of four disciplines. ΔeGFR was significantly smaller at 6, 12, and 24 months after initiation of multidisciplinary care (all P < 0.0001), regardless of the primary cause of CKD and its stage when multidisciplinary intervention was started. Urinary protein level also decreased after initiation of multidisciplinary care. After a median follow-up of 2.9 years, 149 patients had died and 727 had started renal replacement therapy.
Conclusion
Multidisciplinary care may significantly slow the decline in eGFR in patients with CKD and might be effective regardless of the primary disease, including in its earlier stages. Multidisciplinary care is recommended for patients with CKD stage 3–5.
Trial registration
UMIN00004999.
Collapse
|
11
|
Rios P, Sola L, Ferreiro A, Silvariño R, Lamadrid V, Ceretta L, Gadola L. Adherence to multidisciplinary care in a prospective chronic kidney disease cohort is associated with better outcomes. PLoS One 2022; 17:e0266617. [PMID: 36240220 PMCID: PMC9565398 DOI: 10.1371/journal.pone.0266617] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 03/23/2022] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The Renal Healthcare Program Uruguay (NRHP-UY) is a national, multidisciplinary program that provides care to chronic kidney disease (CKD) patients. In this study, we report the global results of CKD patient outcomes and a comparison between those treated at the NRHP-UY Units, with those patients who were initially included in the program but did not adhere to follow up. METHODS A cohort of not-on dialysis CKD patients included prospectively in the NRHP-UY between October 1st 2004 and September 30th 2017 was followed-up until September 30th 2019. Two groups were compared: a) Nephrocare Group: Patients who had at least one clinic visit during the first year on NRHP-UY (n = 11174) and b) Non-adherent Group: Patients who were informed and accepted to be included but had no subsequent data registered after admission (n = 3485). The study was approved by the Ethics Committee and all patients signed an informed consent. Outcomes were studied with Logistic and Cox´s regression analysis, Fine and Gray competitive risk and propensity-score matching tests. RESULTS 14659 patients were analyzed, median age 70 (60-77) years, 56.9% male. The Nephrocare Group showed improved achievement of therapeutic goals, ESKD was more frequent (HR 2.081, CI 95%1.722-2.514) as planned kidney replacement therapy (KRT) start (OR 2.494, CI95% 1.591-3.910), but mortality and the combined event (death and ESKD) were less frequent (HR 0.671, CI95% 0.628-0.717 and 0.777, CI95% 0.731-0.827) (p = 0.000) compared to the Non-adherent group. Results were similar in the propensity-matched group: ESKD (HR 2.041, CI95% 1.643-2.534); planned kidney replacement therapy (KRT) start (OR 2.191, CI95% 1.322-3.631) death (HR 0.692, CI95% 0.637-0.753); combined event (HR 0.801, CI95% 0.742-0.865) (p = 0.000). CONCLUSION Multidisciplinary care within the NRHP-UY is associated with timely initiation of KRT and lower mortality in single outcomes, combined analysis, and propensity-matched analysis.
Collapse
Affiliation(s)
- Pablo Rios
- Comisión Asesora de Programa de Salud Renal, Fondo Nacional de Recursos, Montevideo, Uruguay
| | - Laura Sola
- Comisión Asesora de Programa de Salud Renal, Fondo Nacional de Recursos, Montevideo, Uruguay
| | - Alejandro Ferreiro
- Comisión Asesora de Programa de Salud Renal, Fondo Nacional de Recursos, Montevideo, Uruguay
- Departamento de Nefrología, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - Ricardo Silvariño
- Comisión Asesora de Programa de Salud Renal, Fondo Nacional de Recursos, Montevideo, Uruguay
- Departamento de Nefrología, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - Verónica Lamadrid
- Comisión Asesora de Programa de Salud Renal, Fondo Nacional de Recursos, Montevideo, Uruguay
| | - Laura Ceretta
- Comisión Asesora de Programa de Salud Renal, Fondo Nacional de Recursos, Montevideo, Uruguay
| | - Liliana Gadola
- Comisión Asesora de Programa de Salud Renal, Fondo Nacional de Recursos, Montevideo, Uruguay
- Departamento de Nefrología, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
- * E-mail:
| | | |
Collapse
|
12
|
Lin MT, Hsu CN, Lee CT, Cheng SH. Effect of a Pay-for-Performance Program on Renal Outcomes Among Patients With Early-Stage Chronic Kidney Disease in Taiwan. Int J Health Policy Manag 2022; 11:1307-1315. [PMID: 33906336 PMCID: PMC9808322 DOI: 10.34172/ijhpm.2021.27] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 01/14/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND With the promising outcomes of the pre-ESRD (end-stage renal disease) pay-for-performance (P4P) program, the National Health Insurance Administration (NHIA) of Taiwan launched a P4P program for patients with early chronic kidney disease (CKD) in 2011, targeting CKD patients at stages 1, 2, and 3a. This study aimed to examine the long-term effect of the early-CKD P4P program on CKD progression. METHODS We conducted a matched cohort study using electronic medical records from a large healthcare delivery system in Taiwan. The outcome of interest was CKD progression to estimated glomerular filtration rate (eGFR) <45 mL/min/1.73 m2 between P4P program enrolees and non-enrolees. The difference in the cumulative incidence of CKD progression between the P4P and non-P4P groups was tested using Gray's test. We adopted a cause-specific (CS) hazard model to estimate the hazard in the P4P group as compared to non-P4P group, adjusting for age, sex, baseline renal function, and comorbidities. A subgroup analysis was further performed in CKD patients with diabetes to evaluate the interactive effects between the early-CKD P4P and diabetes P4P programs. RESULTS The incidence per 100 person-months of disease progression was significantly lower in the P4P group than in the non-P4P group (0.44 vs. 0.69, P<.0001), and the CS hazard ratio (CS-HR) for P4P program enrolees compared with non-enrolees was 0.61 (95% CI: 0.58-0.64, P<.0001). The results of the subgroup analysis further revealed an additive effect of the diabetes P4P program on CKD progression; compared to none of both P4P enrolees, the CS-HR for CKD disease progression was 0.60 (95% CI: 0.54-0.67, P<.0001) for patients who were enrolled in both early-CKD P4P and diabetes P4P programs. CONCLUSION The present study results suggest that the early-CKD P4P program is superior to usual care to decelerate CKD progression in patients with early-stage CKD.
Collapse
Affiliation(s)
- Min-Ting Lin
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Chien-Ning Hsu
- Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- School of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chien-Te Lee
- Division of Nephrology, Department of Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shou-Hsia Cheng
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
- Population Health Research Center, National Taiwan University, Taipei, Taiwan
| |
Collapse
|
13
|
Chen TL, Feng YH, Kao SL, Lu JW, Loh CH. Impact of integrated health care on elderly population: A systematic review of Taiwan's experience. Arch Gerontol Geriatr 2022; 102:104746. [PMID: 35691276 DOI: 10.1016/j.archger.2022.104746] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 06/04/2022] [Accepted: 06/06/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Care fragmentation in the elderly population prompted the need for integrated health care systems. However, evidence regarding the impact of the integrated care system in Taiwan is unclear. We aimed to conduct a systematic review to evaluate the impact of Taiwan's integrated health care programs on geriatric population. METHODS We searched bibliographic databases MEDLINE, Embase, Web of Science, and Airiti Library for relevant publications throughout May 2022. Studies investigating the effectiveness of Taiwan's integrated care programs were included. We used the critical appraisal skills programme (CASP) checklist, to assess the risk of bias of included studies. RESULTS Thirty-four studies, with a total of 838,026 study subjects, were assessed. The systematic review on 11 subthemes (diabetes mellitus, chronic kidney disease, hepatitis C virus, fractures, cancer, dementia, atrial fibrillation, chronic obstructive pulmonary disease, mechanical ventilation, terminal illness, outpatients and community-dwelling patients), demonstrated that the implementation of integrated health care could not only provide benefits on survival, self-care ability, health quality, physical, and functional rehabilitation outcomes, but also significantly reduce medical utilization and expenditures. CONCLUSION The integrated health care system for multiple morbidities benefits the Taiwanese geriatric population in physical and functional outcomes. The thematic synthesis provides references for future rigorous clinical trials.
Collapse
Affiliation(s)
- Tai-Li Chen
- Center for Aging and Health, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan; Department of Dermatology, Taipei Veterans Hospital, Taipei, Taiwan
| | - Yun-Hsuan Feng
- School of Medicine, Tzu Chi University, Hualien, Taiwan; Department of Medical Education, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
| | - Sheng-Lun Kao
- Division of Geriatric Medicine, Department of Family Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Jing-Wun Lu
- Department of Physical Medicine and Rehabilitation, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Ching-Hui Loh
- Center for Aging and Health, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan; School of Medicine, Tzu Chi University, Hualien, Taiwan; Division of Geriatric Medicine, Department of Family Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.
| |
Collapse
|
14
|
Lin MY, Chiu YW, Hsu YH, Wu MS, Chang JM, Hsu CC, Yang CW, Yang WC, Hwang SJ. CKD Care Programs and Incident Kidney Failure: A Study of a National Disease Management Program in Taiwan. Kidney Med 2022; 4:100485. [PMID: 35812528 PMCID: PMC9257411 DOI: 10.1016/j.xkme.2022.100485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Rationale & Objective Taiwan implemented national pay-for-performance programs for chronic kidney disease (CKD) care in 2006 and 2011; however, it is unknown whether this affected trends in maintenance dialysis. This study assessed the temporal trends in the incidence, prevalence, and mortality of individuals treated with maintenance dialysis from 2002-2016 in Taiwan. Study Design Follow-up study using Taiwan Renal Disease System Databases. Setting & Participants Participants who received dialysis for ≥90 days. Predictors Age, sex, and calendar year. Outcomes Incidence, prevalence of maintenance dialysis, or death, ascertained using the National Death Registry database. Analytical Approach The estimated annual percentage change was assessed by a generalized linear model, and the association of the programs with changes in the incidence of maintenance dialysis was evaluated using an age-period-cohort model. Results A total of 144,258 incident cases with a follow-up of 346 million person-years were analyzed during the observed periods. The estimated annual percentage change of the expected crude incidence rate was slightly reduced by 0.41% (95% CI, −1.06 to 0.24) and was more obvious in women and patients aged greater than 70 years; whereas, it was significantly increased in those aged greater than 75 years. After disentangling age and cohort effects, the implementation of the care programs was associated with an overall net drift of −1.09% (95% CI, −1.65 to −0.52) per year and a significant linear reduction in the period rate ratio from 1.06 (95% CI, 1.02-1.09) in the years 2002-2006 to 0.95 (95% CI, 0.92-0.98) in 2012-2016, using years 2007-2011 as reference. Limitations The findings of the study may have limited inferences to other countries with different health care systems. Conclusions The implementation of universal CKD care programs in Taiwan has significantly reduced the long-term trends in the incidence of maintenance dialysis; hence, devoting governmental resources to CKD care and prevention is advocated.
Collapse
Affiliation(s)
- Ming-Yen Lin
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Renal Care, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yi-Wen Chiu
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Renal Care, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yung-Ho Hsu
- Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Division of Nephrology, Taipei Medical University-Hsin Kuo Min Hospital, Taoyuan, Taiwan
| | - Mai-Szu Wu
- Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Division of Nephrology, Taipei Medical University-Shuang Ho Hospital, Taipei, Taiwan
| | - Jer-Ming Chang
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Renal Care, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chih-Cheng Hsu
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan
| | - Chih-Wei Yang
- Department of Nephrology, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wu-Chang Yang
- Division of Nephrology, Landseed International Hospital, Taoyuan 32001, Taiwan
| | - Shang-Jyh Hwang
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Renal Care, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Program in Toxicology, College of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan
- Address for Correspondence: Shang-Jyh Hwang, MD, Department of Renal Care, Kaohsiung Medical University, 100, TzYou 1st Rd, San-Ming District, Kaohsiung 807, Taiwan.
| |
Collapse
|
15
|
Huang L, Zhang F. More Research is Still Needed To Support The Real-world Generalizability of The Benefits of Lifestyle Interventions for CKD. J Am Soc Nephrol 2022; 33:1045. [PMID: 35354601 PMCID: PMC9063885 DOI: 10.1681/asn.2022020172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Liuyan Huang
- Department of Nephrology, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Fan Zhang
- Department of Nephrology, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
| |
Collapse
|
16
|
Yoshida K, Shimizu S, Kita Y, Takagi WH, Shibagaki Y, Sakurada T. Impact of inpatient educational programs on mortality after the start of dialysis therapy. Clin Exp Nephrol 2022; 26:819-826. [PMID: 35333998 DOI: 10.1007/s10157-022-02211-2] [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: 11/15/2021] [Accepted: 03/07/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Although inpatient educational programs (IEPs) for non-dialysis-dependent chronic kidney disease (CKD) have been reported to slow disease progression, their legacy effect on prognosis after the start of dialysis therapy is unclear. METHODS Consecutive patients who started dialysis therapy between January 1, 2011 and December 31, 2018 were included in a single-center, retrospective, observational study. The patients were divided into two groups according to whether or not they participated in IEPs before dialysis introduction, and their background characteristics were compared. The survival rate for each group was calculated using the Kaplan-Meier method and compared by the log-rank test. Furthermore, the hazard ratio (HR) of IEP participation adjusted for confounding factors associated with mortality was calculated using Cox regression analysis. RESULTS Of the 490 subjects (median age 69 years, 71.0% male), 129 patients (26.3%) participated in the IEP. At the start of dialysis, the IEP group had higher serum albumin (3.5 vs. 3.3 g/dL, p < 0.001) and lower serum total cholesterol levels (151 vs. 166 mg/dL, p = 0.0076) and the proportion of patients with independence in their daily living activities was high (p = 0.034). The median observation period was 3.4 years, during which 153 patients (31.2%) died. The 5-year survival rates were 81.0 and 61.5% in the IEP and non-IEP groups, respectively (p = 0.0038). Cox regression analysis revealed a HR for IEP of 0.57 (95% Confidence interval 0.37-0.88, p = 0.011). CONCLUSION IEPs for CKD patients are associated with a more favorable prognosis after the start of dialysis.
Collapse
Affiliation(s)
- Keisuke Yoshida
- Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Sayaka Shimizu
- Institute for Health Outcomes and Process Evaluation Research (iHope International), Kyoto, 604-8006, Japan.,Section of Clinical Epidemiology, Department of Community Medicine, Graduate School of Medicine, Kyoto University, Kyoto, 606-8507, Japan
| | - Yohei Kita
- Division of Nephrology, Inagi Municipal Hospital, Inagi, Tokyo, 206-0801, Japan
| | - Wei Han Takagi
- Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Yugo Shibagaki
- Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Tsutomu Sakurada
- Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan.
| |
Collapse
|
17
|
Nkunu V, Wiebe N, Bello A, Campbell S, Tannor E, Varghese C, Stanifer J, Tonelli M. Update on Existing Care Models for Chronic Kidney Disease in Low- and Middle-Income Countries: A Systematic Review. Can J Kidney Health Dis 2022; 9:20543581221077505. [PMID: 35251672 PMCID: PMC8894943 DOI: 10.1177/20543581221077505] [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: 08/04/2021] [Accepted: 11/28/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Approximately 78% of chronic kidney disease (CKD) cases reside in low- and middle-income countries (LMICs). However, little is known about the care models for CKD in LMICs. OBJECTIVE Our objective was to update a prior systematic review on CKD care models in LMICs and summarize information on multidisciplinary care and management of CKD complications. DESIGN We searched MEDLINE, EMBASE, and Global Health databases in September 2020, for papers published between January 1, 2017, and September 14, 2020. We used a combination of search terms, which were different iterations of CKD, care models, and LMICs. The World Bank definition (2019) was used to identify LMICs. SETTING Our review included studies published in LMICs across 4 continents: Africa, Asia, North America (Mexico), and Europe (Ukraine). The study settings included tertiary hospitals (n = 6), multidisciplinary clinics (n = 1), primary health centers (n = 2), referral centers (n = 2), district hospitals (n = 1), teaching hospitals (n = 1), regional hospital (n = 1), and an urban medical center (n = 1). PATIENTS Eighteen studies met inclusion criteria, and encompassed 4679 patients, of which 4665 were adults. Only 9 studies reported mean eGFR which ranged from 7 to 45.90 ml/min/1.73 m2. MEASUREMENTS We retrieved the following details about CKD care: funding, urban or rural location, types of health care staff, and type of care provided, as defined by Kidney Disease Improving Global Outcomes (KDIGO) guidelines for CKD care. METHODS We included studies which met the following criteria: (1) population was largely adults, defined as age 18 years and older; (2) most of the study population had CKD, and not end-stage kidney disease (ESKD); (3) population resided in an LMIC as defined by the World Bank; (4) manuscript described in some detail a clinical care model for CKD; (5) manuscript was in either English or French. Animal studies, case reports, comments, and editorials were excluded. RESULTS Eighteen studies (24 care models with 4665 patients) met inclusion criteria. Out of 24 care models, 20 involved interdisciplinary health care teams. Twenty models incorporated international guidelines for CKD management. However, conservative kidney management (management of kidney failure without dialysis or renal transplant) was in a minority of models (11 of 24). Although there were similarities between all the clinical care models, there was variation in services provided and in funding arrangement; the latter ranged from comprehensive government funding (eg, Sri Lanka, Thailand), to out-of-pocket payments (eg, Benin, Togo). LIMITATIONS These include (1) lack of detail on CKD care in many of the studies, (2) small number of included studies, (3) using a different definition of care model from the original Stanifer et al paper, and (4) using the KDIGO Guidelines as the standard for defining a CKD care model. CONCLUSIONS Most of the CKD models of care include the key elements of CKD care. However, access to such care depends on the funding mechanism available. In addition, few models included conservative kidney management, which should be a priority for future investment. TRIAL REGISTRATION Not applicable.
Collapse
Affiliation(s)
- Victoria Nkunu
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Natasha Wiebe
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Aminu Bello
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Sandra Campbell
- John W. Scott Health Sciences Library, University of Alberta, Edmonton, Canada
| | - Elliot Tannor
- Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Cherian Varghese
- Department of Noncommunicable Diseases, World Health Organization, Geneva, Switzerland
| | - John Stanifer
- Department of Medicine, Duke University, Durham, NC, USA
| | | |
Collapse
|
18
|
Beetham KS, Krishnasamy R, Stanton T, Sacre JW, Douglas B, Isbel NM, Coombes JS, Howden EJ. Effect of a 3-Year Lifestyle Intervention in Patients with Chronic Kidney Disease: A Randomized Clinical Trial. J Am Soc Nephrol 2022; 33:431-441. [PMID: 34893535 PMCID: PMC8819984 DOI: 10.1681/asn.2021050668] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 11/19/2021] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Supervised lifestyle interventions have the potential to significantly improve physical activity and fitness in patients with CKD. METHODS To assess the efficacy of a lifestyle intervention in patients with CKD to improve cardiorespiratory fitness and exercise capacity over 36 months, we conducted a randomized clinical trial, enrolling 160 patients with stage 3-4 CKD, with 81 randomized to usual care and 79 to a 3-year lifestyle intervention. The lifestyle intervention comprised care from a multidisciplinary team, including a nephrologist, nurse practitioner, exercise physiologist, dietitian, diabetes educator, psychologist, and social worker. The exercise training component consisted of an 8-week individualized and supervised gym-based exercise intervention followed by 34 months of a predominantly home-based program. Self-reported physical activity (metabolic equivalent of tasks [METs] minutes per week), cardiorespiratory fitness (peak O2 consumption [VO2peak]), exercise capacity (maximum METs and 6-minute walk distance) and neuromuscular fitness (grip strength and get-up-and-go test time) were evaluated at 12, 24, and 36 months. RESULTS The intervention increased the percentage of patients meeting physical activity guideline targets of 500 MET min/wk from 29% at baseline to 63% at 3 years. At 12 months, both VO2peak and METs increased significantly in the lifestyle intervention group by 9.7% and 30%, respectively, without change in the usual care group. Thereafter, VO2peak declined to near baseline levels, whereas METs remained elevated in the lifestyle intervention group at 24 and 36 months. After 3 years, the intervention had increased the 6-minute walk distance and blunted declines in the get-up-and-go test time. CONCLUSIONS A 3-year lifestyle intervention doubled the percentage of CKD patients meeting physical activity guidelines, improved exercise capacity, and ameliorated losses in neuromuscular and cardiorespiratory fitness.
Collapse
Affiliation(s)
- Kassia S. Beetham
- School of Behavioural and Health Science, Australian Catholic University, Brisbane, Queensland, Australia,School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Rathika Krishnasamy
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia,Sunshine Coast University Hospital, Sunshine Coast, Queensland, Australia
| | - Tony Stanton
- Sunshine Coast University Hospital, Sunshine Coast, Queensland, Australia,School of Health and Sport Sciences, University of the Sunshine Coast, Sunshine Coast, Queensland, Australia,School of Medicine, Griffith University, Sunshine Coast, Queensland, Australia
| | - Julian W. Sacre
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Bettina Douglas
- School of Nursing and Midwifery, The University of Queensland, Brisbane, Queensland, Australia
| | - Nicole M. Isbel
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia,Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Jeff S. Coombes
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Erin J. Howden
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia,Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| |
Collapse
|
19
|
Hsieh YH, Wang WC, Hung TW, Lee CC, Tsai JP. C-C Motif Chemokine Ligand-17 as a Novel Biomarker and Regulator of Epithelial Mesenchymal Transition in Renal Fibrogenesis. Cells 2021; 10:cells10123345. [PMID: 34943853 PMCID: PMC8699042 DOI: 10.3390/cells10123345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 11/19/2021] [Accepted: 11/26/2021] [Indexed: 02/07/2023] Open
Abstract
CCL17, a chemotactic cytokine produced by macrophages, is known to promote inflammatory and fibrotic effects in multiple organs, but its role in mediating renal fibrosis is unclear. In our study cohort of 234 chronic kidney disease (CKD) patients and 65 healthy controls, human cytokine array analysis revealed elevated CCL17 expression in CKD that correlated negatively with renal function. The area under the receiver operating characteristic curve of CCL17 to predict the development of CKD stages 3b–5 was 0.644 (p < 0.001), with the optimal cut-off value of 415.3 ng/mL. In vitro over-expression of CCL17 in HK2 cells had no effect on cell viability, but increased cell motility and the expression of α-SMA, vimentin and collagen I, as shown by western blot analysis. In a unilateral ureteral obstruction (UUO) mouse model, we observed significantly increased interstitial fibrosis and renal tubule dilatation by Masson’s Trichrome and H&E staining, and markedly increased expression of CCL17, vimentin, collagen I, and α-SMA by IHC stain, qRTPCR, and western blotting. CCL17 induced renal fibrosis by promoting the epithelial-mesenchymal transition, resulting in ECM accumulation. CCL17 may be a useful biomarker for predicting the development of advanced CKD.
Collapse
Affiliation(s)
- Yi-Hsien Hsieh
- Institute of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan; (Y.-H.H.); (W.-C.W.)
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
| | - Wen-Chien Wang
- Institute of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan; (Y.-H.H.); (W.-C.W.)
- School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan;
- Department of Medical Education, Taichung Vererans General Hospital, Taichung 40705, Taiwan
| | - Tung-Wei Hung
- School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan;
- Division of Nephrology, Department of Medicine, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
| | - Chu-Che Lee
- Department of Medicine Research, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi 62247, Taiwan;
| | - Jen-Pi Tsai
- School of Medicine, Tzu Chi University, Hualien 97004, Taiwan
- Division of Nephrology, Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi 62247, Taiwan
- Correspondence:
| |
Collapse
|
20
|
Chou CL, Chung CH, Chiu HW, Liao CT, Wu CC, Hsu YH, Chien WC. Association of pre-ESRD care education with patient outcomes in a 10-year longitudinal study of patients with CKD stages 3-5 in Taiwan. Sci Rep 2021; 11:22602. [PMID: 34799610 PMCID: PMC8604975 DOI: 10.1038/s41598-021-01860-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 11/01/2021] [Indexed: 11/30/2022] Open
Abstract
There is little comprehensive education for people with end-stage renal disease (ESRD) progress. We investigated the differences in terms of outcomes between patients with CKD stages 3-5 who enrolled and did not enroll in the pre-ESRD care education in Taiwan. This retrospective cohort study was conducted using data from the National Health Insurance Research Database (NHIRD). All patients diagnosed with CKD stages 3-5 who received the pre-ESRD care education through the pay for performance (P4P) program were enrolled. Based on whether or not they participated in the program, they were categorized into P4P or non-P4P groups. All analyses were performed from January 2006 through December 2015. Study outcomes were risk of hemodialysis dependency, hospitalization, and all-cause mortality. In this study of 29,337 patients, those with CKD stages 3-5 in the P4P group had lower events of hemodialysis, hospitalization, and all-cause mortality compared to patients in the non-P4P group. This study suggested that pre-ESRD care education is associated with increased patient outcomes, resulting in lower hemodialysis and hospitalization events and a higher overall survival rate in patients with CKD stages 3-5. Patient education could raise opportunities to improve pre-ESRD care by reaching patients outside the traditional health care setting.
Collapse
Affiliation(s)
- Chu-Lin Chou
- grid.260565.20000 0004 0634 0356Division of Nephrology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan ,grid.412896.00000 0000 9337 0481Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, No. 250, Wuxing Street, Xinyi District, Taipei City, 110 Taiwan ,grid.412896.00000 0000 9337 0481Taipei Medical University-Research Center of Urology and Kidney, Taipei Medical University, Taipei, Taiwan ,grid.412955.e0000 0004 0419 7197Division of Nephrology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan ,grid.412896.00000 0000 9337 0481Division of Nephrology, Department of Internal Medicine, Hsin Kuo Min Hospital, Taipei Medical University, Taoyuan City, Taiwan
| | - Chi-Hsiang Chung
- grid.260565.20000 0004 0634 0356School of Public Health, National Defense Medical Center, Taipei, Taiwan ,Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan
| | - Hui-Wen Chiu
- grid.412896.00000 0000 9337 0481Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, No. 250, Wuxing Street, Xinyi District, Taipei City, 110 Taiwan ,grid.412896.00000 0000 9337 0481Taipei Medical University-Research Center of Urology and Kidney, Taipei Medical University, Taipei, Taiwan ,grid.412896.00000 0000 9337 0481Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan ,grid.412896.00000 0000 9337 0481Department of Medical Research, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Chia-Te Liao
- grid.412896.00000 0000 9337 0481Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, No. 250, Wuxing Street, Xinyi District, Taipei City, 110 Taiwan ,grid.412896.00000 0000 9337 0481Taipei Medical University-Research Center of Urology and Kidney, Taipei Medical University, Taipei, Taiwan ,grid.412955.e0000 0004 0419 7197Division of Nephrology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Chia-Chao Wu
- grid.260565.20000 0004 0634 0356Division of Nephrology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yung-Ho Hsu
- Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, No. 250, Wuxing Street, Xinyi District, Taipei City, 110, Taiwan. .,Taipei Medical University-Research Center of Urology and Kidney, Taipei Medical University, Taipei, Taiwan. .,Division of Nephrology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan. .,Division of Nephrology, Department of Internal Medicine, Hsin Kuo Min Hospital, Taipei Medical University, Taoyuan City, Taiwan.
| | - Wu-Chien Chien
- School of Public Health, National Defense Medical Center, Taipei, Taiwan. .,Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan. .,Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, 7115R, No. 325, Section 2, Cheng-Kung Road, Neihu District, Taipei City, 11490, Taiwan, Republic of China. .,Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan.
| |
Collapse
|
21
|
Terlizzi V, Sandrini M, Vizzardi V, Tonoli M, Facchini A, Manili L, Zeni L, Cancarini G. Ten-year experience of an outpatient clinic for CKD-5 patients with multidisciplinary team and educational support. Int Urol Nephrol 2021; 54:949-957. [PMID: 34331637 PMCID: PMC8924108 DOI: 10.1007/s11255-021-02963-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 07/07/2021] [Indexed: 10/31/2022]
Abstract
PURPOSE To analyze the results of an outpatient clinic with a multidisciplinary team and educational support for patients with late-stage CKD (lsCKD), to check its possible effect on their outcomes. METHODS Longitudinal cohort study on patients followed up in the MaReA (Malattia Renale Avanzata = CKD5) outpatient clinic at ASST Spedali Civili of Brescia from 2005 to 2015 for at least six months. Trajectory of renal function over time has been evaluated only in those patients with at least four estimations of eGFR before referring to MaReA. RESULTS Seven hundred and six patients were enrolled, their mean age was 72 ± 14 years, 59% were males. At the end of the study, 147 (21%) were still on MaReA, 240 (34%) on dialysis, 92 (13%) on very low-protein diet (VLPDs), 13 (2%) on pre-hemodialysis clinic, 23 (3%) improved renal function, 10 (1%) transplanted, 62 (9%) transferred/lost to follow-up, and 119 (17%) died. Optimal dialysis start (defined as start with definitive dialysis access, as an out-patient and without lsCKD complications) occurred in 180/240 (75%) patients. The results showed a slower eGFR decrease during MaReA follow-up compared to previous renal follow-up: - 2.0 vs. - 4.0 mL/min/1.73 m2 BSA/year (p < 0.05), corresponding to a median delay of 17.7 months in dialysis start in reference to our policy in starting dialysis. The patient cumulative survival was 75% after 24 months and 25% after 70. LIMITATIONS (1) lack of a control group, (2) one-center-study, (3) about all patients were Caucasians. CONCLUSION The follow-up of lsCKD patients on MaReA is associated with an optimal and delayed initiation of dialysis.
Collapse
Affiliation(s)
- Vincenzo Terlizzi
- Operative Unit of Nephrology, ASST Spedali Civili Brescia, Piazzale Spedali Civili, 1, 25123, Brescia, Italy
| | - Massimo Sandrini
- Operative Unit of Nephrology, ASST Spedali Civili Brescia, Piazzale Spedali Civili, 1, 25123, Brescia, Italy
| | - Valerio Vizzardi
- Operative Unit of Nephrology, ASST Spedali Civili Brescia, Piazzale Spedali Civili, 1, 25123, Brescia, Italy.
| | - Mattia Tonoli
- Postgraduate School in Nephrology, University of Brescia, Brescia, Italy
| | - Annalisa Facchini
- Postgraduate School in Nephrology, University of Brescia, Brescia, Italy
| | - Luigi Manili
- Operative Unit of Nephrology, ASST Spedali Civili Brescia, Piazzale Spedali Civili, 1, 25123, Brescia, Italy
| | - Letizia Zeni
- Operative Unit of Nephrology, ASST Spedali Civili Brescia, Piazzale Spedali Civili, 1, 25123, Brescia, Italy
| | - Giovanni Cancarini
- Operative Unit of Nephrology, ASST Spedali Civili Brescia, Piazzale Spedali Civili, 1, 25123, Brescia, Italy.,Postgraduate School in Nephrology, University of Brescia, Brescia, Italy
| |
Collapse
|
22
|
Zimbudzi E, Lo C, Ranasinha S, Earnest A, Teede H, Usherwood T, Polkinghorne KR, Fulcher G, Gallagher M, Jan S, Cass A, Walker R, Russell G, Johnson G, Kerr PG, Zoungas S. A co-designed integrated kidney and diabetes model of care improves mortality, glycaemic control and self-care. Nephrol Dial Transplant 2021; 37:1472-1481. [PMID: 34314493 DOI: 10.1093/ndt/gfab230] [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: 04/13/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Current health-care models are ill-equipped for managing people with diabetes and chronic kidney disease (CKD). We evaluated the impact of a new diabetes and kidney disease service (DKS) on hospitalisation, mortality, clinical and patient relevant outcomes. METHODS Longitudinal analyses of adult patients with diabetes and CKD (stages 3a to 5) were performed using outpatient and hospitalisation data from January 2015 to October 2018. Data was handled according to whether patients received the DKS intervention (n = 196) or standard care (n = 7511). The DKS provided patient-centered, coordinated multi-disciplinary assessment and management of patients. Primary analyses examined hospitalisation and mortality rates between the two groups. Secondary analyses evaluated the impact of the DKS on clinical target attainment, changes in eGFR, HbA1c, self-care and patient activation at 12 months. RESULTS Patients who received the intervention had a higher hospitalisation rate (incidence rate ratio (IRR), 1.20; 95% CI, 1.13 to 1.30; P < 0.0001), shorter median length of stay (2 days [interquartile range (IQR), 6-1] versus 4 days [IQR 9-1]; P < 0.0001) and lower all-cause mortality rate (IRR 0.4; 95% CI, 0.29 to 0.64; P < 0.0001) than those who received standard care. Improvements in overall self-care (MD 2.26, 95% CI 0.83, 3.69; P < 0.001) and in statin use, foot and eye examination were observed. Mean eGFR did not significantly change after 12 months (MD 1.30, 95% CI -4.17, 1.67; P = 0.40) mls/min per 1.73 m2. HbA1c levels significantly decreased by 0.40, 0.35, 0.34 and 0.23% at 3, 6, 9 and 12 months follow-up respectively. CONCLUSIONS A co-designed, person-centred integrated model of care improved all-cause mortality, kidney function, glycaemic control and self-care for patients with diabetes and CKD.
Collapse
Affiliation(s)
- Edward Zimbudzi
- School of Public Health and Preventive Medicine, Monash University, VIC, Australia.,Department of Nephrology, Monash Health, VIC, Australia
| | - Clement Lo
- School of Public Health and Preventive Medicine, Monash University, VIC, Australia.,Diabetes and Vascular Medicine Unit, Monash Health, VIC, Australia
| | - Sanjeeva Ranasinha
- School of Public Health and Preventive Medicine, Monash University, VIC, Australia
| | - Arul Earnest
- School of Public Health and Preventive Medicine, Monash University, VIC, Australia
| | - Helena Teede
- School of Public Health and Preventive Medicine, Monash University, VIC, Australia.,Diabetes and Vascular Medicine Unit, Monash Health, VIC, Australia
| | - Tim Usherwood
- The George Institute for Global Health, University of NSW, NSW, Australia.,Department of General Practice, Sydney Medical School, University of Sydney, Australia
| | - Kevan R Polkinghorne
- School of Public Health and Preventive Medicine, Monash University, VIC, Australia.,Department of Nephrology, Monash Health, VIC, Australia.,School of Clinical Sciences, Monash University, VIC, Australia
| | - Gregory Fulcher
- Department of Diabetes, Endocrinology & Metabolism, Royal North Shore Hospital, University of Sydney, NSW, Australia.,Northern Clinical School, University of Sydney, Sydney, Australia
| | - Martin Gallagher
- The George Institute for Global Health, University of NSW, NSW, Australia.,Concord Clinical School, University of Sydney, NSW, Australia
| | - Stephen Jan
- The George Institute for Global Health, University of NSW, NSW, Australia.,Sydney Medical School, University of Sydney, NSW, Australia
| | - Alan Cass
- The George Institute for Global Health, University of NSW, NSW, Australia.,Menzies School of Health Research, NT, Australia
| | - Rowan Walker
- Department of Renal Medicine, Alfred Health, VIC, Australia
| | - Grant Russell
- School of Primary Health Care, Monash University, VIC, Australia
| | | | - Peter G Kerr
- Department of Nephrology, Monash Health, VIC, Australia.,School of Clinical Sciences, Monash University, VIC, Australia
| | - Sophia Zoungas
- School of Public Health and Preventive Medicine, Monash University, VIC, Australia.,Diabetes and Vascular Medicine Unit, Monash Health, VIC, Australia.,The George Institute for Global Health, University of NSW, NSW, Australia
| |
Collapse
|
23
|
In Vitro and In Vivo Antifibrotic Effects of Fraxetin on Renal Interstitial Fibrosis via the ERK Signaling Pathway. Toxins (Basel) 2021; 13:toxins13070474. [PMID: 34357946 PMCID: PMC8310265 DOI: 10.3390/toxins13070474] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 07/03/2021] [Accepted: 07/08/2021] [Indexed: 01/02/2023] Open
Abstract
Fraxetin, a natural derivative of coumarin, is known to have anti-inflammatory, anti-oxidant, and hepatoprotective effects in multiple diseases and in liver fibrosis. Whether fraxetin exerts similar effects against renal fibrosis is unknown. In a Unilateral Ureteral Obstruction (UUO) mouse model of renal fibrosis, fraxetin decreased UUO-induced renal dysfunction with a marked reduction in renal interstitial collagen fibers as detected by Masson’s Trichrome staining. Fraxetin treatment also inhibited the expression of α-SMA, Collagen I, Collagen IV, fibronectin, N-cadherin, vimentin, phosphorylated-ERK, and increased the expression of E-cadherin in UUO mice, as shown by immunohistochemical staining and western blot analysis. In vitro studies showed that fraxetin and indoxyl sulfate had no cytotoxic effects on MES13 kidney cells, but that fraxetin significantly decreased IS-induced cell motility and decreased protein expression of α-SMA, N-cadherin, vimentin, and Collagen IV via the ERK-mediated signaling pathway. These findings provide insight into the mechanism underlying fraxetin-induced inhibition of fibrogenesis in renal tissue and suggest that fraxetin treatment may be beneficial for slowing CKD progression.
Collapse
|
24
|
King EK, Hsieh MH, Chang DR, Lu CT, Ting IW, Wang CCN, Chen PS, Yeh HC, Chiang HY, Kuo CC. Prediction of non-responsiveness to pre-dialysis care program in patients with chronic kidney disease: a retrospective cohort analysis. Sci Rep 2021; 11:13938. [PMID: 34230524 PMCID: PMC8260802 DOI: 10.1038/s41598-021-93254-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 06/16/2021] [Indexed: 12/29/2022] Open
Abstract
The responsiveness of patients with chronic kidney disease (CKD) to nephrologists’ care is unpredictable. We defined the longitudinal stages (LSs) 1–5 of estimated glomerular filtration rate (eGFR) by group-based trajectory modeling for repeated eGFR measurements of 7135 patients with CKD aged 20–90 years from a 13-year pre-end-stage renal disease (ESRD) care registry. Patients were considered nonresponsive to the pre-dialysis care if they had a more advanced eGFR LS compared with the baseline. Conversely, those with improved or stable eGFR LS were considered responsive. The proportion of patients with CKD stage progression increased with the increase in the baseline CKD stage (stages 1–2: 29.2%; stage 4: 45.8%). The adjusted times to ESRD and all-cause mortality in patients with eGFR LS-5 were 92% (95% confidence interval [CI] 86–96%) and 57% (95% CI 48–65%) shorter, respectively, than in patients with eGFR LS-3A. Among patients with baseline CKD stages 3 and 4, the adjusted times to ESRD and all-cause death in the nonresponsive patients were 39% (95% CI 33–44%) and 20% (95% CI 14–26%) shorter, respectively, than in the responsive patients. Our proposed Renal Care Responsiveness Prediction (RCRP) model performed significantly better than the conventional Kidney Failure Risk Equation in discrimination, calibration, and net benefit according to decision curve analysis. Non-responsiveness to nephrologists’ care is associated with rapid progression to ESRD and all-cause mortality. The RCRP model improves early identification of responsiveness based on variables collected during enrollment in a pre-ESRD program. Urgent attention should be given to characterize the underlying heterogeneous responsiveness to pre-dialysis care.
Collapse
Affiliation(s)
- Emily K King
- Department of Medical Media Design and Application, Interpedia Incorporated, Taichung, Taiwan.,Big Data Center, China Medical University Hospital and College of Medicine, China Medical University, 2, Yude Rd., North Dist., Taichung City, 404, Taiwan
| | - Ming-Han Hsieh
- Division of Nephrology, Department of Internal Medicine, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
| | - David R Chang
- Division of Nephrology, Department of Internal Medicine, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
| | - Cheng-Ting Lu
- Division of Nephrology, Department of Internal Medicine, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
| | - I-Wen Ting
- Division of Nephrology, Department of Internal Medicine, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan.,Big Data Center, China Medical University Hospital and College of Medicine, China Medical University, 2, Yude Rd., North Dist., Taichung City, 404, Taiwan
| | - Charles C N Wang
- Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan.,Center for Artificial Intelligence and Precision Medicine Research, Asia University, Taichung, Taiwan
| | - Pei-Shan Chen
- Big Data Center, China Medical University Hospital and College of Medicine, China Medical University, 2, Yude Rd., North Dist., Taichung City, 404, Taiwan
| | - Hung-Chieh Yeh
- Division of Nephrology, Department of Internal Medicine, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan.,Big Data Center, China Medical University Hospital and College of Medicine, China Medical University, 2, Yude Rd., North Dist., Taichung City, 404, Taiwan.,AKI-CARE (Clinical Advancement, Research and Education) Center, Department of Internal Medicine, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
| | - Hsiu-Yin Chiang
- Big Data Center, China Medical University Hospital and College of Medicine, China Medical University, 2, Yude Rd., North Dist., Taichung City, 404, Taiwan
| | - Chin-Chi Kuo
- Division of Nephrology, Department of Internal Medicine, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan. .,Big Data Center, China Medical University Hospital and College of Medicine, China Medical University, 2, Yude Rd., North Dist., Taichung City, 404, Taiwan. .,AKI-CARE (Clinical Advancement, Research and Education) Center, Department of Internal Medicine, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan.
| |
Collapse
|
25
|
Lim LM, Lin MY, Hwang SJ, Chen HC, Chiu YW. Association of glomerular filtration rate slope with timely creation of vascular access in incident hemodialysis. Sci Rep 2021; 11:13137. [PMID: 34162901 PMCID: PMC8222220 DOI: 10.1038/s41598-021-92359-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 06/09/2021] [Indexed: 12/02/2022] Open
Abstract
The factors associated with the timely creation of distal vascular access for hemodialysis initiation are unclear. We aimed to explore the association between the slope of estimated glomerular filtration rate (eGFR) and the successful usage of vascular access upon hemodialysis initiation. This single center retrospective cohort study enrolled chronic kidney disease patients who undertook a multidisciplinary care program from 2003 to 2016. Using eGFR slope as predictor, we evaluated the vascular access created timely upon hemodialysis initiation. Among the 987 patients, vascular access was created at a median eGFR of 5.8 min/ml/1.73 m2, with a median duration of 3.1 months before hemodialysis. The proportions of vascular access created timely, created not timely (vascular access immature), and not created were 68.5%, 8.8%, and 22.7%, respectively. There was a significant negative association of eGFR upon vascular access creation with eGFR slope (r = − 0.182, P < 0.001). The fastest eGFR slope patients (the first quartile or < − 10 min/ml/1.73 m2/year) had the lowest percentage of vascular access created timely. In the multivariable logistic regression analysis, only higher eGFR upon vascular access creation (P = 0.001) and eGFR slope (P = 0.009) were significantly associated with vascular access created timely. The adjusted odds ratios of each quartile of eGFR slopes for vascular access created timely were 0.46 (95% confidence interval 0.27–0.86), 1.30 (0.62, 2.72), 1.00 (reference), and 0.95 (0.48–1.87), respectively. eGFR slope is associated with the timely creation of vascular access for the initiation of hemodialysis in a reverse-J-shaped pattern and may help determine the time of vascular access creation.
Collapse
Affiliation(s)
- Lee-Moay Lim
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, 100 Tzyou First Road, Sanmin District, Kaohsiung, 80708, Taiwan.,Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ming-Yen Lin
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, 100 Tzyou First Road, Sanmin District, Kaohsiung, 80708, Taiwan.,Faculty of Renal Care, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shang-Jyh Hwang
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, 100 Tzyou First Road, Sanmin District, Kaohsiung, 80708, Taiwan.,Faculty of Renal Care, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hung-Chun Chen
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, 100 Tzyou First Road, Sanmin District, Kaohsiung, 80708, Taiwan.,Faculty of Renal Care, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yi-Wen Chiu
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, 100 Tzyou First Road, Sanmin District, Kaohsiung, 80708, Taiwan. .,Faculty of Renal Care, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
| |
Collapse
|
26
|
Lin YL, Hou JS, Wang CH, Su CY, Liou HH, Hsu BG. Effects of ketoanalogues on skeletal muscle mass in patients with advanced chronic kidney disease: real-world evidence. Nutrition 2021; 91-92:111384. [PMID: 34273683 DOI: 10.1016/j.nut.2021.111384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 04/11/2021] [Accepted: 05/31/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Ketoanalogue (KA) supplementation in patients with chronic kidney disease (CKD) on a restricted protein diet has been shown to maintain their nutritional status in clinical trials. However, a gap existed between the findings of the clinical trials and the real-world practice. The aim of this prospective observational study was to evaluate the KA effect on skeletal muscle mass in patients with stage 4-5 CKD. METHODS Among 170 patients with CKD screened, 148 were recruited. Patients were defined as KA or non-KA users. During a 12-mo follow-up, skeletal muscle and body fat mass were measured via bioelectrical impedance analysis at baseline, 6 mo (n = 108), and 12 mo (n = 85). RESULTS Among the patients (mean age, 66.5 ± 12.9 y), KA users tended to maintain skeletal muscle and body fat mass, whereas non-KA users had a significantly reduced muscle mass (P = 0.011) and body fat gain (P = 0.004). Stratified by median age, in patients ≥68 y of age, non-KA users yielded the most significant muscle mass reduction and fat mass gain, whereas KA users revealed no changes in skeletal muscle and fat mass. CONCLUSION In real-world practice, we concluded that KA supplementation favorably prevents skeletal muscle mass loss and fat mass gain in elderly patients with stage 4-5 CKD.
Collapse
Affiliation(s)
- Yu-Li Lin
- Division of Nephrology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan; School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Jia-Sian Hou
- Division of Nephrology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Chih-Hsien Wang
- Division of Nephrology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Chen-Ying Su
- Division of Dietetics and Nutrition, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Hung-Hsiang Liou
- Division of Nephrology, Department of Internal Medicine, Hsin-Jen Hospital, New Taipei City, Taiwan.
| | - Bang-Gee Hsu
- Division of Nephrology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan; School of Medicine, Tzu Chi University, Hualien, Taiwan.
| |
Collapse
|
27
|
Health Care Delivery, Patient Resources, and Community Reintegration. Phys Med Rehabil Clin N Am 2021; 32:581-589. [PMID: 34175016 DOI: 10.1016/j.pmr.2021.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
When providing health care services, clinicians should provide patient-centered and family-centered care. When providing care for medically complex patients, it is important to think about how health care teams are working together to care for patients. Health care providers need to think about how they can guide their patients to become more independent, have an improved quality of life, and have improved access to their homes and community environments when possible. Clinicians need to recognize the importance of caregivers and the burdens that are put on caregivers. Clinicians should provide support to caregivers whenever possible.
Collapse
|
28
|
Heaf J, Heiro M, Petersons A, Vernere B, Povlsen JV, Sørensen AB, Clyne N, Bumblyte I, Zilinskiene A, Randers E, Løkkegaard N, Ots-Rosenberg M, Kjellevold S, Kampmann JD, Rogland B, Lagreid I, Heimburger O, Lindholm B. Suboptimal dialysis initiation is associated with comorbidities and uraemia progression rate but not with estimated glomerular filtration rate. Clin Kidney J 2021; 14:933-942. [PMID: 33777377 PMCID: PMC7986329 DOI: 10.1093/ckj/sfaa041] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 03/15/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Despite early referral of uraemic patients to nephrological care, suboptimal dialysis initiation (SDI) remains a common problem associated with increased morbimortality. We hypothesized that SDI is related to pre-dialysis care. METHODS In the 'Peridialysis' study, time and reasons for dialysis initiation (DI), clinical and biochemical data and centre characteristics were registered during the pre- and peri-dialytic period for 1583 end-stage kidney disease patients starting dialysis over a 3-year period at 15 nephrology departments in the Nordic and Baltic countries to identify factors associated with SDI. RESULTS SDI occurred in 42%. Risk factors for SDI were late referral, cachexia, comorbidity (particularly cardiovascular), hypoalbuminaemia and rapid uraemia progression. Patients with polycystic renal disease had a lower incidence of SDI. High urea and C-reactive protein levels, acidosis and other electrolyte disorders were markers of SDI, independently of estimated glomerular filtration rate (eGFR). SDI patients had higher eGFR than non-SDI patients during the pre-dialysis period, but lower eGFR at DI. eGFR as such did not predict SDI. Patients with comorbidities had higher eGFR at DI. Centre practice and policy did not associate with the incidence of SDI. CONCLUSIONS SDI occurred in 42% of all DIs. SDI was associated with hypoalbuminaemia, comorbidity and rate of eGFR loss, but not with the degree of renal failure as assessed by eGFR.
Collapse
Affiliation(s)
- James Heaf
- Department of Medicine, Zealand University Hospital, Roskilde, Denmark
- Department of Nephrology, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
| | | | | | | | - Johan V Povlsen
- Department of Nephrology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Naomi Clyne
- Department of Nephrology, Clinical Sciences Lund, Lund University and Skåne University Hospital, Lund, Sweden
| | - Inga Bumblyte
- Nephrological Clinic, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Alanta Zilinskiene
- Nephrological Clinic, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Else Randers
- Department of Medicine, Viborg Regional Hospital, Viborg, Denmark
| | | | | | | | | | - Björn Rogland
- Department of Medicine, Kristianstad Hospital, Kristianstad, Sweden
| | - Inger Lagreid
- Department of Medicine, St Olav University Hospital, Trondheim, Norway
| | - Olof Heimburger
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Bengt Lindholm
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
29
|
Chen IJ, Hsu LT, Lu MC, Chen YJ, Tsou MT, Chen JY. Gender Differences in the Association Between Obesity Indices and Chronic Kidney Disease Among Middle-Aged and Elderly Taiwanese Population: A Community-Based Cross-Sectional Study. Front Endocrinol (Lausanne) 2021; 12:737586. [PMID: 34966356 PMCID: PMC8710780 DOI: 10.3389/fendo.2021.737586] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 11/17/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Traditional risk factors for chronic kidney disease (CKD) include diabetes mellitus (DM), hypertension (HTN), and metabolic syndrome, which are health conditions related to obesity. We aimed to investigate which of the three obesity indices has the strongest association with CKD and to explore whether there are gender differences in these relationships in the middle-aged and elderly Taiwanese population. METHODS This was a cross-sectional, community-based study. It included 400 residents (141 males and 259 females, age 50-90 years) residing in a community in northern Taiwan. Each participant was asked to fill a questionnaire that collected personal information, medical history, medication use, and anthropometric measurements. The laboratory data were obtained by testing the blood and urine samples. The baseline characteristics were compared, and the obesity indices included body mass index (BMI), waist circumference (WC), and visceral adiposity index (VAI). CKD was defined as the presence of renal dysfunction (urine albumin-creatinine ratio ≥ 30 mg/g) or estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73m2. We used a multiple logistic regression model to evaluate the association between each obesity index and CKD for both genders. Further, we used the area under the receiver operating characteristic (ROC) curve (AUC) to examine the best obesity indices to predict CKD in different genders. RESULTS The average age of the subjects was 64.47 ± 8.45 years, and men were significantly older. CKD was found in 31 (22.0%) males and 50 (19.3%) females. In men, there was no significant difference between the CKD and non-CKD groups among the three obesity indices. However, in women, only VAI was significantly higher in subjects with CKD (1.9 [1.1, 3.4]) than in subjects without CKD (1.5 [1.0, 2.2]) (p-value = 0.03). The multivariate logistic regression revealed that even after adjusting for possible confounding factors, VAI was found to be an independent risk factor for CKD in women (OR: 1.32, 95% CI: 1.04-1.69, p = 0.02), but not in men (OR: 1.20, 95% CI: 0.85-1.69, p = 0.30). The AUC of VAI had a significant ability to predict CKD in women but not in men. CONCLUSION Our results showed that among the three obesity indices, VAI had the strongest association with CKD compared to BMI and WC in women. In addition, VAI in women should be given more importance in the screening for CKD among the middle-aged and elderly Taiwanese population.
Collapse
Affiliation(s)
- I-Ju Chen
- Department of Family Medicine, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Le-Tien Hsu
- Department of Gynecology and Obstetrics, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Mei-Chun Lu
- Department of Family Medicine, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Ying-Jen Chen
- Division of General Internal Medicine and Geriatrics, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Meng-Ting Tsou
- Department of Family Medicine and Occupation Medicine, MacKay Memorial Hospital, Taipei City, Taiwan
- Department of Nursing, and Management, MacKay Junior College of Medicine, New Taipei City, Taiwan
| | - Jau-Yuan Chen
- Department of Family Medicine, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
- College of Medicine, Chang Gung University, Taoyuan City, Taiwan
- *Correspondence: Jau-Yuan Chen,
| |
Collapse
|
30
|
Chen YC, Weng SF, Hsu YJ, Wei CJ, Chiu CH. Continuity of care: evaluating a multidisciplinary care model for people with early CKD via a nationwide population-based longitudinal study. BMJ Open 2020; 10:e041149. [PMID: 33376170 PMCID: PMC7778764 DOI: 10.1136/bmjopen-2020-041149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES To control and prevent the burdens associated with chronic kidney disease (CKD), Taiwan's National Health Insurance Administration (NHIA) launched the 'early-CKD programme' in 2011 to extend care and education to patients with CKD. This study aims to evaluate the effectiveness of the early-CKD programme in terms of continuity of care (COC). DESIGN AND PARTICIPANTS This study used secondary data from 2010 to 2014 provided by the NHIA to identify 86 581 participants each for the intervention and control groups. Patients with CKD who participated in the early-CKD programme between 2011 and 2013 were defined as the intervention group. For the control group, propensity score matching was used to select patients with CKD who did not participate in the programme, but were seen by the same group of physicians. INTERVENTION A multidisciplinary care model for patients with early CKD launched in 2011. PRIMARY OUTCOME MEASURES Outcome variables included the continuity of care index (COCI), which measures a physician's COC; number of essential examinations; and resource utilisation. To better identify the difference between groups, we separated COCI into two groups based on mean: high (above mean) and low (below mean). A generalised estimating equation model was used to examine the effects of the early-CKD programme. RESULTS The programme significantly increased the number of essential examinations/tests administered to patients (β=0.61, p<0.001) and improved COCI between physicians and patients (OR=4.18, p<0.001). Medical expenses (β=1.03, p<0.001) and medication expenses (β=0.23, p<0.001) significantly increased after the programme was implemented, but patients' kidney-related hospitalisations and emergency department visits decreased (β=-0.13, p<0.001). CONCLUSION From the COC viewpoint, the programme in Taiwan showed a positive effect on COCI, number of essential examinations and resource utilisation.
Collapse
Affiliation(s)
- Yin-Cheng Chen
- Division of Nephrology, Department of Internal Medicine, Taipei Hospital, Ministry of Health and Welfare, Taipei, Taiwan
| | - Shuen-Fu Weng
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan
- Division of Endocrinology and Metabolism, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yu-Juei Hsu
- Division of Nephrology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chung-Jen Wei
- Department of Public Health, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Chiung-Hsuan Chiu
- School of Health Care Administration, Taipei Medical University, Taipei, Taiwan
| |
Collapse
|
31
|
Hsu HT, Chiang YC, Lai YH, Lin LY, Hsieh HF, Chen JL. Effectiveness of Multidisciplinary Care for Chronic Kidney Disease: A Systematic Review. Worldviews Evid Based Nurs 2020; 18:33-41. [PMID: 33247619 DOI: 10.1111/wvn.12483] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Chronic kidney disease (CKD) is a common chronic disease. As this disease is extremely complex, multidisciplinary care (MDC) is needed to provide complete and continuous care. AIM A systematic literature review was performed to examine the constituents of MDC, the content of MDC interventions, and the health outcomes in CKD patients receiving MDC. METHODS Searches of five Chinese and English databases for studies of CKD patients who had received MDC from 2007 to 2019 revealed 11 studies, which comprised 16,066 CKD patients. The Physiotherapy Evidence Database scale (Physiotherapy Evidence Database, 2017) was used to appraise study quality for randomized controlled trials, and the Joanna Briggs Institute Critical Appraisal tools (Joanna Briggs Institute, 2017) were for cohort studies. RESULTS The MDC teams that provided comprehensive medical care for these patients included nephrologists, nurses, surgeons, general practitioners, pharmacists, psychotherapists, social workers, nutritionists, and other specialists. The literature review revealed that MDC for CKD slows the decline in estimated glomerular filtration rate and decreases patient mortality, the risk of renal replacement therapy, the need for emergent dialysis, and annual medical costs. Analyses of biochemical markers in the CKD patients showed that MDC improves control of serum levels of calcium and phosphate, improves control of parathyroid hormone, and reduces proteinuria and fasting blood glucose values. However, further studies are needed to determine the effects of MDC on all-cause mortality, blood pressure control, hospitalization rate, hospitalization for cardiovascular or infection events, medications use, and other biochemical markers in CKD patients. LINKING EVIDENCE TO ACTION Cross-disciplinary collaboration of healthcare professionals is needed to ensure that patients undergo regular follow-up and periodic assessment of clinical status, in addition to ensuring that relevant resources and assistance are provided in a timely manner. A follow-up period of at least 2 years is also needed to ensure sufficient time to observe MDC results.
Collapse
Affiliation(s)
- Hsin-Tien Hsu
- School of Nursing, College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Nursing, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yen-Chiu Chiang
- Department of Nursing, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan.,Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yu-Hung Lai
- Department of Ophthalmology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Ophthalmology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Li-Yuan Lin
- Department of Nephrology, Chang-Gung Memorial Hospital, Chiayi, Taiwan
| | - Hsiu-Fen Hsieh
- School of Nursing, College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Nursing, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jyu-Lin Chen
- Department of Family Health Nursing, University of California San Francisco, San Francisco, CA, USA
| |
Collapse
|
32
|
Kao YY, Lee WC, Wang RH, Chen JB. Correlation of sociodemographic profiles with psychological problems among hospitalized patients receiving unplanned hemodialysis. Ren Fail 2020; 42:255-262. [PMID: 32146858 PMCID: PMC7144224 DOI: 10.1080/0886022x.2020.1736097] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Purpose In this prospective study, we aimed to examine the sociodemographic factors and clinical factors associated with psychological disorders in chronic kidney disease (CKD) patients receiving unplanned hemodialysis (HD). Methods We prospectively enrolled 187 CKD stage 5 patients receiving unplanned HD at a tertiary hospital from January 2015 to December 2016. We used structured questionnaires to gather data about participants’ anxiety, depression, and sleep disturbance. Generalized linear regression analysis was used to examine the relationships between sociodemographic and laboratory parameters, and severity of psychological distress. Results The mean age of the participants was 60 years, and the number of men and women was 97 and 90, respectively. We did not find a significant association between anxiety, depression, and sleep disturbance scores and gender, age, marital status, religion status, education levels, and employment status and number of comorbidities. Generalized linear regression analysis showed that a multidisciplinary CKD care program in outpatient clinic disclosed a significant negative association with psychological disorders in participants. Conclusions CKD patients exhibited psychological distress when receiving unplanned HD, not closely associated with sociodemographic profiles.
Collapse
Affiliation(s)
- Yu-Yin Kao
- College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Nursing, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Wen-Chin Lee
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.,Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Ruey-Hsia Wang
- College of Nursing, Department of Medical Research, Kaohsiung Medical University, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Jin-Bor Chen
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.,Chang Gung University College of Medicine, Taoyuan, Taiwan
| |
Collapse
|
33
|
Takagi WH, Osako K, Machida S, Koitabashi K, Shibagaki Y, Sakurada T. Inpatient educational program delays the need for dialysis in patients with chronic kidney disease stage G5. Clin Exp Nephrol 2020; 25:166-172. [PMID: 33040245 DOI: 10.1007/s10157-020-01979-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 09/23/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Inpatient educational programs (IEPs) for patients with chronic kidney disease (CKD) decrease CKD progression. However, patients with end-stage kidney disease who started dialysis during the observation period were excluded from previous studies. METHODS After adjusting for age, sex, baseline estimated glomerular filtration rate, hemoglobin level, and the presence of diabetes mellitus using 1:1 propensity score matching (caliper width of 0.008) in the groups that did and did not receive an IEP, we compared the time period from the beginning of CKD stage G5 to the start of dialysis and patient characteristics at the start of dialysis. RESULTS Prior to matching, 41 patients received an IEP and 260 did not. After propensity score matching, the 41 patients who received an IEP had a longer period from the beginning of stage G5 to the start of dialysis (344 vs. 257 days, P = 0.011), shorter hospitalization period upon the start of dialysis (14 vs. 18 days, P = 0.015) compared with the 41 patients who did not receive an IEP. In addition, the proportion of patients with a planned start of dialysis tended to be higher in the IEP group (95.1 vs. 83.0%, P = 0.077). CONCLUSION An IEP may delay the start of dialysis in patients with end-stage kidney disease, contribute to better preparation of vascular access placement and the smoother start of dialysis.
Collapse
Affiliation(s)
- Wei Han Takagi
- Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Kiyomi Osako
- Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Shinji Machida
- Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Kenichiro Koitabashi
- Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Yugo Shibagaki
- Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Tsutomu Sakurada
- Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan.
| |
Collapse
|
34
|
Hsieh YH, Syu RJ, Lee CC, Lin SH, Lee CH, Cheng CW, Tsai JP. Arecoline induces epithelial mesenchymal transition in HK2 cells by upregulating the ERK-mediated signaling pathway. ENVIRONMENTAL TOXICOLOGY 2020; 35:1007-1014. [PMID: 32441858 DOI: 10.1002/tox.22937] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 03/16/2020] [Accepted: 04/22/2020] [Indexed: 06/11/2023]
Abstract
Arecoline, a component of betel nuts, is a known carcinogen that causes oral cancers among those who chew betel nuts. Betel nut chewing is also associated with an increased risk of chronic kidney disease (CKD), but the role of arecoline in this association is unclear. This in vitro study investigates the effects of arecoline on cultured human kidney (HK2) cells. We observed that arecoline had no effect on cell viability but increased cell migration in a dose-dependent manner. Western blot analysis showed that arecoline treatment caused a dose-dependent decrease in E-cadherin expression and dose-dependent increases in N-cadherin, vimentin, α-SMA, and collagen expression; reverse transcriptase-polymerase chain reaction analysis revealed dose-dependent increases in α-SMA and collagen mRNA. Arecoline treatment upregulated the expression of phosphorylated extracellular signal-regulated kinase through epithelial mesenchymal transition and renal fibrosis in HK2 cells. These findings demonstrate that arecoline plays a role in inducing the epithelial mesenchymal transition and fibrogenesis in renal tubule cells and suggest that arecoline promotes the progression of CKD.
Collapse
Affiliation(s)
- Yi-Hsien Hsieh
- Department of Biochemistry, School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Clinical laboratory, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Ru-Jiang Syu
- Division of Nephrology, Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
| | - Chu-Che Lee
- Department of Medicine Research, Buddhist Dalin Tzu Chi Hospital, Chiayi, Taiwan
| | - Shin-Huey Lin
- Institute of Biochemistry, Microbiology and Immunology, Chung Shan Medical University, Taichung, Taiwan
| | - Chien-Hsing Lee
- Division of Pediatric Surgery, Department of Surgery, Children's Hospital of China Medical University, Taichung, Taiwan
- School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan
| | - Chun-Wen Cheng
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Institute of Biochemistry, Microbiology and Immunology, Chung Shan Medical University, Taichung, Taiwan
| | - Jen-Pi Tsai
- Division of Nephrology, Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| |
Collapse
|
35
|
Manyama TL, Tshitake RM, Moloto NB. The role of pharmacists in the renal multidisciplinary team at a tertiary hospital in South Africa: Strategies to increase participation of pharmacists. Health SA 2020; 25:1357. [PMID: 32934826 PMCID: PMC7479385 DOI: 10.4102/hsag.v25i0.1357] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 05/01/2020] [Indexed: 12/13/2022] Open
Abstract
Background Pharmacists are often marginalised from participating fully in a Multidisciplinary Team (MDT). Pharmacists can contribute in the renal MDT by minimising drug-related problems and optimising therapy. Aim The study aimed to explore the current role of pharmacists in renal care at a tertiary hospital in South Africa, and to recommend strategies to improve their participation in the renal MDT. Method An exploratory descriptive qualitative study was conducted using semi-structured interviews. The participants were selected using purposive sampling. The audiotaped interviews were transcribed exactly as spoken and analysed using thematic content analysis. Results Three themes emerged from the analysis: pharmacist’s current scope of practice within the renal MDT, potential future roles of pharmacists, and perceived barriers to participation of pharmacists within the renal MDT. Furthermore, participants provided recommendations to increase pharmacist’s participation in the renal MDT: that is standardisation of practice, skills development of both pharmacist and pharmacist assistants and recognition of pharmacist services in the wards. Conclusion The role of pharmacists at Pietersburg Hospital is the official name of the hospital is confined to stock management and dispensing. Efforts should be made to improve the participation of pharmacists in the MDTs with the intention to standardise the practice of pharmacists in the wards, equip both pharmacists and pharmacist assistants with the necessary skills and recognise pharmacist’s services in the wards.
Collapse
Affiliation(s)
- Tebogo L Manyama
- Department of Pharmacy, Faculty of Health Sciences, University of Limpopo, Mankweng, South Africa
| | - Rendani M Tshitake
- Department of Pharmacy, Faculty of Health Sciences, University of Limpopo, Mankweng, South Africa
| | - Noko B Moloto
- Department of Pharmacy, Faculty of Health Sciences, University of Limpopo, Mankweng, South Africa
| |
Collapse
|
36
|
Zhang L, Lee WC, Wu CH, Kuo LC, Yang HT, Moi SH, Yang CH, Chen JB. Importance of non-medical reasons for dropout in patients on peritoneal dialysis. Clin Exp Nephrol 2020; 24:1050-1057. [PMID: 32757098 DOI: 10.1007/s10157-020-01948-y] [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: 05/07/2020] [Accepted: 07/28/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND To describe the associated factors for non-medical reasons for dropout in peritoneal dialysis (PD) patients. METHODS A retrospective cohort study was performed using registry data of adult patients commencing PD as their initial renal replacement therapy in one hospital-facilitated PD center in Taiwan between 2014 and 2018. The collected data included socio-demographics and relevant medical and PD-related parameters. Kaplan-Meier analysis was used to determine the impact of non-medical reasons and medical reasons on PD dropout. RESULTS The analysis included 224 PD patients, of whom 37 dropped out for non-medical reasons and 187 for medical reasons during the study period. There was significant difference between the two cohorts in age (62.3 years vs. 56.1 years, P = 0.010) and PD vintage (median 3.4 years vs. 4.8 years, P = 0.001). Diabetes was more predominant in the cohort for non-medical reasons than in the one for medical reasons (54.1% vs. 27.3% respectively, P = 0.001). In non-medical reason cohort, two leading reasons given for dropping out were lacking of caregivers (n = 12) and losing confidence (n = 10), whereas PD-related peritonitis (n = 101) was the main medical reason for PD dropout. Using Kaplan-Meier curve analysis, patients in the non-medical reason cohort demonstrated higher cumulative dropout rate compared to patients in the medical reason cohort during a 10-year period (P < 0.001). CONCLUSIONS The main characteristics of PD dropout patients for non-medical reasons are age, diabetes, patients' perception and caregiver support.
Collapse
Affiliation(s)
- Lin Zhang
- Division of Nephrology, Department of Internal Medicine, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Xi Qing District, 88 Chang Ling Rd, Tianjin, China
| | - Wen-Chin Lee
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta Pei Rd, Kaohsiung, Niao Song District, Taiwan
| | - Chien-Hsing Wu
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta Pei Rd, Kaohsiung, Niao Song District, Taiwan
| | - Li-Chueh Kuo
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta Pei Rd, Kaohsiung, Niao Song District, Taiwan
| | - Hong-Tao Yang
- Division of Nephrology, Department of Internal Medicine, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Xi Qing District, 88 Chang Ling Rd, Tianjin, China.
| | - Sin-Hua Moi
- Institute of Biotechnology and Chemical Engineering, I-Shou University, Kaohsiung, 84001, Taiwan
| | - Cheng-Hong Yang
- Department of Electronic Engineering, National Kaohsiung University of Science and Technology, Kaohsiung, Taiwan
| | - Jin-Bor Chen
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta Pei Rd, Kaohsiung, Niao Song District, Taiwan.
| |
Collapse
|
37
|
Saudan P, Ponte B, Marangon N, Martinez C, Berchtold L, Jaques D, Ernandez T, de Seigneux S, Carballo S, Perneger T, Martin PY. Impact of superimposed nephrological care to guidelines-directed management by primary care physicians of patients with stable chronic kidney disease: a randomized controlled trial. BMC Nephrol 2020; 21:128. [PMID: 32272886 PMCID: PMC7147051 DOI: 10.1186/s12882-020-01747-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 02/27/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Optimal clinical care of patients with chronic kidney disease (CKD) requires collaboration between primary care physicians (PCPs) and nephrologists. We undertook a randomised trial to determine the impact of superimposed nephrologist care compared to guidelines-directed management by PCPs in CKD patients after hospital discharge. METHODS Stage 3b-4 CKD patients were enrolled during a hospitalization and randomised in two arms: Co-management by PCPs and nephrologists (interventional arm) versus management by PCPs with written instructions and consultations by nephrologists on demand (standard care). Our primary outcome was death or rehospitalisation within the 2 years post-randomisation. Secondary outcomes were: urgent renal replacement therapy (RRT), decline of renal function and decrease of quality of life at 2 years. RESULTS From November 2009 to the end of June 2013, we randomised 242 patients. Mean follow-up was 51 + 20 months. Survival without rehospitalisation, GFR decline and elective dialysis initiation did not differ between the two arms. Quality of life was also similar in both groups. Compared to randomised patients, those who either declined to participate in the study or were previously known by nephrologists had a worse survival. CONCLUSION These results do not demonstrate a benefit of a regular renal care compared to guided PCPs care in terms of survival or dialysis initiation in CKD patients. Increased awareness of renal disease management among PCPs may be as effective as a co-management by PCPs and nephrologists in order to improve the prognosis of moderate-to-severe CKD. TRIAL REGISTRATION This study was registered on June 29, 2009 in clinicaltrials.gov (NCT00929760) and adheres to CONSORT 2010 guidelines.
Collapse
Affiliation(s)
- Patrick Saudan
- Nephrology Unit, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland.
| | - Belen Ponte
- Nephrology Unit, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Nicola Marangon
- Nephrology Unit, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Chantal Martinez
- Nephrology Unit, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Lena Berchtold
- Nephrology Unit, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - David Jaques
- Nephrology Unit, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Thomas Ernandez
- Nephrology Unit, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Sophie de Seigneux
- Nephrology Unit, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Sebastian Carballo
- Service of General Internal Medicine, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Thomas Perneger
- Division of Clinical Epidemiology, Geneva University Hospitals, Geneva, Switzerland
| | - Pierre-Yves Martin
- Nephrology Unit, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
| |
Collapse
|
38
|
Yang CW, Harris DC, Luyckx VA, Nangaku M, Hou FF, Garcia Garcia G, Abu-Aisha H, Niang A, Sola L, Bunnag S, Eiam-Ong S, Tungsanga K, Richards M, Richards N, Goh BL, Dreyer G, Evans R, Mzingajira H, Twahir A, McCulloch MI, Ahn C, Osafo C, Hsu HH, Barnieh L, Donner JA, Tonelli M. Global case studies for chronic kidney disease/end-stage kidney disease care. Kidney Int Suppl (2011) 2020; 10:e24-e48. [PMID: 32149007 PMCID: PMC7031689 DOI: 10.1016/j.kisu.2019.11.010] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 10/11/2019] [Accepted: 11/07/2019] [Indexed: 01/13/2023] Open
Abstract
The prevalence of chronic kidney disease and its risk factors is increasing worldwide, and the rapid rise in global need for end-stage kidney disease care is a major challenge for health systems, particularly in low- and middle-income countries. Countries are responding to the challenge of end-stage kidney disease in different ways, with variable provision of the components of a kidney care strategy, including effective prevention, detection, conservative care, kidney transplantation, and an appropriate mix of dialysis modalities. This collection of case studies is from 15 countries from around the world and offers valuable learning examples from a variety of contexts. The variability in approaches may be explained by country differences in burden of disease, available human or financial resources, income status, and cost structures. In addition, cultural considerations, political context, and competing interests from other stakeholders must be considered. Although the approaches taken have often varied substantially, a common theme is the potential benefits of multistakeholder engagement aimed at improving the availability and scope of integrated kidney care.
Collapse
Affiliation(s)
- Chih-Wei Yang
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - David C.H. Harris
- Centre for Transplantation and Renal Research, Westmead Institute for Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Valerie A. Luyckx
- Institute of Biomedical Ethics and the History of Medicine, University of Zurich, Zurich, Switzerland
- Renal Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Masaomi Nangaku
- Division of Nephrology, The University of Tokyo School of Medicine, Hongo, Japan
| | - Fan Fan Hou
- State Key Laboratory of Organ Failure Research, National Clinical Research Center for Kidney Disease, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Guillermo Garcia Garcia
- Servicio de Nefrologia, Hospital Civil de Guadalajara Fray Antonio Alcalde, University of Guadalajara Health Sciences Center, Hospital 278, Guadalajara, Jalisco, Mexico
| | | | - Abdou Niang
- Department of Nephrology, Dalal Jamm Hospital, Cheikh Anta Diop University Teaching Hospital, Dakar, Senegal
| | - Laura Sola
- Dialysis Unit, CASMU-IAMPP, Montevideo, Uruguay
| | - Sakarn Bunnag
- Division of Nephrology, Department of Internal Medicine, Rajavithi Hospital, Bangkok, Thailand
| | - Somchai Eiam-Ong
- Department of Medicine, Chulalongkorn Hospital, Bangkok, Thailand
| | - Kriang Tungsanga
- Division of Nephrology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Bhumirajanagarindra Kidney Institute, Bangkok, Thailand
| | | | - Nick Richards
- SEHA Dialysis Services, Abu Dhabi, United Arab Emirates
| | - Bak Leong Goh
- Department of Nephrology and Clinical Research Centre, Hospital Serdang, Jalan Puchong, Kajang, Selangor, Malaysia
| | - Gavin Dreyer
- Department of Nephrology, Barts Health NHS Trust, London, UK
| | - Rhys Evans
- Centre for Nephrology, University College London, London, UK
| | - Henry Mzingajira
- Malawi Ministry of Health, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Ahmed Twahir
- Parklands Kidney Centre, Nairobi, Kenya
- Department of Medicine, The Aga Khan University Hospital, Nairobi, Kenya
| | - Mignon I. McCulloch
- Paediatric Intensive and Critical Unit, Red Cross War Memorial Children’s Hospital, University of Cape Town, Cape Town, South Africa
| | - Curie Ahn
- Division of Nephrology, College of Medicine, Seoul National University, Seoul, Korea
| | - Charlotte Osafo
- School of Medicine and Dentistry, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
| | - Hsiang-Hao Hsu
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Lianne Barnieh
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Pan American Health Organization/World Health Organization’s Coordinating Centre in Prevention and Control of Chronic Kidney Disease, University of Calgary, Calgary, Alberta, Canada
| | - Jo-Ann Donner
- International Society of Nephrology, Brussels, Belgium
| | - Marcello Tonelli
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Pan American Health Organization/World Health Organization’s Coordinating Centre in Prevention and Control of Chronic Kidney Disease, University of Calgary, Calgary, Alberta, Canada
| |
Collapse
|
39
|
Zimbudzi E, Lo C, Ranasinha S, Teede H, Usherwood T, Polkinghorne KR, Fulcher G, Gallagher M, Jan S, Cass A, Walker R, Russell G, Johnson G, Kerr PG, Zoungas S. Health-related quality of life among patients with comorbid diabetes and kidney disease attending a codesigned integrated model of care: a longitudinal study. BMJ Open Diabetes Res Care 2020; 8:8/1/e000842. [PMID: 31958294 PMCID: PMC6954749 DOI: 10.1136/bmjdrc-2019-000842] [Citation(s) in RCA: 4] [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: 08/21/2019] [Revised: 10/07/2019] [Accepted: 11/23/2019] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE To evaluate the impact of an integrated diabetes and kidney disease model of care on health-related quality of life (HRQOL) of patients with comorbid diabetes and chronic kidney disease (CKD). RESEARCH DESIGN AND METHODS A longitudinal study of adult patients (over 18 years) with comorbid diabetes and CKD (stage 3a or worse) who attended a new diabetes kidney disease service was conducted at a tertiary hospital. A questionnaire consisting of demographics, clinical data, and the Kidney Disease Quality of Life (KDQOL-36) was administered at baseline and after 12 months. Paired t-tests were used to compare baseline and 12-month scores. A subgroup analysis examined the effects by patient gender. Multiple regression analysis examined the factors associated with changes in scores. RESULTS 179 patients, 36% of whom were female, with baseline mean±SD age of 65.9±11.3 years, were studied. Across all subscales, HRQOL did not significantly change over time (p value for all mean differences >0.05). However, on subgroup analysis, symptom problem list and physical composite summary scores increased among women (MD=9.0, 95% CI 1.25 to 16.67; p=0.02 and MD=4.5, 95% CI 0.57 to 8.42; p=0.03 respectively) and physical composite scores decreased among men (MD=-3.35, 95% CI -6.26 to -0.44; p=0.03). CONCLUSION The HRQOL of patients with comorbid diabetes and CKD attending a new codesigned, integrated diabetes and kidney disease model of care was maintained over 12 months. Given that HRQOL is known to deteriorate over time in this high-risk population, the impact of these findings on clinical outcomes warrants further investigation.
Collapse
Affiliation(s)
- Edward Zimbudzi
- School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
- Department of Nephrology, Monash Health, Clayton, Victoria, Australia
| | - Clement Lo
- School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
- Diabetes and Vascular Medicine Unit, Monash Health, Clayton, Victoria, Australia
| | - Sanjeeva Ranasinha
- School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Helena Teede
- School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
- Diabetes and Vascular Medicine Unit, Monash Health, Clayton, Victoria, Australia
| | - Tim Usherwood
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- Department of General Practice, The University of Sydney, Sydney, New South Wales, Australia
| | - Kevan R Polkinghorne
- Department of Nephrology, Monash Health, Clayton, Victoria, Australia
- School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
| | - Greg Fulcher
- Department of Diabetes, Endocrinology and Metabolism, Royal North Shore Hospital School, St Leonards, New South Wales, Australia
- Northern Clinical School, The University of Sydney Northern Clinical School, St Leonards, New South Wales, Australia
| | - Martin Gallagher
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- Concord Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Steven Jan
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Alan Cass
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Rowan Walker
- Department of Renal Medicine, Alfred Health, Melbourne, Victoria, Australia
| | - Grant Russell
- Southern Academic Primary Care Research Unit, Department of General Practice, Monash University, Clayton, Victoria, Australia
| | - Greg Johnson
- Diabetes Australia, Canberra, Australian Capital Territory, Australia
| | - Peter G Kerr
- Department of Nephrology, Monash Health, Clayton, Victoria, Australia
- School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
| | - Sophia Zoungas
- School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| |
Collapse
|
40
|
Duong TV, Wu PY, Yang E, Lin YF, Chiou HY, Yang SH. Associations of Waist Circumference, Socioeconomic, Environmental, and Behavioral Factors with Chronic Kidney Disease in Normal Weight, Overweight, and Obese People. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16245093. [PMID: 31847161 PMCID: PMC6949979 DOI: 10.3390/ijerph16245093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 12/06/2019] [Accepted: 12/12/2019] [Indexed: 11/16/2022]
Abstract
Background: Chronic kidney disease (CKD) places a heavy burden on the healthcare system worldwide. The risk factors may vary by body adiposity. We aimed to investigate the associations of socioeconomic, environmental, and behavioral factors with CKD in different groups of body mass indexes (BMI). Methods: A case-control study was conducted in 3280 participants (1048 CKD and 2232 non-CKD) from seven hospitals and nearby communities from May 2012 to August 2015. Personal characteristics, anthropometrics, environmental exposures, and health-related behaviors were assessed using a structured questionnaire. The logistic regression models were utilized for analysis. Results: Older age (odd ratio, OR = 2.85; p < 0.001), being men (OR = 4.23; p < 0.001), smoking (OR = 3.36; p < 0.001), stable income (OR = 0.33; p < 0.001), higher education (OR = 0.37~0.38; p < 0.001), and daily adequate water intake (OR = 0.64; p = 0.010) were associated with CKD in normal weight people. Older age (OR = 2.49; p < 0.001), being men (OR = 3.36; p < 0.001), education (OR = 0.44, p = 0.004), hypertension (OR = 2.93; p<0.001), diabetes (OR = 1.83; p = 0.004), and using traditional Chinese medicine (OR = 2.03, p = 0.014) were associated with CKD in overweight people. Older age (OR = 2.71; p < 0.001), being men (OR = 2.69; p < 0.001), hypertension (OR = 2.93; p < 0.001), diabetes (OR = 1.94; p = 0.001) were associated with CKD in obese people. Conclusions: The associated factors of CKD varied by different groups of BMI. These findings may help to develop potential interventions to manage CKD.
Collapse
Affiliation(s)
- Tuyen Van Duong
- School of Nutrition and Health Sciences, Taipei Medical University, Taipei 11031, Taiwan; (T.V.D.); (P.-Y.W.)
| | - Pei-Yu Wu
- School of Nutrition and Health Sciences, Taipei Medical University, Taipei 11031, Taiwan; (T.V.D.); (P.-Y.W.)
| | - Evelyn Yang
- Department of Obstetrics and Gynecology, Chung Shan Medical University Hospital, Taichung City 40201, Taiwan;
| | - Yuh-Feng Lin
- International Master/Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan;
- Division of Nephrology, Department of Internal Medicine, Taipei Medical University−Shuang Ho Hospital, New Taipei 23561, Taiwan
| | - Hung-Yi Chiou
- School of Public Health, College of Public Health, Taipei Medical University, Taipei 11031, Taiwan;
- Health and Clinical Research Data Center, Data Center, Taipei Medical University, Taipei 11031, Taiwan
- Master Program in Applied Molecular Epidemiology, Taipei Medical University, Taipei 11031, Taiwan
| | - Shwu-Huey Yang
- School of Nutrition and Health Sciences, Taipei Medical University, Taipei 11031, Taiwan; (T.V.D.); (P.-Y.W.)
- Research Center of Geriatric Nutrition, Taipei Medical University, Taipei 11031, Taiwan
- Nutrition Research Center, Taipei Medical University Hospital, Taipei 11031, Taiwan
- Correspondence: ; Tel.: +886-2-2736-1661 (ext. 6568)
| |
Collapse
|
41
|
Chou YH, Yen CJ, Lai TS, Chen YM. Old age is a positive modifier of renal outcome in Taiwanese patients with stages 3-5 chronic kidney disease. Aging Clin Exp Res 2019; 31:1651-1659. [PMID: 30628047 DOI: 10.1007/s40520-018-01117-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 12/31/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND The incidence of end-stage renal disease (ESRD) is increasing in elderly patients with chronic kidney disease (CKD). This contradicts the general notion that elderly people are more likely to die than to ever reach ESRD. And racial disparity in relation to age on kidney disease outcomes has always been a subject of research interest. AIMS We investigated the effect of age on outcome in a cohort with stages 3-5 CKD patients by age category. METHODS A total of 430 patients with a mean age of 65.6 years were enrolled and followed till death, ESRD, or end of 2015. Multivariable Cox regression was used to identify predictors of all-cause mortality. Competing risk-adjusted Cox regression was used to identify determinants of ESRD. The median follow-up was 7.3 (interquartile range 8.8) years. RESULTS Cox regression showed old age and low mean arterial pressure were predictors of mortality before and after onset of ESRD. Competing risk analysis revealed patients aged 20-39 years and 40-64 years exhibited greater risks of ESRD, compared to those aged over 75 years. These effects of age on outcomes occurred independently of traditional risk factors such as low estimated glomerular filtration rate and high proteinuria. CONCLUSIONS Age over 75 years is associated with decreased risk for ESRD even after adjustment for competing mortality. Given the global trends in population aging, there is a need to develop age-specific strategies, on top of the existing stage-based measures, to optimize the management of CKD in the elderly.
Collapse
Affiliation(s)
- Yu-Hsiang Chou
- Department of Internal Medicine, National Taiwan University Hospital Jin-Shan Branch, No. 7, Yulu Rd., Wuhu Village, Jinshan Dist, New Taipei City, 20844, Taiwan
- Renal Division, Department of Internal Medicine, College of Medicine, National Taiwan University Hospital, National Taiwan University, No. 7, Chung Shan S. Rd., Zhongzheng Dist, Taipei, 10002, Taiwan
| | - Chung-Jen Yen
- Renal Division, Department of Internal Medicine, College of Medicine, National Taiwan University Hospital, National Taiwan University, No. 7, Chung Shan S. Rd., Zhongzheng Dist, Taipei, 10002, Taiwan
| | - Tai-Shuan Lai
- Renal Division, Department of Internal Medicine, College of Medicine, National Taiwan University Hospital, National Taiwan University, No. 7, Chung Shan S. Rd., Zhongzheng Dist, Taipei, 10002, Taiwan
| | - Yung-Ming Chen
- Renal Division, Department of Internal Medicine, College of Medicine, National Taiwan University Hospital, National Taiwan University, No. 7, Chung Shan S. Rd., Zhongzheng Dist, Taipei, 10002, Taiwan.
- Department of Internal Medicine, College of Medicine, National Taiwan University, No. 1, Jen-Ai Road, Section 1, Taipei, 100, Taiwan.
| |
Collapse
|
42
|
Hu HY, Jian FX, Lai YJ, Yen YF, Huang N, Hwang SJ. Patient and provider factors associated with enrolment in the pre-end-stage renal disease pay-for-performance programme in Taiwan: a cross-sectional study. BMJ Open 2019; 9:e031354. [PMID: 31519682 PMCID: PMC6747641 DOI: 10.1136/bmjopen-2019-031354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE The incidence and prevalence of end-stage renal disease (ESRD) in Taiwan have been ranked the highest worldwide. Therefore, the National Health Insurance Administration has implemented the pre-ESRD pay-for-performance (P4P) programme since November 2006, which had significantly reduced the incidence of dialysis and all-cause mortality. This study aimed to identify the factors associated with the enrolment in the pre-ESRD P4P programme. DESIGN Cross-sectional study. SETTING The National Health Insurance research database 2007-2012 in Taiwan. PARTICIPANTS Patients with prevalent pre-ESRD aged more than 18 years between January 2007 and December 2012 were enrolled. Patient demographics and hospital characteristics between P4P and non-P4P groups were compared. A logistic regression model was used to analyse the factors associated with P4P enrolment, and a generalised estimating equation was used to verify the results. PRIMARY OUTCOME MEASURE Enrolment in the pre-ESRD P4P programme. RESULTS In total, 82 991 patients were enrolled in the programme, with a 45.6% participation rate. Patients who were males (adjusted OR (AOR)=0.89, 95% CI=0.86 to 0.91) and employed (AOR=0.95, 95% CI=0.92 to 0.97) had a significantly lower probability to be enrolled in the programme. Older patients (66-75 years old, AOR=1.23, 95% CI=1.14 to 1.33) and those with higher Charlson Comorbidities Index (CCI 5+, AOR=4.01, 95% CI=3.55 to 4.53) tended to be enrolled in the programme, while those in the 76+ years age group were not (AOR=1.03, 95% CI=0.95 to 1.13). Hospitals located in the central (AOR=1.48, 95% CI=1.05 to 2.08) and Kao-Ping regions (AOR=1.62, 95% CI=1.18 to 2.22) also tended to enrol patients in the pre-ESRD P4P programme. Enrolment rates increased over time. CONCLUSION Pre-ESRD patients of the female gender, greater age and more comorbidities were more likely to be enrolled in the pre-ESRD P4P programme. Healthcare providers and health authorities should focus attention on patients who are male, younger and with less comorbidities to improve the healthcare quality and equality for all pre-ESRD patients.
Collapse
Affiliation(s)
- Hsiao-Yun Hu
- Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
| | - Feng-Xuan Jian
- Faculty of Renal Care, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yun-Ju Lai
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Puli Branch of Taichung Veterans General Hospital, Nantou, Taiwan
| | - Yung-Feng Yen
- Section of Infectious Diseases, Taipei City Hospital, Taipei, Taiwan
| | - Nicole Huang
- Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan
| | - Shang Jyh Hwang
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| |
Collapse
|
43
|
Yang H, Juang SY, Liao KF, Chen YH. Comparing the Effect of Folic Acid and Pentoxifylline on Delaying Dialysis Initiation in Patients with Advanced Chronic Kidney Disease. Nutrients 2019; 11:nu11092192. [PMID: 31547288 PMCID: PMC6769878 DOI: 10.3390/nu11092192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 09/04/2019] [Accepted: 09/07/2019] [Indexed: 11/17/2022] Open
Abstract
Background: We hypothesized that the nutrient loss and chronic inflammation status may stimulate progression in advanced chronic kidney disease. Therefore, we aimed to generate a study to state the influence of combined nutritional and anti-inflammatory interventions. Methods: The registry from the National Health Insurance Research Database in Taiwan was searched for 20–90 years individuals who had certified end-stage renal disease. From January 2005 through December 2010, the diagnosis code ICD-9 585 (chronic kidney disease, CKD) plus erythropoiesis-stimulating agent (ESA) use was defined as entering advanced chronic kidney disease. The ESA starting date was defined as the first index date, whereas the initiation day of maintenance dialysis was defined as the second index date. The duration between the index dates was analyzed in different medical treatments. Results: There were 10,954 patients analyzed. The combination therapy resulted in the longest duration (n = 2184, median 145 days, p < 0.001) before the dialysis initiation compared with folic acid (n = 5073, median 111 days), pentoxifylline (n = 1119, median 102 days, p = 0.654), and no drug group (control, n = 2578, median 89 days, p < 0.001). Lacking eGFR data and the retrospective nature are important limitations. Conclusions: In patients with advanced CKD on the ESA treatment, the combination of folic acid and pentoxifylline was associated with delayed initiation of hemodialysis.
Collapse
Affiliation(s)
- Hsun Yang
- Department of Nephrology, Department of Internal Medicine, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung 427, Taiwan.
| | - Shiun-Yang Juang
- Department of Medical Research, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung 427, Taiwan.
| | - Kuan-Fu Liao
- Division of Gastroenterology, Department of Internal Medicine, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung 427, Taiwan.
- School of Medicine, Tzu Chi University, Hualien 970, Taiwan.
- Graduate Institute of Integrated Medicine, China Medical University, Taichung 404, Taiwan.
| | - Yi-Hsin Chen
- Department of Nephrology, Department of Internal Medicine, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung 427, Taiwan.
- School of Medicine, Tzu Chi University, Hualien 970, Taiwan.
- Institute of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei 112, Taiwan.
| |
Collapse
|
44
|
Chen JH, Chiu YW, Hwang SJ, Tsai JC, Shi HY, Lin MY. Effect of nephrology referrals and multidisciplinary care programs on renal replacement and medical costs on patients with advanced chronic kidney disease: A retrospective cohort study. Medicine (Baltimore) 2019; 98:e16808. [PMID: 31415394 PMCID: PMC6831162 DOI: 10.1097/md.0000000000016808] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Evidence-based studies have revealed outcomes in patients with chronic kidney disease that differed depending on the design of care delivery. This study compared the effects of 3 types of nephrology care: multidisciplinary care (MDC), nephrology care, and non-nephrology care. We studied their effects on the risks of requiring dialysis and the differences between these methods had on long-term medical resource utilization and costs.We conducted a retrospective cohort study involving patients with an estimated glomerular filtration rate of (eGFR) ≤45 mL/min/1.73 m from 2005 to 2007. Patients were divided into MDC, non-MDC, and non-nephrology referral groups. Between-group differences with regard to the risk of requiring dialysis and annual medical utilization and costs were evaluated using a 5-year follow-up period.In total, 661 patients were included. After other covariates and the competing risk of death were taken into account, we observed a significant (56%) reduction in the incidence of dialysis in both the MDC and non-MDC groups relative to the non-nephrology referral group. Costs were markedly lower in the MDC group relative to the other groups (average savings: US$ 830 per year; 95% confidence interval: 367-1295; P < .001).For patients without nephrology referrals, MDC can substantially reduce their risk of developing end-stage renal disease and lower their medical costs. We therefore strongly advocate that all patients with an eGFR of ≤45 mL/min/1.73 m should be referred to a nephrologist and receive MDC.
Collapse
Affiliation(s)
- Jui-Hsin Chen
- Department of Nursing, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University Hospital
- Department of Healthcare Administration and Medical Informatics, College of Health Sciences
| | - Yi-Wen Chiu
- Department of Internal Medicine, Division of Nephrology, Kaohsiung Medical University Hospital
- Department of Renal Care, College of Medicine
| | - Shang-Jyh Hwang
- Department of Internal Medicine, Division of Nephrology, Kaohsiung Medical University Hospital
- Department of Renal Care, College of Medicine
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung
- Institute of Population Sciences, National Health Research Institutes, Miaoli
| | - Jer-Chia Tsai
- Department of Internal Medicine, Division of Nephrology, Kaohsiung Medical University Hospital
- Department of Renal Care, College of Medicine
| | - Hon-Yi Shi
- Department of Healthcare Administration and Medical Informatics, College of Health Sciences
| | - Ming-Yen Lin
- Department of Internal Medicine, Division of Nephrology, Kaohsiung Medical University Hospital
- Department of Renal Care, College of Medicine
- Master of Public Health Degree Program, College of Public Health, National Taiwan University, Taipei, Taiwan
| |
Collapse
|
45
|
The effects of a participatory structured group educational program on the development of CKD: a population-based study. Clin Exp Nephrol 2019; 23:1031-1038. [PMID: 31030309 DOI: 10.1007/s10157-019-01738-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 04/09/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND The type of lifestyle guidance that is effective for preventing development of chronic kidney disease (CKD) is unknown. Here, we aim to investigate the effects of a participatory structured group education (SGE) program on the development of CKD in a population-based study. METHODS We retrospectively analyzed 1060 adult special health check-up examinees with CKD. Examinees with an estimated glomerular filtration rate (eGFR) from 50 to 60 mL/min/1.73 m2 and/or proteinuria 1+ were encouraged to attend an SGE program. The SGE program included participatory small group discussions on the attendees' remaining risk factors. The primary outcome of this study was the change in eGFR per year. RESULTS The changes in eGFR in examinees who attended the SGE program (n = 209, + 2.9 mL/min/1.73 m2 [95% confidence interval (CI) + 1.9 to + 3.9]) significantly improved compared with control (n = 383, + 1.2 mL/min/1.73 m2 [95% CI + 0.5 to + 1.9], p = 0.006). Attending an SGE program was independently and positively related to the changes in eGFR at 1 year after attendance, after adjusting for classical covariates (β = 1.55 [95% CI 0.37-2.73], p = 0.01). Attending an SGE program was effective for the examinees with a lower eGFR compared with those with only proteinuria. CONCLUSIONS Our SGE program showed the beneficial effects of preventing the development of CKD, independent of classical factors. The type of SGE program that is more effective for preventing development of CKD should be investigated in a long-term analysis.
Collapse
|
46
|
Awdishu L, Moore T, Morrison M, Turner C, Trzebinska D. A Primer on Quality Assurance and Performance Improvement for Interprofessional Chronic Kidney Disease Care: A Path to Joint Commission Certification. PHARMACY 2019; 7:pharmacy7030083. [PMID: 31277293 PMCID: PMC6789732 DOI: 10.3390/pharmacy7030083] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 06/19/2019] [Accepted: 06/27/2019] [Indexed: 01/23/2023] Open
Abstract
Interprofessional care for chronic kidney disease facilitates the delivery of high quality, comprehensive care to a complex, at-risk population. Interprofessional care is resource intensive and requires a value proposition. Joint Commission certification is a voluntary process that improves patient outcomes, provides external validity to hospital administration and enhances visibility to patients and referring providers. This is a single-center, retrospective study describing quality assurance and performance improvement in chronic kidney disease, Joint Commission certification and quality outcomes. A total of 440 patients were included in the analysis. Thirteen quality indicators consisting of clinical and process of care indicators were developed and measured for a period of two years from 2009–2017. Significant improvements or at least persistently high performance were noted for key quality indicators such as blood pressure control (85%), estimation of cardiovascular risk (100%), measurement of hemoglobin A1c (98%), vaccination (93%), referrals for vascular access and transplantation (100%), placement of permanent dialysis access (61%), discussion of advanced directives (94%), online patient education (71%) and completion of office visit documentation (100%). High patient satisfaction scores (94–96%) are consistent with excellent quality of care provided.
Collapse
Affiliation(s)
- Linda Awdishu
- School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, CA 92093, USA.
- Nephrology Department, School of Medicine, University of California, San Diego, CA 92093, USA.
| | - Teri Moore
- Nephrology Department, School of Medicine, University of California, San Diego, CA 92093, USA
| | - Michelle Morrison
- Nephrology Department, School of Medicine, University of California, San Diego, CA 92093, USA
| | - Christy Turner
- Nephrology Department, School of Medicine, University of California, San Diego, CA 92093, USA
| | - Danuta Trzebinska
- Nephrology Department, School of Medicine, University of California, San Diego, CA 92093, USA
| |
Collapse
|
47
|
Aiumtrakul N, Euswas K, Phichedwanichskul K, Rangsin R, Kaewput W, Satirapoj B. Cardiovascular and Renal Outcomes in an Excellent Chronic Kidney Disease Clinic Compared with an Outpatient Clinic in a Primary Care Setting: A Retrospective Cohort Study. KIDNEY DISEASES 2019; 5:144-152. [PMID: 31259176 DOI: 10.1159/000495464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 11/15/2018] [Indexed: 11/19/2022]
Abstract
Background Chronic kidney disease (CKD) is associated with increased cardiovascular morbidity and mortality. In standard care, the physician attempts to control all known risk factors, but treatment goals are achieved with difficulty. Assistance by a multidisciplinary care team may improve outcomes. Objective To compare the cardiovascular and renal endpoints between patients with CKD receiving care from excellent CKD and outpatient clinics. Methods A retrospective cohort study was conducted in a primary care setting in Thailand. Patients with CKD stages 3 and 4 in excellent CKD (n = 96) and outpatient clinics (n = 192) were matched in a 1: 2 ratio with the propensity score. We collected data from electronic medical records concerning the incidences of primary composite outcomes including rapid renal progression, end-stage renal disease, myocardial infarction, congestive heart failure, stroke, and mortality. Multidisciplinary team care in the excellent CKD clinic consisted of physician, nurse, pharmacist, dietitian, physical therapist, and applied Thai traditional physician. The outpatient clinic consisted of physician care only. Results Subjects' mean age was 64.54 ± 10.96 years, and 52.1% were female. During an average 49.63 ± 8.36 months of follow-up, 74 events occurred including 35 (47.30%) patients who experienced renal events, 29 (39.19%) who experienced cardiovascular events, and 10 (13.51%) who experienced loss of life. The Kaplan-Meier curve indicated a higher percentage of subjects without primary composite outcomes in the excellent CKD clinic than those in the outpatient clinic (66.85%; 95% CI 0.48-0.80 vs. 44.71%; 95% CI 0.29-0.60; p = 0.005). From multivariate analysis, the excellent CKD clinic group had a 64% lower risk for primary composite outcomes compared with those in the outpatient clinic (adjusted HR 0.36; 95% CI 0.18-0.74; p = 0.005). Conclusion A multidisciplinary care system can reduce composition outcomes including cardiovascular and renal outcomes for the growing CKD population. The optimal outcomes arise from the medical personnel's teamwork, not from one physician alone.
Collapse
Affiliation(s)
- Noppawit Aiumtrakul
- Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Krischon Euswas
- Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Kitinan Phichedwanichskul
- Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Ram Rangsin
- Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Wisit Kaewput
- Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Bancha Satirapoj
- Department of Medicine, Phramongkutklao College of Medicine, Bangkok, Thailand
| |
Collapse
|
48
|
Seekles ML, Ormandy P, Coyne E. Mapping the UK renal psychosocial workforce: the first comprehensive workforce survey. BMC Nephrol 2019; 20:100. [PMID: 30898110 PMCID: PMC6427898 DOI: 10.1186/s12882-019-1287-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 03/10/2019] [Indexed: 01/08/2023] Open
Abstract
Background Emerging evidence of psychosocial problems in CKD patients has led to an acceptance that a focus on the emotional wellbeing of the patient should be included in the provision of comprehensive CKD care. It is unclear if an increased attention for psychosocial needs in guidelines and policy documents has led to a rise in psychosocial staffing levels or change in composition of staff since the last workforce mapping in 2002. This paper offers a critical analysis and in-depth discussion of findings and their implications, in addition to providing an international perspective and exposing gaps in current knowledge. Methods Data on psychosocial staffing levels was taken from a survey based on the Scottish Renal Association’s (SRA) staffing survey that was sent to all units in England, Wales and Northern-Ireland in 2016. In addition, data from a psychosocial staffing survey designed by and distributed via psychosocial professional groups was used. This data was then completed with Freedom of Information (FOI) requests and collated to describe the current renal psychosocial workforce in all 84 UK renal units. This was compared to results from the last renal workforce mapping in 2002. Results The results from this mapping show great variability in models of service provision, significant exceeding of benchmarks for staffing levels, and a change in staffing patterns over the past 15 years. Adult psychology services have increased in number, but provision remains low due to increased patient numbers, whereas adult social work and paediatric services have decreased. Conclusion A lack in the provision of renal psychosocial services has been identified, together with the absence of a general service provision model. These findings provide a valuable benchmark for units, a context from which to review and monitor provision alongside patient need. Along with recommendations, this paper forms a foundation for future research and workforce planning. Research into best practice models of service provision and the psychosocial needs of CKD patients lies at the heart of the answers to many identified questions. Electronic supplementary material The online version of this article (10.1186/s12882-019-1287-0) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Maaike L Seekles
- School of Health and Society, University of Salford, Room L530, Allerton Building, Salford, M6 6PU, UK.
| | - Paula Ormandy
- School of Health and Society, University of Salford, Room 2.78, Mary Seacole Building, Salford, M6 6PU, UK
| | - Emma Coyne
- Renal Unit, City Hospital Campus, Nottingham University Hospitals NHS Trust Hucknall, Road Nottingham, Nottingham, NG5 1PB, UK
| |
Collapse
|
49
|
Joret MO, Osman K, Dean A, Cao C, van der Werf B, Bhamidipaty V. Multidisciplinary clinics reduce treatment costs and improve patient outcomes in diabetic foot disease. J Vasc Surg 2019; 70:806-814. [PMID: 30850290 DOI: 10.1016/j.jvs.2018.11.032] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 11/04/2018] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Diabetic foot disease poses a significant and rising financial burden on health care systems worldwide. This study investigated the effect of a new multidisciplinary diabetic foot clinic (MDDFC) in a large tertiary hospital on patient outcomes and treatment cost. METHODS Patients' records were retrospectively reviewed to identify all patients who had been managed in a new MDDFC between July 2014 and July 2017. The wound episode-the period from initial presentation to the achievement of a final wound outcome-was identified, and all relevant inpatient and outpatient costs were extracted using a fully absorbed activity-based costing methodology. Risk factor, treatment, outcome, and costing data for this cohort were compared with a group of patients with diabetic foot wounds who had been managed in the same hospital before the advent of the MDDFC using a generalized linear mixed model. RESULTS The MDDFC and pre-MDDFC cohorts included 73 patients with 80 wound episodes and 225 patients with 265 wound episodes, respectively. Compared with the pre-MDDFC cohort, the MDDFC group had fewer inpatient admissions (1.56 vs 2.64; P ≤ .001). MDDFC patients had a lower major amputation rate (3.8% vs 27.5%; P ≤ .001), a lower mortality rate (7.5% vs 19.2%; P ≤ .05), and a higher rate of minor amputation (53.8% vs 31.7%; P ≤ .01). No statistically significant difference was noted in the rate of excisional débridement, skin graft, and open or endovascular revascularization. In the MDDFC cohort, the median total cost, inpatient cost, and outpatient cost per wound episode was New Zealand dollars (NZD) 22,407.465 (U.S. dollars [USD] 17,253.74), NZD 21,638.93 (USD 16,661.97), and NZD 691.915 (USD 532.77), respectively. The MDDFC to pre-MDDFC wound episode total cost ratio was 0.7586 (P < .001). CONCLUSIONS This study is the first to compare the cost and treatment outcomes of diabetic foot patients treated in a large tertiary hospital before and after the introduction of an MDDFC. The results show that an MDDFC improves patient outcomes and reduces the cost of treatment. MDDFCs should be adopted as the standard of care for diabetic foot patients.
Collapse
Affiliation(s)
- Maximilian O Joret
- Department of Vascular Surgery, Auckland Hospital, ADHB, Auckland, New Zealand
| | - Kareem Osman
- Department of Vascular Surgery, Auckland Hospital, ADHB, Auckland, New Zealand
| | - Anastasia Dean
- Department of Vascular Surgery, Auckland Hospital, ADHB, Auckland, New Zealand
| | - Colin Cao
- Department of Business Intelligence, ADHB, Auckland, New Zealand
| | - Bert van der Werf
- Department of Epidemiology and Biostatistics, School of Population Health, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Venu Bhamidipaty
- Department of Vascular Surgery, Auckland Hospital, ADHB, Auckland, New Zealand.
| |
Collapse
|
50
|
Yang H, Juang SY, Liao KF. Proton pump inhibitors use and risk of chronic kidney disease in diabetic patients. Diabetes Res Clin Pract 2019; 147:67-75. [PMID: 30500543 DOI: 10.1016/j.diabres.2018.11.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 11/14/2018] [Accepted: 11/23/2018] [Indexed: 01/15/2023]
Abstract
AIMS Chronic kidney disease consumes a huge amount of medical resources and proton pump inhibitors may be a potential factor for the increasing prevalence. This population-based cohort study investigates the risk of chronic kidney disease in a diabetic population using proton pump inhibitors in Taiwan. METHODS This study is based on a specific diabetic database obtained from the National Health Insurance Research Database. Individuals with a new diagnosis of diabetes from 2002 to 2013 were enrolled. "Exposure" to proton pump inhibitors was defined as at least one prescription and dosage over 180 DDD (defined daily dose) in one year after the index date. A multivariable Cox proportional hazard model and competing-risk regression model were applied. RESULTS There were 5994 patients in the final cohort of proton pump inhibitor users and 23,976 patients in the matched controlled cohort based on 1:4 propensity score matching. Compared with no exposure users, PPIs exposure group had more anemia prevalence, anti-hypertension medication and NSAIDs prescriptions. The multivariable Cox proportional hazard model showed that the adjusted hazard ratio of chronic kidney disease was 1.52 (95% CI 1.40-1.65) in diabetic individuals with PPIs exposure, compared with no exposure users. CONCLUSIONS Proton pump inhibitors use is associated with 1.52-fold increased risk of chronic kidney disease in diabetic patients when the dosage is over 180 DDD in one year in Taiwan.
Collapse
Affiliation(s)
- Hsun Yang
- Division of Nephrology, Department of Internal Medicine, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan
| | - Shiun-Yang Juang
- Department of Medical Research, Taichung Tzu Chi General Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan
| | - Kuan-Fu Liao
- Division of Gastroenterology, Department of Internal Medicine, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan; College of Medicine, Tzu Chi University, Hualien, Taiwan; Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan.
| |
Collapse
|