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Plebani M. Adherence to recommendations and clinical practice guidelines: not an easy task. Clin Chem Lab Med 2023; 61:2065-2066. [PMID: 37665170 DOI: 10.1515/cclm-2023-0920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Affiliation(s)
- Mario Plebani
- University of Padova, Padova, Italy
- Department of Pathology, University of Texas, TX, Galveston, USA
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Williamson T, Gomez-Espinosa E, Stewart F, Dean BB, Singh R, Cui J, Kong SX. Poor adherence to clinical practice guidelines: A call to action for increased albuminuria testing in patients with type 2 diabetes. J Diabetes Complications 2023; 37:108548. [PMID: 37348179 DOI: 10.1016/j.jdiacomp.2023.108548] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 05/30/2023] [Accepted: 06/14/2023] [Indexed: 06/24/2023]
Abstract
We describe the substantial shortfall in adherence to guideline-recommended albumin-to-creatinine ratio (uACR) testing for people in the United States with type 2 diabetes. Poor compliance with current guidelines leads to delays in diagnosis-and treatment- of chronic kidney disease, which adversely affects clinical outcomes and contributes to incremental economic burden.
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Affiliation(s)
| | - Evelyn Gomez-Espinosa
- AmerisourceBergen, Biopharma Services, Carrollton, TX 75056, United States of America
| | - Fiona Stewart
- AmerisourceBergen, Biopharma Services, Carrollton, TX 75056, United States of America
| | - Bonnie B Dean
- AmerisourceBergen, Biopharma Services, Carrollton, TX 75056, United States of America.
| | - Rakesh Singh
- Bayer US LLC, Whippany, NJ 07981, United States of America
| | - Jingsong Cui
- Bayer US LLC, Whippany, NJ 07981, United States of America
| | - Sheldon X Kong
- Bayer US LLC, Whippany, NJ 07981, United States of America
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Yu D, Wang Z, Cai Y, Osuagwu UL, Pickering K, Baker J, Cutfield R, Orr-Walker BJ, Sundborn G, Jayanatha K, Zhao Z, Simmons D. Ethnic differences in 25-year risk of incident chronic kidney disease among people with type 2 diabetes in New Zealand. BMJ Open Diabetes Res Care 2022; 10:10/6/e003077. [PMID: 36521879 PMCID: PMC9756147 DOI: 10.1136/bmjdrc-2022-003077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 10/14/2022] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Insights into ethnic differences in the natural history of chronic kidney disease (CKD) among people with type 2 diabetes mellitus (T2DM) might inform clinical strategies to address disparities in hospitalization and mortality. Risks of CKD II-V stages over a 25-year period between New Zealand Europeans (NZEs), Māori and Pasifika, and with T2DM in Auckland, New Zealand (NZ) were compared. RESEARCH DESIGN AND METHODS As a primary care audit program in Auckland, the Diabetes Care Support Service was linked with national registration databases. People with existing CKD II-V were ruled out. To balance potential confounders, we applied a tapered matching method . 'Quasi-trial'-matched cohorts were set up separately between Māori and NZE and between Pasifika and NZE. Ethnic population differences in risk of any and each stage of CKD over 1994-2018 were examined by weighted Cox regression model. RESULTS The HRs for developing any CKD, CKD stages II-V for Māori (n=2215) versus NZE (n=2028) were 1.18 (95% CI 0.99 to 1.41), 1.10 (95% CI 0.91 to 1.32), 1.70 (95% CI 1.19 to 2.43), 3.93 (95% CI 2.16 to 7.14), and 3.74 (95% CI 1.74 to 8.05), respectively. Compared with NZE (n=2474), the HRs for developing any CKD, CKD stages II-V for Pasifika (n=3101) were 1.31 (95% CI 1.09 to 1.57), 1.26 (95% CI 1.05 to 1.52), 1.71 (95% CI 1.14 to 2.57), 3.75 (95% CI 1.40 to 10.05), and 4.96 (95% CI 1.56 to 15.75), respectively. CONCLUSIONS Among people with T2DM in NZ, significant ethnic differences exist in the risk of progressing to each stage of CKD (stage V in particular). Mechanism studies underlying these differences, as well as the need for identification of biomarkers to predict the early onset renal lesion, are warranted.
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Affiliation(s)
- Dahai Yu
- Department of Nephrology, the First Affiliated Hospital, Zhengzhou University, Zhengzhou, People's Republic of China
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
| | - Zheng Wang
- Department of Nephrology, the First Affiliated Hospital, Zhengzhou University, Zhengzhou, People's Republic of China
| | - Yamei Cai
- Department of Nephrology, the First Affiliated Hospital, Zhengzhou University, Zhengzhou, People's Republic of China
| | | | | | - John Baker
- Diabetes Foundation Aotearoa, Otara, New Zealand
- Department of Diabetes and Endocrinology, Counties Manukau Health, Auckland, New Zealand
| | - Richard Cutfield
- Diabetes Foundation Aotearoa, Otara, New Zealand
- Department of Diabetes and Endocrinology, Waitemata District Health Board, Auckland, New Zealand
| | - Brandon J Orr-Walker
- Diabetes Foundation Aotearoa, Otara, New Zealand
- Department of Diabetes and Endocrinology, Counties Manukau Health, Auckland, New Zealand
| | - Gerhard Sundborn
- Section of Pacific Health, the University of Auckland, Auckland, New Zealand
| | - Kalpa Jayanatha
- Department of Renal Medicine, Counties Manukau Health, Auckland, New Zealand
- Faculty of Medical and Health Sciences, the University of Auckland, Auckland, New Zealand
| | - Zhanzheng Zhao
- Department of Nephrology, the First Affiliated Hospital, Zhengzhou University, Zhengzhou, People's Republic of China
| | - David Simmons
- Department of Nephrology, the First Affiliated Hospital, Zhengzhou University, Zhengzhou, People's Republic of China
- School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
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Tafuna'i M, Turner R, Matalavea B, Voss D, Hazelman L, Richards R, Walker R. Results of a community-based screening programme for chronic kidney disease and associated risk factors, (obesity, diabetes and hypertension) in a Samoan cohort. BMJ Open 2022; 12:e056889. [PMID: 35396298 PMCID: PMC8996012 DOI: 10.1136/bmjopen-2021-056889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES In 2019, under the World Kidney Day theme of 'Kidney health for everyone everywhere', the National Kidney Foundation of Samoa undertook an extensive community screening campaign to detect the estimated prevalence of chronic kidney disease (CKD) and its associated risk factors in the community. SETTING Fifteen screening sites, with 11 urban and rural sites on the main island of Upolu, and 4 in different rural areas on the island of Savaii. PARTICIPANTS All participants were self-referrals to the various screening sites. In total, 1163 Samoans were screened, with similar numbers from both urban and rural areas and similar numbers of female and male. SCREENING ACTIVITIES All participants were screened for CKD using point of care serum creatinine determinations, with calculation of estimated glomerular filtration rate using the CKD-EPI formula and dipstix urinalysis. A standardised screening survey was used to capture demographic and medical history with associated risk factors of obesity, diabetes, using point of care determination of HbA1c and hypertension. Logistic regression was used to investigate the association of CKD with risk factors. RESULTS In total, 1163 people were screened for CKD within the month of March 2019. The prevalance of CKD (grades 1-5) was 44.5% (95% CI 41.6% to 47.4) with individual grade prevalence CKD 1: 3.7%, CKD 2: 6.1%, CKD 3: 30.7%, CKD 4: 2.9% and CKD 5: 1.0%. The prevalence of obesity (body mass index ≥32), diabetes and hypertension was 66.3%, 30.8% and 54.3%, respectively. CONCLUSIONS This is the first paper to report the estimated prevalence of CKD in Samoa or any other Pacific Island nation. It reveals an urgent need for further studies on the epidemiology of CKD in Samoa, to develop country-specific prevention strategies to mitigate this growing burden and prevent subsequent CKD associated complications including development of kidney failure and premature death.
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Affiliation(s)
- Malama Tafuna'i
- National Kidney Foundation of Samoa, Apia, Samoa
- Centre for Pacific Health, University of Otago Division of Health Sciences, Dunedin, New Zealand
| | - Robin Turner
- Centre for Biostatistics, University of Otago Division of Health Sciences, Dunedin, New Zealand
| | | | | | | | - Rosalina Richards
- Centre for Pacific Health, University of Otago Division of Health Sciences, Dunedin, New Zealand
| | - Robert Walker
- Medicine, University of Otago Medical School, Dunedin, New Zealand
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Abstract
Chronic kidney disease (CKD) disproportionately affects Māori (the indigenous people of New Zealand [NZ]) as well as Pacific people, particularly from Samoa, Tonga, and Fiji. As New Zealand is home to the largest population of Pacific people, New Zealand and the Pacific Islands fulfil the definition of a CKD 'hotspot'. Although diabetic nephropathy is the major cause of CKD, with disproportionately higher rates in NZ Māori and Pacific people, there is increasing evidence that there is a familial predisposition to CKD that is not due to diabetes. Further studies are required to understand the reasons for this pre-disposition.
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Affiliation(s)
- Robert J Walker
- Department of Medicine, University of Otago, Dunedin, New Zealand.
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McNoe B, Schollum JBW, Derrett S, Marshall MR, Henderson A, Samaranayaka A, Walker RJ. Recruitment and participant baseline characteristics in the dialysis outcomes in those aged 65 years or older study. BMC Nephrol 2019; 20:137. [PMID: 31014261 PMCID: PMC6480818 DOI: 10.1186/s12882-019-1328-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Accepted: 04/03/2019] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Despite an increasing number of older people commencing dialysis the impact of dialysis on their quality of life and survival, remains unclear. The Dialysis Outcomes in those aged over 65 years or older study is an accelerated prospective cohort longitudinal design study, designed to obtain sufficient health related quality of life data, linked to clinical data, to inform clinicians' and patients' decision-making with respect to end stage kidney disease (ESKD), outcomes, and options for management in New Zealand (NZ). METHODS The study has an accelerated prospective cohort longitudinal design, comprised of cross-sectional and longitudinal components. We report the baseline data on the 225 participants enrolled in the study. Dialysis duration was grouped in tertiles from less than one year (incident patients), 1-3 years and greater than 3 years. Health related quality of life data was obtained from self-reported questionnaires including KDQoL-36, EQ-5D-3 L, FACIT, WHODAS II, and the Personal Well-being Score. RESULTS The median age of the cohort was 71 years and two thirds were male. Three quarters of the participants were on dialysis at the baseline, with 42% of those on home dialysis (haemodialysis or peritoneal dialysis). Māori and Pacific people were over represented (20% Māori and 24% Pacific) in the sample, when compared to the general NZ population of the same age group (where 5% are Māori and 2% are Pacific). At baseline, there were no differences observed in sociodemographic, quality of life or health characteristics between the dialysis groups either by modality or duration of dialysis. CONCLUSIONS We report the baseline characteristics of participants enrolled prospectively into a longitudinal cohort observational study examining health related quality of life factors with clinical characteristics on dialysis outcomes in a group of New Zealanders aged 65 years or older who are either on dialysis or have been educated about dialysis (BMC Nephrol 14:175, 2013). Subsequent publications are planned, analysing the prospective longitudinal data to identify key factors that determine both outcome and quality of life for individuals of this age group. TRIAL REGISTRATION ACTRN12611000024943 .
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Affiliation(s)
- Bronwen McNoe
- Department of Preventive and Social Medicine, University of Otago, PO Box 56, Dunedin, 9054, New Zealand
| | | | - Sarah Derrett
- Department of Preventive and Social Medicine, University of Otago, PO Box 56, Dunedin, 9054, New Zealand
| | - Mark R Marshall
- Department of Renal Medicine, Middlemore Hospital, Counties Manukau District Health Board, Manukau, New Zealand
| | - Andrew Henderson
- Renal Medicine, Hamilton Hospital, Waikato District Health Board, Hamilton, New Zealand
| | | | - Robert J Walker
- Department of Medicine, University of Otago, Dunedin, New Zealand.
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