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McPeake J, Iwashyna TJ, MacTavish P, Devine H, Henderson P, Quasim T, Shaw M. Could an integrated model of health and social care after critical illness reduce socioeconomic disparities in outcomes? A Bayesian analysis. BJA OPEN 2024; 9:100259. [PMID: 38322488 PMCID: PMC10844938 DOI: 10.1016/j.bjao.2024.100259] [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: 08/25/2023] [Accepted: 01/09/2024] [Indexed: 02/08/2024]
Abstract
Background There is limited evidence to understand what impact, if any, recovery services might have for patients across the socioeconomic spectrum after critical illness. We analysed data from a multicentre critical care recovery programme to understand the impact of this programme across the socioeconomic spectrum. Methods The setting for this pre-planned secondary analysis was a critical care rehabilitation programme-Intensive Care Syndrome: Promoting Independence and Return to Employment. Data were collected from five hospital sites running this programme. We utilised a Bayesian approach to analysis and explore any possible effect of the InS:PIRE intervention on Health-Related Quality of Life (HRQoL) across the socioeconomic gradient. A Bayesian quantile, non-linear mixed effects regression model, using a compound symmetry covariance structure, accounting for multiple timepoints was utilised. The Scottish Index of Multiple Deprivation (SIMD) was used to measure socioeconomic status and HRQoL was measured using the EQ-5D-5L. Results In the initial baseline cohort of 182 patients, 55% of patients were male, the median age was 58 yr (inter-quartile range: 50-66 yr) and 129 (79%) patients had two or more comorbidities at ICU admission. Using the neutral prior, there was an overall probability of intervention benefit of 100% (β=0.71, 95% credible interval: 0.34-1.09) over 12 months to those in the SIMD≤3 cohort, and an 98.6% (β=-1.38, 95% credible interval: -2.62 to -0.16) probability of greater benefit (i.e. a steeper increase in improvement) at 12 months in the SIMD≤3 vs SIMD≥4 cohort in the EQ-visual analogue scale. Conclusions Using multicentre data, this re-analysis suggests, but does not prove, that an integrated health and social care intervention is likely to improve outcomes across the socioeconomic gradient after critical illness, with a potentially greater benefit for those from deprived communities. Future research designed to prospectively analyse how critical care recovery programmes could potentially improve outcomes across the socioeconomic gradient is warranted.
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Affiliation(s)
- Joanne McPeake
- The Healthcare Improvement Studies Institute, University of Cambridge, Cambridge, UK
| | | | - Pamela MacTavish
- Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Helen Devine
- Crosshouse University Teaching Hospital, NHS Ayrshire and Arran, Kilmarnock, UK
| | - Phil Henderson
- Royal Alexandria Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Tara Quasim
- Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, Glasgow, UK
- University of Glasgow, School of Medicine, Dentistry and Nursing, Glasgow, UK
| | - Martin Shaw
- University of Glasgow, School of Medicine, Dentistry and Nursing, Glasgow, UK
- Clinical Physics, NHS Greater Glasgow and Clyde, Glasgow, UK
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Regev-Epstein LC, Frishberg Y, Davidovits M, Landau D, Magen D, Weismann I, Stern-Zimmer M, Beckerman P, Keinan-Boker L, Calderon-Margalit R, Vivante A. Dialysis in Israeli Children between 1990 and 2020: Trends and International Comparisons. Clin J Am Soc Nephrol 2023; 18:363-373. [PMID: 36722361 PMCID: PMC10103217 DOI: 10.2215/cjn.0000000000000063] [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: 08/26/2022] [Accepted: 12/22/2022] [Indexed: 01/22/2023]
Abstract
BACKGROUND Childhood kidney failure is a rare condition with worldwide clinical variability. We used a nationwide multicenter analysis to study the pretransplant course of the entire Israeli pediatric kidney failure population over 30 years. METHODS In this nationwide, population-based, historical cohort study, we analyzed medical and demographic data of all children treated with KRT and reported to the Israeli kidney failure registry in 1990-2020. Statistical analysis was performed with incidence rate corrected for age, ethnicity, and calendar year, using the appropriate age-related general population as denominator. RESULTS During the last 30 years, childhood incidence of kidney failure decreased. Average incidence in 2015-2019 was 9.1 cases per million age-related population (pmarp). Arab and Druze children exhibited higher kidney failure incidence rates than Jewish children (18.4 versus 7.0 cases pmarp for minorities versus Jews). The most common kidney failure etiologies among Arab and Jewish children were congenital anomalies of the kidney and urinary tract (approximately 27%), followed by cystic kidney diseases among Arab children (13%) and glomerulonephritis among Jewish children (16%). The most common etiology among Druze children was primary hyperoxaluria type 1 (33%). Israel's national health insurance provides access to primary health care to all citizens. Accordingly, waiting time for deceased-donor transplantation was equal between all ethnicities. Living-donor kidney transplantation rates among minority populations remained low in comparison with Jews over the entire study period. Although all patient groups demonstrated improvement in survival, overall survival rates were mainly etiology dependent. CONCLUSIONS In Israel, Arab and Druze children had a higher incidence of kidney failure, a unique etiological distribution, and a lower rate of living-donor kidney transplantations compared with Jewish children.
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Affiliation(s)
- Lilach C. Regev-Epstein
- Department of Pediatrics B, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
- Department of Pediatric Nephrology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Yaacov Frishberg
- Division of Pediatric Nephrology, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Miriam Davidovits
- Institute of Nephrology, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Daniel Landau
- Institute of Nephrology, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Daniella Magen
- Pediatric Nephrology Institute, Ruth Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Irit Weismann
- Pediatric Nephrology Unit, Galilee Medical Center, Nahariya, Israel
| | - Michal Stern-Zimmer
- Department of Pediatrics B, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Pazit Beckerman
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Institute of Nephrology and Hypertension, Sheba Medical Center, Tel Hashomer, Israel
| | - Lital Keinan-Boker
- Israel Center for Disease Control, Ramat Gan, Israel
- School of Public Health, University of Haifa, Haifa, Israel
| | | | - Asaf Vivante
- Department of Pediatrics B, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Oomen L, Bootsma-Robroeks C, Cornelissen E, de Wall L, Feitz W. Pearls and Pitfalls in Pediatric Kidney Transplantation After 5 Decades. Front Pediatr 2022; 10:856630. [PMID: 35463874 PMCID: PMC9024248 DOI: 10.3389/fped.2022.856630] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 02/15/2022] [Indexed: 11/13/2022] Open
Abstract
Worldwide, over 1,300 pediatric kidney transplantations are performed every year. Since the first transplantation in 1959, healthcare has evolved dramatically. Pre-emptive transplantations with grafts from living donors have become more common. Despite a subsequent improvement in graft survival, there are still challenges to face. This study attempts to summarize how our understanding of pediatric kidney transplantation has developed and improved since its beginnings, whilst also highlighting those areas where future research should concentrate in order to help resolve as yet unanswered questions. Existing literature was compared to our own data of 411 single-center pediatric kidney transplantations between 1968 and 2020, in order to find discrepancies and allow identification of future challenges. Important issues for future care are innovations in immunosuppressive medication, improving medication adherence, careful donor selection with regard to characteristics of both donor and recipient, improvement of surgical techniques and increased attention for lower urinary tract dysfunction and voiding behavior in all patients.
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Affiliation(s)
- Loes Oomen
- Division of Pediatric Urology, Department of Urology, Radboudumc Amalia Children's Hospital, Nijmegen, Netherlands
| | - Charlotte Bootsma-Robroeks
- Department of Pediatric Nephrology, Radboudumc Amalia Children's Hospital, Nijmegen, Netherlands
- Department of Pediatrics, Pediatric Nephrology, Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Elisabeth Cornelissen
- Department of Pediatric Nephrology, Radboudumc Amalia Children's Hospital, Nijmegen, Netherlands
| | - Liesbeth de Wall
- Division of Pediatric Urology, Department of Urology, Radboudumc Amalia Children's Hospital, Nijmegen, Netherlands
| | - Wout Feitz
- Division of Pediatric Urology, Department of Urology, Radboudumc Amalia Children's Hospital, Nijmegen, Netherlands
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Redeker S, Massey EK, Boonstra C, van Busschbach JJ, Timman R, Brulez HFH, Hollander DAAMJ, Hilbrands LB, Bemelman F, Berger SP, van de Wetering J, van den Dorpel RMA, Dekker-Jansen M, Weimar W, Ismail SY. Implementation of the Kidney Team at Home Intervention: Evaluating Generalizability, Implementation Process, and Effects. Transpl Int 2021; 34:2317-2328. [PMID: 34390041 PMCID: PMC9292401 DOI: 10.1111/tri.14011] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 07/02/2021] [Accepted: 08/11/2021] [Indexed: 11/26/2022]
Abstract
Research has shown that a home-based educational intervention for patients with chronic kidney disease results in better knowledge and communication, and more living donor kidney transplantations (LDKT). Implementation research in the field of renal care is almost non-existent. The aims of this study were (1) to demonstrate generalizability, (2) evaluate the implementation process, and (3) to assess the relationship of intervention effects on LDKT-activity. Eight hospitals participated in the project. Patients eligible for all kidney replacement therapies (KRT) were invited to participate. Effect outcomes were KRT-knowledge and KRT-communication, and treatment choice. Feasibility, fidelity and intervention costs were assessed as part of the process evaluation. 332 patients completed the intervention. There was a significant increase in KRT-knowledge and KRT-communication among participants. 129 out of 332 patients (39%) had LDKT-activity, which was in line with the results of the clinical trials. Protocol adherence, knowledge and age were correlated with LDKT-activity. This unique implementation study shows that the results in practice are comparable to the previous trials, and show that the intervention can be implemented, while maintaining quality. Results from the project resulted in the uptake of the intervention in standard care. We urge other countries to investigate the uptake of the intervention.
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Affiliation(s)
- Steef Redeker
- Erasmus Medical Center, Section of Medical Psychology and Psychotherapy, Department of Psychiatry, Rotterdam, the Netherlands
| | - Emma K Massey
- Erasmus Medical Center, Section of Nephrology and Transplantation, Department of Internal Medicine, the Netherlands
| | - Charlotte Boonstra
- Netherlands Institute for Personality Disorders, De Viersprong, Rotterdam, the Netherlands
| | - Jan J van Busschbach
- Erasmus Medical Center, Section of Medical Psychology and Psychotherapy, Department of Psychiatry, Rotterdam, the Netherlands
| | - Reinier Timman
- Erasmus Medical Center, Section of Medical Psychology and Psychotherapy, Department of Psychiatry, Rotterdam, the Netherlands
| | | | | | - Luuk B Hilbrands
- Radboud university medical center, Radboud Institute for Health Sciences, Department of Nephrology, Nijmegen, the Netherlands
| | - Frederike Bemelman
- Amsterdam UMC, Department of Nephrology, Division of Internal Medicine, Amsterdam, the Netherlands
| | - Stefan P Berger
- University of Groningen, University Medical Center Groningen, Department of Internal Medicine, the Netherlands
| | - Jacqueline van de Wetering
- Erasmus Medical Center, Section of Nephrology and Transplantation, Department of Internal Medicine, the Netherlands
| | | | | | - Willem Weimar
- Erasmus Medical Center, Section of Nephrology and Transplantation, Department of Internal Medicine, the Netherlands
| | - Sohal Y Ismail
- Erasmus Medical Center, Section of Medical Psychology and Psychotherapy, Department of Psychiatry, Rotterdam, the Netherlands
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Comorbidity in chronic kidney disease: a large cross-sectional study of prevalence in Scottish primary care. Br J Gen Pract 2021; 71:e243-e249. [PMID: 33558333 PMCID: PMC7888754 DOI: 10.3399/bjgp20x714125] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 09/16/2020] [Indexed: 01/05/2023] Open
Abstract
Background Chronic kidney disease (CKD) is commonly comorbid with hypertension, diabetes, and cardiovascular disease (CVD). However, the extent of comorbidity in CKD across a range of concordant (shared pathophysiology and/or treatment) conditions and discordant (unrelated pathophysiology and/or different or contradictory treatment) conditions is not well documented. Aim To ascertain the prevalence of comorbidity, across 39 physical and mental health comorbidities, in adults with CKD in a large, nationally representative primary care population. Design and setting Cross-sectional analysis of a primary care dataset representing 1 274 374 adults in Scotland. Method This study was a secondary analysis of general practice electronic medical record data using binary logistic regression models adjusted for age, sex, and socioeconomic status. Data of adults aged ≥25 years and 40 long-term conditions were used. Results A total of 98.2% of adults with CKD had at least one comorbidity, versus 51.8% in controls. After adjustment for age, sex, and deprivation, people with CKD were more likely to have 1 (adjusted odds ratio [aOR] 6.5, 95% confidence interval [CI] = 6.0 to 7.1), 2–3 (aOR 15.2, 95% CI = 14.0 to 16.5), 4–6 (odds ratio [OR] 26.6, 95% CI = 24.4 to 28.9), and ≥7 other conditions (OR 41.9, 95% CI = 38.3 to 45.8). Furthermore, all concordant (seven out of seven), the majority of discordant physical health conditions (17 out of 24), and mental health conditions (six out of eight) had statistically significant positive associations with CKD after adjustment. Conclusion Chronic kidney disease is associated with extreme comorbidity across a wide range of mental and physical conditions. Routine care for people with CKD should include recognition and management of comorbidities, and clinical guidelines should support clinicians to do this.
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Abstract
PURPOSE OF REVIEW Although the first successful kidney transplantation 65 years ago was performed with a living donor kidney, the number of living donor kidney transplantations has increased especially during the last 2 decades. The enlargement of living donor programs was made possible by new modes of living donation and by expansion of the living donor pool. At the same time, the long-term risks of kidney donation have been better delineated. In this review, the latest developments on these topics are summarized. RECENT FINDINGS While the results of ABO-incompatible living kidney transplantation are superior to those of deceased donor transplantation, recent meta-analyses show a reduced patient and graft survival as compared with ABO compatible transplantation as well as increased risk of severe infection and bleeding. Kidney paired donation programs can be extended by including compatible couples and by advanced donation, although the latter raises ethical concerns. Living donors appear to have a higher risk of end-stage renal disease and this is especially true for obese donors and probably also for black donors with an APOL1 high-risk genotype. The importance of psychosocial outcomes after living kidney donation is increasingly recognized. SUMMARY Living donor kidney transplantation remains the optimal treatment option for patients with end-stage renal disease. To increase the donor pool, a well developed paired kidney donation program and sufficient reimbursement of costs associated with donation are essential ingredients. Other ways of expanding the donor pool, such as ABO-incompatible transplantation, use of higher risk donors, providing donors with financial incentives and advanced donation are associated with medical, ethical and logistical complications. There should be a careful selection and follow-up of living kidney donors with attention for medical consequences as well as for psychosocial outcomes.
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