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Hoffman DM. My Health Record (and E-scripts): essential new resource for physicians-a personal perspective. Intern Med J 2023; 53:439-442. [PMID: 36972990 DOI: 10.1111/imj.16012] [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: 06/19/2022] [Accepted: 10/08/2022] [Indexed: 03/29/2023]
Abstract
From a personal perspective of an endocrinologist in private practice: Integration of the My Health Record into everyday clinical practice is time- and cost-saving, allows for more accurate record keeping and most importantly improves overall patient care. The main deficiency at present is incomplete uptake by medical specialists in private and public practice, as well as pathology and imaging service providers. We will all reap the benefits as these entities become engaged and contribute towards making this electronic medical record truly universal.
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Affiliation(s)
- David M Hoffman
- Private endocrinologist, Fairfield, Sydney, New South Wales, Australia
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Retarding Chronic Kidney Disease (CKD) Progression: A Practical Nutritional Approach for Non-Dialysis CKD. ACTA ACUST UNITED AC 2016. [DOI: 10.5301/pocj.5000207] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
This is a case report on a patient with non-dialysis chronic kidney disease (CKD) in whom several nutritional issues are briefly discussed from a practical point of view. The article is accompanied by an editorial published in this Journal in relation to the 2nd International Conference of the European Renal Nutrition working group at ERA-EDTA—“Retarding CKD progression: readily available through comprehensive nutritional management?”— and focuses on several practical topics associated with the nutritional approach for the conservative treatment of non-dialysis CKD. The article is divided into 3 sections—basic nutritional assessment, nutritional targets, and nutritional follow-up in non-dialysis CKD—linked to 3 consecutive steps of the clinical follow-up of the patient and the related nutritional concerns and intervention. First visit: Baseline nutritional assessment and basic nutritional considerations in non-dialysis chronic kidney disease (CKD) • What nutritional assessment/monitoring for protein-energy wasting (PEW) should be employed? • Is a body mass index (BMI) of 21 kg/m2 adequate? • What phosphate target should be pursued? • What are the nutritional habits in patients with incident CKD? • What protein needs and amount of dietary protein should be pursued? • Does the quality of protein matter? • What amount of dietary salt should be employed? How should this be obtained? • How should normal serum phosphate be achieved? • What diet should be recommended? Is a vegetarian diet an option? Second visit: Major nutritional targets in non-dialysis CKD • Consequences of unintentional weight loss • What is the role of the renal dietitian in helping the patient adhere to a renal diet? Intermediate visits: Nutritional follow-up in non-dialysis CKD • What treatment for calcium/parathyroid hormone (PTH) will affect CKD progression? Final visits: • Would a dietary recall/intensive dietary education improve adherence with the diet? • Would a very-low-protein diet (VLPD)/ketodiet be indicated for this patient?
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Barry EL, Mott LA, Melamed ML, Rees JR, Ivanova A, Sandler RS, Ahnen DJ, Bresalier RS, Summers RW, Bostick RM, Baron JA. Calcium supplementation increases blood creatinine concentration in a randomized controlled trial. PLoS One 2014; 9:e108094. [PMID: 25329821 PMCID: PMC4198086 DOI: 10.1371/journal.pone.0108094] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 08/18/2014] [Indexed: 01/13/2023] Open
Abstract
Background Calcium supplements are widely used among older adults for osteoporosis prevention and treatment. However, their effect on creatinine levels and kidney function has not been well studied. Methods We investigated the effect of calcium supplementation on blood creatinine concentration in a randomized controlled trial of colorectal adenoma chemoprevention conducted between 2004–2013 at 11 clinical centers in the United States. Healthy participants (N = 1,675) aged 45–75 with a history of colorectal adenoma were assigned to daily supplementation with calcium (1200 mg, as carbonate), vitamin D3 (1000 IU), both, or placebo for three or five years. Changes in blood creatinine and total calcium concentration were measured after one year of treatment and multiple linear regression was used to estimate effects on creatinine concentrations. Results After one year of treatment, blood creatinine was 0.013±0.006 mg/dL higher on average among participants randomized to calcium compared to placebo after adjustment for other determinants of creatinine (P = 0.03). However, the effect of calcium treatment appeared to be larger among participants who consumed the most alcohol (2–6 drinks/day) or whose estimated glomerular filtration rate (eGFR) was less than 60 ml/min/1.73 m2 at baseline. The effect of calcium treatment on creatinine was only partially mediated by a concomitant increase in blood total calcium concentration and was independent of randomized vitamin D treatment. There did not appear to be further increases in creatinine after the first year of calcium treatment. Conclusions Among healthy adults participating in a randomized clinical trial, daily supplementation with 1200 mg of elemental calcium caused a small increase in blood creatinine. If confirmed, this finding may have implications for clinical and public health recommendations for calcium supplementation. Trial Registration ClinicalTrials.gov NCT00153816
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Affiliation(s)
- Elizabeth L Barry
- Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, United States of America
| | - Leila A Mott
- Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, United States of America
| | - Michal L Melamed
- Departments of Medicine and of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - Judith R Rees
- Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, United States of America
| | - Anastasia Ivanova
- Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Robert S Sandler
- Department of Medicine, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Dennis J Ahnen
- Department of Veterans Affairs Eastern Colorado Health Care System and University of Colorado School of Medicine, Denver, Colorado, United States of America
| | - Robert S Bresalier
- Department of Gastroenterology, Hepatology and Nutrition, University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Robert W Summers
- Department of Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, United States of America
| | - Roberd M Bostick
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - John A Baron
- Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, United States of America; Department of Medicine, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, United States of America; Department of Medicine, University of North Carolina, Chapel Hill, North Carolina, United States of America
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Radhakrishnan J, Remuzzi G, Saran R, Williams DE, Rios-Burrows N, Powe N, Brück K, Wanner C, Stel VS, Venuthurupalli SK, Hoy WE, Healy HG, Salisbury A, Fassett RG, O’Donoghue D, Roderick P, Matsuo S, Hishida A, Imai E, Iimuro S. Taming the chronic kidney disease epidemic: a global view of surveillance efforts. Kidney Int 2014; 86:246-50. [PMID: 24897034 PMCID: PMC4593485 DOI: 10.1038/ki.2014.190] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 04/30/2014] [Indexed: 01/12/2023]
Abstract
Chronic kidney disease is now recognized to be a worldwide problem associated with significant morbidity and mortality and there is a steep increase in the number of patients reaching end-stage renal disease. In many parts of the world, the disease affects younger people without diabetes or hypertension. The costs to family and society can be enormous. Early recognition of CKD may help prevent disease progression and the subsequent decline in health and longevity. Surveillance programs for early CKD detection are beginning to be implemented in a few countries. In this article, we will focus on the challenges and successes of these programs with the hope that their eventual and widespread use will reduce the complications, deaths, disabilities, and economic burdens associated with CKD worldwide.
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Affiliation(s)
- Jai Radhakrishnan
- Division of Nephrology, Department of Medicine, Columbia University Medical Center, New York, New York, USA
| | - Giuseppe Remuzzi
- Azienda Ospedaliera Papa Giovanni XXIII, IRCCS—Istituto di Ricerche Farmacologiche Mario Negri, Bergamo, Italy
| | - Rajiv Saran
- Kidney Epidemiology and Cost Center, University of Michigan, Ann Arbor, Michigan, USA
| | | | | | - Neil Powe
- Department of Medicine, University of California-San Francisco, San Francisco, California, USA
| | - Katharina Brück
- Clinical Informatics, Amsterdam Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Vianda S. Stel
- Clinical Informatics, Amsterdam Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Sree K. Venuthurupalli
- Renal Medicine, Toowoomba Hospital, Toowoomba, Queensland, Australia
- Centre for Chronic Disease, University of Queensland, Brisbane, Queensland, Australia
| | - Wendy E. Hoy
- Centre for Chronic Disease, University of Queensland, Brisbane, Queensland, Australia
| | - Helen G. Healy
- Renal Medicine, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
| | - Anne Salisbury
- Centre for Chronic Disease, University of Queensland, Brisbane, Queensland, Australia
| | - Robert G. Fassett
- Renal Medicine, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
- Schools of Medicine and Human Movement Studies, University of Queensland, Brisbane, Queensland, Australia
| | - Donal O’Donoghue
- Institute of Population Health, University of Manchester, Manchester, UK
| | - Paul Roderick
- Public Health and Medical Statistics Group, University of Southampton, Southampton, UK
| | - Seiichi Matsuo
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Akira Hishida
- Department of Nephrology, Yaizu City Hospital, Shizuoka, Japan
| | - Enyu Imai
- Nakayamadera Imai Clinic, Takarazuka, Japan
| | - Satoshi Iimuro
- Clinical Research Support Center, University of Tokyo Hospital, Tokyo, Japan
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