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Takele B, Koyra HC, Sidamo T, Lerango TL. Tripled likelihood: polypharmacy increases the occurrence of drug therapy problems in hospitalized pediatric patients. Front Pharmacol 2024; 15:1375728. [PMID: 38725664 PMCID: PMC11079121 DOI: 10.3389/fphar.2024.1375728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 04/12/2024] [Indexed: 05/12/2024] Open
Abstract
Background A drug therapy problem (DTP) is any undesirable event experienced by a patient that accompanies drug therapy, prevents the patient from achieving their desired therapeutic goals, and requires expert judgment to resolve. Pediatric populations are at a higher risk of DTP than adults due to their immature organ systems, including the liver and kidneys, which play crucial roles in drug metabolism and excretion. Most previous studies have focused on only one element of DTP. Therefore, by considering all elements of DTP, we aimed to assess the prevalence of DTP and associated factors among pediatric patients admitted to the Wolaita Sodo University Comprehensive Specialized Hospital. Methods An institution-based cross-sectional study was conducted among pediatric patients admitted to Wolaita Sodo University Comprehensive Specialized Hospital from 8 July 2020, to 7 July 2021. A simple random sampling technique was employed to select study participants. Cipolle's and Strand's classification method of drug therapy problems was used to identify and categorize DTP. Data were obtained by reviewing the patient's medical records using a data abstraction checklist, entered into Epi data version 4.6, and exported to SPSS version 25 for analysis. Binary logistic regression analysis was performed to identify independent predictors of DTP. Results Medical records of 369 pediatric patients were reviewed, and the overall prevalence of DTP was 60.2% (95% CI:55.2%, 65.2%) with a total of 281 identified DTPs. Among them, 164 (74.2%) had only one DTP. Need additional drug therapy was the most common (140 [49.8%]) DTP identified. The number of disease conditions (AOR = 2.13, 95% CI:1.16, 3.92), polypharmacy (AOR = 3.01, 95% CI:1.70, 5.32), and duration of hospital stay (AOR = 1.80, 95% CI:1.04, 3.10) were independent predictors of DTP among admitted pediatric patients. Conclusion The prevalence of DTP in pediatric patients in the current setting was high. The number of disease conditions, polypharmacy, and duration of hospital stay were independent predictors of DTP. Enhancements to pharmaceutical care services, optimized dosage practices, improved deprescribing by clinicians, and efficient, comprehensive diagnostic procedures have the potential to significantly reduce specific drug therapy problems in hospitalized pediatrics.
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Affiliation(s)
- Bereket Takele
- School of Pharmacy, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Hailu Chare Koyra
- School of Pharmacy, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Temesgen Sidamo
- School of Pharmacy, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Temesgen Leka Lerango
- School of Public Health, College of Health Sciences and Medicine, Dilla University, Dilla, Ethiopia
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2
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Vanholder R, Coppo R, Bos WJ, Damato E, Fakhouri F, Humphreys A, Nistor I, Ortiz A, Pistollato M, Scheres E, Schaefer F. A Policy Call to Address Rare Kidney Disease in Health Care Plans. Clin J Am Soc Nephrol 2023; 18:1510-1518. [PMID: 37294578 PMCID: PMC10637461 DOI: 10.2215/cjn.0000000000000220] [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: 01/23/2023] [Accepted: 06/04/2023] [Indexed: 06/10/2023]
Abstract
Despite a large number of people globally being affected by rare kidney diseases, research support and health care policy programs usually focus on the management of the broad spectrum of CKD without particular attention to rare causes that would require a targeted approach for proper cure. Hence, specific curative approaches for rare kidney diseases are scarce, and these diseases are not treated optimally, with implications on the patients' health and quality of life, on the cost for the health care system, and society. There is therefore a need for rare kidney diseases and their mechanisms to receive the appropriate scientific, political, and policy attention to develop specific corrective approaches. A wide range of policies are required to address the various challenges that target care for rare kidney diseases, including the need to increase awareness, improve and accelerate diagnosis, support and implement therapeutic advances, and inform the management of the diseases. In this article, we provide specific policy recommendations to address the challenges hindering the provision of targeted care for rare kidney diseases, focusing on awareness and prioritization, diagnosis, management, and therapeutic innovation. In combination, the recommendations provide a holistic approach aiming for all aspects of rare kidney disease care to improve health outcomes, reduce the economic effect, and deliver benefits to society. Greater commitment from all the key stakeholders is now needed, and a central role should be assigned to patients with rare kidney disease to partner in the design and implementation of potential solutions.
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Affiliation(s)
- Raymond Vanholder
- European Kidney Health Alliance (EKHA), Brussels, Belgium
- Nephrology Section, Department of Internal Medicine and Pediatrics, University Hospital Ghent, Ghent, Belgium
| | - Rosanna Coppo
- Fondazione Ricerca Molinette, Regina Margherita Hospital, Turin, Italy
| | - Willem J.W. Bos
- Department of Nephrology, Leiden University Medical Centre, Leiden, The Netherlands
- Department of Internal Medicine, St Antonius Ziekenhuis, Utrecht, The Netherlands
| | - Elaine Damato
- Life Sciences, Charles River Associates, Mexico City, Mexico
| | - Fadi Fakhouri
- Department of Nephrology and Hypertension, Department of Medicine, Centre hospitalier universitaire Vaudois, Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | | | - Ionut Nistor
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa,” Iaşi, Romania
- Nephrology Department, Dr C.I. Parhon Hospital, Iaşi, Romania
- Methodological Centre for Medical Research and Evidence-Based Medicine, University of Medicine and Pharmacy “Grigore T. Popa,” Iaşi, Romania
| | - Alberto Ortiz
- IIS-Fundación Jimenez Diaz; Professor of Medicine, Autonomous University of Madrid, Madrid, Spain
- Clinical Nephrology Governance, European Renal Association, Madrid, Spain
| | | | | | - Franz Schaefer
- Division of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, University of Heidelberg, Heidelberg, Germany
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3
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Danese D, Goss D, Romano C, Gupta C. Qualitative assessment of the patient experience of primary hyperoxaluria type 1: an observational study. BMC Nephrol 2023; 24:319. [PMID: 37884879 PMCID: PMC10604408 DOI: 10.1186/s12882-023-03365-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 10/13/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND Without effective intervention, primary hyperoxaluria type 1 (PH1) causes oxalate-induced kidney damage, leading to end-stage kidney disease and serious complications throughout the body. Although PH1 carries a heavy burden that impacts quality of life, literature on the experiences of those living with PH1 and caring for patients with PH1 is limited. This study aimed to describe the diagnostic journey in PH1 and characterize patients' and caregivers' self-reported experiences throughout the disease course. METHODS This was an observational study involving in-depth, semi-structured telephone interviews. Dominant trends were assessed using constant comparative analysis to identify themes in interviewees' descriptions of their experiences. Individuals aged ≥ 12 years and caregivers of children aged 6-17 years with genetically confirmed PH1 were eligible. Informed consent/assent and ability to read and speak English were required. RESULTS Interviewees (16 patients, 12 caregivers) reported a prolonged diagnostic journey due to low disease awareness, among other factors. Upon diagnosis, PH1 was frequently symptomatic, typically involving kidney stone-related symptoms but also potentially symptoms arising beyond the kidneys. PH1 most commonly led to worry and social impairment in adolescents, impaired physical function in adults, and a range of impacts on caregivers. In late-stage disease, dialysis was the most burdensome aspect of living with PH1 (due to time requirements, limitations from living with a catheter, etc.), and this burden was exacerbated by the COVID-19 pandemic. Benefits desired from PH1 management included reductions in laboratory measures of oxalate burden, kidney stone and urination frequency, and oxalate-related skin ulcers. CONCLUSIONS PH1 greatly impacts patients' and caregivers' lives, primarily due to burdensome disease manifestations and associated emotional, physical, and practical impacts, as well as disease management challenges - particularly those related to dialysis in late-stage disease.
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Affiliation(s)
- David Danese
- Alnylam Pharmaceuticals, 675 West Kendall St, Cambridge, MA, 02142, USA.
| | - Diana Goss
- Research Triangle Institute, Research Triangle Park, NC, USA
| | - Carla Romano
- Research Triangle Institute, Research Triangle Park, NC, USA
| | - Catherine Gupta
- Research Triangle Institute, Research Triangle Park, NC, USA
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4
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Tamiya E, Yamashita H, Takabe T, Matsumoto T, Kajihara J, Yamamoto S, Kanoh T, Koide H, Minamino T. Evaluation of the Effect of Topiroxostat on Renal Function in Patients with Hyperuricemia: STOP-C Study, a Retrospective Observational Cohort Study. Drugs Real World Outcomes 2022; 9:299-306. [PMID: 35094305 PMCID: PMC9114256 DOI: 10.1007/s40801-022-00291-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2021] [Indexed: 12/14/2022] Open
Abstract
Background Serum uric acid-lowering therapy is associated with maintaining renal function. Objective We aimed to retrospectively evaluate renal function and serum uric acid in patients with hyperuricemia who received topiroxostat for over a year. Methods Medical records of patients from 1 January, 2015 to 31 October, 2019 in our hospital were used. From the medical records, data of 100 patients with hyperuricemia treated with topiroxostat were extracted (67:33 male:female). The primary endpoints were changes in serum creatinine level and estimated glomerular filtration rate at 12 months after topiroxostat administration. The secondary endpoints were changes in serum creatinine, serum uric acid, and estimated glomerular filtration rate before and after topiroxostat administration. Results The study mainly involved elderly individuals (77.2 ± 9.5 years). Forty-four patients administered uric acid-lowering drugs were switched to topiroxostat. After 12 months, the serum creatinine level and estimated glomerular filtration rate showed no significant changes from baseline; however, the serum uric acid level significantly decreased. The estimated glomerular filtration rate significantly decreased during the 6 months before topiroxostat administration (p < 0.001), but showed no significant change at 6 months after topiroxostat administration (p = 0.849). Conclusions This study revealed that topiroxostat use not only reduced the serum uric acid level but also maintained renal function in elderly patients with hyperuricemia in daily clinical practice.
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Affiliation(s)
- Eiji Tamiya
- Department of Cardiology, Koto Hospital, 6-8-5, Ojima, Koto-ku, Tokyo, Japan.
| | - Haruyo Yamashita
- Department of Cardiology, Koto Hospital, 6-8-5, Ojima, Koto-ku, Tokyo, Japan
| | - Tomosato Takabe
- Department of Cardiology, Koto Hospital, 6-8-5, Ojima, Koto-ku, Tokyo, Japan
| | - Takahiro Matsumoto
- Department of Cardiology, Koto Hospital, 6-8-5, Ojima, Koto-ku, Tokyo, Japan
| | - Jun Kajihara
- Department of Cardiology, Koto Hospital, 6-8-5, Ojima, Koto-ku, Tokyo, Japan
| | - Shouichi Yamamoto
- Department of Cardiology, Koto Hospital, 6-8-5, Ojima, Koto-ku, Tokyo, Japan
| | - Tatsuji Kanoh
- Department of Cardiology, Koto Hospital, 6-8-5, Ojima, Koto-ku, Tokyo, Japan
| | - Hikaru Koide
- Department of Internal Medicine, Koto Hospital, Tokyo, Japan
| | - Tohru Minamino
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
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5
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Apel C, Hornig C, Maddux FW, Ketchersid T, Yeung J, Guinsburg A. Informed decision-making in delivery of dialysis: combining clinical outcomes with sustainability. Clin Kidney J 2021; 14:i98-i113. [PMID: 34987789 PMCID: PMC8711764 DOI: 10.1093/ckj/sfab193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Indexed: 12/31/2022] Open
Abstract
As the prevalence of chronic kidney disease is expected to rise worldwide over the next decades, provision of renal replacement therapy (RRT), will further challenge budgets of all healthcare systems. Most patients today requiring RRT are treated with haemodialysis (HD) therapy and are elderly. This article demonstrates the interdependence of clinical and sustainability criteria that need to be considered to prepare for the future challenges of delivering dialysis to all patients in need. Newer, more sustainable models of high-value care need to be devised, whereby delivery of dialysis is based on value-based healthcare (VBHC) principles, i.e. improving patient outcomes while restricting costs. Essentially, this entails maximizing patient outcomes per amount of money spent or available. To bring such a meaningful change, revised strategies having the involvement of multiple stakeholders (i.e. patients, providers, payers and policymakers) need to be adopted. Although each stakeholder has a vested interest in the value agenda often with conflicting expectations and motivations (or motives) between each other, progress is only achieved if the multiple blocs of the delivery system are advanced as mutually reinforcing entities. Clinical considerations of delivery of dialysis need to be based on the entire patient disease pathway and evidence-based medicine, while the non-clinical sustainability criteria entail, in addition to economics, the societal and ecological implications of HD therapy. We discuss how selection of appropriate modes and features of delivery of HD (e.g. treatment modalities and schedules, selection of consumables, product life cycle assessment) could positively impact decision-making towards value-based renal care. Although the delivery of HD therapy is multifactorial and complex, applying cost-effectiveness analyses for the different HD modalities (conventional in-centre and home HD) can support in guiding payability (balance between clinical value and costs) for health systems. For a resource intensive therapy like HD, concerted and fully integrated care strategies need to be urgently implemented to cope with the global demand and burden of HD therapy.
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Affiliation(s)
- Christian Apel
- Health Economics and Market Access EMEA, Fresenius Medical Care, Bad Homburg, Germany
| | - Carsten Hornig
- Health Economics and Market Access EMEA, Fresenius Medical Care, Bad Homburg, Germany
| | - Frank W Maddux
- Global Medical Office, Fresenius Medical Care, Waltham, MA, USA
| | | | - Julianna Yeung
- Health Economics & Market Access Asia-Pacific, Fresenius Medical Care, Hong Kong
| | - Adrian Guinsburg
- Global Medical Office, Fresenius Medical Care, Buenos Aires, Argentina
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6
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Tada K, Maeda T, Takahashi K, Ito K, Yasuno T, Funakoshi S, Satoh A, Kawazoe M, Yoshimura C, Mukoubara S, Masutani K, Arima H, Nakashima H. Association between serum uric acid and new onset and progression of chronic kidney disease in a Japanese general population: Iki epidemiological study of atherosclerosis and chronic kidney disease. Clin Exp Nephrol 2021; 25:751-759. [PMID: 33689045 DOI: 10.1007/s10157-021-02042-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 02/26/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Although several risk factors for chronic kidney disease (CKD) have been proposed, it remains unclear whether elevated serum uric acid (SUA) is negatively association with kidney function. The aim of this study was to elucidate the association between SUA and new onset and progression of CKD in a Japanese general population. METHODS This was a population-based retrospective cohort study using annual health checkup data of residents of Iki Island. A total of 5,507 adults (979 with CKD and 4,528 without) were included. The outcomes were new onset of CKD among participants without CKD at baseline, and progression of CKD among those with CKD. A Cox proportional hazards model was used to evaluate the association between SUA and new onset and progression of CKD. RESULTS During mean follow-up of 4.6 years, 757 cases of new onset of CKD and 193 with progression of CKD were observed. SUA was significantly associated with new onset of CKD (adjusted hazard ratio 1.13, [95% confidence interval 1.03-1.24] per standard deviation [SD] increase in SUA). In contrast, SUA was not significantly associated with progression of CKD (hazard ratio 1.08, [0.92-1.27] per SD increase). Similar results were obtained when classifying uric acid as categorical. CONCLUSION SUA was significantly associated with increased risk for new onset of CKD, but not with progression of CKD among a Japanese general population.
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Affiliation(s)
- Kazuhiro Tada
- Division of Nephrology and Rheumatology, Department of Internal Medicine, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma Jonan-ku, Fukuoka, 814-0180, Japan
| | - Toshiki Maeda
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma Jonan-ku, Fukuoka, 814-0180, Japan.
| | - Koji Takahashi
- Division of Nephrology and Rheumatology, Department of Internal Medicine, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Kenji Ito
- Division of Nephrology and Rheumatology, Department of Internal Medicine, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Tetsuhiko Yasuno
- Division of Nephrology and Rheumatology, Department of Internal Medicine, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Shunsuke Funakoshi
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma Jonan-ku, Fukuoka, 814-0180, Japan
| | - Atsushi Satoh
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma Jonan-ku, Fukuoka, 814-0180, Japan
| | - Miki Kawazoe
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma Jonan-ku, Fukuoka, 814-0180, Japan
| | - Chikara Yoshimura
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma Jonan-ku, Fukuoka, 814-0180, Japan
| | | | - Kosuke Masutani
- Division of Nephrology and Rheumatology, Department of Internal Medicine, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Hisatomi Arima
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma Jonan-ku, Fukuoka, 814-0180, Japan
| | - Hitoshi Nakashima
- Division of Nephrology and Rheumatology, Department of Internal Medicine, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
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7
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Trichostatin A Alleviates Renal Interstitial Fibrosis Through Modulation of the M2 Macrophage Subpopulation. Int J Mol Sci 2020; 21:ijms21175966. [PMID: 32825118 PMCID: PMC7503910 DOI: 10.3390/ijms21175966] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 08/16/2020] [Accepted: 08/16/2020] [Indexed: 12/16/2022] Open
Abstract
Mounting evidence indicates that an increase in histone deacetylation contributes to renal fibrosis. Although inhibition of histone deacetylase (HDAC) can reduce the extent of fibrosis, whether HDAC inhibitors exert the antifibrotic effect through modulating the phenotypes of macrophages, the key regulator of renal fibrosis, remains unknown. Moreover, the functional roles of the M2 macrophage subpopulation in fibrotic kidney diseases remain incompletely understood. Herein, we investigated the role of HDAC inhibitors on renal fibrogenesis and macrophage plasticity. We found that HDAC inhibition by trichostatin A (TSA) reduced the accumulation of interstitial macrophages, suppressed the activation of myofibroblasts and attenuated the extent of fibrosis in obstructive nephropathy. Moreover, TSA inhibited M1 macrophages and augmented M2 macrophage infiltration in fibrotic kidney tissue. Interestingly, TSA preferentially upregulated M2c macrophages and suppressed M2a macrophages in the obstructed kidneys, which was correlated with a reduction of interstitial fibrosis. TSA also repressed the expression of proinflammatory and profibrotic molecules in cultured M2a macrophages and inhibited the activation of renal myofibroblasts. In conclusion, our study was the first to show that HDAC inhibition by TSA alleviates renal fibrosis in obstructed kidneys through facilitating an M1 to M2c macrophage transition.
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8
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Kyte D, Anderson N, Auti R, Aiyegbusi OL, Bishop J, Bissell A, Brettell E, Calvert M, Chadburn M, Cockwell P, Dutton M, Eddington H, Forster E, Hadley G, Ives NJ, Jackson L, O'Brien S, Price G, Sharpe K, Stringer S, Stephenson G, Verdi R, Waters J, Wilcockson A, Williams J. Development of an electronic patient-reported outcome measure (ePROM) system to aid the management of patients with advanced chronic kidney disease. J Patient Rep Outcomes 2020; 4:55. [PMID: 32642867 PMCID: PMC7343684 DOI: 10.1186/s41687-020-00223-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 06/28/2020] [Indexed: 11/22/2022] Open
Abstract
Background Effective management of patients with chronic kidney disease (CKD) relies on timely detection of clinical deterioration towards end stage kidney failure. We aimed to design an electronic Patient-Reported Outcome Measure (ePROM) system, which would allow patients with advanced CKD (pre-dialysis) to: (i) remotely self-report their symptoms using a simple and secure online platform; (ii) share the data with the clinical team in real-time via the electronic patient record to help optimise care. We adopted a staged development process which included: a systematic review of PROMs used in CKD; formation of a co-design team; prototype system design/development, user acceptance testing and refinement; finalisation of the system for testing in a pilot/feasibility trial. Results A co-design team was convened, including patients with lived experience of CKD; clinical team members; IT/Informatics experts; academics; and Birmingham Clinical Trials Unit representatives. A prototype system was developed and iterative changes made before finalisation during a series of operational meetings. The system allows patients to remotely self-report their symptoms; provides tailored self-management advice; allows monitoring of real-time patient ePROM data; sends automated notifications to the patient/clinical team in the advent of a severe symptom report; and incorporates longitudinal ePROM symptom data into the electronic patient record. Feasibility of the system will be evaluated as part of the National Institute for Health Research funded RePROM (Renal electronic Patient-Reported Outcome Measure) pilot trial (ISRCTN12669006). Conclusions Routine ePROM collection with real-time feedback has the potential to improve outcomes and reduce health service costs. We have successfully developed a trial-ready ePROM system for advanced CKD, the feasibility of which is currently being explored in a pilot trial. Assuming feasibility is demonstrated, formal evaluation of efficacy will take place in a future multi-centre randomised controlled trial.
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Affiliation(s)
- Derek Kyte
- Centre for Patient-Reported Outcomes Research, University of Birmingham, Birmingham, UK. .,Institute of Applied Health Research, University of Birmingham, Birmingham, UK. .,National Institute for Health Research Birmingham Biomedical Research Centre, The Murray Learning Centre, University of Birmingham, Birmingham, UK.
| | - Nicola Anderson
- Centre for Patient-Reported Outcomes Research, University of Birmingham, Birmingham, UK.,University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Ram Auti
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Olalekan Lee Aiyegbusi
- Centre for Patient-Reported Outcomes Research, University of Birmingham, Birmingham, UK.,Institute of Applied Health Research, University of Birmingham, Birmingham, UK.,National Institute for Health Research Birmingham Biomedical Research Centre, The Murray Learning Centre, University of Birmingham, Birmingham, UK
| | - Jon Bishop
- Birmingham Clinical Trials Unit (BCTU), Institute of Applied Health Research University of Birmingham, Birmingham, UK
| | - Andrew Bissell
- Patient Advisory Group, Centre for Patient-Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Elizabeth Brettell
- Birmingham Clinical Trials Unit (BCTU), Institute of Applied Health Research University of Birmingham, Birmingham, UK
| | - Melanie Calvert
- Centre for Patient-Reported Outcomes Research, University of Birmingham, Birmingham, UK.,Institute of Applied Health Research, University of Birmingham, Birmingham, UK.,National Institute for Health Research Birmingham Biomedical Research Centre, The Murray Learning Centre, University of Birmingham, Birmingham, UK.,National Institute for Health Research Applied Research Centre West Midlands, University of Birmingham, Birmingham, UK.,National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre, University of Birmingham, Birmingham, UK.,Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
| | - Marie Chadburn
- Birmingham Clinical Trials Unit (BCTU), Institute of Applied Health Research University of Birmingham, Birmingham, UK
| | - Paul Cockwell
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Mary Dutton
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Helen Eddington
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Elliot Forster
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Gabby Hadley
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Natalie J Ives
- Centre for Patient-Reported Outcomes Research, University of Birmingham, Birmingham, UK.,Birmingham Clinical Trials Unit (BCTU), Institute of Applied Health Research University of Birmingham, Birmingham, UK
| | - Louise Jackson
- Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Sonja O'Brien
- Patient Advisory Group, Centre for Patient-Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Gary Price
- Centre for Patient-Reported Outcomes Research, University of Birmingham, Birmingham, UK.,Patient Advisory Group, Centre for Patient-Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Keeley Sharpe
- Patient Advisory Group, Centre for Patient-Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Gael Stephenson
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Rav Verdi
- Patient Advisory Group, Centre for Patient-Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Judi Waters
- Patient Advisory Group, Centre for Patient-Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Adrian Wilcockson
- Birmingham Clinical Trials Unit (BCTU), Institute of Applied Health Research University of Birmingham, Birmingham, UK
| | - Jim Williams
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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Arai K, Morikawa Y, Ubukata N, Sugimoto K. Synergistic reduction in albuminuria in type 2 diabetic mice by esaxerenone (CS-3150), a novel nonsteroidal selective mineralocorticoid receptor blocker, combined with an angiotensin II receptor blocker. Hypertens Res 2020; 43:1204-1213. [PMID: 32616846 PMCID: PMC7685977 DOI: 10.1038/s41440-020-0495-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 05/19/2020] [Accepted: 05/22/2020] [Indexed: 12/05/2022]
Abstract
Esaxerenone is a novel selective mineralocorticoid receptor (MR) blocker that was recently approved in Japan to treat hypertension. In phase II and III studies, esaxerenone plus a renin–angiotensin system inhibitor markedly reduced the urinary albumin-to-creatinine ratio (UACR) in hypertensive patients with diabetic nephropathy. To evaluate a direct renoprotective effect by MR blockade independent of an antihypertensive effect in the context of diabetic nephropathy, esaxerenone (3 mg/kg), olmesartan (an angiotensin II receptor blocker; 1 mg/kg), or both were orally administered to KK-Ay mice, a type 2 diabetes model, once daily for 56 days. Urinary albumin (Ualb), UACR, and markers, such as podocalyxin, monocyte chemoattractant protein-1 (MCP-1), and 8-hydroxy-2′-deoxyguanosine (8-OHdG), were measured, along with systolic blood pressure (SBP), fasting blood glucose, and serum K+ levels. Prior to the initiation of drug administration, KK-Ay mice showed higher blood glucose, insulin, Ualb excretion, and UACR levels than C57BL/6 J mice, a nondiabetic control, indicating the development of diabetic renal injury. Combined treatment with esaxerenone and olmesartan significantly reduced the change in UACR from baseline compared with the change associated with vehicle at week 8 (−1.750 vs. 0.339 g/gCre; P < 0.002) and significantly inhibited the change in Ualb from baseline compared with the change associated with vehicle at week 8 (P < 0.002). The combination treatment also reduced urinary excretion of podocalyxin and MCP-1, but did not influence 8-OHdG excretion, SBP, blood glucose, or serum K+ levels. Overall, esaxerenone plus olmesartan treatment ameliorated diabetic nephropathy in KK-Ay mice without affecting SBP, suggesting that the renoprotective effects of esaxerenone could be exerted independently of its antihypertensive effect.
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Affiliation(s)
- Kiyoshi Arai
- End-Organ Disease Laboratories, Daiichi Sankyo Co., Ltd., Tokyo, Japan. .,Global Project Management Department, Daiichi Sankyo Co., Ltd., Tokyo, Japan.
| | - Yuka Morikawa
- Rare Disease & LCM Laboratories, Daiichi Sankyo Co., Ltd., Tokyo, Japan.,Specialty Medicine Research Laboratories I, Daiichi Sankyo Co., Ltd., Tokyo, Japan
| | - Naoko Ubukata
- End-Organ Disease Laboratories, Daiichi Sankyo Co., Ltd., Tokyo, Japan.,Specialty Medicine Research Laboratories I, Daiichi Sankyo Co., Ltd., Tokyo, Japan
| | - Kotaro Sugimoto
- Medical Science Department, Daiichi Sankyo Co., Ltd., Tokyo, Japan
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10
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A Prospective Observational Study of Drug Therapy Problems in Pediatric Ward of a Referral Hospital, Northeastern Ethiopia. Int J Pediatr 2020; 2020:4323189. [PMID: 32256614 PMCID: PMC7115047 DOI: 10.1155/2020/4323189] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 12/21/2019] [Accepted: 01/23/2020] [Indexed: 12/01/2022] Open
Abstract
Background A drug therapy problem is any undesirable event experienced by a patient during drug therapy that interferes with achieving the desired goals of therapy. It has been pointed out that hospitalized pediatric patients are particularly prone to drug-related problems. Identifying drug therapy problems enables risk quantification and determination of the potential impact of prevention strategies. The purpose of this study was to assess the drug therapy problems in a pediatric ward of Dessie Referral Hospital, northeast of Ethiopia, and to identify associated factors for drug therapy problems. Methods A prospective observational study design was carried out to assess drug therapy problems in a pediatric ward of Dessie Referral Hospital from February 1, 2018, to May 30, 2018. Ethical approval was obtained, and informed consent was signed by each study participant's parent before the commencement of the study. All patients admitted to the ward during the study period were included in the study. Data was collected by trained pharmacy staffs through medical record reviews of patients using a prepared standard checklist and semistructured questionnaire. The collected data were cleared and checked every day for completeness and consistency before processing. Data were entered, and descriptive statistical analysis was done using SPSS Version 20 Software. A P value of less than 0.05 was considered significant. Results The participants' mean age was 2.32 years with the standard deviation (SD) of 0.76 years. Among 81 patients, 71 (87.7%) of them had at least one drug therapy problem per patient which indicates that the prevalence of the drug therapy problem was substantially high. Needs additional drug was the most predominantly encountered drug therapy problem accounted (30 (25.2%)). On the other hand, ineffective drug was the least (3 (2.5%)) drug therapy problem. Antibiotics (47 (39.5%)) followed by fluid and electrolyte (25 (21%)) were classes of drugs mostly involved in the drug therapy problem. The main risk factors reported to the occurrence of the drug therapy problems were prescribing and dose calculation errors. Conclusion The present study revealed that majority of the patients had at least one DTP per patient; this indicates that prevalence of DTP was very high in the study area. Needs additional drug therapy followed by noncompliance was the major cause of the occurrence of DTP. Antibiotics were the main class of drugs involved in the drug therapy problem, and among the risk factors assessed, prescribing and dose calculation errors showed statistical significance.
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11
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Permyakova A, Gammal A, Hinden L, Weitman M, Weinstock M, Tam J. A Novel Indoline Derivative Ameliorates Diabesity-Induced Chronic Kidney Disease by Reducing Metabolic Abnormalities. Front Endocrinol (Lausanne) 2020; 11:91. [PMID: 32218769 PMCID: PMC7078689 DOI: 10.3389/fendo.2020.00091] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 02/13/2020] [Indexed: 12/13/2022] Open
Abstract
Both diabetes and obesity (diabesity) contribute significantly to the development of chronic kidney disease (CKD). In search of new remedies to reverse or arrest the progression of CKD, we examined the therapeutic potential of a novel compound, AN1284, in a mouse model of CKD induced by type 2 diabetes with obesity. Six-week-old BKS Cg-Dock 7m+/+ Leprdb/J mice with type 2 diabetes and obesity were treated with AN1284 (2.5 or 5 mg kg-1 per day) via micro-osmotic pumps implanted subcutaneously for 3 months. Measures included renal, pancreatic, and liver assessment as well as energy utilization. AN1284 improved kidney function in BSK-db/db animals by reducing albumin and creatinine and preventing renal inflammation and morphological changes. The treatment was associated with weight loss, decreased body fat mass, increased utilization of body fat toward energy, preservation of insulin sensitivity and pancreatic β cell mass, and reduction of dyslipidemia, hepatic steatosis, and liver injury. This indoline derivative protected the kidney from the deleterious effects of hyperglycemia by ameliorating the metabolic abnormalities of diabetes. It could have therapeutic potential for preventing CKD in human subjects with diabesity.
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Affiliation(s)
- Anna Permyakova
- Faculty of Medicine, School of Pharmacy, Institute for Drug Research, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Asaad Gammal
- Faculty of Medicine, School of Pharmacy, Institute for Drug Research, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Liad Hinden
- Faculty of Medicine, School of Pharmacy, Institute for Drug Research, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Michal Weitman
- Department of Chemistry, Bar Ilan University, Ramat Gan, Israel
| | - Marta Weinstock
- Faculty of Medicine, School of Pharmacy, Institute for Drug Research, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Joseph Tam
- Faculty of Medicine, School of Pharmacy, Institute for Drug Research, The Hebrew University of Jerusalem, Jerusalem, Israel
- *Correspondence: Joseph Tam
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12
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Abstract
Chronic kidney disease (CKD) is a major cause of morbidity and premature mortality and represents a significant global public health issue. Underlying this burden are the many complications of CKD, including mineral and bone disorders, anemia, and accelerated cardiovascular disease. Hyperphosphatemia and elevated levels of fibroblast growth factor 23 (FGF23) have been identified as key independent risk factors for the adverse cardiovascular outcomes that frequently occur in patients with CKD. Auryxia® (ferric citrate; Keryx Biopharmaceuticals, Inc., Boston, MA, USA) is an iron-based compound with distinctive chemical characteristics and a mechanism of action that render it dually effective as a therapy in patients with CKD; it has been approved as a phosphate binder for the control of serum phosphate levels in adult CKD patients treated with dialysis and as an iron replacement product for the treatment of iron deficiency anemia in adult CKD patients not treated with dialysis. This review focuses on Auryxia, its mechanism of action, and the clinical attributes that differentiate it from other, non-pharmaceutical-grade, commercially available forms of ferric citrate and from other commonly used phosphate binder and iron supplement therapies for patients with CKD. Consistent with the chemistry and mechanism of action of Auryxia, multiple clinical studies have demonstrated its efficacy in both lowering serum phosphate levels and improving iron parameters in patients with CKD. Levels of FGF23 decrease significantly with Auryxia treatment, but the effects associated with the cardiovascular system remain to be evaluated in longer-term studies.
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Affiliation(s)
- Tomas Ganz
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA. .,CHS 47-200J, Department of Medicine, David Geffen School of Medicine at University of California Los Angeles, 10833 Le Conte Ave., Los Angeles, CA, 90095, USA. .,CHS 47-200J, Department of Pathology, David Geffen School of Medicine at University of California Los Angeles, 10833 Le Conte Ave., Los Angeles, CA, 90095, USA.
| | - Avi Bino
- Institute of Chemistry, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Isidro B Salusky
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
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13
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Pergola PE, Pecoits-Filho R, Winkelmayer WC, Spinowitz B, Rochette S, Thompson-Leduc P, Lefebvre P, Shafai G, Bozas A, Sanon M, Krasa HB. Economic Burden and Health-Related Quality of Life Associated with Current Treatments for Anaemia in Patients with CKD not on Dialysis: A Systematic Review. PHARMACOECONOMICS - OPEN 2019; 3:463-478. [PMID: 30968369 PMCID: PMC6861396 DOI: 10.1007/s41669-019-0132-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
BACKGROUND The cost and health-related quality of life (HRQoL) burden associated with treatments for anaemia of chronic kidney disease (CKD) is not well characterized among non-dialysis-dependent (NDD) patients. OBJECTIVE Our objective was to review the literature on costs and HRQoL associated with current treatments for anaemia of CKD among NDD patients. METHODS The Cochrane Library, MEDLINE, Embase, NHS EED, and NHS HTA databases were searched for original studies published in English between 1 January 2000 and 17 March 2017. The following inclusion criteria were applied: adult population; primary focus was anaemia of CKD; patients received iron supplementation, red blood cell transfusion, or erythropoiesis-stimulating agents (ESAs); and reported results on HRQoL and/or costs. Studies that included NDD patients, did not compare different treatments, and had relevant designs were retained. HRQoL and cost outcomes were summarized in a narrative synthesis. RESULTS In total, 16 studies met the inclusion criteria: six randomized controlled trials, four prospective single-arm trials, three retrospective studies, one prospective observational study, one simulation study, and one cross-sectional survey. All included ESAs. Treatment of anaemia (compared with no treatment) was associated with HRQoL improvements in five of six studies and lower costs in four of four studies. Treatment aiming for higher haemoglobin targets (compared with lower targets) resulted in modest HRQoL improvements, higher healthcare resource utilization (HRU), and higher costs. CONCLUSIONS In NDD patients, untreated anaemia of CKD leads to higher costs, higher HRU, and lower HRQoL compared with initiating anaemia treatment. Relative to aiming for lower haemoglobin targets with ESAs, higher targets conferred modest HRQoL improvements and were associated with higher HRU.
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Affiliation(s)
| | - Roberto Pecoits-Filho
- George Institute for Global Health, Newtown, NSW, Australia
- School of Medicine Pontificia, Universidade Catolica do Parana, Curitiba, PR, Brazil
| | | | | | - Samuel Rochette
- Analysis Group, Inc., 1190 Avenue Des Canadiens-de-Montréal, Tour Deloitte, Suite 1500, Montreal, QC, H3B 0G7, Canada
| | - Philippe Thompson-Leduc
- Analysis Group, Inc., 1190 Avenue Des Canadiens-de-Montréal, Tour Deloitte, Suite 1500, Montreal, QC, H3B 0G7, Canada.
| | - Patrick Lefebvre
- Analysis Group, Inc., 1190 Avenue Des Canadiens-de-Montréal, Tour Deloitte, Suite 1500, Montreal, QC, H3B 0G7, Canada
| | | | - Ana Bozas
- Akebia Therapeutics, Cambridge, MA, USA
| | - Myrlene Sanon
- Otsuka Pharmaceutical Development and Commercialization, Rockville, MD, USA
| | - Holly B Krasa
- Otsuka Pharmaceutical Development and Commercialization, Rockville, MD, USA
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14
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Sugrue DM, Ward T, Rai S, McEwan P, van Haalen HGM. Economic Modelling of Chronic Kidney Disease: A Systematic Literature Review to Inform Conceptual Model Design. PHARMACOECONOMICS 2019; 37:1451-1468. [PMID: 31571136 PMCID: PMC6892339 DOI: 10.1007/s40273-019-00835-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
BACKGROUND Chronic kidney disease (CKD) is a progressive condition that leads to irreversible damage to the kidneys and is associated with an increased incidence of cardiovascular events and mortality. As novel interventions become available, estimates of economic and clinical outcomes are needed to guide payer reimbursement decisions. OBJECTIVE The aim of the present study was to systematically review published economic models that simulated long-term outcomes of kidney disease to inform cost-effectiveness evaluations of CKD treatments. METHODS The review was conducted across four databases (MEDLINE, Embase, the Cochrane library and EconLit) and health technology assessment agency websites. Relevant information on each model was extracted. Transition and mortality rates were also extracted to assess the choice of model parameterisation on disease progression by simulating patient's time with end-stage renal disease (ESRD) and time to ESRD/death. The incorporation of cardiovascular disease in a population with CKD was qualitatively assessed across identified models. RESULTS The search identified 101 models that met the criteria for inclusion. Models were classified into CKD models (n = 13), diabetes models with nephropathy (n = 48), ESRD-only models (n = 33) and cardiovascular models with CKD components (n = 7). Typically, published models utilised frameworks based on either (estimated or measured) glomerular filtration rate (GFR) or albuminuria, in line with clinical guideline recommendations for the diagnosis and monitoring of CKD. Generally, two core structures were identified, either a microsimulation model involving albuminuria or a Markov model utilising CKD stages and a linear GFR decline (although further variations on these model structures were also identified). Analysis of parameter variability in CKD disease progression suggested that mean time to ESRD/death was relatively consistent across model types (CKD models 28.2 years; diabetes models with nephropathy 24.6 years). When evaluating time with ESRD, CKD models predicted extended ESRD survival over diabetes models with nephropathy (mean time with ESRD 8.0 vs. 3.8 years). DISCUSSION This review provides an overview of how CKD is typically modelled. While common frameworks were identified, model structure varied, and no single model type was used for the modelling of patients with CKD. In addition, many of the current methods did not explicitly consider patient heterogeneity or underlying disease aetiology, except for diabetes. However, the variability of individual patients' GFR and albuminuria trajectories perhaps provides rationale for a model structure designed around the prediction of individual patients' GFR trajectories. Frameworks of future CKD models should be informed and justified based on clinical rationale and availability of data to ensure validity of model results. In addition, further clinical and observational research is warranted to provide a better understanding of prognostic factors and data sources to improve economic modelling accuracy in CKD.
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Affiliation(s)
- Daniel M Sugrue
- Health Economics and Outcomes Research Limited, Rhymney House, Unit A Copse Walk, Cardiff Gate Business Park, Cardiff, CF23 8RB, UK.
| | - Thomas Ward
- Health Economics and Outcomes Research Limited, Rhymney House, Unit A Copse Walk, Cardiff Gate Business Park, Cardiff, CF23 8RB, UK
| | - Sukhvir Rai
- Health Economics and Outcomes Research Limited, Rhymney House, Unit A Copse Walk, Cardiff Gate Business Park, Cardiff, CF23 8RB, UK
| | - Phil McEwan
- Health Economics and Outcomes Research Limited, Rhymney House, Unit A Copse Walk, Cardiff Gate Business Park, Cardiff, CF23 8RB, UK
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15
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Shen H, van der Kleij RMJJ, van der Boog PJM, Chang X, Chavannes NH. Electronic Health Self-Management Interventions for Patients With Chronic Kidney Disease: Systematic Review of Quantitative and Qualitative Evidence. J Med Internet Res 2019; 21:e12384. [PMID: 31687937 PMCID: PMC6864489 DOI: 10.2196/12384] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 06/28/2019] [Accepted: 08/19/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) poses a major challenge to public health. In CKD patients, adequate disease self-management has been shown to improve both proximal and distal outcomes. Currently, electronic health (eHealth) interventions are increasingly used to optimize patients' self-management skills. OBJECTIVE This study aimed to systematically review the existing evidence regarding the implementation and effectiveness of eHealth self-management interventions for patients with CKD. METHODS Following a search in 8 databases (up to November 2017), quantitative and qualitative data on process and effect outcomes were extracted from relevant studies. Quality was appraised using the Crowe Critical Appraisal Tool; narrative synthesis was performed to analyze the data extracted. RESULTS Of the 3307 articles retrieved, 24 (comprising 23 studies) were included in this review; of these, almost half were appraised to be of low to moderate quality. There was considerable heterogeneity in the types of interventions used and the outcomes measured. A total of 10 effect and 9 process outcome indicators were identified. The most frequently reported effect outcome indicators were specific laboratory tests and blood pressure (BP), whereas satisfaction was the most frequently reported process outcome indicator. Positive effects were found for proximal outcomes (eg, BP control and medication adherence), and mixed effects were found for more distal outcomes (eg, quality of life). High feasibility, usability, and acceptability of and satisfaction with eHealth self-management interventions were reported. The determinant ability of health care professionals to monitor and, if necessary, anticipate on patient measurements online was mostly cited to influence patients' adherence to interventions. CONCLUSIONS eHealth self-management interventions have the potential to improve disease management and health outcomes. To broaden the evidence base and facilitate intervention upscaling, more detailed descriptions and thorough analysis of the intervention components used are required. In addition, our review reveals that outcomes closely related to the scope and duration of the intervention implemented are most likely to be impacted. For instance, if a 4-week Web-based training to optimize disease management skills is implemented, the outcome perceived control would more likely be affected than kidney function. Although this seems obvious, most studies evaluate only distal outcomes and thereby fail to capture intervention effects that might contribute to long-term health improvement. We advise future researchers to carefully consider their choice of outcomes based on their sensitivity for change. In this way, we ensure that relevant effects are captured and legitimate conclusions are drawn.
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Affiliation(s)
- Hongxia Shen
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
| | - Rianne M J J van der Kleij
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands.,Department of Obstetrics and Gynaecology, Erasmus Medical Center, Rotterdam, Netherlands
| | | | - Xinwei Chang
- Department of Surgery, School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, Netherlands
| | - Niels H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
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16
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A single-nucleus RNA-sequencing pipeline to decipher the molecular anatomy and pathophysiology of human kidneys. Nat Commun 2019; 10:2832. [PMID: 31249312 PMCID: PMC6597610 DOI: 10.1038/s41467-019-10861-2] [Citation(s) in RCA: 155] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 05/31/2019] [Indexed: 12/17/2022] Open
Abstract
Defining cellular and molecular identities within the kidney is necessary to understand its organization and function in health and disease. Here we demonstrate a reproducible method with minimal artifacts for single-nucleus Droplet-based RNA sequencing (snDrop-Seq) that we use to resolve thirty distinct cell populations in human adult kidney. We define molecular transition states along more than ten nephron segments spanning two major kidney regions. We further delineate cell type-specific expression of genes associated with chronic kidney disease, diabetes and hypertension, providing insight into possible targeted therapies. This includes expression of a hypertension-associated mechano-sensory ion channel in mesangial cells, and identification of proximal tubule cell populations defined by pathogenic expression signatures. Our fully optimized, quality-controlled transcriptomic profiling pipeline constitutes a tool for the generation of healthy and diseased molecular atlases applicable to clinical samples. Single-cell studies in solid tissues remain challenging and have benefited from the development of single-nuclei RNA sequencing strategies. Here Lake et al. apply single-nucleus RNA sequencing to human kidney tissues to provide a comprehensive molecular and cellular atlas of the human kidney, with potential implications for the understanding of kidney physiology and disease.
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17
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Incerti D, Browne J, Huber C, Baker CL, Makinson G, Goren A, Willke R, Stevens W. An empirical tool for estimating the share of unmet need due to healthcare inefficiencies, suboptimal access, and lack of effective technologies. BMC Health Serv Res 2019; 19:113. [PMID: 30744613 PMCID: PMC6371562 DOI: 10.1186/s12913-019-3914-7] [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: 03/07/2018] [Accepted: 01/17/2019] [Indexed: 11/10/2022] Open
Abstract
Background Although there has been growing attention to the measurement of unmet need, which is the overall epidemiological burden of disease, current measures ignore the burden that could be eliminated from technological advances or more effective use of current technologies. Methods We developed a conceptual framework and empirical tool that separates unmet need from met need and subcategorizes the causes of unmet need into suboptimal access to and ineffective use of current technologies and lack of current technologies. Statistical models were used to model the relationship between health-related quality of life (HR-QOL) and treatment utilization using data from the National Health and Wellness Survey (NHWS). Predicted HR-QOL was combined with prevalence data from the Global Burden of Disease Study (GBD) to estimate met need and the causes of unmet need due to morbidity in the US and EU5 for five diseases: rheumatoid arthritis, breast cancer, Parkinson’s disease, hepatitis C, and chronic obstructive pulmonary disease (COPD). Results HR-QOL was positively correlated with adherence to medication and patient-perceived quality and negatively correlated with financial barriers. Met need was substantial across all disease and regions, although significant unmet need remains. While the majority of unmet need was driven by lack of technologies rather than ineffective use of current technologies, there was considerable variation across diseases and regions. Overall unmet need was largest for COPD, which had the highest prevalence of all diseases in this study. Conclusion We developed a methodology that can inform decisions about which diseases to invest in and whether those investments should focus on improving access to currently available technologies or inventing new technologies. Electronic supplementary material The online version of this article (10.1186/s12913-019-3914-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Devin Incerti
- Precision Health Economics, 11100 Santa Monica Blvd #500, Los Angeles, CA, 90025, USA.
| | - John Browne
- University College Cork, College Rd, University College, Cork, Ireland
| | - Caroline Huber
- Precision Health Economics, 11100 Santa Monica Blvd #500, Los Angeles, CA, 90025, USA
| | | | | | - Amir Goren
- Kantar Health, 11 Madison Ave # 12, New York, NY, 10010, USA
| | - Richard Willke
- International Society for Pharmacoeconomics and Outcomes Research, 505 Lawrence Square Blvd, South Lawrenceville, NJ, 08648, USA
| | - Warren Stevens
- Parexel International, 2520 Meridian Parkway, Durham, NC, 27713, USA
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18
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Cherrez-Ojeda I, Felix M, Mata VL, Vanegas E, Gavilanes AWD, Chedraui P, Simancas-Racines D, Calderon JC, Ortiz F, Blum G, Plua A, Gonzalez G, Moscoso G, Morquecho W. Preferences of ICT among Patients with Chronic Kidney Disease Undergoing Hemodialysis: An Ecuadorian Cross-Sectional Study. Healthc Inform Res 2018; 24:292-299. [PMID: 30443417 PMCID: PMC6230525 DOI: 10.4258/hir.2018.24.4.292] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 10/18/2018] [Accepted: 10/23/2018] [Indexed: 11/25/2022] Open
Abstract
Objectives The aim of the present study was to assess the frequency of use, and preferences regarding information and communication technologies (ICTs) among Ecuadorian patients with chronic kidney disease (CKD) undergoing hemodialysis. Methods We conducted an anonymous cross-sectional survey-based study from January 2016 to April 2017, involving 393 patients with end-stage renal disease from 9 hemodialysis centers, in which they rated their use and preferences of various ICTs through a modified version of the Michigan Questionnaire. The questionnaire collected information regarding demographics, patients' interest in obtaining health-related information through ICTs, and interest in using ICTs as a potential way to communicate with their healthcare providers. A chi-square test for association and adjusted regression analyses were performed. Results Among all patients who participated, 64.3% reported owning a cellphone, with less than a third reporting active Internet connection. The most used ICT for obtaining information about CKD and/or hemodialysis was web-based Internet, followed by YouTube. SMS was rated the highest to receive and seek health-related information, followed by Facebook. Younger age and higher levels of education were associated with a higher overall usage of ICTs. Finally, more than half of the patients reported interest in using WhatsApp for communicating with their healthcare providers. Conclusions Understanding the preferences of ICTs among patients with CKD undergoing hemodialysis could help to improve their outcomes through the potential uses and benefits of ICTs. Further research is needed to assess their role in improving the care of patients with chronic diseases.
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Affiliation(s)
- Ivan Cherrez-Ojeda
- Universidad Espíritu Santo, Samborondón, Ecuador.,Respiralab Research Group, Guayaquil, Ecuador
| | - Miguel Felix
- Universidad Espíritu Santo, Samborondón, Ecuador.,Respiralab Research Group, Guayaquil, Ecuador
| | - Valeria L Mata
- Universidad Espíritu Santo, Samborondón, Ecuador.,Respiralab Research Group, Guayaquil, Ecuador
| | - Emanuel Vanegas
- Universidad Espíritu Santo, Samborondón, Ecuador.,Respiralab Research Group, Guayaquil, Ecuador
| | - Antonio W D Gavilanes
- Department of Pediatrics, Maastricht University Medical Center, Maastricht, The Netherlands.,School of Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Peter Chedraui
- Instituto de Investigación e Innovación en Salud Integral, Facultad de Ciencias Médicas, Universidad Católica de Santiago de Guayaquil, Guayaquil, Ecuador
| | - Daniel Simancas-Racines
- Centro de Investigación en Salud Pública y Epidemiología Clínica, Facultad de Ciencias de la Salud Eugenio Espejo, Universidad Tecnológica Equinoccial, Quito, Ecuador
| | | | - Fabian Ortiz
- Instituto Ecuatoriano de Diálisis y Trasplantes (IEDYT), Guayaquil, Ecuador.,Unidad de Diálisis del Norte (UNIDIAL), Guayaquil, Ecuador
| | - Guillermina Blum
- Centro de Diálisis de la Fundación Renal del Ecuador "Iñigo Alvarez de Toledo", Guayaquil, Ecuador
| | - Angela Plua
- Instituto del Riñón y Diálisis, MEDICDIAL S.A., Guayaquil, Ecuador
| | | | - Grace Moscoso
- Universidad Espíritu Santo, Samborondón, Ecuador.,Hospital Dr. Abel Gilbert Pontón, Guayaquil, Ecuador
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19
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Liu X, Zhai T, Ma R, Luo C, Wang H, Liu L. Effects of uric acid-lowering therapy on the progression of chronic kidney disease: a systematic review and meta-analysis. Ren Fail 2018; 40:289-297. [PMID: 29619870 PMCID: PMC6014338 DOI: 10.1080/0886022x.2018.1456463] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVES Whether uric acid levels were associated with the progression of chronic kidney disease (CKD) remained controversial. This meta-analysis was aimed to assess the effect of lowering serum uric acid therapy on the progression of CKD to clarify the role of uric acid in the progression of CKD indirectly. METHODS Pubmed, Embase, the Cochrane library, CBM were searched for randomized controlled trials (RCTs) that assessed the efficiency of lowering serum uric acid therapy on the progression of CKD without language restriction. Summary estimates of weighted mean differences (WMDs) and relative risk (RR) were obtained by using random-effect or fixed-effect models. Sensitivity analyses were performed to identify the source of heterogeneity. RESULTS A total of 12 randomized controlled trials with 832 CKD participants were included in the analysis. Pooled estimate for eGFR was in favor of lowering serum uric acid therapy with a mean difference (MD) of 3.88 ml/min/1.73 m2, 95% CI 1.26-6.49 ml/min/1.73 m2, p = .004 and this was consistent with results for serum creatinine. The risk of worsening of kidney function or ESRD or death was significantly decreased in the treatment group compared to the control group (RR 0.39, 95% CI 0.28-0.52, p< .01). CONCLUSIONS Uric acid-lowering therapy may be effective in retarding the progression of CKD. Further randomized controlled trials should be performed to confirm the effect of lowering serum uric acid therapy on the progression of CKD.
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Affiliation(s)
- Xuemei Liu
- a Department of Nephrology , The Affiliated Hospital of Qingdao University , Qingdao , China
| | - Tingting Zhai
- a Department of Nephrology , The Affiliated Hospital of Qingdao University , Qingdao , China
| | - Ruixia Ma
- a Department of Nephrology , The Affiliated Hospital of Qingdao University , Qingdao , China
| | - Congjuan Luo
- a Department of Nephrology , The Affiliated Hospital of Qingdao University , Qingdao , China
| | - Huifang Wang
- a Department of Nephrology , The Affiliated Hospital of Qingdao University , Qingdao , China
| | - Liqiu Liu
- a Department of Nephrology , The Affiliated Hospital of Qingdao University , Qingdao , China
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20
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Song MK, Paul S, Ward SE, Gilet CA, Hladik GA. One-Year Linear Trajectories of Symptoms, Physical Functioning, Cognitive Functioning, Emotional Well-being, and Spiritual Well-being Among Patients Receiving Dialysis. Am J Kidney Dis 2018; 72:198-204. [PMID: 29395483 PMCID: PMC6057855 DOI: 10.1053/j.ajkd.2017.11.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 11/11/2017] [Indexed: 11/11/2022]
Abstract
BACKGROUND This study evaluated 1-year linear trajectories of patient-reported dimensions of quality of life among patients receiving dialysis. STUDY DESIGN Longitudinal observational study. SETTING & PARTICIPANTS 227 patients recruited from 12 dialysis centers. FACTORS Sociodemographic and clinical characteristics. MEASUREMENTS/OUTCOMES Participants completed an hour-long interview monthly for 12 months. Each interview included patient-reported outcome measures of overall symptoms (Edmonton Symptom Assessment System), physical functioning (Activities of Daily Living/Instrumental Activities of Daily Living), cognitive functioning (Patient's Assessment of Own Functioning Inventory), emotional well-being (Center for Epidemiologic Studies Depression Scale, State Anxiety Inventory, and Positive and Negative Affect Schedule), and spiritual well-being (Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale). For each dimension, linear and generalized linear mixed-effects models were used. Linear trajectories of the 5 dimensions were jointly modeled as a multivariate outcome over time. RESULTS Although dimension scores fluctuated greatly from month to month, overall symptoms, cognitive functioning, emotional well-being, and spiritual well-being improved over time. Older compared with younger participants reported higher scores across all dimensions (all P<0.05). Higher comorbidity scores were associated with worse scores in most dimensions (all P<0.01). Nonwhite participants reported better spiritual well-being compared with their white counterparts (P<0.01). Clustering analysis of dimension scores revealed 2 distinctive clusters. Cluster 1 was characterized by better scores than those of cluster 2 in nearly all dimensions at baseline and by gradual improvement over time. LIMITATIONS Study was conducted in a single region of the United States and included mostly patients with high levels of function across the dimensions of quality of life studied. CONCLUSIONS Multidimensional patient-reported quality of life varies widely from month to month regardless of whether overall trajectories improve or worsen over time. Additional research is needed to identify the best approaches to incorporate patient-reported outcome measures into dialysis care.
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Affiliation(s)
- Mi-Kyung Song
- Center for Nursing Excellence in Palliative Care, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA.
| | - Sudeshna Paul
- Center for Nursing Excellence in Palliative Care, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA
| | - Sandra E Ward
- University of Wisconsin-Madison, School of Nursing, Madison, WI
| | - Constance A Gilet
- UNC Kidney Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Gerald A Hladik
- UNC Kidney Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
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21
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Hemodialysis Adequacy Sacrificed for Business: A Qualitative Study. Nephrourol Mon 2018. [DOI: 10.5812/numonthly.68254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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22
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Nguyễn-Thanh T, Kim D, Lee S, Kim W, Park SK, Kang KP. Inhibition of histone deacetylase 1 ameliorates renal tubulointerstitial fibrosis via modulation of inflammation and extracellular matrix gene transcription in mice. Int J Mol Med 2017; 41:95-106. [PMID: 29115561 PMCID: PMC5746318 DOI: 10.3892/ijmm.2017.3218] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Accepted: 10/19/2017] [Indexed: 12/11/2022] Open
Abstract
Renal tubulointerstitial fibrosis is characterized by sustained inflammation and excessive extracellular matrix (ECM) accumulation, leading to chronic kidney disease. Valproic acid (VPA) has anticancer activity through regulation of cell differentiation and apoptosis via inhibition of histone deacetylase (HDAC) activity and is considered a class I HDAC inhibitor. In this study, the effect of VPA on unilateral ureteral obstruction (UUO)‑induced renal fibrosis by modulation of renal inflammation and ECM gene transcription was investigated. VPA treatment increased histone H3 acetylation in both sham‑ and UUO‑operated kidneys and decreased the UUO‑induced increase in tubular injury and ECM deposition in mice. VPA also decreased myofibroblast activation and proliferation in UUO kidneys and NRK‑49F cells. Finally, it was demonstrated that the anti‑fibrotic effect of VPA was associated with regulation of ECM protein promoter enrichment at an acetylated histone H3 site. In conclusion, the findings indicate that VPA may have a beneficial effect on UUO‑induced renal fibrosis via regulation of myofibroblast activation, proliferation, and ECM protein production by chromatin remodeling and ECM protein promoter transcription.
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Affiliation(s)
- Tùng Nguyễn-Thanh
- Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Jeollabuk 54907, Republic of Korea
| | - Dal Kim
- Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Jeollabuk 54907, Republic of Korea
| | - Sik Lee
- Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Jeollabuk 54907, Republic of Korea
| | - Won Kim
- Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Jeollabuk 54907, Republic of Korea
| | - Sung Kwang Park
- Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Jeollabuk 54907, Republic of Korea
| | - Kyung Pyo Kang
- Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Jeollabuk 54907, Republic of Korea
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23
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Trivedi P, Kumar RK, Iyer A, Boswell S, Gerarduzzi C, Dadhania VP, Herbert Z, Joshi N, Luyendyk JP, Humphreys BD, Vaidya VS. Targeting Phospholipase D4 Attenuates Kidney Fibrosis. J Am Soc Nephrol 2017; 28:3579-3589. [PMID: 28814511 DOI: 10.1681/asn.2016111222] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 07/11/2017] [Indexed: 01/13/2023] Open
Abstract
Phospholipase D4 (PLD4), a single-pass transmembrane glycoprotein, is among the most highly upregulated genes in murine kidneys subjected to chronic progressive fibrosis, but the function of PLD4 in this process is unknown. Here, we found PLD4 to be overexpressed in the proximal and distal tubular epithelial cells of murine and human kidneys after fibrosis. Genetic silencing of PLD4, either globally or conditionally in proximal tubular epithelial cells, protected mice from the development of fibrosis. Mechanistically, global knockout of PLD4 modulated innate and adaptive immune responses and attenuated the upregulation of the TGF-β signaling pathway and α1-antitrypsin protein (a serine protease inhibitor) expression and downregulation of neutrophil elastase (NE) expression induced by obstructive injury. In vitro, treatment with NE attenuated TGF-β-induced accumulation of fibrotic markers. Furthermore, therapeutic targeting of PLD4 using specific siRNA protected mice from folic acid-induced kidney fibrosis and inhibited the increase in TGF-β signaling, decrease in NE expression, and upregulation of mitogen-activated protein kinase signaling. Immunoprecipitation/mass spectrometry and coimmunoprecipitation experiments confirmed that PLD4 binds three proteins that interact with neurotrophic receptor tyrosine kinase 1, a receptor also known as TrkA that upregulates mitogen-activated protein kinase. PLD4 inhibition also prevented the folic acid-induced upregulation of this receptor in mouse kidneys. These results suggest inhibition of PLD4 as a novel therapeutic strategy to activate protease-mediated degradation of extracellular matrix and reverse fibrosis.
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Affiliation(s)
- Priyanka Trivedi
- Renal Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Ramya K Kumar
- Renal Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Ashwin Iyer
- Renal Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Sarah Boswell
- Harvard Program in Therapeutic Sciences, Harvard Medical School, Boston, Massachusetts
| | - Casimiro Gerarduzzi
- Renal Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Vivekkumar P Dadhania
- Renal Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,Harvard Program in Therapeutic Sciences, Harvard Medical School, Boston, Massachusetts
| | - Zach Herbert
- Molecular Biology Core Facilities, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Nikita Joshi
- Department of Pathobiology and Diagnostic Investigation, Michigan State University, East Lansing, Michigan
| | - James P Luyendyk
- Department of Pathobiology and Diagnostic Investigation, Michigan State University, East Lansing, Michigan
| | - Benjamin D Humphreys
- Division of Nephrology, Washington University School of Medicine, St. Louis, Missouri; and
| | - Vishal S Vaidya
- Renal Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts; .,Harvard Program in Therapeutic Sciences, Harvard Medical School, Boston, Massachusetts.,Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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24
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Jeffs L, Jain AK, Man RH, Onabajo N, Desveaux L, Shaw J, Hensel J, Agarwal P, Saragosa M, Jamieson T, Wong I, Maione M, Bhatia RS. Exploring the utility and scalability of a telehomecare intervention for patients with chronic kidney disease undergoing peritoneal dialysis-a study protocol. BMC Nephrol 2017; 18:155. [PMID: 28486991 PMCID: PMC5424340 DOI: 10.1186/s12882-017-0557-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 04/16/2017] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Chronic Kidney Disease (CKD) is a pressing global health concern that is placing increased strain on health care resources. CKD patients regularly receive peritoneal dialysis as a common CKD treatment. An emerging technological solution is telehomecare as way to support patients receiving PD in their homes. This study protocol outlines a mixed methods evaluation exploring a telehomecare developed to enhance CKD patients' outcomes and experiences. The study aims to assess the usability, acceptability and scalability of this virtual care application. METHODS A realist evaluation using an embedded case study design will be used to understand the usability, acceptability and scalability of a telehomecare application for patients with CKD undergoing PD. The realist evaluation that is further described in this paper is part of a larger evaluation of the eQ Connect™ intervention that includes a randomized, parallel-arm control trial aimed at determining if utilizing eQ Connect improves selected clinical outcomes for PD patients (CONNECT Trial). DISCUSSION Potential implications of this study include elucidating which components of the intervention are most effective and under what conditions with a focus on the contextual influences. Collectively, our multi-method design will yield knowledge around how best to implement, sustain and spread the telehomecare application that will be useful to guide the development, implementation and evaluation of future virtual care applications aimed at improving the quality of care outcomes and experiences of patients. TRIAL REGISTRATION NCT02670512 . Registered: January 18, 2016.
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Affiliation(s)
- Lianne Jeffs
- Keenan Research Centre, Li Ka Shing Knowledge Institute St Michaels Hospital, 209 Victoria St, Toronto, ON, M5B 1T8, Canada.
| | - Arsh Kumar Jain
- London Health Sciences Centre, 800 Commissioners Rd E, London, ON, N6A 5W9, Canada
| | - Rachel HiuTung Man
- London Health Sciences Centre, 800 Commissioners Rd E, London, ON, N6A 5W9, Canada
| | - Nike Onabajo
- Women's College Hospital, 76 Grenville St, Toronto, ON, M5S 1B2, Canada
| | - Laura Desveaux
- Women's College Hospital, 76 Grenville St, Toronto, ON, M5S 1B2, Canada
| | - James Shaw
- Women's College Hospital, 76 Grenville St, Toronto, ON, M5S 1B2, Canada
| | - Jennifer Hensel
- Women's College Hospital, 76 Grenville St, Toronto, ON, M5S 1B2, Canada
| | - Payal Agarwal
- Women's College Hospital, 76 Grenville St, Toronto, ON, M5S 1B2, Canada
| | - Marianne Saragosa
- Women's College Hospital, 76 Grenville St, Toronto, ON, M5S 1B2, Canada
| | - Trevor Jamieson
- Keenan Research Centre, Li Ka Shing Knowledge Institute St Michaels Hospital, 209 Victoria St, Toronto, ON, M5B 1T8, Canada.,Women's College Hospital, 76 Grenville St, Toronto, ON, M5S 1B2, Canada
| | - Ivy Wong
- Women's College Hospital, 76 Grenville St, Toronto, ON, M5S 1B2, Canada
| | - Maria Maione
- Keenan Research Centre, Li Ka Shing Knowledge Institute St Michaels Hospital, 209 Victoria St, Toronto, ON, M5B 1T8, Canada
| | - R Sacha Bhatia
- Women's College Hospital, 76 Grenville St, Toronto, ON, M5S 1B2, Canada
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25
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Massol J, Janin G, Bachot C, Gousset C, Deville GSC, Chalopin JM. Pilot non dialysis chronic renal insufficiency study (P-ND-CRIS): a pilot study of an open prospective hospital-based French cohort. BMC Nephrol 2017; 18:46. [PMID: 28143424 PMCID: PMC5286676 DOI: 10.1186/s12882-017-0463-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Accepted: 01/26/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Before establishing a prospective cohort, an initial pilot study is recommended. However, there are no precise guidelines on this subject. This paper reports the findings of a French regional pilot study carried out in three nephrology departments, before realizing a major prospective Non Dialysis Chronic Renal Insufficiency study (ND-CRIS). METHODS We carried out an internal pilot study. The objectives of this pilot study were to validate the feasibility (regulatory approval, providing patients with information, availability of variables, refusal rate of eligible patients) and quality criteria (missing data, rate of patients lost to follow-up, characteristics of the patients included and non-included eligible patients, quality control of the data gathered) and estimate the human resources necessary (number of clinical research associates required). RESULTS The authorizations obtained (CCTIRS - CNIL) and the contracts signed with hospitals have fulfilled the regulatory requirements. After validating the information on the study provided to patients, 1849 of them were included in three centres (university hospital, intercommunal hospital, town hospital) between April 2012 and September 2015. The low refusal rate (51 patients) and the characteristics of non-included patients have confirmed the benefit for patients of participating in the study and provide evidence of the feasibility and representativeness of the population studied. The lack of missing data on the variables studied, the quality of the data analyzed and the low number of patients lost to follow-up are evidence of the quality of the study. By taking into account the time spent by CRAs to enter data and to travel, as well as the annual patient numbers in each hospital, we estimate that five CRAs will be required in total. CONCLUSION With no specific guidelines on how to realize a pilot study before implementing a major prospective cohort, we considered it pertinent to report our experience of P-ND-CRIS. This experience confirms that i) feasibility, ii) quality of data and iii) evaluating the resources required must be validated before carrying out a large prospective cohort study such as ND-CRIS.
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Affiliation(s)
- Jacques Massol
- Institut PHISQUARE, 20, rue Saint Saëns, 75015, Paris, France.
| | - Gérard Janin
- Centre Hospitalier de Mâcon, 350, boulevard Escande, 71018, Mâcon, Cedex, France
| | - Camille Bachot
- Institut PHISQUARE, 20, rue Saint Saëns, 75015, Paris, France
| | | | | | - Jean-Marc Chalopin
- Nephrology, CHRU de Besançon, Hôpital Jean Minjoz, 3, boulevard Alexandre Fleming, 25030, Besançon, France
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26
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Small C, Kramer HJ, Griffin KA, Vellanki K, Leehey DJ, Bansal VK, Markossian TW. Non-dialysis dependent chronic kidney disease is associated with high total and out-of-pocket healthcare expenditures. BMC Nephrol 2017; 18:3. [PMID: 28056852 PMCID: PMC5217199 DOI: 10.1186/s12882-016-0432-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 12/21/2016] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Previous studies have documented the high costs of non-dialysis dependent chronic kidney disease (CKD) but out-of-pocket healthcare expenditures remain poorly explored. This study described total direct and out-of-pocket expenditures for adults with non-dialysis dependent CKD and compared expenditures with those for cancer or stroke. METHODS This study used data from the 2011-2013 Medical Expenditure Panel Survey, a national survey of healthcare expenditures in the U.S. POPULATION Expenditures were determined for adults with the following chronic diseases: CKD defined by 585 ICD9 codes (n = 52), cancer (colon, breast or bronchus/lung) (n = 870), or stroke (n = 1104). These represent adults who were aware of their conditions or visited a healthcare provider for the condition during the study period. Generalized linear models were used to estimate the marginal effects of CKD, cancer or stroke on adjusted expenditures compared to adults without CKD, cancer or stroke (n = 72,241) while controlling for demographics and co-morbidities and incorporating the sample weights of the complex survey design. RESULTS The mean age for group with CKD, cancer or stroke was 65.5, 66.1, and 68.2 years, respectively, while mean age for group without CKD, cancer or stroke was 47.8 years. Median values of total direct and out of pocket healthcare expenditures ranged from as high as $12,877 (Interquartile Range [IQR] $5031-$19,710) and $1439 ($688-$2732), respectively, with CKD, to as low as $1189 (IQR $196-$4388) and $226 (IQR $20-$764) in the group without CKD, cancer or stroke. After adjusting for demographics and comorbidities, the adjusted difference in total direct healthcare expenditures was $4746 (95% CI $1775-$7718) for CKD, $8608 (95% CI $6167-$11,049) for cancer and $5992 (95% CI $4208-$7775) for stroke vs. group without CKD, cancer or stroke. Adjusted difference in out-of-pocket healthcare expenditures was highest for adults with CKD ($760; 95% CI 0-$1745) and was larger than difference noted for cancer ($419; 95% CI 158-679) or stroke ($246; 95% CI 87-406) relative to group without CKD, cancer or stroke. CONCLUSIONS Total and out of pocket health expenditures for adults with non-dialysis dependent CKD are high and may be equal to or higher than expenditures incurred by adults with cancer or stroke.
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Affiliation(s)
- Christina Small
- Department of Public Health Sciences, Loyola University Chicago, 2160 S. First Ave, Maywood, IL, 60153, USA
| | - Holly J Kramer
- Department of Public Health Sciences, Loyola University Chicago, 2160 S. First Ave, Maywood, IL, 60153, USA.,Division of Nephrology and Hypertension, Loyola University Medical Center, Maywood, IL, USA.,Hines Veterans Affairs Medical Center, Hines, IL, USA
| | - Karen A Griffin
- Division of Nephrology and Hypertension, Loyola University Medical Center, Maywood, IL, USA.,Hines Veterans Affairs Medical Center, Hines, IL, USA
| | - Kavitha Vellanki
- Division of Nephrology and Hypertension, Loyola University Medical Center, Maywood, IL, USA.,Hines Veterans Affairs Medical Center, Hines, IL, USA
| | - David J Leehey
- Division of Nephrology and Hypertension, Loyola University Medical Center, Maywood, IL, USA.,Hines Veterans Affairs Medical Center, Hines, IL, USA
| | - Vinod K Bansal
- Division of Nephrology and Hypertension, Loyola University Medical Center, Maywood, IL, USA
| | - Talar W Markossian
- Department of Public Health Sciences, Loyola University Chicago, 2160 S. First Ave, Maywood, IL, 60153, USA.
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Damien P, Lanham HJ, Parthasarathy M, Shah NL. Assessing key cost drivers associated with caring for chronic kidney disease patients. BMC Health Serv Res 2016; 16:690. [PMID: 28031020 PMCID: PMC5192586 DOI: 10.1186/s12913-016-1922-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 11/16/2016] [Indexed: 02/06/2023] Open
Abstract
Background To examine key factors influencing chronic kidney disease (CKD) patients’ total expenditure and offer recommendations on how to reduce total cost of CKD care without compromising quality. Methods Using the 2002–2011 Medical Expenditure Panel Survey (MEPS) data, our cross-sectional study analyzed 197 patient records—79 patients with one record and 59 with two entries per patient (138 unique patients). We used three patient groups, based on international statistical classification of diseases version 9 code for condition (ICD9CODX) classification, to focus inference from the analysis: (a) non-dialysis dependent CKD, (b) dialysis and (c) transplant. Covariate information included region, demographic, co-morbid conditions and types of services. We used descriptive methods and multivariate generalized linear models to understand the impact of cost drivers. We compared actual and predicted CKD cost of care data using a hold-out sample of nine, randomly selected patients to validate the models. Results Total costs were significantly affected by treatment type, with dialysis being significantly higher than non-dialysis and transplant groups. Costs were highest in the West region of the U.S. Average costs for patients with public insurance were significantly higher than patients with private insurance (p < .0743), and likewise, for patients with co-morbid conditions over those without co-morbid conditions (p < .001). Conclusions Managing CKD patients both before and after the onset of dialysis treatment and managing co-morbid conditions in individuals with CKD are potential sources of substantial cost savings in the care of CKD patients. Comparing total costs pre and post the United States Affordable Care Act could provide invaluable insights into managing the cost-quality tradeoff in CKD care.
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Affiliation(s)
- Paul Damien
- McCombs School of Business, University of Texas in Austin, Austin, USA
| | - Holly J Lanham
- McCombs School of Business, University of Texas in Austin, Austin, USA. .,The University of Texas Health Science Center San Antonio, San Antonio, USA. .,South Texas Veterans Health Care System, San Antonio, USA.
| | | | - Nikhil L Shah
- Piedmont Clinic, Atlanta, GA, USA.,Georgia Institute of Technology, Atlanta, GA, USA
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Manjarres L, Sanchez P, Cabezas MC, Fornasini M, Freire V, Albert A. Budget impact of secondary hyperparathyroidism treatment in chronic kidney disease in an Ecuadorian social security hospital. BMC Health Serv Res 2016; 16:443. [PMID: 27566059 PMCID: PMC5002117 DOI: 10.1186/s12913-016-1671-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Accepted: 08/15/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) is a disorder with high morbidity and mortality worldwide whose complications generate multiple costs. In Ecuador, only a few healthcare institutions have implemented management protocols aimed to reduce costs and to improve the quality of life of patients. The aim of this study is to evaluate the short-term (1-year) and long-term (5-year) costs and savings in the management of secondary hyperparathyroidism (SHPT) of hemodialyzed CKD patients by comparing calcitriol and paricalcitol in a large social security hospital in Quito, Ecuador. METHODS The estimation model assessed the resources used in the management of SHPT by comparing prospectively the cost savings within 1-year and 5-year time horizon with calcitriol and paricalcitol. Hospitalization, erythropoietin (EPO), treatment doses, intravenous iron consumption, and medical supplies were estimated according international references, based on the initial parathormone level (iPTH) of patients. The Ecuadorian National Reference costs (2014-2015) and institutional costs were used to calculate treatment costs. A statistical sensitivity analysis was also performed. RESULTS The study was based on data from 354 patients of whom 147 (41.4 %) had a value of iPTH in the range 300-600 pg/ml, 45 (12.8 %) in the range 601-800 pg/ml, and 162 (45.7 %) over 800 pg/ml. The 1-year estimated costs per patient for calcitriol and paricalcitol, respectively, were: medication, 63.88 USD and 1,123.44 USD; EPO, 19,522.95 USD and 16,478 USD; intravenous iron 143.21 USD and 187.76 USD. Yearly hospitalization costs per patient were 11,647.99 USD with calcitriol and 8,019.41 USD with paricalcitol. Total yearly costs per patient amounted to 31,378.02 USD with calcitriol and 25,809.50 USD with paricalcitol. Total savings using paricalcitol were 5,568.52 USD per patient compared with calcitriol. The 5-year cumulative medication costs were 319 USD for calcitriol and 2,403 USD for paricalcitol; EPO with calcitriol was 97,615 USD and with paricalcitol 82,394 USD; intravenous iron with calcitriol was 716 USD and paricalcitol 939 USD. Hospitalization costs for patients with calcitriol and paricalcitol were 43,095 USD and 62,595 USD, respectively. Total savings using paricalcitol amounted 32,414 USD per patient compared with calcitriol. CONCLUSIONS Paricalcitol use generated more cost savings than calcitriol after 1 and 5 years.
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Affiliation(s)
- Luis Manjarres
- Nephrology Service, Carlos Andrade Marin Hospital, Quito, Ecuador
| | - Pilar Sanchez
- Nephrology Service, Carlos Andrade Marin Hospital, Quito, Ecuador
| | - María C Cabezas
- Medical School, Pontifical Catholic University of Ecuador, Quito, Ecuador. .,Health & Research Services, Quito, Ecuador.
| | - Marco Fornasini
- Translational Research Center, Universidad de las Américas (UDLA), Quito, Ecuador
| | - Valeria Freire
- Medical School, Pontifical Catholic University of Ecuador, Quito, Ecuador
| | - Adelin Albert
- Public Health Department, University of Liège, Liège, Belgium
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Valentijn PP, Biermann C, Bruijnzeels MA. Value-based integrated (renal) care: setting a development agenda for research and implementation strategies. BMC Health Serv Res 2016; 16:330. [PMID: 27481044 PMCID: PMC4970292 DOI: 10.1186/s12913-016-1586-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 07/27/2016] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Integrated care services are considered a vital strategy for improving the Triple Aim values for people with chronic kidney disease. However, a solid scholarly explanation of how to develop, implement and evaluate such value-based integrated renal care services is limited. The aim of this study was to develop a framework to identify the strategies and outcomes for the implementation of value-based integrated renal care. METHODS First, the theoretical foundations of the Rainbow Model of Integrated Care and the Triple Aim were united into one overarching framework through an iterative process of key-informant consultations. Second, a rapid review approach was conducted to identify the published research on integrated renal care, and the Cochrane Library, Medline, Scopus, and Business Source Premier databases were searched for pertinent articles published between 2000 and 2015. Based on the framework, a coding schema was developed to synthesis the included articles. RESULTS The overarching framework distinguishes the integrated care domains: 1) type of integration, 2) enablers of integration and the interrelated outcome domains, 3) experience of care, 4) population health and 5) costs. The literature synthesis indicated that integrated renal care implementation strategies have particularly focused on micro clinical processes and physical outcomes, while little emphasis has been placed on meso organisational as well as macro system integration processes. In addition, evidence regarding patients' perceived outcomes and economic outcomes has been weak. CONCLUSION These results underscore that the future challenge for researchers is to explore which integrated care implementation strategies achieve better health and improved experience of care at a lower cost within a specific context. For this purpose, this study's framework and evidence synthesis have set a developmental agenda for both integrated renal care practice and research. Accordingly, we plan further work to develop an implementation model for value-based integrated renal services.
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Affiliation(s)
- Pim P Valentijn
- Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands. .,Department Integrated Care University, Essenburgh, Hierden, The Netherlands.
| | - Claus Biermann
- Faculty of Social Science, Ruhr University Bochum, Bochum, Germany
| | - Marc A Bruijnzeels
- Jan van Es Institute, Netherlands Expert Centre Integrated Primary Care, Almere, The Netherlands
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30
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Massol J, Janin G, Bachot C, Gousset C, Sainte-Claire Deville G, Chalopin JM. The Non-Dialysis Chronic Renal Insufficiency study (ND-CRIS): an open prospective hospital-based cohort study in France. BMC Nephrol 2016; 17:92. [PMID: 27448596 PMCID: PMC4957911 DOI: 10.1186/s12882-016-0307-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 06/22/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) amounts to a heavy burden for health services. There is no long-running epidemiological tool for CKD before dialysis. We here present the protocol for a cohort of patients with "non-dialysis" CKD receiving care in the Bourgogne-Franche-Comté region of France. The aim of this cohort was to periodically describe the characteristics of patients included and their care provision, to analyse evolution in care and patients' kidney function outcomes. METHODS The ND-CRIS cohort is prevalent and incident. Patients are included in the cohort if over 18, with a glomerula filtration rate (GFR) <60 ml/min/1.73 m2, non-dialysed, informed on the research and not having opposed it, and followed by a nephrologist in one of the 9 centres in the region, (3 pilot centres joined by 6 others in 2015). All the patients are followed up, with varying time lapses according to the degree of GFR deterioration. Data is collected by clinical research assistants (CRAs) using a dedicated computerised case-report form (CRF). Professional practices are assessed using indicators defined by the French Health Authority. The follow-up of patients included should enable assessment of the evolution of their GFR and co-morbidities. The periodic descriptions should give insight into evolution in epidemiological terms. DISCUSSION The ND-CRIS meets a need in epidemiological tools in France for CKD. The cohort does claim to be representative, of ND-CKD patients receiving care from nephrologists. The open and incident nature of the cohort and the number of patients included in the ND-CRIS should provide answers to questions that cannot be answered by smaller solely prevalent cohorts. The numbers of patients included over the study period (2391 patients in 3 centres in 3 years) suggests that the figure of 5000 patients should be reached by 2017. The participation of nephrologists and the rate of inclusions point to the feasibility of the implementation of this cohort. Beyond the information to be found in the CRFs, this cohort should also enable ad hoc studies, in particular in the area of pharmaco-epidemiology, and it could later serve as a research platform and as a public health surveillance tool.
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Affiliation(s)
- Jacques Massol
- />Institut PHISQUARE, 20, rue Saint Saëns, 75015 Paris, France
| | - Gérard Janin
- />Centre Hospitalier de Mâcon, 350, boulevard Escande, 71018 Mâcon Cedex, France
| | - Camille Bachot
- />Institut PHISQUARE, 20, rue Saint Saëns, 75015 Paris, France
| | | | | | - Jean-Marc Chalopin
- />Department of Nephrology, CHRU de Besançon, Hôpital Jean Minjoz, 3, boulevard Alexandre Fleming, 25030 Besançon, France
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Kim DH, Choi BH, Ku SK, Park JH, Oh E, Kwak MK. Beneficial Effects of Sarpogrelate and Rosuvastatin in High Fat Diet/Streptozotocin-Induced Nephropathy in Mice. PLoS One 2016; 11:e0153965. [PMID: 27097221 PMCID: PMC4838298 DOI: 10.1371/journal.pone.0153965] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 04/06/2016] [Indexed: 01/18/2023] Open
Abstract
Chronic kidney disease (CKD) is a major complication of metabolic disorders such as diabetes mellitus, obesity, and hypertension. Comorbidity of these diseases is the factor exacerbating CKD progression. Statins are commonly used in patients with metabolic disorders to decrease the risk of cardiovascular complications. Sarpogrelate, a selective antagonist of 5-hydroxytryptamine (5-HT) 2A receptor, inhibits platelet aggregation and is used to improve peripheral circulation in diabetic patients. Here, we investigated the effects of sarpogrelate and rosuvastatin on CKD in mice that were subjected to a high fat diet (HFD) for 22 weeks and a single low dose of streptozotocin (STZ, 40 mg/kg). When mice were administrated sarpogrelate (50 mg/kg, p.o.) for 13 weeks, albuminuria and urinary cystatin C excretion were normalized and histopathological changes such as glomerular mesangial expansion, tubular damage, and accumulations in lipid droplets and collagen were significantly improved. Sarpogrelate treatment repressed the HFD/STZ-induced CD31 and vascular endothelial growth factor receptor-2 expressions, indicating the attenuation of glomerular endothelial proliferation. Additionally, sarpogrelate inhibited interstitial fibrosis by suppressing the increases in transforming growth factor-β1 (TGF-β1) and plasminogen activator inhibitor-1 (PAI-1). All of these functional and histological improvements were also seen in rosuvastatin (20 mg/kg) group and, notably, the combinatorial treatment with sarpogrelate and rosuvastatin showed additive beneficial effects on histopathological changes by HFD/STZ. Moreover, sarpogrelate reduced circulating levels of PAI-1 that were elevated in the HFD/STZ group. As supportive in vitro evidence, sarpogrelate incubation blocked TGF-β1/5-HT-inducible PAI-1 expression in murine glomerular mesangial cells. Taken together, sarpogrelate and rosuvastatin may be advantageous to control the progression of CKD in patients with comorbid metabolic disorders, and particularly, the use of sarpogrelate as adjunctive therapy with statins may provide additional benefits on CKD.
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Affiliation(s)
- Dong-hyun Kim
- College of pharmacy, The Catholic University of Korea, Bucheon, Gyeonggi-do, 420-743, Republic of Korea
| | - Bo-hyun Choi
- College of pharmacy, The Catholic University of Korea, Bucheon, Gyeonggi-do, 420-743, Republic of Korea
| | - Sae-Kwang Ku
- College of Korean Medicine, Daegu Haany University, Gyeongsan, Gyeonsangbuk-do, 712-715, Republic of Korea
| | - Jeong-hyeon Park
- College of pharmacy, The Catholic University of Korea, Bucheon, Gyeonggi-do, 420-743, Republic of Korea
| | - Euichaul Oh
- College of pharmacy, The Catholic University of Korea, Bucheon, Gyeonggi-do, 420-743, Republic of Korea
| | - Mi-Kyoung Kwak
- College of pharmacy, The Catholic University of Korea, Bucheon, Gyeonggi-do, 420-743, Republic of Korea
- * E-mail:
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Liu X, Liu X, Huang W, Leo S, Li Y, Liu M, Yuan H. Evening -versus morning- dosing drug therapy for chronic kidney disease patients with hypertension: a systematic review. Kidney Blood Press Res 2014; 39:427-40. [PMID: 25471279 DOI: 10.1159/000368456] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS There is a strong correlation between non-dipping status and cardiovascular events in chronic kidney disease (CKD) patients. Our study is designed to identify the effect of evening administration of antihypertensive drugs to hypertensive CKD patients. METHODS A comprehensive search of Medline, Embase, the Chinese Biomedical Literature Database, Wanfang Data, Chinese National Knowledge Infrastructure, and the Cochrane Central Register of Controlled Trials was performed in July 2014. Concurrent controlled or crossover trials (including randomized and non-randomized experimental trials) designed to evaluate the effects of evening- versus morning-dosing hypertensive drug regimens on clinical outcomes in CKD patients with hypertension were included. All statistical analyses were performed using the RevMan software, which is available free from the Cochrane Collaboration. RESULTS Seven trials involving 1277 patients were identified, and the randomized controlled trials (RCTs) and non-randomized controlled trials (non-RCTs) were classified into two groups. Taking at least one blood pressure-lowering medication at bedtime was not shown to reduce total death (P=0.056) or cardiovascular death (P=0.059) but was shown to reduce total events (P<0.001) and major cardiovascular events (P<0.001) in both RCTs and non-RCTs. Compared with a morning dosing regimen, taking antihypertensive drug in the evening significantly lowered nighttime systolic blood pressure (SBP) (P<0.0001) and diastolic blood pressure (P<0.05) in patients in the RCTs but did not affect blood pressure in patients in the non-RCTs (P<0.05). There is limited evidence from one non-RCT that taking an antihypertensive drug (benazepril 10 mg) in the evening did not increase adverse events (P=0.72) or withdrawals due to adverse events (P=0.64). CONCLUSIONS A regimen of antihypertensive drugs in the evening should be considered for CKD patients with hypertension to lower nighttime blood pressure and help prevent total events and cardiovascular mortality. More studies are needed to verify the results of this study.
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Affiliation(s)
- Xing Liu
- Department of Cardiology, the Third Xiang-Ya Hospital, Central South University, Changsha, Hunan, China
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Kowalczyk A, Kleniewska P, Kolodziejczyk M, Skibska B, Goraca A. The role of endothelin-1 and endothelin receptor antagonists in inflammatory response and sepsis. Arch Immunol Ther Exp (Warsz) 2014; 63:41-52. [PMID: 25288367 PMCID: PMC4289534 DOI: 10.1007/s00005-014-0310-1] [Citation(s) in RCA: 157] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Accepted: 07/18/2014] [Indexed: 12/12/2022]
Abstract
Endothelin-1 (ET-1) is a potent endogenous vasoconstrictor, mainly secreted by endothelial cells. It acts through two types of receptors: ETA and ETB. Apart from a vasoconstrictive action, ET-1 causes fibrosis of the vascular cells and stimulates production of reactive oxygen species. It is claimed that ET-1 induces proinflammatory mechanisms, increasing superoxide anion production and cytokine secretion. A recent study has shown that ET-1 is involved in the activation of transcription factors such as NF-κB and expression of proinflammatory cytokines including TNF-α, IL-1, and IL-6. It has been also indicated that during endotoxaemia, the plasma level of ET-1 is increased in various animal species. Some authors indicate a clear correlation between endothelin plasma level and morbidity/mortality rate in septic patients. These pathological effects of ET-1 may be abrogated at least partly by endothelin receptor blockade. ET-1 receptor antagonists may be useful for prevention of various vascular diseases. This review summarises the current knowledge regarding endothelin receptor antagonists and the role of ET-1 in sepsis and inflammation.
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Affiliation(s)
- Agata Kowalczyk
- Chair of Experimental and Clinical Physiology, Department of Cardiovascular Physiology, Medical University of Lodz, Mazowiecka 6/8, 92-215, Lodz, Poland,
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Diamantidis CJ, Becker S. Health information technology (IT) to improve the care of patients with chronic kidney disease (CKD). BMC Nephrol 2014; 15:7. [PMID: 24405907 PMCID: PMC3893503 DOI: 10.1186/1471-2369-15-7] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Accepted: 01/04/2014] [Indexed: 11/10/2022] Open
Abstract
Several reports show that patients with chronic disease who are empowered with information technology (IT) tools for monitoring, training and self-management have improved outcomes, however there are few such applications employed in kidney disease. This review explores the current and potential uses of health IT platforms to advance kidney disease care by offering innovative solutions to inform, engage and communicate with individuals with CKD.
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