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Yuan G, Yang Y, Lin Y, Lin J, Wu Y. Current status and development trends in CKD with frailty research from 2000 to 2021: a bibliometric analysis. Ren Fail 2024; 46:2292142. [PMID: 38178378 PMCID: PMC10773684 DOI: 10.1080/0886022x.2023.2292142] [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: 04/12/2023] [Accepted: 12/01/2023] [Indexed: 01/06/2024] Open
Abstract
INTRODUCTION The prevalence of chronic kidney disease (CKD) is gradually increasing in the elderly population. At the same time, frailty has become one of the research hotspots in the field of geriatrics. Bibliometric analyses help to understand the direction of a field. Therefore, this study aimed to analyze the status and emerging trends of frailty in CKD patients. DATA AND METHODS The Web of Science Core Collection (WoSCC) database was screened for relevant literature published between 1 January 2000 and 31 December 2021. Next, publications were analyzed for information including authors, journals, cited references, citing journals, institutions, countries and regions, high-frequency keywords and co-citations using VOSviewer, Microsoft Excel, and R software. RESULTS A total of 2223 articles were obtained, from which 613 relevant articles were selected based on title and abstract screening. There was an upward trend in the number of annual publications and Johansen KL was considered the most contributing author in the field. The Clinical Journal of the American Society of Nephrology was the most productive research journal. Johns Hopkins University is the most published organization. The United States is the global leader in the field and contributes the most to research. Research hotspots focus on epidemiological studies of frailty and frailty intervention. CONCLUSIONS This study presents a comprehensive bibliometric analysis of CKD and frailty research. Key findings highlight the current focus on early screening and assessment of frailty in CKD patients, as well as physical function interventions in frail patients.
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Affiliation(s)
- Guowei Yuan
- The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
- Department of Hemodialysis, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Yaqin Yang
- The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
- Department of Hemodialysis, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Yujie Lin
- The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jiarong Lin
- The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
- Department of Hemodialysis, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Yuchi Wu
- The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
- Department of Hemodialysis, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
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Sawant-Basak A, Urva S, Mukker JK, Haertter S, Mariano D, Parasrampuria DA, Goteti K, Singh RSP, Chiney M, Liao MZ, Chang SS, Mehta R. Role of Clinical Pharmacology in Diversity and Inclusion in Global Drug Development: Current Practices and Industry Perspectives: White Paper. Clin Pharmacol Ther 2024. [PMID: 38973127 DOI: 10.1002/cpt.3350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 05/24/2024] [Indexed: 07/09/2024]
Abstract
The 2022 United States Food and Drug Administration (US FDA) draft guidance on diversity plan (DP), which will be implemented through the Diversity Action Plans by December 2025, under the 21st Century Cures Act, marks a pivotal effort by the FDA to ensure that registrational studies adequately reflect the target patient populations based on diversity in demographics and baseline characteristics. This white paper represents the culminated efforts of the International Consortium of Quality and Innovation (IQ) Diversity and Inclusion (D&I) Working Group (WG) to assess the implementation of the draft FDA guidance by members of the IQ consortium in the discipline of clinical pharmacology (CP). This article describes current practices in the industry and emphasizes the tools and techniques of quantitative pharmacology that can be applied to support the inclusion of a diverse population during global drug development, to support diversity and inclusion of underrepresented patient populations, in multiregional clinical trials (MRCTs). It outlines strategic and technical recommendations to integrate demographics, including age, sex/gender, race/ethnicity, and comorbidities, in multiregional phase III registrational studies, through the application of quantitative pharmacology. Finally, this article discusses the challenges faced during global drug development, which may otherwise limit the enrollment of a broader, potentially diverse population in registrational trials. Based on the outcomes of the IQ survey that provided the current awareness of diversity planning, it is envisioned that in the future, industry efforts in the inclusion of previously underrepresented populations during global drug development will culminate in drug labels that apply to the intended patient populations at the time of new drug application or biologics license application rather than through post-marketing requirements.
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Affiliation(s)
- Aarti Sawant-Basak
- Clinical Pharmacology and Pharmacometrics, AstraZeneca, Waltham, MA, USA
| | - Shweta Urva
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, USA
| | - Jatinder Kaur Mukker
- EMD Serono Research and Development Institute, Inc., affiliated with Merck KGaA, Darmstadt, Germany., Billerica, Massachusetts, USA
| | | | - Dean Mariano
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, USA
| | | | - Kosalaram Goteti
- EMD Serono Research and Development Institute, Inc., affiliated with Merck KGaA, Darmstadt, Germany., Billerica, Massachusetts, USA
| | | | | | | | | | - Rashmi Mehta
- Clinical Pharmacology Modeling and Simulation, GSK PLC, Durham, North Carolina, USA
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Wang YC, Ho HY, Kuo LP, Fang SY, Chiu MH, Liu ZY, Lam CF, Huang YC, Roan JN. Proprotein Convertase Subtilisin/Kexin Type 9 Inhibitor Improves the Vascular Function of Arteriovenous Fistula in Rats with Hyperglycemia. ACTA CARDIOLOGICA SINICA 2024; 40:421-436. [PMID: 39045368 PMCID: PMC11261354 DOI: 10.6515/acs.202407_40(4).20240510a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 05/10/2024] [Indexed: 07/25/2024]
Abstract
Objectives Few evidence-based medications to improve the primary patency of arteriovenous fistulas in patients with diabetes who require hemodialysis are available. We investigated whether proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) could improve arteriovenous fistula function through pleiotropic effects in a rat model of hyperglycemia. Methods Ex vivo effects of PCSK9i on the aorta of Sprague-Dawley (SD) rats were investigated using an organ bath system. For in vivo experiments, an abdominal aortocaval (AC) fistula was generated in SD rats (200-250 g) after inducing hyperglycemia through streptozotocin administration (80 mg/kg, intraperitoneal). Alirocumab (50 mg/kg/week, subcutaneous) was administered on the day of fistula surgery and day 7. Echocardiography, blood flow through the aorta-limb, vasomotor reactivity, and serum biochemistry were examined on D14. Furthermore, enzyme-linked immunosorbent assay and immunoblotting were performed. Results PCSK9i induced aorta relaxation ex vivo through a potassium channel-associated mechanism. PCSK9i significantly improved blood flow and preserved endothelial function without changes in cardiac function and serum lipid levels in rats with hyperglycemia. The levels of lectin-like oxidized low-density lipoprotein receptor-1, superoxide dismutase, cyclooxygenase-2, caspase-1, and interleukin-1β were significantly reduced in the treatment group. PCSK9i decreased the ratio of phosphorylated to total p38 mitogen-activated protein kinase and extracellular signal-regulated kinase in the aorta of rats with hyperglycemia. Conclusions Short-term treatment with PCSK9i preserved endothelial function, induced vascular dilatation, and increased blood flow in the AC fistula of rats with hyperglycemia. The pleiotropic mechanisms were associated with the suppression of oxidative stress and tissue inflammation during hyperglycemia.
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Affiliation(s)
- Yi-Chen Wang
- Division of Cardiovascular Surgery, Department of Surgery
| | - Hsin-Yu Ho
- Division of Cardiovascular Surgery, Department of Surgery
| | - Lan-Pin Kuo
- Division of Cardiovascular Surgery, Department of Surgery
| | - Shih-Yuan Fang
- Department of Anesthesiology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan
| | - Meng-Hsuan Chiu
- Department of Anesthesiology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan
| | - Zhi-Yan Liu
- Division of Cardiovascular Surgery, Department of Surgery
| | - Chen-Fuh Lam
- Department of Anesthesiology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chia-Yi
| | - Yu-Ching Huang
- Division of Cardiovascular Surgery, Department of Surgery
| | - Jun-Neng Roan
- Division of Cardiovascular Surgery, Department of Surgery
- Medical Device Innovation Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Kitala-Tańska K, Kania-Zimnicka E, Tański D, Kwella N, Stompór T, Stompór M. Prevalence and Management of Chronic Pain, Including Neuropathic Pain, in Dialysis Patients with End-Stage Renal Disease. Med Sci Monit 2024; 30:e943808. [PMID: 38751083 PMCID: PMC11107387 DOI: 10.12659/msm.943808] [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: 01/15/2024] [Accepted: 02/22/2024] [Indexed: 05/23/2024] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) is a growing global health concern. Chronic pain, as a common symptom of CKD, particularly among patients with end-stage renal disease (ESRD), is influenced by complications, dialysis procedures, and comorbidities. We aimed to evaluate chronic pain and probable neuropathic pain in 96 dialysis patients with ESRD using the Douleur Neuropathique 4 (DN4) questionnaire. MATERIAL AND METHODS A total of 96 patients from a single dialysis center were enrolled for the purpose of this study. ESRD was caused by diseases causing kidney damage, such as diabetes. The average duration of maintenance dialysis was 4.6±5.67 years. Comorbidities, functional and mental assessment, and pharmacological treatment data were collected using a questionnaire. The satisfaction with life scale was also used. Chronic pain was defined as lasting more than 3 months. The DN4 was used to determine the neuropathic component of pain. RESULTS Chronic pain was observed in 63.5% of the study participants, with 47.5% of them reporting the presence of neuropathic pain accompanied by a neuropathic component. Significantly more patients with chronic pain reported mood disorders and reduced life satisfaction, but there was no difference in their activities of daily living-assessed functional status or duration of dialysis. Patients experiencing chronic pain received non-steroidal anti-inflammatory drugs, paracetamol, and opioids. CONCLUSIONS Chronic pain, especially with a neuropathic component, is highly prevalent in patients with CKD, and its treatment remains ineffective. Undiagnosed components of pain can contribute to underdiagnosis and inadequate therapy. Further studies and staff education are needed to address this important issue.
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Affiliation(s)
- Klaudia Kitala-Tańska
- Department of Pharmacology and Toxicology, Faculty of Medicine, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland
| | - Ewa Kania-Zimnicka
- Students’ Scientific Society of Geriatrics, University of Warmia and Mazury, Olsztyn, Poland
| | - Damian Tański
- Department of Cytophysiology, Chair of Histology and Embryology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Norbert Kwella
- Department of Internal Medicine, University of Warmia and Mazury, Olsztyn, Poland
| | - Tomasz Stompór
- Department of Internal Medicine, University of Warmia and Mazury, Olsztyn, Poland
| | - Małgorzata Stompór
- Department of Family Medicine and Infectious Diseases, University of Warmia and Mazury, Olsztyn, Poland
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Tsartsalis D, Dimitroglou Y, Kalompatsou A, Koukos M, Patsourakos D, Tolis E, Tzoras S, Petras D, Tsioufis C, Aggeli C. Resting strain analysis to identify myocardial ischemia in patients with advanced chronic kidney disease. Clin Physiol Funct Imaging 2024; 44:240-250. [PMID: 38314900 DOI: 10.1111/cpf.12871] [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: 07/05/2023] [Revised: 01/14/2024] [Accepted: 01/18/2024] [Indexed: 02/07/2024]
Abstract
BACKGROUND Chronic kidney disease (CKD) is associated with higher incidence of cardiovascular death. Screening for coronary artery disease in asymptomatic or mildly symptomatic patients is challenging. OBJECTIVE The aim of this study was to investigate the incremental value of resting deformation analysis in predicting positive results for myocardial ischemia during stress transthoracic echocardiography in patients with end-stage CKD. METHODS Sixty-one patients (mean age: 62.3 ± 11.8, 65.7% men) with end-stage CKD were included in the study. Patients underwent a resting transthoracic echocardiogram and a dobutamine stress contrast echo (DSE) protocol. Positive results of DSE were defined as stress-induced left ventricular (LV) wall motion abnormalities. RESULTS The study cohort had normal or mildly impaired systolic function: mean LV ejection fraction (EF) was 49.2% (±10.4) and mean LV global longitudinal strain (GLS) was 14.4% (±4.5). Half of our population had impaired left atrial (LA) strain: mean LA reservoir, conduit, and contractile reserve were 24.1% (±12.6), 10.6% (±5.9), and 13.6% (±9.2), respectively. DSE was positive for ischemia in 55.7%. A significant negative association with DSE results was found for LV EF, LV GLS and the conduit phase of LA strain. Both LV and LA dimensions showed positive correlation with presence of ischemia in DSE. Multivariate logistic regression analysis showed that LV GLS was independently associated with DSE (p = 0.007), after controlling for covariates, with high diagnostic accuracy. CONCLUSION Resting LV deformation could predict positive results during DSE, thus may be useful to better identify renal patients who might benefit from coronary artery screening.
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Affiliation(s)
- Dimitrios Tsartsalis
- First Department of Cardiology, 'Hippokration' Hospital, University of Athens, Medical School, Athens, Greece
| | - Yannis Dimitroglou
- First Department of Cardiology, 'Hippokration' Hospital, University of Athens, Medical School, Athens, Greece
| | - Argyro Kalompatsou
- First Department of Cardiology, 'Hippokration' Hospital, University of Athens, Medical School, Athens, Greece
| | - Markos Koukos
- First Department of Cardiology, 'Hippokration' Hospital, University of Athens, Medical School, Athens, Greece
| | - Dimitrios Patsourakos
- First Department of Cardiology, 'Hippokration' Hospital, University of Athens, Medical School, Athens, Greece
| | - Elias Tolis
- First Department of Cardiology, 'Hippokration' Hospital, University of Athens, Medical School, Athens, Greece
| | - Spiros Tzoras
- Department of Clinical Physiology, Akademiska Sjukhuset, Uppsala, Sweden
| | - Dimitrios Petras
- Department of Nephrology, 'Hippokration' Hospital, Athens, Greece
| | - Costas Tsioufis
- First Department of Cardiology, 'Hippokration' Hospital, University of Athens, Medical School, Athens, Greece
| | - Constantina Aggeli
- First Department of Cardiology, 'Hippokration' Hospital, University of Athens, Medical School, Athens, Greece
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Mourchid R, Yassine A, Bellahcen M, Cherrah Y, Serragui S. Chronic kidney disease in America, Africa, and Asia: Overview of treatment cost and options. ANNALES PHARMACEUTIQUES FRANÇAISES 2024; 82:392-400. [PMID: 38218427 DOI: 10.1016/j.pharma.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 01/02/2024] [Accepted: 01/07/2024] [Indexed: 01/15/2024]
Abstract
Chronic kidney disease (CKD) is one of the non-infectious diseases that threaten patients' lives on a daily basis. Its prevalence is high, but under-reported by patients and those living with the disease, as it is silent and asymptomatic in the early stages. Kidney disease increases the risk of heart and vascular disease. These problems can manifest themselves slowly, over a long period of time. Early detection and treatment can often prevent chronic kidney disease from worsening. As kidney disease progresses, it can lead to kidney failure, requiring dialysis or a kidney transplant to stay alive. In this narrative review, we will mainly discuss different treatment option costs in different countries and how much they cost healthcare systems in countries in three different continents.
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Affiliation(s)
- Rania Mourchid
- Pharmaco-epidemiology and pharmacoeconomics research team, Pharmacology and Toxicology Laboratory, Faculty of Medicine and Pharmacy, Mohammed V University, 10100 Rabat, Morocco.
| | - Amal Yassine
- National health Insurance agency, 10100 Rabat, Morocco.
| | - Mohammed Bellahcen
- Hemodialysis Center Fondation Amal Hay Nahda Rabat, 10210 Rabat, Morocco.
| | - Yahia Cherrah
- Pharmaco-epidemiology and pharmacoeconomics research team, Pharmacology and Toxicology Laboratory, Faculty of Medicine and Pharmacy, Mohammed V University, 10100 Rabat, Morocco.
| | - Samira Serragui
- Pharmaco-epidemiology and pharmacoeconomics research team, Pharmacology and Toxicology Laboratory, Faculty of Medicine and Pharmacy, Mohammed V University, 10100 Rabat, Morocco.
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Fisher AT, Mulaney-Topkar B, Sheehan BM, Garcia-Toca M, Sorial E, Sgroi MD. Association between heart failure and arteriovenous access patency in patients with end-stage renal disease on hemodialysis. J Vasc Surg 2024; 79:1187-1194. [PMID: 38157996 DOI: 10.1016/j.jvs.2023.12.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 11/17/2023] [Accepted: 12/19/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Heart disease and chronic kidney disease are often comorbid conditions owing to shared risk factors, including diabetes and hypertension. However, the effect of congestive heart failure (CHF) on arteriovenous fistula (AVF) and AV graft (AVG) patency rates is poorly understood. We hypothesize preexisting HF may diminish blood flow to the developing AVF and worsen patency. METHODS We conducted a single-institution retrospective review of 412 patients with end-stage renal disease who underwent hemodialysis access creation from 2015 to 2021. Patients were stratified based on presence of preexisting CHF, defined as clinical symptoms plus evidence of reduced left ventricular ejection fraction (EF) (<50%) or diastolic dysfunction on preoperative echocardiography. Baseline demographics, preoperative measures of cardiac function, and dialysis access-related surgical history were collected. Kaplan-Meier time-to-event analyses were performed for primary patency, primary-assisted patency, and secondary patency using standard definitions for patency from the literature. We assessed differences in patency for patients with CHF vs patients without CHF, patients with a reduced vs a normal EF, and AVG vs AVF in patients with CHF. RESULTS We included 204 patients (50%) with preexisting CHF with confirmatory echocardiography. Patients with CHF were more likely to be male and have comorbidities including, diabetes, chronic obstructive pulmonary disease, hypertension, and a history of cerebrovascular accident. The groups were not significantly different in terms of prior fistula history (P = .99), body mass index (P = .74), or type of hemodialysis access created (P = .54). There was no statistically significant difference in primary patency, primary-assisted patency, or secondary patency over time in the CHF vs non-CHF group (log-rank P > .05 for all three patency measures). When stratified by preoperative left ventricular EF, patients with an EF of <50% had lower primary (38% vs 51% at 1 year), primary-assisted (76% vs 82% at 1 year), and secondary patency (86% vs 93% at 1 year) rates than those with a normal EF. Difference reached significance for secondary patency only (log-rank P = .029). AVG patency was compared against AVF patency within the CHF subgroup, with significantly lower primary-assisted (39% vs 87% at 1 year) and secondary (62% vs 95%) patency rates for AVG (P < .0001 for both). CONCLUSIONS In this 7-year experience of hemodialysis access creation, reduced EF is associated with lower secondary patency. Preoperative CHF (including HF with reduced EF and HF with preserved EF together) is not associated with significant differences in overall hemodialysis access patency rates over time, but patients with CHF who receive AVG have markedly worse patency than those who receive AVF. For patients with end-stage renal disease and CHF, the risks and benefits must be carefully weighed, particularly for those with low EF or lack of a suitable vein for fistula creation.
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Affiliation(s)
- Andrea T Fisher
- Division of Vascular Surgery, Stanford University School of Medicine, Stanford, CA.
| | - Bianca Mulaney-Topkar
- Division of Vascular Surgery, Stanford University School of Medicine, Stanford, CA; Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA
| | - Brian M Sheehan
- Division of Vascular Surgery, Stanford University School of Medicine, Stanford, CA; Division of Vascular Surgery, Intermountain Health, Salt Lake City, UT
| | - Manuel Garcia-Toca
- Division of Vascular Surgery, Stanford University School of Medicine, Stanford, CA; Division of Vascular Surgery, Emory University School of Medicine, Atlanta, GA
| | - Ehab Sorial
- Division of Vascular Surgery, Stanford University School of Medicine, Stanford, CA; Vascular and Interventional Specialists of Orange County, Orange, CA
| | - Michael D Sgroi
- Division of Vascular Surgery, Stanford University School of Medicine, Stanford, CA
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Bakari AI, Yahaya JJ, Matobogolo BM, Abraham ZS, Mpondo B. Adequacy of haemodialysis and associated factors among patients with end-stage kidney disease in Tanzania. J Taibah Univ Med Sci 2024; 19:287-295. [PMID: 38283378 PMCID: PMC10821596 DOI: 10.1016/j.jtumed.2023.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 12/07/2023] [Accepted: 12/25/2023] [Indexed: 01/30/2024] Open
Abstract
Objectives Adequate haemodialysis helps maintain normal renal function by removing toxins and other waste products in patients with end-stage kidney disease. This study was aimed at determining the prevalence and predictors of adequacy of haemodialysis and outcomes in patients with end-stage kidney disease. Methods This longitudinal analytical hospital-based study was conducted at two dialysis centres in Dodoma city, Tanzania, between February and July of 2020. Adequacy of haemodialysis was measured with single-pool (sp) Kt/V and urea reduction rate (URR) formulae. Binary logistic regression and multivariable analysis were used to assess the independent predictors of adequacy of haemodialysis. Results The analysis included 100 patients with a mean age of 50.6 ± 15.0 years. The prevalence of adequacy of haemodialysis according to URR and sp-Kt/V was 72 % and 75 %, respectively. Having <12 months since dialysis initiation (AOR = 7.3, 95 % CI = 0.11-0.90, p = 0.032), fewer than three dialysis sessions per week (AOR = 6.9, 95 % CI = 1.52-31.49, p = 0.013) and severe anaemia (AOR = 2.2, 95 % CI = 0.26-0.93, p = 0.033) were predictors of inadequate haemodialysis, according to the URR formula. Having fewer than three dialysis sessions per week was significantly associated with inadequate haemodialysis (AOR = 5.6, 95 % CI = 1.47-19.66, p = 0.011), according to the sp-Kt/V formula. The mortality rate was 11.2 %, and cardiovascular disease and uremic syndrome were responsible for most deaths. Conclusion This study indicated a high percentage of adequacy of haemodialysis among patients with end-stage kidney disease. Having fewer than three dialysis sessions per week, late initiation of dialysis after diagnosis of end-stage kidney disease and severe anaemia were predictors of inadequate haemodialysis among patients.
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Affiliation(s)
- Abilah I. Bakari
- Department of Internal Medicine, School of Medicine and Dentistry, University of Dodoma, Dodoma, Tanzania
| | - James J. Yahaya
- Department of Pathology, School of Health Sciences, Soroti University, Soroti, Uganda
| | - Boaz M. Matobogolo
- Department of Internal Medicine, School of Medicine and Dentistry, University of Dodoma, Dodoma, Tanzania
| | - Zephania S. Abraham
- Department of Surgery, School of Medicine and Dentistry, University of Dodoma, Dodoma, Tanzania
| | - Bonaventura Mpondo
- Department of Internal Medicine, School of Medicine and Dentistry, University of Dodoma, Dodoma, Tanzania
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Mavrogeorgis E, Valkenburg S, Siwy J, Latosinska A, Glorieux G, Mischak H, Jankowski J. Integration of Urinary Peptidome and Fecal Microbiome to Explore Patient Clustering in Chronic Kidney Disease. Proteomes 2024; 12:11. [PMID: 38651370 PMCID: PMC11036268 DOI: 10.3390/proteomes12020011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 03/15/2024] [Accepted: 03/22/2024] [Indexed: 04/25/2024] Open
Abstract
Millions of people worldwide currently suffer from chronic kidney disease (CKD), requiring kidney replacement therapy at the end stage. Endeavors to better understand CKD pathophysiology from an omics perspective have revealed major molecular players in several sample sources. Focusing on non-invasive sources, gut microbial communities appear to be disturbed in CKD, while numerous human urinary peptides are also dysregulated. Nevertheless, studies often focus on isolated omics techniques, thus potentially missing the complementary pathophysiological information that multidisciplinary approaches could provide. To this end, human urinary peptidome was analyzed and integrated with clinical and fecal microbiome (16S sequencing) data collected from 110 Non-CKD or CKD individuals (Early, Moderate, or Advanced CKD stage) that were not undergoing dialysis. Participants were visualized in a three-dimensional space using different combinations of clinical and molecular data. The most impactful clinical variables to discriminate patient groups in the reduced dataspace were, among others, serum urea, haemoglobin, total blood protein, urinary albumin, urinary erythrocytes, blood pressure, cholesterol measures, body mass index, Bristol stool score, and smoking; relevant variables were also microbial taxa, including Roseburia, Butyricicoccus, Flavonifractor, Burkholderiales, Holdemania, Synergistaceae, Enterorhabdus, and Senegalimassilia; urinary peptidome fragments were predominantly derived from proteins of collagen origin; among the non-collagen parental proteins were FXYD2, MGP, FGA, APOA1, and CD99. The urinary peptidome appeared to capture substantial variation in the CKD context. Integrating clinical and molecular data contributed to an improved cohort separation compared to clinical data alone, indicating, once again, the added value of this combined information in clinical practice.
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Affiliation(s)
- Emmanouil Mavrogeorgis
- Mosaiques Diagnostics GmbH, 30659 Hannover, Germany; (E.M.); (J.S.); (A.L.); (H.M.)
- Institute for Molecular Cardiovascular Research (IMCAR), RWTH Aachen University Hospital, 52074 Aachen, Germany
| | - Sophie Valkenburg
- Nephrology Unit, Department of Internal Medicine and Pediatrics, Ghent University Hospital, 9000 Ghent, Belgium; (S.V.); (G.G.)
| | - Justyna Siwy
- Mosaiques Diagnostics GmbH, 30659 Hannover, Germany; (E.M.); (J.S.); (A.L.); (H.M.)
| | - Agnieszka Latosinska
- Mosaiques Diagnostics GmbH, 30659 Hannover, Germany; (E.M.); (J.S.); (A.L.); (H.M.)
| | - Griet Glorieux
- Nephrology Unit, Department of Internal Medicine and Pediatrics, Ghent University Hospital, 9000 Ghent, Belgium; (S.V.); (G.G.)
| | - Harald Mischak
- Mosaiques Diagnostics GmbH, 30659 Hannover, Germany; (E.M.); (J.S.); (A.L.); (H.M.)
| | - Joachim Jankowski
- Institute for Molecular Cardiovascular Research (IMCAR), RWTH Aachen University Hospital, 52074 Aachen, Germany
- Experimental Vascular Pathology, Cardiovascular Research Institute Maastricht (CARIM), University of Maastricht, 6229 Maastricht, The Netherlands
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Jayanti S, Rangan GK. Advances in Human-Centered Care to Address Contemporary Unmet Needs in Chronic Dialysis. Int J Nephrol Renovasc Dis 2024; 17:91-104. [PMID: 38525412 PMCID: PMC10961023 DOI: 10.2147/ijnrd.s387598] [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: 12/23/2023] [Accepted: 03/12/2024] [Indexed: 03/26/2024] Open
Abstract
Advances in the treatment of kidney failure with chronic dialysis have stagnated over the past three decades, with over 50% of patients still managed by conventional in-hospital haemodialysis. In parallel, the demands of chronic dialysis medical care have changed and evolved due to a growing population that has higher frailty and multimorbidity. Thus, the gap between the needs of kidney failure patients and the healthcare capability to provide effective overall management has widened. To address this problem, healthcare policy has increasingly aligned towards a human-centred approach. The paradigm shift of human-centred approach places patients at the forefront of decision-making processes, ensuring that specific needs are understood and prioritised. Integration of human-centred approaches with patient care has been shown to improve satisfaction and quality of life. The aim of this narrative is to evaluate the current clinical challenges for managing kidney failure for dialysis providers; summarise current experiences and unmet needs of chronic dialysis patients; and finally emphasise how human-centred care has advanced chronic dialysis care. Specific incremental advances include implementation of renal supportive care; home-assisted dialysis; hybrid dialysis; refinements to dialysis methods; whereas emerging advances include portable and wearable dialysis devices and the potential for the integration of artificial intelligence in clinical practice.
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Affiliation(s)
- Sumedh Jayanti
- Department of Renal Medicine, Westmead Hospital, Sydney, NSW, Australia
- Michael Stern Laboratory for Polycystic Kidney Disease, Centre for Transplant and Renal Research, Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia
| | - Gopala K Rangan
- Department of Renal Medicine, Westmead Hospital, Sydney, NSW, Australia
- Michael Stern Laboratory for Polycystic Kidney Disease, Centre for Transplant and Renal Research, Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia
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11
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Wiler JL, Kosinski LR, Mills TL, Walton J. Where Are All the Specialists? Current Challenges of Integrating Specialty Care Into Population-Based Total Cost of Care Payment Models. Ann Intern Med 2024; 177:375-382. [PMID: 38466999 DOI: 10.7326/m23-2991] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/13/2024] Open
Abstract
The Centers for Medicare & Medicaid Services Innovation Center (CMMI) has set the goal for 100% of traditional Medicare beneficiaries to be part of an accountable care relationship by 2030. Lack of meaningful financial incentives, intolerable or unpredictable risk, infrastructure costs, patient engagement, voluntary participation, and operational complexity have been noted by the provider and health care delivery community as barriers to participation or reasons for exiting programs. In addition, most piloted and implemented population-based total cost of care (PB-TCOC) payment models have focused on the role of the primary care physician being the accountability (that is, attributable) leader of a patient's multifaceted care team as well as acting as the mayor of the "medical neighborhood," leaving the role of specialty care physicians undefined. Successful provider specialist integration into PB-TCOC models includes meaningful participation of specialists in achieving whole-person, high-value care where all providers are financially motivated to participate; there is unambiguous prospective attribution and clearly defined accountability for each participating party throughout the care journey or episode; there is a known care attribution transition accountability plan; there is actionable, transparent, and timely data available with appropriate data development and basic analytic costs covered; and there is advanced payment to the accountable person or entity for management of the care episode that is part of a longitudinal care plan. Payment models should be created to address the 7 challenges raised here if specialists are to be incented to join TCOC models that achieve CMMI's goal.
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Affiliation(s)
- Jennifer L Wiler
- University of Colorado School of Medicine, Aurora, Colorado (J.L.W.)
| | | | | | - James Walton
- JWalton, LLC Healthcare Advisory Services, Dallas, Texas (J.W.)
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12
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Stepanova N, Driianska V, Rysyev A, Ostapenko T, Kalinina N. IL-6 and IL-17 as potential links between pre-existing hypertension and long-term COVID sequelae in patients undergoing hemodialysis: a multicenter cross-sectional study. Sci Rep 2024; 14:4968. [PMID: 38424126 PMCID: PMC10904824 DOI: 10.1038/s41598-024-54930-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 02/19/2024] [Indexed: 03/02/2024] Open
Abstract
Long COVID, characterized by persistent symptoms following acute infection, poses a significant health challenge, particularly for patients with pre-existing chronic conditions such as hypertension. We hypothesized that an increase in the production of interleukins (IL)-6 and IL-17 could serve as a potential mechanism linking pre-existing uncontrolled blood pressure (BP) to the occurrence of long-term COVID sequelae in patients undergoing hemodialysis (HD). This cross-sectional study examined serum IL-6 and IL-17 levels in 80 patients undergoing HD, considering preinfection BP, the presence of long-term COVID sequelae, and the time interval after acute COVID-19 infection, which was either 5 or 10 months. Controlled BP was defined as a 3-month average pre-dialysis BP < 140/90 mmHg and post-dialysis < 130/80 mmHg. The findings suggest that the prevalence of long-term COVID sequelae was significantly higher in patients with uncontrolled BP than in the BP-controlled group. Both IL-6 and IL-17 concentrations were also significantly higher in patients with uncontrolled BP compared with the BP-controlled group. The patients with long-term COVID sequelae had higher IL-6 and IL-17 values than the fully recovered patients at both time points, but their concentrations decreased significantly over time. Further research and prospective studies are warranted to validate these findings.
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Affiliation(s)
- Natalia Stepanova
- Department of Nephrology and Dialysis, State Institution "Institute of Nephrology of the National Academy of Medical Sciences", Kyiv, Ukraine.
| | - Victoria Driianska
- Laboratory of Immunology, State Institution "Institute of Nephrology of the National Academy of Medical Sciences", Kyiv, Ukraine
| | - Andriy Rysyev
- Dialysis Medical Center LLC "Link-Medital", Odesa, Ukraine
| | | | - Nataliia Kalinina
- Laboratory of Immunology, State Institution "Institute of Nephrology of the National Academy of Medical Sciences", Kyiv, Ukraine
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13
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Krishnamoorthy N, Kalyan M, Hediyal TA, Anand N, Kendaganna PH, Pendyala G, Yelamanchili SV, Yang J, Chidambaram SB, Sakharkar MK, Mahalakshmi AM. Role of the Gut Bacteria-Derived Metabolite Phenylacetylglutamine in Health and Diseases. ACS OMEGA 2024; 9:3164-3172. [PMID: 38284070 PMCID: PMC10809373 DOI: 10.1021/acsomega.3c08184] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 12/19/2023] [Accepted: 12/21/2023] [Indexed: 01/30/2024]
Abstract
Over the past few decades, it has been well established that gut microbiota-derived metabolites can disrupt gut function, thus resulting in an array of diseases. Notably, phenylacetylglutamine (PAGln), a bacterial derived metabolite, has recently gained attention due to its role in the initiation and progression of cardiovascular and cerebrovascular diseases. This meta-organismal metabolite PAGln is a byproduct of amino acid acetylation of its precursor phenylacetic acid (PAA) from a range of dietary sources like egg, meat, dairy products, etc. The microbiota-dependent metabolism of phenylalanine produces PAA, which is a crucial intermediate that is catalyzed by diverse microbial catalytic pathways. PAA conjugates with glutamine and glycine in the liver and kidney to predominantly form phenylacetylglutamine in humans and phenylacetylglycine in rodents. PAGln is associated with thrombosis as it enhances platelet activation mediated through the GPCRs receptors α2A, α2B, and β2 ADRs, thereby aggravating the pathological conditions. Clinical evidence suggests that elevated levels of PAGln are associated with pathology of cardiovascular, cerebrovascular, and neurological diseases. This Review further consolidates the microbial/biochemical synthesis of PAGln and discusses its role in the above pathophysiologies.
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Affiliation(s)
- Naveen
Kumar Krishnamoorthy
- Department
of Pharmacology, JSS College of Pharmacy, JSS Academy of Higher Education and Research, Mysuru 570015, India
- Centre
for Experimental Pharmacology and Toxicology, Central Animal Facility, JSS Academy of Higher Education and Research, Mysuru 570015, India
| | - Manjunath Kalyan
- Department
of Pharmacology, JSS College of Pharmacy, JSS Academy of Higher Education and Research, Mysuru 570015, India
- Centre
for Experimental Pharmacology and Toxicology, Central Animal Facility, JSS Academy of Higher Education and Research, Mysuru 570015, India
| | - Tousif Ahmed Hediyal
- Department
of Pharmacology, JSS College of Pharmacy, JSS Academy of Higher Education and Research, Mysuru 570015, India
- Centre
for Experimental Pharmacology and Toxicology, Central Animal Facility, JSS Academy of Higher Education and Research, Mysuru 570015, India
| | - Nikhilesh Anand
- Department
of Pharmacology, College of Medicine, American
University of Antigua, P. O. Box W-1451, Saint John’s, Antigua and Barbuda
| | - Pavan Heggadadevanakote Kendaganna
- Centre
for Experimental Pharmacology and Toxicology, Central Animal Facility, JSS Academy of Higher Education and Research, Mysuru 570015, India
| | - Gurudutt Pendyala
- Department
of Anesthesiology, University of Nebraska
Medical Center (UNMC), Omaha, Nebraska 68198, United States
- Department
of Genetics, Cell Biology, and Anatomy, UNMC, Omaha, Nebraska 68198, United States
- Child Health
Research Institute, UNMC, Omaha, Nebraska 68198, United States
- National
Strategic Research Institute, UNMC, Omaha, Nebraska 68198, United States
| | - Sowmya V. Yelamanchili
- Department
of Anesthesiology, University of Nebraska
Medical Center (UNMC), Omaha, Nebraska 68198, United States
- Department
of Genetics, Cell Biology, and Anatomy, UNMC, Omaha, Nebraska 68198, United States
- National
Strategic Research Institute, UNMC, Omaha, Nebraska 68198, United States
| | - Jian Yang
- Drug
Discovery and Development Research Group, College of Pharmacy and
Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan S7N 5E5, Canada
| | - Saravana Babu Chidambaram
- Department
of Pharmacology, JSS College of Pharmacy, JSS Academy of Higher Education and Research, Mysuru 570015, India
- Centre
for Experimental Pharmacology and Toxicology, Central Animal Facility, JSS Academy of Higher Education and Research, Mysuru 570015, India
| | - Meena Kishore Sakharkar
- Drug
Discovery and Development Research Group, College of Pharmacy and
Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan S7N 5E5, Canada
| | - Arehally M. Mahalakshmi
- Department
of Pharmacology, JSS College of Pharmacy, JSS Academy of Higher Education and Research, Mysuru 570015, India
- Centre
for Experimental Pharmacology and Toxicology, Central Animal Facility, JSS Academy of Higher Education and Research, Mysuru 570015, India
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14
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Coumoundouros C, Farrand P, Sanderman R, von Essen L, Woodford J. "Systems seem to get in the way": a qualitative study exploring experiences of accessing and receiving support among informal caregivers of people living with chronic kidney disease. BMC Nephrol 2024; 25:7. [PMID: 38172754 PMCID: PMC10765659 DOI: 10.1186/s12882-023-03444-3] [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: 09/20/2023] [Accepted: 12/19/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND The well-being of informal caregivers of people living with chronic kidney disease is influenced by their experiences with support, however, few studies have focused on exploring these experiences. This study aimed to explore informal caregivers' experiences accessing and receiving support while caring for someone living with chronic kidney disease. METHODS Informal caregivers of people living with chronic kidney disease (n = 13) in the United Kingdom were primarily recruited via community organisations and social media adverts to participate in semi-structured interviews. Interviews explored support needs, experiences of receiving support from different groups (e.g. healthcare professionals, family/friends), and barriers and facilitators to accessing support. Support was understood as including emotional, practical, and informational support. Data were analysed using reflexive thematic analysis. RESULTS Three themes were generated: (1) "Systems seem to get in the way" - challenges within support systems, illustrating the challenges informal caregivers encountered when navigating complex support systems; (2) Relying on yourself, describing how informal caregivers leveraged their existing skills and networks to access support independently, while recognising the limitations of having to rely on yourself to find support; and (3) Support systems can "take the pressure off", showing how support systems were able to help informal caregivers cope with the challenges they experienced if certain conditions were met. CONCLUSIONS In response to the challenges informal caregivers experienced when seeking support, improvements are needed to better consider informal caregiver needs within healthcare systems, and to develop interventions tailored to informal caregiver needs and context. Within the healthcare system, informal caregivers may benefit from system navigation support and better integration within healthcare teams to ensure their informational support needs are met. New interventions developed to support informal caregivers should fit within their existing support systems and incorporate the qualities of support, such as empathy, that were valued. Additionally, use of an equity framework and user-centered design approaches during intervention development could help ensure interventions are accessible and acceptable.
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Affiliation(s)
- Chelsea Coumoundouros
- Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, Dag Hammarskjölds väg 14B, Uppsala, 751 05, Sweden
- Clinical Education, Development and Research (CEDAR); Psychology, University of Exeter, Exeter, UK
| | - Paul Farrand
- Clinical Education, Development and Research (CEDAR); Psychology, University of Exeter, Exeter, UK
| | - Robbert Sanderman
- Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Louise von Essen
- Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, Dag Hammarskjölds väg 14B, Uppsala, 751 05, Sweden
| | - Joanne Woodford
- Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, Dag Hammarskjölds väg 14B, Uppsala, 751 05, Sweden.
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15
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Goraya N, Montgomery AH, Kalantar-Zadeh K, Moore LW, Wesson DE. Diet is Foundational to the Management of Chronic Kidney Disease. J Ren Nutr 2024; 34:1-3. [PMID: 38160704 DOI: 10.1053/j.jrn.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 12/27/2023] [Indexed: 01/03/2024] Open
Affiliation(s)
- Nimrit Goraya
- Baylor College of Medicine, Temple, Texas; Baylor Scott & White Health, Temple, Texas
| | | | | | - Linda W Moore
- Houston Methodist Hospital, Department of Surgery, Houston, Texas
| | - Donald E Wesson
- Dell Medical School - The University of Texas at Austin, Austin, Texas.
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16
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Low JK, Crawford K, Lai J, Manias E. Factors associated with readmission in chronic kidney disease: Systematic review and meta-analysis. J Ren Care 2023; 49:229-242. [PMID: 35809061 DOI: 10.1111/jorc.12437] [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: 12/03/2021] [Revised: 05/14/2022] [Accepted: 06/05/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Risk factors associated with all-cause hospital readmission are poorly characterised in patients with chronic kidney disease. OBJECTIVE A systematic review and meta-analysis were conducted to identify risk factors and protectors of hospital readmission in chronic kidney disease. DESIGN, PARTICIPANTS & MEASUREMENTS Studies involving adult patients were identified from four databases from inception to 31/03/2020. Random-effects meta-analyses were conducted to determine factors associated with all-cause 30-day hospital readmission in general chronic kidney disease, in dialysis and in kidney transplant recipient groups. RESULTS Eighty relevant studies (chronic kidney disease, n = 14 studies; dialysis, n = 34 studies; and transplant, n = 32 studies) were identified. Meta-analysis revealed that in both chronic kidney disease and transplant groups, increasing age in years and days spent at the hospital during the initial stay were associated with a higher risk of 30-day readmission. Other risk factors identified included increasing body mass index (kg/m2 ) in the transplant group, and functional impairment and discharge destination in the dialysis group. Within the chronic kidney disease group, having an outpatient follow-up appointment with a nephrologist within 14 days of discharge was protective against readmission but this was not protective if provided by a primary care provider or a cardiologist. CONCLUSION Risk-reduction interventions that can be implemented include a nephrologist appointment within 14 days of hospital discharge, rehabilitation programme for functional improvement in the dialysis group and meal plans in the transplant group. Future risk analysis should focus on modifiable factors to ensure that strategies can be tested and implemented in those who are more at risk.
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Affiliation(s)
- Jac Kee Low
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Melbourne, Victoria, Australia
| | - Kimberley Crawford
- Monash Nursing and Midwifery, Monash University, Clayton, Victoria, Australia
| | - Jerry Lai
- eSolution, Deakin University, Geelong, Victoria, Australia
- Intersect Australia, Sydney, New South Wales, Australia
| | - Elizabeth Manias
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Melbourne, Victoria, Australia
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17
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Sirimalla S, Mateti UV, Shenoy P, Shetty S. Health Education for Chronic Kidney Disease Patients Not on Dialysis Through the Pictorial Patient Information Leaflet. J Pharm Technol 2023; 39:274-280. [PMID: 37974594 PMCID: PMC10640865 DOI: 10.1177/87551225231198988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023] Open
Abstract
Background: Educating the patient with patient information leaflets is helpful to increase understanding and awareness about chronic kidney disease. Various educational materials are available online, but their quality is mixed. The content was found to be unreliable or incomprehensible. Objective: The study aimed to develop, validate, test the readability, translation, and design of the patient information leaflet and focused on assessing patients' knowledge levels using questionnaires after providing the validated patient information leaflet. Methods: A prospective study was conducted among chronic kidney disease patients who were not on dialysis. The patient information leaflet was prepared based on experts' opinions and a thorough review of various resources. Experts validated the content of the patient information leaflet through the content validity index. After being validated, the Baker Able leaflet design scale was used to evaluate the layout and design. Knowledge assessment questions were validated using item-content validity index scores to assess patient knowledge before and after providing the patient information leaflet. Results: A total of 60 randomly selected chronic kidney disease patients were enrolled. The content validity index of the patient information leaflet was found to be 0.9. The Baker Able leaflet design score was found to be 25. Knowledge was assessed and it showed that score had increased from 42 ± 6.95 to 73.5 ± 6.70, respectively, with a P-value <0.000. Conclusion: This study concluded that the patient information leaflet was developed based on standard procedures. Significant improvement was seen in patients' knowledge after utilizing a validated patient information leaflet.
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Affiliation(s)
- Shivaprasad Sirimalla
- Department of Pharmacy Practice, NGSM Institute of Pharmaceutical Sciences (NGSMIPS), NITTE (Deemed to be University), Mangaluru, India
| | - Uday Venkat Mateti
- Department of Pharmacy Practice, NGSM Institute of Pharmaceutical Sciences (NGSMIPS), NITTE (Deemed to be University), Mangaluru, India
| | - Pradeep Shenoy
- Department of Nephrology, KS Hegde Medical Academy (KSHEMA), Justice KS Hegde Charitable Hospital, NITTE (Deemed to be University), Mangaluru, India
| | - Shraddha Shetty
- Department of Biostatistics, KS Hegde Medical Academy (KSHEMA), NITTE (Deemed to be University), Mangaluru, India
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18
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Goyal E, Puria A, Chaudhary S, Kumar A, Raj R, Kumar S. Impact of psychiatric comorbidity on quality of life and activities of daily living among patients suffering from chronic kidney disease undergoing hemodialysis. Ind Psychiatry J 2023; 32:S151-S156. [PMID: 38370951 PMCID: PMC10871403 DOI: 10.4103/ipj.ipj_218_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 05/29/2023] [Accepted: 07/20/2023] [Indexed: 02/20/2024] Open
Abstract
Introduction Chronic Kidney Disease (CKD) is a debilitating illness that impairs an individual's physical and social functioning and ultimately affects the quality of life (QOL). Aim To determine the impact of psychiatric comorbidity on QOL and activities of daily living in individuals suffering from CKD undergoing hemodialysis. Materials and Methods Fifty subjects suffering from CKD undergoing hemodialysis were consequently enrolled in the department of medicine. Institutional ethics committee permission was obtained before the start of the study. The interview was conducted only after the hemodialysis procedure. Consent was obtained and socio-demographic details were noted in the socio-demographic proforma. Schedule for Clinical Assessment in Neuropsychiatry (SCAN) was used to assess psychiatric comorbidity. QOL was assessed on Short Form-36 (SF-36). Katz Index of Independence of Activities of Daily Living scale (KADL) was used to assess the activities of living of such individuals. Results 46% (n = 23) of subjects suffering from CKD had psychiatric co-morbidity. The most common psychiatric disorder observed was moderate depressive disorder (14%, n = 7) followed by adjustment disorder (12%, n = 6). QOL on SF-36 in all eight domains was low compared to the general population. There was a high statistically significant negative impact of psychiatric comorbidity on QOL on eight domains of SF-36 and activities of daily living. (P = 0.001). Conclusion Psychiatric co-morbidity is common in CKD patients on hemodialysis. Quality of life is lower compared to the general population. There is a negative impact of psychiatric co-morbidity on quality of life and activities of daily living.
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Affiliation(s)
- Ekram Goyal
- Department of Psychiatry, Dr. B. R. Ambedkar State Institute of Medical Sciences, Mohali, Punjab, India
| | - Alka Puria
- Department of Biochemistry, Government Medical College, Patiala, Punjab, India
| | - Suprakash Chaudhary
- Department of Psychiatry, Dr. D. Y. Patil Medical College, Pimpri, Pune, Maharashtra, India
| | - Ajay Kumar
- Department of Psychiatry, Government Medical College, Patiala, Punjab, India
| | - Richa Raj
- Department of Biochemistry, DMCH Lahersarai, Darbhanga, Bihar, India
| | - Sidhartha Kumar
- Department of Microbiology, DMCH Lahersarai, Darbhanga, Bihar, India
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19
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Xu Y, Evans M, Mazhar F, Ärnlöv J, Cockburn E, Barany P, Carrero JJ. Poor recognition and undertreatment of anemia in patients with chronic kidney disease managed in primary care. J Intern Med 2023; 294:628-639. [PMID: 37463872 DOI: 10.1111/joim.13702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
BACKGROUND Anemia is a common complication of chronic kidney disease (CKD), but limited awareness and treatment options may hinder its management among CKD patients followed in primary care. METHODS We evaluated adults with CKD stages 3-5 attending primary care in Stockholm, Sweden, 2012-2018. We assessed the incidence of anemia, clinical reactions, and association with subsequent major adverse cardiovascular events (MACE) and death. RESULTS We identified 45,637 patients with CKD stages 3-5 free from anemia (mean age 78 years; 64% females; 79% CKD stage 3b). During a median follow-up of 2.4 years, 26% of patients developed anemia, and 10.4% developed severe anemia (hemoglobin <10 g/dL). Within 6 months from the anemia event, iron tests were infrequent; ferritin and transferrin saturation were tested in 27% and 11% of anemia cases, respectively, and 49% and 24% of severe anemia cases. Few patients were recognized with a clinical diagnosis (15% of anemia cases; 68% of severe anemias). Only 19% of patients with anemia received treatment, primarily iron (10%) and blood transfusions (7%); erythropoietin-stimulating agent use was anecdotal (∼1%). Treatment rates for severe anemia were higher, but 43% of patients still failed to receive treatment. Developing anemia was associated with a higher risk of MACE and death. CONCLUSION Anemia was common and associated with adverse outcomes among patients with CKD stages 3-5 managed in primary care. Iron stores were infrequently tested, and a large proportion of patients with anemia remained untreated/under-recognized.
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Affiliation(s)
- Yang Xu
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University Health Science Center, Beijing, China
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Marie Evans
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Division of Nephrology, Karolinska University Hospital, Solna, Sweden
| | - Faizan Mazhar
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Johan Ärnlöv
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | | | - Peter Barany
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Division of Nephrology, Karolinska University Hospital, Solna, Sweden
| | - Juan-Jesus Carrero
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Division of Nephrology, Department of Clinical Sciences, Danderyd Hospital, Danderyd, Sweden
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20
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Tanriover C, Copur S, Mutlu A, Peltek IB, Galassi A, Ciceri P, Cozzolino M, Kanbay M. Early aging and premature vascular aging in chronic kidney disease. Clin Kidney J 2023; 16:1751-1765. [PMID: 37915901 PMCID: PMC10616490 DOI: 10.1093/ckj/sfad076] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Indexed: 11/03/2023] Open
Abstract
Aging is the progressive decline of body functions and a number of chronic conditions can lead to premature aging characterized by frailty, a diseased vasculature, osteoporosis, and muscle wasting. One of the major conditions associated with premature and accelerated aging is chronic kidney disease (CKD), which can also result in early vascular aging and the stiffening of the arteries. Premature vascular aging in CKD patients has been considered as a marker of prognosis of mortality and cardiovascular morbidity and therefore requires further attention. Oxidative stress, inflammation, advanced glycation end products, fructose, and an aberrant gut microbiota can contribute to the development of early aging in CKD patients. There are several key molecular pathways and molecules which play a role in aging and vascular aging including nuclear factor erythroid 2-related factor 2 (Nrf-2), AMP-activated protein kinase (AMPK), sirtuin 1 (SIRT1), and klotho. Potential therapeutic strategies can target these pathways. Future studies are needed to better understand the importance of premature aging and early vascular aging and to develop therapeutic alternatives for these conditions.
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Affiliation(s)
- Cem Tanriover
- Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Sidar Copur
- Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Ali Mutlu
- Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | | | - Andrea Galassi
- Department of Health Sciences, Renal Division, University of Milan, Milan, Italy
| | - Paola Ciceri
- Department of Health Sciences, Renal Division, University of Milan, Milan, Italy
| | - Mario Cozzolino
- Department of Health Sciences, Renal Division, University of Milan, Milan, Italy
| | - Mehmet Kanbay
- Department of Medicine, Division of Nephrology, Koc University School of Medicine, Istanbul, Turkey
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21
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Edyko K, Edyko P, Nowicka M, Kurnatowska I. Assessments of and Attitudes towards Specialist Teleconsultations among Nephrology and Posttransplant Outpatients during the COVID-19 Pandemic. Healthcare (Basel) 2023; 11:2737. [PMID: 37893811 PMCID: PMC10606026 DOI: 10.3390/healthcare11202737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 09/28/2023] [Accepted: 09/29/2023] [Indexed: 10/29/2023] Open
Abstract
In Poland, teleconsultations (TCs) were not legally regulated or even conducted until the COVID-19 pandemic, which necessitated their abrupt implementation and posed a challenge to patients and doctors. The aim of this study was to assess the quality of TCs and the satisfaction with this mode of consultation among nephrology and kidney transplant outpatients with a high risk of severe courses of SARS-CoV-2 infection. A self-designed questionnaire regarding patients' demographics; digital fluency; and participation in, satisfaction with, and attitude towards TCs was distributed among patients in the nephrology and posttransplant outpatient clinics at two hospitals in central Poland. The questionnaires were completed by 294 adult patients, of whom 72.1% (n = 212) had participated in TCs at one of the abovementioned clinics. Almost all (96.7%) of the TCs were conducted via phone, and in 94.8% of cases, they fulfilled the purpose of the consultation. The most commonly reported advantages were not having to leave home and the reduced risk of infection. Only a few patients felt that TCs offer no advantages. The patients' profiles and demographic data had no significant effect on their assessments of teleconsultations. Despite the overall positive rating given to TCs, patients unhesitatingly indicated that a face-to-face visit would be a preferable way to contact a specialist.
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Affiliation(s)
- Krzysztof Edyko
- Student Scientific Society Affiliated with the Department of Internal Medicine and Transplant Nephrology, Chair of Pulmonology, Rheumatology, and Clinical Immunology, Medical University of Łódź, Tadeusza Kościuszki 4, 90-419 Łódź, Poland
| | - Paweł Edyko
- Student Scientific Society Affiliated with the Department of Internal Medicine and Transplant Nephrology, Chair of Pulmonology, Rheumatology, and Clinical Immunology, Medical University of Łódź, Tadeusza Kościuszki 4, 90-419 Łódź, Poland
| | - Maja Nowicka
- Department of Internal Medicine and Transplant Nephrology, Chair of Pulmonology, Rheumatology, and Clinical Immunology, Medical University of Łódź, Kopcińskiego 22, 90-153 Łódź, Poland
| | - Ilona Kurnatowska
- Department of Internal Medicine and Transplant Nephrology, Chair of Pulmonology, Rheumatology, and Clinical Immunology, Medical University of Łódź, Kopcińskiego 22, 90-153 Łódź, Poland
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Zafar R, Rehman IU, Shah Y, Ming LC, Goh HP, Goh KW. Comparative analysis of potential drug-drug interactions in a public and private hospital among chronic kidney disease patients in Khyber Pakhtunkhwa: A retrospective cross-sectional study. PLoS One 2023; 18:e0291417. [PMID: 37773947 PMCID: PMC10540949 DOI: 10.1371/journal.pone.0291417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 08/29/2023] [Indexed: 10/01/2023] Open
Abstract
INTRODUCTION Chronic kidney disease (CKD) is a significant public health challenge due to its rising incidence, mortality, and morbidity. Patients with kidney diseases often suffer from various comorbid conditions, making them susceptible to potential drug-drug interactions (pDDIs) due to polypharmacy and multiple prescribers. Inappropriate prescriptions for CKD patients and their consequences in the form of pDDIs are a major challenge in Pakistan. AIM This study aimed to compare the incidence and associated risk factors of pDDIs among a public and private sector hospital in Khyber Pakhtunkhwa, Pakistan. METHOD A retrospective cross-sectional study design was conducted to compare pDDIs among public and private sector hospitals from January 2023 to February 2023. Patients profile data for the full year starting from January 1 2022 to December 302022, was accessed All adult patients aged 18 years and above, of both genders, who currently have or have previously been diagnosed with end-stage renal disease (ESRD) were included. For assessing pDDIs, patient data was retrieved and checked using Lexicomp UpToDate® for severity and documentation of potential drug-drug interactions. RESULTS A total of 358 patients' data was retrieved (with n = 179 in each hospital); however, due to incomplete data, n = 4 patients were excluded from the final analysis. The prevalence of pDDIs was found to be significantly higher in private hospitals (84.7%) than in public hospitals (26.6%), with a p-value <0.001. Patients in the age category of 41-60 years (AOR = 6.2; p = 0.008) and those prescribed a higher number of drugs (AOR = 1.2; p = 0.027) were independently associated with pDDIs in private hospitals, while the higher number of prescribed drugs (AOR = 2.9; p = <0.001) was an independent risk factor for pDDIs in public hospitals. The majority of pDDIs (79.0%) were of moderate severity, and a significant number of patients (15.1%) also experienced major pDDIs, with a p-value <0.001. The majority of pDDIs had fair documentation for reliability rating in both public and private hospitals. CONCLUSION The prevalence of pDDIs was higher among CKD patients at private hospitals, and most of the pDDIs were of moderate severity. A considerable number of patients also experienced major pDDIs. The risk of experiencing pDDIs was found to be higher in older patients and among those prescribed a higher number of drugs.
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Affiliation(s)
- Roheena Zafar
- Department of Pharmacy, Garden Campus, Abdul Wali Khan University Mardan, Mardan, Pakistan
- Department of Pharmacy, North West General Hospital and Research Center, Hayatabad Peshawar, Pakistan
| | - Inayat Ur Rehman
- Department of Pharmacy, Garden Campus, Abdul Wali Khan University Mardan, Mardan, Pakistan
| | - Yasar Shah
- Department of Pharmacy, Garden Campus, Abdul Wali Khan University Mardan, Mardan, Pakistan
| | - Long Chiau Ming
- School of Medical and Life Sciences, Sunway University, Bandar Sunway, Malaysia
| | - Hui Poh Goh
- PAPRSB Institute of Health Sciences, Universiti Brunei Darussalam, Bandar Seri Begawan, Brunei Darussalam
| | - Khang Wen Goh
- Faculty of Data Science and Information Technology, INTI International University, Nilai, Malaysia
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Li L, Liu H, Zhang Q, Jin H, Tao H, Zhu R, Zhou Z. Serum amyloid A and risks of all-cause and cardiovascular mortality in chronic kidney disease: a systematic review and dose-response meta-analysis. Ren Fail 2023; 45:2250877. [PMID: 37930241 PMCID: PMC10512819 DOI: 10.1080/0886022x.2023.2250877] [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: 05/08/2023] [Accepted: 08/17/2023] [Indexed: 11/07/2023] Open
Abstract
BACKGROUNDS The available literature on the correlation between serum amyloid A (SAA) and prognosis of chronic kidney disease (CKD) are limited, and the findings from existing studies are inconclusive. This meta-analysis aimed to evaluate the available evidence regarding the link between SAA and risks of all-cause and cardiovascular mortality in CKD patients. Additionally, we aimed to investigate the potential dose-response relationships, provided that adequate data is accessible. METHODS Pubmed and Embase were searched for related literature (last update: 12 July 2023). The pooled effect estimates were calculated using random- or fixed-effects models depending on heterogeneity among studies. RESULTS This meta-analysis incorporated 8 studies encompassing 2331 CKD patients. The findings revealed an 85% increase in all-cause mortality risk [hazard risk (HR) 1.85, 95% confidence interval (CI) 1.29-2.65] and a 39% increase in cardiovascular mortality risk (HR 1.07, 95% CI 1.07-1.80) when comparing the highest tertile of baseline SAA levels to the lowest tertile. Furthermore, a positive linear relationship between SAA and all-cause mortality risk was observed (Pnon-linearity = 0.959), with a 17.7% increase in risk for each 10 mg/L SAA increase (HR 1.177, 95% CI 1.055-1.313). Similarly, a linear relationship between SAA and cardiovascular mortality risk was identified (Pnon-linearity = 0.477) with a 19.3% increase in risk for each 10 mg/L SAA increase (HR 1.193, 95% CI 1.025-1.388). CONCLUSIONS This meta-analysis provided evidence that SAA levels are positively and linearly associated with risks of all-cause and cardiovascular mortality among CKD patients.
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Affiliation(s)
- Li Li
- Department of Clinical Laboratory, Binhai County People’s Hospital, Binhai, China
| | - Hongli Liu
- Department of Clinical Laboratory, Nantong Tumor Hospital, Tumor Hospital Affiliated to Nantong University, China
| | - Qinglin Zhang
- Department of Blood Transfusion, Affiliated Hospital 6 of Nantong University, The Yancheng School of Clinical Medicine of Nanjing Medical University, Yancheng Third People’s Hospital, Jiangsu, China
| | - Hao Jin
- Department of Blood Transfusion, Affiliated Hospital 6 of Nantong University, The Yancheng School of Clinical Medicine of Nanjing Medical University, Yancheng Third People’s Hospital, Jiangsu, China
| | - Hui Tao
- Department of Blood Transfusion, Affiliated Hospital 6 of Nantong University, The Yancheng School of Clinical Medicine of Nanjing Medical University, Yancheng Third People’s Hospital, Jiangsu, China
| | - Rong Zhu
- Department of Clinical Laboratory, Affiliated Hospital 6 of Nantong University, The Yancheng School of Clinical Medicine of Nanjing Medical University, Yancheng Third People’s Hospital, Yancheng, China
| | - Zhongwei Zhou
- Department of Clinical Laboratory, Affiliated Hospital 6 of Nantong University, The Yancheng School of Clinical Medicine of Nanjing Medical University, Yancheng Third People’s Hospital, Yancheng, China
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Hole B, Scanlon M, Tomson C. Shared decision making: a personal view from two kidney doctors and a patient. Clin Kidney J 2023; 16:i12-i19. [PMID: 37711639 PMCID: PMC10497374 DOI: 10.1093/ckj/sfad064] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Indexed: 09/16/2023] Open
Abstract
Shared decision making (SDM) combines the clinician's expertise in the treatment of disease with the patient's expertise in their lived experience and what is important to them. All decisions made in the care of patients with kidney disease can potentially be explored through SDM. Adoption of SDM in routine kidney care faces numerous institutional and practical barriers. Patients with chronic disease who have become accustomed to paternalistic care may need support to engage in SDM-even though most patients actively want more involvement in decisions about their care. Nephrologists often underestimate the risks and overestimate the benefits of investigations and treatments and often default to recommending burdensome treatments rather than discussing prognosis openly. Guideline bodies continue to issue recommendations written for healthcare professionals without providing patient decision aids. To mitigate health inequalities, care needs to be taken to provide SDM to all patients, not just the highly health-literate patients least likely to need additional support in decision making. Kidney doctors spend much of their time in the consulting room, and it is unjustifiable that so little attention is paid to the teaching, audit and maintenance of consultation skills. Writing letters to the patient to summarise the consultation rather than sending them a copy of a letter between health professionals sets the tone for a consultation in which the patient is an active partner. Adoption of SDM will require nephrologists to relinquish long-established paternalistic models of care and restructure care around the values and preferences of patients.
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Affiliation(s)
- Barnaby Hole
- North Bristol NHS Trust, Department of Nephrology, Bristol, UK
- University of Bristol, Bristol Medical School, Bristol, UK
| | - Miranda Scanlon
- North Bristol NHS Trust, Department of Nephrology, Bristol, UK
- Kidney Research UK, Lay Advisory Group, Peterborough, UK
| | - Charlie Tomson
- North Bristol NHS Trust, Department of Nephrology, Bristol, UK
- Kidney Research UK, Board of Trustees, Peterborough, UK
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Abstract
After initially being licensed as treatment for diabetes, the range of indications for sodium-glucose co-transporter 2 (SGLT2) inhibitors has expanded to include chronic heart failure and chronic kidney disease. This article provides an overview of some of the evidence that supports the use of SGLT2 inhibitors in the management of chronic heart failure and chronic kidney disease, discusses the safety of this group of drugs and considers the practical application of their use.
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26
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Mallouh MA, Briggs A, Hawkins S, Heffern C. Health Economic Analysis of Pharmacist-Led Annual Wellness Visits. Sr Care Pharm 2023; 38:185-192. [PMID: 37185146 DOI: 10.4140/tcp.n.2023.185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Objective To quantify the financial and clinical implications of pharmacists completing Medicare Annual Wellness Visits (AWV). Design Retrospective, observational, population-based health economic analysis utilizing electronic medical record data. Setting A single family-practice clinic within a Missouri-based not-for-profit community health system. Patients/Participants Medicare patients in their second year of coverage who had not been seen for an AWV within the previous 12 months. Intervention Patients attended a subsequent AWV conducted by a licensed ambulatory care pharmacist between July 1 and December 31, 2021. The pharmacist completed all necessary visit requirements and helped facilitate completion of preventive screenings. Main Outcome Measures Primary outcomes measured were financial implications of pharmacists completing AWVs. The primary objective was to quantify the direct and indirect financial benefits for a health system incorporating pharmacist-led AWVs. Direct revenue was calculated based on the number of visits completed multiplied by the reimbursement rate paid to the health care system by the Centers for Medicare & Medicaid Services (CMS). Indirect revenue was estimated based on the number and type of interventions completed by the patient. The secondary outcome measured was the clinical impact of pharmacist-led AWVs through quantifying preventive care service needs and completion of these services. Alongside these measures, the number of medication discrepancies and drug interactions were also measured and cost avoidance estimated. Annual cost in salary of a pharmacist was considered, but additional cost of overhead was beyond the scope of the study. Results Thirty-nine AWVs were completed. Two hundred six recommended screenings, labs, and immunizations were identified, of which 24% were completed. The pharmacists were also able to identify 205 medication issues. These visits generated $4,593.42 in direct revenue. Recommended preventive care generated $2,161.71 in indirect revenue. Conclusion Pharmacist-led AWVs are financially beneficial to the health care system and increases the number of completed AWVs while avoiding demand for additional physician time.
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Affiliation(s)
| | - Alyse Briggs
- 2 Community Health Network, Indianapolis, Indiana
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Zhou Z, Liu H, Ju H, Chen H, Jin H, Sun M. Circulating GDF-15 in relation to the progression and prognosis of chronic kidney disease: A systematic review and dose-response meta-analysis. Eur J Intern Med 2023; 110:77-85. [PMID: 36740468 DOI: 10.1016/j.ejim.2023.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 12/26/2022] [Accepted: 01/22/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND Patients with chronic kidney disease (CKD) typically exhibit circulating growth differentiation factor-15 (GDF-15) at high levels. This meta-analysis aimed to evaluate the potential value of GDF-15 in predicting CKD progression and prognosis. Furthermore, when sufficient information was provided, the dose-response correlation was studied. METHODS Studies were searched in Web of Science, Embase, and PubMed from inception until November 2022. By using random- or fixed-effects models, the pooled effect size was estimated in accordance with heterogeneity in existing research. RESULTS This study covered 14 studies from 12 articles with 7813 subjects participating in the research. CKD patients in the top GDF-15 tertile had notably higher risks of CKD progression (HR 2.60, 95% CI 2.06-3.27), all-cause mortality (HR 2.05, 95% CI 1.44-2.92), cardiovascular mortality (HR 2.82, 95% CI 1.85-4.30), and cardiovascular events (HR 2.74, 95% CI 2.21-3.40), as compared to CKD patients in the bottom tertile. In the dose-response study, the risks for CKD progression, all-cause death, cardiovascular death, and cardiovascular events were increased by 31% (HR 1.31, 95% CI 1.06-1.61), 44% (HR 1.44, 95% CI 1.08-1.92), 67% (HR 1.67, 95% CI 1.37-2.03), and 55% (HR 1.55, 95% CI 1.31-1.83), respectively, with per 1 ng/mL increase in GDF-15. The positive linear correlations between GDF-15 and CKD progression and prognosis in a certain GDF-15 concentration range of approximately 0-3 ng/mL were indicated by the dose-response curve. CONCLUSIONS Circulating GDF-15 independently predicted CKD progression and worse prognosis; however, the predicted correlations may fall into a specific range of GDF-15 concentrations.
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Affiliation(s)
- Zhongwei Zhou
- Department of Clinical Laboratory, The Sixth Affiliated Hospital of Nantong University, Yancheng Third People's Hospital, Jiangsu 224001, China
| | - Hongli Liu
- Department of Clinical Laboratory, Nantong Tumor Hospital, Tumor Hospital Affiliated to Nantong University, Jiangsu 226361, China
| | - Huixiang Ju
- Department of Clinical Laboratory, The Sixth Affiliated Hospital of Nantong University, Yancheng Third People's Hospital, Jiangsu 224001, China
| | - Hongmei Chen
- Department of Clinical Laboratory, The Sixth Affiliated Hospital of Nantong University, Yancheng Third People's Hospital, Jiangsu 224001, China
| | - Hao Jin
- Department of Blood Transfusion, The Sixth Affiliated Hospital of Nantong University, Yancheng Third People's Hospital, Jiangsu 224001, China.
| | - Mingzhong Sun
- Department of Clinical Laboratory, The Sixth Affiliated Hospital of Nantong University, Yancheng Third People's Hospital, Jiangsu 224001, China.
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The Effect of Chronic Kidney Disease or End-stage Kidney Disease on Perioperative Outcomes and Healthcare Utilization in Patients Undergoing Bariatric Surgery. Obes Surg 2023; 33:1476-1485. [PMID: 36922464 DOI: 10.1007/s11695-023-06542-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 02/28/2023] [Accepted: 03/07/2023] [Indexed: 03/17/2023]
Abstract
BACKGROUND As chronic kidney disease (CKD) has a higher prevalence in patients with obesity, there is an increasing need to understand the safety of bariatric surgery for patients with advanced CKD. This study determined if short-term bariatric surgical outcomes and healthcare utilization differ in patients with advanced CKD. METHODS A retrospective analysis of the Healthcare Cost and Utilization Project National Inpatient Sample (NIS) was performed. Patients with obesity who underwent bariatric surgery from 2015 to 2019 were included. Patients without CKD, with CKD, and end-stage kidney disease (ESKD) were compared for outcome differences. Univariate and multivariable regression was used to determine the association between perioperative outcomes to CKD status. RESULTS The unadjusted analysis found significantly higher mortality and overall complication rate in CKD and ESKD patients, however, after adjustment for confounders, only the ICU admission rate remained significantly higher for patients CKD compared to non-CKD patients (odds ratio 4.21, 95% CI [3.29-5.39]). Length of stay was longer for patients with CKD (mean difference (MD) 0.14 days, 95% CI, [0.04, 0.23]) and patients with ESKD (MD 0.27 days, 95% CI, [0.10, 0.43]) compared to non-CKD patients. Patients with ESKD had higher admission costs compared to non-CKD patients (MD $1982.65). CONCLUSION Patients with CKD and ESKD have increased healthcare utilization and higher rates of ICU admission after bariatric surgery compared to non-CKD patients. Otherwise, there is no significant difference in other post-operative complications and mortality. Bariatric surgery may therefore be safely offered to this patient population in hospitals with on-site ICU capacity.
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Cook S, Schmedt N, Broughton J, Kalra PA, Tomlinson LA, Quint JK. Characterising the burden of chronic kidney disease among people with type 2 diabetes in England: a cohort study using the Clinical Practice Research Datalink. BMJ Open 2023; 13:e065927. [PMID: 36882249 PMCID: PMC10008473 DOI: 10.1136/bmjopen-2022-065927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
OBJECTIVES To describe prevalence of chronic kidney disease (CKD), demographic and clinical characteristics, treatment patterns and rates of cardiovascular and renal complications for patients with type 2 diabetes (T2D) treated in routine clinical care. DESIGN Repeat cross-sectional study (6 monthly cross-sections) and cohort study from 1 January 2017 to 31 December 2019. SETTING Primary care data from English practices contributing to the UK Clinical Practice Research Datalink linked to Hospital Episode Statistics and Office for National Statistics mortality data. PARTICIPANTS Patients with T2D aged >18 years, at least one year of registration data. PRIMARY AND SECONDARY OUTCOMES Primary outcome was prevalence of CKD defined as chronic kidney disease epidemiology collaboration (CKD-EPI) estimated glomerular filtration rate <60 mL/min/1.73 m2, and/or urinary albumin creatinine ratio ≥3 mg/mmol in the past 24 months. Secondary outcomes were prescriptions of medications of interest and clinical and demographic characteristics in the past 3 months.In the cohort study rates of renal and cardiovascular complications, all-cause mortality and hospitalisations over the study period were compared among those with and without CKD. RESULTS There were 574 190 eligible patients with T2D as of 1 January 2017 and 664 296 as of 31 December 2019. Estimated prevalence of CKD across the study period was stable at approximately 30%. Medication use was stable over time in people with CKD and T2D, with low use of steroidal mineralocorticoid receptor antagonists (approximately 4.5% across all time points) and a low use but steady increase in use of sodium-glucose co-transporter-2 inhibitors (from 2.6% to 6.2%). Rates of all complications were higher in those with CKD at the start of the study period, with increasing rates, with increased severity of CKD, heart failure and albuminuria. CONCLUSIONS The burden of CKD in patients with T2D is high and associated with substantially increased rates of complications particularly in those with comorbid heart failure.
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Affiliation(s)
- Sarah Cook
- National Heart and Lung Institute, Imperial College London, London, UK
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | - Philip A Kalra
- Division of Cardiovascular Sciences, University of Manchester, Manchester, UK
- Department of Renal Medicine, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - Laurie A Tomlinson
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Jennifer K Quint
- National Heart and Lung Institute, Imperial College London, London, UK
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Dashtban A, Mizani MA, Pasea L, Denaxas S, Corbett R, Mamza JB, Gao H, Morris T, Hemingway H, Banerjee A. Identifying subtypes of chronic kidney disease with machine learning: development, internal validation and prognostic validation using linked electronic health records in 350,067 individuals. EBioMedicine 2023; 89:104489. [PMID: 36857859 PMCID: PMC9989643 DOI: 10.1016/j.ebiom.2023.104489] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 01/31/2023] [Accepted: 02/06/2023] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND Although chronic kidney disease (CKD) is associated with high multimorbidity, polypharmacy, morbidity and mortality, existing classification systems (mild to severe, usually based on estimated glomerular filtration rate, proteinuria or urine albumin-creatinine ratio) and risk prediction models largely ignore the complexity of CKD, its risk factors and its outcomes. Improved subtype definition could improve prediction of outcomes and inform effective interventions. METHODS We analysed individuals ≥18 years with incident and prevalent CKD (n = 350,067 and 195,422 respectively) from a population-based electronic health record resource (2006-2020; Clinical Practice Research Datalink, CPRD). We included factors (n = 264 with 2670 derived variables), e.g. demography, history, examination, blood laboratory values and medications. Using a published framework, we identified subtypes through seven unsupervised machine learning (ML) methods (K-means, Diana, HC, Fanny, PAM, Clara, Model-based) with 66 (of 2670) variables in each dataset. We evaluated subtypes for: (i) internal validity (within dataset, across methods); (ii) prognostic validity (predictive accuracy for 5-year all-cause mortality and admissions); and (iii) medications (new and existing by British National Formulary chapter). FINDINGS After identifying five clusters across seven approaches, we labelled CKD subtypes: 1. Early-onset, 2. Late-onset, 3. Cancer, 4. Metabolic, and 5. Cardiometabolic. Internal validity: We trained a high performing model (using XGBoost) that could predict disease subtypes with 95% accuracy for incident and prevalent CKD (Sensitivity: 0.81-0.98, F1 score:0.84-0.97). Prognostic validity: 5-year all-cause mortality, hospital admissions, and incidence of new chronic diseases differed across CKD subtypes. The 5-year risk of mortality and admissions in the overall incident CKD population were highest in cardiometabolic subtype: 43.3% (42.3-42.8%) and 29.5% (29.1-30.0%), respectively, and lowest in the early-onset subtype: 5.7% (5.5-5.9%) and 18.7% (18.4-19.1%). MEDICATIONS Across CKD subtypes, the distribution of prescription medication classes at baseline varied, with highest medication burden in cardiometabolic and metabolic subtypes, and higher burden in prevalent than incident CKD. INTERPRETATION In the largest CKD study using ML, to-date, we identified five distinct subtypes in individuals with incident and prevalent CKD. These subtypes have relevance to study of aetiology, therapeutics and risk prediction. FUNDING AstraZeneca UK Ltd, Health Data Research UK.
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Affiliation(s)
- Ashkan Dashtban
- Institute of Health Informatics, University College London, London, UK
| | - Mehrdad A Mizani
- Institute of Health Informatics, University College London, London, UK; British Heart Foundation Data Science Centre, Health Data Research UK, London, UK
| | - Laura Pasea
- Institute of Health Informatics, University College London, London, UK
| | - Spiros Denaxas
- Institute of Health Informatics, University College London, London, UK
| | | | - Jil B Mamza
- Medical and Scientific Affairs, BioPharmaceuticals Medical, AstraZeneca, London, UK
| | - He Gao
- Medical and Scientific Affairs, BioPharmaceuticals Medical, AstraZeneca, London, UK
| | - Tamsin Morris
- Medical and Scientific Affairs, BioPharmaceuticals Medical, AstraZeneca, London, UK
| | - Harry Hemingway
- Institute of Health Informatics, University College London, London, UK; Health Data Research UK, University College London, London, UK
| | - Amitava Banerjee
- Institute of Health Informatics, University College London, London, UK; Barts Health NHS Trust, London, UK; University College London Hospitals NHS Trust, London, UK.
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The Growing Challenge of Chronic Kidney Disease: An Overview of Current Knowledge. Int J Nephrol 2023; 2023:9609266. [PMID: 36908289 PMCID: PMC9995188 DOI: 10.1155/2023/9609266] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 02/02/2023] [Accepted: 02/17/2023] [Indexed: 03/05/2023] Open
Abstract
Chronic kidney disease (CKD) is becoming one of the world's most prevalent noncommunicable chronic diseases. The World Health Organization projects CKD to become the 5th most common chronic disease in 2040. Causes of CKD are multifactorial and diverse, but early-stage symptoms are often few and silent. Progression rates are highly variable, but patients encounter both an increased risk for end-stage kidney disease (ESKD) as well as increased cardiovascular risk. End-stage kidney disease incidence is generally low, but every single case carries a significant burden of illness and healthcare costs, making prevention by early intervention both desirable and worthwhile. This review focuses on the prevalence, diagnosis, and causes of CKD. In addition, we discuss the developments in the general treatment of CKD, with particular attention to what can be initiated in general practice. With the addition of recent landmark findings and the expansion of the indication for using sodium-glucose cotransporter 2 inhibitors, there are now new effective treatments to add to standard therapy. This will also be relevant for primary care physicians as many patients with CKD have their family physician as their primary health care professional handling kidney function preservation. In the future, more precise and less invasive diagnostic methods may not only improve the determination of the underlying cause of CKD but may also carry information regarding which treatment to use (i.e. personalized medicine). This could lead to a reduced number of preventive treatments per individual, while at the same time improving the prognosis. This review summarizes ongoing efforts in this area.
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Lee DY, Yoo DK, Han SY, Lee K, Lee Y, Teopiz KM, Mansur RB, Rosenblat JD, McIntyre RS. Association between depressive symptoms and bone density in elderly patients with non-dialysis dependent chronic kidney disease. J Affect Disord 2022; 319:549-554. [PMID: 36113692 DOI: 10.1016/j.jad.2022.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 09/04/2022] [Accepted: 09/09/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Depression is a disease that is commonly accompanied by elderly chronic kidney disease (CKD) patients, but when the two diseases are accompanied, etiology or combination are not well known. We aimed to evaluate the etiology of CKD and comorbid depression by investigating bone disorders that are observed in persons affected by both CKD and depression. METHODS We conducted a cross-sectional study with a total of 646 patients with CKD. We compared the sociodemographic factors, kidney function, markers for CKD-Mineral and Bone Disorder (CKD-MBD) and bone mineral density according to the depressive symptoms. We conducted a univariate and multivariate logistic regression analysis to calculate odd ratios (95 % confidence interval) between depressive symptoms and low bone mineral density. RESULTS Individuals with CKD and depressive symptoms were associated with lower level of education attained, living alone, exercising less, low 24-hour urine phosphorus, and low bone density. Depressive symptoms were significantly associated with low bone density in lowest parts (1.55 [1.06-2.29]) and in total hip (1.72 [1.17-2.53]) even after adjusting for diabetes mellitus, hypertension, kidney function, proteinuria, age, sex, smoking, and body mass index. LIMITATIONS A cross-sectional design was used in this study and the bone biopsy for diagnosis of CKD-MBD was not done because of invasiveness and practical difficulties. CONCLUSION Low bone density was associated with depressive symptoms in elderly patients with non-dialysis chronic kidney disease.
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Affiliation(s)
- Dong-Young Lee
- Department of Internal Medicine, Veterans Healthcare Service Medical Center, Seoul, Republic of Korea
| | - Dong Kyun Yoo
- Department of Internal Medicine, Veterans Healthcare Service Medical Center, Seoul, Republic of Korea
| | - Sang Youb Han
- Department of Internal Medicine, Inje University College of Medicine, Ilsan-Paik Hospital, Goyang, Gyeonggi, Republic of Korea
| | - Kangbaek Lee
- Yonsei Miso Dental Clinic, Seongnam, Gyeonggi, Republic of Korea
| | - Young Lee
- Veterans Medical Research Institute, Veterans Healthcare Service Medical Center, Seoul, Republic of Korea
| | - Kayla M Teopiz
- Mood Disorders Psychopharmacology Unit, Poul Hansen Family Centre for Depression, University of Health Network, Toronto, Ontario, Canada
| | - Rodrigo B Mansur
- Mood Disorders Psychopharmacology Unit, Poul Hansen Family Centre for Depression, University of Health Network, Toronto, Ontario, Canada; Braxia Health, Mississauga, Ontario, Canada; Department of Psychiatry, University of Toronto, Ontario, Canada
| | - Joshua D Rosenblat
- Mood Disorders Psychopharmacology Unit, Poul Hansen Family Centre for Depression, University of Health Network, Toronto, Ontario, Canada; Braxia Health, Mississauga, Ontario, Canada; Department of Psychiatry, University of Toronto, Ontario, Canada
| | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit, Poul Hansen Family Centre for Depression, University of Health Network, Toronto, Ontario, Canada; Braxia Health, Mississauga, Ontario, Canada; Department of Psychiatry, University of Toronto, Ontario, Canada.
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Lee A. Many drugs are available for hypertension, with more in development. DRUGS & THERAPY PERSPECTIVES 2022. [DOI: 10.1007/s40267-022-00951-5] [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]
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Mc Laughlin L, Neukirchinger B, Noyes J. Interventions for and experiences of shared decision-making underpinning reproductive health, family planning options and pregnancy for women with or at high risk of kidney disease: a systematic review and qualitative framework synthesis. BMJ Open 2022; 12:e062392. [PMID: 35940837 PMCID: PMC9364395 DOI: 10.1136/bmjopen-2022-062392] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To determine intervention effects and synthesise qualitative research that explored women with or at high risk of kidney disease experiences of shared decision-making in relation to their reproductive health, family planning options and pregnancy. DESIGN A systematic review of interventions and a qualitative evidence synthesis. DATA SOURCES We searched Cochrane, CINAHL, MEDLINE, Scopus, ProQuest, Elsevier, PubMed, ScienceDirect and Web of Science. ELIGIBILITY CRITERIA Shared decision-making interventions and qualitative studies related to reproductive health involving women with or at high risk of kidney disease published from 1980 until January 2021 in English (clinical settings, global perspective). DATA EXTRACTION AND SYNTHESIS Titles were screened against the inclusion criteria and full-text articles were reviewed by the whole team. Framework synthesis was undertaken. RESULTS We screened 1898 studies. No evidence-based interventions were identified. 18 qualitative studies were included, 11 kidney disease-specific studies and 7 where kidney disease was a common comorbidity. Women frequently felt unprepared and uninformed about their reproductive options. Conversations with healthcare professionals were commonly described as frustrating and unhelpful, often due to a perceived loss of autonomy and a mismatch in preferences and life goals. Examples of shared decision-making were rare. Kidney disease exacerbated societal expectations of traditional gender roles (eg, wife, mother, carer) including capability to have children and associated factors, for example, parenting, (sexual) relationships, body image and independent living (including financial barriers to starting a family). Local interventions were limited to types of counselling. A new health system model was developed to support new interventions. CONCLUSION There is a clear need to establish new interventions, test those already in development and develop new clinical guidance for the management of women with or at high risk of kidney disease in relation to their reproductive health, including options to preserve fertility earlier. Other health conditions with established personalised reproductive care packages, for example, cancer, could be used to benchmark kidney practice alongside the new model developed here.
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Affiliation(s)
- Leah Mc Laughlin
- School of Medical and Health Sciences, Bangor University, Bangor, UK
| | | | - Jane Noyes
- School of Medical and Health Sciences, Bangor University, Bangor, UK
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Ng FYC, Song HJJMD, Tan BKJ, Teo CB, Wong ETY, Boey PY, Cheng CY. Bidirectional association between glaucoma and chronic kidney disease: A systematic review and meta-analysis. EClinicalMedicine 2022; 49:101498. [PMID: 35747173 PMCID: PMC9189872 DOI: 10.1016/j.eclinm.2022.101498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 05/18/2022] [Accepted: 05/23/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Glaucoma and chronic kidney disease (CKD) are prevalent and debilitating conditions, with common pathogenic pathways like oxidative stress and fluid dysregulation. We evaluated if there is a bidirectional association between them, as previous studies have yielded conflicting results. METHODS In this systematic review and meta-analysis, we searched PubMed, Embase and Cochrane Library from inception until 15 June 2021, including full-length English articles published in peer-reviewed journals reporting on glaucoma and CKD as either exposure or outcome, among participants aged ≥18 years. We pooled overall summary estimates of odds ratios using random-effect meta-analysis and conducted subgroup meta-analyses and univariate meta regression. We assessed risk of bias using the Newcastle-Ottawa Scale (NOS) and quality of evidence using the GRADE framework. Our article is PROSPERO-registered and adherent to both PRISMA and MOOSE guidelines. This review is registered with PROSPERO (CRD42021262846). FINDINGS We identified 14 articles comprising of 3 retrospective cohort studies and 12 cross-sectional studies from 2,428 records, including 1,978,254 participants. Risk of bias was low to moderate. Participants with CKD at baseline had higher pooled odds of glaucoma (odds ratio[OR]=1.18, 95% confidence interval[CI]=1.04-1.33, I2=66%, N=12) compared to participants without CKD. The association remained significant in subgroups of longitudinal studies, participants with diabetes, East Asian studies and primary open-angle glaucoma. In the reverse direction, participants with glaucoma at baseline had over three-fold higher odds of incident CKD compared to participants without glaucoma after 10-15 years of follow-up in longitudinal studies (OR=3.67, 95% CI=2.16-6.24, I2=75%, N=2). All studies adjusted for age and sex, while most studies adjusted for comorbidities such as diabetes and hypertension. Meta-regression identified ethnicity (East Asians vs Non-East Asians) as a significant effect moderator. Associations were robust to trim-and-fill adjustment for publication bias, single-study influence and cumulative meta-analyses. INTERPRETATION Our meta-analysis suggests a bidirectional relationship between glaucoma and CKD, particularly among East Asians. Further studies are required to elucidate underlying mechanisms and account for differential association by ethnicity. FUNDING Ching-Yu Cheng is supported by Clinician Scientist Award (NMRC/CSA-SI/0012/2017) of the Singapore Ministry of Health's National Medical Research Council.
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Affiliation(s)
- Faye Yu Ci Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | | | - Chong Boon Teo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Emmett Tsz Yeung Wong
- Division of Nephrology, Department of Medicine, National University Hospital, Singapore
| | - Pui Yi Boey
- Glaucoma Service, Singapore National Eye Centre, Singapore
- Ophthalmology & Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School, Singapore
| | - Ching-Yu Cheng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Glaucoma Service, Singapore National Eye Centre, Singapore
- Ocular Epidemiology Research Group, Singapore Eye Research Institute, Singapore
- Ophthalmology & Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School, Singapore
- Corresponding author at: Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, 20 College Road, The Academia, Level 6, Singapore.
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Morales DR, Moreno-Martos D, Matin N, McGettigan P. Health conditions in adults with HIV compared with the general population: A population-based cross-sectional analysis. EClinicalMedicine 2022; 47:101392. [PMID: 35497059 PMCID: PMC9046106 DOI: 10.1016/j.eclinm.2022.101392] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 03/21/2022] [Accepted: 03/28/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Life expectancy in adults with human immunodeficiency virus (HIV) has increased and managing other health conditions is increasingly important for patients and healthcare planning. The aim of this study was to examine the prevalence and association between different health conditions and HIV status. METHODS We performed a cross-sectional analysis of adult UK Clinical Practice Research Datalink primary care electronic medical records linked to hospital admissions as of Nov 30, 2015. We examined 47 health condition groups and 304 physical and mental health conditions by HIV status, after adjustment for age, sex, social deprivation status using logistic regression. FINDINGS There were 964 patients with HIV (61.7% male; 92.8% aged <65 years) and 941,113 non-HIV patients (49.4% male; 75.2% aged <65 years). Condition groups with the greatest prevalence in HIV that were also highly prevalent in adults without HIV included: lipid disorder (41.4% vs 40.2%), and hypertension (19.1% vs 24.6%). Following adjustment, 18 (37.5%) condition groups were more likely in adults with HIV and ten (20.8%) were less likely. Individual conditions that were less likely in adults with HIV included: atrial fibrillation (odds ratio [OR] 0.37 [95% CI 0.20-0.64]) and hypertension (OR_0.78 [0.65-0.94]); rheumatoid arthritis (OR 0.27 [0.05-0.84]); asthma (OR_0.65 (0.53-0.80]); and certain eye diseases such as macular degeneration (OR_0.30 [0.09-0.70]). Meanwhile individual conditions that were more likely included: liver fibrosis, sclerosis, and cirrhosis (OR_3.23 [1.85-5.20]); pulmonary embolism (OR_2.06 [1.15-3.36]); male infertility (OR_2.23 [1.50-3.16]) and female infertility (OR_2.01 [1.34-2.88]); bipolar disorder (OR_2.93 [1.52-5.05]) and depression (OR_1.49 [1.28-1.71]); cervical malignancy (OR_4.64 [1.15-12.15]); and infections. INTERPRETATION Comorbidity is common in adults with HIV, with physical and mental health conditions spanning a wide spectrum. HIV management should consider multidisciplinary care models to provide optimal patient care. FUNDING The project was funded by the Bart's Charity; DRM was funded by a Wellcome Trust Clinical Research Career Development Fellowship; DRM and DMM received funding from the HDR-UK Precision therapeutics programme.
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Affiliation(s)
- Daniel R. Morales
- Division of Population Health and Genomics, University of Dundee, Dundee, United Kingdom
- Department of Public Health, University of Southern Denmark, Denmark
- Corresponding author at: Division of Population Health and Genomics, University of Dundee, Dundee, United Kingdom.
| | - David Moreno-Martos
- Division of Population Health and Genomics, University of Dundee, United Kingdom
| | - Nashaba Matin
- Barts Health NHS Trust, Grahame Hayton Unit, Royal London Hospital, London, United Kingdom
| | - Patricia McGettigan
- William Harvey Research Institute, Queen Mary University of London, United Kingdom
- Corresponding author.
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Zhou Z, Jin H, Ju H, Sun M, Chen H, Li L. Circulating Trimethylamine-N-Oxide and Risk of All-Cause and Cardiovascular Mortality in Patients With Chronic Kidney Disease: A Systematic Review and Meta-Analysis. Front Med (Lausanne) 2022; 9:828343. [PMID: 35433743 PMCID: PMC9012260 DOI: 10.3389/fmed.2022.828343] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 03/09/2022] [Indexed: 12/25/2022] Open
Abstract
Background Trimethylamine-N-oxide (TMAO) is expected to be a prognostic biomarker among patients suffering from chronic kidney disease (CKD). However, investigations on the association between TMAO and CKD prognosis are conflicting. In the present article, we aimed to assess the relationship of circulating TMAO with the risk of all-cause and cardiovascular mortality among CKD patients by a meta-analysis. Methods Data were collected from PubMed, EMBASE, and Web of Science for systematically searching related literature (last update: February 2022). The multivariable-adjusted hazard risks (HR) and their 95% confidence intervals (CI) were pooled using random effects models. Results Eleven prospective cohort studies covering 7,899 CKD patients were enrolled in this meta-analysis. When comparing individuals in the top and bottom baseline TMAO levels thirds, the multivariate adjusted pooled HR was 1.29 (95% CI 1.11–1.51, P = 0.001) for all-cause mortality, and 1.45 (95% CI 1.01–2.09, P = 0.043) for cardiovascular death. For continuous variables, per 1 unit increase of circulating TMAO levels was associated with a 3% higher all-cause mortality (HR 1.03, 95% CI 1.00–1.06, P = 0.032), but not significantly associated with cardiovascular death (HR 1.08, 95% CI 0.92–1.27, P = 0.346). Stratified analyses revealed that the positive relationship between TMAO and all-cause mortality remained significant after adjusting for diabetes, blood pressure, blood lipid, renal function, or inflammatory parameters. Conclusion Higher circulating TMAO was associated with an increased mortality risk among patients with CKD, and this relationship may be dependent on TMAO dose and independent of renal function, inflammation, diabetes, hypertension, and dyslipidemia. Systematic Review Registration [https://www.INPLASY.COM], identifier [INPLASY2021100049].
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Affiliation(s)
- Zhongwei Zhou
- Department of Clinical Laboratory, Yancheng Third People’s Hospital, The Sixth Affiliated Hospital of Nantong University, Yancheng, China
| | - Hao Jin
- Department of Blood Transfusion, Yancheng Third People’s Hospital, The Sixth Affiliated Hospital of Nantong University, Yancheng, China
| | - Huixiang Ju
- Department of Clinical Laboratory, Yancheng Third People’s Hospital, The Sixth Affiliated Hospital of Nantong University, Yancheng, China
| | - Mingzhong Sun
- Department of Clinical Laboratory, Yancheng Third People’s Hospital, The Sixth Affiliated Hospital of Nantong University, Yancheng, China
| | - Hongmei Chen
- Department of Clinical Laboratory, Yancheng Third People’s Hospital, The Sixth Affiliated Hospital of Nantong University, Yancheng, China
| | - Li Li
- Department of Clinical Laboratory, Binhai County People’s Hospital, Yancheng, China
- *Correspondence: Li Li,
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Shouqair TM, Rabbani SA, Sridhar SB, Kurian MT. Evaluation of Drug-Related Problems in Chronic Kidney Disease Patients. Cureus 2022; 14:e24019. [PMID: 35573572 PMCID: PMC9091809 DOI: 10.7759/cureus.24019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2022] [Indexed: 01/01/2023] Open
Abstract
Background Chronic kidney disease (CKD) is a challenging global health problem with increasing prevalence worldwide. Concurrence of CKD and comorbidities results in the use of multiple medications and exposing patients to polypharmacy. Polypharmacy in CKD is common across all the stages of the disease and leads to poor medication adherence, higher healthcare costs, and drug-related problems, such as drug-drug interactions (DDIs) and adverse drug reactions (ADRs). DDIs and ADRs in CKD patients may lower the quality of life, increase the length of hospital stay, and augment the risks of morbidity and mortality. Methodology This was a hospital-based, prospective, cross-sectional study conducted in a secondary care hospital. The study population comprised 130 adult CKD patients admitted to the nephrology department including those on maintenance hemodialysis. Study-related data were obtained from the electronic patient case records. Medications prescribed to the patients were analyzed for potential DDIs (pDDIs) using Portable Emergency and Primary Care Information Database (PEPID 12.1) drug interaction checker. All observed and reported suspected ADRs related to the prescribed drugs were evaluated for causality, severity, preventability, and predictability. Results Out of the 130 patients, majority were males (n = 71, 54.6%), in the age group of 61-70 years (n = 45, 34.6%), and belonged to CKD stage 5 (n = 105, 80.8%). The mean number of drugs prescribed was 11.1 ± 3.8 per patient. The prevalence of pDDIs was found to be 89.2%. Upon analysis by the PEPID database, 708 pDDIs with 215 different pairs of interacting drugs were identified. Polypharmacy (odds ratio (OR): 62.34, 95% confidence interval (CI): 7.97-487.64, p < 0.001) was identified as an independent predictor of the occurrence of pDDIs. Negative binomial regression analysis revealed that dyslipidemia (incidence rate ratio (IRR): 2.7, 95% CI 2.09-3.48, p < 0.001) and diabetes (IRR: 1.2, 95% CI 1.01-1.54, p = 0.040) increased the probability of occurrence of pDDI by 2.7 and 1.2 folds, respectively. Furthermore, the likelihood of pDDI increased with every one-day increase in the length of hospital stay (IRR: 1.02, 95% CI 1.00-1.03, p = 0.015) by 1.02 times and polypharmacy (IRR: 6.30, 95% CI 3.04-13.02, p < 0.001) by 6.3 times. The incidence of ADRs was found to be 10.7%. Majority of suspected ADRs were possible (n = 7, 50.0%), of mild and moderate severity (n = 7, 50.0%), and non-preventable (n = 8, 57.1%) type. Conclusions This study investigated two important drug-related problems, pDDIs, and ADRs, in the CKD population. High proportion of CKD patients in the study had pDDIs. Comorbid conditions such as dyslipidemia and diabetes mellitus, length of hospital stay, and polypharmacy were significantly associated with increased likelihood of pDDIs. Furthermore, there was a burden of ADRs in the study population, of which most ADRs were possible and of mild to moderate severity. Prevention, identification, and resolution of these problems in CKD patients is important and can be achieved through medication optimization, which requires a proactive interdisciplinary collaboration between clinicians, clinical pharmacists, and other healthcare professionals.
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Affiliation(s)
- Tasneem M Shouqair
- Department of Clinical Pharmacy and Pharmacology, Ras Al Khaimah College of Pharmacy, Ras Al Khaimah Medical and Health Sciences University, Ras Al Khaimah, ARE
| | - Syed Arman Rabbani
- Department of Clinical Pharmacy and Pharmacology, Ras Al Khaimah College of Pharmacy, Ras Al Khaimah Medical and Health Sciences University, Ras Al Khaimah, ARE
| | - Sathvik B Sridhar
- Department of Clinical Pharmacy and Pharmacology, Ras Al Khaimah College of Pharmacy, Ras Al Khaimah Medical and Health Sciences University, Ras Al Khaimah, ARE
| | - Martin T Kurian
- Department of Nephrology, Ibrahim Bin Hamad Obaidullah Hospital, Ras Al Khaimah, ARE
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Pollock C, James G, Garcia Sanchez JJ, Arnold M, Carrero JJ, Lam CSP, Chen H, Nolan S, Pecoits-Filho R. Cost of End-of-Life Inpatient Encounters in Patients with Chronic Kidney Disease in the United States: A Report from the DISCOVER CKD Retrospective Cohort. Adv Ther 2022; 39:1432-1445. [PMID: 35112306 PMCID: PMC8810284 DOI: 10.1007/s12325-021-02010-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 11/30/2021] [Indexed: 11/23/2022]
Abstract
Introduction Real-world data reporting healthcare resource utilisation and costs associated with end-of-life care for patients with chronic kidney disease (CKD) are limited. We examined length of hospitalisation and costs associated with end-of-life inpatient encounters using retrospective data from DISCOVER CKD. Methods Data on inpatient encounters for patients with CKD aged ≥ 18 years between January 2016 and March 2020 were extracted from the US Premier Hospital Database. Encounters ending in death were identified and grouped by reason for the encounter, using the International Classification of Diseases, Tenth Revision, and by their insurance coverage. Encounters were evaluated overall and stratified according to cardiovascular (CV), kidney failure and infection-related reasons, and by their coverage by commercial, Medicaid, Medicare or other insurers. Length of hospitalisation and total costs were calculated for encounters. Results Among 237,734 encounters ending in death, the mean [standard deviation (SD)] age was 74.2 (12.4) years, and 45.3% of patients were female. In total, 25,118, 4210 and 76,307 encounters were classified as relating to CV reasons, kidney failure and infection, respectively. Among all encounters, the mean (SD) length of hospitalisation ranged from 9.1 (11.2) (Medicare) to 12.8 (18.4) (Medicaid) days. Across insurers, encounters related to kidney failure were associated with the longest hospitalisations compared with CV and infection [mean range (days): 10.7–15.9 vs. 7.5–10.5 and 8.7–12.7, respectively]. The median [interquartile range (IQR)] total cost of any inpatient encounter was $17,057 ($8040–35,873). Kidney failure-related encounters had higher costs compared with CV and infection [median (IQR), $18,469 ($8673–38,315) vs. $17,503 ($7766–39,693) and $16,403 ($7762–34,910), respectively]. Medicaid-covered encounters had the highest costs of all insurers [median (IQR), $16,189 ($7725–33,443)]. Conclusions Among patients with CKD, end-of-life encounters were most frequently related to infection. Encounters relating to kidney failure incurred the highest costs. Trial registration ClinicalTrials.gov identifier: NCT04034992. Graphical Abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1007/s12325-021-02010-3.
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Gur E, Levy D, Topaz G, Naser R, Wand O, Kitay-Cohen Y, Benchetrit S, Sarel E, Cohen-Hagai K. Disease severity and renal outcomes of patients with chronic kidney disease infected with COVID-19. Clin Exp Nephrol 2022; 26:445-452. [PMID: 35230569 PMCID: PMC8886555 DOI: 10.1007/s10157-022-02180-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 01/03/2022] [Indexed: 12/12/2022]
Abstract
INTRODUCTION While there is evidence of the presence of the coronavirus in the kidneys and resultant acute kidney injury (AKI), information on the effect of chronic kidney disease (CKD) on COVID-19 outcomes and its pathogenesis is currently lacking. METHODS This retrospective, observational study evaluated the outcomes of all consecutive patients hospitalized during COVID-19 outbreaks in Meir Medical Center. Serum creatinine level was assessed before hospitalization ("baseline serum creatinine") and at admission, as well as minimum and maximum serum creatinine levels during hospitalization. RESULTS Among 658 patients, 152 had eGFR < 60 ml/min (termed the CKD group), 506 patients served as controls. Patients in the CKD group were older, with higher prevalence of hypertension, diabetes mellitus and atherosclerosis. Disease severity and clinical presentation of CKD group were comparable to that of control group. Odds ratio for AKI was 5.8 (95%CI 3.8-8.7; p < 0.001) in CKD group vs. control group and 3.4 (95%CI 1.1-10.8) for renal replacement therapy (p < 0.026). Among the CKD group, 32.2% died after COVID-19 infection versus 14.8% of the controls (p < 0.001). Mortality increased as CKD stage increased (14.8% in controls, 29.6% in CKD stage 3, and 39.3% in CKD stages 4 and 5, p < 0.001). CONCLUSION Despite comparable disease severity at presentation, patients with CKD had significantly more AKI events and required more renal replacement therapy during hospitalization than control patients did. Mortality increased as CKD stage increased.
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Affiliation(s)
- Efrat Gur
- Department of Internal Medicine C, Meir Medical Center, Kefar Sava, Israel
| | - David Levy
- Department of Internal Medicine C, Meir Medical Center, Kefar Sava, Israel
| | - Guy Topaz
- Department of Internal Medicine C, Meir Medical Center, Kefar Sava, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rawand Naser
- Department of Internal Medicine C, Meir Medical Center, Kefar Sava, Israel
| | - Ori Wand
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Pulmonology, Meir Medical Center, Kefar Sava, Israel
| | - Yona Kitay-Cohen
- Department of Internal Medicine C, Meir Medical Center, Kefar Sava, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sydney Benchetrit
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Nephrology and Hypertension, Meir Medical Center, 59 Tchernichovsky St., 4428164, Kefar Sava, Israel
| | - Erez Sarel
- Department of Anesthesiology, Meir Medical Center, Kefar Sava, Israel
| | - Keren Cohen-Hagai
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. .,Department of Nephrology and Hypertension, Meir Medical Center, 59 Tchernichovsky St., 4428164, Kefar Sava, Israel.
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Dinh HTT, Nguyen NT, Bonner A. Healthcare systems and professionals are key to improving health literacy in chronic kidney disease. J Ren Care 2021; 48:4-13. [PMID: 34291578 DOI: 10.1111/jorc.12395] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 07/05/2021] [Accepted: 07/08/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Comorbidity is prevalent in people with chronic kidney disease (CKD) and this status burdens one's health literacy skills to understand about their health, make decisions, and to adhere with treatment. OBJECTIVES To examine health literacy in people with CKD and comorbidities. DESIGN A cross-sectional study was conducted between November 2018 and April 2019. PARTICIPANTS Convenience sampling recruited 367 adults with CKD and at least one comorbid disease. MEASUREMENTS Data were collected using the 9-domain Health Literacy Questionnaire. Demographic and clinical characteristics were also collected. Charlson Comorbidity Index calculated comorbidity status. Parametric tests were used to distinguish health literacy between various groups. RESULTS Participants' average age was 58.8 years, 54.7% had CKD Grade 5, 72.5% had a severe comorbidity index (≥6), and nearly 40% were on haemodialysis. Lower health literacy proportions were found in domains related to Healthcare providers' support (58.3%) and Appraisal of health information (38.4%). Lower levels of education, income, or living in rural areas were each significantly more likely to contribute to lower health literacy levels (range 4-7 domains). Greater comorbidity severity was also significantly associated with lower health literacy in two domains. CONCLUSION People with CKD had difficulties in various health literacy domains primarily related to communication and critical appraisal. These domains can be improved by healthcare professionals and changes in hospital policies. Due to frequent contact with patients in kidney services, renal clinicians have a crucial role in ensuring greater communication occurs as this will better assist patients to understand their healthcare needs.
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Affiliation(s)
- Ha T T Dinh
- School of Nursing, University of Tasmania, Launceston, Tasmania, Australia.,School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia
| | - Nguyet T Nguyen
- University of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam
| | - Ann Bonner
- School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia.,Kidney Health Service, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
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Abstract
Within the last decade, clustering of comorbidities has become an increasing health problem on a global scale and will continue to challenge healthcare professionals in the coming years. People with multiple diseases find difficulties in managing their daily lives due to the implications each disease brings; attending and keeping up to date with hospital appointments, being prescribed and taking various medications, the effects of mental health and quality of life, and the impact it has on their families. Most research in clinical trials often exclude individuals with multimorbidity and observational studies mainly focus on single disease outcomes, therefore there is an opportunity to encourage future research in an area which could help prevent further cases and improve the lives of those already living with multimorbidity. This review aims to summarise the rising prevalence and most common clusters, highlight the challenges faced in healthcare, and explore ways to improve future research.
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