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Birnie K, Tomson C, Caskey FJ, Ben-Shlomo Y, Nitsch D, Casula A, Murray EJ, Sterne JAC. Comparative Effectiveness of Dynamic Treatment Strategies for Medication Use and Dosage: Emulating a Target Trial Using Observational Data. Epidemiology 2023; 34:879-887. [PMID: 37757876 PMCID: PMC7615288 DOI: 10.1097/ede.0000000000001649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
BACKGROUND Availability of detailed data from electronic health records (EHRs) has increased the potential to examine the comparative effectiveness of dynamic treatment strategies using observational data. Inverse probability (IP) weighting of dynamic marginal structural models can control for time-varying confounders. However, IP weights for continuous treatments may be sensitive to model choice. METHODS We describe a target trial comparing strategies for treating anemia with darbepoetin in hemodialysis patients using EHR data from the UK Renal Registry 2004 to 2016. Patients received a specified dose (microgram/week) or did not receive darbepoetin. We compared 4 methods for modeling time-varying treatment: (A) logistic regression for zero dose, standard linear regression for log dose; (B) logistic regression for zero dose, heteroscedastic linear regression for log dose; (C) logistic regression for zero dose, heteroscedastic linear regression for log dose, multinomial regression for patients who recently received very low or high doses; and (D) ordinal logistic regression. RESULTS For this dataset, method (C) was the only approach that provided a robust estimate of the mortality hazard ratio (HR), with less-extreme weights in a fully weighted analysis and no substantial change of the HR point estimate after weight truncation. After truncating IP weights at the 95th percentile, estimates were similar across the methods. CONCLUSIONS EHR data can be used to emulate target trials estimating the comparative effectiveness of dynamic strategies adjusting treatment to evolving patient characteristics. However, model checking, monitoring of large weights, and adaptation of model strategies to account for these is essential if an aspect of treatment is continuous.
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Affiliation(s)
- Kate Birnie
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Charles Tomson
- Department of Renal Medicine, Freeman Hospital, Newcastle upon Tyne, UK
| | - Fergus J Caskey
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Department of Renal Medicine, North Bristol NHS Trust, Bristol, UK
| | - Yoav Ben-Shlomo
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Dorothea Nitsch
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
- Department of Nephrology, Royal Free London NHS Foundation Trust, London, UK
| | - Anna Casula
- UK Renal Registry, UK Kidney Association, Bristol, UK
| | - Eleanor J Murray
- Department of Epidemiology, School of Public Health, Boston University, Boston, MA, USA
| | - Jonathan AC Sterne
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Health Data Research UK South-West
- NIHR Bristol Biomedical Research Centre, Bristol, UK
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Fink JC, Maguire RM, Blakeman T, Tomlinson LA, Tomson C, Wagner LA, Zhan M. Medication Holds in CKD During Acute Volume-Depleting Illnesses: A Randomized Controlled Trial of a "Sick-Day" Protocol. Kidney Med 2022; 4:100527. [PMID: 36046613 PMCID: PMC9421397 DOI: 10.1016/j.xkme.2022.100527] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Rationale & Objective Some drugs prescribed for chronic kidney disease (CKD) may become hazardous on sick days with volume depletion by increasing the risk of acute kidney injury (AKI) and kidney function loss; however, the risks and benefits of their use during intercurrent illness is unknown. Study Design 6-month pragmatic trial examining a sick-day protocol to determine if withholding prespecified drugs during a volume-depleting illness reduces the incidence AKI or kidney function loss in CKD. Setting & Participants 315 veterans with stage 3-5 CKD, treated with a renin-angiotensin-aldosterone inhibitor blocker, diuretic, nonsteroidal anti-inflammatory drug, or metformin were randomized into the study with n = 159 and n = 156 in sick-day protocol and usual care groups, respectively. Intervention Sick-day protocol administered via interactive voice response system (IVRS) or usual care with 6-month follow-up. Outcomes The outcomes of the study are as follows: (1) Change in kidney function, (2) incidence of AKI based on International Classification of Diseases, Tenth Revision codes and ambulatory laboratory testing, (3) urgent service utilizations, and (4) sick days. Results The mean age was 70.1 ± 7.4 and 69.2 ± 8.1 years, with a mean baseline glomerular filtration rate (GFR) of 43.1 ± 13.1 and 43.8 ± 13.0 mL/min/1.73 m2, and 112 (70%) and 100 (64%) of participants with diabetes in the sick-day protocol and usual care groups, respectively. The mean change in GFR in the sick-day protocol and usual care groups from baseline to 6-month follow-up, adjusting for baseline GFR, was -0.71 (95% CI, -2.11 to 0.69) and -0.72 (95% CI, -2.12 to 0.68), respectively, with no significant difference, P = 0.99. Hospitalizations in the sick-day protocol and usual care groups were 11.5/100 and 8.4/100 events per person-months, respectively, with the adjusted rate ratio not significantly increased (prevalence ratio, 1.30; 95% CI, 0.96-1.76). Participants interacted with the IVRS in 81% of expected weeks and 19 had one or more qualifying events. In 33 true sick days, participants correctly followed the protocol in only 14. Limitations Low incidence of sick days over the 6-month period of the study. Conclusions The sick-day protocol was not associated with a significant reduction in AKI episodes or kidney function loss in a high-risk CKD population. Engagement with the IVRS was high, but successful implementation of the sick-day protocol was not optimal. Trial Registration ClinicalTrials.gov; NCT03141905.
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Affiliation(s)
- Jeffrey C. Fink
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Rebecca M. Maguire
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Thomas Blakeman
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) Greater Manchester, Centre for Primary Care, Division of Population health, University of Manchester, Manchester, United Kingdom
| | - Laurie A. Tomlinson
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Charles Tomson
- Department of Renal Medicine, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, United Kingdom
| | - Lee-Ann Wagner
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Min Zhan
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD
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Cheung A, Chang TI, Cushman W, Furth S, Hou FF, Ix JH, Knoll G, Muntner P, Pecoits-Filho R, Sarnak MJ, Tobe SW, Tomson C, Mann J. Abstract 52: KDIGO (Kidney Disease: Improving Global Outcomes) Guideline Update On The Management Of Blood Pressure In Chronic Kidney Disease: What’s New And What’s Different From Other Guidelines. Hypertension 2021. [DOI: 10.1161/hyp.78.suppl_1.52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
In 2012, KDIGO released a guideline on BP management in CKD not receiving dialysis. The emergence of new trials and meta-analyses coupled with wider recognition of the importance of standardized BP measurement protocols have prompted a call to update the 2012 guideline. This summary will outline the changes to the prior recommendations and highlight similarities to guidelines from ACC/AHA and ESC/ESH.
Methods:
A systematic review was undertaken to formally assess the following issues: 1) BP measurement; 2) lifestyle interventions; BP management in 3) patients with CKD, with and without diabetes, 4) kidney transplant recipients, and 5) children with CKD.
Results:
A total of 6863 citations were screened. Of these, 290 RCTs, 14 observational studies, and 35 systematic reviews were included in the evidence review. A major addition to the KDIGO 2021 guideline is a chapter devoted to BP measurement. KDIGO recommends the use of standardized office BP over routine BP. Out-of-office measurements (ABPM, HBPM) can be used to complement standardized readings. This emphasis on standardized office BP measurement is similar to recommendations from ACC/AHA and ESC/ESH. A systolic BP target of <120 mm Hg is suggested; however, the guidance emphasizes that the target is only applicable when BP is measured using standardized office protocols. RASi are the preferred agents for adults with CKD with increased albuminuria. For lifestyle interventions, dietary sodium intake should be limited to <2 g/day, and ≥150 minutes/week of physical activity is recommended. A BP target of <130/80 mm Hg and use of CCB or ARB are preferred in kidney transplant recipients. BP in children with CKD should be guided by 24-hour MAP using ambulatory monitoring, targeting ≤50th percentile for age, sex, and height. Similar to ACC/AHA and ESC/ESH guidelines, KDIGO also encourages shared-decision making between patients and clinicians in the individualization of BP therapy.
Conclusions:
KDIGO has revised its guideline for BP management in CKD based on a rigorous development process and emerging new evidence underscoring the importance of standardized office BP measurement and a lower systolic BP target of <120 mm Hg for achieving potential cardiovascular, kidney, and mortality benefits.
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Affiliation(s)
| | | | | | | | | | - Joachim H Ix
- UNIVERSITY OF CALIFORNIA SAN DIEGO, San Diego, CA
| | - Gregory Knoll
- The Ottawa Hosp, Ottawa Hosp Rsch Institute, Ottawa, Canada
| | | | | | | | | | - Charles Tomson
- Freeman Hosp, Newcastle upon Tyne Hosps NHS Trust, Newcastle upon Tyne, United Kingdom
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4
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Gibbons A, Bayfield J, Cinnirella M, Draper H, Johnson RJ, Oniscu GC, Ravanan R, Tomson C, Roderick P, Metcalfe W, Forsythe JLR, Dudley C, Watson CJE, Bradley JA, Bradley C. Changes in quality of life (QoL) and other patient-reported outcome measures (PROMs) in living-donor and deceased-donor kidney transplant recipients and those awaiting transplantation in the UK ATTOM programme: a longitudinal cohort questionnaire survey with additional qualitative interviews. BMJ Open 2021; 11:e047263. [PMID: 33853805 PMCID: PMC8098938 DOI: 10.1136/bmjopen-2020-047263] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 01/13/2021] [Accepted: 01/22/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To examine quality of life (QoL) and other patient-reported outcome measures (PROMs) in kidney transplant recipients and those awaiting transplantation. DESIGN Longitudinal cohort questionnaire surveys and qualitative semi-structured interviews using thematic analysis with a pragmatic approach. SETTING Completion of generic and disease-specific PROMs at two time points, and telephone interviews with participants UK-wide. PARTICIPANTS 101 incident deceased-donor (DD) and 94 incident living-donor (LD) kidney transplant recipients, together with 165 patients on the waiting list (WL) from 18 UK centres recruited to the Access to Transplantation and Transplant Outcome Measures (ATTOM) programme completed PROMs at recruitment (November 2011 to March 2013) and 1 year follow-up. Forty-one of the 165 patients on the WL received a DD transplant and 26 received a LD transplant during the study period, completing PROMs initially as patients on the WL, and again 1 year post-transplant. A subsample of 10 LD and 10 DD recipients participated in qualitative semi-structured interviews. RESULTS LD recipients were younger, had more educational qualifications and more often received a transplant before dialysis. Controlling for these and other factors, cross-sectional analyses at 12 months post-transplant suggested better QoL, renal-dependent QoL and treatment satisfaction for LD than DD recipients. Patients on the WL reported worse outcomes compared with both transplant groups. However, longitudinal analyses (controlling for pre-transplant differences) showed that LD and DD recipients reported similarly improved health status and renal-dependent QoL (p<0.01) pre-transplant to post-transplant. Patients on the WL had worsened health status but no change in QoL. Qualitative analyses revealed transplant recipients' expectations influenced their recovery and satisfaction with transplant. CONCLUSIONS While cross-sectional analyses suggested LD kidney transplantation leads to better QoL and treatment satisfaction, longitudinal assessment showed similar QoL improvements in PROMs for both transplant groups, with better outcomes than for those still wait-listed. Regardless of transplant type, clinicians need to be aware that managing expectations is important for facilitating patients' adjustment post-transplant.
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Affiliation(s)
- Andrea Gibbons
- Department of Psychology, University of Winchester, Winchester, UK
- Health Psychology Research Unit, Royal Holloway University of London, Egham, UK
| | - Janet Bayfield
- Health Psychology Research Unit, Royal Holloway University of London, Egham, UK
- Health Psychology Research Unit, Health Psychology Research Ltd, Egham, UK
| | - Marco Cinnirella
- Department of Psychology, Royal Holloway, University of London, Egham, UK
| | - Heather Draper
- Health Sciences, University of Warwick, Warwick Medical School, Coventry, UK
| | - Rachel J Johnson
- Statistics and Clinical Studies, NHS Blood and Transplant, Bristol, UK
| | - Gabriel C Oniscu
- Edinburgh Transplant Centre, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Rommel Ravanan
- Richard Bright Renal Unit, Southmead Hospital, Bristol, UK
| | - Charles Tomson
- Department of Renal Medicine, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Paul Roderick
- Academic Unit of Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Wendy Metcalfe
- Edinburgh Transplant Centre, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - John L R Forsythe
- Edinburgh Transplant Centre, Royal Infirmary of Edinburgh, Edinburgh, UK
- Organ Donation and Transplantation, NHS Blood and Transplant Organ Donation and Transplantation Directorate, Bristol, UK
| | | | - Christopher J E Watson
- Department of Surgery, University of Cambridge, Cambridge, UK
- NIHR Cambridge Biomedical Research Centre and the NIHR Blood and Transplant Research Unit in Organ Donation and Transplantation, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | - J Andrew Bradley
- Department of Surgery, University of Cambridge, Cambridge, UK
- NIHR Cambridge Biomedical Research Centre and the NIHR Blood and Transplant Research Unit in Organ Donation and Transplantation, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | - Clare Bradley
- Health Psychology Research Unit, Royal Holloway University of London, Egham, UK
- Health Psychology Research Unit, Health Psychology Research Ltd, Egham, UK
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5
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Evangelidis N, Sautenet B, Manera KE, Howell M, Craig JC, Viecelli AK, O'Lone E, Scholes‐Robertson N, Johnson DW, Cho Y, Tomson C, Wheeler DC, Tong A. Perspectives on blood pressure by patients on haemo‐ and peritoneal dialysis. Nephrology (Carlton) 2020; 26:62-69. [DOI: 10.1111/nep.13775] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 06/01/2020] [Accepted: 08/10/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Nicole Evangelidis
- Sydney School of Public Health, The University of Sydney Sydney New South Wales Australia
- Centre for Kidney Research, The Children's Hospital at Westmead Sydney New South Wales Australia
| | - Benedicte Sautenet
- Service de Néphrologie, Hôpital Bretonneau, CHRU Tours, Université de Tours et Nantes, SPHERE‐ INSERM 1246 Tours France
| | - Karine E. Manera
- Sydney School of Public Health, The University of Sydney Sydney New South Wales Australia
- Centre for Kidney Research, The Children's Hospital at Westmead Sydney New South Wales Australia
| | - Martin Howell
- Sydney School of Public Health, The University of Sydney Sydney New South Wales Australia
- Centre for Kidney Research, The Children's Hospital at Westmead Sydney New South Wales Australia
| | - Jonathan C. Craig
- College of Medicine and Public Health, Flinders University Adelaide Australia
| | - Andrea K. Viecelli
- Department of Nephrology Princess Alexandra Hospital Brisbane Queensland Australia
- Australasian Kidney Trials Network, Centre for Health Services Research, University of Queensland Brisbane Queensland Australia
| | - Emma O'Lone
- Sydney School of Public Health, The University of Sydney Sydney New South Wales Australia
- Centre for Kidney Research, The Children's Hospital at Westmead Sydney New South Wales Australia
| | - Nicole Scholes‐Robertson
- Sydney School of Public Health, The University of Sydney Sydney New South Wales Australia
- Centre for Kidney Research, The Children's Hospital at Westmead Sydney New South Wales Australia
| | - David W. Johnson
- Department of Nephrology Princess Alexandra Hospital Brisbane Queensland Australia
- Australasian Kidney Trials Network, Centre for Health Services Research, University of Queensland Brisbane Queensland Australia
- Translational Research Institute Brisbane Queensland Australia
| | - Yeoungjee Cho
- Department of Nephrology Princess Alexandra Hospital Brisbane Queensland Australia
- Australasian Kidney Trials Network, Centre for Health Services Research, University of Queensland Brisbane Queensland Australia
- Translational Research Institute Brisbane Queensland Australia
| | | | | | - Allison Tong
- Sydney School of Public Health, The University of Sydney Sydney New South Wales Australia
- Centre for Kidney Research, The Children's Hospital at Westmead Sydney New South Wales Australia
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Abstract
Investigation for secondary causes is recommended in early onset hypertension. However, obesity is associated with higher blood pressure (BP), so investigation for alternative secondary causes may not be necessary in all obese patients. We sought to define a rational approach to investigation across strata of age, body mass index (BMI) sex and race, based on BP distributions in the US National Health and Nutrition Examination Surveys 2005 to 2016. The majority (71% [95% CI, 59%–79%] and 64% [95% CI, 57%–69%] by European and US definitions respectively) of early onset hypertension cases were attributable to BP distribution shifts accompanying obesity and male sex. Male versus female sex, BMI>40 versus 18.2<BMI≤25 and Black versus White race were accompanied by adjusted mean systolic BP differences of 9 (95% CI, 8–9) mm Hg, 13 (95% CI, 12–15) mm Hg, and 3 (95% CI, 2–4) mm Hg respectively. Normal BMI women above the age cutoff for investigation were less likely to be hypertensive than obese younger men meeting current investigation criteria (
P
<0.001). Targeting investigations to combinations of sex, BMI, and age with low hypertension prevalence would reduce the number investigated while still identifying as many secondary cases. Limiting investigations to patients with a BP exceeded by ≤5% of their respective sex/BMI/age category would give investigation thresholds ranging from ≥130/≥80 and ≥140/≥90 for normal BMI women and men, respectively, at age 20 to 30 years, to ≥160/≥100 and ≥170/≥105 for women and men with BMI ≥40 at age 30 to 40 years. In conclusion, we propose refined strategies for investigation of early onset hypertension in the context of an obesity epidemic.
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Affiliation(s)
- Philip Thompson
- From the Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Freeman Road, United Kingdom (P.T., I.L., C.T., N.S., T.E.)
| | - Ian Logan
- From the Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Freeman Road, United Kingdom (P.T., I.L., C.T., N.S., T.E.)
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom (I.L., N.S., T.E.)
| | - Charles Tomson
- From the Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Freeman Road, United Kingdom (P.T., I.L., C.T., N.S., T.E.)
| | - Neil Sheerin
- From the Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Freeman Road, United Kingdom (P.T., I.L., C.T., N.S., T.E.)
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom (I.L., N.S., T.E.)
| | - Timothy Ellam
- From the Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Freeman Road, United Kingdom (P.T., I.L., C.T., N.S., T.E.)
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom (I.L., N.S., T.E.)
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7
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Pruthi R, Robb ML, Oniscu GC, Tomson C, Bradley A, Forsythe JL, Metcalfe W, Bradley C, Dudley C, Johnson RJ, Watson C, Draper H, Fogarty D, Ravanan R, Roderick PJ. Inequity in Access to Transplantation in the United Kingdom. Clin J Am Soc Nephrol 2020; 15:830-842. [PMID: 32467306 PMCID: PMC7274279 DOI: 10.2215/cjn.11460919] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 04/24/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND OBJECTIVES Despite the presence of a universal health care system, it is unclear if there is intercenter variation in access to kidney transplantation in the United Kingdom. This study aims to assess whether equity exists in access to kidney transplantation in the United Kingdom after adjustment for patient-specific factors and center practice patterns. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS In this prospective, observational cohort study including all 71 United Kingdom kidney centers, incident RRT patients recruited between November 2011 and March 2013 as part of the Access to Transplantation and Transplant Outcome Measures study were analyzed to assess preemptive listing (n=2676) and listing within 2 years of starting dialysis (n=1970) by center. RESULTS Seven hundred and six participants (26%) were listed preemptively, whereas 585 (30%) were listed within 2 years of commencing dialysis. The interquartile range across centers was 6%-33% for preemptive listing and 25%-40% for listing after starting dialysis. Patient factors, including increasing age, most comorbidities, body mass index >35 kg/m2, and lower socioeconomic status, were associated with a lower likelihood of being listed and accounted for 89% and 97% of measured intercenter variation for preemptive listing and listing within 2 years of starting dialysis, respectively. Asian (odds ratio, 0.49; 95% confidence interval, 0.33 to 0.72) and Black (odds ratio, 0.43; 95% confidence interval, 0.26 to 0.71) participants were both associated with reduced access to preemptive listing; however Asian participants were associated with a higher likelihood of being listed after starting dialysis (odds ratio, 1.42; 95% confidence interval, 1.12 to 1.79). As for center factors, being registered at a transplanting center (odds ratio, 3.1; 95% confidence interval, 2.36 to 4.07) and a universal approach to discussing transplantation (odds ratio, 1.4; 95% confidence interval, 1.08 to 1.78) were associated with higher preemptive listing, whereas using a written protocol was associated negatively with listing within 2 years of starting dialysis (odds ratio, 0.7; 95% confidence interval, 0.58 to 0.9). CONCLUSIONS Patient case mix accounts for most of the intercenter variation seen in access to transplantation in the United Kingdom, with practice patterns also contributing some variation. Socioeconomic inequity exists despite having a universal health care system.
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Affiliation(s)
- Rishi Pruthi
- Transplant, Renal and Urology Directorate, Guy's and St. Thomas' National Health Service Foundation Trust, London, United Kingdom .,Academic Unit of Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Matthew L Robb
- Statistics and Clinical Studies, National Health Service Blood and Transplant, Bristol, United Kingdom
| | - Gabriel C Oniscu
- Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | | | - Andrew Bradley
- Department of Surgery, University of Cambridge and the National Institute for Health Research Cambridge Biomedical Research Centre, Cambridge, United Kingdom
| | - John L Forsythe
- Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Wendy Metcalfe
- Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Clare Bradley
- Health Psychology Research Unit, Royal Holloway, University of London, Egham, United Kingdom
| | | | - Rachel J Johnson
- Statistics and Clinical Studies, National Health Service Blood and Transplant, Bristol, United Kingdom
| | - Christopher Watson
- Department of Surgery, University of Cambridge and the National Institute for Health Research Cambridge Biomedical Research Centre, Cambridge, United Kingdom
| | - Heather Draper
- Department of Social Science and Systems in Health, University of Warwick, Coventry, United Kingdom
| | - Damian Fogarty
- Nephrology Unit, Belfast Health and Social Care Trust, Belfast, Northern Ireland, United Kingdom
| | - Rommel Ravanan
- Richard Bright Renal Unit, Southmead Hospital, Bristol, United Kingdom
| | - Paul J Roderick
- Academic Unit of Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
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8
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Taylor DM, Fraser S, Dudley C, Oniscu GC, Tomson C, Ravanan R, Roderick P. Health literacy and patient outcomes in chronic kidney disease: a systematic review. Nephrol Dial Transplant 2019; 33:1545-1558. [PMID: 29165627 DOI: 10.1093/ndt/gfx293] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 08/29/2017] [Indexed: 11/14/2022] Open
Abstract
Background Limited health literacy affects 25% of people with chronic kidney disease (CKD), and may reduce self-management skills resulting in poorer clinical outcomes. By disproportionately affecting people with low socio-economic status and non-white ethnicity, limited health literacy may promote health inequity. Methods We performed a systematic review of quantitative studies of health literacy and clinical outcomes among adults with CKD. Results A total of 29 studies (13 articles; 16 conference abstracts) were included. One included non-USA patients. Of the 29 studies, 5 were cohort studies and 24 were cross-sectional. In all, 18 300 patients were studied: 4367 non-dialysis CKD; 13 202 dialysis; 390 transplant; 341 unspecified. Median study size was 127 [interquartile range (IQR) 92-238)], but 480 (IQR 260-2392) for cohort studies. Median proportion of non-white participants was 48% (IQR 17-70%). Six health literacy measures were used. Outcomes included patient attributes, care processes, clinical/laboratory parameters and 'hard' clinical outcomes. Limited health literacy was significantly, independently associated with hospitalizations, emergency department use, missed dialysis sessions, cardiovascular events and mortality (in cohort studies). Study quality was high (1 study), moderate (3 studies) and poor (25 studies), limited by sampling methods, variable adjustment for confounders and reduced methodological detail given in conference abstracts. Conclusions There is limited robust evidence of the causal effects of health literacy on patient outcomes in CKD. Available evidence suggests associations with adverse clinical events, increased healthcare use and mortality. Prospective studies are required to determine the causal effects of health literacy on outcomes in CKD patients, and examine the relationships between socio-economic status, comorbidity, health literacy and CKD outcomes. Intervention development and evaluation will determine whether health literacy is a modifiable determinant of poor outcomes in CKD.
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Affiliation(s)
- Dominic M Taylor
- Department of Primary Care and Population Sciences, University of Southampton, Southampton, UK.,Richard Bright Renal Service, North Bristol NHS Trust, Bristol, UK
| | - Simon Fraser
- Department of Primary Care and Population Sciences, University of Southampton, Southampton, UK
| | - Chris Dudley
- Richard Bright Renal Service, North Bristol NHS Trust, Bristol, UK
| | | | - Charles Tomson
- Department of Renal Medicine, Freeman Hospital, Newcastle-upon Tyne, UK
| | - Rommel Ravanan
- Richard Bright Renal Service, North Bristol NHS Trust, Bristol, UK
| | - Paul Roderick
- Richard Bright Renal Service, North Bristol NHS Trust, Bristol, UK
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Macdougall IC, White C, Reid C, Anker SD, Bhandari S, Farrington K, Kalra PA, Mcmurray J, Murray H, Tomson C, Wheeler DC, Winearls CG, Ford I. SaO033IV IRON DOSING AND INFECTION RISK IN THE PIVOTAL TRIAL: A PRE-SPECIFIED SECONDARY ANALYSIS. Nephrol Dial Transplant 2019. [DOI: 10.1093/ndt/gfz101.sao033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | - Chante Reid
- King's College Hospital, London, United Kingdom
| | | | - Sunil Bhandari
- Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom
| | | | - Philip A Kalra
- Salford Royal NHS Foundation Trust, Manchester, United Kingdom
| | | | | | | | | | | | - Ian Ford
- University of Glasgow, Glasgow, United Kingdom
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10
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Affiliation(s)
- Charles Tomson
- Department of Renal Medicine, Freeman Hospital, Newcastle upon Tyne, United Kingdom; and
| | - Laurie A Tomlinson
- London School of Hygiene and Tropical Medicine Non-Communicable Disease Epidemiology, London, United Kingdom
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11
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Nistor I, De Sutter J, Drechsler C, Goldsmith D, Soler MJ, Tomson C, Wiecek A, Donciu MD, Bolignano D, Van Biesen W, Covic A. Effect of renin-angiotensin-aldosterone system blockade in adults with diabetes mellitus and advanced chronic kidney disease not on dialysis: a systematic review and meta-analysis. Nephrol Dial Transplant 2018; 33:12-22. [PMID: 29106631 DOI: 10.1093/ndt/gfx072] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 03/17/2017] [Indexed: 01/08/2023] Open
Abstract
The presumed superiority of renin-angiotensin-aldosterone system (RAAS)-blocking agents over other antihypertensive agents in patients with diabetes to delay development of end-stage kidney disease (ESKD) has recently been challenged. In addition, there is ongoing uncertainty whether RAAS-blocking agents reduce mortality and/or delay ESKD in patients with diabetes and chronic kidney disease (CKD) stages 3-5. In this subgroup, there might be an expedited need for renal replacement therapy (RRT) when RAAS-blocking agents are used. We conducted a meta-analysis of randomized controlled trials (RCTs) of at least 6-months duration in adult patients with diabetes who also have non-dialysis CKD stages 3-5. RCTs comparing single RAAS-blocking agents to placebo or alternative antihypertensive agents were included. Outcomes of interest were all-cause mortality, cardiovascular morbidity, progression of renal function, ESKD and adverse events. A total of nine trials (n = 9797 participants with CKD stages 3-5) fit our inclusion criteria. There was no difference between the RAAS group and control group regarding all-cause mortality {relative risk [RR] = 0.97 [95% confidence interval (CI) 0.85-1.10]}, cardiovascular mortality [RR = 1.03 (95% CI 0.75-1.41)] and adverse events [RR = 1.05 (95% CI 0.89-1.25)]. There was a trend for a favourable effect for non-fatal cardiovascular events [RR = 0.90 (95% CI 0.81-1.00)] and a lower risk of the composite endpoint need for RRT/doubling of serum creatinine [RR = 0.81 (95% CI 0.70-0.92)] in the RAAS-blocking agents group versus the control group. We found evidence that in patients with diabetes mellitus and CKD stages 3-5, treatment with RAAS-blocking agents did not result in a clear survival advantage. The effect on renal outcomes did depend on the selected outcome measure. However, we did not find evidence that the use of RAAS-blocking agents expedited the need for RRT in patients with CKD stages 3-5.
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Affiliation(s)
- Ionut Nistor
- Nephrology Department, Gr. T. Popa University of Medicine and Pharmacy, Iasi, Romania.,ERBP Methods Support Team, Ghent University Hospital, Ghent, Belgium
| | | | - Christiane Drechsler
- ERBP Methods Support Team, Ghent University Hospital, Ghent, Belgium.,Division of Nephrology, University Hospital Würzburg and Comprehensive Heart Failure Center, Würzburg, Germany
| | - David Goldsmith
- Renal and Transplantation Department, Guy's Hospital, London, UK
| | - Maria Jose Soler
- Department of Nephrology, Hospital del Mar, Barcelona, Spain, Institut Hospital del Mar of Medical Research (IMIM), Barcelona, Spain
| | - Charles Tomson
- Department of Renal Medicine, Freeman Hospital, Newcastle upon Tyne, UK
| | - Andrzej Wiecek
- Department of Nephrology, Transplantation and Internal Medicine, Medical University of Silesia, Katowice, Poland
| | - Mihaela-Dora Donciu
- Nephrology Department, Gr. T. Popa University of Medicine and Pharmacy, Iasi, Romania
| | - Davide Bolignano
- ERBP Methods Support Team, Ghent University Hospital, Ghent, Belgium.,Institute of Clinical Physiology, National Council of Research, Reggio Calabria, Italy
| | - Wim Van Biesen
- Renal Division, Ghent University Hospital, Ghent, Belgium
| | - Adrian Covic
- Nephrology Department, Gr. T. Popa University of Medicine and Pharmacy, Iasi, Romania
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12
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Abstract
The introduction of the term 'acute kidney injury' (AKI) along with an international classification scheme,1 caused some initial confusion, but most clinicians and many patients now understand that the term 'injury' denotes damage to the internal workings of the kidney, rather than physical trauma. However, of greater concern is the use of the term 'nephrotoxic' to include drugs that are, in most settings, nephroprotective. We argue that this imprecise terminology, unfortunately adopted by the National Institute for Health and Care Excellence (NICE) among others, is potentially harmful, and that the terms 'nephrotoxin' and 'nephrotoxic' should not be used to describe haemodynamically mediated and fully reversible effects of some drugs on excretory function.
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Affiliation(s)
- Mike Jones
- University Hospital of North Durham, Durham, UK
| | - Charles Tomson
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
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13
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Chong J, Fotheringham J, Tomson C, Ellam T. Renal albumin excretion in healthy young adults and its association with mortality risk in the US population. Nephrol Dial Transplant 2018; 35:458-464. [DOI: 10.1093/ndt/gfy242] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Accepted: 06/24/2018] [Indexed: 01/09/2023] Open
Abstract
Abstract
Background
Current classification systems do not specify a healthy normal range for urinary albumin excretion. Occult microvascular disease induced by a Western lifestyle may mean that normal values for apparently healthy adults exceed optimal levels defined by mortality risk.
Methods
Using a national population sample [the US Third National Health and Nutrition Examination Survey (NHANES III) cohort; n = 11 887], the distributions of albumin:creatinine ratio (ACR) and fractional excretion of albumin (FEalb) were studied in healthy young adults [ages 20–40 years, without cardiovascular disease (CVD) or risk factors]. The threshold for mortality risk prediction in the whole adult population sample was then studied across ACR/FEalb categories corresponding to quartiles for healthy young adults.
Results
ACR quartiles for healthy young adults were 2.7, 4.2 and 5.9 mg/g in men and 3.8, 6.2 and 9.8 mg/g in women. Increases in ACR below the medians for healthy young adults were not associated with increased mortality or with cardiovascular risk factors when tested in the whole adult population. Increases above this threshold were independently associated with mortality risk [hazard ratio 1.2 (95% confidence interval 1.1–1.4) and 1.8 (1.6–2.0) for Quartiles 3 and 4, respectively]. The prevalence of an optimal ACR below the mortality risk threshold was <25% in the setting of diabetes, hypertension, age >70 years or CVD. Using FEalb to define quartiles of albuminuria gave the same findings.
Conclusion
Based on mortality risk in the whole adult population, there is an optimal range of albumin excretion (ACR < 6 mg/g and 4 mg/g for women and men, respectively). However, only half of even apparently healthy young US adults fall within this range.
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Affiliation(s)
- Jiehan Chong
- Sheffield Kidney Institute, Northern General Hospital, Sheffield, UK
| | | | - Charles Tomson
- Department of Renal Medicine, Freeman Hospital, Newcastle upon Tyne, UK
| | - Timothy Ellam
- Department of Renal Medicine, Freeman Hospital, Newcastle upon Tyne, UK
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14
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Gallagher H, Soar J, Tomson C. New guideline for perioperative management of people with inherited salt-wasting alkaloses. Br J Anaesth 2018; 116:746-9. [PMID: 27199308 DOI: 10.1093/bja/aew102] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Affiliation(s)
- H Gallagher
- South West Thames Renal Unit, Epsom and St Helier NHS Trust, Carshalton, UK
| | - J Soar
- Anaesthetics Department, Southmead Hospital, North Bristol NHS Trust, Bristol BS10 5NB, UK
| | - C Tomson
- Department of Renal Medicine, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
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15
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Taylor DM, Bradley JA, Bradley C, Draper H, Johnson R, Metcalfe W, Oniscu G, Robb M, Tomson C, Watson C, Ravanan R, Roderick P. Limited health literacy in advanced kidney disease. Kidney Int 2017; 90:685-95. [PMID: 27521115 DOI: 10.1016/j.kint.2016.05.033] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 05/23/2016] [Accepted: 05/26/2016] [Indexed: 12/21/2022]
Abstract
Limited health literacy may reduce the ability of patients with advanced kidney disease to understand their disease and treatment and take part in shared decision making. In dialysis and transplant patients, limited health literacy has been associated with low socioeconomic status, comorbidity, and mortality. Here, we investigated the prevalence and associations of limited health literacy using data from the United Kingdom-wide Access to Transplantation and Transplant Outcome Measures (ATTOM) program. Incident dialysis, incident transplant, and transplant wait-listed patients ages 18 to 75 were recruited from 2011 to 2013 and data were collected from patient questionnaires and case notes. A score >2 in the Single-Item Literacy Screener was used to define limited health literacy. Univariate and multivariate analyses were performed to identify patient factors associated with limited health literacy. We studied 6842 patients, 2621 were incident dialysis, 1959 were wait-listed, and 2262 were incident transplant. Limited health literacy prevalence was 20%, 15%, and 12% in each group, respectively. Limited health literacy was independently associated with low socioeconomic status, poor English fluency, and comorbidity. However, transplant wait-listing, preemptive transplantation, and live-donor transplantation were associated with increasing health literacy.
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Affiliation(s)
- Dominic M Taylor
- Department of Primary Care and Population Sciences, University of Southampton, Southampton, UK; Richard Bright Renal Service, North Bristol National Health Service Trust, Bristol, UK.
| | - John A Bradley
- Department of Surgery, University of Cambridge, and National Institute for Health Research Cambridge Biomedical Research Centre, Cambridge, UK
| | - Clare Bradley
- Health Psychology Research Unit, Royal Holloway, University of London, London, UK
| | - Heather Draper
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | | | | | - Matthew Robb
- National Health Service Blood and Transplant, UK
| | - Charles Tomson
- Department of Renal Medicine, Freeman Hospital, Newcastle-upon Tyne, UK
| | - Chris Watson
- Department of Surgery, University of Cambridge, and National Institute for Health Research Cambridge Biomedical Research Centre, Cambridge, UK
| | - Rommel Ravanan
- Richard Bright Renal Service, North Bristol National Health Service Trust, Bristol, UK
| | - Paul Roderick
- Department of Primary Care and Population Sciences, University of Southampton, Southampton, UK
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16
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Birnie K, Caskey F, Ben-Shlomo Y, Sterne JAC, Gilg J, Nitsch D, Tomson C. Erythropoiesis-stimulating agent dosing, haemoglobin and ferritin levels in UK haemodialysis patients 2005-13. Nephrol Dial Transplant 2017; 32:692-698. [PMID: 27190350 PMCID: PMC5410985 DOI: 10.1093/ndt/gfw043] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Accepted: 02/10/2016] [Indexed: 02/03/2023] Open
Abstract
Background: Erythropoiesis-stimulating agents (ESAs) with intravenous iron supplementation are the main treatment for anaemia in patients with chronic kidney disease. Although observational studies suggest better outcomes for patients who achieve higher haemoglobin (Hb) levels, randomized controlled trials comparing higher and lower Hb targets have led to safety concerns over higher targets and to changes in treatment guidelines. Methods: Quarterly data from 2005 to 2013 were obtained on 28 936 haemodialysis patients from the UK Renal Registry. We examined trends in ESA use and average dose, Hb and ferritin values over time and Hb according to the UK Renal Association guideline range. Results: The average ESA dose declined over time, with sharper decreases of epoetin seen towards the end of 2006 and from 2009. Average Hb for patients on ESAs was 114.1 g/L [95% confidence interval (CI) 113.7, 114.6] in the first quarter of 2005, which decreased to 109.6 g/L (95% CI 109.3, 109.9) by the end of 2013. Average serum ferritin was 353 µg/L (95% CI 345, 360) at the start of 2005, increasing to 386 µg/L (95% CI 380, 392) in the final quarter of 2013. The percentage of patients with Hb in the range of 100–120 g/L increased from 46.1 at the start of 2005 to 57.6 at the end of 2013. Conclusions: Anaemia management patterns for haemodialysis patients changed in the UK between 2005 and 2013. These patterns most likely reflect clinician response to emerging trial evidence and practice guidelines. Registries play an important role in continued observation of anaemia management and will monitor further changes as new evidence on optimal care emerges.
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Affiliation(s)
- Kate Birnie
- School of Social and Community Medicine, University of Bristol, Clifton, Bristol, UK
| | - Fergus Caskey
- School of Social and Community Medicine, University of Bristol, Clifton, Bristol, UK.,UK Renal Registry, Southmead Hospital, Bristol, UK.,Renal Unit, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Yoav Ben-Shlomo
- School of Social and Community Medicine, University of Bristol, Clifton, Bristol, UK
| | - Jonathan A C Sterne
- School of Social and Community Medicine, University of Bristol, Clifton, Bristol, UK
| | - Julie Gilg
- UK Renal Registry, Southmead Hospital, Bristol, UK
| | - Dorothea Nitsch
- Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Charles Tomson
- Department of Renal Medicine, Freeman Hospital, Newcastle upon Tyne, UK
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17
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Abrams P, Hashim H, Tomson C, Macgowan A, Skews R, Warren K. The use of intravesical gentamicin to treat recurrent urinary tract infections in lower urinary tract dysfunction. Neurourol Urodyn 2017; 36:2109-2116. [DOI: 10.1002/nau.23250] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 01/23/2017] [Accepted: 01/24/2017] [Indexed: 11/07/2022]
Affiliation(s)
- Paul Abrams
- Bristol Urological Institute; Southmead Hospital; Bristol United Kingdom
| | - Hashim Hashim
- Bristol Urological Institute; Southmead Hospital; Bristol United Kingdom
| | | | - Alasdair Macgowan
- Bristol Urological Institute; Southmead Hospital; Bristol United Kingdom
| | - Rachel Skews
- Bristol Urological Institute; Southmead Hospital; Bristol United Kingdom
| | - Katherine Warren
- Bristol Urological Institute; Southmead Hospital; Bristol United Kingdom
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18
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Whiting P, Morden A, Tomlinson LA, Caskey F, Blakeman T, Tomson C, Stone T, Richards A, Savović J, Horwood J. What are the risks and benefits of temporarily discontinuing medications to prevent acute kidney injury? A systematic review and meta-analysis. BMJ Open 2017; 7:e012674. [PMID: 28389482 PMCID: PMC5541442 DOI: 10.1136/bmjopen-2016-012674] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 09/21/2016] [Accepted: 10/25/2016] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES To summarise evidence on temporary discontinuation of medications to prevent acute kidney injury (AKI). DESIGN Systematic review and meta-analysis of randomised and non-randomised studies. PARTICIPANTS Adults taking diuretics, ACE inhibitors (ACEI), angiotensin receptor blockers (ARB), direct renin inhibitors, non-steroidal anti-inflammatories, metformin or sulfonylureas, experiencing intercurrent illnesses, radiological or surgical procedures. INTERVENTIONS Temporary discontinuation of any of the medications of interest. PRIMARY AND SECONDARY OUTCOME MEASURES Risk of AKI. Secondary outcome measures were estimated glomerular filtration rate and creatinine post-AKI, urea, systolic and diastolic blood pressure, death, clinical outcomes and biomarkers. RESULTS 6 studies were included (1663 participants), 3 randomised controlled trials (RCTs) and 3 prospective cohort studies. The mean age ranged from 65 to 73 years, and the proportion of women ranged from 31% to 52%. All studies were in hospital settings; 5 evaluated discontinuation of medication prior to coronary angiography and 1 prior to cardiac surgery. 5 studies evaluated discontinuation of ACEI and ARBs and 1 small cohort study looked at discontinuation of non-steroidal anti-inflammatory drugs. No studies evaluated discontinuation of medication in the community following an acute intercurrent illness. There was an increased risk of AKI of around 15% in those in whom medication was continued compared with those in whom it was discontinued (relative risk (RR) 1.17, 95% CI 0.99 to 1.38; 5 studies). When only results from RCTs were pooled, the increase in risk was almost 50% (RR 1.48, 95% CI 0.84 to 2.60; 3 RCTs), but the CI was wider. There was no difference between groups for any secondary outcomes. CONCLUSIONS There is low-quality evidence that withdrawal of ACEI/ARBs prior to coronary angiography and cardiac surgery may reduce the incidence of AKI. There is no evidence of the impact of drug cessation interventions on AKI incidence during intercurrent illness in primary or secondary care. TRIAL REGISTRATION NUMBER PROSPERO CRD42015023210.
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Affiliation(s)
- Penny Whiting
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Andrew Morden
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Laurie A Tomlinson
- UK Renal Registry, Bristol, UK
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Fergus Caskey
- School of Social and Community Medicine, University of Bristol, Bristol, UK
- UK Renal Registry, Bristol, UK
| | - Thomas Blakeman
- Centre for Primary Care, Institute of Population Health, The University of Manchester, Manchester, UK
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) Greater Manchester, Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester, UK
| | - Charles Tomson
- Department of Renal Medicine, Freeman Hospital, Newcastle Upon Tyne Hospitals Foundation Trust, Tyne and Wear, UK
| | - Tracey Stone
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Alison Richards
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Jelena Savović
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Jeremy Horwood
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- School of Social and Community Medicine, University of Bristol, Bristol, UK
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19
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Blakeman T, Griffith K, Lasserson D, Lopez B, Tsang JY, Campbell S, Tomson C. Development of guidance on the timeliness in response to acute kidney injury warning stage test results for adults in primary care: an appropriateness ratings evaluation. BMJ Open 2016; 6:e012865. [PMID: 27729353 PMCID: PMC5073517 DOI: 10.1136/bmjopen-2016-012865] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 08/19/2016] [Accepted: 09/12/2016] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVES Tackling the harm associated with acute kidney injury (AKI) is a global priority. In England, a national computerised AKI algorithm is being introduced across the National Health Service (NHS) to drive this change. The study sought to maximise its clinical utility and minimise the potential for burden on clinicians and patients in primary care. DESIGN An appropriateness ratings evaluation using the RAND/UCLA Appropriateness Method. SETTING Clinical scenarios were developed to test the timeliness in (1) communication of AKI warning stage test results from clinical pathology services to primary care, and (2) primary care clinician response to an AKI warning stage test result. PARTICIPANTS A 10-person panel was purposively sampled with representation from clinical biochemistry, acute and emergency medicine and general practice. General practitioners (GPs) represented typical practice in relation to rural and urban practice, out of hours care, GP commissioning and those interested in reducing the impact of medicalisation and 'overdiagnosis'. RESULTS There was agreement that delivery of AKI warning stage test results through interruptive methods of communication (ie, telephone) from laboratories to primary care was the appropriate next step for patients with an AKI warning stage 3 test result. In the context of acute illness, waiting up to 72 hours to respond to an AKI warning stage test result was deemed an inappropriate action in 62 out of the 65 (94.5%) cases. There was agreement that a clinician response was required within 6 hours, or less, in 39 out of 40 (97.5%) clinical cases relating AKI warning stage test results in the presence of moderate hyperkalaemia. CONCLUSIONS The study has informed national guidance to support a timely and calibrated response to AKI warning stage test results for adults in primary care. Further research is needed to support effective implementation, with a view to examine the effect on health outcomes and costs.
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Affiliation(s)
- Tom Blakeman
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) Greater Manchester, Centre for Primary Care, Institute of Population Health, The University of Manchester, Manchester, UK
| | - Kathryn Griffith
- RCGP Clinical champion for Kidney Care, Royal College of General Practitioners, London, UK
| | - Dan Lasserson
- Department of Geratology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Berenice Lopez
- Department of Clinical Biochemistry, Norfolk and Norwich University Hospitals Foundation Trust, Norwich, UK
| | - Jung Y Tsang
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) Greater Manchester, Centre for Primary Care, Institute of Population Health, The University of Manchester, Manchester, UK
| | - Stephen Campbell
- NIHR Greater Manchester Primary Care Patient Safety, Translational Research Centre, Institute of Population Health, Centre for Primary Care, University of Manchester, Manchester, UK
| | - Charles Tomson
- Department of Renal Medicine, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
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20
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Brück K, Stel VS, Gambaro G, Hallan S, Völzke H, Ärnlöv J, Kastarinen M, Guessous I, Vinhas J, Stengel B, Brenner H, Chudek J, Romundstad S, Tomson C, Gonzalez AO, Bello AK, Ferrieres J, Palmieri L, Browne G, Capuano V, Van Biesen W, Zoccali C, Gansevoort R, Navis G, Rothenbacher D, Ferraro PM, Nitsch D, Wanner C, Jager KJ. CKD Prevalence Varies across the European General Population. J Am Soc Nephrol 2016; 27:2135-47. [PMID: 26701975 PMCID: PMC4926978 DOI: 10.1681/asn.2015050542] [Citation(s) in RCA: 331] [Impact Index Per Article: 41.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 09/24/2015] [Indexed: 12/22/2022] Open
Abstract
CKD prevalence estimation is central to CKD management and prevention planning at the population level. This study estimated CKD prevalence in the European adult general population and investigated international variation in CKD prevalence by age, sex, and presence of diabetes, hypertension, and obesity. We collected data from 19 general-population studies from 13 European countries. CKD stages 1-5 was defined as eGFR<60 ml/min per 1.73 m(2), as calculated by the CKD-Epidemiology Collaboration equation, or albuminuria >30 mg/g, and CKD stages 3-5 was defined as eGFR<60 ml/min per 1.73 m(2) CKD prevalence was age- and sex-standardized to the population of the 27 Member States of the European Union (EU27). We found considerable differences in both CKD stages 1-5 and CKD stages 3-5 prevalence across European study populations. The adjusted CKD stages 1-5 prevalence varied between 3.31% (95% confidence interval [95% CI], 3.30% to 3.33%) in Norway and 17.3% (95% CI, 16.5% to 18.1%) in northeast Germany. The adjusted CKD stages 3-5 prevalence varied between 1.0% (95% CI, 0.7% to 1.3%) in central Italy and 5.9% (95% CI, 5.2% to 6.6%) in northeast Germany. The variation in CKD prevalence stratified by diabetes, hypertension, and obesity status followed the same pattern as the overall prevalence. In conclusion, this large-scale attempt to carefully characterize CKD prevalence in Europe identified substantial variation in CKD prevalence that appears to be due to factors other than the prevalence of diabetes, hypertension, and obesity.
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Affiliation(s)
- Katharina Brück
- European Renal Association-European Dialysis and Transplant Association Registry, Department of Medical Informatics, Amsterdam Medical Center, Amsterdam, The Netherlands;
| | - Vianda S Stel
- European Renal Association-European Dialysis and Transplant Association Registry, Department of Medical Informatics, Amsterdam Medical Center, Amsterdam, The Netherlands
| | - Giovanni Gambaro
- Division of Nephrology and Dialysis, Columbus-Gemelli University Hospital, Catholic University of the Sacred Heart, Rome, Italy
| | - Stein Hallan
- Department of Nephrology, St. Olav's Hospital/Faculty of Medicine, The Norwegian University of Science and Technology, Trondheim, Norway
| | - Henry Völzke
- Department of Clinical Epidemiology research, University Medicine Greifswald, Greifswald, Germany
| | - Johan Ärnlöv
- Department of Medical Sciences/Molecular Epidemiology, Uppsala University, Uppsala, Sweden
| | - Mika Kastarinen
- Finnish Medicines Agency, Department of Internal Medicine and Nephrology, Kuopio/National Institute for Health and Welfare, Helsinki, Finland
| | - Idris Guessous
- Department of Community Medicine, Primary Care and Emergency medicine, Geneva University Hospital, Geneva, Switzerland
| | - José Vinhas
- Department of Medicine, Setubal Hospital Centre, Setubal, Portugal
| | - Bénédicte Stengel
- Research Centre in Epidemiology and Population Health, INSERM Unit 1018, Villejuif, France
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center/Network Aging Research, University of Heidelberg, Heidelberg, Germany
| | - Jerzy Chudek
- Department of Pathophysiology, Medical Faculty/Department of Nephrology Endocrinology and Metabolic Diseases, Medical University of Silesia, Katowice, Poland
| | - Solfrid Romundstad
- Department of Nephrology, Levanger Hospital, Health Trust Nord-Trøndelag/The Norwegian University of Science and Technology, Norway
| | - Charles Tomson
- Department of Nephrology, Freeman Hospital, Newcastle upon Tyne, UK
| | | | - Aminu K Bello
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - Jean Ferrieres
- Department of Cardiology, Toulouse University School of Medicine, Rangueil Hospital, Toulouse, France
| | - Luigi Palmieri
- Department of Epidemiology of Cerebro and Cardiovascular Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Gemma Browne
- Department of Epidemiology & Public Health, University College Cork & Mercy University Hospital, Cork, Ireland
| | - Vincenzo Capuano
- Unità Operativa di Cardiologia ed UTIC, Mercato S. Severino Hospital, Salerno, Italy
| | - Wim Van Biesen
- Department of Nephrology, Ghent University Hospital, Ghent, Belgium
| | - Carmine Zoccali
- Consiglio Nazionale delle Ricerche-Istituto di Fisiologia Clinica, Clinical Epidemiology and Pathophysiology of Renal Diseases and Hypertension, Reggio Calabria, Italy
| | - Ron Gansevoort
- Department of Nephrology/Graduate School of Medical Sciences and
| | - Gerjan Navis
- Department of Epidemiology of Cerebro and Cardiovascular Diseases, Istituto Superiore di Sanità, Rome, Italy
| | | | - Pietro Manuel Ferraro
- Division of Nephrology and Dialysis, Columbus-Gemelli University Hospital, Catholic University of the Sacred Heart, Rome, Italy
| | - Dorothea Nitsch
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine and University College London, Centre for Nephrology, London, United Kingdom; and
| | - Christoph Wanner
- Department of Nephrology, University Hospital Würzburg, Würzburg, Germany
| | - Kitty J Jager
- European Renal Association-European Dialysis and Transplant Association Registry, Department of Medical Informatics, Amsterdam Medical Center, Amsterdam, The Netherlands
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21
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Brück K, Jager KJ, Dounousi E, Kainz A, Nitsch D, Ärnlöv J, Rothenbacher D, Browne G, Capuano V, Ferraro PM, Ferrieres J, Gambaro G, Guessous I, Hallan S, Kastarinen M, Navis G, Gonzalez AO, Palmieri L, Romundstad S, Spoto B, Stengel B, Tomson C, Tripepi G, Völzke H, Wiȩcek A, Gansevoort R, Schöttker B, Wanner C, Vinhas J, Zoccali C, Van Biesen W, Stel VS. Methodology used in studies reporting chronic kidney disease prevalence: a systematic literature review. Nephrol Dial Transplant 2016. [PMID: 26209739 PMCID: PMC4514069 DOI: 10.1093/ndt/gfv131] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background Many publications report the prevalence of chronic kidney disease (CKD) in the general population. Comparisons across studies are hampered as CKD prevalence estimations are influenced by study population characteristics and laboratory methods. Methods For this systematic review, two researchers independently searched PubMed, MEDLINE and EMBASE to identify all original research articles that were published between 1 January 2003 and 1 November 2014 reporting the prevalence of CKD in the European adult general population. Data on study methodology and reporting of CKD prevalence results were independently extracted by two researchers. Results We identified 82 eligible publications and included 48 publications of individual studies for the data extraction. There was considerable variation in population sample selection. The majority of studies did not report the sampling frame used, and the response ranged from 10 to 87%. With regard to the assessment of kidney function, 67% used a Jaffe assay, whereas 13% used the enzymatic assay for creatinine determination. Isotope dilution mass spectrometry calibration was used in 29%. The CKD-EPI (52%) and MDRD (75%) equations were most often used to estimate glomerular filtration rate (GFR). CKD was defined as estimated GFR (eGFR) <60 mL/min/1.73 m2 in 92% of studies. Urinary markers of CKD were assessed in 60% of the studies. CKD prevalence was reported by sex and age strata in 54 and 50% of the studies, respectively. In publications with a primary objective of reporting CKD prevalence, 39% reported a 95% confidence interval. Conclusions The findings from this systematic review showed considerable variation in methods for sampling the general population and assessment of kidney function across studies reporting CKD prevalence. These results are utilized to provide recommendations to help optimize both the design and the reporting of future CKD prevalence studies, which will enhance comparability of study results.
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Affiliation(s)
- Katharina Brück
- ERA-EDTA Registry, Amsterdam Medical Center, Amsterdam, The Netherlands
| | - Kitty J Jager
- ERA-EDTA Registry, Amsterdam Medical Center, Amsterdam, The Netherlands
| | - Evangelia Dounousi
- Department of Nephrology, Medical School, University of Ioannina, Ioannina, Greece
| | - Alexander Kainz
- Department of Internal Medicine III/Nephrology, Medical University, Vienna, Austria
| | - Dorothea Nitsch
- Epidemiology and Population Health, LSHTM and UCL Centre for Nephrology, London, UK
| | - Johan Ärnlöv
- Department of Medical Sciences/Molecular Epidemiology, Uppsala University, Uppsala, Sweden
| | | | - Gemma Browne
- Department of Epidemiology & Public Health, University College Cork, Ireland
| | - Vincenzo Capuano
- Unità Opaerativa di Cardiologia ed UTIC, Mercato S. Severino Hospital, Mercato S. Severino, Italy
| | - Pietro Manuel Ferraro
- Nephrology and Dialysis, Columbus-Gemelli University Hospital, Catholic University of the Sacred Heart, Rome, Italy
| | - Jean Ferrieres
- Department of Cardiology, Toulouse University School of Medicine, Rangueil Hospital, Toulouse, France
| | - Giovanni Gambaro
- Nephrology and Dialysis, Columbus-Gemelli University Hospital, Catholic University of the Sacred Heart, Rome, Italy
| | - Idris Guessous
- Unit of Population Epidemiology, Division of primary care medicine, Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospital, Geneva, Switzerland
| | - Stein Hallan
- Department of Nephrology, St Olav Hospital, Norway/Faculty of Medicine, The Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Mika Kastarinen
- Finnish Medicines Agency, Kuopio/National Institute for Health and Welfare, Helsinki, Finland
| | - Gerjan Navis
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, Groningen, The Netherlands
| | | | | | - Solfrid Romundstad
- Department of Nephrology, Levanger Hospital, Health Trust Nord-Trøndelag/The Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Belinda Spoto
- Department of Nephrology, Dialysis and Transplantation Unit, CNR-IFC, Clinical Epidemiology and Pathophysiology of Renal Diseases and Hypertension, Reggio Calabria, Italy
| | - Benedicte Stengel
- Research Centre in Epidemiology and Population Health, Inserm Unit 1018, Villejuif, France
| | - Charles Tomson
- Department of Nephrology, Freeman Hospital, Newcastle upon Tyne, UK
| | - Giovanni Tripepi
- Department of Nephrology, Dialysis and Transplantation Unit, CNR-IFC, Clinical Epidemiology and Pathophysiology of Renal Diseases and Hypertension, Reggio Calabria, Italy
| | - Henry Völzke
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Andrzej Wiȩcek
- Departement of Nephrology, Transplantology and Internal Diseases, Faculty of Medicine in Katowice, Medical University of Silesia in Katowice, Poland
| | - Ron Gansevoort
- Department of Nephrology/Graduate School of Medical Sciences, University Medical Center Groningen, Groningen, The Netherlands
| | - Ben Schöttker
- Division of Clinical Epidemiology and Ageing Research, German Cancer Research, Heidelberg, Germany
| | - Christoph Wanner
- Department of Nephrology, University Hospital Würzburg, Würzburg, Germany
| | - Jose Vinhas
- Department of Nephrology, Setubal Hospital Centre, Setubal, Portugal
| | - Carmine Zoccali
- Department of Nephrology, Dialysis and Transplantation Unit, CNR-IFC, Clinical Epidemiology and Pathophysiology of Renal Diseases and Hypertension, Reggio Calabria, Italy
| | - Wim Van Biesen
- Department of Nephrology, Ghent University Hospital, Ghent, Belgium
| | - Vianda S Stel
- ERA-EDTA Registry, Amsterdam Medical Center, Amsterdam, The Netherlands
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22
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Oniscu GC, Ravanan R, Wu D, Gibbons A, Li B, Tomson C, Forsythe JL, Bradley C, Cairns J, Dudley C, Watson CJE, Bolton EM, Draper H, Robb M, Bradbury L, Pruthi R, Metcalfe W, Fogarty D, Roderick P, Bradley JA. Access to Transplantation and Transplant Outcome Measures (ATTOM): study protocol of a UK wide, in-depth, prospective cohort analysis. BMJ Open 2016; 6:e010377. [PMID: 26916695 PMCID: PMC4769394 DOI: 10.1136/bmjopen-2015-010377] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION There is significant intercentre variability in access to renal transplantation in the UK due to poorly understood factors. The overarching aims of this study are to improve equity of access to kidney and kidney-pancreas transplantation across the UK and to optimise organ allocation to maximise the benefit and cost-effectiveness of transplantation. METHODS AND ANALYSIS 6844 patients aged 18-75 years starting dialysis and/or receiving a transplant together with matched patients active on the transplant list from all 72 UK renal units were recruited between November 2011 and March 2013 and will be followed for at least 3 years. The outcomes of interest include patient survival, access to the transplant list, receipt of a transplant, patient-reported outcome measures (PROMs) including quality of life, treatment satisfaction, well-being and health status on different forms of renal replacement therapy. Sociodemographic and clinical data were prospectively collected from case notes and from interviews with patients and local clinical teams. Qualitative process exploration with clinical staff will help identify unit-specific factors that influence access to renal transplantation. A health economic analysis will explore costs and outcomes associated with alternative approaches to organ allocation. The study will deliver: (1) an understanding of patient and unit-specific factors influencing access to renal transplantation in the UK, informing potential changes to practices and policies to optimise outcomes and reduce intercentre variability; (2) a patient-survival probability model to standardise access to the renal transplant list and (3) an understanding of PROMs and health economic impact of kidney and kidney-pancreas transplantation to inform the development of a more sophisticated and fairer organ allocation algorithm. ETHICS AND DISSEMINATION The protocol has been independently peer reviewed by National Institute for Health Research (NIHR) and approved by the East of England Research Ethics Committee. The results will be published in peer-reviewed journals and presented at conferences.
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Affiliation(s)
| | - Rommel Ravanan
- Richard Bright Renal Unit, Southmead Hospital, Bristol, UK
| | - Diana Wu
- Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Andrea Gibbons
- Health Psychology Research Unit, Royal Holloway, University of London, London, UK
| | - Bernadette Li
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Charles Tomson
- Department of Renal Medicine, Freeman Hospital, Newcastle upon Tyne, UK
| | - John L Forsythe
- Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Clare Bradley
- Health Psychology Research Unit, Royal Holloway, University of London, London, UK
| | - John Cairns
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Christopher J E Watson
- Department of Surgery, University of Cambridge and the NIHR Cambridge Biomedical Research Centre, Cambridge, UK
| | - Eleanor M Bolton
- Department of Surgery, University of Cambridge and the NIHR Cambridge Biomedical Research Centre, Cambridge, UK
| | - Heather Draper
- School of Health and Population Sciences, University of Birmingham, Birmingham, UK
| | | | | | | | - Wendy Metcalfe
- Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, UK
| | | | - Paul Roderick
- Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - J Andrew Bradley
- Department of Surgery, University of Cambridge and the NIHR Cambridge Biomedical Research Centre, Cambridge, UK
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23
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Brück K, Jager KJ, Dounousi E, Kainz A, Nitsch D, Ärnlöv J, Rothenbacher D, Browne G, Capuano V, Ferraro PM, Ferrieres J, Gambaro G, Guessous I, Hallan S, Kastarinen M, Navis G, Otero Gonzalez A, Palmieri L, Romundstad S, Spoto B, Stengel B, Tomson C, Tripepi G, Völzke H, Wiȩcek A, Gansevoort R, Schöttker B, Wanner C, Vinhas J, Zoccali C, Van Biesen W, Stel VS. Methodology used in studies reporting chronic kidney disease prevalence: a systematic literature review. Nephrol Dial Transplant 2016; 31:680. [DOI: 10.1093/ndt/gfw024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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24
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Bailey PK, Ben-Shlomo Y, de Salis I, Tomson C, Owen-Smith A. Better the donor you know? A qualitative study of renal patients' views on 'altruistic' live-donor kidney transplantation. Soc Sci Med 2015; 150:104-11. [PMID: 26745864 DOI: 10.1016/j.socscimed.2015.12.041] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 11/25/2015] [Accepted: 12/23/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND In the UK there is a short-fall between individuals requiring a renal transplant and kidneys available for transplantation. Non-directed 'altruistic' living kidney donation has emerged as a strategy for bridging this gap between supply and demand, with the number increasing each year. OBJECTIVE This study aimed to explore the views of potential recipients towards non-directed 'altruistic' live-donor kidney transplantation. METHODS Semi-structured interviews with 32 UK deceased-donor kidney transplant recipients were performed. Interviews explored willingness to consider directed and non-directed live-donor kidney transplants (LDKTs). Interviews were recorded, transcribed verbatim and transcripts were analysed using the constant comparison method described in Grounded Theory. RESULTS For those not willing to accept a non-directed 'altruistic' LDKT, the following themes were identified: i) Prioritising other recipients above self; ii) Fear of acquiring an unknown donor's characteristics, and iii) Concern for the donor - unnecessary risk. For those willing to accept a non-directed 'altruistic' LDKT the following themes were identified: iv) Prioritising known above unknown persons, v) Belief that they are as deserving as other potential recipients, and vi) Advantages of a LDKT. CONCLUSIONS Drawing on 'gift exchange theory', this study contributes to our understanding of the experience of the intended recipient of a gift. The anonymity of the donor-recipient appears to be seen as a benefit of non-directed 'altruistic' live-donor transplants, freeing recipients from the obligations of the gift. However, those who feel unworthy of the 'gifted transplant' are concerned about the donor and by the lack of opportunity for direct reciprocity. Highlighting the 'reciprocal benefits' reported by donors may allow individuals whose preference is a live-donor transplant to accept one if offered. These insights provide the transplant community with targets for intervention, through which the concerns of potential recipients might be addressed.
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Affiliation(s)
- Phillippa K Bailey
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
| | - Yoav Ben-Shlomo
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Isabel de Salis
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Charles Tomson
- Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Road, Newcastle upon Tyne, Tyne and Wear, NE7 7DN, UK
| | - Amanda Owen-Smith
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
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25
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Morden A, Horwood J, Whiting P, Savovic J, Tomlinson L, Blakeman T, Tomson C, Richards A, Stone T, Caskey F. The risks and benefits of patients temporarily discontinuing medications in the event of an intercurrent illness: a systematic review protocol. Syst Rev 2015; 4:139. [PMID: 26497494 PMCID: PMC4619996 DOI: 10.1186/s13643-015-0135-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 10/15/2015] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Acute kidney injury (AKI) is common and often leads to significant morbidity and/or death. The development of AKI, or complications associated with it, may be due to use of certain medications in at-risk patients experiencing an intercurrent illness. Implicated drugs include diuretics, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers/direct renin inhibitors, non-steroidal anti-inflammatory drugs (NSAIDs), metformin and sulfonylureas. Expert consensus opinion (and clinical guidelines) recommend considering discontinuation of diuretics, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers/direct renin inhibitors, NSAIDs, metformin and sulfonylureas in the event of an intercurrent illness to prevent AKI onset or reduce severity or complications. However, the evidence base for these recommendations is very limited. This systematic review aims to address the available evidence for the temporary discontinuation of diuretics, ACE inhibitors, angiotensin receptor blockers, direct renin inhibitors, non-steroidal anti-inflammatories and metformin and sulfonylureas for those at risk of AKI or with newly diagnosed AKI. METHODS/DESIGN Randomised controlled trials; non-randomised trials; cohort studies; case-control studies; interrupted time series studies; and before-and-after studies featuring adults aged 18 and over in any setting currently taking diuretics, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers/direct renin inhibitors, NSAIDs and metformin; experiencing an intercurrent illness; or undergoing a radiological/surgical procedure (planned or unplanned) will be searched for. Relevant trial registers and systematic review databases will be searched. Systematic reviews will be assessed for methodological quality using the ROBIS tool, trials will be assessed using the Cochrane risk of bias tool, and observational studies will be assessed using the ACROBAT-NRS tool. If sufficient studies assessing similar populations, study type, settings and outcomes are found, then a formal meta-analysis will be performed to estimate summary measures of effect. If not, a narrative synthesis will be adopted. DISCUSSION This review will synthesise evidence for the efficacy of discontinuing diuretics, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers/direct renin inhibitors, NSAIDs, metformin or sulfonylureas to prevent or delay onset of AKI or associated complications. Results will provide guidance on efficacy and safety of this strategy and potentially help to develop an intervention to test the best mechanism of guiding medication discontinuation in at-risk populations. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42015023210.
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Affiliation(s)
- Andrew Morden
- NIHR CLAHRC West, Bristol, UK.
- School of Social and Community Medicine, University of Bristol, Bristol, UK.
| | - Jeremy Horwood
- NIHR CLAHRC West, Bristol, UK
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Penny Whiting
- NIHR CLAHRC West, Bristol, UK
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Jelena Savovic
- NIHR CLAHRC West, Bristol, UK
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Laurie Tomlinson
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Thomas Blakeman
- Centre for Primary Care, Institute of Population Health, The University of Manchester, Manchester, UK
- NIHR CLAHRC Greater Manchester, Manchester, UK
| | - Charles Tomson
- Department of Renal Medicine, Freeman Hospital, Newcastle Upon Tyne Hospitals Foundation Trust, Tyne and Wear, UK
| | - Alison Richards
- NIHR CLAHRC West, Bristol, UK
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Tracey Stone
- NIHR CLAHRC West, Bristol, UK
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Fergus Caskey
- School of Social and Community Medicine, University of Bristol, Bristol, UK
- UK Renal Registry, Bristol, UK
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26
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Rhodes HL, Yarram-Smith L, Rice SJ, Tabaksert A, Edwards N, Hartley A, Woodward MN, Smithson SL, Tomson C, Welsh GI, Williams M, Thwaites DT, Sayer JA, Coward RJM. Clinical and genetic analysis of patients with cystinuria in the United Kingdom. Clin J Am Soc Nephrol 2015; 10:1235-45. [PMID: 25964309 DOI: 10.2215/cjn.10981114] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 03/30/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Cystinuria is a rare inherited renal stone disease. Mutations in the amino acid exchanger System b(0,+), the two subunits of which are encoded by SLC3A1 and SLC7A9, predominantly underlie this disease. The work analyzed the epidemiology of cystinuria and the influence of mutations in these two genes on disease severity in a United Kingdom cohort. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Prevalent patients were studied from 2012 to 2014 in the northeast and southwest of the United Kingdom. Clinical phenotypes were defined, and genetic analysis of SLC3A1 and SLC7A9 combining Sanger sequencing and multiplex ligation probe-dependent amplification was performed. RESULTS In total, 76 patients (42 men and 34 women) were studied. All subjects had proven cystine stones. Median age of presentation (first stone episode) was 24 years old, but 21% of patients presented after 40 years old. Patients had varied clinical courses, with 37% of patients having ≥10 stone episodes; 70% had evidence of CKD, and 9% had reached ESRD as a result of cystinuria and its complications. Patients with cystinuria received a variety of different therapies, with no obvious treatment consensus. Notably, 20% of patients had staghorn calculi, with associated impaired renal function in 80% of these patients. Genetic analysis revealed that biallelic mutations were present in either SLC3A1 (n=27) or SLC7A9 (n=20); 22 patients had only one mutated allele detected (SLC3A1 in five patients and SLC7A9 in 17 patients). In total, 37 different mutant variant alleles were identified, including 12 novel mutations; 22% of mutations were caused by large gene rearrangements. No genotype-phenotype association was detected in this cohort. CONCLUSIONS Patients with cystinuria in the United Kingdom often present atypically with staghorn calculi at ≥40 years old and commonly develop significant renal impairment. There is no association of clinical course with genotype. Treatments directed toward reducing stone burden need to be rationalized and developed to optimize patient care.
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Affiliation(s)
- Hannah L Rhodes
- Academic and Children's Renal Unit, School of Clinical Sciences, University of Bristol, Bristol, United Kingdom
| | | | - Sarah J Rice
- Institute for Cell and Molecular Biosciences, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Ayla Tabaksert
- Institute for Cell and Molecular Biosciences, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Noel Edwards
- Institute of Genetic Medicine, International Centre for Life and
| | - Alice Hartley
- Department of Urology, National Health Service Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Mark N Woodward
- Academic and Children's Renal Unit, School of Clinical Sciences, University of Bristol, Bristol, United Kingdom
| | - Sarah L Smithson
- Department of Clinical Genetics, University Hospitals, Bristol, United Kingdom; and
| | - Charles Tomson
- Richard Bright Renal Unit, Southmead Hospital, Bristol, United Kingdom; Department of Renal Medicine, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Gavin I Welsh
- Academic and Children's Renal Unit, School of Clinical Sciences, University of Bristol, Bristol, United Kingdom
| | | | - David T Thwaites
- Institute for Cell and Molecular Biosciences, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - John A Sayer
- Institute of Genetic Medicine, International Centre for Life and Department of Renal Medicine, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Richard J M Coward
- Academic and Children's Renal Unit, School of Clinical Sciences, University of Bristol, Bristol, United Kingdom
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Brück K, Jager KJ, Dounousi E, Kainz A, Gambaro G, Hallan S, Spoto B, Tomson C, Tripepi G, Wanner C, Zoccali C, Van Biesen W, Stel VS. FP369METHODOLOGY USED IN STUDIES REPORTING CHRONIC KIDNEY DISEASE PREVALENCE: A SYSTEMATIC LITERATURE REVIEW. Nephrol Dial Transplant 2015. [DOI: 10.1093/ndt/gfv175.51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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28
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Covic A, De Sutter J, Drechsler C, David Goldsmith D, Soler MJ, Tomson C, Wiecek A, Donciu MD, Bolignano D, Van Biesen W, Nistor I. FP357EFFECT OF RAAS BLOCKADE IN ADULTS WITH DIABETES MELLITUS AND ADVANCED CHRONIC KIDNEY DISEASE NOT ON DIALYSIS: A SYSTEMATIC REVIEW AND META-ANALYSIS. Nephrol Dial Transplant 2015. [DOI: 10.1093/ndt/gfv175.39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Roderick P, Rayner H, Tonkin-Crine S, Okamoto I, Eyles C, Leydon G, Santer M, Klein J, Yao GL, Murtagh F, Farrington K, Caskey F, Tomson C, Loud F, Murphy E, Elias R, Greenwood R, O’Donoghue D. A national study of practice patterns in UK renal units in the use of dialysis and conservative kidney management to treat people aged 75 years and over with chronic kidney failure. Health Services and Delivery Research 2015. [DOI: 10.3310/hsdr03120] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundConservative kidney management (CKM) is recognised as an alternative to dialysis for a significant number of older adults with multimorbid stage 5 chronic kidney disease (CKD5). However, little is known about the way CKM is delivered or how it is perceived.AimTo determine the practice patterns for the CKM of older patients with CKD5, to inform service development and future research.Objectives(1) To describe the differences between renal units in the extent and nature of CKM, (2) to explore how decisions are made about treatment options for older patients with CKD5, (3) to explore clinicians’ willingness to randomise patients with CKD5 to CKM versus dialysis, (4) to describe the interface between renal units and primary care in managing CKD5 and (5) to identify the resources involved and potential costs of CKM.MethodsMixed-methods study. Interviews with 42 patients aged > 75 years with CKD5 and 60 renal unit staff in a purposive sample of nine UK renal units. Interviews informed the design of a survey to assess CKM practice, sent to all 71 UK units. Nineteen general practitioners (GPs) were interviewed concerning the referral of CKD patients to secondary care. We sought laboratory data on new CKD5 patients aged > 75 years to link with the nine renal units’ records to assess referral patterns.ResultsSixty-seven of 71 renal units completed the survey. Although terminology varied, there was general acceptance of the role of CKM. Only 52% of units were able to quantify the number of CKM patients. A wide range reflected varied interpretation of the designation ‘CKM’ by both staff and patients. It is used to characterise a future treatment option as well as non-dialysis care for end-stage kidney failure (i.e. a disease state equivalent to being on dialysis). The number of patients in the latter group on CKM was relatively small (median 8, interquartile range 4.5–22). Patients’ expectations of CKM and dialysis were strongly influenced by renal staff. In a minority of units, CKM was not discussed. When discussed, often only limited information about illness progression was provided. Staff wanted more research into the relative benefits of CKM versus dialysis. There was almost universal support for an observational methodology and a quarter would definitely be willing to participate in a randomised clinical trial, indicating that clinicians placed value on high-quality evidence to inform decision-making. Linked data indicated that most CKD5 patients were known to renal units. GPs expressed a need for guidance on when to refer older multimorbid patients with CKD5 to nephrology care. There was large variation in the scale and model of CKM delivery. In most, the CKM service was integrated within the service for all non-renal replacement therapy CKD5 patients. A few units provided dedicated CKM clinics and some had dedicated, modest funding for CKM.ConclusionsConservative kidney management is accepted across UK renal units but there is much variation in the way it is described and delivered. For best practice, and for CKM to be developed and systematised across all renal units in the UK, we recommend (1) a standard definition and terminology for CKM, (2) research to measure the relative benefits of CKM and dialysis and (3) development of evidence-based staff training and patient education interventions.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Paul Roderick
- Primary Care and Population Sciences, University of Southampton, UK
| | - Hugh Rayner
- Department of Renal Medicine, Heart of England NHS Foundation Trust, Birmingham, UK
| | | | - Ikumi Okamoto
- Primary Care and Population Sciences, University of Southampton, UK
| | - Caroline Eyles
- Primary Care and Population Sciences, University of Southampton, UK
| | - Geraldine Leydon
- Primary Care and Population Sciences, University of Southampton, UK
| | - Miriam Santer
- Primary Care and Population Sciences, University of Southampton, UK
| | - Jonathan Klein
- Southampton Management School, University of Southampton, UK
| | - Guiqing Lily Yao
- Primary Care and Population Sciences, University of Southampton, UK
| | - Fliss Murtagh
- Cicely Saunders Institute, King’s College London, UK
| | | | | | | | | | - Emma Murphy
- Cicely Saunders Institute, King’s College London, UK
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30
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Affiliation(s)
- Barnaby Hole
- Department of Renal Medicine, Southmead Hospital, Bristol BS10 5NB, UK
| | | | - Charles Tomson
- Department of Renal Medicine, Southmead Hospital, Bristol BS10 5NB, UK
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31
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Okamoto I, Tonkin-Crine S, Rayner H, Murtagh FEM, Farrington K, Caskey F, Tomson C, Loud F, Greenwood R, O'Donoghue DJ, Roderick P. Conservative care for ESRD in the United Kingdom: a national survey. Clin J Am Soc Nephrol 2014; 10:120-6. [PMID: 25388518 DOI: 10.2215/cjn.05000514] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Conservative kidney management (CKM) has been developed in the United Kingdom (UK) as an alternative to dialysis for older patients with stage 5 CKD (CKD5) and multiple comorbidities. This national survey sought to describe the current scale and pattern of delivery of conservative care in UK renal units and identify their priorities for its future development. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS A survey on practice patterns of CKM for patients age 75 and older with CKD5 was sent to clinical directors of all 71 adult renal units in the UK in March 2013. RESULTS Sixty-seven units (94%) responded. All but one unit reported providing CKM for some patients. Terminology varied, although "conservative management" was the most frequently used term (46%). Lack of an agreed-upon definition of when a patient is receiving CKM made it difficult to obtain meaningful data on the numbers of such patients. Fifty-two percent provided the number of CKM patients age ≥ 75 years in 2012; the median was 45 per unit (interquartile range [IQR], 20-83). The median number of symptomatic CKM patients who would otherwise have started dialysis was eight (IQR, 4.5-22). CKM practice patterns varied: 35% had a written guideline, 23% had dedicated CKM clinics, 45% had dedicated staff, and 50% provided staff training on CKM. Most units (88%) provided primary care clinicians with information/advice regarding CKM. Eighty percent identified a need for better evidence comparing outcomes on CKM versus dialysis, and 65% considered it appropriate to enter patients into a randomized trial. CONCLUSIONS CKM is provided in almost all UK renal units, but scale and organization vary widely. Lack of common terminology and definitions hinders the development and assessment of CKM. Many survey respondents expressed support for further research comparing outcomes with conservative care versus dialysis.
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Affiliation(s)
- Ikumi Okamoto
- Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Sarah Tonkin-Crine
- Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Hugh Rayner
- Department of Renal Medicine, Heart of England NHS Foundation Trust, Birmingham, United Kingdom
| | - Fliss E M Murtagh
- Department of Palliative Care, Policy and Rehabilitation, King's College London, London, United Kingdom
| | | | - Fergus Caskey
- Renal Unit, Southmead Hospital, Bristol, United Kingdom
| | | | - Fiona Loud
- British Kidney Patient Association, United Kingdom; and
| | | | - Donal J O'Donoghue
- Department of Renal Medicine, Salford Royal NHS Foundation Trust, Salford, United Kingdom
| | - Paul Roderick
- Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom;
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Couchoud C, Bolignano D, Nistor I, Jager KJ, Heaf J, Heimburger O, Van Biesen W, Bilo H, Bolignano D, Coentrao L, Couchoud C, Covic A, Drechsler C, De Sutter J, Goldsmith D, Gnudi L, Heaf J, Heimburger O, Jager K, Nacak H, Nistor I, Soler M, Tomson C, Van Biesen W, Vanhuffel L, Van Laecke S, Weekers L, Wiecek A. Dialysis modality choice in diabetic patients with end-stage kidney disease: a systematic review of the available evidence. Nephrol Dial Transplant 2014; 30:310-20. [DOI: 10.1093/ndt/gfu293] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Haynes R, Staplin N, Emberson J, Herrington WG, Tomson C, Agodoa L, Tesar V, Levin A, Lewis D, Reith C, Baigent C, Landray MJ. Evaluating the contribution of the cause of kidney disease to prognosis in CKD: results from the Study of Heart and Renal Protection (SHARP). Am J Kidney Dis 2014; 64:40-8. [PMID: 24613056 PMCID: PMC4068325 DOI: 10.1053/j.ajkd.2013.12.013] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Accepted: 12/29/2013] [Indexed: 02/07/2023]
Abstract
Background The relevance of the cause of kidney disease to prognosis among patients with chronic kidney disease is uncertain. Study Design Observational study. Settings & Participants 6,245 nondialysis participants in the Study of Heart and Renal Protection (SHARP). Predictor Baseline cause of kidney disease was categorized into 4 groups: cystic kidney disease, diabetic nephropathy, glomerulonephritis, and other recorded diagnoses. Outcomes End-stage renal disease (ESRD; dialysis or transplantation) and death. Results During an average 4.7 years' follow-up, 2,080 participants progressed to ESRD, including 454 with cystic kidney disease (23% per year), 378 with glomerulonephritis (10% per year), 309 with diabetic nephropathy (12% per year), and 939 with other recorded diagnoses (8% per year). By comparison with patients with cystic kidney disease, other disease groups had substantially lower adjusted risks of ESRD (relative risks of 0.28 [95% CI, 0.24-0.32], 0.40 [95% CI, 0.34-0.47], and 0.29 [95% CI, 0.25-0.32] for glomerulonephritis, diabetic nephropathy, and other recorded diagnoses, respectively). Albuminuria and baseline estimated glomerular filtration rate were associated more weakly with risk of ESRD in patients with cystic kidney disease than the 3 other diagnostic categories (P for interaction, <0.001 and 0.01, respectively). Death before ESRD was uncommon in patients with cystic kidney disease, but was a major competing risk for participants with diabetic nephropathy, whose adjusted risk of death was 2-fold higher than that of the cystic kidney disease group (relative risk, 2.35 [95% CI, 1.73-3.18]). Limitations Exclusion of patients with prior myocardial infarction or coronary revascularization. Conclusions The cause of kidney disease has substantial prognostic implications. Other things being equal, patients with cystic kidney disease are at much higher risk of ESRD (and much lower risk of death before ESRD) than other patients. Patients with diabetic nephropathy are at particularly high risk of death prior to reaching ESRD.
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Affiliation(s)
- Richard Haynes
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Natalie Staplin
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Jonathan Emberson
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - William G Herrington
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | | | - Lawrence Agodoa
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - Vladimir Tesar
- First Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic
| | - Adeera Levin
- University of British Columbia, Vancouver, BC, Canada
| | - David Lewis
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Christina Reith
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Colin Baigent
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Martin J Landray
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.
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Speeckaert M, Van Biesen W, Delanghe J, Slingerland R, Wiecek A, Heaf J, Drechsler C, Lacatus R, Vanholder R, Nistor I, Bilo H, Bolignano D, Couchoud C, Covic A, Coentrao L, Sutter JD, Drechsler C, Gnudi L, Goldsmith D, Heaf J, Heimburger O, Jager K, Nacak H, Nistor I, Soler M, Tomson C, Vanhuffel L, Biesen WV, Laecke SV, Weekers L, Wiecek A. Are there better alternatives than haemoglobin A1c to estimate glycaemic control in the chronic kidney disease population? Nephrol Dial Transplant 2014; 29:2167-77. [DOI: 10.1093/ndt/gfu006] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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van de Luijtgaarden MWM, Noordzij M, van Biesen W, Couchoud C, Cancarini G, Bos WJW, Dekker FW, Gorriz JL, Iatrou C, Wanner C, Finne P, Stojceva-Taneva O, Cala S, Stel VS, Tomson C, Jager KJ. Conservative care in Europe--nephrologists' experience with the decision not to start renal replacement therapy. Nephrol Dial Transplant 2013; 28:2604-12. [PMID: 24013682 DOI: 10.1093/ndt/gft287] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND For some patients with end-stage renal disease (ESRD), providing conservative care until death may be an acceptable alternative for renal replacement therapy (RRT). We aimed to estimate the occurrence of conservative care in Europe and evaluated opinions about which factors nephrologists consider important in their decision not to offer RRT. METHODS With a web-based survey sent to nephrologists in 11 European countries, we inquired how often RRT was not started in 2009 and how specific factors would influence the nephrologists' decision to provide conservative care. We compared subgroups by nephrologist and facility characteristics using chi-square tests and Mann-Whitney U tests. RESULTS We received 433 responses. Nephrologists decided to offer conservative care in 10% of their patients [interquartile range (IQR) 5-20%]. An additional 5% (IQR 2-10%) of the patients chose conservative care as they refused when nephrologists intended to start RRT. Patient preference (93%), severe clinical conditions (93%), vascular dementia (84%) and low physical functional status (75%) were considered extremely or quite important in the nephrologists' decision to provide conservative care. Nephrologists from countries with a low incidence of RRT, not-for-profit centres and public centres more often scored these factors as extremely or quite important than their counterparts from high-incidence countries, for-profit centres and private centres. CONCLUSIONS Nephrologists estimated conservative care was provided to up to 15% of their patients in 2009. The presence of severe clinical conditions, vascular dementia and a low physical functional status are important factors in the decision-making not to start RRT. Patient preference was considered as a very important factor, confirming the importance of extensive patient education and shared decision-making.
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Affiliation(s)
- Moniek W M van de Luijtgaarden
- ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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Dmitrieva O, de Lusignan S, Macdougall IC, Gallagher H, Tomson C, Harris K, Desombre T, Goldsmith D. Association of anaemia in primary care patients with chronic kidney disease: cross sectional study of quality improvement in chronic kidney disease (QICKD) trial data. BMC Nephrol 2013; 14:24. [PMID: 23351270 PMCID: PMC3626717 DOI: 10.1186/1471-2369-14-24] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Accepted: 01/21/2013] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Anaemia is a known risk factor for cardiovascular disease and treating anaemia in chronic kidney disease (CKD) may improve outcomes. However, little is known about the scope to improve primary care management of anaemia in CKD. METHODS An observational study (N = 1,099,292) with a nationally representative sample using anonymised routine primary care data from 127 Quality Improvement in CKD trial practices (ISRCTN5631023731). We explored variables associated with anaemia in CKD: eGFR, haemoglobin (Hb), mean corpuscular volume (MCV), iron status, cardiovascular comorbidities, and use of therapy which associated with gastrointestinal bleeding, oral iron and deprivation score. We developed a linear regression model to identify variables amenable to improved primary care management. RESULTS The prevalence of Stage 3-5 CKD was 6.76%. Hb was lower in CKD (13.2 g/dl) than without (13.7 g/dl). 22.2% of people with CKD had World Health Organization defined anaemia; 8.6% had Hb ≤ 11 g/dl; 3% Hb ≤ 10 g/dl; and 1% Hb ≤ 9 g/dl. Normocytic anaemia was present in 80.5% with Hb ≤ 11; 72.7% with Hb ≤ 10 g/dl; and 67.6% with Hb ≤ 9 g/dl; microcytic anaemia in 13.4% with Hb ≤ 11 g/dl; 20.8% with Hb ≤ 10 g/dl; and 24.9% where Hb ≤ 9 g/dl. 82.7% of people with microcytic and 58.8% with normocytic anaemia (Hb ≤ 11 g/dl) had a low ferritin (<100 ug/mL). Hypertension (67.2% vs. 54%) and diabetes (30.7% vs. 15.4%) were more prevalent in CKD and anaemia; 61% had been prescribed aspirin; 73% non-steroidal anti-inflammatory drugs (NSAIDs); 14.1% warfarin 12.4% clopidogrel; and 53.1% aspirin and NSAID. 56.3% of people with CKD and anaemia had been prescribed oral iron. The main limitations of the study are that routine data are inevitably incomplete and definitions of anaemia have not been standardised. CONCLUSIONS Medication review is needed in people with CKD and anaemia prior to considering erythropoietin or parenteral iron. Iron stores may be depleted in over >60% of people with normocytic anaemia. Prescribing oral iron has not corrected anaemia.
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Affiliation(s)
- Olga Dmitrieva
- Department of Health Care Management and Policy, University of Surrey, Guildford, Surrey, GU2 7XH, UK
| | - Simon de Lusignan
- Department of Health Care Management and Policy, University of Surrey, Guildford, Surrey, GU2 7XH, UK
| | - Iain C Macdougall
- Renal Medicine, Cheyne Wing, King’s College Hospital, London, SE5 9RS, UK
| | - Hugh Gallagher
- Epsom & St Helier University Hospitals NHS Trust SW Thames Renal Unit, St. Helier Hospital, Wrythe Lane, Carshalton, Surrey, SM5 1AA, UK
| | - Charles Tomson
- Southmead Hospital, Southmead Road, Westbury-on-Trym, Bristol, BS10 5NB, UK
| | - Kevin Harris
- University Hospitals of Leicester, Gwendolen Road, Leicester, LE5 4PW, UK
| | - Terry Desombre
- Department of Health Care Management and Policy, University of Surrey, Guildford, Surrey, GU2 7XH, UK
| | - David Goldsmith
- Renal and Transplantation Department, Guy's Hospital, 6th Floor, Borough Wing, Great Maze Pond, London, SE1 9RT, UK
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van de Luijtgaarden MW, Noordzij M, Tomson C, Couchoud C, Cancarini G, Ansell D, Bos WJW, Dekker FW, Gorriz JL, Iatrou C, Garneata L, Wanner C, Cala S, Stojceva-Taneva O, Finne P, Stel VS, van Biesen W, Jager KJ. Factors Influencing the Decision to Start Renal Replacement Therapy: Results of a Survey Among European Nephrologists. Am J Kidney Dis 2012; 60:940-8. [DOI: 10.1053/j.ajkd.2012.07.015] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2012] [Accepted: 07/23/2012] [Indexed: 11/11/2022]
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Abstract
Oral bowel-cleansing preparations are used before colonic surgery and endoscopic and radiological assessment of the intestine to minimise faecal contamination. In February 2009, the UK National Patient Safety Agency issued a Rapid Response Report highlighting the potential risk of harm associated with the use of these preparations and instructing local NHS Trusts to implement safeguards to reduce this risk. This guidance has been prepared to help NHS Trusts to respond to these concerns, as the risk of complications is influenced by both individual patient risk factors and the choice of bowel preparation, for which definitive guidance was not previously available. This document provides an outline of the different available oral bowel-cleansing agents and the complications that may arise. This is followed by recommendations for their use in different patient groups and circumstances. The recommendations are based on consensus between the authors, each of whom circulated drafts to members of their specialist society. The evidence for these recommendations has been assessed using the modified GRADE system. The recommendations cover the choice, administration and complications (relative and absolute) of the different oral bowel-cleansing agents, with specific guidance provided for different patient groups.
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Agnes H, Kalman P, Jozsef A, Henrik B, Mucsi I, Kamata K, Sano T, Naito S, Okamoto T, Okina C, Kamata M, Murano J, Kobayashi K, Uchida M, Aoyama T, Takeuchi Y, Nagaba Y, Sakamoto H, Torino C, Torino C, Panuccio V, Clementi A, Garozzo M, Bonanno G, Boito R, Natale G, Cicchetti T, Chippari A, Logozzo D, Alati G, Cassani S, Sellaro A, D'arrigo G, Tripepi G, Roberta A, Postorino M, Mallamaci F, Zoccali C, Buonanno E, Brancaccio S, Fimiani V, Napolitano P, Spadola R, Morrone L, DI Iorio B, Russo D, Betriu A, Martinez-Alonso M, Vidal T, Valdivielso J, Fernandez E, Bernadette F, Jean-Baptiste B, Frimat L, Madala ND, Thusi GP, Sibisi N, Mazibuko BG, Assounga AGH, Tsai NC, Wang HH, Chen YC, Hung CC, Hwang SJ, Chen HC, Branco P, Adragao T, Birne R, Martins AR, Vizinho R, Gaspar A, Grilo MJ, Barata JD, Bonhorst D, Adragao P, Kim JS, Yang JW, Kim MK, Choi SO, Han BG, Nathalie N, Sunny E, Glorieux G, Daniela B, Fellype B, Sophie L, Horst D L, Ziad M, Raymond V, Yanai M, Okada K, Takeuchi K, Nitta K, Takahashi S, Morena M, Jaussent I, Halkovich A, Dupuy AM, Bargnoux AS, Chenine L, Leray-Moragues H, Klouche K, Vernhet H, Canaud B, Cristol JP, Shutov A, Serov V, Kuznetsova J, Menzorov M, Serova D, Petrescu L, Zugravu A, Capusa C, Stancu S, Cinca S, Anghel C, Timofte D, Medrihan L, Ionescu D, Mircescu G, Hsu TW, Kuo KL, Hung SC, Tarng DC, Lee S, Kim I, Lee D, Rhee H, Song S, Seong E, Kwak I, Holzmann M, Gardell C, Jeppsson A, Sartipy U, Solak Y, Yilmaz MI, Caglar K, Saglam M, Yaman H, Sonmez A, Unal HU, Gok M, Gaipov A, Kayrak M, Eyileten T, Turk S, Vural A, DI Lullo L, Floccari F, Rivera R, Granata A, D'amelio A, Logias F, Otranto G, Malaguti M, Santoboni A, Fiorini F, Connor T, Oygar D, Nitsch D, Gale D, Steenkamp R, Neild GH, Maxwell P, Louise Hogsbro I, Redal-Baigorri B, Sautenet B, Halimi JM, Caille A, Goupille P, Giraudeau B, Solak Y, Yilmaz MI, Caglar K, Saglam M, Yaman H, Unal HU, Gok M, Oguz Y, Gaipov A, Yenicesu M, Cetinkaya H, Eyileten T, Turk S, Vural A, Chen YC, Wang HH, Tsai NC, Hung CC, Hwang SJ, Chen HC, Ishimoto Y, Ohki T, Sugahara M, Kanemitsu T, Kobayashi M, Uchida L, Kotera N, Tanaka S, Sugimoto T, Mise N, Miyazaki N, Matsumoto J, Murata I, Yoshida G, Morishita K, Ushikoshi H, Nishigaki K, Ogura S, Minatoguchi S, Harvey R, Harvey R, Ala A, Banerjee D, Farmer C, Irving J, Hobbs H, Wheeler T, Klebe B, Stevens P, Selim G, Selim G, Stojceva-Taneva O, Tozija L, Stojcev N, Gelev S, Dzekova-Vidimliski P, Pavleska S, Sikole A, Qureshi AR, Evans M, Stendahl M, Prutz KG, Elinder CG, Tamagaki K, Kado H, Nakata M, Kitani T, Ota N, Ishida R, Matsuoka E, Shiotsu Y, Ishida M, Mori Y, Christelle M, Rognant N, Evelyne D, Sophie F, Laurent J, Maurice L, Silverwood R, Pierce M, Kuh D, Savage C, Ferro C, Nitsch D, Moniek DG, De Goeij M, Nynke H, Gurbey O, Joris R, Friedo D, Clayton P, Grace B, Cass A, Mcdonald S, Lorenzo V, Martin Conde M, Betriu A, Dusso A, Valdivielso JM, Fernandez E, Roggeri DP, Cannella G, Cozzolino M, Mazzaferro S, Messa P, Brancaccio D, De Souza Faria R, Fernandes N, Lovisi J, Moura Marta M, Reboredo M, Do Vale Pinheiro B, Bastos M, Hundt F, Hundt F, Pabst S, Hammerstingl C, Gerhardt T, Skowasch D, Woitas R, Lopes AA, Silva LF, Matos CM, Martins MS, Silva FA, Lopes GB, Pizzarelli F, Dattolo P, Tripepi G, Michelassi S, Rossi C, Bandinelli S, Mieth M, Mass R, Ferrucci L, Zoccali C, Parisi S, Arduino S, Attini R, Fassio F, Biolcati M, Pagano A, Bossotti C, Ferraresi M, Gaglioti P, Todros T, Piccoli GB, Salgado TM, Arguello B, Benrimoj SI, Fernandez-Llimos F, Bailey P, Tomson C, Ben-Shlomo Y, Santoro A, Rucci P, Mandreoli M, Caruso F, Corradini M, Flachi M, Gibertoni D, Rigotti A, Russo G, Fantini M, Mahapatra HS, Choudhury S, Buxi G, Sharma N, Gupta Y, Sekhar V, Mahapatra HS, Choudhury S, Buxi G, Sharma N, Gupta Y, Sekhar V, Yanagisawa N, Ando M, Ajisawa A, Tsuchiya K, Nitta K, Janusz O, Mikolaj M, Jacek M, Boleslaw R, Prakash S, Coffin R, Schold J, Einstadter D, Stark S, Rodgers D, Howard M, Sehgal A, Stevens P, Irving J, Wheeler T, Klebe B, Farmer C, Palmer S, Tong A, Manns B, Craig J, Ruospo M, Gargano L, Strippoli G, Ruospo M, Palmer S, Vecchio M, Gargano L, Petruzzi M, De Benedictis M, Pellegrini F, Strippoli G, Ohno Y, Ishimura E, Naganuma T, Kondo K, Fukushima W, Mui K, Inaba M, Hirota Y, Sun X, Sun X, Jiang S, Gu H, Chen Y, XI C, Qiao X, Chen X, Daher E, Junior GS, Jacinto CN, Pimentel RS, Aguiar GBR, Lima CB, Borges RC, Mota LPC, Melo JVL, Melo SA, Canamary VT, Alves M, Araujo SMHA, Chen YC, Hung CC, Huang YK, Tsai NC, Wang HH, Hung CC, Hwang SJ, Chen HC, Rogacev K, Cremers B, Zawada A, Seiler S, Binder N, Ege P, Grosse-Dunker G, Heisel I, Hornof F, Jeken J, Rebling N, Ulrich C, Scheller B, Bohm M, Fliser D, Heine GH, Robinson B, Wang M, Bieber B, Fluck R, Kerr PG, Wikstrom B, Krishnan M, Nissenson A, Pisoni RL, Mykleset S, Osthus TB, Waldum B, Os I, Buttigieg J, Buttigieg J, Cassar A, Farrugia Agius J, Redal-Baigorri B, Hara M, Ando M, Tsuchiya K, Nitta K, Yamato M, Yasuda K, Sasaki K. Clinical Nephrology - Epidemiology II. Nephrol Dial Transplant 2012. [DOI: 10.1093/ndt/gfs236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Bonani M, Brockmann J, Cohen CD, Fehr T, Nocito A, Schiesser M, Serra AL, Blum M, Struker M, Frey DF, Wuthrich RP, Kim YW, Park SJ, Kim TH, Kim YH, Kang SW, Webb L, Casula A, Tomson C, Ben-Shlomo Y, Webb L, Casula A, Ben-Shlomo Y, Tomson C, Mansour H, Akl A, Wafa E, El Shahawy M, Palma R, Swaminathan S, Irish AB, Kolonko A, Chudek J, Wiecek A, Vanrenterghem Y, Kuypers D, Katrien DV, Evenepoel P, Claes K, Bammens B, Meijers B, Naesens M, Kolonko A, Chudek J, Wiecek A, Lo S, Chan CK, Yong D, Wong PN, Kwan TH, Cheng YL, Fung KS, Choy BY, Chau KF, Leung CB, Ebben J, Liu J, Chen SC, Collins A, Ho YW, Abelli M, Ferrario DI Torvajana A, Ticozzelli E, Maiga B, Ferrario DI Torvajana A, Patane A, Albrizio P, Gregorini M, Libetta C, Rampino T, Albrizio P, Geraci P, Dal Canton A, Rotter MT, Jacobi J, Pressmar K, Amann K, Eckardt KU, Weidemann A, Muller K, Stein M, Diezemann C, Sefrin A, Babel N, Reinke P, Schachtner T, Costa C, Touscoz GA, Sidoti F, Sinesi F, Mantovani S, Simeone S, Balloco C, Piasentin Alessio E, Messina M, Segoloni G, Cavallo R, Sharma R.K, Kaul DA, Gupta RK, Gupta A, Prasad N, Bhadhuria D, Suresh KJ, Benaboud S, Prie D, Thervet E, Urien S, Legendre C, Souberbielle JC, Hirt D, Friedlander G, Treluyer JM, Courbebaisse M, Arias M, Arias M, Campistol J, Pascual J, Grinyo JM, Hernandez D, Morales JM, Pallardo LM, Seron D, Senecal L, Boucher A, Dandavino R, Boucher A, Colette S, Vallee M, Lafrance JP, Tung-Min Y, Min-Ju W, Cheng-Hsu C, Chi-Hung C, Kuo-Hsiung S, Mei-Chin W, Direkze S, Khorsavi M, Khorsavi M, Stuart S, Goode A, Jones G, Chudek J, Kolonko A, Wiecek A, Massimetti C, Napoletano I, Imperato G, Muratore MT, Fazio S, Pessina G, Brescia F, Feriozzi S, Tanaka K, Sakai K, Futaki A, Hyoudo Y, Muramatsu M, Kawamura T, Shishido S, Hara S, Kushiyama A, Aikawa A, Jankowski K, Gozdowska J, Lewandowska D, Kwiatkowski A, Durlik M, Pruszczyk P, Obi Y, Ichimaru N, Kato T, Okumi M, Kaimori J, Yazawa K, Nonomura N, Isaka Y, Takahara S, Aimele M, Christophe R, Geraldine D, Eric R, Alexandre H, Masson I, Nicolas M, Ivan T, Acil J, Lise T, Aoumeur HA, Laurence D, Pierre D, Etienne C, Lionel R, Nassim K, Emmanuel M, Eric A, Christophe M, Webb L, Casula A, Tomson C, Ben-Shlomo Y, Alexandre K, Pierre B, Jean-Philippe H, Dominique P, Christophe L, Alexei G, Michel D, Shah P, Kute VB, Vanikar A, Gumber M, Modi P, Trivedi H, GoIebiewska J, Debska-Slizien A, Rutkowski B, Domanski L, Dutkiewicz G, Kloda K, Pawlik A, Ciechanowicz A, Binczak-Kuleta A, Rozanski J, Myslak M, Safranow K, Ciechanowski K, Aline CS, Basset T, Delavenne X, Alamartine E, Mariat C, Kloda K, Domanski L, Pawlik A, Bobrek-Lesiakowska K, Wisniewska M, Romanowski M, Safranow K, Kurzawski M, Rozanski J, Myslak M, Ciechanowski K, De Borst M, Baia L, Navis G, Bakker S, Ranghino A, Tognarelli G, Basso E, Messina M, Manzione AM, Daidola G, Segoloni GP, Kimura T, Yagisawa T, Ishikawa N, Sakuma Y, Hujiwara T, Nukui A, Yashi M, Kim JH, Kim SS, Han DJ, Park SK, Randhawa G, Gumber M, Kute VB, Shah P, Patel H, Vanikar A, Modi P, Trivedi H, Taheri S, Goker-Alpan O, Ibrahim J, Nedd K, Shankar S, Lein H, Barshop B, Boyd E, Holida M, Hillman R, Ibrahim J, Mardach R, Wienreb N, Rever B, Forte R, Desai A, Wijatyk A, Chang P, Martin R. Transplantation - clinical I. Nephrol Dial Transplant 2012. [DOI: 10.1093/ndt/gfs230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Tahir MA, Dmitrieva O, de Lusignan S, van Vlymen J, Chan T, Golmohamad R, Harris K, Tomson C, Thomas N, Gallagher H. Confidence and quality in managing CKD compared with other cardiovascular diseases and diabetes mellitus: a linked study of questionnaire and routine primary care data. BMC Fam Pract 2011; 12:83. [PMID: 21819552 PMCID: PMC3199784 DOI: 10.1186/1471-2296-12-83] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2010] [Accepted: 08/05/2011] [Indexed: 11/18/2022]
Abstract
Background Much of chronic disease is managed in primary care and chronic kidney disease (CKD) is a recent addition. We are conducting a cluster randomised study of quality improvement interventions in CKD (QICKD) - Clinical Trials Registration: ISRCTN56023731. CKD registers have a lower than expected prevalence and an initial focus group study suggested variable levels of confidence in managing CKD. Our objective is to compare practitioner confidence and achievement of quality indicators for CKD with hypertension and diabetes. Method We validated a new questionnaire to test confidence. We compared confidence with achievement of pay-for-performance indicators (P4P) and implementation of evidence-based guidance. We achieved a 74% (148/201) response rate. Results 87% (n = 128) of respondents are confident in managing hypertension (HT) compared with 59% (n = 87) in managing HT in CKD (HT+CKD); and with 61% (n = 90) in HT, CKD and diabetes (CKD+HT+DM). 85.2% (P4P) and 62.5% (National targets) of patients with hypertension are at target; in patients with HT and CKD 65.1% and 53.3%; in patients with HT, CKD and DM 67.8% and 29.6%. Confidence in managing proteinuria in CKD is low (42%, n = 62). 87% of respondents knew BP treatment thresholds in CKD, but only 53% when proteinuria is factored in. Male GPs, younger (< 35 yrs), and older (> 54 yrs) clinicians are more confident than females and 35 to 54 year olds in managing CKD. 84% of patients with hypertension treated with angiotensin modulating drugs achieve achieved P4P targets compared to 67% of patients with CKD. Conclusions Practitioners are less likely to achieve management targets where their confidence is low.
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Affiliation(s)
- Mohammad A Tahir
- Primary Care Informatics, Division of Public Health Sciences and Education, St George's - University of London, Cranmer Terrace, London SW17 0RE, UK.
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Baigent C, Landray MJ, Reith C, Emberson J, Wheeler DC, Tomson C, Wanner C, Krane V, Cass A, Craig J, Neal B, Jiang L, Hooi LS, Levin A, Agodoa L, Gaziano M, Kasiske B, Walker R, Massy ZA, Feldt-Rasmussen B, Krairittichai U, Ophascharoensuk V, Fellström B, Holdaas H, Tesar V, Wiecek A, Grobbee D, de Zeeuw D, Grönhagen-Riska C, Dasgupta T, Lewis D, Herrington W, Mafham M, Majoni W, Wallendszus K, Grimm R, Pedersen T, Tobert J, Armitage J, Baxter A, Bray C, Chen Y, Chen Z, Hill M, Knott C, Parish S, Simpson D, Sleight P, Young A, Collins R. The effects of lowering LDL cholesterol with simvastatin plus ezetimibe in patients with chronic kidney disease (Study of Heart and Renal Protection): a randomised placebo-controlled trial. Lancet 2011; 377:2181-92. [PMID: 21663949 PMCID: PMC3145073 DOI: 10.1016/s0140-6736(11)60739-3] [Citation(s) in RCA: 1645] [Impact Index Per Article: 126.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND Lowering LDL cholesterol with statin regimens reduces the risk of myocardial infarction, ischaemic stroke, and the need for coronary revascularisation in people without kidney disease, but its effects in people with moderate-to-severe kidney disease are uncertain. The SHARP trial aimed to assess the efficacy and safety of the combination of simvastatin plus ezetimibe in such patients. METHODS This randomised double-blind trial included 9270 patients with chronic kidney disease (3023 on dialysis and 6247 not) with no known history of myocardial infarction or coronary revascularisation. Patients were randomly assigned to simvastatin 20 mg plus ezetimibe 10 mg daily versus matching placebo. The key prespecified outcome was first major atherosclerotic event (non-fatal myocardial infarction or coronary death, non-haemorrhagic stroke, or any arterial revascularisation procedure). All analyses were by intention to treat. This trial is registered at ClinicalTrials.gov, NCT00125593, and ISRCTN54137607. FINDINGS 4650 patients were assigned to receive simvastatin plus ezetimibe and 4620 to placebo. Allocation to simvastatin plus ezetimibe yielded an average LDL cholesterol difference of 0·85 mmol/L (SE 0·02; with about two-thirds compliance) during a median follow-up of 4·9 years and produced a 17% proportional reduction in major atherosclerotic events (526 [11·3%] simvastatin plus ezetimibe vs 619 [13·4%] placebo; rate ratio [RR] 0·83, 95% CI 0·74-0·94; log-rank p=0·0021). Non-significantly fewer patients allocated to simvastatin plus ezetimibe had a non-fatal myocardial infarction or died from coronary heart disease (213 [4·6%] vs 230 [5·0%]; RR 0·92, 95% CI 0·76-1·11; p=0·37) and there were significant reductions in non-haemorrhagic stroke (131 [2·8%] vs 174 [3·8%]; RR 0·75, 95% CI 0·60-0·94; p=0·01) and arterial revascularisation procedures (284 [6·1%] vs 352 [7·6%]; RR 0·79, 95% CI 0·68-0·93; p=0·0036). After weighting for subgroup-specific reductions in LDL cholesterol, there was no good evidence that the proportional effects on major atherosclerotic events differed from the summary rate ratio in any subgroup examined, and, in particular, they were similar in patients on dialysis and those who were not. The excess risk of myopathy was only two per 10,000 patients per year of treatment with this combination (9 [0·2%] vs 5 [0·1%]). There was no evidence of excess risks of hepatitis (21 [0·5%] vs 18 [0·4%]), gallstones (106 [2·3%] vs 106 [2·3%]), or cancer (438 [9·4%] vs 439 [9·5%], p=0·89) and there was no significant excess of death from any non-vascular cause (668 [14·4%] vs 612 [13·2%], p=0·13). INTERPRETATION Reduction of LDL cholesterol with simvastatin 20 mg plus ezetimibe 10 mg daily safely reduced the incidence of major atherosclerotic events in a wide range of patients with advanced chronic kidney disease. FUNDING Merck/Schering-Plough Pharmaceuticals; Australian National Health and Medical Research Council; British Heart Foundation; UK Medical Research Council.
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Affiliation(s)
- Colin Baigent
- Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK
| | - Martin J Landray
- Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK
| | - Christina Reith
- Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK
| | - Jonathan Emberson
- Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK
| | | | | | - Christoph Wanner
- Department of Medicine 1, Division of Nephrology, University of Wuerzburg, Wuerzburg, Germany
| | - Vera Krane
- Department of Medicine 1, Division of Nephrology, University of Wuerzburg, Wuerzburg, Germany
| | - Alan Cass
- The George Institute for Global Health, University of Sydney, Sydney, NSW, Australia
| | - Jonathan Craig
- Sydney School of Public Health, Children's Hospital at Westmead, University of Sydney, Sydney, NSW, Australia
| | - Bruce Neal
- The George Institute for Global Health, University of Sydney, Sydney, NSW, Australia
| | - Lixin Jiang
- China Oxford Centre for International Health Research, Fuwai Hospital, Beijing, Chinese Academy of Medical Sciences and Peking Union Medical College, China
| | - Lai Seong Hooi
- Department of Medicine and Haemodialysis Unit, Sultanah Aminah Hospital, Johor Bahru, Malaysia
| | - Adeera Levin
- University of British Columbia, Vancouver, BC, Canada
| | - Lawrence Agodoa
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Mike Gaziano
- Harvard Medical School, VA Boston, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Robert Walker
- Dunedin School of Medicine, University of Otago, Otago, New Zealand
| | - Ziad A Massy
- Division of Clinical Pharmacology and Division of Nephrology, Amiens University Hospital, and INSERM ERI-12, University of Picardie Jules Verne, Amiens, France
| | | | - Udom Krairittichai
- Division of Nephrology, Department of Medicine, Rajavithi Hospital, Bangkok, Thailand
| | - Vuddidhej Ophascharoensuk
- Renal Division, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | | | - Hallvard Holdaas
- Renal Section, Department of Organ Transplantation, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Vladimir Tesar
- Department of Nephrology, First School of Medicine and General University Hospital, Charles University, Prague, Czech Republic
| | - Andrzej Wiecek
- Department of Nephrology, Endocrinology and Metabolic Diseases, Medical University of Silesia, Katowice, Poland
| | - Diederick Grobbee
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - Dick de Zeeuw
- Department of Clinical Pharmacology, University Medical Center Groningen, Groningen, Netherlands
| | | | | | - David Lewis
- Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK
| | - William Herrington
- Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK
| | - Marion Mafham
- Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK
| | | | - Karl Wallendszus
- Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK
| | - Richard Grimm
- Berman Center for Outcomes and Clinical Research, Hennepin County Medical Center, University of Minnesota, Minneapolis, MN, USA
| | - Terje Pedersen
- University of Oslo and Centre of Preventive Medicine, Oslo University Hospital Ullevål, Oslo, Norway
| | | | - Jane Armitage
- Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK
| | - Alex Baxter
- Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK
| | - Christopher Bray
- Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK
| | - Yiping Chen
- Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK
| | - Zhengming Chen
- Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK
| | - Michael Hill
- Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK
| | - Carol Knott
- Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK
| | - Sarah Parish
- Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK
| | - David Simpson
- Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK
| | - Peter Sleight
- Nuffield Department of Clinical Medicine, John Radcliffe Hospital, Oxford, UK
| | - Alan Young
- Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK
| | - Rory Collins
- Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK
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Robinson B, Zhang J, Thumma J, Gillespie B, Combe C, Fukuhara S, Harambat J, Morgenstern H, Port F, Pisoni R, Collier T, Steenkamp R, Tomson C, Caskey F, Ansell D, Roderick P, Nitsch D, Chanouzas D, Ng KP, Fallouh B, Baharani J, Righetti M, Ferrario G, Serbelloni P, Milani S, Lisi L, Tommasi A, Okuno S, Ishimura E, Yamakawa K, Tsuboniwa N, Norimine K, Kagitani S, Shoji S, Yamakawa T, Nishizawa Y, Inaba M, de Jager DJ, Halbesma N, Krediet RT, Boeschoten EW, le Cessie S, Dekker FW, Grootendorst DC, Miranda AC, Bento D, Madeira J, Cruz J, Saglimbene VM, De berardis G, Pellegrini F, Johnson DW, Craig JC, Hegbrant JBA, Strippoli GFM, Tzanno C, Nisihara F, Stein G, Clesco P, Uezima C, Martins JP, Esposito P, Di Benedetto A, Tinelli C, De Silvestri A, Marcelli D, Dal Canton A, Capurro F, De Mauri A, David P, Navino C, Chiarinotti D, De Leo M, De Leo M, Sato Y, Sato M, Johtoku Y, Appunu K, Baharani J, Kara B, Severova- Andreevska G, Trajceska L, Gelev S, Amitov V, Sikole A, Lomidze M, Rtskhiladze I, Metreveli D, Bartel J, Abramishvili N, Zangurashvili L, Barnova M, Buachidze K, Jashiashvili N, Kankia N, Khitarishvili T, Dzagania T, Tschokhonelidze I, Sarishvili N, Shamanadze A, Amet S, Launay-Vacher V, Stengel B, Castot A, Frances C, Gauvrit JY, Grenier N, Reinhardt G, Clement O, Kreft-Jais C, Janus N, Choukroun G, Laville M, Deray G, Szlanka B, Borbas B, Joseph J, Somers F, Vanga SR, Alscher MD, Rutherford P, De Mauri A, Conte M, Capurro F, David P, De Maria M, Navino C, De Leo M, De Mauri A, Conte M, Capurro F, David P, Chiarinotti D, Navino C, De Leo M, Kan WC, Chien CC, Wang HY, Hwang JC, Wang CJ, Castledine C, Gilg J, Rogers C, Ben-Shlomo Y, Yoav C, Dattolo P, Amidone M, Antognoli G, Michelassi S, Sisca S, Pizzarelli F, Kimber A, Tomson C, Maggs C, Steenkamp R, Smith H, Madziarska K, Weyde W, Kopec W, Penar J, Krajewska M, Klak R, Zukowska Szczechowska E, Gosek K, Golebiowski T, Strempska B, Kusztal M, Klinger M, Ito M, Masakane I, Ito S, Nagasawa J, Liao SC, Lee IN, Cheng CT, Halle MP, Hertig A, Kengue AP, Ashuntantang G, Rondeau E, Ridel C, Selim G, Stojceva-Taneva O, Tozija L, Gelev S, Stojcev N, Dzekova P, Trajcevska L, Severova G, Pavleska S, Sikole A, Paunovic K, Dimitrijevic Z, Paunovic G, Ljubenovic S, Djordjevic V, Stojanovic M, Mitsopoulos E, Tsiatsiou M, Ginikopoulou E, Minasidis I, Kousoula V, Tsikeloudi M, Manou E, Tsakiris D, Ortalda V, Yabarek T, Aslam N, Tomei P, Messa M, Lupo A, Ito S, Masakane I, Kudo K, Ito M, Nagasawa J, Osthus TBH, Amro A, Preljevic V, Leivestad T, Dammen T, Os I, Panocchia N, Di Stasio E, Liberatori M, Tazza L, Bossola M, Wilson R, Smyth M, Copley JB, Hanafusa N, Yamagata K, Nishi H, Nishi S, Iseki K, Tsubakihara Y, Fusaro M, Tripepi G, Crepaldi G, Maggi S, D'Angelo A, Naso A, Plebani M, Vajente N, Giannini S, Calo L, Miozzo D, Cristofaro R, Gallieni M, Hung PH, Shen CH, Hsiao CY, Chiang PC, Hung KY. Epidemiology & outcome in CKD 5D (2). Clin Kidney J 2011. [DOI: 10.1093/ndtplus/4.s2.58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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de Lusignan S, Tomson C, Harris K, van Vlymen J, Gallagher H. Creatinine fluctuation has a greater effect than the formula to estimate glomerular filtration rate on the prevalence of chronic kidney disease. Nephron Clin Pract 2010; 117:c213-24. [PMID: 20805694 DOI: 10.1159/000320341] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2010] [Accepted: 05/29/2010] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Cases of chronic kidney disease (CKD) are defined by the estimated glomerular filtration rate (eGFR), calculated using the Modified Diet in Renal Disease (MDRD) or, more recently, the CKD Epidemiology Collaboration (CKD-EPI) formula. This study set out to promote a systematic approach to reporting CKD prevalence. DESIGN, SETTING, PARTICIPANTS AND MEASUREMENTS The study explores the impact of the way in which eGFR is calculated on the prevalence of CKD. We took into account whether including (1) ethnicity, (2) using a single eGFR, (3) using more than 1 eGFR value or (4) using the CKD-EPI formula affected the estimates of prevalence. SAMPLE Of 930,997 registered patients, 36% (332,891) have their eGFR defined (63% of those aged 50-74 years, 81% >75 years). RESULTS The prevalence of stage 3-5 CKD is 5.41% (n = 50,331). (1) Not including ethnicity data the prevalence would be 5.49%, (2) just using the latest eGFR 6.4%, (3) excluding intermediary values 5.55% and (4) using the CKD-EPI equation 4.8%. All changes in eGFR (t test) and the proportion with CKD (χ(2) test) were significant (p < 0.001). Using serum-creatinine-calculated eGFR instead of laboratory data reduced the prevalence of stage 3-5 CKD by around 0.01%. Sixty-six percent of people with stage 3-5 disease have cardiovascular disease and 4.0% significant proteinuria using the MDRD formula; the corresponding figures using CKD-EPI are 74 and 4.6%. CONCLUSIONS A standardised approach to reporting case finding would allow a better comparison of prevalence estimates. Using a single eGFR tends to inflate the reported prevalence of CKD by ignoring creatinine fluctuation; this effect is greater than the difference between MDRD and CKD-EPI.
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Affiliation(s)
- Simon de Lusignan
- Division of Community Health Sciences, St. George's, University of London, London, UK.
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Stel VS, Tomson C, Ansell D, Casino FG, Collart F, Finne P, Ioannidis GA, De Meester J, Salomone M, Traynor JP, Zurriaga O, Jager KJ. Level of renal function in patients starting dialysis: an ERA-EDTA Registry study. Nephrol Dial Transplant 2010; 25:3315-25. [PMID: 20400449 DOI: 10.1093/ndt/gfq209] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The aims of this European study were (i) to compare the level of renal function at the start of dialysis between age groups, gender, primary renal disease, comorbid conditions, treatment modality, time periods and countries, and (ii) to determine which baseline characteristics are associated with the level of renal function at the start of dialysis. METHODS Renal registries participating in the European Renal Association-European Dialysis and Transplant Association Registry provided data on serum creatinine 0-4 weeks before the start of dialysis in incident dialysis patients in 1999 and 2003. Data were available in 11 472 patients from nine renal registries. Glomerular filtration rate (GFR) was estimated by the four-variable Modification of Diet in Renal Disease equation. RESULTS The unadjusted median eGFR at the start of dialysis was 7.0 mL/min/1.73 m(2) in the 1999 data (median serum creatinine 7.5 mg/dL) and 7.7 mL/min/1.73 m(2) in the 2003 data (serum creatinine 7.0 mg/dL). Using linear regression with adjustment for the other covariates, older patients, males, patients with diabetes mellitus, hypertension/renal vascular disease (HT/RVD) as primary renal disease (vs glomerulonephritis), ischaemic heart disease or peripheral vascular disease and patients starting on peritoneal dialysis (PD) initiated dialysis at higher levels of eGFR (range Δ eGFR: 0.1-1.2 mL/min/1.73 m(2)). Using the same analyses, eGFR differed between countries (range: 6.5-8.6 mL/min/1.73 m(2)). CONCLUSIONS During 2003, patients started dialysis at somewhat higher eGFR levels than those starting during 1999. There were also international differences in eGFR. Such differences may, at least in part, be explained by differences in creatinine measurement methods between countries and time periods. Finally, older patients, males, patients with HT/RVD or comorbidity and those starting on PD had slightly higher eGFR levels than younger patients, females, those with glomerulonephritis, without comorbidity and those starting on haemodialysis. Further research is needed into other, more clinically related factors affecting the decision to start dialysis.
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Affiliation(s)
- Vianda S Stel
- ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
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Affiliation(s)
- Lesley Archer
- Department of Radiology, Southmead Hospital, Bristol BS10 5NB, UK.
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de Lusignan S, Khunti K, Belsey J, Hattersley A, van Vlymen J, Gallagher H, Millett C, Hague NJ, Tomson C, Harris K, Majeed A. A method of identifying and correcting miscoding, misclassification and misdiagnosis in diabetes: a pilot and validation study of routinely collected data. Diabet Med 2010; 27:203-9. [PMID: 20546265 DOI: 10.1111/j.1464-5491.2009.02917.x] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIMS Incorrect classification, diagnosis and coding of the type of diabetes may have implications for patient management and limit our ability to measure quality. The aim of the study was to measure the accuracy of diabetes diagnostic data and explore the scope for identifying errors. METHOD We used two sets of anonymized routinely collected computer data: the pilot used Cutting out Needless Deaths Using Information Technology (CONDUIT) study data (n = 221 958), which we then validated using 100 practices from the Quality Improvement in Chronic Kidney Disease (QICKD) study (n = 760,588). We searched for contradictory diagnostic codes and also compatibility with prescription, demographic and laboratory test data. We classified errors as: misclassified-incorrect type of diabetes; misdiagnosed-where there was no evidence of diabetes; or miscoded-cases where it was difficult to infer the type of diabetes. RESULTS The standardized prevalence of diabetes was 5.0 and 4.0% in the CONDUIT and the QICKD data, respectively: 13.1% (n = 930) of CONDUIT and 14.8% (n = 4363) QICKD are incorrectly coded; 10.3% (n = 96) in CONDUIT and 26.2% (n = 1143) in QICKD are misclassified; nearly all of these cases are people classified with Type 1 diabetes who should be classified as Type 2. Approximately 5% of T2DM in both samples have no objective evidence to support a diagnosis of diabetes. Miscoding was present in approximately 7.8% of the CONDUIT and 6.1% of QICKD diabetes records. CONCLUSIONS The prevalence of miscoding, misclassification and misdiagnosis of diabetes is high and there is substantial scope for further improvement in diagnosis and data quality. Algorithms which identify likely misdiagnosis, misclassification and miscoding could be used to flag cases for review.
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Nitsch D, Kadalayil L, Mangtani P, Steenkamp R, Ansell D, Tomson C, Dos Santos Silva I, Roderick P. Validation and utility of a computerized South Asian names and group recognition algorithm in ascertaining South Asian ethnicity in the national renal registry. QJM 2009; 102:865-72. [PMID: 19828643 DOI: 10.1093/qjmed/hcp142] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The UK Renal Registry (UKRR) reports on equity and quality of renal replacement therapy (RRT). Ethnic origin is a key variable, but it is only recorded for 76% patients overall in the UKRR and there is wide variation in the degree of its completeness between renal centres. Most South Asians have distinctive names. AIM To test the relative performance of a computerized name recognition algorithm (SANGRA) in identifying South Asian names using the UKRR database. DESIGN Cross-sectional study of patients (n = 27 832) starting RRT in 50 renal centres in England and Wales from 1997 to 2005. METHODS Kappa statistics were used to assess the degree of agreement of SANGRA coding with existing ethnicity information in UKRR centres. RESULTS In 12 centres outside London (number of patients = 7555) with 11% (n = 747) self-ascribed South Asian ethnicity, the level of agreement between SANGRA and self-ascribed ethnicity was high (kappa=0.91, 95% CI 0.90-0.93). In two London centres (n = 779) with 21% (n = 165) self-ascribed South Asian ethnicity, SANGRA's agreement with self-ascribed ethnicity was lower (kappa=0.60, 95% CI 0.54-0.67), primarily due to difficulties in distinguishing between South Asian ethnicity and other non-White ethnic minorities. Use of SANGRA increased numbers defined as South Asian from 1650 to 2076 with no overall change in percentage of South Asians. Kappa values showed no obvious association with degree of missing data returns to the UKRR. CONCLUSION SANGRA's use, taking into account its lower validity in London, allows increased power and generalizability for both ethnic specific analyses and for analyses where adjustment for ethnic origin is important.
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Affiliation(s)
- D Nitsch
- Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
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