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Grant CH, Caskey FJ, Davids MR, Sahay M, Bello AK, Nitsch D, Bell S. The global landscape of kidney registries: immense challenges and unique opportunities. Nat Rev Nephrol 2024:10.1038/s41581-024-00833-1. [PMID: 38565773 DOI: 10.1038/s41581-024-00833-1] [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: 04/04/2024]
Affiliation(s)
| | - Fergus J Caskey
- Population Health Sciences, University of Bristol, Bristol, UK
| | - M Razeen Davids
- Division of Nephrology, Department of Medicine, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Manisha Sahay
- Department of Nephrology, Osmania General Hospital & Osmania Medical College, Hyderabad, India
| | - Aminu K Bello
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Dorothea Nitsch
- Faculty of Epidemiology & Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Samira Bell
- Division of Population Health & Genomics, University of Dundee, Dundee, UK.
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Prikhodina L, Komissarov K, Bulanov N, Arruebo S, Bello AK, Caskey FJ, Damster S, Donner JA, Jha V, Johnson DW, Levin A, Malik C, Nangaku M, Okpechi IG, Tonelli M, Ye F, Gaipov A. Capacity for the management of kidney failure in the International Society of Nephrology Newly Independent States and Russia region: report from the 2023 ISN Global Kidney Health Atlas (ISN-GKHA). Kidney Int Suppl (2011) 2024; 13:71-82. [PMID: 38618496 PMCID: PMC11010601 DOI: 10.1016/j.kisu.2024.01.005] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 01/17/2024] [Accepted: 01/29/2024] [Indexed: 04/16/2024] Open
Abstract
The International Society of Nephrology Global Kidney Health Atlas (ISN-GKHA) was established to aid understanding of the status and capacity of countries to provide optimal kidney care worldwide. This report presents the current characteristics of kidney care in the ISN Newly Independent States (NIS) and Russia region. Although the median prevalence of chronic kidney disease (CKD) was higher (11.4%) than the global median (9.5%), the median CKD-related death rate (1.4%) and prevalence of treated kidney failure (KF) in the region (411 per million population [pmp]) were lower than they are globally (2.5% and 822.8 pmp, respectively). Capacity to provide an adequate frequency of hemodialysis (HD) and kidney transplantation services is present in all the countries (100%). In spite of significant economic advancement, the region has critical shortages of nephrologists, dietitians, transplant coordinators, social workers, palliative care physicians, and kidney supportive care nurses. Home HD remains unavailable in any country in the region. Although national registries for dialysis and kidney transplantation are available in most of the countries across the ISN NIS and Russia region, few registries exist for nondialysis CKD and acute kidney injury. Although a national strategy for improving care for CKD patients is presented in more than half of the countries, no country in the region had a CKD-specific policy. Strategies that incorporate workforce training, planning, and development for all KF caregivers could help ensure sustainable kidney care delivery in the ISN NIS and Russia region.
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Affiliation(s)
- Larisa Prikhodina
- Division of Inherited & Acquired Kidney Diseases, Veltishev Research Clinical Institute for Pediatrics & Children Surgery, Pirogov Russian National Research Medical University, Moscow, Russia
- Russian Medical Academy of Continuous Postgraduate Education, Moscow, Russia
| | - Kirill Komissarov
- Nephrology, Renal Replacement Therapy and Kidney Transplantation Department, State Institution “Minsk Scientific and Practical Center for Surgery, Transplantation and Hematology,” Minsk, Belarus
| | - Nikolay Bulanov
- Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow, Russia
| | | | - Aminu K. Bello
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Fergus J. Caskey
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Jo-Ann Donner
- International Society of Nephrology, Brussels, Belgium
| | - Vivekanand Jha
- George Institute for Global Health, University of New South Wales (UNSW), New Delhi, India
- School of Public Health, Imperial College, London, UK
- Manipal Academy of Higher Education, Manipal, India
| | - David W. Johnson
- Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia; Centre for Kidney Disease Research, University of Queensland at Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Translational Research Institute, Brisbane, Queensland, Australia
- Australasian Kidney Trials Network at the University of Queensland, Brisbane, Queensland, Australia
| | - Adeera Levin
- Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Charu Malik
- International Society of Nephrology, Brussels, Belgium
| | - Masaomi Nangaku
- Division of Nephrology and Endocrinology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Ikechi G. Okpechi
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa
- Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa
| | - Marcello Tonelli
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Canada and Pan-American Health Organization/World Health Organization’s Collaborating Centre in Prevention and Control of Chronic Kidney Disease, University of Calgary, Calgary, Alberta, Canada
| | - Feng Ye
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Abduzhappar Gaipov
- Department of Medicine, School of Medicine, Nazarbayev University, Astana, Kazakhstan
- Clinical Academic Department of Internal Medicine, CF “University Medical Center,” Astana, Kazakhstan
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Alparslan C, Malyszko J, Caskey FJ, Aleckovic-Halilovic M, Hrušková Z, Arruebo S, Bello AK, Damster S, Donner JA, Jha V, Johnson DW, Levin A, Malik C, Nangaku M, Okpechi IG, Tonelli M, Ye F, Tesar V, Racki S. Capacity for the management of kidney failure in the International Society of Nephrology Eastern and Central Europe region: report from the 2023 ISN Global Kidney Health Atlas (ISN-GKHA). Kidney Int Suppl (2011) 2024; 13:29-42. [PMID: 38618499 PMCID: PMC11010604 DOI: 10.1016/j.kisu.2024.01.006] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 01/11/2024] [Accepted: 01/15/2024] [Indexed: 04/16/2024] Open
Abstract
Delivery of care for kidney failure (KF) globally has a significant disparity; even in some countries, it means end of life for the person. The International Society of Nephrology Global Kidney Health Atlas (ISN-GKHA) tries to address gaps in KF care and standardize global nephrology care. From the third iteration of the ISN-GKHA, we present data for countries in the ISN Eastern and Central Europe region. The median prevalences of chronic kidney disease (12.8%) and treated KF (873.5 pmp) were higher than the global rates, respectively. Hemodialysis was the most preferred modality for KF in adults, whereas kidney replacement therapy was more balanced in children. Although most of the countries in the region had lower-middle-income and upper-middle-income levels, health expenditures for kidney health care were almost generally covered publicly. Nephrologists were responsible for the medical kidney care of people with KF in all countries. There was adequate infrastructure to provide all kinds of treatment for kidney care in the region. Regional characteristics such as high levels of obesity, smoking, and Balkan nephropathy as an endemic disease coupled with a shortage of workforce and finance continued to affect kidney care in the region negatively. By making organizational and legislative arrangements, partnerships with national authorities and societies may accelerate the improvement of kidney health care in the region.
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Affiliation(s)
- Caner Alparslan
- Department of Pediatric Nephrology, İzmir Democracy University School of Medicine, İzmir, Turkey
| | - Jolanta Malyszko
- Department of Nephrology, Dialysis and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Fergus J. Caskey
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Mirna Aleckovic-Halilovic
- Clinic for Internal Diseases, Department of Nephrology, Dialysis and Transplantation, University Hospital Center Tuzla, Tuzla, Bosnia and Herzegovina
| | - Zdenka Hrušková
- Department of Nephrology, First Faculty of Medicine, Charles University and General Hospital in Prague, Prague, Czech Republic
| | - Silvia Arruebo
- The International Society of Nephrology, Brussels, Belgium
| | - Aminu K. Bello
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | | | - Jo-Ann Donner
- The International Society of Nephrology, Brussels, Belgium
| | - Vivekanand Jha
- George Institute for Global Health, University of New South Wales, New Delhi, India
- School of Public Health, Imperial College, London, UK
- Manipal Academy of Higher Education, Manipal, India
| | - David W. Johnson
- Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Centre for Kidney Disease Research, University of Queensland at Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Translational Research Institute, Brisbane, Queensland, Australia
- Australasian Kidney Trials Network at the University of Queensland, Brisbane, Queensland, Australia
| | - Adeera Levin
- Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Charu Malik
- The International Society of Nephrology, Brussels, Belgium
| | - Masaomi Nangaku
- Division of Nephrology and Endocrinology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Ikechi G. Okpechi
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa
- Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa
| | - Marcello Tonelli
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Canada and Pan-American Health Organization/World Health Organization’s Collaborating Centre in Prevention and Control of Chronic Kidney Disease, University of Calgary, Calgary, Alberta, Canada
| | - Feng Ye
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Vladimir Tesar
- Department of Nephrology, First Faculty of Medicine, Charles University and General Hospital in Prague, Prague, Czech Republic
| | - Sanjin Racki
- Department of Nephrology, Dialysis and Transplantation, University Hospital Center Rijeka, Rijeka, Croatia
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Tannor EK, Davidson B, Nlandu Y, Bagasha P, Bilchut WH, Davids MR, Diongole HM, Ekrikpo UE, Hafiz EO, Ibrahim KS, Kalyesubula R, Nalado AM, Olanrewaju TO, Onu UC, Pereira-Kamath N, Sakajiki AM, Salah M, Vincent L, Arruebo S, Bello AK, Caskey FJ, Damster S, Donner JA, Jha V, Johnson DW, Levin A, Malik C, Nangaku M, Okpechi IG, Tonelli M, Ye F, Ashuntantang GE, Arogundade FA. Capacity for the management of kidney failure in the International Society of Nephrology Africa region: report from the 2023 ISN Global Kidney Atlas (ISN-GKHA). Kidney Int Suppl (2011) 2024; 13:12-28. [PMID: 38618494 PMCID: PMC11010621 DOI: 10.1016/j.kisu.2024.01.002] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 01/09/2024] [Accepted: 01/15/2024] [Indexed: 04/16/2024] Open
Abstract
The burden of chronic kidney disease and associated risk of kidney failure are increasing in Africa. The management of people with chronic kidney disease is fraught with numerous challenges because of limitations in health systems and infrastructures for care delivery. From the third iteration of the International Society of Nephrology Global Kidney Health Atlas, we describe the status of kidney care in the ISN Africa region using the World Health Organization building blocks for health systems. We identified limited government health spending, which in turn led to increased out-of-pocket costs for people with kidney disease at the point of service delivery. The health care workforce across Africa was suboptimal and further challenged by the exodus of trained health care workers out of the continent. Medical products, technologies, and services for the management of people with nondialysis chronic kidney disease and for kidney replacement therapy were scarce due to limitations in health infrastructure, which was inequitably distributed. There were few kidney registries and advocacy groups championing kidney disease management in Africa compared with the rest of the world. Strategies for ensuring improved kidney care in Africa include focusing on chronic kidney disease prevention and early detection, improving the effectiveness of the available health care workforce (e.g., multidisciplinary teams, task substitution, and telemedicine), augmenting kidney care financing, providing quality, up-to-date health information data, and improving the accessibility, affordability, and delivery of quality treatment (kidney replacement therapy or conservative kidney management) for all people living with kidney failure.
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Affiliation(s)
- Elliot Koranteng Tannor
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Renal Unit, Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Bianca Davidson
- Division of Nephrology and Hypertension, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Yannick Nlandu
- Nephrology Unit, Kinshasa University Hospital, Kinshasa, Democratic Republic of the Congo
| | - Peace Bagasha
- Department of Internal Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
- Directorate of Internal Medicine, Mulago National Referral Hospital, Kampala, Uganda
| | | | - M. Razeen Davids
- Division of Nephrology, Department of Medicine, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Hassane M. Diongole
- Division of Nephrology, Department of Medicine, National Hospital Zinder, Zinder, Niger
- Faculty of Health Sciences, University of Zinder, Zinder, Niger
| | - Udeme E. Ekrikpo
- Department of Medicine, University of Uyo/University of Uyo Teaching Hospital, Uyo, Nigeria
| | - Ehab O.A. Hafiz
- Electron Microscopy Department, Clinical Laboratory Division, Theodor Bilharz Research Institute, Giza, Egypt
| | - Kwaifa Salihu Ibrahim
- Nephrology Unit, Department of Medicine, Wuse District Hospital, Abuja, Nigeria
- Department of Internal Medicine, College of Health Sciences, Nile University, Federal Capital Territory, Abuja, Nigeria
| | - Robert Kalyesubula
- Department of Physiology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Aisha M. Nalado
- Department of Medicine, Bayero University Kano, Kano, Nigeria
| | - Timothy O. Olanrewaju
- Division of Nephrology, Department of Medicine, College of Health Sciences, University of Ilorin, Ilorin, Nigeria
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Ugochi Chika Onu
- Renal Unit, Department of Medicine, University of Nigeria Teaching Hospital, ItukuOzalla, Enugu State, Nigeria
| | | | - Aminu Muhammad Sakajiki
- Department of Medicine, Usmanu Danfodiyo University and Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
| | - Mohamed Salah
- National Institute of Urology & Nephrology, Cairo, Egypt
| | | | - Silvia Arruebo
- The International Society of Nephrology, Brussels, Belgium
| | - Aminu K. Bello
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Fergus J. Caskey
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Jo-Ann Donner
- The International Society of Nephrology, Brussels, Belgium
| | - Vivekanand Jha
- George Institute for Global Health, University of New South Wales (UNSW), New Delhi, India
- School of Public Health, Imperial College, London, UK
- Manipal Academy of Higher Education, Manipal, India
| | - David W. Johnson
- Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Centre for Kidney Disease Research, University of Queensland at Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Translational Research Institute, Brisbane, Queensland, Australia
- Australasian Kidney Trials Network at the University of Queensland, Brisbane, Queensland, Australia
| | - Adeera Levin
- Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Charu Malik
- The International Society of Nephrology, Brussels, Belgium
| | - Masaomi Nangaku
- Division of Nephrology and Endocrinology, the University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Ikechi G. Okpechi
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa
- Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa
| | - Marcello Tonelli
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Canada and Pan-American Health Organization/World Health Organization’s Collaborating Centre in Prevention and Control of Chronic Kidney Disease, University of Calgary, Calgary, Alberta, Canada
| | - Feng Ye
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Gloria Enow Ashuntantang
- Faculty of Medicine and Biomedical Sciences, Yaounde General Hospital, University of Yaounde I, Yaounde, Cameroon
| | - Fatiu Abiola Arogundade
- Renal Unit, Department of Medicine, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
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Lowe-Jones R, Ethier I, Fisher LA, Wong MM, Thompson S, Nakhoul G, Sandal S, Chanchlani R, Davison SN, Ghimire A, Jindal K, Osman MA, Riaz P, Saad S, Sozio SM, Tungsanga S, Cambier A, Arruebo S, Bello AK, Caskey FJ, Damster S, Donner JA, Jha V, Johnson DW, Levin A, Malik C, Nangaku M, Okpechi IG, Tonelli M, Ye F, Parekh RS, Anand S. Capacity for the management of kidney failure in the International Society of Nephrology North America and the Caribbean region: report from the 2023 ISN Global Kidney Health Atlas (ISN-GKHA). Kidney Int Suppl (2011) 2024; 13:83-96. [PMID: 38618503 PMCID: PMC11010606 DOI: 10.1016/j.kisu.2024.01.003] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 01/11/2024] [Accepted: 01/15/2024] [Indexed: 04/16/2024] Open
Abstract
The International Society of Nephrology Global Kidney Health Atlas charts the availability and capacity of kidney care globally. In the North America and the Caribbean region, the Atlas can identify opportunities for kidney care improvement, particularly in Caribbean countries where structures for systematic data collection are lacking. In this third iteration, respondents from 12 of 18 countries from the region reported a 2-fold higher than global median prevalence of dialysis and transplantation, and a 3-fold higher than global median prevalence of dialysis centers. The peritoneal dialysis prevalence was lower than the global median, and transplantation data were missing from 6 of the 10 Caribbean countries. Government-funded payments predominated for dialysis modalities, with greater heterogeneity in transplantation payor mix. Services for chronic kidney disease, such as monitoring of anemia and blood pressure, and diagnostic capability relying on serum creatinine and urinalyses were universally available. Notable exceptions in Caribbean countries included non-calcium-based phosphate binders and kidney biopsy services. Personnel shortages were reported across the region. Kidney failure was identified as a governmental priority more commonly than was chronic kidney disease or acute kidney injury. In this generally affluent region, patients have better access to kidney replacement therapy and chronic kidney disease-related services than in much of the world. Yet clear heterogeneity exists, especially among the Caribbean countries struggling with dialysis and personnel capacity. Important steps to improve kidney care in the region include increased emphasis on preventive care, a focus on home-based modalities and transplantation, and solutions to train and retain specialized allied health professionals.
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Affiliation(s)
- Racquel Lowe-Jones
- Department of Medicine, Cayman Islands Health Services Authority, Georgetown, Grand Cayman, Cayman Islands
| | - Isabelle Ethier
- Division of Nephrology, Centre Hospitalier de l’Université de Montréal, Montréal, Québec, Canada
- Health Innovation and Evaluation hub, Centre de Recherche du Centre Hospitalier de l’Université de Montréal, Montréal, Québec, Canada
| | - Lori-Ann Fisher
- Department of Medicine, University Hospital of the West Indies, Kingston, Jamaica
- University of West Indies, Kingston, Jamaica
| | - Michelle M.Y. Wong
- Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Stephanie Thompson
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Georges Nakhoul
- Department of Kidney Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Shaifali Sandal
- Division of Nephrology, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Rahul Chanchlani
- Division of Pediatric Nephrology, Department of Pediatrics, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Sara N. Davison
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Anukul Ghimire
- Division of Nephrology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kailash Jindal
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Mohamed A. Osman
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Parnian Riaz
- Division of Nephrology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Syed Saad
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Stephen M. Sozio
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Somkanya Tungsanga
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Division of General Internal Medicine-Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Alexandra Cambier
- Division of Pediatric Nephrology, CHU Sainte Justine, University of Montreal, Montreal, Quebec, Canada
| | - Silvia Arruebo
- The International Society of Nephrology, Brussels, Belgium
| | - Aminu K. Bello
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Fergus J. Caskey
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Jo-Ann Donner
- The International Society of Nephrology, Brussels, Belgium
| | - Vivekanand Jha
- George Institute for Global Health, University of New South Wales (UNSW), New Delhi, India
- School of Public Health, Imperial College, London, UK
- Manipal Academy of Higher Education, Manipal, India
| | - David W. Johnson
- Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Centre for Kidney Disease Research, University of Queensland at Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Translational Research Institute, Brisbane, Queensland, Australia
- Australasian Kidney Trials Network at the University of Queensland, Brisbane, Queensland, Australia
| | - Adeera Levin
- Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Charu Malik
- The International Society of Nephrology, Brussels, Belgium
| | - Masaomi Nangaku
- Division of Nephrology and Endocrinology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Ikechi G. Okpechi
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa
- Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa
| | - Marcello Tonelli
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Canada and Pan-American Health Organization/World Health Organization’s Collaborating Centre in Prevention and Control of Chronic Kidney Disease, University of Calgary, Calgary, Alberta, Canada
| | - Feng Ye
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Rulan S. Parekh
- Department of Medicine, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Shuchi Anand
- Department of Medicine (Nephrology), Stanford University, Palo Alto, California, USA
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Pippias M, Alfano G, Kelly DM, Soler MJ, De Chiara L, Olanrewaju TO, Arruebo S, Bello AK, Caskey FJ, Damster S, Donner JA, Jha V, Johnson DW, Levin A, Malik C, Nangaku M, Okpechi IG, Tonelli M, Ye F, Coppo R, Lightstone L. Capacity for the management of kidney failure in the International Society of Nephrology Western Europe region: report from the 2023 ISN Global Kidney Health Atlas (ISN-GKHA). Kidney Int Suppl (2011) 2024; 13:136-151. [PMID: 38618502 PMCID: PMC11010628 DOI: 10.1016/j.kisu.2024.01.008] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 01/08/2024] [Accepted: 01/10/2024] [Indexed: 04/16/2024] Open
Abstract
Western Europe boasts advanced health care systems, robust kidney care guidelines, and a well-established health care workforce. Despite this, significant disparities in kidney replacement therapy incidence, prevalence, and transplant access exist. This paper presents the third International Society of Nephrology Global Kidney Health Atlas's findings on kidney care availability, accessibility, affordability, and quality in 22 Western European countries, representing 99% of the region's population. The known chronic kidney disease (CKD) prevalence across Western Europe averages 10.6%, slightly above the global median. Cardiovascular diseases account for a substantial portion of CKD-related deaths. Kidney failure incidence varies. Government health expenditure differs; however, most countries offer government-funded acute kidney injury, dialysis, and kidney transplantation care. Hemodialysis and peritoneal dialysis are universally available, with variations in the number of dialysis centers. Kidney transplantation is available in all countries (except for 3 microstates), with variable transplant center prevalence. Conservative kidney management (CKM) is increasingly accessible. The region's kidney care workforce is substantial, exceeding global averages; however, workforce shortages are reported. Barriers to optimal kidney care include limited workforce capacity, lack of surveillance mechanisms, and suboptimal integration into national noncommunicable disease (NCD) strategies. Policy recognition of CKD as a health priority varies across countries. Although Western Europe exhibits strong kidney care infrastructure, opportunities for improvement exist, particularly in CKD prevention, surveillance, awareness, and policy implementation. Efforts to improve CKD care should include automated detection, educational support, and enhanced workflows. Based on these findings, health care professionals, stakeholders, and policymakers are called to act to enhance kidney care across the region.
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Affiliation(s)
- Maria Pippias
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Renal Unit, North Bristol NHS Trust, Bristol, UK
| | - Gaetano Alfano
- Nephrology Dialysis and Transplant Unit, Azienda Ospedaliero—Universitaria di Modena, Modena, Italy
| | - Dearbhla M. Kelly
- Wolfson Centre for the Prevention of Stroke and Dementia, University of Oxford, John Radcliffe Hospital, Oxford, UK
- Department of Intensive Care Medicine, John Radcliffe Hospital, Oxford, UK
| | - Maria Jose Soler
- Vall d’Hebron University Hospital, Vall d’Hebron Institute of Research, CSUR National Unit of Expertise for Complex Glomerular Diseases of Spain, Barcelona, Spain
| | - Letizia De Chiara
- Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Florence, Italy
| | - Timothy O. Olanrewaju
- Division of Nephrology, Department of Medicine, College of Health Sciences, University of Ilorin, Ilorin, Nigeria
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Silvia Arruebo
- The International Society of Nephrology, Brussels, Belgium
| | - Aminu K. Bello
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Fergus J. Caskey
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Jo-Ann Donner
- The International Society of Nephrology, Brussels, Belgium
| | - Vivekanand Jha
- George Institute for Global Health, University of New South Wales (UNSW), New Delhi, India
- School of Public Health, Imperial College, London, UK
- Manipal Academy of Higher Education, Manipal, India
| | - David W. Johnson
- Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Centre for Kidney Disease Research, University of Queensland at Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Translational Research Institute, Brisbane, Queensland, Australia
- Australasian Kidney Trials Network at the University of Queensland, Brisbane, Queensland, Australia
| | - Adeera Levin
- Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Charu Malik
- The International Society of Nephrology, Brussels, Belgium
| | - Masaomi Nangaku
- Division of Nephrology and Endocrinology, the University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Ikechi G. Okpechi
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa
- Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa
| | - Marcello Tonelli
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Canada and Pan-American Health Organization/World Health Organization’s Collaborating Centre in Prevention and Control of Chronic Kidney Disease, University of Calgary, Calgary, Alberta, Canada
| | - Feng Ye
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Rosanna Coppo
- Fondazione Ricerca Molinette, Regina Margherita Hospital, Turin, Italy
| | - Liz Lightstone
- Centre for Inflammatory Disease, Department of Immunology and Inflammation, Imperial College London, London, UK
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7
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Meuleman Y, van der Bent Y, Gentenaar L, Caskey FJ, Bart HA, Konijn WS, Bos WJW, Hemmelder MH, Dekker FW. Exploring Patients' Perceptions About Chronic Kidney Disease and Their Treatment: A Qualitative Study. Int J Behav Med 2024; 31:263-275. [PMID: 37226037 PMCID: PMC10208195 DOI: 10.1007/s12529-023-10178-x] [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] [Accepted: 04/18/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Unhelpful illness perceptions can be changed by means of interventions and can lead to improved outcomes. However, little is known about illness perceptions in patients with chronic kidney disease (CKD) prior to kidney failure, and no tools exist in nephrology care to identify and support patients with unhelpful illness perceptions. Therefore, this study aims to: (1) identify meaningful and modifiable illness perceptions in patients with CKD prior to kidney failure; and (2) explore needs and requirements for identifying and supporting patients with unhelpful illness perceptions in nephrology care from patients' and healthcare professionals' perspectives. METHODS Individual semi-structured interviews were conducted with purposive heterogeneous samples of Dutch patients with CKD (n = 17) and professionals (n = 10). Transcripts were analysed using a hybrid inductive and deductive approach: identified themes from the thematic analysis were hereafter organized according to Common-Sense Model of Self-Regulation principles. RESULTS Illness perceptions considered most meaningful are related to the seriousness (illness identity, consequences, emotional response and illness concern) and manageability (illness coherence, personal control and treatment control) of CKD. Over time, patients developed more unhelpful seriousness-related illness perceptions and more helpful manageability-related illness perceptions, caused by: CKD diagnosis, disease progression, healthcare support and approaching kidney replacement therapy. Implementing tools to identify and discuss patients' illness perceptions was considered important, after which support for patients with unhelpful illness perceptions should be offered. Special attention should be paid towards structurally embedding psychosocial educational support for patients and caregivers to deal with CKD-related symptoms, consequences, emotions and concerns about the future. CONCLUSIONS Several meaningful and modifiable illness perceptions do not change for the better by means of nephrology care. This underlines the need to identify and openly discuss illness perceptions and to support patients with unhelpful illness perceptions. Future studies should investigate whether implementing illness perception-based tools will indeed improve outcomes in CKD.
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Affiliation(s)
- Yvette Meuleman
- Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, the Netherlands.
| | - Yvonne van der Bent
- Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Leandra Gentenaar
- Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Fergus J Caskey
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Hans Aj Bart
- Dutch Kidney Patients Association, Bussum, the Netherlands
| | - Wanda S Konijn
- Dutch Kidney Patients Association, Bussum, the Netherlands
| | - Willem Jan W Bos
- Department of Nephrology, Leiden University Medical Centre, Leiden, the Netherlands
- Department of Internal Medicine, St Antonius Hospital, Nieuwegein, the Netherlands
| | - Marc H Hemmelder
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands
- CARIM School for Cardiovascular Research, University Maastricht, Maastricht, the Netherlands
| | - Friedo W Dekker
- Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, the Netherlands
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8
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Karam S, Amouzegar A, Alshamsi IR, Al Ghamdi SM, Anwar S, Ghnaimat M, Saeed B, Arruebo S, Bello AK, Caskey FJ, Damster S, Donner JA, Jha V, Johnson DW, Levin A, Malik C, Nangaku M, Okpechi IG, Tonelli M, Ye F, Abu-Alfa AK, Savaj S. Capacity for the management of kidney failure in the International Society of Nephrology Middle East region: report from the 2023 ISN Global Kidney Health Atlas (ISN-GKHA). Kidney Int Suppl (2011) 2024; 13:57-70. [PMID: 38618498 PMCID: PMC11010631 DOI: 10.1016/j.kisu.2024.01.009] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 01/29/2024] [Accepted: 01/31/2024] [Indexed: 04/16/2024] Open
Abstract
The highest financial and symptom burdens and the lowest health-related quality-of-life scores are seen in people with kidney failure. A total of 11 countries in the International Society of Nephrology (ISN) Middle East region responded to the ISN-Global Kidney Health Atlas. The prevalence of chronic kidney disease (CKD) in the region ranged from 4.9% in Yemen to 12.2% in Lebanon, whereas prevalence of kidney failure treated with dialysis or transplantation ranged from 152 per million population (pmp) in the United Arab Emirates to 869 pmp in Kuwait. Overall, the incidence of kidney transplantation was highest in Saudi Arabia (20.2 pmp) and was lowest in Oman (2.2 pmp). Chronic hemodialysis (HD) and peritoneal dialysis (PD) services were available in all countries, whereas kidney transplantation was available in most countries of the region. Public government funding that makes acute dialysis, chronic HD, chronic PD, and kidney transplantation medications free at the point of delivery was available in 54.5%, 72.7%, 54.5%, and 54.5% of countries, respectively. Conservative kidney management was available in 45% of countries. Only Oman had a CKD registry; 7 countries (64%) had dialysis registries, and 8 (73%) had kidney transplantation registries. The ISN Middle East region has a high burden of kidney disease and multiple challenges to overcome. Prevention and detection of kidney disease can be improved by the design of tailored guidelines, allocation of additional resources, improvement of early detection at all levels of care, and implementation of sustainable health information systems.
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Affiliation(s)
- Sabine Karam
- Division of Nephrology and Hypertension, Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
- Division of Nephrology and Hypertension, Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Atefeh Amouzegar
- Division of Nephrology, Department of Medicine, Firoozgar Clinical Research Development Center, Iran University of Medical Sciences, Tehran, Iran
| | | | - Saeed M.G. Al Ghamdi
- Department of Medicine, King Faisal Specialist Hospital & Research Center, Jeddah, Saudi Arabia
| | - Siddiq Anwar
- Department of Nephrology, Sheikh Shakhbout Medical City (SSMC), Abu Dhabi, United Arab Emirates
| | - Mohammad Ghnaimat
- Nephrology Division, Internal Medicine Department, Al Rasheed Center Hospital, Amman, Jordan
| | - Bassam Saeed
- Farah Association for Children with Kidney Disease, Damascus, Syria
| | | | - Aminu K. Bello
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Fergus J. Caskey
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Jo-Ann Donner
- International Society of Nephrology, Brussels, Belgium
| | - Vivekanand Jha
- George Institute for Global Health, University of New South Wales (UNSW), New Delhi, India
- School of Public Health, Imperial College, London, UK
- Manipal Academy of Higher Education, Manipal, India
| | - David W. Johnson
- Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Centre for Kidney Disease Research, University of Queensland at Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Translational Research Institute, Brisbane, Queensland, Australia
- Australasian Kidney Trials Network at the University of Queensland, Brisbane, Queensland, Australia
| | - Adeera Levin
- Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Charu Malik
- International Society of Nephrology, Brussels, Belgium
| | - Masaomi Nangaku
- Division of Nephrology and Endocrinology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Ikechi G. Okpechi
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa
- Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa
| | - Marcello Tonelli
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Canada and Pan-American Health Organization/World Health Organization’s Collaborating Centre in Prevention and Control of Chronic Kidney Disease, University of Calgary, Calgary, Alberta, Canada
| | - Feng Ye
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Ali K. Abu-Alfa
- Division of Nephrology and Hypertension, Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
- Section of Nephrology, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Shokoufeh Savaj
- Department of Nephrology, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
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9
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Francis A, Wainstein M, Irish G, Abdul Hafidz MI, Chen T, Cho Y, Htay H, Kanjanabuch T, Lalji R, Neuen BL, See E, Shah A, Smyth B, Tungsanga S, Viecelli A, Yeung EK, Arruebo S, Bello AK, Caskey FJ, Damster S, Donner JA, Jha V, Johnson DW, Levin A, Malik C, Nangaku M, Okpechi IG, Tonelli M, Ye F, Wong MG, Bavanandan S. Capacity for the management of kidney failure in the International Society of Nephrology Oceania and South East Asia (OSEA) region: report from the 2023 ISN Global Kidney Health Atlas (ISN-GKHA). Kidney Int Suppl (2011) 2024; 13:110-122. [PMID: 38618497 PMCID: PMC11010617 DOI: 10.1016/j.kisu.2024.01.004] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 01/08/2024] [Accepted: 01/10/2024] [Indexed: 04/16/2024] Open
Abstract
The International Society of Nephrology (ISN) region of Oceania and South East Asia (OSEA) is a mix of high- and low-income countries, with diversity in population demographics and densities. Three iterations of the ISN-Global Kidney Health Atlas (GKHA) have been conducted, aiming to deliver in-depth assessments of global kidney care across the spectrum from early detection of CKD to treatment of kidney failure. This paper reports the findings of the latest ISN-GKHA in relation to kidney-care capacity in the OSEA region. Among the 30 countries and territories in OSEA, 19 (63%) participated in the ISN-GKHA, representing over 97% of the region's population. The overall prevalence of treated kidney failure in the OSEA region was 1203 per million population (pmp), 45% higher than the global median of 823 pmp. In contrast, kidney replacement therapy (KRT) in the OSEA region was less available than the global median (chronic hemodialysis, 89% OSEA region vs. 98% globally; peritoneal dialysis, 72% vs. 79%; kidney transplantation, 61% vs. 70%). Only 56% of countries could provide access to dialysis to at least half of people with incident kidney failure, lower than the global median of 74% of countries with available dialysis services. Inequalities in access to KRT were present across the OSEA region, with widespread availability and low out-of-pocket costs in high-income countries and limited availability, often coupled with large out-of-pocket costs, in middle- and low-income countries. Workforce limitations were observed across the OSEA region, especially in lower-middle-income countries. Extensive collaborative work within the OSEA region and globally will help close the noted gaps in kidney-care provision.
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Affiliation(s)
- Anna Francis
- Department of Nephrology, Queensland Children’s Hospital, South Brisbane, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Marina Wainstein
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
- West Moreton Kidney Health Service, Ipswich Hospital, Brisbane, Queensland, Australia
| | - Georgina Irish
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, South Australia Health and Medical Research Institute, Adelaide, South Australia, Australia
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
- Central and Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, South Australia Health, Adelaide, South Australia, Australia
| | | | - Titi Chen
- Department of Renal Medicine, Westmead Hospital, Westmead, New South Wales, Australia
- Faculty of Medicine and Health, the University of Sydney, Camperdown, New South Wales, Australia
- The Westmead Institute for Medical Research, Westmead, New South Wales, Australia
| | - Yeoungjee Cho
- Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Australasian Kidney Trials Network at the University of Queensland, Brisbane, Queensland, Australia
| | - Htay Htay
- Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Talerngsak Kanjanabuch
- Division of Nephrology, Department of Medicine, Chulalongkorn University, Bangkok, Thailand
- Center of Excellence in Kidney Metabolic Disorders, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Rowena Lalji
- Department of Nephrology, Queensland Children’s Hospital, South Brisbane, Queensland, Australia
- Centre for Kidney Disease Research, University of Queensland, Brisbane, Queensland, Australia
- Metro South and Integrated Nephrology and Transplant Services (MINTS), Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Brendon L. Neuen
- Kidney Trials Unit, Royal North Shore Hospital, Sydney, New South Wales, Australia
- The George Institute for Global Health, Sydney, New South Wales, Australia
| | - Emily See
- Department of Nephrology, Royal Melbourne Hospital, Parkville, VIC, Australia
- Department of Nephrology, Royal Children’s Hospital, Parkville, VIC, Australia
- Department of Critical Care, University of Melbourne, Melbourne, Australia
| | - Anim Shah
- Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia
| | - Brendan Smyth
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, Australia
- Department of Renal Medicine, St George Hospital, Kogarah, Australia
| | - Somkanya Tungsanga
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Division of General Internal Medicine-Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Andrea Viecelli
- Australasian Kidney Trials Network at the University of Queensland, Brisbane, Queensland, Australia
- Department of Kidney and Transplant Services, Division of Medicine, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
- University of Queensland, Queensland, Australia
| | - Emily K. Yeung
- Department of Nephrology, Monash Health, Clayton, Victoria, Australia
| | - Silvia Arruebo
- The International Society of Nephrology, Brussels, Belgium
| | - Aminu K. Bello
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Fergus J. Caskey
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Jo-Ann Donner
- The International Society of Nephrology, Brussels, Belgium
| | - Vivekanand Jha
- George Institute for Global Health, University of New South Wales (UNSW), New Delhi, India
- School of Public Health, Imperial College, London, UK
- Manipal Academy of Higher Education, Manipal, India
| | - David W. Johnson
- Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Australasian Kidney Trials Network at the University of Queensland, Brisbane, Queensland, Australia
- Centre for Kidney Disease Research, University of Queensland at Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Translational Research Institute, Brisbane, Queensland, Australia
| | - Adeera Levin
- Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Charu Malik
- The International Society of Nephrology, Brussels, Belgium
| | - Masaomi Nangaku
- Division of Nephrology and Endocrinology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Ikechi G. Okpechi
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa
- Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa
| | - Marcello Tonelli
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Canada and Pan-American Health Organization/World Health Organization’s Collaborating Centre in Prevention and Control of Chronic Kidney Disease, University of Calgary, Calgary, Alberta, Canada
| | - Feng Ye
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Muh Geot Wong
- Faculty of Medicine and Health, the University of Sydney, Camperdown, New South Wales, Australia
- Department of Renal Medicine, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Sunita Bavanandan
- Department of Nephrology Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
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10
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Wijewickrama E, Alam MR, Bajpai D, Divyaveer S, Iyengar A, Kumar V, Qayyum A, Yadav SP, Yadla M, Arruebo S, Bello AK, Caskey FJ, Damster S, Donner JA, Jha V, Johnson DW, Levin A, Malik C, Nangaku M, Okpechi IG, Tonelli M, Ye F, Singh Shah D, Prasad N. Capacity for the management of kidney failure in the International Society of Nephrology South Asia region: report from the 2023 ISN Global Kidney Health Atlas (ISN-GKHA). Kidney Int Suppl (2011) 2024; 13:123-135. [PMID: 38618495 PMCID: PMC11010620 DOI: 10.1016/j.kisu.2024.01.007] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 01/10/2024] [Indexed: 04/16/2024] Open
Abstract
The South Asia region is facing a high burden of chronic kidney disease (CKD) with limited health resources and low expenditure on health care. In addition to the burden of CKD and kidney failure from traditional risk factors, CKD of unknown etiologies from India and Sri Lanka compounds the challenges of optimal management of CKD in the region. From the third edition of the International Society of Nephrology Global Kidney Health Atlas (ISN-GKHA), we present the status of CKD burden, infrastructure, funding, resources, and health care personnel using the World Health Organization's building blocks for health systems in the ISN South Asia region. The poor status of the public health care system and low health care expenditure resulted in high out-of-pocket expenditures for people with kidney disease, which further compounded the situation. There is insufficient country capacity across the region to provide kidney replacement therapies to cover the burden. The infrastructure was also not uniformly distributed among the countries in the region. There were no chronic hemodialysis centers in Afghanistan, and peritoneal dialysis services were only available in Bangladesh, India, Nepal, Pakistan, and Sri Lanka. Kidney transplantation was not available in Afghanistan, Bhutan, and Maldives. Conservative kidney management was reported as available in 63% (n = 5) of the countries, yet no country reported availability of the core CKM care components. There was a high hospitalization rate and early mortality because of inadequate kidney care. The lack of national registries and actual disease burden estimates reported in the region prevent policymakers' attention to CKD as an important cause of morbidity and mortality. Data from the 2023 ISN-GKHA, although with some limitations, may be used for advocacy and improving CKD care in the region.
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Affiliation(s)
- Eranga Wijewickrama
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
- University Medical Unit, National Hospital of Sri Lanka, Colombo, Sri Lanka
- National Institute of Nephrology, Dialysis and Transplantation, Colombo, Sri Lanka
| | - Muhammad Rafiqul Alam
- Department of Nephrology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Divya Bajpai
- Department of Nephrology, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, India
| | - Smita Divyaveer
- Department of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Arpana Iyengar
- Department of Paediatric Nephrology, St. John’s National Academy of Health Sciences, Bangalore, India
| | - Vivek Kumar
- Department of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ahad Qayyum
- Department of Nephrology and Transplantation, Bahria Town International Hospital, Lahore, Punjab, Pakistan
| | - Shankar Prasad Yadav
- Department of Pediatrics, B. P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Manjusha Yadla
- Department of Nephrology, Gandhi Medical College, Hyderabad, India
| | - Silvia Arruebo
- The International Society of Nephrology, Brussels, Belgium
| | - Aminu K. Bello
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Fergus J. Caskey
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Jo-Ann Donner
- The International Society of Nephrology, Brussels, Belgium
| | - Vivekanand Jha
- George Institute for Global Health, University of New South Wales, New Delhi, India
- School of Public Health, Imperial College, London, UK
- Manipal Academy of Higher Education, Manipal, India
| | - David W. Johnson
- Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Centre for Kidney Disease Research, University of Queensland at Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Translational Research Institute, Brisbane, Queensland, Australia
- Australasian Kidney Trials Network at the University of Queensland, Queensland, Australia
| | - Adeera Levin
- Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Charu Malik
- The International Society of Nephrology, Brussels, Belgium
| | - Masaomi Nangaku
- Division of Nephrology and Endocrinology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Ikechi G. Okpechi
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa
- Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa
| | - Marcello Tonelli
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Canada and Pan-American Health Organization/World Health Organization’s Collaborating Centre in Prevention and Control of Chronic Kidney Disease, University of Calgary, Calgary, Alberta, Canada
| | - Feng Ye
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Dibya Singh Shah
- Department of Nephrology and Transplant Medicine, Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal
| | - Narayan Prasad
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Science, Lucknow, India
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11
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Wing-Shing Fung W, Park HC, Hirakawa Y, Arruebo S, Bello AK, Caskey FJ, Damster S, Donner JA, Jha V, Johnson DW, Levin A, Malik C, Nangaku M, Okpechi IG, Tonelli M, Ueda S, Ye F, Suzuki Y, Wang AYM. Capacity for the management of kidney failure in the International Society of Nephrology North and East Asia region: report from the 2023 ISN Global Kidney Health Atlas (ISN-GKHA). Kidney Int Suppl (2011) 2024; 13:97-109. [PMID: 38618501 PMCID: PMC11010612 DOI: 10.1016/j.kisu.2024.02.001] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 01/31/2024] [Accepted: 02/03/2024] [Indexed: 04/16/2024] Open
Abstract
Globally, there remain significant disparities in the capacity and quality of kidney care, as evidenced by the third edition of the International Society of Nephrology Global Kidney Health Atlas (ISN-GKHA). In the ISN North and East Asia region, the chronic kidney disease (CKD) burden varied widely; Taiwan had the heaviest burden of treated kidney failure (3679 per million population [pmp]) followed by Japan and South Korea. Except in Hong Kong, hemodialysis (HD) was the main dialysis modality for all other countries in the region and was much higher than the global median prevalence. Kidney transplantation services were generally available in the region, but the prevalence was much lower than that of dialysis. Most countries had public funding for kidney replacement therapy (KRT). The median prevalence of nephrologists was 28.7 pmp, higher than that of any other ISN region, with variation across countries. Home HD was available in only 17% of the countries, whereas conservative kidney management was available in 50%. All countries had official registries for dialysis and transplantation; however, only China and Japan had CKD registries. Advocacy groups for CKD, kidney failure, and KRT were uncommon throughout the region. Overall, all countries in the region had capacity for KRT, albeit with some shortages in their kidney care workforce. These data are useful for stakeholders to address gaps in kidney care and to reduce workforce shortages through increased use of multidisciplinary teams and telemedicine, policy changes to promote prevention and treatment of kidney failure, and increased advocacy for kidney disease in the region.
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Affiliation(s)
- Winston Wing-Shing Fung
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Hyeong Cheon Park
- Division of Nephrology, Department of Internal Medicine, Gangnam Severance Hospital, Seoul, Korea
- Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Seoul, Korea
| | - Yosuke Hirakawa
- Division of Nephrology and Endocrinology, University of Tokyo School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Silvia Arruebo
- The International Society of Nephrology, Brussels, Belgium
| | - Aminu K. Bello
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Fergus J. Caskey
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Jo-Ann Donner
- The International Society of Nephrology, Brussels, Belgium
| | - Vivekanand Jha
- George Institute for Global Health, University of New South Wales, New Delhi, India
- School of Public Health, Imperial College, London, UK
- Manipal Academy of Higher Education, Manipal, India
| | - David W. Johnson
- Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Centre for Kidney Disease Research, University of Queensland at Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Translational Research Institute, Brisbane, Queensland, Australia; Australasian Kidney Trials Network at the University of Queensland, Brisbane, Queensland, Australia
| | - Adeera Levin
- Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Charu Malik
- The International Society of Nephrology, Brussels, Belgium
| | - Masaomi Nangaku
- Division of Nephrology and Endocrinology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Ikechi G. Okpechi
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa
- Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa
| | - Marcello Tonelli
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Canada and Pan-American Health Organization/World Health Organization’s Collaborating Centre in Prevention and Control of Chronic Kidney Disease, University of Calgary, Calgary, Alberta, Canada
| | - Seiji Ueda
- Department of Nephrology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Feng Ye
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Yusuke Suzuki
- Department of Nephrology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Angela Yee-Moon Wang
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China
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12
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Calice-Silva V, Neyra JA, Ferreiro Fuentes A, Singer Wallbach Massai KK, Arruebo S, Bello AK, Caskey FJ, Damster S, Donner JA, Jha V, Johnson DW, Levin A, Malik C, Nangaku M, Okpechi IG, Tonelli M, Ye F, Madero M, Tzanno Martins C. Capacity for the management of kidney failure in the International Society of Nephrology Latin America region: report from the 2023 ISN Global Kidney Health Atlas (ISN-GKHA). Kidney Int Suppl (2011) 2024; 13:43-56. [PMID: 38618500 PMCID: PMC11010616 DOI: 10.1016/j.kisu.2024.01.001] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 01/10/2024] [Accepted: 01/15/2024] [Indexed: 04/16/2024] Open
Abstract
Successful management of chronic kidney disease (CKD) in Latin America (LA) continues to represent a challenge due to high disease burden and geographic disparities and difficulties in terms of capacity, accessibility, equity, and quality of kidney failure care. Although LA has experienced significant social and economic progress over the past decades, there are still important inequities in health care access. Through this third iteration of the International Society of Nephrology Global Kidney Health Atlas, the indicators regarding kidney failure care in LA are updated. Survey responses were received from 22 of 31 (71%) countries in LA representing 96.5% of its total population. Median CKD prevalence was 10.2% (interquartile range: 8.4%-12.3%), median CKD disability-adjusted life year was 753.4 days (interquartile range: 581.3-1072.5 days), and median CKD mortality was 5.5% (interquartile range: 3.2%-6.3%). Regarding dialysis modality, hemodialysis continued to be the most used therapy, whereas peritoneal dialysis reached a plateau and kidney transplantation increased steadily over the past 10 years. In 20 (91%) countries, >50% of people with kidney failure could access dialysis, and in only 2 (9%) countries, people who had access to dialysis could initiate dialysis with peritoneal dialysis. A mix of public and private systems collectively funded most aspects of kidney replacement therapy (dialysis and transplantation) with many people incurring up to 50% of out-of-pocket costs. Few LA countries had CKD/kidney replacement therapy registries, and almost no acute kidney injury registries were reported. There was large variability in the nature and extent of kidney failure care in LA mainly related to countries' funding structures and limited surveillance and management initiatives.
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Affiliation(s)
- Viviane Calice-Silva
- Pro-Rim Foundation, Joinville, Santa Catarina, Brazil
- Department of Clinical Medicine, Faculty of Medicine, University of the Region of Joinville (UNIVILLE), Joinville, Santa Catarina, Brazil
| | - Javier A. Neyra
- Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | - Krissia Kamile Singer Wallbach Massai
- Nephrology’s Intensive Care Unit, Division of Nephrology, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
- Chronic Kidney Disease Department, Hospital do Rim/Federal University of São Paulo, São Paulo, Brazil
| | - Silvia Arruebo
- The International Society of Nephrology, Brussels, Belgium
| | - Aminu K. Bello
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Fergus J. Caskey
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Jo-Ann Donner
- The International Society of Nephrology, Brussels, Belgium
| | - Vivekanand Jha
- George Institute for Global Health, University of New South Wales (UNSW), New Delhi, India
- School of Public Health, Imperial College, London, UK
- Manipal Academy of Higher Education, Manipal, India
| | - David W. Johnson
- Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Centre for Kidney Disease Research, University of Queensland at Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Translational Research Institute, Brisbane, Queensland, Australia
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Queensland, Australia
| | - Adeera Levin
- Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Charu Malik
- The International Society of Nephrology, Brussels, Belgium
| | - Masaomi Nangaku
- Division of Nephrology and Endocrinology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Ikechi G. Okpechi
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa
- Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa
| | - Marcello Tonelli
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Canada and Pan-American Health Organization/World Health Organization’s Collaborating Centre in Prevention and Control of Chronic Kidney Disease, University of Calgary, Calgary, Alberta, Canada
| | - Feng Ye
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Magdalena Madero
- Division of Nephrology, Department of Medicine, National Heart Institute, Mexico City, Mexico
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13
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Pippias M, Abeysekera RA, Arruebo S, Davids MR, Damster S, Gonzales-Bedat MC, Hanafusa N, Hoshino J, Hradsky A, Irish GL, Jager KJ, Karam S, Kumar V, McDonald SP, Rosa-Diez GJ, Tannor EK, Wetmore JB, Caskey FJ. A toolkit for ISN's registry initiative, SharE-RR. Kidney Int 2024; 105:646-648. [PMID: 38519226 DOI: 10.1016/j.kint.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 01/18/2024] [Accepted: 02/02/2024] [Indexed: 03/24/2024]
Affiliation(s)
- Maria Pippias
- Population Health Sciences, University of Bristol, Bristol, Avon, UK; Department of Renal Medicine, North Bristol NHS Trust, Bristol, Avon, UK
| | - Rajitha A Abeysekera
- Department of Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka; Centre for Education Research & Training in Kidney Disease, University of Peradeniya, Peradeniya, Sri Lanka
| | | | - M Razeen Davids
- Division of Nephrology, Department of Medicine, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | | | - Maria C Gonzales-Bedat
- Latin American Dialysis & Renal Transplantation Registry, Sociedad Latinoamericana de Nefrología e Hipertensión (SLANH), Panama City, Panama
| | - Norio Hanafusa
- Department of Blood Purification, Tokyo Women's Medical University, Tokyo, Japan; The Japanese Society for Dialysis Therapy, Tokyo, Japan
| | - Junichi Hoshino
- Department of Nephrology, Tokyo Women's Medical University, Tokyo, Japan
| | - Anne Hradsky
- International Society of Nephrology, Brussels, Belgium
| | - Georgina L Irish
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia; Department of Medicine, The University of Adelaide, Adelaide, South Australia, Australia
| | - Kitty J Jager
- ERA Registry, Amsterdam Public Health research institute - Quality of Care, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands; Department of Medical Informatics, Amsterdam Public Health research institute - Quality of Care, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Sabine Karam
- Department of Medicine, Division of Nephrology & Hypertension, University of Minnesota, Minneapolis, Minnesota, USA; Department of Internal Medicine, Division of Nephrology and Hypertension, American University of Beirut, Beirut, Lebanon
| | - Vivek Kumar
- Department of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Stephen P McDonald
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia; Centre for Clinical Epidemiology, Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Guillermo J Rosa-Diez
- Latin American Dialysis & Renal Transplantation Registry, Sociedad Latinoamericana de Nefrología e Hipertensión (SLANH), Panama City, Panama; Division of Nephrology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Elliot K Tannor
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; Renal Unit, Directorate of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - James B Wetmore
- Division of Nephrology, Hennepin Healthcare, Minneapolis, Minnesota, USA; Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Fergus J Caskey
- Population Health Sciences, University of Bristol, Bristol, Avon, UK; Department of Renal Medicine, North Bristol NHS Trust, Bristol, Avon, UK.
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14
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Ghimire A, Shah S, Okpechi IG, Ye F, Tungsanga S, Vachharajani T, Levin A, Johnson D, Ravani P, Tonelli M, Thompson S, Jha V, Luyckx V, Jindal K, Shah N, Caskey FJ, Kazancioglu R, Bello AK. Global variability of vascular and peritoneal access for chronic dialysis. Nephrology (Carlton) 2024; 29:135-142. [PMID: 38018697 DOI: 10.1111/nep.14259] [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] [Received: 09/12/2023] [Revised: 11/03/2023] [Accepted: 11/17/2023] [Indexed: 11/30/2023]
Abstract
AIM Vascular and peritoneal access are essential elements for sustainability of chronic dialysis programs. Data on availability, patterns of use, funding models, and workforce for vascular and peritoneal accesses for dialysis at a global scale is limited. METHODS An electronic survey of national leaders of nephrology societies, consumer representative organizations, and policymakers was conducted from July to September 2018. Questions focused on types of accesses used to initiate dialysis, funding for services, and availability of providers for access creation. RESULTS Data from 167 countries were available. In 31 countries (25% of surveyed countries), >75% of patients initiated haemodialysis (HD) with a temporary catheter. Seven countries (5% of surveyed countries) had >75% of patients initiating HD with arteriovenous fistulas or grafts. Seven countries (5% of surveyed countries) had >75% of their patients starting HD with tunnelled dialysis catheters. 57% of low-income countries (LICs) had >75% of their patients initiating HD with a temporary catheter compared to 5% of high-income countries (HICs). Shortages of surgeons to create vascular access were reported in 91% of LIC compared to 46% in HIC. Approximately 95% of participating countries in the LIC category reported shortages of surgeons for peritoneal dialysis (PD) access compared to 26% in HIC. Public funding was available for central venous catheters, fistula/graft creation, and PD catheter surgery in 57%, 54% and 54% of countries, respectively. CONCLUSION There is a substantial variation in the availability, funding, workforce, and utilization of vascular and peritoneal access for dialysis across countries regions, with major gaps in low-income countries.
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Affiliation(s)
- Anukul Ghimire
- Division of Nephrology and Immunology, University of Alberta, Edmonton, Alberta, Canada
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Samveg Shah
- Division of Nephrology and Immunology, University of Alberta, Edmonton, Alberta, Canada
| | - Ikechi G Okpechi
- Division of Nephrology and Immunology, University of Alberta, Edmonton, Alberta, Canada
| | - Feng Ye
- Division of Nephrology and Immunology, University of Alberta, Edmonton, Alberta, Canada
| | - Somkanya Tungsanga
- Division of Nephrology and Immunology, University of Alberta, Edmonton, Alberta, Canada
| | - Tushar Vachharajani
- School of Medicine, Wayne State University, Detroit, Michigan, United States
| | - Adeera Levin
- Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - David Johnson
- Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Pietro Ravani
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Marcello Tonelli
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Stephanie Thompson
- Division of Nephrology and Immunology, University of Alberta, Edmonton, Alberta, Canada
| | - Vivekananda Jha
- George Institute of Global Health, New Delhi, India
- School of Public Health, Imperial College, London, UK
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - Valerie Luyckx
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Kailash Jindal
- Division of Nephrology and Immunology, University of Alberta, Edmonton, Alberta, Canada
| | - Nikhil Shah
- Division of Nephrology and Immunology, University of Alberta, Edmonton, Alberta, Canada
| | - Fergus J Caskey
- Bristol Population Health Science Institute, University of Bristol, Bristol, UK
| | - Rumeyza Kazancioglu
- School of Medicine, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
| | - Aminu K Bello
- Division of Nephrology and Immunology, University of Alberta, Edmonton, Alberta, Canada
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15
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Bello AK, Okpechi IG, Levin A, Ye F, Damster S, Arruebo S, Donner JA, Caskey FJ, Cho Y, Davids MR, Davison SN, Htay H, Jha V, Lalji R, Malik C, Nangaku M, See E, Sozio SM, Tonelli M, Wainstein M, Yeung EK, Johnson DW. An update on the global disparities in kidney disease burden and care across world countries and regions. Lancet Glob Health 2024; 12:e382-e395. [PMID: 38365413 DOI: 10.1016/s2214-109x(23)00570-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 11/27/2023] [Accepted: 12/04/2023] [Indexed: 02/18/2024]
Abstract
BACKGROUND Since 2015, the International Society of Nephrology (ISN) Global Kidney Health Atlas (ISN-GKHA) has spearheaded multinational efforts to understand the status and capacity of countries to provide optimal kidney care, particularly in low-resource settings. In this iteration of the ISN-GKHA, we sought to extend previous findings by assessing availability, accessibility, quality, and affordability of medicines, kidney replacement therapy (KRT), and conservative kidney management (CKM). METHODS A consistent approach was used to obtain country-level data on kidney care capacity during three phases of data collection in 2016, 2018, and 2022. The current report includes a detailed literature review of published reports, databases, and registries to obtain information on the burden of chronic kidney disease and estimate the incidence and prevalence of treated kidney failure. Findings were triangulated with data from a multinational survey of opinion leaders based on the WHO's building blocks for health systems (ie, health financing, service delivery, access to essential medicines and health technology, health information systems, workforce, and governance). Country-level data were stratified by the ISN geographical regions and World Bank income groups and reported as counts and percentages, with global, regional, and income level estimates presented as medians with interquartile ranges. FINDINGS The literature review used information on prevalence of chronic kidney disease from 161 countries. The global median prevalence of chronic kidney disease was 9·5% (IQR 5·9-11·7) with the highest prevalence in Eastern and Central Europe (12·8%, 11·9-14·1). For the survey analysis, responses received covered 167 (87%) of 191 countries, representing 97·4% (7·700 billion of 7·903 billion) of the world population. Chronic haemodialysis was available in 162 (98%) of 165 countries, chronic peritoneal dialysis in 130 (79%), and kidney transplantation in 116 (70%). However, 121 (74%) of 164 countries were able to provide KRT to more than 50% of people with kidney failure. Children did not have access to haemodialysis in 12 (19%) of 62 countries, peritoneal dialysis in three (6%) countries, or kidney transplantation in three (6%) countries. CKM (non-dialysis management of people with kidney failure chosen through shared decision making) was available in 87 (53%) of 165 countries. The annual median costs of KRT were: US$19 380 per person for haemodialysis, $18 959 for peritoneal dialysis, and $26 903 for the first year of kidney transplantation. Overall, 74 (45%) of 166 countries allocated public funding to provide free haemodialysis at the point of delivery; use of this funding scheme increased with country income level. The median global prevalence of nephrologists was 11·8 per million population (IQR 1·8-24·8) with an 80-fold difference between low-income and high-income countries. Differing degrees of health workforce shortages were reported across regions and country income levels. A quarter of countries had a national chronic kidney disease-specific strategy (41 [25%] of 162) and chronic kidney disease was recognised as a health priority in 78 (48%) of 162 countries. INTERPRETATION This study provides new information about the global burden of kidney disease and its treatment. Countries in low-resource settings have substantially diminished capacity for kidney care delivery. These findings have major policy implications for achieving equitable access to kidney care. FUNDING International Society of Nephrology.
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Affiliation(s)
- Aminu K Bello
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
| | - Ikechi G Okpechi
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada; Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa; Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa
| | - Adeera Levin
- Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Feng Ye
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | | | - Silvia Arruebo
- The International Society of Nephrology, Brussels, Belgium
| | - Jo-Ann Donner
- The International Society of Nephrology, Brussels, Belgium
| | - Fergus J Caskey
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Yeoungjee Cho
- Australasian Kidney Trials Network at the University of Queensland, Brisbane, QLD, Australia; Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - M Razeen Davids
- Division of Nephrology, Department of Medicine, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Sara N Davison
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Htay Htay
- Department of Renal Medicine, Singapore General Hospital, Singapore; Duke-NUS Medical School, Singapore
| | - Vivekanand Jha
- George Institute for Global Health, University of New South Wales (UNSW), New Delhi, India; School of Public Health, Imperial College London, London, UK; Manipal Academy of Higher Education, Manipal, India
| | - Rowena Lalji
- Centre for Kidney Disease Research, University of Queensland, Brisbane, QLD, Australia; Department of Nephrology, Queensland Children's Hospital, Brisbane, QLD, Australia; Metro South and Integrated Nephrology and Transplant Services (MINTS), Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Charu Malik
- The International Society of Nephrology, Brussels, Belgium
| | - Masaomi Nangaku
- Division of Nephrology and Endocrinology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Emily See
- Royal Melbourne Hospital and Royal Children's Hospital, Melbourne, VIC, Australia; Department of Critical Care, University of Melbourne, Melbourne, VIC, Australia
| | - Stephen M Sozio
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Marcello Tonelli
- Department of Medicine, University of Calgary, Calgary, AB, Canada; Canada and Pan-American Health Organization/World Health Organization's Collaborating Centre in Prevention and Control of Chronic Kidney Disease, University of Calgary, Calgary, AB, Canada
| | - Marina Wainstein
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia; West Moreton Kidney Health Service, Ipswich Hospital, Brisbane, QLD, Australia
| | - Emily K Yeung
- Department of Nephrology, Monash Health, Clayton, VIC, Australia
| | - David W Johnson
- Australasian Kidney Trials Network at the University of Queensland, Brisbane, QLD, Australia; Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, QLD, Australia; Centre for Kidney Disease Research, University of Queensland, Brisbane, QLD, Australia; Translational Research Institute, Brisbane, QLD, Australia
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16
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Al-Talib M, Caskey FJ, Inward C, Ben-Shlomo Y, Hamilton AJ. Psychosocial Health Among Young Adults With Kidney Failure: A Longitudinal Follow-up of the SPEAK (Surveying Patients Experiencing Young Adult Kidney Failure) Study. Kidney Med 2024; 6:100763. [PMID: 38317758 PMCID: PMC10840100 DOI: 10.1016/j.xkme.2023.100763] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024] Open
Abstract
Rationale & Objective There have been no longitudinal studies examining the evolution of psychosocial health of young adults with kidney failure as they age. We aimed to address this in the Surveying Patients Experiencing Young Adult Kidney Failure-2 (SPEAK-2) study. Study Design 5-year follow-up longitudinal survey of the original SPEAK cohort. Setting & Participants 16- to 30-year-olds in the UK receiving kidney replacement therapy (KRT) between 2015 and 2017 who participated in the SPEAK study. Exposure Kidney failure and KRT modality. Outcomes Psychosocial health and lifestyle behaviors. Analytical Approach Within-cohort changes in psychosocial health were analyzed using the paired t test, Wilcoxon signed-rank test and McNemar's test. We compared responses to the age-matched population and examined the impact of changes in KRT modality on psychological health using linear regression for continuous outcome variables as well as logistic, ordered logistic and multinomial logistic regression for binary, ordered categorical and unordered categorical variables, respectively. Results We obtained 158 survey responses; 129 had previously responded to SPEAK. Of these, 90% had a kidney transplant. Compared to the general population, respondents were less likely to be married or have children and were more likely to be living with their parents. Respondents had nearly 15 times greater odds of being unable to work due to health (odds ratio [OR] = 14.41; 95% confidence interval [CI], 8.0-26.01; P < 0.001). Respondents had poorer quality of life and mental wellbeing and were more likely to report psychological problems (OR = 5.37; 95% CI, 3.45-8.35; P < 0.001). A negative association between remaining on or moving to dialysis and psychosocial health was observed, although this was attenuated when controlling for the psychosocial state in SPEAK. Limitations Low response rate resulting in imprecise and potentially biased estimates and impact of COVID-19 pandemic while survey was active on psychosocial health. Conclusions Young adults with kidney failure have persistent poorer psychosocial health compared to their healthy peers as they age. Our findings also suggest a potential causal relationship between KRT modality and psychosocial health.
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Affiliation(s)
- Mohammed Al-Talib
- Population Health Sciences, University of Bristol, Bristol, United Kingdom
- Richard Bright Renal Unit, Southmead Hospital, North Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Fergus J. Caskey
- Population Health Sciences, University of Bristol, Bristol, United Kingdom
- Richard Bright Renal Unit, Southmead Hospital, North Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Carol Inward
- Bristol Royal Hospital for Children, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
| | - Yoav Ben-Shlomo
- Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Alexander J. Hamilton
- Population Health Sciences, University of Bristol, Bristol, United Kingdom
- Exeter Kidney Unit, Royal Devon and Exeter Hospital, Exeter, United Kingdom
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17
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Toader AM, Campbell MK, Quint JK, Robling M, Sydes MR, Thorn J, Wright-Hughes A, Yu LM, Abbott TEF, Bond S, Caskey FJ, Clout M, Collinson M, Copsey B, Davies G, Driscoll T, Gamble C, Griffin XL, Hamborg T, Harris J, Harrison DA, Harji D, Henderson EJ, Logan P, Love SB, Magee LA, O'Brien A, Pufulete M, Ramnarayan P, Saratzis A, Smith J, Solis-Trapala I, Stubbs C, Farrin A, Williamson P. Using healthcare systems data for outcomes in clinical trials: issues to consider at the design stage. Trials 2024; 25:94. [PMID: 38287428 PMCID: PMC10823676 DOI: 10.1186/s13063-024-07926-z] [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] [Received: 09/13/2023] [Accepted: 01/12/2024] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND Healthcare system data (HSD) are increasingly used in clinical trials, augmenting or replacing traditional methods of collecting outcome data. This study, PRIMORANT, set out to identify, in the UK context, issues to be considered before the decision to use HSD for outcome data in a clinical trial is finalised, a methodological question prioritised by the clinical trials community. METHODS The PRIMORANT study had three phases. First, an initial workshop was held to scope the issues faced by trialists when considering whether to use HSDs for trial outcomes. Second, a consultation exercise was undertaken with clinical trials unit (CTU) staff, trialists, methodologists, clinicians, funding panels and data providers. Third, a final discussion workshop was held, at which the results of the consultation were fed back, case studies presented, and issues considered in small breakout groups. RESULTS Key topics included in the consultation process were the validity of outcome data, timeliness of data capture, internal pilots, data-sharing, practical issues, and decision-making. A majority of consultation respondents (n = 78, 95%) considered the development of guidance for trialists to be feasible. Guidance was developed following the discussion workshop, for the five broad areas of terminology, feasibility, internal pilots, onward data sharing, and data archiving. CONCLUSIONS We provide guidance to inform decisions about whether or not to use HSDs for outcomes, and if so, to assist trialists in working with registries and other HSD providers to improve the design and delivery of trials.
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Affiliation(s)
- Alice-Maria Toader
- MRC-NIHR Trials Methodology Research Partnership, Department of Health Data Science, University of Liverpool, Liverpool, UK.
| | - Marion K Campbell
- Health Services Research Unit, University of Aberdeen, Aberdeen, AB25 2ZD, UK
| | - Jennifer K Quint
- School of Public Health &, National Heart and Lung Institute, Imperial College London, London, UK
| | - Michael Robling
- Centre for Trials Research, Cardiff University, Cardiff, CF14 4YS, UK
| | - Matthew R Sydes
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London, UK
- BHF Data Science Centre, Health Data Research UK, London, UK
| | - Joanna Thorn
- Health Economics Bristol, Population Health Sciences, University of Bristol, Bristol, UK
| | - Alexandra Wright-Hughes
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research,, University of Leeds, Leeds, LS2 9JT, UK
| | - Ly-Mee Yu
- Oxford Primary Care CTU, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Tom E F Abbott
- William Harvey Research Institute, Queen Mary University of London, London, EC1M 6BQ, UK
| | - Simon Bond
- Cambridge Clinical Trials Unit, Cambridge, UK
| | - Fergus J Caskey
- BHF Data Science Centre, Health Data Research UK, London, UK
| | - Madeleine Clout
- Bristol Trials Centre, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2PS, UK
| | - Michelle Collinson
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research,, University of Leeds, Leeds, LS2 9JT, UK
| | - Bethan Copsey
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research,, University of Leeds, Leeds, LS2 9JT, UK
| | - Gwyneth Davies
- UCL Great Ormond Street Institute of Child Health, London, WC1N 1EH, UK
| | | | - Carrol Gamble
- Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| | - Xavier L Griffin
- Barts Bone and Joint Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Thomas Hamborg
- Pragmatic Clinical Trials Unit, Wolfson Institute of Population Health, Queen Mary University of London, London, E1 2AB, UK
| | - Jessica Harris
- Bristol Trials Centre, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2PS, UK
| | | | - Deena Harji
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research,, University of Leeds, Leeds, LS2 9JT, UK
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Emily J Henderson
- Ageing and Movement Research Group, Bristol Medical School, University of Bristol, Bristol, UK
- Older People's Unit, Royal United Hospitals NHS Foundation Trust, Bath, UK
| | - Pip Logan
- School of Medicine, University of Nottingham and Nottingham City Care Partnership, Nottingham, UK
| | - Sharon B Love
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London, UK
| | - Laura A Magee
- Department of Women and Children's Health, King's College London, London, UK
| | - Alastair O'Brien
- Division of Medicine, UCL Institute for Liver and Digestive Health, Royal Free Campus, Upper 3Rd FloorRowland Hill Street, London, NW3 2PF, UK
| | - Maria Pufulete
- Bristol Medical School, University of Bristol, Bristol, BS8 2PS, UK
| | | | - Athanasios Saratzis
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Jo Smith
- Keele Clinical Trials Unit, Faculty of Medicine and Health Sciences, Keele University, Staffordshire, UK
| | - Ivonne Solis-Trapala
- Keele Clinical Trials Unit, Faculty of Medicine and Health Sciences, Keele University, Staffordshire, UK
| | - Clive Stubbs
- Birmingham Clinical Trials Unit (BCTU), Institute of Applied Health Research College of Medical and Dental Sciences, The University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Amanda Farrin
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research,, University of Leeds, Leeds, LS2 9JT, UK
| | - Paula Williamson
- MRC-NIHR Trials Methodology Research Partnership, Department of Health Data Science, University of Liverpool, Liverpool, UK
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18
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Hayward SJ, Chesnaye NC, Hole B, Aylward R, Meuleman Y, Torino C, Porto G, Szymczak M, Drechsler C, Dekker FW, Evans M, Jager KJ, Wanner C, Caskey FJ. Protein Biomarkers and Major Cardiovascular Events in Older People With Advanced CKD: The European Quality (EQUAL) Study. Kidney Med 2024; 6:100745. [PMID: 38162538 PMCID: PMC10757029 DOI: 10.1016/j.xkme.2023.100745] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024] Open
Abstract
Rationale & Objective Cardiovascular disease is the leading cause of morbidity and mortality in chronic kidney disease (CKD). We investigated 184 inflammatory and cardiovascular proteins to determine their potential as biomarkers for major cardiovascular events (MACEs). Study Design The European Quality (EQUAL) is an observational cohort study that enrolled people aged ≥65 years with an estimated glomerular filtration rate ≤20 mL/min/1.73 m2. Setting & Participants Recruited participants were split into the discovery (n = 611) and replication cohorts (n = 292). Exposure Levels of 184 blood proteins were measured at the baseline visit, and each protein was analyzed individually. Outcome MACE. Analytical Approach Cox proportional hazard models adjusted for age, sex, estimated glomerular filtration rate, previous MACE, and country were used to determine the risk of MACE. Proteins with false discovery rate adjusted P values of <0.05 in the discovery cohort were tested in the replication cohort. Sensitivity analyses were performed by adjusting for traditional risk factors, CKD-specific risk factors, and level of proteinuria and segregating atherosclerotic and nonatherosclerotic MACE. Results During a median follow-up of 2.9 years, 349 people (39%) experienced a MACE. Forty-eight proteins were associated with MACE in the discovery cohort; 9 of these were reproduced in the replication cohort. Three of these proteins maintained a strong association with MACE after adjustment for traditional and CKD-specific risk factors and proteinuria. Tenascin (TNC), fibroblast growth factor-23 (FGF-23), and V-set and immunoglobulin domain-containing protein 2 (VSIG2) were associated with both atherosclerotic and nonatherosclerotic MACE. All replicated proteins except carbonic anhydrase 1 and carbonic anhydrase 3 were associated with nonatherosclerotic MACE. Limitations Single protein concentration measurements and limited follow-up time. Conclusions Our findings corroborate previously reported relationships between FGF-23, vascular cell adhesion protein-1, TNC, and placental growth factor with cardiovascular outcomes in CKD. We identify 5 proteins not previously linked with MACE in CKD that may be targets for future therapies. Plain-Language Summary Kidney disease increases the risk of heart disease, stroke, and other vascular conditions. Blood tests that predict the likelihood of these problems may help to guide treatment, but studies are needed in people with kidney disease. We analyzed blood tests from older people with kidney disease, looking for proteins associated with higher risk of these conditions. Nine proteins were identified, of which 3 showed a strong effect after all other information was considered. This work supports previous research regarding 4 of these proteins and identifies 5 additional proteins that may be associated with higher risk. Further work is needed to confirm our findings and to determine whether these proteins can be used to guide treatment.
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Affiliation(s)
- Samantha J.L. Hayward
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom
| | - Nicholas C. Chesnaye
- Amsterdam UMC, University of Amsterdam, ERA Registry, Medical Informatics, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, The Netherlands
| | - Barnaby Hole
- Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Ryan Aylward
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa
| | - Yvette Meuleman
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Claudia Torino
- Institute of Clinical Physiology, National Research Council, Reggio Calabria, Italy
| | - Gaetana Porto
- GOM Bianchi Melacrino Morelli, Reggio Calabria, Italy
| | - Maciej Szymczak
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland
| | | | - Friedo W. Dekker
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Marie Evans
- Department of Clinical Sciences Intervention and Technology, Karolinska Institutet and Karolinska, Stockholm, Sweden
| | - Kitty J. Jager
- Amsterdam UMC, University of Amsterdam, ERA Registry, Medical Informatics, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, The Netherlands
| | - Christoph Wanner
- Division of Nephrology, University Hospital of Wurzburg, Wurzburg, Germany
| | - Fergus J. Caskey
- Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - EQUAL investigators
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom
- Amsterdam UMC, University of Amsterdam, ERA Registry, Medical Informatics, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, The Netherlands
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
- Institute of Clinical Physiology, National Research Council, Reggio Calabria, Italy
- GOM Bianchi Melacrino Morelli, Reggio Calabria, Italy
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland
- Division of Nephrology, University Hospital of Wurzburg, Wurzburg, Germany
- Department of Clinical Sciences Intervention and Technology, Karolinska Institutet and Karolinska, Stockholm, Sweden
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19
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Jaure A, Vastani RT, Teixeira-Pinto A, Ju A, Craig JC, Viecelli AK, Scholes-Robertson N, Josephson MA, Ahn C, Butt Z, Caskey FJ, Dobbels F, Fowler K, Jowsey-Gregoire S, Jha V, Tan JC, Sautenet B, Howell M. Validation of a Core Patient-Reported Outcome Measure for Life Participation in Kidney Transplant Recipients: the SONG Life Participation Instrument. Kidney Int Rep 2024; 9:87-95. [PMID: 38312789 PMCID: PMC10831350 DOI: 10.1016/j.ekir.2023.10.018] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 10/04/2023] [Accepted: 10/23/2023] [Indexed: 02/06/2024] Open
Abstract
Introduction Life participation has been established as a critically important core for trials in kidney transplantation. We aimed to validate a patient-reported outcome measure for life participation in kidney transplant recipients. Methods A psychometric evaluation of the Standardized Outcomes in Nephrology life participation (SONG-LP) measure was conducted in adult kidney transplant recipients. The measure includes 4 items of life participation (leisure, family, work, and social) each with a 5-point Likert scale. Each item is scored from 0 (never) to 4 (always) and the summary measure score the average of each item. Results A total of 249 adult kidney transplant recipients from 20 countries participated. The SONG-LP instrument demonstrated internal consistency (Cronbach's α = 0.87; 95% confidence intervals [CI]: 0.83-0.90, baseline) and test-retest reliability over 1 week (intraclass correlation coefficient of 0.62; 95% CI: 0.54-0.70). There was moderate to high correlation (0.65; 95% CI: 0.57-0.72) with the PROMIS Ability to Participate in Social Roles and Activities Short Form 8a that assessed a similar construct, and moderate correlation with measures that assessed related concepts (i.e., EQ5D 0.57; 95% CI: 0.49-0.65), PROMIS Cognitive Functional Abilities Subset Short Form 4a (0.40; 95% CI: 0.29-0.50). Conclusion The SONG-LP instrument is a simple, internally consistent, reliable measure for kidney transplant recipients and correlates with similar measures. Routine incorporation in clinical trials will ensure consistent and appropriate assessment of life participation for informed patient-centered decision-making.
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Affiliation(s)
- Allison Jaure
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Kidney Research, The Children’s Hospital at Westmead, Westmead, New South Wales, Australia
| | - Rahim T. Vastani
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Kidney Research, The Children’s Hospital at Westmead, Westmead, New South Wales, Australia
| | - Armando Teixeira-Pinto
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Kidney Research, The Children’s Hospital at Westmead, Westmead, New South Wales, Australia
| | - Angela Ju
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Kidney Research, The Children’s Hospital at Westmead, Westmead, New South Wales, Australia
| | - Jonathan C. Craig
- College of Medicine and Public Health, Flinders University, South Australia, Australia
| | - Andrea K. Viecelli
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
- Faculty of Medicine, University of Queensland, Brisbane, 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, Westmead, New South Wales, Australia
| | - Michelle A. Josephson
- Department of Medicine (Section of Nephrology), The University of Chicago, Chicago, Illinois, USA
| | - Curie Ahn
- Transplantation Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Transplantation Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Zeeshan Butt
- Departments of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Phreesia, Inc., Wilmington, Delaware, USA
| | - Fergus J. Caskey
- Population Health Sciences, Bristol Medical School, University of Bristol, UK
| | - Fabienne Dobbels
- Department of Public Health and Primary Care, KU Leuven, Belgium
| | - Kevin Fowler
- The Voice of the Patient, Saint Louis, Missouri, USA
| | | | - Vivekanand Jha
- George Institute for Global Health, University of New South Wales, New Delhi, India
- School of Public Health, Imperial College, London, UK
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - Jane C. Tan
- Department of Medicine, Stanford University, Stanford, California, USA
| | | | - 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, Westmead, New South Wales, Australia
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20
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Astley M, Caskey FJ, Evans M, Torino C, Szymczak M, Drechsler C, Pippias M, de Rooij E, Porto G, Stel VS, Dekker FW, Wanner C, Jager KJ, Chesnaye NC. The impact of gender on the risk of cardiovascular events in older adults with advanced chronic kidney disease. Clin Kidney J 2023; 16:2396-2404. [PMID: 38046000 PMCID: PMC10689190 DOI: 10.1093/ckj/sfad088] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Indexed: 12/05/2023] Open
Abstract
Background Patients with chronic kidney disease (CKD) are at a higher risk of major adverse cardiovascular events (MACE) compared with the general population, but gender differences in this risk, especially in older adults, are not fully known. We aim to identify gender differences in the risk of MACE in older European CKD patients, and explore factors that may explain these differences. Methods The European Quality study (EQUAL) is a prospective study on stage 4-5 CKD patients, ≥65 years old, not on dialysis, from Germany, Italy, the Netherlands, Poland, Sweden and the UK. Cox regression and cumulative incidence competing risk curves were used to identify gender differences in MACE risks. Mediation analysis was used to identify variables which may explain risk differences between men and women. Results A total of 417 men out of 1134 (37%) and 185 women out of 602 women (31%) experienced at least one MACE, over a follow-up period of 5 years. Women had an 18% lower risk of first MACE compared with men (hazard ratio 0.82; 95% confidence interval 0.69-0.97; P = .02), which was attenuated after adjusting for pre-existing cardiometabolic comorbidities and cardiovascular risk factors. There were no significant gender differences in the risk of recurrent MACE or fatal MACE. The risk difference in MACE by gender was larger in patients aged 65-75 years, compared with patients over 75 years. Conclusions In a cohort of older adults with advanced CKD, women had lower risks of MACE. These risk differences were partially explained by pre-existing cardiometabolic comorbidities and cardiovascular risk factors.
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Affiliation(s)
- Megan Astley
- Amsterdam UMC location University of Amsterdam, ERA Registry, Medical Informatics, Amsterdam, the Netherlands
- Amsterdam Public Health, Health Behaviours and Chronic Diseases and Methodology, Amsterdam, the Netherlands
| | - Fergus J Caskey
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Marie Evans
- Renal Unit, Department of Clinical Intervention and Technology (CLINTEC), Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Claudia Torino
- IFC-CNR, Clinical Epidemiology and Pathophysiology of Renal Diseases and Hypertension, Reggio Calabria, Italy
| | - Maciej Szymczak
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland
| | | | - Maria Pippias
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- North Bristol NHS Trust, Renal Unit, Bristol, UK
| | - Esther de Rooij
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Gaetana Porto
- G.O.M., Bianchi Melacrino Morelli, Reggio Calabria, Italy
| | - Vianda S Stel
- Amsterdam UMC location University of Amsterdam, ERA Registry, Medical Informatics, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
| | - Friedo W Dekker
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Christoph Wanner
- Division of Nephrology, University Hospital of Würzburg, Würzburg, Germany
| | - Kitty J Jager
- Amsterdam UMC location University of Amsterdam, ERA Registry, Medical Informatics, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
| | - Nicholas C Chesnaye
- Amsterdam UMC location University of Amsterdam, ERA Registry, Medical Informatics, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
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21
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Reston RE, Caskey FJ, Hole B, Udayaraj U, Weinman J. CareKnowDo-A Multichannel Digital and Telephone Support Program for People With Chronic Kidney Disease: Feasibility Randomized Controlled Trial. JMIR Form Res 2023; 7:e33147. [PMID: 37995117 DOI: 10.2196/33147] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 07/05/2022] [Accepted: 01/03/2023] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) is a common, progressive condition. Lifestyle changes and antihypertensive medication can slow the progression to end-stage kidney disease, which requires renal replacement therapy. However, adherence to these recommendations is often low. OBJECTIVE The aim of CareKnowDo was to assess the feasibility of rolling out a digital self-management support and adherence program integrated with a patient-facing electronic health record, Patient View (PV). METHODS A 2-arm, parallel, individual-level pragmatic feasibility pilot randomized controlled trial was conducted at 2 National Health Service (NHS) sites in the United Kingdom. A total of 61 patients with CKD were randomized 1:1 into 2 groups and provided with either a new, tailored digital and telephone support program (CareKnowDo: 31/61, 51%) integrated with PV or standard care (PV alone: 30/61, 49%). Quantitative measures included clinical and psychosocial measures. The primary outcomes were feasibility based: recruitment rate, dropout, and the exploration of associations. RESULTS Of the 1392 patients screened in local kidney clinics, 269 (19.32%) met the basic inclusion criteria; the first 22.7% (61/269) who met the eligibility criteria were recruited to participate in the study. Of the 69 patients, 23 (38%) patients completed the final 6-month follow-up web-based survey. Reasons for the attrition were explored. A higher belief in the ability of the treatment to control CKD was associated with lower blood pressure at baseline (r=0.52; P=.005), and a higher perceived understanding of CKD at baseline was associated with lower blood pressure at follow-up (r=0.66; P<.001). Beliefs about medicines at baseline were associated with blood pressure at baseline but not at follow-up. This was true for both concerns about medicines (r=0.58; P=.001) and perceived necessity of medicines (r=0.42; P=.03). CONCLUSIONS A tailored digital and nurse call-based program to enhance support for patients with CKD was piloted in 2 NHS sites and found to be feasible and acceptable. However, to maximize the effectiveness of the intervention (and of future trials), consideration should be given to the target audience most likely to benefit, as well as how to help them access the program as quickly and easily as possible. TRIAL REGISTRATION NHS Health Research Authority, IRAS ID 184206; https://www.hra.nhs.uk/planning-and-improving -research/application-summaries/research-summaries/careknowdo-pilot-version-1/.
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Affiliation(s)
| | - Fergus J Caskey
- University of Bristol, Bristol, United Kingdom
- North Bristol National Health Service Trust, Bristol, United Kingdom
| | - Barnaby Hole
- University of Bristol, Bristol, United Kingdom
- North Bristol National Health Service Trust, Bristol, United Kingdom
| | - Udaya Udayaraj
- Oxford University Hospitals National Health Service Foundation Trust, Oxford, United Kingdom
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - John Weinman
- School of Cancer & Pharmaceutical Sciences, King's College London, London, United Kingdom
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22
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Scott J, Bidulka P, Taylor DM, Udayaraj U, Caskey FJ, Birnie K, Deanfield J, de Belder M, Denaxas S, Weston C, Adlam D, Nitsch D. Management and outcomes of myocardial infarction in people with impaired kidney function in England. BMC Nephrol 2023; 24:325. [PMID: 37919679 PMCID: PMC10623815 DOI: 10.1186/s12882-023-03377-x] [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] [Received: 05/10/2023] [Accepted: 10/23/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND Acute myocardial infarction (AMI) causes significant mortality and morbidity in people with impaired kidney function. Previous observational research has demonstrated reduced use of invasive management strategies and inferior outcomes in this population. Studies from the USA have suggested that disparities in care have reduced over time. It is unclear whether these findings extend to Europe and the UK. METHODS Linked data from four national healthcare datasets were used to investigate management and outcomes of AMI by estimated glomerular filtration rate (eGFR) category in England. Multivariable logistic and Cox regression models compared management strategies and outcomes by eGFR category among people with kidney impairment hospitalised for AMI between 2015-2017. RESULTS In a cohort of 5 835 people, we found reduced odds of invasive management in people with eGFR < 60mls/min/1.73m2 compared with people with eGFR ≥ 60 when hospitalised for non-ST segment elevation MI (NSTEMI). The association between eGFR and odds of invasive management for ST-elevation MI (STEMI) varied depending on the availability of percutaneous coronary intervention. A graded association between mortality and eGFR category was demonstrated both in-hospital and after discharge for all people. CONCLUSIONS In England, patients with reduced eGFR are less likely to receive invasive management compared to those with preserved eGFR. Disparities in care may however be decreasing over time, with the least difference seen in patients with STEMI managed via the primary percutaneous coronary intervention pathway. Reduced eGFR continues to be associated with worse outcomes after AMI.
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Affiliation(s)
- Jemima Scott
- Population Health Sciences, University of Bristol, Bristol, England.
- Richard Bright Renal Service, North Bristol NHS Trust, Southmead Hospital, Bristol, England.
| | - Patrick Bidulka
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London, England
| | - Dominic M Taylor
- Population Health Sciences, University of Bristol, Bristol, England
- Richard Bright Renal Service, North Bristol NHS Trust, Southmead Hospital, Bristol, England
| | - Udaya Udayaraj
- Oxford Kidney Unit, Churchill Hospital, Oxford, England
- Nuffield Department of Medicine, University of Oxford, Oxford, England
| | - Fergus J Caskey
- Population Health Sciences, University of Bristol, Bristol, England
- Richard Bright Renal Service, North Bristol NHS Trust, Southmead Hospital, Bristol, England
| | - Kate Birnie
- Population Health Sciences, University of Bristol, Bristol, England
| | - John Deanfield
- National Institute for Cardiovascular Outcomes Research (NICOR), NHS Arden & Greater East Midlands Commissioning Support Unit, Leicester, England
- Institute of Cardiovascular Sciences, University College London, London, UK
| | - Mark de Belder
- National Institute for Cardiovascular Outcomes Research (NICOR), NHS Arden & Greater East Midlands Commissioning Support Unit, Leicester, England
| | - Spiros Denaxas
- British Heart Foundation, Data Science Centre, London, UK
- University College London Hospitals Biomedical Research Centre, London, UK
| | - Clive Weston
- Glangwili General Hospital, Dolgwili Road, Carmarthen, Wales, UK
| | - David Adlam
- Department of Cardiovascular Sciences, University of Leicester, and NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Dorothea Nitsch
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London, England
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23
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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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24
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Magagnoli L, Cozzolino M, Caskey FJ, Evans M, Torino C, Porto G, Szymczak M, Krajewska M, Drechsler C, Stenvinkel P, Pippias M, Dekker FW, de Rooij ENM, Wanner C, Chesnaye NC, Jager KJ. Association between CKD-MBD and mortality in older patients with advanced CKD-results from the EQUAL study. Nephrol Dial Transplant 2023; 38:2562-2575. [PMID: 37230954 PMCID: PMC10615632 DOI: 10.1093/ndt/gfad100] [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] [Received: 10/17/2022] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Chronic kidney disease-mineral and bone disorder (CKD-MBD) is a common complication of CKD; it is associated with higher mortality in dialysis patients, while its impact in non-dialysis patients remains mostly unknown. We investigated the associations between parathyroid hormone (PTH), phosphate and calcium (and their interactions), and all-cause, cardiovascular (CV) and non-CV mortality in older non-dialysis patients with advanced CKD. METHODS We used data from the European Quality study, which includes patients aged ≥65 years with estimated glomerular filtration rate ≤20 mL/min/1.73 m2 from six European countries. Sequentially adjusted Cox models were used to assess the association between baseline and time-dependent CKD-MBD biomarkers and all-cause, CV and non-CV mortality. Effect modification between biomarkers was also assessed. RESULTS In 1294 patients, the prevalence of CKD-MBD at baseline was 94%. Both PTH [adjusted hazard ratio (aHR) 1.12, 95% confidence interval (CI) 1.03-1.23, P = .01] and phosphate (aHR 1.35, 95% CI 1.00-1.84, P = .05), but not calcium (aHR 1.11, 95% CI 0.57-2.17, P = .76), were associated with all-cause mortality. Calcium was not independently associated with mortality, but modified the effect of phosphate, with the highest mortality risk found in patients with both hypercalcemia and hyperphosphatemia. PTH level was associated with CV mortality, but not with non-CV mortality, whereas phosphate was associated with both CV and non-CV mortality in most models. CONCLUSIONS CKD-MBD is very common in older non-dialysis patients with advanced CKD. PTH and phosphate are independently associated with all-cause mortality in this population. While PTH level is only associated with CV mortality, phosphate seems to be associated with both CV and non-CV mortality.
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Affiliation(s)
- Lorenza Magagnoli
- University of Milan, Department of Health Sciences, Milan, Italy
- ASST Santi Paolo e Carlo, Renal Division, Milan, Italy
| | - Mario Cozzolino
- University of Milan, Department of Health Sciences, Milan, Italy
- ASST Santi Paolo e Carlo, Renal Division, Milan, Italy
| | - Fergus J Caskey
- University of Bristol, Population Health Sciences, Bristol, UK
- North Bristol NHS Trust, Renal Unit, Bristol, UK
| | - Marie Evans
- Karolinska Institutet, Department of Clinical Intervention and Technology (CLINTEC), Stockholm, Sweden
| | - Claudia Torino
- Istituto di Fisiologia Clinica Consiglio Nazionale delle Ricerche (IFC-CNR), Clinical Epidemiology and Pathophysiology of Renal Diseases and Hypertension, Reggio Calabria, Italy (IT)
| | - Gaetana Porto
- G.O.M., Azienda Ospedaliera Bianchi-Melacrino-Morelli, Reggio Calabria, Italy
| | - Maciej Szymczak
- Wroclaw Medical University, Department of Nephrology and Transplantation Medicine, Wroclaw, Poland
| | - Magdalena Krajewska
- Wroclaw Medical University, Department of Nephrology and Transplantation Medicine, Wroclaw, Poland
| | | | - Peter Stenvinkel
- Karolinska Institutet, Department of Clinical Intervention and Technology (CLINTEC), Stockholm, Sweden
| | - Maria Pippias
- University of Bristol, Population Health Sciences, Bristol, UK
- North Bristol NHS Trust, Renal Unit, Bristol, UK
| | - Friedo W Dekker
- Leiden University Medical Center, Department of Clinical Epidemiology, Leiden, The Netherlands
| | - Esther N M de Rooij
- Leiden University Medical Center, Department of Clinical Epidemiology, Leiden, The Netherlands
| | - Christoph Wanner
- University Hospital Würzburg, Division of Nephrology, Würzburg, Germany
| | - Nicholas C Chesnaye
- Amsterdam UMC location AMC, Medical Informatics, ERA Registry, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, The Netherlands
| | - Kitty J Jager
- Amsterdam UMC location AMC, Medical Informatics, ERA Registry, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, The Netherlands
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25
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Chesnaye NC, Caskey FJ, Dekker FW, de Rooij ENM, Evans M, Heimburger O, Pippias M, Torino C, Porto G, Szymczak M, Drechsler C, Wanner C, Jager KJ. Clinical and patient-reported trajectories at end-of-life in older patients with advanced CKD. Nephrol Dial Transplant 2023; 38:2494-2502. [PMID: 37193666 DOI: 10.1093/ndt/gfad091] [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] [Received: 12/19/2022] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND We explore longitudinal trajectories of clinical indicators, patient-reported outcomes, and hospitalizations, in the years preceding death in a population of older patients with advanced chronic kidney disease (CKD). METHODS The EQUAL study is a European observational prospective cohort study with an incident eGFR <20 ml/min per 1.73 m2 and ≥65 years of age. The evolution of each clinical indicator was explored using generalized additive models during the 4 years preceding death. RESULTS We included 661 decedents with a median time to death of 2.0 years (IQR 0.9-3.2). During the years preceding death, eGFR, Subjective Global Assessment score, and blood pressure declined, with accelerations seen at 6 months preceding death. Serum hemoglobin, hematocrit, cholesterol, calcium, albumin, and sodium values declined slowly during follow-up, with accelerations observed between 6 and 12 months preceding death. Physical and mental quality of life declined linearly throughout follow-up. The number of reported symptoms was stable up to 2 years prior to death, with an acceleration observed at 1 year prior to death. The rate of hospitalization was stable at around one hospitalization per person year, increasing exponentially at 6 months preceding death. CONCLUSIONS We identified clinically relevant physiological accelerations in patient trajectories that began ∼6 to 12 months prior to death, which are likely multifactorial in nature, but correlate with a surge in hospitalizations. Further research should focus on how to effectively use this knowledge to inform patient and family expectations, to benefit the planning of (end-of-life) care, and to establish clinical alert systems.
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Affiliation(s)
- Nicholas C Chesnaye
- ERA Registry, Amsterdam UMC location University of Amsterdam, Medical Informatics, Meibergdreef 9, Amsterdam, Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
| | - Fergus J Caskey
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Friedo W Dekker
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Esther N M de Rooij
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Marie Evans
- Renal unit, department of Clinical Intervention and technology (CLINTEC), Karolinska Institutet and Karolinska University hospital, Stockholm, Sweden
| | - Olof Heimburger
- Department of Clinical Sciences Intervention and Technology, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Maria Pippias
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Renal unit, Southmead Hospital, North Bristol Trust, Bristol, UK
| | - Claudia Torino
- IFC-CNR, Clinical Epidemiology and Pathophysiology of Renal Diseases and Hypertension, Reggio Calabria, Italy
| | - Gaetana Porto
- GOM Bianchi Melacrino Morelli, Reggio Calabria, Italy
| | - Maciej Szymczak
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland
| | | | - Christoph Wanner
- Division of Nephrology, University Hospital of Würzburg, Würzburg, Germany
| | - Kitty J Jager
- ERA Registry, Amsterdam UMC location University of Amsterdam, Medical Informatics, Meibergdreef 9, Amsterdam, Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
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Nangaku M, Kitching AR, Boor P, Fornoni A, Floege J, Coates PT, Himmelfarb J, Lennon R, Anders HJ, Humphreys BD, Caskey FJ, Fogo AB. Corrigendum to "International Society of Nephrology first consensus guidance for preclinical animal studies in translational nephrology." Kidney International, 2023;104:36-45. Kidney Int 2023; 104:859. [PMID: 37739620 DOI: 10.1016/j.kint.2023.08.001] [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: 09/24/2023]
Affiliation(s)
- Masaomi Nangaku
- Division of Nephrology and Endocrinology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan.
| | - A Richard Kitching
- Centre for Inflammatory Diseases, Monash University Department of Medicine, Clayton, Victoria, Australia; Department of Nephrology, Monash Health, Clayton, Victoria, Australia; Department of Paediatric Nephrology, Monash Health, Clayton, Victoria, Australia
| | - Peter Boor
- Institute of Pathology, Rheinisch Westfälische Technische Hochschule (RWTH) Aachen University, Aachen, Germany
| | - Alessia Fornoni
- Katz Family Division of Nephrology and Hypertension, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA; Peggy and Harold Katz Family Drug Discovery Center, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Jürgen Floege
- Division of Nephrology and Rheumatology, Rheinisch Westfälische Technische Hochschule (RWTH) University Hospital, Aachen, Germany
| | - P Toby Coates
- Central and Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, South Australia, Australia; University of Adelaide, Medical Specialties, Adelaide, Australia; South Australian Medical Research Institute, Adelaide, South Australia, Australia
| | - Jonathan Himmelfarb
- Kidney Research Institute, Division of Nephrology, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Rachel Lennon
- Wellcome Centre for Cell-Matrix Research, Division of Cell-Matrix Biology and Regenerative Medicine, School of Biological Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Department of Paediatric Nephrology, Royal Manchester Children's Hospital, Manchester University Hospitals National Health Service (NHS) Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Hans-Joachim Anders
- Department of Medicine IV, Hospital of Ludwig Maximilian University of Munich, Munich, Germany
| | - Benjamin D Humphreys
- Division of Nephrology, Department of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Fergus J Caskey
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Agnes B Fogo
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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27
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Davies SJ, Coyle D, Lindley EJ, Keane D, Belcher J, Caskey FJ, Dasgupta I, Davenport A, Farrington K, Mitra S, Ormandy P, Wilkie M, MacDonald J, Zanganeh M, Andronis L, Solis-Trapala I, Sim J. Bio-impedance spectroscopy added to a fluid management protocol does not improve preservation of residual kidney function in incident hemodialysis patients in a randomized controlled trial. Kidney Int 2023; 104:587-598. [PMID: 37263353 DOI: 10.1016/j.kint.2023.05.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 03/10/2023] [Revised: 05/15/2023] [Accepted: 05/18/2023] [Indexed: 06/03/2023]
Abstract
Avoiding excessive dialysis-associated volume depletion may help preserve residual kidney function (RKF). To establish whether knowledge of the estimated normally hydrated weight from bioimpedance measurements (BI-NHW) when setting the post-hemodialysis target weight (TW) might mitigate rate of loss of RKF, we undertook an open label, randomized controlled trial in incident patients receiving HD, with clinicians and patients blinded to bioimpedance readings in controls. A total of 439 patients with over 500 ml urine/day or residual GFR exceeding 3 ml/min/1.73m2 were recruited from 34 United Kingdom centers and randomized 1:1, stratified by center. Fluid assessments were made for up to 24 months using a standardized proforma in both groups, supplemented by availability of BI-NHW in the intervention group. Primary outcome was time to anuria, analyzed using competing-risk survival models adjusted for baseline characteristics, by intention to treat. Secondary outcomes included rate of RKF decline (mean urea and creatinine clearance), blood pressure and patient-reported outcomes. There were no group differences in cause-specific hazard rates of anuria (0.751; 95% confidence interval (0.459, 1.229)) or sub-distribution hazard rates (0.742 (0.453, 1.215)). RKF decline was markedly slower than anticipated, pooled linear rates in year 1: -0.178 (-0.196, -0.159)), year 2: -0.061 (-0.086, -0.036)) ml/min/1.73m2/month. Blood pressure and patient-reported outcomes did not differ by group. The mean difference agreement between TW and BI-NHW was similar for both groups, Bioimpedance: -0.04 kg; Control: -0.25 kg. Thus, use of a standardized clinical protocol for fluid assessment when setting TW is associated with excellent preservation of RKF. Hence, bioimpedance measurements are not necessary to achieve this.
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Affiliation(s)
- Simon J Davies
- School of Medicine, Keele University, Keele, Staffordshire, UK.
| | - David Coyle
- NIHR Devices for Dignity, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | | | - David Keane
- CÚRAM SFI Research Centre for Medical Devices, University of Galway, Galway, Ireland
| | - John Belcher
- School of Medicine, Keele University, Keele, Staffordshire, UK
| | - Fergus J Caskey
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Indranil Dasgupta
- Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Andrew Davenport
- UCL Department of Renal Medicine, Royal Free Hampstead NHS Trust, University College, London, UK
| | - Ken Farrington
- Renal Medicine, East & North Hertfordshire NHS Trust, Hertfordshire, UK
| | - Sandip Mitra
- Manchester Academic Health Sciences Centre (MAHSC), University Hospital Manchester, Manchester, UK
| | - Paula Ormandy
- School of Health and Society, University of Salford, Manchester, UK
| | - Martin Wilkie
- Renal Medicine, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Jamie MacDonald
- Institute of Applied Human Physiology, Bangor University, Bangor, UK
| | - Mandana Zanganeh
- Centre for Health Economics at Warwick, University of Warwick, Coventry, UK
| | - Lazaros Andronis
- Centre for Health Economics at Warwick, University of Warwick, Coventry, UK
| | | | - Julius Sim
- School of Medicine, Keele University, Keele, Staffordshire, UK
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28
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de Rooij ENM, de Fijter JW, Le Cessie S, Hoorn EJ, Jager KJ, Chesnaye NC, Evans M, Windahl K, Caskey FJ, Torino C, Szymczak M, Drechsler C, Wanner C, Dekker FW, Hoogeveen EK. Serum Potassium and Risk of Death or Kidney Replacement Therapy in Older People With CKD Stages 4-5: Eight-Year Follow-up. Am J Kidney Dis 2023; 82:257-266.e1. [PMID: 37182596 DOI: 10.1053/j.ajkd.2023.03.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 10/26/2022] [Accepted: 03/02/2023] [Indexed: 05/16/2023]
Abstract
RATIONALE & OBJECTIVE Hypokalemia may accelerate kidney function decline. Both hypo- and hyperkalemia can cause sudden cardiac death. However, little is known about the relationship between serum potassium and death or the occurrence of kidney failure requiring replacement therapy (KRT). We investigated this relationship in older people with chronic kidney disease (CKD) stage 4-5. STUDY DESIGN Prospective observational cohort study. SETTING & PARTICIPANTS We followed 1,714 patients (≥65 years old) from the European Quality (EQUAL) study for 8 years from their first estimated glomerular filtration rate (eGFR)<20mL/min/1.73m2 measurement. EXPOSURE Serum potassium was measured every 3 to 6 months and categorized as≤3.5,>3.5-≤4.0,>4.0-≤4.5,>4.5-≤5.0 (reference),>5.0-≤5.5, >5.5-≤6.0, and>6.0mmol/L. OUTCOME The combined outcome death before KRT or start of KRT. ANALYTICAL APPROACH The association between categorical and continuous time-varying potassium and death or KRT start was examined using Cox proportional hazards and restricted cubic spline analyses, adjusted for age, sex, diabetes, cardiovascular disease, renin-angiotensin-aldosterone system (RAAS) inhibition, eGFR, and subjective global assessment (SGA). RESULTS At baseline, 66% of participants were men, 42% had diabetes, 47% cardiovascular disease, and 54% used RAAS inhibitors. Their mean age was 76±7 (SD) years, mean eGFR was 17±5 (SD) mL/min/1.73m2, and mean SGA was 6.0±1.0 (SD). Over 8 years, 414 (24%) died before starting KRT, and 595 (35%) started KRT. Adjusted hazard ratios for death or KRT according to the potassium categories were 1.6 (95% CI, 1.1-2.3), 1.4 (95% CI, 1.1-1.7), 1.1 (95% CI, 1.0-1.4), 1 (reference), 1.1 (95% CI, 0.9-1.4), 1.8 (95% CI, 1.4-2.3), and 2.2 (95% CI, 1.5-3.3). Hazard ratios were lowest at a potassium of about 4.9mmol/L. LIMITATIONS Shorter intervals between potassium measurements would have allowed for more precise estimations. CONCLUSIONS We observed a U-shaped relationship between serum potassium and death or KRT start among patients with incident CKD 4-5, with a nadir risk at a potassium level of 4.9mmol/L. These findings underscore the potential importance of preventing both high and low potassium in patients with CKD 4-5. PLAIN-LANGUAGE SUMMARY Abnormal potassium blood levels may increase the risk of death or kidney function decline, especially in older people with chronic kidney disease (CKD). We studied 1,714 patients aged≥65 years with advanced CKD from the European Quality (EQUAL) study and followed them for 8 years. We found that both low and high levels of potassium were associated with an increased risk of death or start of kidney replacement therapy, with the lowest risk observed at a potassium level of 4.9 mmol/L. In patients with CKD, the focus is often on preventing high blood potassium. However, this relatively high optimum potassium level stresses the potential importance of also preventing low potassium levels in older patients with advanced CKD.
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Affiliation(s)
- Esther N M de Rooij
- Department of Nephrology, Leiden University Medical Center, Leiden; Department of Clinical Epidemiology, Leiden University Medical Center, Leiden.
| | | | - Saskia Le Cessie
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden
| | - Ewout J Hoorn
- Department of Internal Medicine, Division of Nephrology and Transplantation, Erasmus Medical Center, Rotterdam
| | - Kitty J Jager
- European Renal Association (ERA) Registry, Amsterdam UMC, University of Amsterdam, Medical Informatics, Amsterdam; Amsterdam Public Health Research Institute, Quality of Care, Amsterdam
| | - Nicholas C Chesnaye
- European Renal Association (ERA) Registry, Amsterdam UMC, University of Amsterdam, Medical Informatics, Amsterdam; Amsterdam Public Health Research Institute, Quality of Care, Amsterdam
| | - Marie Evans
- Renal Unit, Department of Clinical Intervention and Technology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Karin Windahl
- Renal Unit, Department of Clinical Intervention and Technology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Fergus J Caskey
- Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Claudia Torino
- National Research Council, Institute of Clinical Physiology, Reggio Calabria, Italy
| | - Maciej Szymczak
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland
| | | | - Christoph Wanner
- Division of Nephrology, University Hospital of Würzburg, Würzburg, Germany
| | - Friedo W Dekker
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden
| | - Ellen K Hoogeveen
- Department of Nephrology, Leiden University Medical Center, Leiden; Department of Clinical Epidemiology, Leiden University Medical Center, Leiden; Department of Nephrology, Jeroen Bosch Hospital, Den Bosch, the Netherlands
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29
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Nangaku M, Kitching AR, Boor P, Fornoni A, Floege J, Coates PT, Himmelfarb J, Lennon R, Anders HJ, Humphreys BD, Caskey FJ, Fogo AB. International Society of Nephrology first consensus guidance for preclinical animal studies in translational nephrology. Kidney Int 2023; 104:36-45. [PMID: 37001557 DOI: 10.1016/j.kint.2023.03.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [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: 03/02/2023] [Revised: 03/13/2023] [Accepted: 03/17/2023] [Indexed: 03/29/2023]
Abstract
Preclinical tests in animal models are key steps in early drug development. Consequently, the International Society of Nephrology held a consensus meeting that connected experts in the global kidney community in order to provide guidance on optimal management of translational animal studies for the development of new drugs to treat kidney disease, entitled "TRANSFORM; TRAnslational Nephrology Science FOR new Medications." The meeting covered various themes, including the following: (i) selection of disease model; (ii) pharmacokinetics; (iii) interventions in late preclinical models; (iv) choice of animal; (v) statistical power; (vi) organoids and organ-on-a-chip models; and (vii) reporting of results. This guidance is the first to be provided on the optimal conduct of translational animal studies for the development of new drugs to treat kidney disease. These recommendations are designed to accelerate development of new drugs for efficacious treatment of kidney diseases, and to improve the prognosis and quality of life of patients with a variety of kidney diseases.
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Affiliation(s)
- Masaomi Nangaku
- Division of Nephrology and Endocrinology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan.
| | - A Richard Kitching
- Centre for Inflammatory Diseases, Monash University Department of Medicine, Clayton, Victoria, Australia; Department of Nephrology, Monash Health, Clayton, Victoria, Australia; Department of Paediatric Nephrology, Monash Health, Clayton, Victoria, Australia
| | - Peter Boor
- Institute of Pathology, Rheinisch Westfälische Technische Hochschule (RWTH) Aachen University, Aachen, Germany
| | - Alessia Fornoni
- Katz Family Division of Nephrology and Hypertension, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA; Peggy and Harold Katz Family Drug Discovery Center, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Jürgen Floege
- Division of Nephrology and Rheumatology, Rheinisch Westfälische Technische Hochschule (RWTH) University Hospital, Aachen, Germany
| | - P Toby Coates
- Central and Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, South Australia, Australia; University of Adelaide, Medical Specialties, Adelaide, Australia; South Australian Medical Research Institute, Adelaide, South Australia, Australia
| | - Jonathan Himmelfarb
- Kidney Research Institute, Division of Nephrology, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Rachel Lennon
- Wellcome Centre for Cell-Matrix Research, Division of Cell-Matrix Biology and Regenerative Medicine, School of Biological Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Department of Paediatric Nephrology, Royal Manchester Children's Hospital, Manchester University Hospitals National Health Service (NHS) Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Hans-Joachim Anders
- Department of Medicine IV, Hospital of Ludwig Maximilian University of Munich, Munich, Germany
| | - Benjamin D Humphreys
- Division of Nephrology, Department of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Fergus J Caskey
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Agnes B Fogo
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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30
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Al-Talib M, Caskey FJ, Inward C, Ben-Shlomo Y, Hamilton AJ. Psychological Health in Young Adults With Kidney Failure: A 5-Year Follow-up of the SPEAK Study. Kidney Med 2023; 5:100637. [PMID: 37304737 PMCID: PMC10248860 DOI: 10.1016/j.xkme.2023.100637] [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: 06/13/2023] Open
Affiliation(s)
- Mohammed Al-Talib
- Department of Population Health Sciences, University of Bristol, Bristol, United Kingdom
- Richard Bright Renal Unit, Southmead Hospital, North Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Fergus J. Caskey
- Department of Population Health Sciences, University of Bristol, Bristol, United Kingdom
- Richard Bright Renal Unit, Southmead Hospital, North Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Carol Inward
- Bristol Royal Hospital for Children, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
| | - Yoav Ben-Shlomo
- Department of Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Alexander J. Hamilton
- Department of Population Health Sciences, University of Bristol, Bristol, United Kingdom
- Exeter Kidney Unit, Royal Devon and Exeter Hospital, Exeter, United Kingdom
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31
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Levin A, Okpechi IG, Caskey FJ, Yang CW, Tonelli M, Jha V. Perspectives on early detection of chronic kidney disease: the facts, the questions, and a proposed framework for 2023 and beyond. Kidney Int 2023; 103:1004-1008. [PMID: 37125982 DOI: 10.1016/j.kint.2023.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 02/23/2023] [Accepted: 03/09/2023] [Indexed: 05/02/2023]
Affiliation(s)
- Adeera Levin
- Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ikechi G Okpechi
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa; Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa
| | - Fergus J Caskey
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Chih-Wei Yang
- Kidney Research Center and Department of Nephrology, Chang Gung Memorial Hospital, Linkou, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Marcello Tonelli
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Vivekanand Jha
- George Institute for Global Health, University of New South Wales, New Delhi, India; School of Public Health, Imperial College, London, UK; Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India.
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32
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O'Lone E, Apple FS, Burton JO, Caskey FJ, Craig JC, de Filippi CR, Forfang D, Hicks KA, Jha V, Mahaffey KW, Mark PB, Rossignol P, Scholes-Robertson N, Jaure A, Viecelli AK, Wang AY, Wheeler DC, White D, Winkelmayer WC, Herzog CA. Defining Myocardial Infarction in trials of people receiving hemodialysis: consensus report from the SONG-HD MI Expert Working group. Kidney Int 2023; 103:1028-1037. [PMID: 37023851 DOI: 10.1016/j.kint.2023.02.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 10/04/2022] [Revised: 01/22/2023] [Accepted: 02/15/2023] [Indexed: 04/08/2023]
Abstract
Cardiovascular disease is the leading cause of death in patients receiving hemodialysis. Currently there is no standardized definition of myocardial infarction (MI) for patients receiving hemodialysis. Through an international consensus process MI was established as the core CVD measure for this population in clinical trials. The Standardised Outcomes in Nephrology Group - Hemodialysis (SONG-HD) initiative convened a multidisciplinary, international working group to address the definition of MI in this population.Based on current evidence, the working group recommends using the 4th Universal Definition of MI with specific caveats with regard to the interpretation of "ischemic symptoms" and performing a baseline 12-lead electrocardiogram to facilitate interpretation of acute changes on subsequent tracings. The working group does not recommend obtaining baseline cardiac troponin values, though does recommend obtaining serial cardiac biomarkers in settings where ischemia is suspected. Application of an evidence-based uniform definition should increase the reliability and accuracy of trial results.
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Affiliation(s)
- E O'Lone
- The University of Sydney, Camperdown, Sydney, Australia.
| | - F S Apple
- Departments of Laboratory Medicine and Pathology, Hennepin Healthcare/Hennepin County Medical Center and University of Minnesota, Minneapolis, Minnesota
| | - J O Burton
- Department of Cardiovascular Sciences, University of Leicester and NIHR Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital Leicester, Leicester, UK
| | - F J Caskey
- Population Health Sciences, University of Bristol, Southmead Hospital, Bristol, UK
| | - J C Craig
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - C R de Filippi
- Inova Heart and Vascular Institute, Falls Church, VA, USA
| | - D Forfang
- The National Forum of ESRD Networks, Kidney Patient Advisory Council (KPAC) WI USA
| | - K A Hicks
- Division of Cardiology and Nephrology, Office of Cardiology, Hematology, Endocrinology, and Nephrology, Center for Drug Evaluation and Research (CDER), United States Food and Drug Administration, Silver Spring, Maryland, USA
| | - V Jha
- George Institute of Global Health, UNSW, New Delhi, India; School of Public Health, Imperial College, London, UK; Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - K W Mahaffey
- The Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine, Stanford, CA
| | - P B Mark
- University of Glasgow, Institute of Cardiovascular and Medical Sciences, Glasgow, UK
| | - P Rossignol
- Université de Lorraine, Centre d'Investigation Clinique Plurithématique 1433 -INSERM- CHRU de Nancy, Inserm U1116 & FCRIN INI-CRCT (Cardiovascular and RenalClinical Trialists), Vandoeuvre-les-Nancy, France; Medical specialties and nephrology -hemodialysis departments, Princess Grace Hospital, and Monaco Private Hemodialysis Centre, Monaco, Monaco
| | - N Scholes-Robertson
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - A Jaure
- The University of Sydney, Camperdown, Sydney, Australia; Centre for Kidney Research, Children's Hospital at Westmead, Westmead, NSW, Australia
| | - A K Viecelli
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
| | - A Y Wang
- Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - D C Wheeler
- University College London, London, United Kingdom
| | - D White
- American Association of Kidney Patients, Tampa, Florida
| | - W C Winkelmayer
- Selzman Institute for Kidney Health, Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - C A Herzog
- Chronic Disease Research Group, Hennepin Healthcare Research Institute,Minneapolis, Minnesota; Division of Cardiology, Department of Medicine, Hennepin Healthcare and University of Minnesota, Minneapolis, Minnesota
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Doidge JC, Gould DW, Sadique Z, Borthwick M, Hatch RA, Caskey FJ, Forni L, Lawrence RF, MacEwan C, Ostermann M, Mouncey PR, Harrison DA, Rowan KM, Young JD, Watkinson PJ. Regional citrate anticoagulation versus systemic heparin anticoagulation for continuous kidney replacement therapy in intensive care. J Crit Care 2023; 74:154218. [PMID: 36494257 PMCID: PMC9977605 DOI: 10.1016/j.jcrc.2022.154218] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 11/10/2022] [Accepted: 11/14/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE Many intensive care units (ICUs) have transitioned from systemic heparin anticoagulation (SHA) to regional citrate anticoagulation (RCA) for continuous kidney replacement therapy (CKRT). We evaluated the clinical and health economic impacts of ICU transition to RCA. MATERIALS AND METHODS We surveyed all adult general ICUs in England and Wales to identify transition dates and conducted a micro-costing study in eight ICUs. We then conducted an interrupted time-series analysis of linked, routinely collected health records. RESULTS In 69,001 patients who received CKRT (8585 RCA, 60,416 SHA) in 181 ICUs between 2009 and 2017, transition to RCA was not associated with a change in 90-day mortality (adjusted odds ratio 0.98, 95% CI 0.89-1.08) but was associated with step-increases in duration of kidney support (0.53 days, 95% CI 0.28-0.79), advanced cardiovascular support (0.23 days, 95% CI 0.09-0.38) and ICU length of stay (0.86 days, 95% CI 0.24-1.49). The estimated one-year incremental net monetary benefit per patient was £ - 2376 (95% CI £ - 3841-£ - 911), with an estimated likelihood of cost-effectiveness of <0.1%. CONCLUSIONS Transition to RCA was associated with significant increases in healthcare resource use, without corresponding clinical benefit, and is highly unlikely to be cost-effective over a one-year time horizon.
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Affiliation(s)
- James C Doidge
- Intensive Care National Audit and Research Centre, 24 High Holborn, London WC1V 6AZ, United Kingdom.
| | - Doug W Gould
- Intensive Care National Audit and Research Centre, 24 High Holborn, London WC1V 6AZ, United Kingdom
| | - Zia Sadique
- Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Mark Borthwick
- Departments of Pharmacy and Critical Care, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, United Kingdom
| | - Robert A Hatch
- Kadoorie Centre for Critical Care Research, Nuffield Department of Clinical Neurosciences, University of Oxford, OX3 9DU, United Kingdom
| | - Fergus J Caskey
- Bristol Medical School, University of Bristol, 39 Whatley Road, Bristol BS8 2PS, United Kingdom; UK Renal Registry, Brandon House, Building 20a1, Southmead Road, Bristol BS34 7RR, United Kingdom
| | - Lui Forni
- Department of Clinical and Experimental Medicine, Faculty of Health Sciences, University of Surrey, Guildford GU2 7XH, United Kingdom; Intensive Care Unit, Royal Surrey County Hospital NHS Foundation Trust, Guildford GU2 7XX, United Kingdom
| | | | - Clare MacEwan
- Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford OX3 9DU, United Kingdom
| | - Marlies Ostermann
- King's College London, Guy's & St Thomas' Hospital, Department of Critical Care, Westminster Bridge Road, London SE1 7EH, United Kingdom
| | - Paul R Mouncey
- Intensive Care National Audit and Research Centre, 24 High Holborn, London WC1V 6AZ, United Kingdom
| | - David A Harrison
- Intensive Care National Audit and Research Centre, 24 High Holborn, London WC1V 6AZ, United Kingdom
| | - Kathryn M Rowan
- Intensive Care National Audit and Research Centre, 24 High Holborn, London WC1V 6AZ, United Kingdom
| | - J Duncan Young
- Kadoorie Centre for Critical Care Research and Education, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU, United Kingdom
| | - Peter J Watkinson
- Nuffield Department of Clinical Neurosciences, University of Oxford, Level 6, West Wing, John Radcliffe Hospital, Oxford OX3 9DU, United Kingdom; NIHR Biomedical Research Centre, Oxford, Oxford University Hospitals NHS Trust, Kadoorie Centre for Critical Care Research and Education, Headley Way, Oxford OX3 9DU, United Kingdom
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Taylor DM, Nimmo AM, Caskey FJ, Johnson R, Pippias M, Melendez-Torres G. Complex Interventions Across Primary and Secondary Care to Optimize Population Kidney Health: A Systematic Review and Realist Synthesis to Understand Contexts, Mechanisms, and Outcomes. Clin J Am Soc Nephrol 2023; 18:01277230-990000000-00097. [PMID: 36888919 PMCID: PMC10278806 DOI: 10.2215/cjn.0000000000000136] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 11/07/2022] [Accepted: 02/22/2023] [Indexed: 03/10/2023]
Abstract
BACKGROUND CKD affects 850 million people worldwide and is associated with high risk of kidney failure and death. Existing, evidence-based treatments are not implemented in at least a third of eligible patients, and there is socioeconomic inequity in access to care. While interventions aiming to improve delivery of evidence-based care exist, these are often complex, with intervention mechanisms acting and interacting in specific contexts to achieve desired outcomes. METHODS We undertook realist synthesis to develop a model of these context-mechanism-outcome interactions. We included references from two existing systematic reviews and from database searches. Six reviewers produced a long list of study context-mechanism-outcome configurations based on review of individual studies. During group sessions, these were synthesized to produce an integrated model of intervention mechanisms, how they act and interact to deliver desired outcomes, and in which contexts these mechanisms work. RESULTS Searches identified 3371 relevant studies, of which 60 were included, most from North America and Europe. Key intervention components included automated detection of higher-risk cases in primary care with management advice to general practitioners, educational support, and non-patient-facing nephrologist review. Where successful, these components promote clinician learning during the process of managing patients with CKD, promote clinician motivation to take steps toward evidence-based CKD management, and integrate dynamically with existing workflows. These mechanisms have the potential to result in improved population kidney disease outcomes and cardiovascular outcomes in supportive contexts (organizational buy-in, compatibility of interventions, geographical considerations). However, patient perspectives were unavailable and therefore did not contribute to our findings. CONCLUSIONS This systematic review and realist synthesis describes how complex interventions work to improve delivery of CKD care, providing a framework within which future interventions can be developed. Included studies provided insight into the functioning of these interventions, but patient perspectives were lacking in available literature.
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Affiliation(s)
- Dominic M. Taylor
- Renal Service, North Bristol NHS Trust, United Kingdom
- Population Health Sciences, Bristol Medical School, University of Bristol, United Kingdom
| | - Ailish M. Nimmo
- Renal Service, North Bristol NHS Trust, United Kingdom
- Population Health Sciences, Bristol Medical School, University of Bristol, United Kingdom
| | - Fergus J. Caskey
- Renal Service, North Bristol NHS Trust, United Kingdom
- Population Health Sciences, Bristol Medical School, University of Bristol, United Kingdom
| | - Rachel Johnson
- Population Health Sciences, Bristol Medical School, University of Bristol, United Kingdom
| | - Maria Pippias
- Renal Service, North Bristol NHS Trust, United Kingdom
- Population Health Sciences, Bristol Medical School, University of Bristol, United Kingdom
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Bailey PK, Caskey FJ, MacNeill S, Ashford R, Pryce L, Kayler L, Ben-Shlomo Y. Investigating strategies to improve AccesS to Kidney transplantation (the ASK trial): a protocol for a feasibility randomised controlled trial with parallel process evaluation. Pilot Feasibility Stud 2023; 9:13. [PMID: 36670510 PMCID: PMC9854094 DOI: 10.1186/s40814-023-01241-1] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 01/04/2023] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The UK's living-donor kidney transplant (LDKT) activity falls behind that of many other countries internationally, with less than 20% of those eligible receiving a LDKT each year. Certain individuals with kidney disease in the UK appear to be particularly disadvantaged in accessing a LDKT; the most socioeconomically deprived people with kidney disease are 60% less likely to receive a LDKT than the least deprived. Improving equity in living-donor kidney transplantation has been highlighted as an international research priority. METHODS This feasibility trial was designed to determine the feasibility of delivery and acceptability of a multicomponent intervention designed to improve access to living-donor kidney transplantation. The intervention comprises three main components: (i) a meeting between a home educator and the transplant candidate for a dedicated discussion about living-donor kidney transplantation, living kidney donation and potential donors; (ii) a standardized letter from a healthcare professional to a candidate's potential donors and (iii) a home-based education and family engagement session including two home educators, the transplant candidate and their family. The primary objectives are to establish the feasibility (i) of delivering the developed intervention in existing care pathways and (ii) of undertaking a randomised controlled trial of the intervention. A mixed-methods parallel process evaluation will investigate the acceptability, implementation and mechanisms of impact of the intervention. The trial is based at two UK hospitals: a transplanting hospital and a non-transplanting referral hospital. Individuals are eligible if they are ≥ 18 years old, are active on the kidney transplant waiting list or have been referred for transplant listing and do not have a potential living-donor undergoing surgical assessment. Randomisation will be undertaken with concealed allocation. Participants will be randomly allocated 1:1 to (i) the intervention or (ii) usual care, stratified by site to ensure a balance in terms of local differences. Minimisation will be used to ensure balance in sex, age group and socioeconomic strata, with probability weighting of 0.8 in order to reduce predictability. The primary outcomes are recruitment (% of those eligible and invited who consent to randomisation) and retention (% of participants completing follow-up). DISCUSSION Findings will inform the design of a future fully powered, randomised controlled trial to formally evaluate the effectiveness of the intervention at improving equitable access to living-donor kidney transplantation. TRIAL REGISTRATION ISRCTN Registry ISRCTN10989132 Applied 30/10/20.
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Affiliation(s)
- Pippa K. Bailey
- grid.5337.20000 0004 1936 7603Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, BS8 2PS UK ,grid.416201.00000 0004 0417 1173Southmead Hospital, North Bristol NHS Trust, Bristol, BS10 5NB UK
| | - Fergus J. Caskey
- grid.5337.20000 0004 1936 7603Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, BS8 2PS UK ,grid.416201.00000 0004 0417 1173Southmead Hospital, North Bristol NHS Trust, Bristol, BS10 5NB UK
| | - Stephanie MacNeill
- grid.5337.20000 0004 1936 7603Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, BS8 2PS UK
| | - Rachel Ashford
- grid.5337.20000 0004 1936 7603Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, BS8 2PS UK
| | - Lindsay Pryce
- grid.5337.20000 0004 1936 7603Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, BS8 2PS UK
| | - Liise Kayler
- grid.414557.60000 0000 9161 9095Erie County Medical Center, Buffalo, NY 14215 USA
| | - Yoav Ben-Shlomo
- grid.5337.20000 0004 1936 7603Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, BS8 2PS UK
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Neuen BL, Bello AK, Levin A, Lunney M, Osman MA, Ye F, Ashuntantang GE, Bellorin-Font E, Gharbi MB, Davison S, Ghnaimat M, Harden P, Jha V, Kalantar-Zadeh K, Kerr PG, Klarenbach S, Kovesdy CP, Luyckx V, Ossareh S, Perl J, Rashid HU, Rondeau E, See EJ, Saad S, Sola L, Tchokhonelidze I, Tesar V, Tungsanga K, Kazancioglu RT, Wang AYM, Yang CW, Zemchenkov A, Zhao MH, Jager KJ, Caskey FJ, Perkovic V, Jindal KK, Okpechi IG, Tonelli M, Feehally J, Harris DC, Johnson DW. National health policies and strategies for addressing chronic kidney disease: Data from the International Society of Nephrology Global Kidney Health Atlas. PLOS Glob Public Health 2023; 3:e0001467. [PMID: 36963092 PMCID: PMC10021302 DOI: 10.1371/journal.pgph.0001467] [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] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 12/14/2022] [Indexed: 02/04/2023]
Abstract
National strategies for addressing chronic kidney disease (CKD) are crucial to improving kidney health. We sought to describe country-level variations in non-communicable disease (NCD) strategies and CKD-specific policies across different regions and income levels worldwide. The International Society of Nephrology Global Kidney Health Atlas (GKHA) was a multinational cross-sectional survey conducted between July and October 2018. Responses from key opinion leaders in each country regarding national NCD strategies, the presence and scope of CKD-specific policies, and government recognition of CKD as a health priority were described overall and according to region and income level. 160 countries participated in the GKHA survey, comprising 97.8% of the world's population. Seventy-four (47%) countries had an established national NCD strategy, and 53 (34%) countries reported the existence of CKD-specific policies, with substantial variation across regions and income levels. Where CKD-specific policies existed, non-dialysis CKD care was variably addressed. 79 (51%) countries identified government recognition of CKD as a health priority. Low- and low-middle income countries were less likely to have strategies and policies for addressing CKD and have governments which recognise it as a health priority. The existence of CKD-specific policies, and a national NCD strategy more broadly, varied substantially across different regions around the world but was overall suboptimal, with major discrepancies between the burden of CKD in many countries and governmental recognition of CKD as a health priority. Greater recognition of CKD within national health policy is critical to improving kidney healthcare globally.
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Affiliation(s)
- Brendon L Neuen
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- Department of Renal Medicine, Royal North Shore Hospital, Sydney, Australia
| | - Aminu K Bello
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Adeera Levin
- Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Meaghan Lunney
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
| | - Mohamed A Osman
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Feng Ye
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Gloria E Ashuntantang
- Faculty of Medicine and Biomedical Sciences, Yaounde General Hospital, University of Yaounde, Yaounde, Cameroon
| | - Ezequiel Bellorin-Font
- Division of Nephology and Hypertension, Department of Medicine, Saint Louis University, Saint Louis, Missouri, United States of America
| | - Mohammed Benghanem Gharbi
- Urinary Tract Diseases Department, Faculty of Medicine and Pharmacy of Casablanca, University Hassan II of Casablanca, Casablanca, Morocco
| | - Sara Davison
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Mohammad Ghnaimat
- Nephrology Division, Department of Internal Medicine, The Specialty Hospital, Amman, Jordan
| | - Paul Harden
- Oxford Kidney Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Vivekanand Jha
- George Institute for Global Health India, New Delhi, India
- School of Public Health, Imperial College, London, United Kingdom
- Manipal Academy of Higher Education, Manipal, India
| | - Kamyar Kalantar-Zadeh
- Division of Nephrology and Hypertension, University of California Irvine Medical Center, Orange, California, United States of America
| | - Peter G Kerr
- Department of Medicine, Monash University, Melbourne, Australia
| | - Scott Klarenbach
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Csaba P Kovesdy
- University of Tennessee Health Science Center, Memphis, Tennessee, United States of America
| | - Valerie Luyckx
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
- Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Shahrzad Ossareh
- Division of Nephrology, Department of Medicine, Hasheminejad Kidney Center, Iran University of Medical Sciences, Tehran, Iran
| | - Jeffrey Perl
- Division of Nephrology, St. Michael's Hospital and the Keenan Research Centre in the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
- Division of Nephrology, Department of Medicine, University of Toronto, Toronto, Canada
| | - Harun Ur Rashid
- Department of Nephrology, Kidney Foundation Hospital and Research Institute, Dhaka, Bangladesh
| | - Eric Rondeau
- Intensive Care Nephrology and Transplantation Department, Hopital Tenon, Assistance Publique-Hopitaux de Paris, Paris, France
- Sorbonne Université, Paris, France
| | - Emily J See
- Department of Intensive Care, Austin Health, Melbourne, Australia
- School of Medicine, University of Melbourne, Melbourne, Australia
| | - Syed Saad
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Laura Sola
- Dialysis Unit, CASMU-IAMPP, Montevideo, Uruguay
| | - Irma Tchokhonelidze
- Nephrology Development Clinical Center, Tbilisi State Medical University, Tbilisi, Georgia
| | - Vladimir Tesar
- Department of Nephrology, General University Hospital, Charles University, Prague, Czech Republic
| | - Kriang Tungsanga
- Department of Medicine, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand
| | | | - Angela Yee-Moon Wang
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Chih-Wei Yang
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Alexander Zemchenkov
- Department of Internal Disease and Nephrology, North-Western State Medical University named after I.I. Mechnikov, Saint Petersburg, Russia
- Department of Nephrology and Dialysis, Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russia
| | - Ming-Hui Zhao
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China
- Key Lab of Renal Disease, Ministry of Health of China, Beijing, China
- Key Lab of Chronic Kidney Disease Prevention and Treatment, Ministry of Education of China; Beijing, China
- Peking-Tsinghua Center for Life Sciences, Beijing, China
| | - Kitty J Jager
- ERA Registry, Department of Medical Informatics, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Fergus J Caskey
- Population Health Sciences, University of Bristol, Bristol, United Kingdom
- The Richard Bright Renal Unit, Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom
| | - Vlado Perkovic
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Kailash K Jindal
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Ikechi G Okpechi
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Canada
- Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa
- Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa
| | - Marcello Tonelli
- Department of Medicine, University of Calgary, Calgary, Canada
- Pan-American Health Organization/World Health Organization's Collaborating Centre in Prevention and Control of Chronic Kidney Disease, University of Calgary, Calgary, Canada
| | | | - David C Harris
- Centre for Transplantation and Renal Research, Westmead Institute for Medical Research, University of Sydney, Sydney, Australia
| | - David W Johnson
- Centre for Kidney Disease Research, University of Queensland, Brisbane, Australia
- Translational Research Institute, Brisbane, Australia
- Metro South and Ipswich Nephrology and Transplant Services (MINTS), Princess Alexandra Hospital, Brisbane, Australia
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Wijewickrama ES, Abdul Hafidz MI, Robinson BM, Johnson DW, Liew A, Dreyer G, Caskey FJ, Bello AK, Zaidi D, Damster S, Salaro S, Luyckx VA, Bajpai D. Availability and prioritisation of COVID-19 vaccines among patients with advanced chronic kidney disease and kidney failure during the height of the pandemic: a global survey by the International Society of Nephrology. BMJ Open 2022; 12:e065112. [PMID: 36585149 PMCID: PMC9808761 DOI: 10.1136/bmjopen-2022-065112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE Patients with advanced chronic kidney disease (CKD) or kidney failure receiving replacement therapy (KFRT) are highly vulnerable to COVID-19 infection, morbidity and mortality. Vaccination is effective, but access differs around the world. We aimed to ascertain the availability, readiness and prioritisation of COVID-19 vaccines for this group of patients globally. SETTING AND PARTICIPANTS Collaborators from the International Society of Nephrology (ISN), Dialysis Outcomes and Practice Patterns Study and ISN-Global Kidney Health Atlas developed an online survey that was administered electronically to key nephrology leaders in 174 countries between 2 July and 4 August 2021. RESULTS Survey responses were received from 99 of 174 countries from all 10 ISN regions, among which 88/174 (50%) were complete. At least one vaccine was available in 96/99 (97%) countries. In 71% of the countries surveyed, patients on dialysis were prioritised for vaccination, followed by patients living with a kidney transplant (KT) (62%) and stage 4/5 CKD (51%). Healthcare workers were the most common high priority group for vaccination. At least 50% of patients receiving in-centre haemodialysis, peritoneal dialysis or KT were estimated to have completed vaccination at the time of the survey in 55%, 64% and 51% of countries, respectively. At least 50% of patients in all three patient groups had been vaccinated in >70% of high-income countries and in 100% of respondent countries in Western Europe.The most common barriers to vaccination of patients were vaccine hesitancy (74%), vaccine shortages (61%) and mass vaccine distribution challenges (48%). These were reported more in low-income and lower middle-income countries compared with high-income countries. CONCLUSION Patients with advanced CKD or KFRT were prioritised in COVID-19 vaccination in most countries. Multiple barriers led to substantial variability in the successful achievement of COVID-19 vaccination across the world, with high-income countries achieving the most access and success.
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Affiliation(s)
| | | | | | - David W Johnson
- Department of Kidney and Transplant Services, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | | | - Gavin Dreyer
- Renal Medicine, Barts Health NHS Trust, London, UK
| | - Fergus J Caskey
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Aminu K Bello
- Nephrology, University of Alberta, Edmonton, Alberta, Canada
| | - Deenaz Zaidi
- Medicine, University of Alberta, Edmonton, Alberta, Canada
| | | | - Silvia Salaro
- International Society of Nephrology, Brussels, Belgium
| | - Valerie Ann Luyckx
- Nephrology, University Children's Hospital, Zurich, Switzerland
- Department of Paediatrics and Child Heath, University of Cape Town, Cape Town, South Africa
- Renal Division, Brigham and Women's Hospital, Harvard medical School, Boston, MA, USA
| | - Divya Bajpai
- Nephrology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
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de Rooij ENM, Meuleman Y, de Fijter JW, Jager KJ, Chesnaye NC, Evans M, Caskey FJ, Torino C, Porto G, Szymczak M, Drechsler C, Wanner C, Dekker FW, Hoogeveen EK. Symptom Burden before and after Dialysis Initiation in Older Patients. Clin J Am Soc Nephrol 2022; 17:1719-1729. [PMID: 36357126 PMCID: PMC9718015 DOI: 10.2215/cjn.09190822] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [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: 08/05/2022] [Accepted: 10/14/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND AND OBJECTIVES For older patients with kidney failure, lowering symptom burden may be more important than prolonging life. Dialysis initiation may affect individual kidney failure-related symptoms differently, but the change in symptoms before and after start of dialysis has not been studied. Therefore, we investigated the course of total and individual symptom number and burden before and after starting dialysis in older patients. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS The European Quality (EQUAL) study is an ongoing, prospective, multicenter study in patients ≥65 years with an incident eGFR ≤20 ml/min per 1.73 m2. Using the dialysis symptom index (DSI), 30 symptoms were assessed every 3-6 months between 2012 and 2021. Scores for symptom number range from zero to 30 and, for burden, from zero to 150, with higher scores indicating more severity. Using mixed effects models, we studied symptoms during the year preceding and the year after dialysis initiation. RESULTS We included 456 incident patients on dialysis who filled out at least one DSI during the year before or after dialysis. At dialysis initiation, mean (SD) participant age was 76 (6) years, 75% were men, mean (SD) eGFR was 8 (3) ml/min per 1.73 m2, 44% had diabetes, and 46% had cardiovascular disease. In the year before dialysis initiation, symptom number increased +3.6 (95% confidence interval [95% CI], +2.5 to +4.6) and symptom burden increased +13.3 (95% CI, +9.5 to +17.0). In the year after, symptom number changed -0.9 (95% CI, -3.4 to +1.5) and burden decreased -5.9 (95% CI, -14.9 to -3.0). At dialysis initiation, "fatigue," "decreased interest in sex," and "difficulty becoming sexually aroused" had the highest prevalence of 81%, 69%, and 68%, respectively, with a burden of 2.7, 2.4, and 2.3, respectively. "Fatigue" somewhat improved after dialysis initiation, whereas the prevalence and burden of sexual symptoms further increased. CONCLUSIONS Symptom burden worsened considerably before and stabilized after dialysis initiation. "Fatigue," "decreased interest in sex," and "difficulty becoming sexually aroused" were considered most burdensome, of which only "fatigue" somewhat improved after dialysis initiation.
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Affiliation(s)
- Esther N M de Rooij
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands
| | - Yvette Meuleman
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Johan W de Fijter
- Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands
| | - Kitty J Jager
- European Renal Association Registry, Department of Medical Informatics, Academic Medical Center, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, The Netherlands
| | - Nicholas C Chesnaye
- European Renal Association Registry, Department of Medical Informatics, Academic Medical Center, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, The Netherlands
| | - Marie Evans
- Renal Unit, Department of Clinical Intervention and Technology, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
| | - Fergus J Caskey
- Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Claudia Torino
- National Research Council - Institute of Clinical Physiology, Reggio Calabria, Italy
| | - Gaetana Porto
- Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli, Reggio Calabria, Italy
| | - Maciej Szymczak
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland
| | | | - Christoph Wanner
- Division of Nephrology, University Hospital of Würzburg, Würzburg, Germany
| | - Friedo W Dekker
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
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Dai L, Massy ZA, Stenvinkel P, Chesnaye NC, Larabi IA, Alvarez JC, Caskey FJ, Torino C, Porto G, Szymczak M, Krajewska M, Drechsler C, Wanner C, Jager KJ, Dekker FW, Evenepoel P, Evans M, Torp A, Iwig B, Perras B, Marx C, Drechsler C, Blaser C, Wanner C, Emde C, Krieter D, Fuchs D, Irmler E, Platen E, Schmidt-Gürtler H, Schlee H, Naujoks H, Schlee I, Cäsar S, Beige J, Röthele J, Mazur J, Hahn K, Blouin K, Neumeier K, Anding-Rost K, Schramm L, Hopf M, Wuttke N, Frischmuth N, Ichtiaris P, Kirste P, Schulz P, Aign S, Biribauer S, Manan S, Röser S, Heidenreich S, Palm S, Schwedler S, Delrieux S, Renker S, Schättel S, Stephan T, Schmiedeke T, Weinreich T, Leimbach T, Stövesand T, Bahner U, Seeger W, Cupisti A, Sagliocca A, Ferraro A, Mele A, Naticchia A, Còsaro A, Ranghino A, Stucchi A, Pignataro A, De Blasio A, Pani A, Tsalouichos A, Antonio B, Iorio BRD, Alessandra B, Abaterusso C, Somma C, D'alessandro C, Torino C, Zullo C, Pozzi C, Bergamo D, Ciurlino D, Motta D, Russo D, Favaro E, Vigotti F, Ansali F, Conte F, Cianciotta F, Giacchino F, Cappellaio F, Pizzarelli F, Greco G, Porto G, Bigatti G, Marinangeli G, Cabiddu G, Fumagalli G, Caloro G, Piccoli G, Capasso G, Gambaro G, Tognarelli G, Bonforte G, Conte G, Toscano G, Del Rosso G, Capizzi I, Baragetti I, Oldrizzi L, Gesualdo L, Biancone L, Magnano M, Ricardi M, Bari MD, Laudato M, Sirico ML, Ferraresi M, Provenzano M, Malaguti M, Palmieri N, Murrone P, Cirillo P, Dattolo P, Acampora P, Nigro R, Boero R, Scarpioni R, Sicoli R, Malandra R, Savoldi S, Bertoli S, Borrelli S, Maxia S, Maffei S, Mangano S, Cicchetti T, Rappa T, Palazzo V, De Simone W, Schrander A, van Dam B, Siegert C, Gaillard C, Beerenhout C, Verburgh C, Janmaat C, Hoogeveen E, Hoorn E, Dekker F, Boots J, Boom H, Eijgenraam JW, Kooman J, Rotmans J, Jager K, Vogt L, Raasveld M, Vervloet M, van Buren M, van Diepen M, Chesnaye N, Leurs P, Voskamp P, van Esch S, Boorsma S, Berger S, Konings C, Aydin Z, Musiała A, Szymczak A, Olczyk E, Augustyniak-Bartosik H, Miśkowiec-Wiśniewska I, Manitius J, Pondel J, Jędrzejak K, Nowańska K, Nowak Ł, Szymczak M, Durlik M, Dorota S, Nieszporek T, Heleniak Z, Jonsson A, Rogland B, Wallquist C, Vargas D, Dimény E, Sundelin F, Uhlin F, Welander G, Hernandez IB, Gröntoft KC, Stendahl M, Svensson ME, Evans M, Heimburger O, Kashioulis P, Melander S, Almquist T, Woodman A, McKeever A, Ullah A, McLaren B, Harron C, Barrett C, O'Toole C, Summersgill C, Geddes C, Glowski D, McGlynn D, Sands D, Caskey F, Roy G, Hirst G, King H, McNally H, Masri-Senghor H, Murtagh H, Rayner H, Turner J, Wilcox J, Berdeprado J, Wong J, Banda J, Jones K, Haydock L, Wilkinson L, Carmody M, Weetman M, Joinson M, Dutton M, Matthews M, Morgan N, Bleakley N, Cockwell P, Roderick P, Mason P, Kalra P, Sajith R, Chapman S, Navjee S, Crosbie S, Brown S, Tickle S, Mathavakkannan S, Kuan Y. The association between TMAO, CMPF, and clinical outcomes in advanced chronic kidney disease: results from the European QUALity (EQUAL) Study. Am J Clin Nutr 2022; 116:1842-1851. [PMID: 36166845 PMCID: PMC9761748 DOI: 10.1093/ajcn/nqac278] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 08/18/2022] [Accepted: 09/24/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Trimethylamine N-oxide (TMAO), a metabolite from red meat and fish consumption, plays a role in promoting cardiovascular events. However, data regarding TMAO and its impact on clinical outcomes are inconclusive, possibly due to its undetermined dietary source. OBJECTIVES We hypothesized that circulating TMAO derived from fish intake might cause less harm compared with red meat sources by examining the concomitant level of 3-carboxy-4-methyl-5-propyl-2-furanpropionate (CMPF), a known biomarker of fish intake, and investigated the association between TMAO, CMPF, and outcomes. METHODS Patients were recruited from the European QUALity (EQUAL) Study on treatment in advanced chronic kidney disease among individuals aged ≥65 y whose estimated glomerular filtration rate (eGFR) had dropped for the first time to ≤20 mL/min per 1.73 m2 during the last 6 mo. The association between TMAO, CMPF, and outcomes including all-cause mortality and kidney replacement therapy (KRT) was assessed among 737 patients. Patients were further stratified by median cutoffs of TMAO and CMPF, suggesting high/low red meat and fish intake. RESULTS During a median of 39 mo of follow-up, 232 patients died. Higher TMAO was independently associated with an increased risk of all-cause mortality (multivariable HR: 1.46; 95% CI: 1.17, 1.83). Higher CMPF was associated with a reduced risk of both all-cause mortality (HR: 0.79; 95% CI: 0.71, 0.89) and KRT (HR: 0.80; 95% CI: 0.71, 0.90), independently of TMAO and other clinically relevant confounders. In comparison to patients with low TMAO and CMPF, patients with low TMAO and high CMPF had reduced risk of all-cause mortality (adjusted HR: 0.49; 95% CI: 0.31, 0.73), whereas those with high TMAO and high CMPF showed no association across adjusted models. CONCLUSIONS High CMPF conferred an independent role in health benefits and might even counteract the unfavorable association between TMAO and outcomes. Whether higher circulating CMPF concentrations are due to fish consumption, and/or if CMPF is a protective factor, remains to be verified.
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Affiliation(s)
- Lu Dai
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden,Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Ziad A Massy
- Division of Nephrology, Ambroise Paré University Hospital, Boulogne-Billancourt, France,Centre for Research in Epidemiology and Population Health (CESP), Inserm UMRS 1018, Team 5, University Versailles-Saint Quentin, University Paris-Saclay, Paris, France
| | - Peter Stenvinkel
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Nicholas C Chesnaye
- ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Islam Amine Larabi
- Laboratory of Pharmacology and Toxicology, CHU, Raymond Poincare, Garches, France,INSERM U1173, UFR des Sciences de la Santé Simone Veil, Montigny le Bretonneux, Université de Versailles-Saint-Quentin-en-Yvelines, Versailles, France
| | - Jean Claude Alvarez
- Laboratory of Pharmacology and Toxicology, CHU, Raymond Poincare, Garches, France,INSERM U1173, UFR des Sciences de la Santé Simone Veil, Montigny le Bretonneux, Université de Versailles-Saint-Quentin-en-Yvelines, Versailles, France
| | - Fergus J Caskey
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Claudia Torino
- IFC-CNR, Clinical Epidemiology and Pathophysiology of Renal Diseases and Hypertension, Reggio Calabria, Italy
| | - Gaetana Porto
- G.O.M., Bianchi Melacrino Morelli, Reggio Calabria, Italy
| | - Maciej Szymczak
- Clinical Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Magdalena Krajewska
- Clinical Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland
| | | | - Christoph Wanner
- Division of Nephrology, University Hospital of Würzburg, Würzburg, Germany
| | - Kitty J Jager
- ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Friedo W Dekker
- ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Pieter Evenepoel
- Department of Microbiology, Immunology, and Transplantation, Nephrology and Renal Transplantation Research Group, KU Leuven, Leuven, Belgium,Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium
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Ramspek CL, Boekee R, Evans M, Heimburger O, Snead CM, Caskey FJ, Torino C, Porto G, Szymczak M, Krajewska M, Drechsler C, Wanner C, Chesnaye NC, Jager KJ, Dekker FW, Snoeijs MG, Rotmans JI, van Diepen M. Predicting Kidney Failure, Cardiovascular Disease and Death in Advanced CKD Patients. Kidney Int Rep 2022; 7:2230-2241. [PMID: 36217520 PMCID: PMC9546766 DOI: 10.1016/j.ekir.2022.07.165] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 07/18/2022] [Indexed: 11/28/2022] Open
Affiliation(s)
- Chava L. Ramspek
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
- Correspondence: Chava L. Ramspek, Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands.
| | - Rosemarijn Boekee
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Marie Evans
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
| | - Olof Heimburger
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
| | - Charlotte M. Snead
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Fergus J. Caskey
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Claudia Torino
- Department of Clinical Epidemiology of Renal Diseases and Hypertension, Consiglio Nazionale della Ricerche-Istituto di Fisiologia Clinica, Reggio Calabria, Italy
| | - Gaetana Porto
- Grande Ospedale Metropolitano, Bianchi Melacrino Morelli, Reggio Calabria, Italy
| | - Maciej Szymczak
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Magdalena Krajewska
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Christiane Drechsler
- Division of Nephrology, Department of Internal Medicine, University Hospital Wurzburg, Wurzburg, Germany
| | - Christoph Wanner
- Division of Nephrology, University Hospital of Wurzburg, Wurzburg, Germany
| | - Nicholas C. Chesnaye
- Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Kitty J. Jager
- Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Friedo W. Dekker
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Maarten G.J. Snoeijs
- Department of Vascular Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Joris I. Rotmans
- Department of Internal Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - Merel van Diepen
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
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de Rooij EN, Meuleman Y, de Fijter JW, Le Cessie S, Jager KJ, Chesnaye NC, Evans M, Pagels AA, Caskey FJ, Torino C, Porto G, Szymczak M, Drechsler C, Wanner C, Dekker FW, Hoogeveen EK. Quality of Life before and after the Start of Dialysis in Older Patients. Clin J Am Soc Nephrol 2022; 17:1159-1167. [PMID: 35902127 PMCID: PMC9435986 DOI: 10.2215/cjn.16371221] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 12/18/2021] [Accepted: 06/01/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND AND OBJECTIVES In older people with kidney failure, improving health-related quality of life is often more important than solely prolonging life. However, little is known about the effect of dialysis initiation on health-related quality of life in older patients. Therefore, we investigated the evolution of health-related quality of life before and after starting dialysis in older patients with kidney failure. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS The European Quality study is an ongoing prospective, multicenter study in patients aged ≥65 years with an incident eGFR ≤20 ml/min per 1.73 m2. Between April 2012 and December 2021, health-related quality of life was assessed every 3-6 months using the 36-item Short-Form Health Survey (SF-36), providing a mental component summary (MCS) and a physical component summary (PCS). Scores range from zero to 100, with higher scores indicating better health-related quality of life. With linear mixed models, we explored the course of health-related quality of life during the year preceding and following dialysis initiation. RESULTS In total, 457 patients starting dialysis were included who filled out at least one SF-36 during follow-up. At dialysis initiation, mean ± SD age was 76±6 years, eGFR was 8±3 ml/min per 1.73 m2, 75% were men, 9% smoked, 45% had diabetes, and 46% had cardiovascular disease. Median (interquartile range) MCS was 53 (38-73), and median PCS was 39 (27-58). During the year preceding dialysis, estimated mean change in MCS was -13 (95% confidence interval, -17 to -9), and in PCS, it was -11 (95% confidence interval, -15 to -7). In the year following dialysis, estimated mean change in MCS was +2 (95% confidence interval, -7 to +11), and in PCS, it was -2 (95% confidence interval, -11 to +7). Health-related quality-of-life patterns were similar for most mental (mental health, role emotional, social functioning, vitality) and physical domains (physical functioning, bodily pain, role physical). CONCLUSIONS Patients experienced a clinically relevant decline of both mental and physical health-related quality of life before dialysis initiation, which stabilized thereafter. These results may help inform older patients with kidney failure who decided to start dialysis.
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Affiliation(s)
- Esther N.M. de Rooij
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands,Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands
| | - Yvette Meuleman
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Johan W. de Fijter
- Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands
| | - Saskia Le Cessie
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands,Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Kitty J. Jager
- European Renal Association Registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Nicholas C. Chesnaye
- European Renal Association Registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Marie Evans
- Renal Unit, Department of Clinical Intervention and Technology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Agneta A. Pagels
- Department of Medicine, Karolinska Institute, Stockholm, Sweden,Department of Nephrology, Karolinska University Hospital, Stockholm, Sweden
| | - Fergus J. Caskey
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Claudia Torino
- Institute of Clinical Physiology-National Research Council, Clinical Epidemiology and Pathophysiology of Renal Diseases and Hypertension, Reggio Calabria, Italy
| | - Gaetana Porto
- Grande Ospedale Metropolitano Bianchi Melacrino Morelli, Reggio Calabria, Italy
| | - Maciej Szymczak
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland
| | | | - Christoph Wanner
- Division of Nephrology, University Hospital of Wurzburg, Wurzburg, Germany
| | - Friedo W. Dekker
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Ellen K. Hoogeveen
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands,Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands,Department of Nephrology, Jeroen Bosch Hospital, Den Bosch, The Netherlands
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Caskey FJ, Procter S, MacNeill SJ, Wade J, Taylor J, Rooshenas L, Liu Y, Annaw A, Alloway K, Davenport A, Power A, Farrington K, Mitra S, Wheeler DC, Law K, Lewis-White H, Ben-Shlomo Y, Hollingworth W, Donovan J, Lane JA. The high-volume haemodiafiltration vs high-flux haemodialysis registry trial (H4RT): a multi-centre, unblinded, randomised, parallel-group, superiority study to compare the effectiveness and cost-effectiveness of high-volume haemodiafiltration and high-flux haemodialysis in people with kidney failure on maintenance dialysis using linkage to routine healthcare databases for outcomes. Trials 2022; 23:532. [PMID: 35761367 PMCID: PMC9235280 DOI: 10.1186/s13063-022-06357-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 04/25/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND More than a third of the 65,000 people living with kidney failure in the UK attend a dialysis unit 2-5 times a week to have their blood cleaned for 3-5 h. In haemodialysis (HD), toxins are removed by diffusion, which can be enhanced using a high-flux dialyser. This can be augmented with convection, as occurs in haemodiafiltration (HDF), and improved outcomes have been reported in people who are able to achieve high volumes of convection. This study compares the clinical- and cost-effectiveness of high-volume HDF compared with high-flux HD in the treatment of kidney failure. METHODS This is a UK-based, multi-centre, non-blinded randomised controlled trial. Adult patients already receiving HD or HDF will be randomised 1:1 to high-volume HDF (aiming for 21+ L of substitution fluid adjusted for body surface area) or high-flux HD. Exclusion criteria include lack of capacity to consent, life expectancy less than 3 months, on HD/HDF for less than 4 weeks, planned living kidney donor transplant or home dialysis scheduled within 3 months, prior intolerance of HDF and not suitable for high-volume HDF for other clinical reasons. The primary outcome is a composite of non-cancer mortality or hospital admission with a cardiovascular event or infection during follow-up (minimum 32 months, maximum 91 months) determined from routine data. Secondary outcomes include all-cause mortality, cardiovascular- and infection-related morbidity and mortality, health-related quality of life, cost-effectiveness and environmental impact. Baseline data will be collected by research personnel on-site. Follow-up data will be collected by linkage to routine healthcare databases - Hospital Episode Statistics, Civil Registration, Public Health England and the UK Renal Registry (UKRR) in England, and equivalent databases in Scotland and Wales, as necessary - and centrally administered patient-completed questionnaires. In addition, research personnel on-site will monitor for adverse events and collect data on adherence to the protocol (monthly during recruitment and quarterly during follow-up). DISCUSSION This study will provide evidence of the effectiveness and cost-effectiveness of HD as compared to HDF for adults with kidney failure in-centre HD or HDF. It will inform management for this patient group in the UK and internationally. TRIAL REGISTRATION ISRCTN10997319 . Registered on 10 October 2017.
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Affiliation(s)
- Fergus J Caskey
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
- Renal unit, Southmead Hospital, North Bristol NHS Trust, Bristol, BS10 5NB, UK.
| | - Sunita Procter
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
- Bristol Trials Centre, 1-5 Whiteladies Road, Bristol Medical School, University of Bristol, Bristol, BS8 1NU, UK
| | - Stephanie J MacNeill
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
- Bristol Trials Centre, 1-5 Whiteladies Road, Bristol Medical School, University of Bristol, Bristol, BS8 1NU, UK
| | - Julia Wade
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Jodi Taylor
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
- Bristol Trials Centre, 1-5 Whiteladies Road, Bristol Medical School, University of Bristol, Bristol, BS8 1NU, UK
| | - Leila Rooshenas
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Yumeng Liu
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
- Bristol Trials Centre, 1-5 Whiteladies Road, Bristol Medical School, University of Bristol, Bristol, BS8 1NU, UK
| | - Ammar Annaw
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
- Bristol Trials Centre, 1-5 Whiteladies Road, Bristol Medical School, University of Bristol, Bristol, BS8 1NU, UK
| | - Karen Alloway
- Research and Innovation, Southmead Hospital, Bristol, BS10 5NB, UK
| | - Andrew Davenport
- UCL Department of Renal Medicine, Royal Free Hospital, University College London, London, England
| | - Albert Power
- Renal unit, Southmead Hospital, North Bristol NHS Trust, Bristol, BS10 5NB, UK
| | - Ken Farrington
- Renal Unit, Lister Hospital, East and North Hertfordshire NHS Trust, Coreys Mill Lane, Coreys Mill Ln, Stevenage, SG1 4AB, UK
| | - Sandip Mitra
- Renal Unit, Manchester University Hospitals NHS Trust, Manchester, UK
| | - David C Wheeler
- UCL Department of Renal Medicine, Royal Free Hospital, University College London, London, England
- George Institute for Global Health, Sydney, Australia
| | - Kristian Law
- Public and patient involvement representative, Bristol, UK
| | | | - Yoav Ben-Shlomo
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Will Hollingworth
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
- Bristol Trials Centre, 1-5 Whiteladies Road, Bristol Medical School, University of Bristol, Bristol, BS8 1NU, UK
| | - Jenny Donovan
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - J Athene Lane
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
- Bristol Trials Centre, 1-5 Whiteladies Road, Bristol Medical School, University of Bristol, Bristol, BS8 1NU, UK
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Thapa S, Jardine T, Davids T, Caskey FJ, Davids MR. Incidence and 1-Year Survival of Elderly South Africans Starting Kidney Replacement Therapy. Kidney Int Rep 2022; 7:2071-2075. [PMID: 36090500 PMCID: PMC9458990 DOI: 10.1016/j.ekir.2022.05.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 05/22/2022] [Accepted: 05/30/2022] [Indexed: 11/26/2022] Open
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Tong A, Oberbauer R, Bellini MI, Budde K, Caskey FJ, Dobbels F, Pengel L, Rostaing L, Schneeberger S, Naesens M. Patient-Reported Outcomes as Endpoints in Clinical Trials of Kidney Transplantation Interventions. Transpl Int 2022; 35:10134. [PMID: 35669971 PMCID: PMC9163311 DOI: 10.3389/ti.2022.10134] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [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: 10/21/2021] [Accepted: 02/17/2022] [Indexed: 12/13/2022]
Abstract
Patient-reported outcomes (PROs) that assess individuals' perceptions of life participation, medication adherence, disease symptoms, and therapy side effects are extremely relevant in the context of kidney transplantation. All PROs are potentially suitable as primary or secondary endpoints in interventional trials that aim to improve outcomes for transplant recipients. Using PRO measures (PROMs) in clinical trials facilitates assessment of the patient's perspective of their health, but few measures have been developed and evaluated in kidney transplant recipients; robust methodologies, which use validated instruments and established frameworks for reporting, are essential. Establishing a core PROM for life participation in kidney transplant recipients is a critically important need, which is being developed and validated by the Standardized Outcomes in Nephrology (SONG)-Tx Initiative. Measures involving electronic medication packaging and smart technologies are gaining traction for monitoring adherence, and could provide more robust information than questionnaires, interviews, and scales. This article summarizes information on PROs and PROMs that was included in a Broad Scientific Advice request on clinical trial design and endpoints in kidney transplantation. This request was submitted to the European Medicines Agency (EMA) by the European Society for Organ Transplantation in 2016. Following modifications, the EMA provided its recommendations in late 2020.
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Affiliation(s)
- Allison Tong
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Rainer Oberbauer
- Department of Nephrology and Dialysis, Medical University of Vienna, Vienna, Austria
| | | | - Klemens Budde
- Department of Nephrology and Medical Intensive Care, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Fergus J. Caskey
- Department of Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Fabienne Dobbels
- Department of Public Health and Primary Care, Academic Center for Nursing and Midwifery, KU Leuven, Leuven, Belgium
| | - Liset Pengel
- Centre for Evidence in Transplantation, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | - Lionel Rostaing
- Department of Nephrology, Dialysis and Transplantation, Toulouse University Hospital, Toulouse, France
| | - Stefan Schneeberger
- Department of General, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Maarten Naesens
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
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45
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Greenham L, Bennett PN, Dansie K, Viecelli AK, Jesudason S, Mister R, Smyth B, Westall P, Herzog S, Brown C, Handke W, Palmer SC, Caskey FJ, Couchoud C, Simes J, McDonald SP, Morton RL. The Symptom Monitoring with Feedback Trial (SWIFT): protocol for a registry-based cluster randomised controlled trial in haemodialysis. Trials 2022; 23:419. [PMID: 35590395 PMCID: PMC9118566 DOI: 10.1186/s13063-022-06355-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 02/01/2022] [Accepted: 04/25/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Kidney failure prevalence is increasing worldwide. Haemodialysis, peritoneal dialysis or kidney transplantation are undertaken to extend life with kidney failure. People receiving haemodialysis commonly experience fatigue, pain, nausea, cramping, itching, sleeping difficulties, anxiety and depression. This symptom burden contributes to poor health-related quality of life (QOL) and is a major reason for treatment withdrawal and death. The Symptom monitoring WIth Feedback Trial (SWIFT) will test the hypothesis that regular symptom monitoring with feedback to people receiving haemodialysis and their treating clinical team can improve QOL. METHODS We are conducting an Australia and New Zealand Dialysis and Transplant (ANZDATA) registry-based cluster randomised controlled trial to determine the clinical- and cost-effectiveness at 12 months, of 3-monthly symptom monitoring using the Integrated Palliative Outcome Scale-Renal (IPOS-Renal) survey with clinician feedback, compared with usual care among adults treated with haemodialysis. Participants complete symptom scoring using a tablet, which are provided to participants and to clinicians. The trial aims to recruit 143 satellite haemodialysis centres, (up to 2400 participants). The primary outcome is change in health-related QOL, as measured by EuroQol 5-Dimension, 5-Level (EQ-5D-5L) instrument. Secondary outcomes include overall survival, symptom severity (including haemodialysis-associated fatigue), healthcare utilisation and cost-effectiveness. DISCUSSION SWIFT is the first registry-based trial in the Australian haemodialysis population to investigate whether regular symptom monitoring with feedback to participants and clinicians improves QOL. SWIFT is embedded in the ANZDATA Registry facilitating pragmatic recruitment from public and private dialysis clinics, throughout Australia. SWIFT will inform future collection, storage and reporting of patient-reported outcome measures (PROMs) within a clinical quality registry. As the first trial to rigorously estimate the efficacy and cost-effectiveness of routine PROMs collection and reporting in haemodialysis units, SWIFT will provide invaluable information to health services, clinicians and researchers working to improve the lives of those with kidney failure. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12620001061921 . Registered on 16 October 2020.
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Affiliation(s)
- Lavern Greenham
- Australia and New Zealand Dialysis and Transplant Registry, Adelaide, SA, Australia
| | - Paul N Bennett
- Satellite Healthcare, San Jose, CA, USA.,University of South Australia, Adelaide, SA, Australia
| | - Kathryn Dansie
- Australia and New Zealand Dialysis and Transplant Registry, Adelaide, SA, Australia
| | - Andrea K Viecelli
- Princess Alexandra Hospital, Woolloongabba, QLD, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Shilpanjali Jesudason
- Central Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, SA, Australia.,University of Adelaide, Adelaide, SA, Australia
| | - Rebecca Mister
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia
| | - Brendan Smyth
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia.,Department of Renal Medicine, St George Hospital, Kogarah, NSW, Australia
| | - Portia Westall
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia
| | - Samuel Herzog
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia
| | - Chris Brown
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia
| | | | | | | | - Cecile Couchoud
- Renal Epidemiology and Information Network (REIN), Agence de la Biomédecine, Saint-Denis, Paris, France
| | - John Simes
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia
| | - Stephen P McDonald
- Australia and New Zealand Dialysis and Transplant Registry, Adelaide, SA, Australia.,Central Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, SA, Australia.,University of Adelaide, Adelaide, SA, Australia
| | - Rachael L Morton
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia.
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46
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Gould DW, Doidge J, Sadique MZ, Borthwick M, Hatch R, Caskey FJ, Forni L, Lawrence RF, MacEwen C, Ostermann M, Mouncey PR, Harrison DA, Rowan KM, Young JD, Watkinson PJ. Erratum: Heparin versus citrate anticoagulation for continuous renal replacement therapy in intensive care: the RRAM observational study. Health Technol Assess 2022; 26:85-86. [PMID: 35543576 DOI: 10.3310/zxhi9396-c202204] [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: 11/22/2022] Open
Abstract
Abstract
Data corrected and figures revised.
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Affiliation(s)
- Doug W Gould
- Clinical Trials Unit, Intensive Care National Audit & Research Centre (ICNARC), London, UK
| | - James Doidge
- Clinical Trials Unit, Intensive Care National Audit & Research Centre (ICNARC), London, UK
| | - M Zia Sadique
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Mark Borthwick
- John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Robert Hatch
- Kadoorie Centre for Critical Care Research and Education, NIHR Biomedical Research Centre, Oxford, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Fergus J Caskey
- UK Renal Registry, Bristol, UK.,Population Health Sciences, University of Bristol, Bristol, UK
| | - Lui Forni
- Department of Clinical and Experimental Medicine, Faculty of Health Sciences, University of Surrey, Guildford, UK.,Intensive Care Unit, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
| | | | - Clare MacEwen
- John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Marlies Ostermann
- Department of Intensive Care, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Paul R Mouncey
- Clinical Trials Unit, Intensive Care National Audit & Research Centre (ICNARC), London, UK
| | - David A Harrison
- Clinical Trials Unit, Intensive Care National Audit & Research Centre (ICNARC), London, UK
| | - Kathryn M Rowan
- Clinical Trials Unit, Intensive Care National Audit & Research Centre (ICNARC), London, UK
| | - J Duncan Young
- Kadoorie Centre for Critical Care Research and Education, NIHR Biomedical Research Centre, Oxford, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Peter J Watkinson
- Kadoorie Centre for Critical Care Research and Education, NIHR Biomedical Research Centre, Oxford, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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47
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Okpechi IG, Caskey FJ, Gaipov A, Tannor EK, Noubiap JJ, Effa E, Ekrikpo UE, Hamonic LN, Ashuntantang G, Bello AK, Donner JA, Figueiredo AE, Inagi R, Madero M, Malik C, Moorthy M, Pecoits-Filho R, Tesar V, Levin A, Jha V. Early Identification of Chronic Kidney Disease – A Scoping Review of the Global Populations. Kidney Int Rep 2022; 7:1341-1353. [PMID: 35685314 PMCID: PMC9171699 DOI: 10.1016/j.ekir.2022.03.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 03/18/2022] [Accepted: 03/28/2022] [Indexed: 11/26/2022] Open
Abstract
Introduction Decisions on whether to screen for chronic kidney disease (CKD) or not remain contentious in nephrology. This study provides a global overview of early CKD identification efforts. Methods Guidelines for scoping reviews were followed and studies were identified by searching MEDLINE, EMBASE, Cochrane Library, CINAHL, ISI Web of Science, and PsycINFO. Data extracted from included studies focused on the following 4 themes: study population, measurement methods, interventions used, and available policies. Results We identified 290 CKD screening and detection programs from 83 countries. Overall sample size was 3.72 million (North East Asia: 1.19 million), detection of CKD was the aim in 97.6%, 63.1% used population-based screening methods, and only 12.4% were in rural populations. Reported CKD prevalence (stages 3–5) was higher in targeted- (14.8%) than population-based studies (8.0%). Number of persons needed to screen (NNS) to identify 1 case was also lower in targeted studies (7 vs. 13). Single measurements (80%) and the combination of estimation of glomerular filtration rate with a urine test (albuminuria/proteinuria) (71.4%) were frequently used to detect CKD. Only 2.8% of studies included an intervention such as pharmacotherapy in identified cases. Policies on early identification were available in 30.1% of countries included. Conclusion Methods for early CKD identification vary worldwide, often leading to wide variations in the reported prevalence. Efforts to standardize measurement methods for early detection focusing on high-risk populations and ensuring appropriate interventions are available to those identified with CKD will improve the value of programs and improve patient outcomes.
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48
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Maarse BCE, Chesnaye NC, Schouten R, Michels WM, Bos WJW, Szymczak M, Krajewska M, Evans M, Heimburger O, Caskey FJ, Wanner C, Jager KJ, Dekker FW, Meuleman Y. Reply to ‘Depression and clinical outcomes in CKD: do anti-depressants play a role? (EQUAL STUDY)’. Clin Kidney J 2022; 15:1630-1632. [PMID: 35892026 PMCID: PMC9308089 DOI: 10.1093/ckj/sfac081] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Indexed: 11/25/2022] Open
Affiliation(s)
| | - Nicholas C Chesnaye
- ERA Registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Robbert Schouten
- Department of Nephrology, OLVG Hospital, Amsterdam, The Netherlands
| | - Wieneke M Michels
- Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Willem Jan W Bos
- Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
- Department of Internal Medicine, Sint Antonius Hospital, Nieuwegein, The Netherlands
| | - Maciej Szymczak
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Magdalena Krajewska
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Marie Evans
- Department of Clinical Sciences Intervention and Technology, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Olof Heimburger
- Department of Clinical Sciences Intervention and Technology, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Fergus J Caskey
- Renal Unit, Southmead Hospital, Bristol, UK
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Christoph Wanner
- Department of Medicine, Division of Nephrology, University Hospital of Würzburg, Würzburg, Germany
| | - Kitty J Jager
- ERA Registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Friedo W Dekker
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Yvette Meuleman
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
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49
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Wong K, Caskey FJ, Casula A, Ben-Shlomo Y, Bailey P. The UK Chinese population with kidney failure: Clinical characteristics, management and access to kidney transplantation using 20 years of UK Renal Registry and NHS Blood and Transplant data. PLoS One 2022; 17:e0264313. [PMID: 35226673 PMCID: PMC8884499 DOI: 10.1371/journal.pone.0264313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 02/08/2022] [Indexed: 11/18/2022] Open
Abstract
Background Little is known about the clinical demographics of and access to transplantation for Chinese diaspora populations with kidney disease. Methods The UK Renal Registry provided data on adults with ethnicity recorded as ‘Chinese’ or ‘White’ starting Kidney Replacement Therapy (KRT) 1/1/97-31/12/17. Baseline characteristics were compared between Chinese and White patients. Multivariable logistic regression models were used to investigate the relationships between Chinese ethnicity and i) being listed for deceased-donor transplantation at start of KRT, ii) being listed 2 years after start of KRT, iii) pre-emptive kidney transplantation, iv) kidney transplantation 3 years after start of KRT, and v) living-donor kidney transplantation (LDKT). Results UK Chinese patients were younger at start of KRT (61.6 vs 65.6 years, p <0.001) and had more diabetic kidney disease (29% vs 20%, p<0.001) and glomerulonephritis (21% vs 13%, p<0.001) than White patients. We found evidence of interaction between ethnicity and sex. Compared to UK White men, UK Chinese men had lower odds of pre-emptive transplant (aOR 0.28, 95% CI [0.10–0.76]) and transplant within 3 years of KRT start (aOR 0.65, [95% CI 0.49–0.87], P = 0.004). UK White women and Chinese women had the same likelihood of pre-emptive transplant (aOR 0.78, 95% CI [0.38–1.61]), or transplant within 3 years of KRT start (aOR 0.94, 95% CI [0.60–1.46]). Both UK Chinese men and women had markedly lower odds of LDKT compared to Whites aOR 0.34 [95% CI 0.21–0.53]. Conclusions UK Chinese are less likely to receive a LDKT. UK Chinese men have lower odds of accessing pre-emptive wait-listing and transplantation. Understanding whether these disparities reflect modifiable barriers will help ensure equitable access to transplantation.
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Affiliation(s)
- Katie Wong
- Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, United Kingdom
- Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom
- * E-mail:
| | - Fergus J. Caskey
- Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, United Kingdom
- Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom
| | | | - Yoav Ben-Shlomo
- Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Pippa Bailey
- Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, United Kingdom
- Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom
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50
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Gould DW, Doidge J, Sadique MZ, Borthwick M, Hatch R, Caskey FJ, Forni L, Lawrence RF, MacEwen C, Ostermann M, Mouncey PR, Harrison DA, Rowan KM, Young JD, Watkinson PJ. Heparin versus citrate anticoagulation for continuous renal replacement therapy in intensive care: the RRAM observational study. Health Technol Assess 2022; 26:1-58. [PMID: 35212260 DOI: 10.3310/zxhi9396] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND In the UK, 10% of admissions to intensive care units receive continuous renal replacement therapy with regional citrate anticoagulation replacing systemic heparin anticoagulation over the last decade. Regional citrate anticoagulation is now used in > 50% of intensive care units, despite little evidence of safety or effectiveness. AIM The aim of the Renal Replacement Anticoagulant Management study was to evaluate the clinical and health economic impacts of intensive care units moving from systemic heparin anticoagulation to regional citrate anticoagulation for continuous renal replacement therapy. DESIGN This was an observational comparative effectiveness study. SETTING The setting was NHS adult general intensive care units in England and Wales. PARTICIPANTS Participants were adults receiving continuous renal replacement therapy in an intensive care unit participating in the Intensive Care National Audit & Research Centre Case Mix Programme national clinical audit between 1 April 2009 and 31 March 2017. INTERVENTIONS Exposure - continuous renal replacement therapy in an intensive care unit after completion of transition to regional citrate anticoagulation. Comparator - continuous renal replacement therapy in an intensive care unit before starting transition to regional citrate anticoagulation or had not transitioned. OUTCOME MEASURES Primary effectiveness - all-cause mortality at 90 days. Primary economic - incremental net monetary benefit at 1 year. Secondary outcomes - mortality at hospital discharge, 30 days and 1 year; days of renal, cardiovascular and advanced respiratory support in intensive care unit; length of stay in intensive care unit and hospital; bleeding and thromboembolic events; prevalence of end-stage renal disease at 1 year; and estimated lifetime incremental net monetary benefit. DATA SOURCES Individual patient data from the Intensive Care National Audit & Research Centre Case Mix Programme were linked with the UK Renal Registry, Hospital Episode Statistics (for England), Patient Episodes Data for Wales and Civil Registrations (Deaths) data sets, and combined with identified periods of systemic heparin anticoagulation and regional citrate anticoagulation (survey of intensive care units). Staff time and consumables were obtained from micro-costing. Continuous renal replacement therapy system failures were estimated from the Post-Intensive Care Risk-adjusted Alerting and Monitoring data set. EuroQol-3 Dimensions, three-level version, health-related quality of life was obtained from the Intensive Care Outcomes Network study. RESULTS Out of the 188 (94.9%) units that responded to the survey, 182 (96.8%) use continuous renal replacement therapy. After linkage, data were available from 69,001 patients across 181 intensive care units (60,416 during periods of systemic heparin anticoagulation use and 8585 during regional citrate anticoagulation use). The change to regional citrate anticoagulation was not associated with a step change in 90-day mortality (odds ratio 0.98, 95% confidence interval 0.89 to 1.08). Secondary outcomes showed step increases in days of renal support (difference in means 0.53 days, 95% confidence interval 0.28 to 0.79 days), advanced cardiovascular support (difference in means 0.23 days, 95% confidence interval 0.09 to 0.38 days) and advanced respiratory support (difference in means, 0.53 days, 95% CI 0.03 to 1.03 days) with a trend toward fewer bleeding episodes (odds ratio 0.90, 95% confidence interval 0.76 to 1.06) with transition to regional citrate anticoagulation. The micro-costing study indicated that regional citrate anticoagulation was more expensive and was associated with an estimated incremental net monetary loss (step change) of -£2376 (95% confidence interval -£1912 to £911). The estimated likelihood of cost-effectiveness at 1 year was less than 0.1%. LIMITATIONS Lack of patient-level treatment data means that the results represent average effects of changing to regional citrate anticoagulation in intensive care units. Administrative data are subject to variation in data quality over time, which may contribute to observed trends. CONCLUSIONS The introduction of regional citrate anticoagulation has not improved outcomes for patients and is likely to have substantially increased costs. This study demonstrates the feasibility of evaluating effects of changes in practice using routinely collected data. FUTURE WORK (1) Prioritise other changes in clinical practice for evaluation and (2) methodological research to understand potential implications of trends in data quality. TRIAL REGISTRATION This trial is registered as ClinicalTrials.gov NCT03545750. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 13. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Doug W Gould
- Clinical Trials Unit, Intensive Care National Audit & Research Centre (ICNARC), London, UK
| | - James Doidge
- Clinical Trials Unit, Intensive Care National Audit & Research Centre (ICNARC), London, UK
| | - M Zia Sadique
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Mark Borthwick
- John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Robert Hatch
- Kadoorie Centre for Critical Care Research and Education, NIHR Biomedical Research Centre, Oxford, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Fergus J Caskey
- UK Renal Registry, Bristol, UK.,Population Health Sciences, University of Bristol, Bristol, UK
| | - Lui Forni
- Department of Clinical and Experimental Medicine, Faculty of Health Sciences, University of Surrey, Guildford, UK.,Intensive Care Unit, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
| | | | - Clare MacEwen
- John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Marlies Ostermann
- Department of Intensive Care, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Paul R Mouncey
- Clinical Trials Unit, Intensive Care National Audit & Research Centre (ICNARC), London, UK
| | - David A Harrison
- Clinical Trials Unit, Intensive Care National Audit & Research Centre (ICNARC), London, UK
| | - Kathryn M Rowan
- Clinical Trials Unit, Intensive Care National Audit & Research Centre (ICNARC), London, UK
| | - J Duncan Young
- Kadoorie Centre for Critical Care Research and Education, NIHR Biomedical Research Centre, Oxford, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Peter J Watkinson
- Kadoorie Centre for Critical Care Research and Education, NIHR Biomedical Research Centre, Oxford, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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