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Graham-Brown MPM, Casula A, Savino M, Humphrey T, Pyart R, Amaran M, Williams J, Crowe K, Medcalf JF. A National audit of the care of patients with acute kidney injury in England and Wales in 2019 and the association with patient outcomes. Clin Med (Lond) 2024; 24:100028. [PMID: 38387536 DOI: 10.1016/j.clinme.2024.100028] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
BACKGROUND Acute kidney injury (AKI) is a common complication of hospitalisations. This national audit assessed the care received by patients with AKI in hospital Trusts in England and Wales. METHODS Twenty four hospital Trusts across England and Wales took part. Patients with AKI stage2/3 were identified using the UK Renal Registry AKI master patient index. Data was returned through a secure portal with linkage to hospital episode statistic mortality and hospitalisation data. Completion rates of AKI care standards and regional variations in care were established. RESULTS 989 AKI episodes were included in the analyses. In-hospital 30-day mortality was 31-33.1% (AKI 2/3). Standard AKI interventions were completed in >80% of episodes. Significant inter-hospital variation remained in attainment of AKI care standards after adjustment for age and sex. Recording of urinalysis (41.9%) and timely imaging (37.2%) were low. Information on discharge summaries relating to medication changes/re-commencement and follow-up blood tests associated with reduced mortality. No quality indicators relating to clinical management associated with mortality. Better communication on discharge summaries associated with reduced mortality. CONCLUSIONS Outcomes for patients with AKI in hospital remain poor. Regional variation in care exists. Work is needed to assess whether improving and standardising care improves patient outcomes.
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Affiliation(s)
- M P M Graham-Brown
- Department of Cardiovascular Sciences, University of Leicester, LE1 9HN, United Kingdom; NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom; John Walls Renal Unit, Leicester General Hospital, University Hospitals of Leicester NHS Trust, United Kingdom.
| | - A Casula
- UK Renal Registry, United Kingdom
| | - M Savino
- UK Renal Registry, United Kingdom; Bristol Royal Infirmary, Division of Acute Medicine
| | - T Humphrey
- Department of Renal Medicine, Cambridge University Hospitals NHS Foundation Trust, United Kingdom
| | - R Pyart
- UK Renal Registry, United Kingdom
| | - M Amaran
- Renal Unit, St George's Hospital, London, United Kingdom
| | - J Williams
- School of Medicine, University of Exeter, United Kingdom
| | - K Crowe
- Glasgow Renal & Transplant Unit, NHS Greater Glasgow & Clyde, United Kingdom
| | - J F Medcalf
- John Walls Renal Unit, Leicester General Hospital, University Hospitals of Leicester NHS Trust, United Kingdom; UK Renal Registry, United Kingdom
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2
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Marrington R, Barton AL, Yates A, McKane W, Selby NM, Murray JS, Medcalf JF, MacKenzie F, Myers M. National recommendations to standardise acute kidney injury detection and alerting. Ann Clin Biochem 2023; 60:406-416. [PMID: 37218087 DOI: 10.1177/00045632231180403] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
BACKGROUND National Health Service England issued a Patient Safety Alert in 2014 mandating all acute Trusts in England to implement Acute Kidney Injury (AKI) warning stage results and to do so using a standardised algorithm. In 2021, the Renal and Pathology Getting It Right First Time (GIRFT) teams found significant variation in AKI reporting across the UK. A survey was designed to capture information on the entire AKI detection and alerting process to investigate the potential sources of this unwarranted variation. METHODS In August 2021, an online survey consisting of 54 questions was made available to all UK laboratories. The questions covered creatinine assays, laboratory information management systems (LIMS), the AKI algorithm and AKI reporting. RESULTS We received 101 responses from laboratories. Data were reviewed for England only - 91 laboratories. Findings included that 72% used enzymatic creatinine. In addition, 7 manufacturer-analytical platforms, 15 different LIMS and a wide range of creatinine reference ranges were in use. In 68% of laboratories, the AKI algorithm was installed by the LIMS provider. Marked variation was found in the minimum age of AKI reporting with only 18% starting at the recommended 1 month/28-days. Some 89% phoned all new AKI2s and AKI3s, as per AKI guidance while 76% provided comments/hyperlinks in reports. CONCLUSIONS The national survey has identified laboratory practices that potentially contribute to unwarranted variation in the reporting of AKI in the England. This has formed the basis for improvement work to remedy the situation, including national recommendations, included within this article.
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Affiliation(s)
- Rachel Marrington
- Birmingham Quality (UK NEQAS), University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Anna L Barton
- Clinical Chemistry, Royal Cornwall Hospital, Truro, UK
| | - Alexandra Yates
- Clinical Biochemistry, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - William McKane
- Sheffield Kidney Institute, Northern General Hospital, Sheffield, UK
| | - Nicholas M Selby
- Centre for Kidney Research and Innovation, Academic Unit for Translational Medical Sciences, School of Medicine (Royal Derby Hospital Campus), University of Nottingham, UK
| | - Jonathan S Murray
- Renal Unit, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | | | - Finlay MacKenzie
- Birmingham Quality (UK NEQAS), University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Martin Myers
- Clinical Biochemistry, Royal Preston Hospital, Preston, UK
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3
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Maher F, Teece L, Major RW, Bradbury N, Medcalf JF, Brunskill NJ, Booth S, Gray LJ. Using the kidney failure risk equation to predict end-stage kidney disease in CKD patients of South Asian ethnicity: an external validation study. Diagn Progn Res 2023; 7:22. [PMID: 37798742 PMCID: PMC10552237 DOI: 10.1186/s41512-023-00157-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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 09/11/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND The kidney failure risk equation (KFRE) predicts the 2- and 5-year risk of needing kidney replacement therapy (KRT) using four risk factors - age, sex, urine albumin-to-creatinine ratio (ACR) and creatinine-based estimated glomerular filtration rate (eGFR). Although the KFRE has been recalibrated in a UK cohort, this did not consider minority ethnic groups. Further validation of the KFRE in different ethnicities is a research priority. The KFRE also does not consider the competing risk of death, which may lead to overestimation of KRT risk. This study externally validates the KFRE for patients of South Asian ethnicity and compares methods for accounting for ethnicity and the competing event of death. METHODS Data were gathered from an established UK cohort containing 35,539 individuals diagnosed with chronic kidney disease. The KFRE was externally validated and updated in several ways taking into account ethnicity, using recognised methods for time-to-event data, including the competing risk of death. A clinical impact assessment compared the updated models through consideration of referrals made to secondary care. RESULTS The external validation showed the risk of KRT differed by ethnicity. Model validation performance improved when incorporating ethnicity and its interactions with ACR and eGFR as additional risk factors. Furthermore, accounting for the competing risk of death improved prediction. Using criteria of 5 years ≥ 5% predicted KRT risk, the competing risks model resulted in an extra 3 unnecessary referrals (0.59% increase) but identified an extra 1 KRT case (1.92% decrease) compared to the previous best model. Hybrid criteria of predicted risk using the competing risks model and ACR ≥ 70 mg/mmol should be used in referrals to secondary care. CONCLUSIONS The accuracy of KFRE prediction improves when updated to consider South Asian ethnicity and to account for the competing risk of death. This may reduce unnecessary referrals whilst identifying risks of KRT and could further individualise the KFRE and improve its clinical utility. Further research should consider other ethnicities.
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Affiliation(s)
- Francesca Maher
- Department of Population Health Sciences, University of Leicester, Leicester, UK
| | - Lucy Teece
- Department of Population Health Sciences, University of Leicester, Leicester, UK
| | - Rupert W Major
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- John Walls Renal Unit, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Naomi Bradbury
- Department of Population Health Sciences, University of Leicester, Leicester, UK
| | - James F Medcalf
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- John Walls Renal Unit, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Nigel J Brunskill
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- John Walls Renal Unit, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Sarah Booth
- Department of Population Health Sciences, University of Leicester, Leicester, UK
| | - Laura J Gray
- Department of Population Health Sciences, University of Leicester, Leicester, UK.
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4
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Wong E, Peracha J, Pitcher D, Casula A, Steenkamp R, Medcalf JF, Nitsch D. Seasonal mortality trends for hospitalised patients with acute kidney injury across England. BMC Nephrol 2023; 24:144. [PMID: 37226118 DOI: 10.1186/s12882-023-03094-5] [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: 09/14/2022] [Accepted: 02/22/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND Incidence of acute kidney injury (AKI) is known to peak in winter months. This is likely influenced by seasonality of commonly associated acute illnesses. We set out to assess seasonal mortality trends for patients who develop AKI across the English National Health Service (NHS) and to better understand associations with patient 'case-mix'. METHODS The study cohort included all hospitalised adult patients in England who triggered a biochemical AKI alert in 2017. We modelled the impact of season on 30-day mortality using multivariable logistic regression; adjusting for age, sex, ethnicity, index of multiple deprivation (IMD), primary diagnosis, comorbidity (RCCI), elective/emergency admission, peak AKI stage and community/hospital acquired AKI. Seasonal odds ratios for AKI mortality were then calculated and compared across individual NHS hospital trusts. RESULTS The crude 30-day mortality for hospitalised AKI patients was 33% higher in winter compared to summer. Case-mix adjustment for a wide range of clinical and demographic factors did not fully explain excess winter mortality. The adjusted odds ratio of patients dying in winter vs. summer was 1.25 (1.22-1.29), this was higher than for Autumn and Spring vs. Summer, 1.09 (1.06-1.12) and 1.07 (1.04-1.11) respectively and varied across different NHS trusts (9 out of 90 centres outliers). CONCLUSION We have demonstrated an excess winter mortality risk for hospitalised patients with AKI across the English NHS, which could not be fully explained by seasonal variation in patient case-mix. Whilst the explanation for worse winter outcomes is not clear, unaccounted differences including 'winter-pressures' merit further investigation.
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Affiliation(s)
- Esther Wong
- Renal Registry, Kidney Association, Brandon House 20a1, Southmead Road, Bristol, BS34 7RR, UK.
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
| | - Javeria Peracha
- Department of Renal Medicine, Royal Wolverhampton NHS Trust, Wolverhampton, WV10 0QP, UK
| | - David Pitcher
- Renal Registry, Kidney Association, Brandon House 20a1, Southmead Road, Bristol, BS34 7RR, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Department of Renal Medicine, University College London, London, UK
| | - Anna Casula
- Renal Registry, Kidney Association, Brandon House 20a1, Southmead Road, Bristol, BS34 7RR, UK
| | - Retha Steenkamp
- Renal Registry, Kidney Association, Brandon House 20a1, Southmead Road, Bristol, BS34 7RR, UK
| | - James F Medcalf
- Renal Registry, Kidney Association, Brandon House 20a1, Southmead Road, Bristol, BS34 7RR, UK
- Department of Health Sciences, University of Leicester, Leicester, LE1 7RH, UK
- John Walls Renal Unit, University Hospitals Leicester NHS Trust, Leicester, LE1 5WW, UK
| | - Dorothea Nitsch
- Renal Registry, Kidney Association, Brandon House 20a1, Southmead Road, Bristol, BS34 7RR, UK
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
- Department of Nephrology, Royal Free London NHS Foundation trust, London, NW3 2QG, UK
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5
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Selvaskandan H, Hull KL, Adenwalla S, Ahmed S, Cusu MC, Graham-Brown M, Gray L, Hall M, Hamer R, Kanbar A, Kanji H, Lambie M, Lee HS, Mahdi K, Major R, Medcalf JF, Natarajan S, Oseya B, Stringer S, Tabinor M, Burton J. Risk factors associated with COVID-19 severity among patients on maintenance haemodialysis: a retrospective multicentre cross-sectional study in the UK. BMJ Open 2022; 12:e054869. [PMID: 35636784 PMCID: PMC9152624 DOI: 10.1136/bmjopen-2021-054869] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 12/14/2022] Open
Abstract
OBJECTIVES To assess the applicability of risk factors for severe COVID-19 defined in the general population for patients on haemodialysis. SETTING A retrospective cross-sectional study performed across thirty four haemodialysis units in midlands of the UK. PARTICIPANTS All 274 patients on maintenance haemodialysis who tested positive for SARS-CoV-2 on PCR testing between March and August 2020, in participating haemodialysis centres. EXPOSURE The utility of obesity, diabetes status, ethnicity, Charlson Comorbidity Index (CCI) and socioeconomic deprivation scores were investigated as risk factors for severe COVID-19. MAIN OUTCOMES AND MEASURES Severe COVID-19, defined as requiring supplemental oxygen or respiratory support, or a C reactive protein of ≥75 mg/dL (RECOVERY trial definitions), and its association with obesity, diabetes status, ethnicity, CCI, and socioeconomic deprivation. RESULTS 63.5% (174/274 patients) developed severe disease. Socioeconomic deprivation associated with severity, being most pronounced between the most and least deprived quartiles (OR 2.81, 95% CI 1.22 to 6.47, p=0.015), after adjusting for age, sex and ethnicity. There was no association between obesity, diabetes status, ethnicity or CCI with COVID-19 severity. We found no evidence of temporal evolution of cases (p=0.209) or clustering that would impact our findings. CONCLUSION The incidence of severe COVID-19 is high among patients on haemodialysis; this cohort should be considered high risk. There was strong evidence of an association between socioeconomic deprivation and COVID-19 severity. Other risk factors that apply to the general population may not apply to this cohort.
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Affiliation(s)
- Haresh Selvaskandan
- John Walls Renal Unit, University Hospitals of Leicester NHS Trust, Leicester, UK
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Katherine L Hull
- John Walls Renal Unit, University Hospitals of Leicester NHS Trust, Leicester, UK
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Sherna Adenwalla
- John Walls Renal Unit, University Hospitals of Leicester NHS Trust, Leicester, UK
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Safa Ahmed
- Department of Renal Transplantation and Nephrology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Maria-Cristina Cusu
- Department of Renal Medicine, Northampton General Hospital NHS Trust, Northampton, UK
| | - Matthew Graham-Brown
- John Walls Renal Unit, University Hospitals of Leicester NHS Trust, Leicester, UK
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Laura Gray
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Matt Hall
- Nottingham Renal and Transplant Unit, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Rizwan Hamer
- Department of Renal Transplantation and Nephrology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Ammar Kanbar
- Department of Renal Medicine, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - Hemali Kanji
- Department of Renal Transplantation and Nephrology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Mark Lambie
- School of Medicine, Keele University, Keele, UK
| | - Han Sean Lee
- Nottingham Renal and Transplant Unit, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Khalid Mahdi
- Department of Renal Medicine, Lincoln County Hospital, Lincoln, UK
| | - Rupert Major
- John Walls Renal Unit, University Hospitals of Leicester NHS Trust, Leicester, UK
- Department of Health Sciences, University Hospital of Leicester, Leicester, UK
| | - James F Medcalf
- John Walls Renal Unit, University Hospitals of Leicester NHS Trust, Leicester, UK
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | | | - Boavojuvie Oseya
- Department of Renal Medicine, Northampton General Hospital NHS Trust, Northampton, UK
| | - Stephanie Stringer
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Matthew Tabinor
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - James Burton
- John Walls Renal Unit, University Hospitals of Leicester NHS Trust, Leicester, UK
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
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6
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Savino M, Santhakumaran S, Currie CSM, Onggo BSS, Evans KM, Medcalf JF, Nitsch D, Steenkamp R. Comparison of Outcomes of In-Centre Haemodialysis Patients between the 1st and 2nd COVID-19 Outbreak in England, Wales, and Northern Ireland: A UK Renal Registry Analysis. Nephron Clin Pract 2022; 146:469-480. [PMID: 35354143 PMCID: PMC9059036 DOI: 10.1159/000523731] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 02/18/2022] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION This retrospective cohort study compares in-centre haemodialysis (ICHD) patients' outcomes between the 1st and 2nd waves of the COVID-19 pandemic in England, Wales, and Northern Ireland. METHODS All people aged ≥18 years receiving ICHD at 31 December 2019, who were still alive and not in receipt of a kidney transplant at 1 March and who had a positive polymerase chain reaction test for SARS-CoV-2 between 1 March 2020 and 31 January 2021, were included. The COVID-19 infections were split into two "waves": wave 1 from March to August 2020 and wave 2 from September 2020 to January 2021. Cumulative incidence of COVID-19, multivariable Cox models for risk of positivity, median, and 95% credible interval of reproduction number in dialysis units were calculated separately for wave 1 and wave 2. Survival and hazard ratios for mortality were described with age- and sex-adjusted Kaplan-Meier plots and multivariable Cox proportional models. RESULTS 4,408 ICHD patients had COVID-19 during the study period. Unadjusted survival at 28 days was similar in both waves (wave 1 75.6% [95% confidence interval [CI]: 73.7-77.5], wave 2 76.3% [95% CI 74.3-78.2]), but death occurred more rapidly after detected infection in wave 1. Long vintage treatment and not being on the transplant waiting list were associated with higher mortality in both waves. CONCLUSIONS Risk of death of patients on ICHD treatment with COVID-19 remained unchanged between the first and second outbreaks. This highlights that this vulnerable patient group needs to be prioritized for interventions to prevent severe COVID-19, including vaccination, and the implementation of measures to reduce the risk of transmission alone is not sufficient.
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Affiliation(s)
| | | | - Christine S M Currie
- Department of Mathematical Sciences, University of Southampton, Southampton, United Kingdom
| | - Bhakti S S Onggo
- Department of Mathematical Sciences, University of Southampton, Southampton, United Kingdom
| | | | - James F Medcalf
- UK Renal Registry, Bristol, United Kingdom.,University of Leicester, Leicester, United Kingdom.,Leicester General Hospital, Leicester, United Kingdom
| | - Dorothea Nitsch
- UK Renal Registry, Bristol, United Kingdom.,London School of Hygiene and Tropical Medicine, London, United Kingdom.,Royal Free London NHS Foundation Trust, London, United Kingdom
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7
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Major RW, Shepherd D, Medcalf JF, Xu G, Gray LJ, Brunskill NJ. Comorbidities and outcomes in South Asian individuals with chronic kidney disease: an observational primary care cohort. Nephrol Dial Transplant 2021; 37:108-114. [PMID: 33439998 DOI: 10.1093/ndt/gfaa291] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 03/04/2020] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND South Asian (SA) individuals are more likely to develop end-stage renal disease (ESRD), but how chronic kidney disease (CKD) differs in relation to demographics, comorbidities and outcomes has not been studied. We aimed to study differences in SA individuals with CKD compared with White individuals. METHODS This was an observational CKD cohort comparing SA with White individuals. Inclusion criteria were ≥18 years of age and two or more Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) eGFRs <60 mL/min/1.73 m2 >3 months apart. Individuals with ESRD at baseline were excluded. Baseline characteristics, including eGFR formulae [CKD-EPI and CKD-EPI-Pakistan (CKD-EPI-PK)], were compared. Analysis using competing risk regression for cardiovascular (CV) and ESRD events and Cox proportional hazard model for mortality was performed. RESULTS From an adult population of 277 248 individuals, 17 248 individuals had CKD, of whom 1990 (11.5%) were of SA ethnicity. Age-adjusted prevalence of CKD was similar between ethnicities. SA individuals were more likely to be male, younger and socioeconomically deprived, and to have diabetes mellitus, CV disease and advanced CKD. Mean CKD-EPI-PK eGFR was 6.5 mL/min/1.73 m2 lower (41.1 versus 47.6, 95% confidence interval for difference 6.47-6.56) than for CKD-EPI. During 5 years of follow-up, 5109 (29.6%) individuals died, 2072 (12.0%) had a CV and 156 (0.90%) an ESRD event. Risk for SA individuals was higher for ESRD, similar to CV events and lower for mortality. Each 1 mL/min/1.73 m2 decrease in CKD-EPI-PK was associated with a 13.1% increased ESRD risk (adjusted subdistribution hazard ratio 0.869, 95% confidence interval 0.841-0.898). CONCLUSIONS SA individuals with CKD were younger and had more advanced disease than White individuals. Risk of ESRD was higher and CKD-EPI-PK was associated with ESRD risk in SA individuals. Specific CKD interventions, including the use of CKD-EPI-PK, should be considered in SA populations.
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Affiliation(s)
- Rupert W Major
- John Walls Renal Unit, University Hospitals of Leicester, Leicester General Hospital, Leicester, UK.,Department of Health Sciences, University of Leicester, Leicester, UK
| | - David Shepherd
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - James F Medcalf
- John Walls Renal Unit, University Hospitals of Leicester, Leicester General Hospital, Leicester, UK.,Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Gang Xu
- John Walls Renal Unit, University Hospitals of Leicester, Leicester General Hospital, Leicester, UK
| | - Laura J Gray
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Nigel J Brunskill
- John Walls Renal Unit, University Hospitals of Leicester, Leicester General Hospital, Leicester, UK.,Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
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8
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Peracha J, Pitcher D, Santhakumaran S, Steenkamp R, Fotheringham J, Day J, Medcalf JF, Nitsch D, Lipkin GW, McKane WS. Centre variation in mortality following post-hospitalisation acute kidney injury: Analysis of a large national cohort. Nephrol Dial Transplant 2021; 37:2201-2213. [PMID: 34902021 DOI: 10.1093/ndt/gfab348] [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: 11/25/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Routine monitoring of outcomes for patients with Acute Kidney Injury (AKI) is important to drive ongoing quality improvement in patient care. In this study, we describe development of a case-mix adjusted 30-day mortality indicator for patients with post-hospitalisation AKI (H-AKI) across England, to facilitate identification of any unwarranted centre-variation in outcomes. METHODS We utilised a routinely collected national dataset of biochemically detected AKI cases, linked with national hospitals administrative and mortality data. 250,504 H-AKI episodes were studied in total, across 103 NHS hospital trusts, between January 2017 - December 2018. Standardised mortality ratios (SMRs) were calculated for each trust using logistic regression; adjusting for age, sex, primary diagnosis, comorbidity score, AKI severity, month of AKI, and admission method. RESULTS Mean 30-day mortality rate was high at 28.6%. SMRs for 23/103 trusts were classed as outliers, 12 above and 11 below the 95% control limits. Patients with H-AKI had mortality rates over 5 times higher than the overall hospitalised population in 90/136 diagnosis groups and over 10 times higher in 60/136 groups. Presentation at trusts with a co-located specialist nephrology service was associated with a lower mortality risk, as was South Asian or Black ethnicity. Deprivation, however, was associated with higher mortality. CONCLUSIONS This is the largest multi-centre analysis of mortality for patients with biochemically ascertained H-AKI to date, demonstrating once again the considerable risk associated with developing even mild elevations in serum creatinine. Mortality rates varied considerably across centres and those identified as outliers will now need to carefully interrogate local care pathways to understand and address reasons for this, with national policy required to tackle the identified health disparities.
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Affiliation(s)
- Javeria Peracha
- UK Renal Registry, The Renal Association, Bristol, UK.,Department of Renal Medicine, University Hospitals Birmingham NHS Trust, Birmingham, UK
| | - David Pitcher
- UK Renal Registry, The Renal Association, Bristol, UK
| | | | | | - James Fotheringham
- School of Health and Related Research, University of Sheffield, Sheffield UK.,Sheffield Kidney Institute, Sheffield Teaching Hospitals NHSFT, Sheffield, UK
| | - Jamie Day
- Getting it Right First Time Programme, NHS England and NHS Improvement, UK
| | - James F Medcalf
- UK Renal Registry, The Renal Association, Bristol, UK.,John Walls Renal Unit, University Hospitals Leicester NHS Trust, Leicester, UK
| | - Dorothea Nitsch
- UK Renal Registry, The Renal Association, Bristol, UK.,Faculty of Epidemiology and Public Health, London School of Hygiene and Tropical Medicine, London, UK.,Department of Nephrology, University College London Hospitals NHS Trust, London, UK
| | - Graham W Lipkin
- Department of Renal Medicine, University Hospitals Birmingham NHS Trust, Birmingham, UK
| | - William S McKane
- Sheffield Kidney Institute, Sheffield Teaching Hospitals NHSFT, Sheffield, UK
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9
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Savino M, Santhakumaran S, Evans KM, Steenkamp R, Benoy-Deeney F, Medcalf JF, Nitsch D. Outcomes of patients with COVID-19 on kidney replacement therapy: a comparison among modalities in England. Clin Kidney J 2021; 14:2573-2581. [PMID: 34938533 PMCID: PMC8499928 DOI: 10.1093/ckj/sfab160] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 05/06/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Chronic kidney disease is a recognized risk factor of poor outcomes from coronavirus disease 2019 (COVID-19). METHODS This retrospective cohort study used the UK Renal Registry database of people on kidney replacement therapy (KRT) at the end of 2019 in England and who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) between 1 March 2020 and 31 August 2020 to analyse the incidence and outcomes of COVID-19 among different KRT modalities. Comparisons with 2015-2019 mortality data were used to estimate excess deaths. RESULTS A total of 2783 individuals on KRT tested positive for SARS-CoV-2. Patients from more-deprived areas {most deprived versus least deprived hazard ratio [HR] 1.20 [95% confidence interval (CI) 1.04-1.39]} and those with diabetes compared with those without [HR 1.51 (95% CI 1.39-1.64)] were more likely to test positive. Approximately 25% of in-centre haemodialysis and transplanted patients died within 28 days of testing positive compared with 36% of those on home therapies. Mortality was higher in those ≥80 years of age compared with those 60-79 years [odds ratio (OR) 1.71 (95% CI 1.34-2.19)] and much lower in those listed for transplantation compared with those not listed [OR 0.56 (95% CI 0.40-0.80)]. Overall, excess mortality in 2020 for people on KRT was 36% higher than the 2015-2019 average. Excess deaths peaked in April 2020 at the height of the pandemic and were characterized by wide ethnic and regional disparities. CONCLUSIONS The impact of COVID-19 on the English KRT population highlights their extreme vulnerability and emphasizes the need to protect and prioritize this group for vaccination. COVID-19 has widened underlying inequalities in people with kidney disease, making interventions that address health inequalities a priority.
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Affiliation(s)
| | | | | | | | | | - James F Medcalf
- UK Renal Registry, Bristol, UK
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- Leicester General Hospital, Leicester, UK
| | - Dorothea Nitsch
- UK Renal Registry, Bristol, UK
- London School of Hygiene and Tropical Medicine, London, UK
- Royal Free London NHS Foundation Trust, London, UK
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10
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Savino M, Plumb L, Casula A, Evans K, Wong E, Kolhe N, Medcalf JF, Nitsch D. Acute kidney injury identification for pharmacoepidemiologic studies: Use of laboratory electronic acute kidney injury alerts versus electronic health records in Hospital Episode Statistics. Pharmacoepidemiol Drug Saf 2021; 30:1687-1695. [PMID: 34418198 DOI: 10.1002/pds.5347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 02/26/2021] [Revised: 06/30/2021] [Accepted: 08/16/2021] [Indexed: 01/17/2023]
Abstract
PURPOSE A laboratory-based acute kidney injury (AKI) electronic-alert (e-alert) system, with e-alerts sent to the UK Renal Registry (UKRR) and collated in a master patient index (MPI), has recently been implemented in England. The aim of this study was to determine the degree of correspondence between the UKRR-MPI and AKI International Classification Disease-10 (ICD-10) N17 coding in Hospital Episode Statistics (HES) and whether hospital N17 coding correlated with 30-day mortality and emergency re-admission after AKI. METHODS AKI e-alerts in people aged ≥18 years, collated in the UKRR-MPI during 2017, were linked to HES data to identify a hospitalised AKI population. Multivariable logistic regression was used to analyse associations between absence/presence of N17 codes and clinicodemographic features. Correlation of the percentage coded with N17 and 30-day mortality and emergency re-admission after AKI were calculated at hospital level. RESULTS In 2017, there were 301 540 adult episodes of hospitalised AKI in England. AKI severity was positively associated with coding in HES, with a high degree of inter-hospital variability-AKI stage 1 mean of 48.2% [SD 14.0], versus AKI stage 3 mean of 83.3% [SD 7.3]. N17 coding in HES depended on demographic features, especially age (18-29 years vs. ≥85 years OR 0.22, 95% CI 0.21-0.23), as well as sex and ethnicity. There was no evidence of association between the proportion of episodes coded for AKI with short-term AKI outcomes. CONCLUSION Coding of AKI in HES is influenced by many factors that result in an underestimation of AKI. Using e-alerts to triangulate the true incidence of AKI could provide a better understanding of the factors that affect hospital coding, potentially leading to improved coding, patient care and pharmacoepidemiologic research.
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Affiliation(s)
| | - Lucy Plumb
- UK Renal Registry, Bristol, UK.,Population Health Sciences, University of Bristol Medical School, Bristol, UK
| | | | | | | | | | - James F Medcalf
- UK Renal Registry, Bristol, UK.,Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.,Leicester General Hospital, Leicester, UK
| | - Dorothea Nitsch
- UK Renal Registry, Bristol, UK.,London School of Hygiene and Tropical Medicine, London, UK.,Royal Free London NHS Foundation Trust, London, UK
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MacNeill SJ, Ford D, Evans K, Medcalf JF. Chapter 2 UK Renal Replacement Therapy Adult Prevalence in 2016: National and Centre-specific Analyses. Nephron Clin Pract 2018; 139 Suppl 1:47-74. [DOI: 10.1159/000490960] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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12
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Kerr M, Matthews B, Medcalf JF, O'Donoghue D. End-of-life care for people with chronic kidney disease: cause of death, place of death and hospital costs. Nephrol Dial Transplant 2018; 32:1504-1509. [PMID: 27207901 DOI: 10.1093/ndt/gfw098] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 10/28/2015] [Accepted: 04/01/2016] [Indexed: 11/13/2022] Open
Abstract
Background End-of-life care for people with chronic kidney disease (CKD) has been identified as an area of great clinical need internationally. We estimate causes and place of death and cost of hospital care for people with CKD in England in the final 3 years of life. Methods Hospital Episode Statistics data were linked to Office for National Statistics mortality data to identify all patients in England aged ≥18 years who died 1 April 2006-31 March 2010, and had a record of hospital care after 1 April 2003 (the study group). The underlying cause and place of death were examined in Office for National Statistics data, for patients without and with CKD (identified by International Classification of Diseases version 10 codes N18, I12 and I13). Costs of hospital admissions and outpatient attendances were estimated using National Health Service Reference Cost data. Associations between CKD and hospital costs, and between place of death and hospital costs in those with CKD, were examined using multivariate regressions. Results There were 1 602 105 people in the study group. Of these, 13.2% were recorded as having CKD. The proportion of deaths at home was 10.7% in people with CKD and 17.2% in the age- and gender-matched non-CKD group. Regression analysis suggests that CKD was associated with an increase in hospital costs of £3380 in the last 12 months of life, holding constant place of death, comorbidities and other variables. For the CKD group, home death was associated with a reduction in hospital costs of £2811 in the 12 months before death. The most commonly recorded cause of death in people with CKD was heart disease. CKD was not mentioned on the death certificate in two-thirds of deaths in people with the condition. Conclusions People with CKD are less likely to die at home than those without CKD. The condition is associated with increased hospital costs at the end of life regardless of place of death. Home death in CKD is associated with a substantial reduction in hospital costs at the end of life.
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Affiliation(s)
- Marion Kerr
- Insight Health Economics Ltd, Richmond, Surrey, UK
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13
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Medcalf JF, Davies C, Hollinshead J, Matthews B, O'Donoghue D. Incidence, care quality and outcomes of patients with acute kidney injury in admitted hospital care. QJM 2016; 109:777-783. [PMID: 27261489 DOI: 10.1093/qjmed/hcw072] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 04/20/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND/INTRODUCTION Acute kidney injury (AKI) is common in acute hospital admission and associated with worse patient outcomes. AIM To measure incidence, care quality and outcome of AKI in admitted hospital care. DESIGN Forty-six of 168 acute NHS healthcare trusts in UK caring for 2 million acute hospital admissions per annum collected information on adults identified with AKI stage 3 (3-fold rise in serum creatinine or creatinine >354 µmol/l) through routine biochemical testing over a 5-month period in 2012. METHODS Information was collected on patient and care characteristics. Primary outcomes were survival and recovery of kidney function at 1 month. RESULTS A total of 15 647 patients were identified with biochemical AKI stage 3. Case note reviews were available for 7726 patients. In 80%, biochemical AKI stage 3 was confirmed clinically. Among this group, median age was 75 years, median length of stay was 12 days and the overall mortality within 1 month was 38%. Significant factors in a multivariable model predicting survival included age and some causes of AKI. Dipstick urinalysis, medication review, discussion with a nephrologist and acceptance for transfer to a renal unit were also associated with higher survival, but not early review by a senior doctor, acceptance for transfer to critical care or requirement for renal replacement therapy. Eighteen percent of people did not have their kidney function checked 1 month after the episode had resolved. DISCUSSION/CONCLUSIONS This large study of in-hospital AKI supports the efficacy of biochemical detection of AKI in common usage. AKI mortality remains substantial, length of stay comparable with single-centre studies, and much of the variation is poorly explained (model Cox and Snell R2 = 0.131) from current predictors.
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Affiliation(s)
- J F Medcalf
- From the John Walls Renal Unit, Leicester, UK
| | - C Davies
- Public Health Analyst, Knowledge Intelligence Service Public Health England, Nottingham, UK
| | - J Hollinshead
- Public Health Analyst, Knowledge Intelligence Service Public Health England, Nottingham, UK
| | - B Matthews
- Long Term Conditions Programme Lead, Sustainable Improvement Team, NHS England, Leeds, UK
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14
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Cook LBM, Melamed A, Demontis MA, Laydon DJ, Fox JM, Tosswill JHC, de Freitas D, Price AD, Medcalf JF, Martin F, Neuberger JM, Bangham CRM, Taylor GP. Rapid dissemination of human T-lymphotropic virus type 1 during primary infection in transplant recipients. Retrovirology 2016; 13:3. [PMID: 26745892 PMCID: PMC4706667 DOI: 10.1186/s12977-015-0236-7] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 12/22/2015] [Indexed: 11/24/2022] Open
Abstract
Background Human T-lymphotropic virus type 1 (HTLV-1) infects an estimated 10 million persons globally with transmission resulting in lifelong infection. Disease, linked to high proviral load, occurs in a minority. In established infection HTLV-1 replicates through infectious spread and clonal expansion of infected lymphocytes. Little is known about acute HTLV-1 infection. The kinetics of early HTLV-1 infection, following transplantation-acquired infection in three recipients from one HTLV-1 infected donor, is reported. The recipients were treated with two HTLV-1 enzyme inhibitors 3 weeks post exposure following the detection of HTLV-1 provirus at low level in each recipient. HTLV-1 infection was serially monitored by serology, quantification of proviral load and HTLV-1 2LTR DNA circles and by HTLV-1 unique integration site analysis. Results HTLV-1 antibodies were first detected 16–39 days post-transplantation. HTLV-1 provirus was detected by PCR on day 16–23 and increased by 2–3 log by day 38–45 with a peak proviral doubling time of 1.4 days, after which
steady state was reached. The rapid proviral load expansion was associated with high frequency of HTLV-1 2LTR DNA circles. The number of HTLV-1 unique integration sites was high compared with established HTLV-1 infection. Clonal expansion of infected cells was detected as early as day 37 with high initial oligoclonality index, consistent with early mitotic proliferation. Conclusions In recipients infected through organ transplantation HTLV-1 disseminated rapidly despite early anti-HTLV-1 treatment. Proviral load set point was reached within 6 weeks. Seroconversion was not delayed. Unique integration site analysis and HTLV-1 2LTR DNA circles indicated early clonal expansion and high rate of infectious spread.
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Affiliation(s)
- Lucy B M Cook
- Section of Virology, Department of Medicine, Imperial College London, Norfolk Place, London, W2 1PG, UK.
| | - Anat Melamed
- Section of Virology, Department of Medicine, Imperial College London, Norfolk Place, London, W2 1PG, UK.
| | - Maria Antonietta Demontis
- Section of Virology, Department of Medicine, Imperial College London, Norfolk Place, London, W2 1PG, UK.
| | - Daniel J Laydon
- Section of Virology, Department of Medicine, Imperial College London, Norfolk Place, London, W2 1PG, UK.
| | - James M Fox
- Department of Biology and Hull York Medical School, Centre for Immunology and Infection, University of York, York, UK.
| | | | - Declan de Freitas
- Department of Renal Medicine, Manchester Royal Infirmary, Central Manchester NHS Foundation Trust, Oxford Road, Manchester, UK.
| | - Ashley D Price
- Department of Infection and Tropical Medicine, Royal Victoria Infirmary, Newcastle-upon-Tyne, UK.
| | - James F Medcalf
- John Walls Renal Unit, Leicester General Hospital, Gwendolen Road, Leicester, UK.
| | - Fabiola Martin
- Department of Biology and Hull York Medical School, Centre for Immunology and Infection, University of York, York, UK.
| | - James M Neuberger
- Organ Donation and Transplantation, NHS Blood and Transplant, Bristol, UK.
| | - Charles R M Bangham
- Section of Virology, Department of Medicine, Imperial College London, Norfolk Place, London, W2 1PG, UK.
| | - Graham P Taylor
- Section of Virology, Department of Medicine, Imperial College London, Norfolk Place, London, W2 1PG, UK.
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16
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Medcalf JF, Walls J, Pawluczyk IZ, Harris KP. Effects of glucose dialysate on extracellular matrix production by human peritoneal mesothelial cells (HPMC): the role of TGF-beta. Nephrol Dial Transplant 2001; 16:1885-92. [PMID: 11522874 DOI: 10.1093/ndt/16.9.1885] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Dialysate glucose has been implicated in the loss of peritoneal membrane function seen in long-term CAPD patients. METHODS In order to investigate this in vitro, human peritoneal mesothelial cells (HPMC) were cultured in a 50:50 mix of dialysis solution and M199 for 12 h. The dialysate was laboratory manufactured and designed to be identical in composition to PD4 (LAB). The final glucose concentration ranged between 5 and 40 mmol/l. Experiments were conducted in the presence and absence of an anti-transforming growth factor-beta (TGF-beta) antibody. Cell viability was measured by lactate dehydrogenase (LDH) release. Fibronectin (FN) and TGF-beta protein were measured by ELISA, and FN gene expression was measured by Northern analysis. Separately, the effects of recombinant TGF-beta(1) added to M199: dialysate at 5 mmol/l glucose were investigated. RESULTS Forty millimoles per litre d-glucose LAB caused a decrease in cell viability, as evidenced by an increase in LDH release (6.0+/-1.3 vs 2.6+/-0.7%). This effect was dependent on osmolality. Forty millimoles per litre d-glucose LAB stimulated a 15.4+/-4.6% increase in FN, a 46.5+/-18.3% increase in TGF-beta protein (both P<0.05), and 1.4+/-0.09-fold increase in FN mRNA compared with 5 mmol/l d-glucose LAB. Exogenous TGF-beta 0-1 ng/ml induced a dose-dependent increase in FN protein (280+/-45% increase at TGF-beta 1 ng/ml, P<0.0001), and FN mRNA levels (10.0+/-1.8-fold at TGF-beta 1 ng/ml). The increase in FN in response to 40 mmol/l glucose was significantly reduced by anti-TGF-beta antibody to levels not different from control (93.8+/-6.6%, P<0.05 vs no Ab). CONCLUSIONS These data suggest that the pro-fibrotic effect of glucose dialysate on HPMC is mediated through stimulation of TGF-beta, which promotes FN gene expression and protein production.
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Affiliation(s)
- J F Medcalf
- Department of Nephrology, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK
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Abstract
BACKGROUND Patients on continuous ambulatory peritoneal dialysis (CAPD) are dependent on residual renal function for solute and water clearances, and this declines with time on dialysis. Loop diuretics have been postulated to slow this decline. METHODS Sixty-one patients new to dialysis were randomly assigned to either furosemide 250 mg every day or no furosemide at the time of CAPD training and were followed prospectively. Urine volume (UV), urea clearance (C(Urea)), and creatinine clearance on cimetidine (C(Cr)) were measured at randomization at six months and at one year. Patients underwent a standard four-hour peritoneum equilibrium test, and total body water was measured by bioelectrical impedance. Results were expressed on an intention-to-treat basis. RESULTS UV, C(Cr), and C(Urea) were similar at randomization (1020 +/- 104 vs. 1040 +/- 130 mL/24 hours, 4.95 +/- 0.51 vs. 4.07 +/- 0.40 mL/min/1.73 m2, 0.91 +/- 0.09 vs. 0.84 +/- 0.08, diuretic vs. control). UV in the diuretic-treated group increased, whereas in the control group, it declined (+176 vs. -200 mL/24 hours at 6 months and +48.8 vs. -305 mL/24 hours at 1 year, P < 0.05). C(Cr) and C(Urea) declined at a constant rate and were unaffected by diuretic administration (0.12 +/- 0.05 vs. 0.071 +/- 0.04 mL/min/1.73 m2/month, 0.020 +/- 0.01 vs. 0.019 +/- 0.01 per month). Urinary sodium excretion increased in the diuretic group and declined in the control group (+0.72 +/- 0.85 vs. -2.56 +/- 1.31 mmol/24 hours/month, P = 0.04). Body weight rose in both groups (4.3 vs. 3.0 kg), but the percentage of total body weight rose in the control group and remained constant in the diuretic group (52 +/- 2.4 vs. 64 +/- 6.6%, P = 0.10). CONCLUSIONS Long-term furosemide produces a significant increase in UV over 12 months when on CAPD and may result in clinically significant improvement in fluid balance. However, furosemide has no effect on preserving residual renal function.
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Affiliation(s)
- J F Medcalf
- Department of Nephrology, Leicester General Hospital, Leicester, England, United Kingdom
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Medcalf JF, Harris KP, Walls J. Role of diuretics in the preservation of residual renal function in patients on continuous ambulatory peritoneal dialysis. Kidney Int 2001. [DOI: 10.1046/j.1523-1755.2001.00598.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Medcalf JF, Walls J. New frontiers in continuous ambulatory peritoneal dialysis. Kidney Int Suppl 1997; 62:S108-10. [PMID: 9350696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- J F Medcalf
- Department of Nephrology, Leicester General Hospital, England, United Kingdom
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Medcalf JF, Brownjohn AM, Turney JH. Pulmonary haemorrhage in association with IgA nephropathy. Nephrol Dial Transplant 1996; 11:1148-9. [PMID: 8671986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Affiliation(s)
- J F Medcalf
- The Renal Unit, The General Infirmary at Leeds, Leeds LS1 3EX, UK
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Rahman MA, Goodhead K, Medcalf JF, O'Connor M, Bennett T. Haemodynamic responses to nonhypotensive central hypovolaemia induced by lower body negative pressure in men and women. Eur J Appl Physiol Occup Physiol 1991; 63:151-5. [PMID: 1748107 DOI: 10.1007/bf00235186] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Haemodynamic responses to low levels of lower body negative pressure (LBNP) were investigated in two groups of healthy, normotensive volunteers (8 men and 8 women) during two repeated experimental runs on two occasions, the latter determined by the different phases of the menstrual cycle in the women. The data consisted of systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean blood pressure (MBP), pulse rate (fc), forearm blood flow (FBF) and forearm vascular conductance (FC). The resting cardiovascular status was similar in men and women, except that women had a significantly higher fc than men. LBNP (1.3, 2.7 and 4 kPa) had no significant effect on any BP variable or on fc. However, FBF and FC were reduced at all levels of LBNP. Significant overshoots in FBF and FC were seen in all subjects following the release of LBNP of 2.7 and 4 kPa and, in most cases, after release of LBNP of 1.3 kPa. There were no significant gender differences in any of the responses to LBNP. Furthermore, none of the cardiovascular variables measured showed significant differences between the follicular and luteal phases of the menstrual cycle in women, either at rest or during exposure to LBNP, and the responses in the men on the two occasions were not different. These findings indicate that gender differences in responses to LBNP hypothesized previously are not apparent during and after exposure to low levels of LBNP.
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Affiliation(s)
- M A Rahman
- Department of Physiology and Pharmacology, Medical School, Queen's Medical Centre, University of Nottingham, England
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