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McDonnell T, Storrar J, Chinnadurai R, Heal C, Chrysochou C, Ritchie J, Rainone F, Poulikakos D, Kalra P, Sinha S. The epidemiology of primary FSGS including cluster analysis over a 20-year period. BMC Nephrol 2023; 24:365. [PMID: 38072955 PMCID: PMC10712143 DOI: 10.1186/s12882-023-03405-w] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 11/21/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION Focal segmental glomerulosclerosis (FSGS) is one of the leading causes of nephrotic syndrome in adults. This epidemiological study describes a renal centre's 20-year experience of primary FSGS. METHODS Patients were identified with a diagnosis of primary FSGS after exclusion of known secondary causes. In this retrospective observational study, data was collected for baseline demographics, immunosuppression and outcomes. A two-step cluster analysis was used to identify natural groupings within the dataset. RESULTS The total cohort was made up of 87 patients. Those who received immunosuppression had lower median serum albumin than those who did not- 23g/L vs 40g/L (p<0.001) and higher median urine protein creatinine ratios (uPCR)- 795mg/mmol vs 318mg/mmol (p <0.001). They were more likely to achieve complete remission (62% vs 40%, p=0.041), but relapsed more 48.6% vs 22% (p=0.027). Overall 5 year mortality was 10.3% and 5 year progression to RRT was seen in 17.2%. Complete remission was observed in 49.4%. The 2-step cluster analysis separated the cohort into 3 clusters: cluster 1 (n=26) with 'nephrotic-range proteinuria'; cluster 2 (n=43) with 'non-nephrotic-range proteinuria'; and cluster 3 (n=18) with nephrotic syndrome. Immunosuppression use was comparable in clusters 1 and 3, but lower in cluster 2 (77.8% and 69.2% vs 11.6%, p<0.001). Rates of complete remission were greatest in clusters 1 and 3 vs cluster 2: 57.7% and 66.7% vs 37.2%. CONCLUSION People who received immunosuppression had lower serum albumin and achieved remission more frequently, but were also prone to relapse. Our cluster analysis highlighted 3 FSGS phenotypes: a nephrotic cluster that clearly require immunosuppression; a cohort with preserved serum albumin and non-nephrotic range proteinuria who will benefit from supportive care; and lastly a cluster with heavy proteinuria but serum albumin > 30g/L. This group may still have immune mediated disease and thus could potentially benefit from immunosuppression. TRIAL REGISTRATION This study protocol was reviewed and approved by the 'Research and Innovation committee of the Northern Care Alliance NHS Group', study approval number (Ref: ID 22HIP54).
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Affiliation(s)
- Thomas McDonnell
- Donal O'Donoghue Renal Research Centre, Northern Care Alliance NHS Foundation Trust, Salford Royal Hospital, Stott Lane, Salford, UK
- Faculty of Biology, Medicine and Health, School of Medical Sciences, University of Manchester, Oxford Road, Manchester, UK
| | - Joshua Storrar
- Donal O'Donoghue Renal Research Centre, Northern Care Alliance NHS Foundation Trust, Salford Royal Hospital, Stott Lane, Salford, UK
- Faculty of Biology, Medicine and Health, School of Medical Sciences, University of Manchester, Oxford Road, Manchester, UK
| | - Rajkumar Chinnadurai
- Donal O'Donoghue Renal Research Centre, Northern Care Alliance NHS Foundation Trust, Salford Royal Hospital, Stott Lane, Salford, UK
- Faculty of Biology, Medicine and Health, School of Medical Sciences, University of Manchester, Oxford Road, Manchester, UK
| | - Calvin Heal
- Centre for Biostatistics, University of Manchester, Oxford Road, Manchester, UK
| | - Constantina Chrysochou
- Donal O'Donoghue Renal Research Centre, Northern Care Alliance NHS Foundation Trust, Salford Royal Hospital, Stott Lane, Salford, UK
- Faculty of Biology, Medicine and Health, School of Medical Sciences, University of Manchester, Oxford Road, Manchester, UK
| | - James Ritchie
- Donal O'Donoghue Renal Research Centre, Northern Care Alliance NHS Foundation Trust, Salford Royal Hospital, Stott Lane, Salford, UK
- Faculty of Biology, Medicine and Health, School of Medical Sciences, University of Manchester, Oxford Road, Manchester, UK
| | - Francesco Rainone
- Donal O'Donoghue Renal Research Centre, Northern Care Alliance NHS Foundation Trust, Salford Royal Hospital, Stott Lane, Salford, UK
- Faculty of Biology, Medicine and Health, School of Medical Sciences, University of Manchester, Oxford Road, Manchester, UK
| | - Dimitrios Poulikakos
- Donal O'Donoghue Renal Research Centre, Northern Care Alliance NHS Foundation Trust, Salford Royal Hospital, Stott Lane, Salford, UK
- Faculty of Biology, Medicine and Health, School of Medical Sciences, University of Manchester, Oxford Road, Manchester, UK
| | - Philip Kalra
- Donal O'Donoghue Renal Research Centre, Northern Care Alliance NHS Foundation Trust, Salford Royal Hospital, Stott Lane, Salford, UK
- Faculty of Biology, Medicine and Health, School of Medical Sciences, University of Manchester, Oxford Road, Manchester, UK
| | - Smeeta Sinha
- Donal O'Donoghue Renal Research Centre, Northern Care Alliance NHS Foundation Trust, Salford Royal Hospital, Stott Lane, Salford, UK.
- Faculty of Biology, Medicine and Health, School of Medical Sciences, University of Manchester, Oxford Road, Manchester, UK.
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Al-Chalabi S, Santhirasekaran S, Kalra PA, Ritchie J, Poulikakos D, Sinha S. Revolutionising outpatient clinic experience (RevOCE): the future of chronic kidney disease care and associated multimorbidity. Future Healthc J 2023; 10:13-14. [PMID: 38406680 PMCID: PMC10884676 DOI: 10.7861/fhj.10-3-s13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Affiliation(s)
- Saif Al-Chalabi
- Renal Department, Salford Care Organisation, Northern Care Alliance NHS Foundation Trust, UK
| | | | - Philip A Kalra
- Renal Department, Salford Care Organisation, Northern Care Alliance NHS Foundation Trust, UK
| | - James Ritchie
- Renal Department, Salford Care Organisation, Northern Care Alliance NHS Foundation Trust, UK
| | - Dimitrios Poulikakos
- Renal Department, Salford Care Organisation, Northern Care Alliance NHS Foundation Trust, UK
| | - Smeeta Sinha
- Renal Department, Salford Care Organisation, Northern Care Alliance NHS Foundation Trust, UK
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Al-Chalabi S, Alderson H, Garratt N, Green D, Kalra PA, Ritchie J, Santhirasekaran S, Poulikakos D, Sinha S. Improving outpatient clinic experience: the future of chronic kidney disease care and associated multimorbidity. BMJ Open Qual 2023; 12:e002188. [PMID: 37532458 PMCID: PMC10401237 DOI: 10.1136/bmjoq-2022-002188] [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: 11/10/2022] [Accepted: 07/07/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) is estimated to affect more than 2.5 million adults in England, and this is expected to rise to 4.2 million by 2036 (1). Population-level digital healthcare systems have the potential to enable earlier detection of CKD providing an opportunity to introduce interventions that attenuate progression and reduce the risk of end-stage kidney disease (ESKD) and cardiovascular diseases (CVD). Services that can support patients with CKD, CVD, and diabetes mellitus (DM) have the potential to reduce fragmented clinical care and optimise pharmaceutical management. METHODS AND RESULTS The Salford renal service has established an outpatient improvement programme which aims to address these issues via two projects. Firstly, the development of a CKD dashboard that can stratify patients by their kidney failure risk equation (KFRE) risk. High-risk patients would be invited to attend an outpatient clinic if appropriate. Specialist advice and guidance would be offered to primary care providers looking after patients with medium risk. Patients with lower risk would continue with standard care via their primary care provider unless there was another indication for a nephrology referral. The CKD dashboard identified 11546 patients (4.4% of the total adult population in Salford) with T2DM and CKD. The second project is the establishment of the Metabolic CardioRenal (MRC) clinic. It provided care for 209 patients in the first 8 months of its establishment with a total of 450 patient visits. Initial analysis showed clustering of cardiorenal metabolic diseases with 85% having CKD stages 3 and 4 and 73.2% having DM. In addition, patients had a significant burden of CVD with 50.2% having hypertension and 47.8% having heart failure. CONCLUSION There is a pressing need to create new outpatient models of care to tackle the rising epidemic of cardio-renal metabolic diseases. This model of service has potential benefits at both organisational and patient levels including improving patient management via risk stratification, increased care capacity and reduction of variation of care. Patients will benefit from earlier intervention, appropriate referral for care, reduction in CKD-related complications, and reduction in hospital visits and cardiovascular events. In addition, this combined digital and patient-facing model of care will allow rapid translation of advances in cardio-renal metabolic diseases into clinical practice.
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Affiliation(s)
- Saif Al-Chalabi
- Department of Renal Medicine, Northern Care Alliance NHS Foundation Trust, Salford, UK
- Faculty of Biology Medicine and Health, The University of Manchester, Manchester, UK
| | - Helen Alderson
- Department of Renal Medicine, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - Natalie Garratt
- Research & Innovation, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - Darren Green
- Department of Renal Medicine, Northern Care Alliance NHS Foundation Trust, Salford, UK
- Faculty of Biology Medicine and Health, The University of Manchester, Manchester, UK
| | - Philip A Kalra
- Department of Renal Medicine, Northern Care Alliance NHS Foundation Trust, Salford, UK
- Faculty of Biology Medicine and Health, The University of Manchester, Manchester, UK
| | - James Ritchie
- Department of Renal Medicine, Northern Care Alliance NHS Foundation Trust, Salford, UK
- Faculty of Biology Medicine and Health, The University of Manchester, Manchester, UK
| | | | - Dimitrios Poulikakos
- Department of Renal Medicine, Northern Care Alliance NHS Foundation Trust, Salford, UK
- Faculty of Biology Medicine and Health, The University of Manchester, Manchester, UK
| | - Smeeta Sinha
- Department of Renal Medicine, Northern Care Alliance NHS Foundation Trust, Salford, UK
- Faculty of Biology Medicine and Health, The University of Manchester, Manchester, UK
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Storrar J, Gill-Taylor T, Chinnadurai R, Chrysochou C, Poulikakos D, Rainone F, Ritchie J, Lamerton E, Kalra PA, Sinha S. A low rate of end-stage kidney disease in membranous nephropathy: A single centre study over 2 decades. PLoS One 2022; 17:e0276053. [PMID: 36228014 PMCID: PMC9560622 DOI: 10.1371/journal.pone.0276053] [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: 07/08/2022] [Accepted: 09/27/2022] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Membranous nephropathy is the commonest cause of nephrotic syndrome in non-diabetic Caucasian adults over the age of 40 years. Primary membranous nephropathy is limited to the kidneys. Clinical management aims to induce remission, either spontaneously with supportive care, or with immunosuppression. Here, we describe the natural history of this condition in a large tertiary centre in the UK. METHODS 178 patients with primary membranous nephropathy were identified over 2 decades. We collected data on demographics, baseline laboratory values, treatment received and outcomes including progression to renal replacement therapy and death. Analysis was performed on the whole cohort and specific subgroups. Univariate and multivariate Cox regression was also performed. RESULTS Median age was 58.3 years with 63.5% male. Median baseline creatinine was 90μmol/L and urine protein-creatinine ratio 664g/mol. Remission (partial or complete) was achieved in 134 (75.3%), either spontaneous in 60 (33.7%) or after treatment with immunosuppression in 74 (41.6%), and of these 57 (42.5%) relapsed. Progression to renal replacement therapy was seen in 10.1% (much lower than classically reported) with mortality in 29.8%. Amongst the whole cohort, those who went into remission had improved outcomes compared to those who did not go into remission (less progression to renal replacement therapy [4.5% vs 28%] and death [20.1% vs 67%]. Those classified as high-risk (based on parameters including eGFR, proteinuria, serum albumin, PLA2R antibody level, rate of renal function decline) also had worse outcomes than those at low-risk (mortality seen in 52.6% vs 10.8%, p<0.001). The median follow-up period was 59.5 months. CONCLUSION We provide a comprehensive epidemiologic analysis of primary membranous nephropathy at a large tertiary UK centre. Only 10.1% progressed to renal replacement therapy. For novelty, the KDIGO risk classification was linked to outcomes, highlighting the utility of this classification system for identifying patients most likely to progress.
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Affiliation(s)
- Joshua Storrar
- Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, United Kingdom
- University of Manchester, Manchester, United Kingdom
- * E-mail:
| | - Tarra Gill-Taylor
- Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, United Kingdom
| | - Rajkumar Chinnadurai
- Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, United Kingdom
| | - Constantina Chrysochou
- Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, United Kingdom
| | - Dimitrios Poulikakos
- Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, United Kingdom
| | - Francesco Rainone
- Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, United Kingdom
| | - James Ritchie
- Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, United Kingdom
| | - Elizabeth Lamerton
- Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, United Kingdom
| | - Philip A. Kalra
- Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, United Kingdom
| | - Smeeta Sinha
- Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, United Kingdom
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Hamilton P, Kanigicherla D, Hanumapura P, Blaikie K, Ritchie J, Sinha S, Brenchley P, Mitra S. Peptide GAM immunoadsorption in anti-PLA 2 R positive autoimmune membranous nephropathy. The PRISM trial. J Clin Apher 2021; 37:40-53. [PMID: 34753218 DOI: 10.1002/jca.21949] [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: 07/08/2021] [Revised: 09/17/2021] [Accepted: 10/21/2021] [Indexed: 11/09/2022]
Abstract
Membranous nephropathy associated with anti-PLA2 R autoantibody is a significant cause of nephrotic syndrome worldwide. Treatment remains empiric with a significant side-effect burden despite an increase in our understanding of the disease. We studied the effect of selectively removing this pathogenic autoantibody using immunoadsorption in adult patients with biopsy proven anti-PLA2 R membranous nephropathy. This was a multicenter, single-arm prospective clinical trial carried out in the United Kingdom. Twelve patients underwent five consecutive sessions of peptide GAM immunoadsorption with 12 months follow-up. Primary outcome was anti-PLA2 R titer at week 2. Secondary outcomes were safety and tolerability of therapy, antibody profile, and change in proteinuria, renal excretory function, serum albumin, total immunoglobulin, and quality of life at weeks 12, 24, and 52. Patients were also stratified by the presence or absence of the high-risk allele (heterozygous or homozygous for HLA-DQA1*05). Median pretreatment anti-PLA2 R was 702.50 U/mL, 1045.00 U/mL at week 2 (P-value .023) and 165.00 U/mL at week 52 (P-value .017). The treatment was well tolerated and safe. Two patients required rescue immunosuppression during the follow-up period. There was a significant improvement in serum albumin with a median at baseline of 20.50 g/L rising to 25.00 g/L at week 52 (P-value <.001). There was no statistical difference over the follow-up period in proteinuria or renal function. Patients in possession of a high-risk allele saw improvement in anti-PLA2 R titers, possibly representing a cohort more likely to benefit from immunoadsorption. Immunoadsorption therapy is a safe treatment and well-tolerated treatment in anti-PLA2 R positive autoimmune membranous nephropathy.
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Affiliation(s)
- Patrick Hamilton
- Manchester Institute of Nephrology & Transplantation, Manchester Royal Infirmary, Manchester, UK.,Manchester Academic Health Science Centre (MAHSC), The University of Manchester, Manchester, UK.,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, UK
| | - Durga Kanigicherla
- Manchester Institute of Nephrology & Transplantation, Manchester Royal Infirmary, Manchester, UK.,Manchester Academic Health Science Centre (MAHSC), The University of Manchester, Manchester, UK
| | - Prasanna Hanumapura
- Manchester Institute of Nephrology & Transplantation, Manchester Royal Infirmary, Manchester, UK
| | - Kieran Blaikie
- Centre for Biostatistics, The University of Manchester, Manchester, UK
| | - James Ritchie
- Manchester Academic Health Science Centre (MAHSC), The University of Manchester, Manchester, UK.,Department of Renal Medicine, Salford Royal NHS Foundation Trust, Salford, UK
| | - Smeeta Sinha
- Manchester Academic Health Science Centre (MAHSC), The University of Manchester, Manchester, UK.,Department of Renal Medicine, Salford Royal NHS Foundation Trust, Salford, UK
| | - Paul Brenchley
- Manchester Institute of Nephrology & Transplantation, Manchester Royal Infirmary, Manchester, UK.,Manchester Academic Health Science Centre (MAHSC), The University of Manchester, Manchester, UK.,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, UK
| | - Sandip Mitra
- Manchester Institute of Nephrology & Transplantation, Manchester Royal Infirmary, Manchester, UK.,Manchester Academic Health Science Centre (MAHSC), The University of Manchester, Manchester, UK.,NIHR Devices for Dignity MedTech Cooperative, Sheffield, UK
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Lodge MDS, Abeygunaratne T, Alderson H, Ali I, Brown N, Chrysochou C, Donne R, Erekosima I, Evans P, Flanagan E, Gray S, Green D, Hegarty J, Hyde A, Kalra PA, Lamerton E, Lewis D, Middleton R, New D, Nipah R, O'Donoghue D, O'Riordan E, Poulikakos D, Rainone F, Raman M, Ritchie J, Sinha S, Wood G, Tollitt J. Safely reducing haemodialysis frequency during the COVID-19 pandemic. BMC Nephrol 2020; 21:532. [PMID: 33287730 PMCID: PMC7720264 DOI: 10.1186/s12882-020-02172-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 07/14/2020] [Accepted: 11/17/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients undergoing haemodialysis (HD) are at higher risk of developing worse outcomes if they contract COVID-19. In our renal service we reduced HD frequency from thrice to twice-weekly in selected patients with the primary aim of reducing COVID 19 exposure and transmission between HD patients. METHODS Dialysis unit nephrologists identified 166 suitable patients (38.4% of our HD population) to temporarily convert to twice-weekly haemodialysis immediately prior to the peak of the COVID-19 pandemic in our area. Changes in pre-dialysis weight, systolic blood pressure (SBP) and biochemistry were recorded weekly throughout the 4-week project. Hyperkalaemic patients (serum potassium > 6.0 mmol/L) were treated with a potassium binder, sodium bicarbonate and received responsive dietary advice. RESULTS There were 12 deaths (5 due to COVID-19) in the HD population, 6 of which were in the twice weekly HD group; no deaths were definitively associated with change of dialysis protocol. A further 19 patients were either hospitalised and/or developed COVID-19 and thus transferred back to thrice weekly dialysis as per protocol. 113 (68.1%) were still receiving twice-weekly HD by the end of the 4-week project. Indications for transfer back to thrice weekly were; fluid overload (19), persistent hyperkalaemia (4), patient request (4) and compliance (1). There were statistically significant increases in SBP and pre-dialysis potassium during the project. CONCLUSIONS Short term conversion of a large but selected HD population to twice-weekly dialysis sessions was possible and safe. This approach could help mitigate COVID-19 transmission amongst dialysis patients in centres with similar organisational pressures.
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Affiliation(s)
| | - Thilini Abeygunaratne
- Department of Renal Medicine, Salford Royal NHS Trust, Stott Lane, Salford, M68HD, UK
| | - Helen Alderson
- Department of Renal Medicine, Salford Royal NHS Trust, Stott Lane, Salford, M68HD, UK
| | - Ibrahim Ali
- Department of Renal Medicine, Salford Royal NHS Trust, Stott Lane, Salford, M68HD, UK
| | - Nina Brown
- Department of Renal Medicine, Salford Royal NHS Trust, Stott Lane, Salford, M68HD, UK
| | | | - Rosie Donne
- Department of Renal Medicine, Salford Royal NHS Trust, Stott Lane, Salford, M68HD, UK
| | - Ibi Erekosima
- Department of Renal Medicine, Salford Royal NHS Trust, Stott Lane, Salford, M68HD, UK
| | - Philip Evans
- Department of Renal Medicine, Salford Royal NHS Trust, Stott Lane, Salford, M68HD, UK
| | - Emma Flanagan
- Department of Renal Medicine, Salford Royal NHS Trust, Stott Lane, Salford, M68HD, UK
| | - Simon Gray
- Department of Renal Medicine, Salford Royal NHS Trust, Stott Lane, Salford, M68HD, UK
| | - Darren Green
- Department of Renal Medicine, Salford Royal NHS Trust, Stott Lane, Salford, M68HD, UK
| | - Janet Hegarty
- Department of Renal Medicine, Salford Royal NHS Trust, Stott Lane, Salford, M68HD, UK
| | - Audrey Hyde
- Department of Renal Medicine, Salford Royal NHS Trust, Stott Lane, Salford, M68HD, UK
| | - Philip A Kalra
- Department of Renal Medicine, Salford Royal NHS Trust, Stott Lane, Salford, M68HD, UK
| | - Elizabeth Lamerton
- Department of Renal Medicine, Salford Royal NHS Trust, Stott Lane, Salford, M68HD, UK
| | - David Lewis
- Department of Renal Medicine, Salford Royal NHS Trust, Stott Lane, Salford, M68HD, UK
| | - Rachel Middleton
- Department of Renal Medicine, Salford Royal NHS Trust, Stott Lane, Salford, M68HD, UK
| | - David New
- Department of Renal Medicine, Salford Royal NHS Trust, Stott Lane, Salford, M68HD, UK
| | - Robert Nipah
- Department of Renal Medicine, Salford Royal NHS Trust, Stott Lane, Salford, M68HD, UK
| | - Donal O'Donoghue
- Department of Renal Medicine, Salford Royal NHS Trust, Stott Lane, Salford, M68HD, UK
| | - Edmond O'Riordan
- Department of Renal Medicine, Salford Royal NHS Trust, Stott Lane, Salford, M68HD, UK
| | - Dimitrios Poulikakos
- Department of Renal Medicine, Salford Royal NHS Trust, Stott Lane, Salford, M68HD, UK
| | - Francesco Rainone
- Department of Renal Medicine, Salford Royal NHS Trust, Stott Lane, Salford, M68HD, UK
| | - Maharajan Raman
- Department of Renal Medicine, Salford Royal NHS Trust, Stott Lane, Salford, M68HD, UK
| | - James Ritchie
- Department of Renal Medicine, Salford Royal NHS Trust, Stott Lane, Salford, M68HD, UK
| | - Smeeta Sinha
- Department of Renal Medicine, Salford Royal NHS Trust, Stott Lane, Salford, M68HD, UK
| | - Grahame Wood
- Department of Renal Medicine, Salford Royal NHS Trust, Stott Lane, Salford, M68HD, UK
| | - J Tollitt
- Department of Renal Medicine, Salford Royal NHS Trust, Stott Lane, Salford, M68HD, UK.
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Dupuis LL, Quinones CM, Ritchie J, Carpenter PA, Bauters T, Yeh RF, Anasetti C, Boelens JJ, Hamerschlak N, Hassan M, Kang HJ, Kanda Y, Paci A, Perales MA, Shaw PJ, Seewaldt VL, Savani BN, Militano O, Pulsipher MA, McCune JS. Response to Kawedia et al Letter to Editor in Response to the Article by McCune Et Al "Harmonization of Busulfan Plasma Exposure Unit (BPEU): A Community-Initiated Consensus Statement". Biol Blood Marrow Transplant 2020; 26:e235-e236. [PMID: 32531439 DOI: 10.1016/j.bbmt.2020.06.001] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 06/01/2020] [Indexed: 11/19/2022]
Affiliation(s)
- L Lee Dupuis
- Department of Pharmacy and Research Institute, The Hospital for Sick Children and Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
| | - Christine M Quinones
- Department of Population Sciences, Beckman Research Institute at City of Hope, Duarte, CA, USA
| | - James Ritchie
- Pathology & Laboratory Medicine Department, Emory University, Atlanta, GA, USA
| | - Paul A Carpenter
- Clinical Research Division, Fred Hutchinson Cancer Research Center and Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Tiene Bauters
- Chair, European Society for Blood and Marrow Transplantation (EBMT) Pharmacist Committee, Pediatric Hemato-Oncology & Stem Cell Transplantation, Ghent University Hospital, Belgium
| | - Rosa F Yeh
- Pharmacokinetics Laboratory, Seattle Cancer Care Alliance, Seattle, WA, USA
| | - Claudio Anasetti
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Jaap J Boelens
- Chief, Stem Cell Transplantation and Cellular Therapies, MSK Kids, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Nelson Hamerschlak
- Hematology and Bone Marrow Transplantation Department, Hospital Israelita Albert Einstein, São Paulo Area, Brazil
| | - Moustapha Hassan
- Division of Experimental Cancer Medicine, Department of Laboratory Medicine at Karolinska Institutet and Division of Clinical Research Centrum at Karolinska University Hospital, Stockholm, Sweden
| | - Hyoung Jin Kang
- Department of Pediatrics, Seoul National Univeristy College of Medicine, Seoul National University Cancer Research Institute, Seoul National University Children's Hospital, Seoul, Korea
| | - Yoshinobu Kanda
- Division of Hematology, Department of Medicine, Jichi Medical University and Division of Hematology, Saitama Medical Center, Jichi Medical University, Japan
| | - Angelo Paci
- Department of Pharmacology, Institute Gustave Roussy Cancer Center, Grand Paris, School of Pharmacy - Paris Sud University, France
| | - Miguel-Angel Perales
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center and Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Peter J Shaw
- BMT Services, The Children's Hospital at Westmead, Westmead, New South Wales, and Discipline of Child and Adolescent Health, University of Sydney, Australia
| | - Victoria L Seewaldt
- Department of Population Sciences, Beckman Research Institute at City of Hope, Duarte, CA, USA
| | - Bipin N Savani
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Michael A Pulsipher
- Transplantation and Cellular Therapy Section, Children's Hospital Los Angeles Cancer and Blood Disease Institute, USC Keck School of Medicine, Los Angeles, CA, USA
| | - Jeannine S McCune
- Department of Population Sciences, Beckman Research Institute at City of Hope, Duarte, CA, USA.
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8
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Misra G, Sim J, El‐Gizawy Z, Watts K, Jerreat S, Coia T, Ritchie J, O'Brien S. Laparoscopic ablation or excision with helium thermal coagulator versus electrodiathermy for the treatment of mild‐to‐moderate endometriosis: randomised controlled trial. BJOG 2020; 127:1528-1535. [DOI: 10.1111/1471-0528.16279] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2020] [Indexed: 11/30/2022]
Affiliation(s)
- G Misra
- Maternity Unit University Hospitals of North Midlands Royal Stoke University Hospital Stoke‐on‐Trent Staffordshire UK
| | - J Sim
- School of Primary, Community and Social Care Keele University Keele Staffordshire UK
| | - Z El‐Gizawy
- Maternity Unit University Hospitals of North Midlands Royal Stoke University Hospital Stoke‐on‐Trent Staffordshire UK
| | - K Watts
- Research and Innovation University Hospitals of North Midlands Royal Stoke University Hospital Stoke‐on‐Trent Staffordshire UK
| | - S Jerreat
- Maternity Unit University Hospitals of North Midlands Royal Stoke University Hospital Stoke‐on‐Trent Staffordshire UK
| | - T Coia
- Maternity Unit University Hospitals of North Midlands Royal Stoke University Hospital Stoke‐on‐Trent Staffordshire UK
| | - J Ritchie
- Maternity Unit University Hospitals of North Midlands Royal Stoke University Hospital Stoke‐on‐Trent Staffordshire UK
| | - S O'Brien
- Maternity Unit University Hospitals of North Midlands Royal Stoke University Hospital Stoke‐on‐Trent Staffordshire UK
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9
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Reilly E, Alshakh R, Beynon C, Cates M, Das D, Majeed S, Memon A, O'Beirn P, Ritchie J, Pauling JD. Differing commissioning arrangements may contribute to geographic variation in clinical management of digital ulcers in systemic sclerosis. Clin Med (Lond) 2020; 20:343-345. [PMID: 32414728 PMCID: PMC7354016 DOI: 10.7861/clinmed.2020-0031] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Phosphodiesterase inhibitors (such as sildenafil) and endothelin receptor antagonist, bosentan, are effective for digital ulcer disease in systemic sclerosis (SSc-DU) and are endorsed in international treatment recommendations. Commissioning of high-cost drugs, such as bosentan, however, differs across devolved nations of the UK. We report a multicentre service evaluation project to examine 'real world' management of SSc-DU before and following the 2015 UK Scleroderma Study Group (UKSSG) guidance, across south-west (SW) England and Wales. Results showed that iloprost and sildenafil use for SSc-DU was higher in patients in Wales prior to 2015. Between 2015-2017, sildenafil use for SSc-DU increased in SW England while remaining stable in Wales. Bosentan use for SSc-DU after 2015 in SW England increased, while remaining stable and proportionately lower in Wales. These findings demonstrate that differing commissioning guidance across devolved nations of the UK seems to contribute to geographic variation in patient care.
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Affiliation(s)
- Elizabeth Reilly
- Royal National Hospital for Rheumatic Diseases, Bath, UK and University of Bath, Bath, UK
| | | | | | | | | | | | | | | | | | - John D Pauling
- Royal National Hospital for Rheumatic Diseases, Bath, UK and University of Bath, Bath, UK
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10
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Fenton A, Chinnadurai R, Gullapudi L, Kampanis P, Dasgupta I, Ritchie J, Harding S, Ferro CJ, Kalra PA, Taal MW, Cockwell P. Association between non-malignant monoclonal gammopathy and adverse outcomes in chronic kidney disease: A cohort study. PLoS Med 2020; 17:e1003050. [PMID: 32109242 PMCID: PMC7048272 DOI: 10.1371/journal.pmed.1003050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 02/03/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In studies including the general population, the presence of non-malignant monoclonal gammopathy (MG) can be causally associated with kidney damage and shorter survival. We assessed whether the presence of an MG is associated with a higher risk of kidney failure or death in individuals with chronic kidney disease (CKD). METHODS AND FINDINGS Data were used from 3 prospective cohorts of individuals with CKD (not on dialysis or with a kidney transplant): (1) Renal Impairment in Secondary Care (RIISC, Queen Elizabeth Hospital and Heartlands Hospital, Birmingham, UK, N = 878), (2) Salford Kidney Study (SKS, Salford Royal Hospital, Salford, UK, N = 861), and (3) Renal Risk in Derby (RRID, Derby, UK, N = 1,739). Participants were excluded if they had multiple myeloma or any other B cell lymphoproliferative disorder with end-organ damage. Median age was 71.0 years, 50.6% were male, median estimated glomerular filtration rate was 42.3 ml/min/1.73 m2, and median urine albumin-to-creatinine ratio was 3.4 mg/mmol. All non-malignant MG was identified in the baseline serum of participants of RIISC. Further, light chain MG (LC-MG) was identified and studied in participants of RIISC, SKS, and RRID. Participants were followed up for kidney failure (defined as the initiation of dialysis or kidney transplantation) and death. Associations with the risk of kidney failure were estimated by competing-risks regression (handling death as a competing risk), and associations with death were estimated by Cox proportional hazards regression. In total, 102 (11.6%) of the 878 RIISC participants had an MG. During a median follow-up time of 74.0 months, there were 327 kidney failure events and 202 deaths. The presence of MG was not associated with risk of kidney failure (univariable subhazard ratio [SHR] 0.97 [95% CI 0.68 to 1.38], P = 0.85; multivariable SHR 1.16 [95% CI 0.80 to 1.69], P = 0.43), and although there was a higher risk of death in univariable analysis (hazard ratio [HR] 2.13 [95% CI 1.49 to 3.02], P < 0.001), this was not significant in multivariable analysis (HR 1.37 [95% CI 0.93 to 2.00], P = 0.11). Fifty-five (1.6%) of the 3,478 participants from all 3 studies had LC-MG. During a median follow-up time of 62.5 months, 564 of the 3,478 participants progressed to kidney failure, and 803 died. LC-MG was not associated with risk of kidney failure (univariable SHR 1.07 [95% CI 0.58 to 1.96], P = 0.82; multivariable SHR 1.42 [95% CI 0.78 to 2.57], P = 0.26). There was a higher risk of death in those with LC-MG in the univariable model (HR 2.51 [95% CI 1.59 to 3.96], P < 0.001), but not in the multivariable model (HR 1.49 [95% CI 0.93 to 2.39], P = 0.10). An important limitation of this work was that only LC-MG, rather than any MG, could be identified in participants from SKS and RRID. CONCLUSIONS The prevalence of MG was higher in this CKD cohort than that reported in the general population. However, the presence of an MG was not independently associated with a significantly higher risk of kidney failure or, unlike in the general population, risk of death.
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Affiliation(s)
- Anthony Fenton
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
- * E-mail:
| | | | - Latha Gullapudi
- Division of Medical Sciences and Graduate Entry Medicine, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | | | - Indranil Dasgupta
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - James Ritchie
- Salford Royal NHS Foundation Trust, Salford, United Kingdom
| | | | - Charles J. Ferro
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | | | - Maarten W. Taal
- Division of Medical Sciences and Graduate Entry Medicine, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Paul Cockwell
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
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11
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Sykes L, Asar O, Ritchie J, Raman M, Vassallo D, Alderson HV, O’Donoghue DJ, Green D, Diggle PJ, Kalra PA. The influence of multiple episodes of acute kidney injury on survival and progression to end stage kidney disease in patients with chronic kidney disease. PLoS One 2019; 14:e0219828. [PMID: 31318937 PMCID: PMC6638939 DOI: 10.1371/journal.pone.0219828] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 07/02/2019] [Indexed: 11/18/2022] Open
Abstract
Background Acute kidney injury (AKI) and chronic kidney disease (CKD) are common syndromes associated with significant morbidity, mortality and cost. The extent to which repeated AKI episodes may cumulatively affect the rate of progression of all-cause CKD has not previously been investigated. In this study, we explored the hypothesis that repeated episodes of AKI increase the rate of renal functional deterioration loss in patients recruited to a large, all-cause CKD cohort. Methods Patients from the Salford Kidney Study (SKS) were considered. Application of KDIGO criteria to all available laboratory measurements of renal function identified episodes of AKI. A competing risks model was specified for four survival events: Stage 1 AKI; stage 2 or 3 AKI; dialysis initiation or transplant before AKI event; death before AKI event. The model was adjusted for patient age, gender, smoking status, alcohol intake, diabetic status, cardiovascular co-morbidities, and primary renal disease. Analyses were performed for patients’ first, second, and third or more AKI episodes. Results A total of 48,338 creatinine measurements were available for 2287 patients (median 13 measures per patient [IQR 6–26]). There was a median age of 66.8years, median eGFR of 28.4 and 31.6% had type 1 or 2 diabetes. Six hundred and forty three (28.1%) patients suffered one or more AKI events; 1000 AKI events (58% AKI 1) in total were observed over a median follow-up of 2.6 years [IQR 1.1–3.2]. In patients who suffered an AKI, a second AKI was more likely to be a stage 2 or 3 AKI than stage 1 [HR 2.04, p 0.01]. AKI events were associated with progression to RRT, with multiple episodes of AKI progressively increasing likelihood of progression to RRT [HR 14.4 after 1 episode of AKI, HR 28.4 after 2 episodes of AKI]. However, suffering one or more AKI events was not associated with an increased risk of mortality. Conclusions AKI events are associated with more rapid CKD deterioration as hypothesised, and also with a greater severity of subsequent AKI. However, our study did not find an association of AKI with increased mortality risk in this CKD cohort.
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Affiliation(s)
- Lynne Sykes
- Department of Renal Medicine, Salford Royal NHS Foundation Trust, Salford, United Kingdom
| | - Ozgur Asar
- Department of Biostatistics and Medical Informatics, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - James Ritchie
- Department of Renal Medicine, Salford Royal NHS Foundation Trust, Salford, United Kingdom
| | - Maharajan Raman
- Department of Renal Medicine, Salford Royal NHS Foundation Trust, Salford, United Kingdom
| | - Diana Vassallo
- Department of Renal Medicine, Salford Royal NHS Foundation Trust, Salford, United Kingdom
| | - Helen V. Alderson
- Department of Renal Medicine, Salford Royal NHS Foundation Trust, Salford, United Kingdom
| | - Donal J. O’Donoghue
- Department of Renal Medicine, Salford Royal NHS Foundation Trust, Salford, United Kingdom
| | - Darren Green
- Department of Renal Medicine, Salford Royal NHS Foundation Trust, Salford, United Kingdom
- * E-mail:
| | - Peter J. Diggle
- CHICAS Research Group, Lancaster Medical School, Lancaster University, Lancaster, United Kingdom
| | - Philip A. Kalra
- Department of Renal Medicine, Salford Royal NHS Foundation Trust, Salford, United Kingdom
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Sykes L, Asar O, Ritchie J, Diggle P, Kalra PA. FO073THE EFFECT OF REPEATED ACUTE KIDNEY INJURY ON SURVIVAL AND PROGRESSION TO END STAGE KIDNEY DISEASE IN CKD. Nephrol Dial Transplant 2019. [DOI: 10.1093/ndt/gfz096.fo073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Lynne Sykes
- Salford Royal NHS Foundation Trust, Manchester, United Kingdom
| | - Osgur Asar
- Acibadem University Hospital Atakent, Istanbul, Turkey, Turkey
| | - James Ritchie
- Salford Royal NHS Foundation Trust, Manchester, United Kingdom
| | - Peter Diggle
- Lancaster University, Bailrigg, Lancaster, UK, Bailrigg, United Kingdom
| | - Phillip A Kalra
- Salford Royal NHS Foundation Trust, Manchester, United Kingdom
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13
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McCune JS, Quinones CM, Ritchie J, Carpenter PA, van Maarseveen E, Yeh RF, Anasetti C, Boelens JJ, Hamerschlak N, Hassan M, Kang HJ, Kanda Y, Paci A, Perales MA, Shaw PJ, Seewaldt VL, Savani BN, Hsieh A, Poon B, Mohty M, Pulsipher MA, Pasquini M, Dupuis LL. Harmonization of Busulfan Plasma Exposure Unit (BPEU): A Community-Initiated Consensus Statement. Biol Blood Marrow Transplant 2019; 25:1890-1897. [PMID: 31136799 DOI: 10.1016/j.bbmt.2019.05.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 03/05/2019] [Revised: 04/26/2019] [Accepted: 05/21/2019] [Indexed: 12/12/2022]
Abstract
Busulfan therapeutic drug monitoring (TDM) is often used to achieve target plasma exposures. Variability in busulfan plasma exposure units (BPEU) is a potential source for misinterpretation of publications and protocols and is a barrier to data capture by hematopoietic cell transplantation (HCT) registry databases. We sought to harmonize to a single BPEU for international use. Using Delphi consensus methodology, iterative surveys were sent to an increasing number of relevant clinical stakeholders. In survey 1, 14 stakeholders were asked to identify ideal properties of a BPEU. In survey 2, 52 stakeholders were asked (1) to evaluate BPEU candidates according to ideal BPEU properties established by survey 1 and local position statements for TDM and (2) to identify potential facilitators and barriers to adoption of the harmonized BPEU. The most frequently used BPEU identified, in descending order, were area under the curve (AUC) in μM × min, AUC in mg × h/L, concentration at steady state (Css) in ng/mL, AUC in μM × h, and AUC in μg × h/L. All respondents conceptually agreed on the ideal properties of a BPEU and to adopt a harmonized BPEU. Respondents were equally divided between selecting AUC in μM × min versus mg × h/L for harmonization. AUC in mg × h/L was finally selected as the harmonized BPEU, because it satisfied most of the survey-determined ideal properties for the harmonized BPEU and is read easily understood in the clinical practice environment. Furthermore, 10 major professional societies have endorsed AUC in mg × h/L as the harmonized unit for reporting to HCT registry databases and for use in future protocols and publications.
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Affiliation(s)
- Jeannine S McCune
- Clinical Research Division, Fred Hutchinson Cancer Research Center and Department of Pharmaceutics, University of Washington, Seattle, WA, USA; Molecular Prevention, Intervention and Technology Division, Beckman Research Institute, City of Hope, Duarte, CA, USA.
| | - Christine M Quinones
- Molecular Prevention, Intervention and Technology Division, Beckman Research Institute at City of Hope, Duarte, CA, USA
| | - James Ritchie
- Pathology & Laboratory Medicine Department, Emory University, Atlanta, GA, USA
| | - Paul A Carpenter
- Clinical Research Division, Fred Hutchinson Cancer Research Center and Department of Pharmaceutics, University of Washington, Seattle, WA, USA
| | - Erik van Maarseveen
- Clinical Pharmacology, University Medical Center Utrecht, Utrecht, Princess Maxima Center for Pediatric Oncology, Utrecht and Drug Analysis and Toxicology division (KKGT) of the Dutch Foundation for Quality Assessment in Medical Laboratories (SKML), Utrecht, Netherlands
| | - Rosa F Yeh
- Pharmacokinetics Laboratory, Seattle Cancer Care Alliance, Seattle, WA, USA
| | - Claudio Anasetti
- Department of Blood and Marrow Transplant, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA; Molecular Prevention, Intervention and Technology Division, Beckman Research Institute, City of Hope, Duarte, CA, USA
| | - Jaap J Boelens
- Pediatric Blood and Marrow Transplantation Program, University Medical Center Utrecht, Utrecht, Princess Maxima Center for Pediatric Oncology, Utrecht, Netherlands; Stem Cell Transplantation and Cellular Therapies, MSK Kids, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Nelson Hamerschlak
- Hematology and Bone Marrow Transplantation Department, Hospital Israelita Albert Einstein, São Paulo Area, Brazil
| | - Moustapha Hassan
- Division of Experimental Cancer Medicine, Department of Laboratory Medicine at Karolinska Institutet and Division of Clinical Research Centrum at Karolinska University Hospital, Stockholm, Sweden
| | - Hyoung Jin Kang
- Department of Pediatrics, Seoul National Univeristy College of Medicine, Seoul National University Cancer Research Institute, Seoul National University Children's Hospital, Seoul, Korea
| | - Yoshinobu Kanda
- Division of Hematology, Department of Medicine, Jichi Medical University and Division of Hematology, Saitama Medical Center, Jichi Medical University, Japan
| | - Angelo Paci
- Department of Pharmacology, Institute Gustave Roussy Cancer Center, Grand Paris, School of Pharmacy - Paris Sud University, France
| | - Miguel-Angel Perales
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center and Department of Medicine, Weill Cornell Medical College New York, NY, USA
| | - Peter J Shaw
- BMT Services, The Children's Hospital at Westmead, Westmead, New South Wales, and Discipline of Child and Adolescent Health, University of Sydney, Australia
| | - Victoria L Seewaldt
- Molecular Prevention, Intervention and Technology Division, Beckman Research Institute at City of Hope, Duarte, CA, USA
| | - Bipin N Savani
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Angela Hsieh
- Medical Content Manager at McKesson Specialty Health, Seattle, WA, USA
| | - Betsy Poon
- Department of Pharmacy, AdventHealth for Children, Orlando, FL, USA
| | - Mohamad Mohty
- Department of Hematology and Cell Therapy, Acute Leukemia Working Party EBMT Paris Office, Hôpital Saint-Antoine, Paris, France
| | - Michael A Pulsipher
- Division of Hematology, Oncology, and Blood and Marrow Transplantation, Children's Hospital Los Angeles, USC Keck School of Medicine, Los Angeles, CA, USA
| | - Marcelo Pasquini
- CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - L Lee Dupuis
- Department of Pharmacy and Research Institute, The Hospital for Sick Children and Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
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Tollitt J, Bennett N, Darby D, Flanagan E, Chadwick P, Sinha S, Kalra PA, Ritchie J, Poulikakos D. The importance of acute kidney injury in suspected community acquired infection. PLoS One 2019; 14:e0216412. [PMID: 31063508 PMCID: PMC6504101 DOI: 10.1371/journal.pone.0216412] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 04/21/2019] [Indexed: 01/18/2023] Open
Abstract
Background Most sepsis and acute kidney injury (AKI) cases are community acquired (CA). The aim of this study was to evaluate the characteristics of suspected community acquired infection (sCA-I) and CA-AKI and their impact upon patient outcomes. Methods All adult creatinine blood tests from non-elective, non-dialysis attendances to a single centre over a 29-month period were analysed retrospectively. We defined sCA-I and CA-AKI cases as antibiotic prescription and AKI alert within 48 hours of attendance respectively. Binary logistic regression models were created to determine associations with 30-day mortality, intensive care unit (ICU) admission and length of stay (LOS) dichotomised at median. Results Of 61,471 attendances 28.1% and 5.7% suffered sCA-I or CA-AKI in isolation respectively, 3.4% suffered both. sCA-I was present in 58.8% of CA-AKI cases and CA-AKI was present in 11.9% of CA-I cases. The combination of sCA-I and CA-AKI was associated with a higher risk for all outcomes compared to sCA-I or CA-AKI in isolation. The 30-day mortality was 8.1%, 11.8% and 26.2% in patients with sCA-I, CA-AKI and when sCA-I and CA-AKI occurred in combination respectively. The adjusted odds ratios (OR) and 95% confidence intervals (CI) for 30-day mortality, ICU admission and LOS for sCA-I combined with CA-AKI stage 1 were OR 6.09:CI: 5.21–7.12, OR 12.52 CI: 10.54–14.88 and OR 8.97 CI: 7.62–10.56, respectively, and for combined sCA-I and CA-AKI stage 3 were OR 9.23 CI: 6.91–12.33, OR 29.26 CI: 22.46–38.18 and OR 9.48 CI: 6.82–13.18 respectively. Conclusion The combination of sCA-I and CA-AKI is associated with worse outcomes.
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Affiliation(s)
- James Tollitt
- Renal Department, Salford Royal NHS Trust, Salford, United Kingdom
- University of Manchester, Oxford Road, Manchester, United Kingdom
- * E-mail:
| | - Nicola Bennett
- University of Manchester, Oxford Road, Manchester, United Kingdom
| | - Denise Darby
- Pathology Department, Salford Royal NHS Trust, Salford, United Kingdom
| | - Emma Flanagan
- Informatics Department, Salford Royal NHS Trust, Salford, United Kingdom
| | - Paul Chadwick
- Pathology Department, Salford Royal NHS Trust, Salford, United Kingdom
| | - Smeeta Sinha
- Renal Department, Salford Royal NHS Trust, Salford, United Kingdom
- University of Manchester, Oxford Road, Manchester, United Kingdom
| | - Philip A. Kalra
- Renal Department, Salford Royal NHS Trust, Salford, United Kingdom
- University of Manchester, Oxford Road, Manchester, United Kingdom
| | - James Ritchie
- Renal Department, Salford Royal NHS Trust, Salford, United Kingdom
- University of Manchester, Oxford Road, Manchester, United Kingdom
| | - Dimitrios Poulikakos
- Renal Department, Salford Royal NHS Trust, Salford, United Kingdom
- University of Manchester, Oxford Road, Manchester, United Kingdom
- AKI Lead for Greater Manchester and Eastern Cheshire Strategic Clinical Networks, Manchester, United Kingdom
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15
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Vassallo D, Alderson H, Vuilleumier N, Ritchie J, Green D, Pagano S, Virzi J, Chrysochou C, Kalra PA. Association of novel biomarkers with major clinical outcomes in a cohort of patients with atherosclerotic renovascular disease. Ann Clin Biochem 2019; 56:488-501. [PMID: 31037953 DOI: 10.1177/0004563219850850] [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] [Indexed: 11/16/2022]
Abstract
Introduction In this study, we investigate whether the addition of biomarkers to a model based on traditional risk factors improves risk prediction and patient selection for revascularization in atherosclerotic renovascular disease. Methods Patients in the Salford Renovascular Study who had the following biomarkers analysed on a baseline sample were included in this study: FGF-23, Cystatin C, kidney injury molecule-1, myeloperoxidase, neutrophil gelatinase-associated lipocalin, N-terminal prohormone of brain natriuretic peptide (NT-proBNP), high-sensitivity Troponin T and anti-apolipoprotein A1 IgG. Cox proportional hazards models and net reclassification index were used to study the effects of either individual or a panel of biomarkers on predicting death, end-stage kidney disease and cardiovascular events. Results A total of 112 patients were followed up for a median 59.9 months (IQR 33.6–86.9). In total, 75 patients died, 21 reached end-stage kidney disease and 36 suffered a cardiovascular event. Only NT-proBNP maintained a statistically significant association with all end-points (death: HR 1.62 [95% CI 1.26–2.10], P < 0.0005; end-stage kidney disease: HR 1.51 [95% 1.19–1.91], P = 0.001; cardiovascular event: HR 1.56 [95% CI 1.23–1.97], P < 0.0005). Risk reclassification improved with addition of all biomarkers as a panel to the base model. Only patients with NT-proBNP concentrations above 300 ng/L gained benefit from revascularization with regard to all adverse end-points compared with medically managed patients. Conclusions NT-proBNP is independently associated with increased risk for all adverse events in atherosclerotic renovascular disease. Novel biomarkers may have an incremental risk predictive value when used in combination with traditional risk factors, and NT-proBNP may have value in patient selection for revascularization. Given the small size of this study, larger multicentre studies are required to validate these findings.
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Affiliation(s)
- Diana Vassallo
- 1 Department of Renal Medicine, Salford Royal NHS Foundation Trust, Salford, UK
| | - Helen Alderson
- 1 Department of Renal Medicine, Salford Royal NHS Foundation Trust, Salford, UK
| | - Nicolas Vuilleumier
- 2 Division of Laboratory Medicine, Department of Genetics and Laboratory Medicine, Geneva University Hospital, Geneva, Switzerland.,3 Department of Human Protein Sciences, Geneva Faculty of Medicine, Geneva, Switzerland
| | - James Ritchie
- 1 Department of Renal Medicine, Salford Royal NHS Foundation Trust, Salford, UK
| | - Darren Green
- 1 Department of Renal Medicine, Salford Royal NHS Foundation Trust, Salford, UK
| | - Sabrina Pagano
- 2 Division of Laboratory Medicine, Department of Genetics and Laboratory Medicine, Geneva University Hospital, Geneva, Switzerland.,3 Department of Human Protein Sciences, Geneva Faculty of Medicine, Geneva, Switzerland
| | - Julien Virzi
- 2 Division of Laboratory Medicine, Department of Genetics and Laboratory Medicine, Geneva University Hospital, Geneva, Switzerland.,3 Department of Human Protein Sciences, Geneva Faculty of Medicine, Geneva, Switzerland
| | | | - Philip A Kalra
- 1 Department of Renal Medicine, Salford Royal NHS Foundation Trust, Salford, UK
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Reilly E, Alshakh R, Beynon C, Cates M, Das D, Majeed S, Memon A, O’Beirn P, Ritchie J, Pauling JD. 003 Changes in the management of systemic sclerosis-related digital ulcer disease between 2015-2017 across devolved nations of the United Kingdom: a multi-centre service evaluation project across South West England and Wales. Rheumatology (Oxford) 2019. [DOI: 10.1093/rheumatology/kez106.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Elizabeth Reilly
- Rheumatology, Royal National Hospital for Rheumatic Diseases, Bath, UNITED KINGDOM
- Pharmacy and Pharmacology, University of Bath, Bath, UNITED KINGDOM
| | - Randa Alshakh
- Rheumatology, Bristol Royal Infirmary, Bristol, UNITED KINGDOM
| | - Celia Beynon
- Rheumatology, University Hospital of Wales, Cardiff, UNITED KINGDOM
| | - Matthew Cates
- Rheumatology, Torbay and South Devon NHS Trust, Torquay, UNITED KINGDOM
| | - Dhivya Das
- Rheumatology, Wrexham Maelor Hospital, Wrexham, UNITED KINGDOM
| | - Shuja Majeed
- Rheumatology, Great Western Hospital, Swindon, UNITED KINGDOM
| | - Ahsan Memon
- Rheumatology, Royal Devon and Exeter Hospital, Exeter, UNITED KINGDOM
| | - Patrick O’Beirn
- Rheumatology, University Hospital of Wales, Cardiff, UNITED KINGDOM
| | - James Ritchie
- Rheumatology, Weston General Hospital, Weston-super-Mare, UNITED KINGDOM
| | - John D Pauling
- Rheumatology, Royal National Hospital for Rheumatic Diseases, Bath, UNITED KINGDOM
- Pharmacy and Pharmacology, University of Bath, Bath, UNITED KINGDOM
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Ritchie J, Sykes A, Weber P, Wren S. Immuno-oncology: the next generation of breakthrough therapies. Highlights from The Society for Medicines Research Symposium. Oxford, UK - June 21, 2019. DRUG FUTURE 2019. [DOI: 10.1358/dof.2019.44.7.3050019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Tollitt J, Flanagan E, McCorkindale S, Glynn-Atkins S, Emmett L, Darby D, Ritchie J, Bennett B, Sinha S, Poulikakos D. Improved management of acute kidney injury in primary care using e-alerts and an educational outreach programme. Fam Pract 2018; 35:684-689. [PMID: 29718171 DOI: 10.1093/fampra/cmy030] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE Acute kidney injury (AKI) detected in primary care is associated with increased morbidity and mortality. AKI electronic alerts (e-alerts) and educational programmes have recently been implemented but their contribution to improve AKI care is unknown. This project aimed to improve response to AKI detected in primary care and used a factorial design to evaluate the impact of the UK National Health Service (NHS) AKI e-alert and AKI educational outreach sessions on time to response to primary care AKI stages 2 and 3 between April and August 2016. METHODS A total of 46 primary care practices were randomized into four groups. A 2 × 2 factorial design exposed each group to different combinations of two interventions. The primary outcome was 'time to repeat test' or hospitalization following AKI e-alert for stages 2 and 3. Yates algorithm was used to evaluate the impact of each intervention. Time to response and mortality pre- and post-intervention were analysed using Mann-Whitney U test and chi-square test respectively. The factorial design included two interventions: an AKI educational outreach programme and the NHS AKI e-alerts. RESULTS 1807 (0.8%) primary care blood tests demonstrated AKI 1-3 (78.3% stage 1, 14.8% stage 2, 6.9% stage 3). There were 391 stage 2 and 3 events from 251 patients. E-alerts demonstrated a reduction in mean response time (-29 hours). Educational outreach had a smaller effect (-3 hours). Median response time to AKI 2 and 3 pre- and post-interventions was 27 hours versus 16 hours respectively (P = 0.037). Stage 2 and 3 event-related 30-day all-cause mortality decreased following the interventions (15.6% versus 3.9% P = 0.036). CONCLUSION AKI e-alerts in primary care hasten response to AKI 2 and 3 and reduce all-cause mortality. Educational outreach sessions further improve response time.
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Affiliation(s)
- James Tollitt
- Renal Department, Salford Royal NHS Trust, Salford, UK
| | | | | | | | - Lauren Emmett
- Renal Department, Salford Royal NHS Trust, Salford, UK
| | - Denise Darby
- Pathology Department, Salford Royal NHS Trust, Salford, UK
| | - James Ritchie
- Renal Department, Salford Royal NHS Trust, Salford, UK
| | | | - Smeeta Sinha
- Renal Department, Salford Royal NHS Trust, Salford, UK
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Ditzler G, LaBarck J, Ritchie J, Rosen G, Polikar R. Extensions to Online Feature Selection Using Bagging and Boosting. IEEE Trans Neural Netw Learn Syst 2018; 29:4504-4509. [PMID: 29028210 DOI: 10.1109/tnnls.2017.2746107] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Feature subset selection can be used to sieve through large volumes of data and discover the most informative subset of variables for a particular learning problem. Yet, due to memory and other resource constraints (e.g., CPU availability), many of the state-of-the-art feature subset selection methods cannot be extended to high dimensional data, or data sets with an extremely large volume of instances. In this brief, we extend online feature selection (OFS), a recently introduced approach that uses partial feature information, by developing an ensemble of online linear models to make predictions. The OFS approach employs a linear model as the base classifier, which allows the $l_{0}$ -norm of the parameter vector to be constrained to perform feature selection leading to sparse linear models. We demonstrate that the proposed ensemble model typically yields a smaller error rate than any single linear model, while maintaining the same level of sparsity and complexity at the time of testing.
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Cham S, Achariyapota V, Sia T, Ritchie J, Vattakalam R, Wright J, Tergas A, Hou J. Clinical genomic profiling identifies potential prognostic markers in patients with gynecologic carcinosarcoma. Gynecol Oncol 2018. [DOI: 10.1016/j.ygyno.2018.04.405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Storrar J, Ritchie J, Darby D, Smethurst S, Alshawy K, Ebah L, Sinha S, Poulikakos D. FP246EVALUATION OF POINT OF CARE CREATININE TESTING FOR EARLY IDENTIFICATION AND MANAGEMENT OF COMMUNITY ACQUIRED ACUTE KIDNEY INJURY. Nephrol Dial Transplant 2018. [DOI: 10.1093/ndt/gfy104.fp246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - James Ritchie
- Renal, Salford Royal Hospital, Salford, United Kingdom
| | - Denise Darby
- Pathology, Salford Royal Hospital, Salford, United Kingdom
| | | | - Khalid Alshawy
- Salford Care Homes, Salford Care Homes Practice, Salford, United Kingdom
| | - Leonard Ebah
- Renal, University of Manchester, Manchester, United Kingdom
| | - Smeeta Sinha
- Renal, Salford Royal Hospital, Salford, United Kingdom
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Ritchie J, Lang S, Goddard R, Roy D, Marshall R. 058 Life-threateningneurological impairment as a primary manifestation of adult onset Still’sdisease: successfully treated with anakinra. Rheumatology (Oxford) 2018. [DOI: 10.1093/rheumatology/key075.282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- James Ritchie
- Rheumatology Department, Bristol Royal Infirmary, Bristol, UNITED KINGDOM
| | - Samantha Lang
- Core Medicine, Bristol Royal Infirmary, Bristol, UNITED KINGDOM
| | - Rachael Goddard
- Core Medicine, Bristol Royal Infirmary, Bristol, UNITED KINGDOM
| | - Deeptarka Roy
- Intensive Care, Bristol Royal Infirmary, Bristol, UNITED KINGDOM
| | - Robert Marshall
- Rheumatology Department, Bristol Royal Infirmary, Bristol, UNITED KINGDOM
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Chinnadurai R, Ritchie J, Green D, Kalra PA. Non-alcoholic fatty liver disease and clinical outcomes in chronic kidney disease. Nephrol Dial Transplant 2018; 34:449-457. [DOI: 10.1093/ndt/gfx381] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Accepted: 12/19/2017] [Indexed: 12/11/2022] Open
Affiliation(s)
| | - James Ritchie
- Department of Renal Medicine, Salford Royal NHS Foundation Trust, Salford, UK
| | - Darren Green
- Department of Renal Medicine, Salford Royal NHS Foundation Trust, Salford, UK
| | - Philip A Kalra
- Department of Renal Medicine, Salford Royal NHS Foundation Trust, Salford, UK
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Dawson L, Allan S, Brough D, Ritchie J, Weber P, Wren S. Targeting the immune system in disease. Highlights from the Society for Medicines Research meeting. Manchester, UK - March 8, 2018. DRUG FUTURE 2018. [DOI: 10.1358/dof.2018.043.04.2808577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Ritchie J. Laboratory Medicine in Pain Management: Evolution to Guidelines - Defining a Standard of Care. J Appl Lab Med 2018; 2:473-474. [PMID: 33636899 DOI: 10.1373/jalm.2016.022962] [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] [Received: 05/26/2017] [Accepted: 07/13/2017] [Indexed: 11/06/2022]
Affiliation(s)
- James Ritchie
- Emory University, Pathology & Laboratory Medicine, Atlanta, GA
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26
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Constantin T, Tangpricha V, Shah R, Oyesiku NM, Ioachimescu O, Ritchie J, Ioachimescu AG. Response to Letter: "Calcium and Bone Turnover Markers in Acromegaly: A Prospective, Controlled Study". J Clin Endocrinol Metab 2017; 102:3561-3562. [PMID: 28911163 DOI: 10.1210/jc.2017-01380] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Accepted: 06/27/2017] [Indexed: 11/19/2022]
Affiliation(s)
| | - Vin Tangpricha
- Emory University School of Medicine, Atlanta, Georgia 30322
- Atlanta Veterans Affairs Medical Center, Decatur, Georgia 30033
| | - Reshma Shah
- Emory University School of Medicine, Atlanta, Georgia 30322
| | | | - Octavian Ioachimescu
- Emory University School of Medicine, Atlanta, Georgia 30322
- Atlanta Veterans Affairs Medical Center, Decatur, Georgia 30033
| | - James Ritchie
- Emory University School of Medicine, Atlanta, Georgia 30322
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Constantin T, Tangpricha V, Shah R, Oyesiku NM, Ioachimescu OC, Ritchie J, Ioachimescu AG. Calcium and Bone Turnover Markers in Acromegaly: A Prospective, Controlled Study. J Clin Endocrinol Metab 2017; 102:2416-2424. [PMID: 28407138 DOI: 10.1210/jc.2016-3693] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [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: 11/13/2016] [Accepted: 04/06/2017] [Indexed: 11/19/2022]
Abstract
CONTEXT Acromegaly has been associated with calcium-phosphate and bone turnover alterations. Controlled studies of these interactions are sparse. OBJECTIVE To evaluate calcium and bone metabolism in active and treated acromegaly. DESIGN/SETTING/PATIENTS We conducted a controlled, prospective study at a tertiary referral center. We studied 22 patients with acromegaly referred for surgical or medical therapy (ACM) and 22 with nonfunctioning pituitary adenomas referred for surgery (control). MAIN OUTCOME MEASURES Calcium (serum and urine), phosphorus, parathyroid hormone (PTH), 25-hydroxy- and 1,25-dihydroxy-vitamin D, bone turnover markers [serum C-terminal telopeptide of type 1 collagen (CTX) and procollagen type 1 N-terminal propeptide (P1NP)], and cytokines [receptor activator of nuclear factor κB ligand (RANK-L) and osteoprotegerin (OPG)] at baseline and 3 to 6 months after treatment. RESULTS At baseline, the ACM group had lower PTH levels than controls (36.3 ± 13.9 pg/mL vs 56.0 ± 19.9 pg/mL) and higher phosphorus (4.34 ± 0.71 mg/dL vs 3.55 ± 0.50 mg/dL) (P < 0.01). Groups had similar levels of serum and urine calcium and 25-hydroxy- and 1,25-dihydroxy-vitamin D. The ACM group had higher bone turnover markers than control; P1NP and CTX were strongly correlated (r2 = 0.82, P < 0.05). CTX was dependent on age and disease group but not on sex or gonadal status. After treatment of acromegaly, serum calcium (9.52 ± 0.43 mg/dL to 9.26 ± 0.28 mg/dL), phosphorus (4.34 ± 0.71 mg/dL to 3.90 ± 0.80 mg/dL), and CTX (0.91 ± 0.75 ng/mL to 0.63 ± 0.68 ng/mL) decreased, while PTH increased (36.3 ± 13.9 pg/mL to 48.9 ± 16.7 pg/mL) (P < 0.01). 25-hydroxy-vitamin D, P1NP, and RANK-L/OPG ratio did not change significantly. CONCLUSION Acromegaly patients exhibited PTH-independent calcium-phosphate alterations and enhanced coupled bone formation and resorption. Within 6 months of treatment, bone resorption decreased, whereas RANK-L/OPG changes were inconsistent.
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Affiliation(s)
- Tina Constantin
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia 30307
| | - Vin Tangpricha
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia 30307
- Atlanta VA Medical Center, Decatur, Georgia 30033
| | - Reshma Shah
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia 30307
| | - Nelson M Oyesiku
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia 30307
| | - Octavian C Ioachimescu
- Atlanta VA Medical Center, Decatur, Georgia 30033
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia 30307
| | - James Ritchie
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia 30307
| | - Adriana G Ioachimescu
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia 30307
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia 30307
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Chrysochou C, Green D, Ritchie J, Buckley DL, Kalra PA. Kidney volume to GFR ratio predicts functional improvement after revascularization in atheromatous renal artery stenosis. PLoS One 2017; 12:e0177178. [PMID: 28594847 PMCID: PMC5464522 DOI: 10.1371/journal.pone.0177178] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [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: 01/16/2017] [Accepted: 04/22/2017] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Randomized controlled trials (RCT) have shown no overall benefit of renal revascularization in atherosclerotic renovascular disease (ARVD). However, 25% of patients demonstrate improvement in renal function. We used the ratio of magnetic resonance parenchymal volume (PV) to isotopic single kidney glomerular filtration rate (isoSKGFR) ratio as our method to prospectively identify "improvers" before revascularization. METHODS Patients with renal artery stenosis who were due revascularization were recruited alongside non-ARVD hypertensive CKD controls. Using the controls, 95% CI were calculated for expected PV:isoSK-GFR at given renal volumes. For ARVD patients, "improvers" were defined as having both >15% and >1ml/min increase in isoSK-GFR at 4 months after revascularization. Sensitivity and specificity of PV:isoSK-GFR for predicting improvers was calculated. RESULTS 30 patients (mean age 68 ±8 years), underwent revascularization, of whom 10 patients had intervention for bilateral RAS. Stented kidneys which manifested >15% improvement in function had larger PV:isoSK-GFR compared to controls (19±16 vs. 6±4ml/ml/min, p = 0.002). The sensitivity and specificity of this equation in predicting a positive renal functional outcome were 64% and 88% respectively. Use of PV:isoSK-GFR increased prediction of functional improvement (area under curve 0.93). Of note, non-RAS contralateral kidneys which improved (n = 5) also demonstrated larger PV:isoSK-GFR (15.2±16.2 ml/ml/min, p = 0.006). CONCLUSION This study offers early indicators that the ratio of PV:isoSK-GFR may help identify patients with kidneys suitable for renal revascularization which could improve patient selection for a procedure associated with risks. Calculation of the PV:isoSK-GFR ratio is easy, does not require MRI contrast agent.
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Affiliation(s)
- Constantina Chrysochou
- The University of Manchester, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Stott Lane, Salford, United Kingdom
| | - Darren Green
- The University of Manchester, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Stott Lane, Salford, United Kingdom
| | - James Ritchie
- The University of Manchester, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Stott Lane, Salford, United Kingdom
| | - David L. Buckley
- Division of Biomedical Imaging, University of Leeds, LIGHT Laboratories, Leeds, United Kingdom
| | - Philip A. Kalra
- The University of Manchester, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Stott Lane, Salford, United Kingdom
- * E-mail:
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Ritchie J, Green D, Chrysochou T, Hegarty J, Handley K, Ives N, Wheatley K, Houston G, Wright J, Neyses L, Chalmers N, Mark P, Patel R, Moss J, Roditi G, Eadington D, Lukaschuk E, Cleland J, Kalra PA. Effect of renal artery revascularization upon cardiac structure and function in atherosclerotic renal artery stenosis: cardiac magnetic resonance sub-study of the ASTRAL trial. Nephrol Dial Transplant 2017; 32:1006-1013. [PMID: 27257278 DOI: 10.1093/ndt/gfw107] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 04/09/2016] [Indexed: 11/13/2022] Open
Abstract
Background Cardiac abnormalities are frequent in patients with atherosclerotic renovascular disease (ARVD). The Angioplasty and Stenting for Renal Artery Lesions (ASTRAL) trial studied the effect of percutaneous renal revascularization combined with medical therapy compared with medical therapy alone in 806 patients with ARVD. Methods This was a pre-specified sub-study of ASTRAL (clinical trials registration, current controlled trials number: ISRCTN59586944), designed to consider the effect of percutaneous renal artery angioplasty and stenting on change in cardiac structure and function, measured using cardiac magnetic resonance (CMR) imaging. Fifty-one patients were recruited from six selected ASTRAL centres. Forty-four completed the study (medical therapy n = 21; revascularization n = 23). Full analysis of CMR was possible in 40 patients (18 medical therapy and 22 revascularization). CMR measurements of left and right ventricular end systolic (LV and RVESV) and diastolic volume (LV and RVEDV), ejection fraction (LVEF) and mass (LVM) were made shortly after recruitment and before revascularization in the interventional group, and again after 12 months. Reporting was performed by CMR analysts blinded to randomization arm. Results Groups were well matched for mean age (70 versus 72 years), blood pressure (148/71 versus 143/74 mmHg), degree of renal artery stenosis (75 versus 75%) and comorbid conditions. In both randomized groups, improvements in cardiac structural parameters were seen at 12 months, but there were no significant differences between treatment groups. Median left ventricular changes between baseline and 12 months (medical versus revascularization) were LVEDV -1.9 versus -5.8 mL, P = 0.4; LVESV -2.1 versus 0.3 mL, P = 0.7; LVM -5.4 versus -6.3 g, P = 0.8; and LVEF -1.5 versus -0.8%, P = 0.7. Multivariate regression also found that randomized treatment assignment was not associated with degree of change in any of the CMR measurements. Conclusions In this sub-study of the ASTRAL trial, renal revascularization did not offer additional benefit to cardiac structure or function in unselected patients with ARVD.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Patrick Mark
- Queen Elizabeth University Hospital, Govan, Glasgow, UK
| | - Rajan Patel
- Queen Elizabeth University Hospital, Govan, Glasgow, UK
| | - Jon Moss
- Queen Elizabeth University Hospital, Govan, Glasgow, UK
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Chinnadurai R, Vassallo D, Ritchie J, Green D, Kalra P. SP334HIGH PREVALENCE OF NON-ALCOHOLIC FATTY LIVER DISEASE IN CHRONIC KIDNEY DISEASE. Nephrol Dial Transplant 2017. [DOI: 10.1093/ndt/gfx146.sp334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Chinnadurai R, Green D, Ritchie J, Kalra P. MO017STRONG ASSOCIATION OF NON-ALCOHOLIC FATTY LIVER DISEASE WITH CARDIOVASCULAR OUTCOMES IN DIABETIC NEPHROPATHY. Nephrol Dial Transplant 2017. [DOI: 10.1093/ndt/gfx116.mo017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Vassallo D, Alderson H, Ritchie J, Green D, Chrysochou C, Kalra P. MP378ASSOCIATION OF NOVEL BIOMARKERS WITH LONG-TERM OUTCOMES IN ATHEROSCLEROTIC RENOVASCULAR DISEASE. Nephrol Dial Transplant 2017. [DOI: 10.1093/ndt/gfx170.mp378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Huckle A, Ritchie J, Alderson H, Green D, Kalra P, Sinha S. MP582UK CALCIPHYLAXIS STUDY: INTERIM ANALYSIS. Nephrol Dial Transplant 2017. [DOI: 10.1093/ndt/gfx177.mp582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Sykes L, Nipah R, Ritchie J. SO044THE INTRODUCTION OF A NOVEL SMARTPHONE APP TO TACKLE ACUTE KIDNEY INJURY IN NORTH WEST ENGLAND. Nephrol Dial Transplant 2017. [DOI: 10.1093/ndt/gfx107.so044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Ritchie J. 025. A CASE OF CROWNED DENS SYNDROME: AN IMPORTANT CAUSE OF NECK PAIN. Rheumatology (Oxford) 2017. [DOI: 10.1093/rheumatology/kex062.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Vassallo D, Ritchie J, Green D, Chrysochou C, Kalra PA. The effect of revascularization in patients with anatomically significant atherosclerotic renovascular disease presenting with high-risk clinical features. Nephrol Dial Transplant 2017; 33:497-506. [DOI: 10.1093/ndt/gfx025] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 01/28/2017] [Indexed: 12/21/2022] Open
Affiliation(s)
- Diana Vassallo
- Department of Renal Medicine, Salford Royal NHS Foundation Trust, Salford, UK
| | - James Ritchie
- Department of Renal Medicine, Salford Royal NHS Foundation Trust, Salford, UK
| | - Darren Green
- Department of Renal Medicine, Salford Royal NHS Foundation Trust, Salford, UK
| | | | - Philip A Kalra
- Department of Renal Medicine, Salford Royal NHS Foundation Trust, Salford, UK
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Feldhammer M, Menasco D, Zhang W, Ritchie J. A Targeted, Evidence-Based Clinical Decision Support Intervention to Reduce Unnecessary Complete Blood Count Orders. Am J Clin Pathol 2017. [DOI: 10.1093/ajcp/aqw191.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Feldhammer M, Menasco D, Zhang W, Ritchie J. Validation of a Liquid Chromatography-Tandem Mass Spectrometry Method for Nicotine and Its Metabolites Reveals a Low Clinical Utility for the Tobacco Alkaloid Anabasine. Am J Clin Pathol 2017. [DOI: 10.1093/ajcp/aqw191.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Durrant M, Macdonald G, Ritchie J, Sykes A. Innovative partnerships for medicines research: How is the landscape evolving? Highlights from the Society for Medicines Research Symposium. Babraham Research Campus, Cambridge, UK - June 15, 2017. DRUG FUTURE 2017. [DOI: 10.1358/dof.2017.042.07.2682629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Vohra RS, Pasquali S, Kirkham AJ, Marriott P, Johnstone M, Spreadborough P, Alderson D, Griffiths EA, Fenwick S, Elmasry M, Nunes Q, Kennedy D, Basit Khan R, Khan MAS, Magee CJ, Jones SM, Mason D, Parappally CP, Mathur P, Saunders M, Jamel S, Ul Haque S, Zafar S, Shiwani MH, Samuel N, Dar F, Jackson A, Lovett B, Dindyal S, Winter H, Fletcher T, Rahman S, Wheatley K, Nieto T, Ayaani S, Youssef H, Nijjar RS, Watkin H, Naumann D, Emeshi S, Sarmah PB, Lee K, Joji N, Heath J, Teasdale RL, Weerasinghe C, Needham PJ, Welbourn H, Forster L, Finch D, Blazeby JM, Robb W, McNair AGK, Hrycaiczuk A, Charalabopoulos A, Kadirkamanathan S, Tang CB, Jayanthi NVG, Noor N, Dobbins B, Cockbain AJ, Nilsen-Nunn A, Siqueira J, Pellen M, Cowley JB, Ho WM, Miu V, White TJ, Hodgkins KA, Kinghorn A, Tutton MG, Al-Abed YA, Menzies D, Ahmad A, Reed J, Khan S, Monk D, Vitone LJ, Murtaza G, Joel A, Brennan S, Shier D, Zhang C, Yoganathan T, Robinson SJ, McCallum IJD, Jones MJ, Elsayed M, Tuck L, Wayman J, Carney K, Aroori S, Hosie KB, Kimble A, Bunting DM, Fawole AS, Basheer M, Dave RV, Sarveswaran J, Jones E, Kendal C, Tilston MP, Gough M, Wallace T, Singh S, Downing J, Mockford KA, Issa E, Shah N, Chauhan N, Wilson TR, Forouzanfar A, Wild JRL, Nofal E, Bunnell C, Madbak K, Rao STV, Devoto L, Siddiqi N, Khawaja Z, Hewes JC, Gould L, Chambers A, Urriza Rodriguez D, Sen G, Robinson S, Carney K, Bartlett F, Rae DM, Stevenson TEJ, Sarvananthan K, Dwerryhouse SJ, Higgs SM, Old OJ, Hardy TJ, Shah R, Hornby ST, Keogh K, Frank L, Al-Akash M, Upchurch EA, Frame RJ, Hughes M, Jelley C, Weaver S, Roy S, Sillo TO, Galanopoulos G, Cuming T, Cunha P, Tayeh S, Kaptanis S, Heshaishi M, Eisawi A, Abayomi M, Ngu WS, Fleming K, Singh Bajwa D, Chitre V, Aryal K, Ferris P, Silva M, Lammy S, Mohamed S, Khawaja A, Hussain A, Ghazanfar MA, Bellini MI, Ebdewi H, Elshaer M, Gravante G, Drake B, Ogedegbe A, Mukherjee D, Arhi C, Giwa Nusrat Iqbal L, Watson NF, Kumar Aggarwal S, Orchard P, Villatoro E, Willson PD, Wa K, Mok J, Woodman T, Deguara J, Garcea G, Babu BI, Dennison AR, Malde D, Lloyd D, Satheesan S, Al-Taan O, Boddy A, Slavin JP, Jones RP, Ballance L, Gerakopoulos S, Jambulingam P, Mansour S, Sakai N, Acharya V, Sadat MM, Karim L, Larkin D, Amin K, Khan A, Law J, Jamdar S, Smith SR, Sampat K, M O'shea K, Manu M, Asprou FM, Malik NS, Chang J, Johnstone M, Lewis M, Roberts GP, Karavadra B, Photi E, Hewes J, Gould L, Chambers A, Rodriguez D, O'Reilly DA, Rate AJ, Sekhar H, Henderson LT, Starmer BZ, Coe PO, Tolofari S, Barrie J, Bashir G, Sloane J, Madanipour S, Halkias C, Trevatt AEJ, Borowski DW, Hornsby J, Courtney MJ, Virupaksha S, Seymour K, Robinson S, Hawkins H, Bawa S, Gallagher PV, Reid A, Wood P, Finch JG, Parmar J, Stirland E, Gardner-Thorpe J, Al-Muhktar A, Peterson M, Majeed A, Bajwa FM, Martin J, Choy A, Tsang A, Pore N, Andrew DR, Al-Khyatt W, Taylor C, Bhandari S, Chambers A, Subramanium D, Toh SKC, Carter NC, Mercer SJ, Knight B, Tate S, Pearce B, Wainwright D, Vijay V, Alagaratnam S, Sinha S, Khan S, El-Hasani SS, Hussain AA, Bhattacharya V, Kansal N, Fasih T, Jackson C, Siddiqui MN, Chishti IA, Fordham IJ, Siddiqui Z, Bausbacher H, Geogloma I, Gurung K, Tsavellas G, Basynat P, Kiran Shrestha A, Basu S, Chhabra Mohan Harilingam A, Rabie M, Akhtar M, Kumar P, Jafferbhoy SF, Hussain N, Raza S, Haque M, Alam I, Aseem R, Patel S, Asad M, Booth MI, Ball WR, Wood CPJ, Pinho-Gomes AC, Kausar A, Rami Obeidallah M, Varghase J, Lodhia J, Bradley D, Rengifo C, Lindsay D, Gopalswamy S, Finlay I, Wardle S, Bullen N, Iftikhar SY, Awan A, Ahmed J, Leeder P, Fusai G, Bond-Smith G, Psica A, Puri Y, Hou D, Noble F, Szentpali K, Broadhurst J, Date R, Hossack MR, Li Goh Y, Turner P, Shetty V, Riera M, Macano CAW, Sukha A, Preston SR, Hoban JR, Puntis DJ, Williams SV, Krysztopik R, Kynaston J, Batt J, Doe M, Goscimski A, Jones GH, Smith SR, Hall C, Carty N, Ahmed J, Panteleimonitis S, Gunasekera RT, Sheel ARG, Lennon H, Hindley C, Reddy M, Kenny R, Elkheir N, McGlone ER, Rajaganeshan R, Hancorn K, Hargreaves A, Prasad R, Longbotham DA, Vijayanand D, Wijetunga I, Ziprin P, Nicolay CR, Yeldham G, Read E, Gossage JA, Rolph RC, Ebied H, Phull M, Khan MA, Popplewell M, Kyriakidis D, Hussain A, Henley N, Packer JR, Derbyshire L, Porter J, Appleton S, Farouk M, Basra M, Jennings NA, Ali S, Kanakala V, Ali H, Lane R, Dickson-Lowe R, Zarsadias P, Mirza D, Puig S, Al Amari K, Vijayan D, Sutcliffe R, Marudanayagam R, Hamady Z, Prasad AR, Patel A, Durkin D, Kaur P, Bowen L, Byrne JP, Pearson KL, Delisle TG, Davies J, Tomlinson MA, Johnpulle MA, Slawinski C, Macdonald A, Nicholson J, Newton K, Mbuvi J, Farooq A, Sidhartha Mothe B, Zafrani Z, Brett D, Francombe J, Spreadborough P, Barnes J, Cheung M, Al-Bahrani AZ, Preziosi G, Urbonas T, Alberts J, Mallik M, Patel K, Segaran A, Doulias T, Sufi PA, Yao C, Pollock S, Manzelli A, Wajed S, Kourkulos M, Pezzuto R, Wadley M, Hamilton E, Jaunoo S, Padwick R, Sayegh M, Newton RC, Hebbar M, Farag SF, Spearman J, Hamdan MF, D'Costa C, Blane C, Giles M, Peter MB, Hirst NA, Hossain T, Pannu A, El-Dhuwaib Y, Morrison TEM, Taylor GW, Thompson RLE, McCune K, Loughlin P, Lawther R, Byrnes CK, Simpson DJ, Mawhinney A, Warren C, McKay D, McIlmunn C, Martin S, MacArtney M, Diamond T, Davey P, Jones C, Clements JM, Digney R, Chan WM, McCain S, Gull S, Janeczko A, Dorrian E, Harris A, Dawson S, Johnston D, McAree B, Ghareeb E, Thomas G, Connelly M, McKenzie S, Cieplucha K, Spence G, Campbell W, Hooks G, Bradley N, Hill ADK, Cassidy JT, Boland M, Burke P, Nally DM, Hill ADK, Khogali E, Shabo W, Iskandar E, McEntee GP, O'Neill MA, Peirce C, Lyons EM, O'Sullivan AW, Thakkar R, Carroll P, Ivanovski I, Balfe P, Lee M, Winter DC, Kelly ME, Hoti E, Maguire D, Karunakaran P, Geoghegan JG, Martin ST, McDermott F, Cross KS, Cooke F, Zeeshan S, Murphy JO, Mealy K, Mohan HM, Nedujchelyn Y, Fahad Ullah M, Ahmed I, Giovinazzo F, Milburn J, Prince S, Brooke E, Buchan J, Khalil AM, Vaughan EM, Ramage MI, Aldridge RC, Gibson S, Nicholson GA, Vass DG, Grant AJ, Holroyd DJ, Jones MA, Sutton CMLR, O'Dwyer P, Nilsson F, Weber B, Williamson TK, Lalla K, Bryant A, Carter CR, Forrest CR, Hunter DI, Nassar AH, Orizu MN, Knight K, Qandeel H, Suttie S, Belding R, McClarey A, Boyd AT, Guthrie GJK, Lim PJ, Luhmann A, Watson AJM, Richards CH, Nicol L, Madurska M, Harrison E, Boyce KM, Roebuck A, Ferguson G, Pati P, Wilson MSJ, Dalgaty F, Fothergill L, Driscoll PJ, Mozolowski KL, Banwell V, Bennett SP, Rogers PN, Skelly BL, Rutherford CL, Mirza AK, Lazim T, Lim HCC, Duke D, Ahmed T, Beasley WD, Wilkinson MD, Maharaj G, Malcolm C, Brown TH, Shingler GM, Mowbray N, Radwan R, Morcous P, Wood S, Kadhim A, Stewart DJ, Baker AL, Tanner N, Shenoy H, Hafiz S, Marchi JA, Singh-Ranger D, Hisham E, Ainley P, O'Neill S, Terrace J, Napetti S, Hopwood B, Rhys T, Downing J, Kanavati O, Coats M, Aleksandrov D, Kallaway C, Yahya S, Weber B, Templeton A, Trotter M, Lo C, Dhillon A, Heywood N, Aawsaj Y, Hamdan A, Reece-Bolton O, McGuigan A, Shahin Y, Ali A, Luther A, Nicholson JA, Rajendran I, Boal M, Ritchie J. Population-based cohort study of variation in the use of emergency cholecystectomy for benign gallbladder diseases. Br J Surg 2016; 103:1716-1726. [PMID: 27748962 DOI: 10.1002/bjs.10288] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 06/21/2016] [Accepted: 07/06/2016] [Indexed: 01/05/2023]
Abstract
Abstract
Background
The aims of this prospective population-based cohort study were to identify the patient and hospital characteristics associated with emergency cholecystectomy, and the influences of these in determining variations between hospitals.
Methods
Data were collected for consecutive patients undergoing cholecystectomy in acute UK and Irish hospitals between 1 March and 1 May 2014. Potential explanatory variables influencing the performance of emergency cholecystectomy were analysed by means of multilevel, multivariable logistic regression modelling using a two-level hierarchical structure with patients (level 1) nested within hospitals (level 2).
Results
Data were collected on 4744 cholecystectomies from 165 hospitals. Increasing age, lower ASA fitness grade, biliary colic, the need for further imaging (magnetic retrograde cholangiopancreatography), endoscopic interventions (endoscopic retrograde cholangiopancreatography) and admission to a non-biliary centre significantly reduced the likelihood of an emergency cholecystectomy being performed. The multilevel model was used to calculate the probability of receiving an emergency cholecystectomy for a woman aged 40 years or over with an ASA grade of I or II and a BMI of at least 25·0 kg/m2, who presented with acute cholecystitis with an ultrasound scan showing a thick-walled gallbladder and a normal common bile duct. The mean predicted probability of receiving an emergency cholecystectomy was 0·52 (95 per cent c.i. 0·45 to 0·57). The predicted probabilities ranged from 0·02 to 0·95 across the 165 hospitals, demonstrating significant variation between hospitals.
Conclusion
Patients with similar characteristics presenting to different hospitals with acute gallbladder pathology do not receive comparable care.
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Affiliation(s)
| | - R S Vohra
- Trent Oesophago-Gastric Unit, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - S Pasquali
- Surgical Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy
| | - A J Kirkham
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - P Marriott
- West Midlands Research Collaborative, Academic Department of Surgery, University of Birmingham, Birmingham, UK
| | - M Johnstone
- West Midlands Research Collaborative, Academic Department of Surgery, University of Birmingham, Birmingham, UK
| | - P Spreadborough
- West Midlands Research Collaborative, Academic Department of Surgery, University of Birmingham, Birmingham, UK
| | - D Alderson
- Academic Department of Surgery, University of Birmingham, Birmingham, UK
| | - E A Griffiths
- Department of Upper Gastrointestinal Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - S Fenwick
- Aintree University Hospital NHS Foundation Trust
| | - M Elmasry
- Aintree University Hospital NHS Foundation Trust
| | - Q Nunes
- Aintree University Hospital NHS Foundation Trust
| | - D Kennedy
- Aintree University Hospital NHS Foundation Trust
| | | | | | | | | | - D Mason
- Wirral University Teaching Hospital
| | | | | | | | - S Jamel
- Barnet and Chase Farm Hospital
| | | | - S Zafar
- Barnet and Chase Farm Hospital
| | | | - N Samuel
- Barnsley District General Hospital
| | - F Dar
- Barnsley District General Hospital
| | | | | | | | | | | | | | - K Wheatley
- Sandwell and West Birmingham Hospitals NHS Trust
| | - T Nieto
- Sandwell and West Birmingham Hospitals NHS Trust
| | - S Ayaani
- Sandwell and West Birmingham Hospitals NHS Trust
| | - H Youssef
- Heart of England Foundation NHS Trust
| | | | - H Watkin
- Heart of England Foundation NHS Trust
| | - D Naumann
- Heart of England Foundation NHS Trust
| | - S Emeshi
- Heart of England Foundation NHS Trust
| | | | - K Lee
- Heart of England Foundation NHS Trust
| | - N Joji
- Heart of England Foundation NHS Trust
| | - J Heath
- Blackpool Teaching Hospitals NHS Foundation Trust
| | - R L Teasdale
- Blackpool Teaching Hospitals NHS Foundation Trust
| | | | - P J Needham
- Bradford Teaching Hospitals NHS Foundation Trust
| | - H Welbourn
- Bradford Teaching Hospitals NHS Foundation Trust
| | - L Forster
- Bradford Teaching Hospitals NHS Foundation Trust
| | - D Finch
- Bradford Teaching Hospitals NHS Foundation Trust
| | | | - W Robb
- University Hospitals Bristol NHS Trust
| | | | | | | | | | | | | | | | - B Dobbins
- Calderdale and Huddersfield NHS Trust
| | | | | | | | - M Pellen
- Hull and East Yorkshire NHS Trust
| | | | - W-M Ho
- Hull and East Yorkshire NHS Trust
| | - V Miu
- Hull and East Yorkshire NHS Trust
| | - T J White
- Chesterfield Royal Hospital NHS Foundation Trust
| | - K A Hodgkins
- Chesterfield Royal Hospital NHS Foundation Trust
| | - A Kinghorn
- Chesterfield Royal Hospital NHS Foundation Trust
| | - M G Tutton
- Colchester Hospital University NHS Foundation Trust
| | - Y A Al-Abed
- Colchester Hospital University NHS Foundation Trust
| | - D Menzies
- Colchester Hospital University NHS Foundation Trust
| | - A Ahmad
- Colchester Hospital University NHS Foundation Trust
| | - J Reed
- Colchester Hospital University NHS Foundation Trust
| | - S Khan
- Colchester Hospital University NHS Foundation Trust
| | - D Monk
- Countess of Chester NHS Foundation Trust
| | - L J Vitone
- Countess of Chester NHS Foundation Trust
| | - G Murtaza
- Countess of Chester NHS Foundation Trust
| | - A Joel
- Countess of Chester NHS Foundation Trust
| | | | - D Shier
- Croydon Health Services NHS Trust
| | - C Zhang
- Croydon Health Services NHS Trust
| | | | | | | | - M J Jones
- North Cumbria University Hospitals Trust
| | - M Elsayed
- North Cumbria University Hospitals Trust
| | - L Tuck
- North Cumbria University Hospitals Trust
| | - J Wayman
- North Cumbria University Hospitals Trust
| | - K Carney
- North Cumbria University Hospitals Trust
| | | | | | | | | | | | | | | | | | | | | | - M P Tilston
- Northern Lincolnshire and Goole NHS Foundation Trust
| | - M Gough
- Northern Lincolnshire and Goole NHS Foundation Trust
| | - T Wallace
- Northern Lincolnshire and Goole NHS Foundation Trust
| | - S Singh
- Northern Lincolnshire and Goole NHS Foundation Trust
| | - J Downing
- Northern Lincolnshire and Goole NHS Foundation Trust
| | - K A Mockford
- Northern Lincolnshire and Goole NHS Foundation Trust
| | - E Issa
- Northern Lincolnshire and Goole NHS Foundation Trust
| | - N Shah
- Northern Lincolnshire and Goole NHS Foundation Trust
| | - N Chauhan
- Northern Lincolnshire and Goole NHS Foundation Trust
| | - T R Wilson
- Doncaster and Bassetlaw Hospitals NHS Foundation Trust
| | - A Forouzanfar
- Doncaster and Bassetlaw Hospitals NHS Foundation Trust
| | - J R L Wild
- Doncaster and Bassetlaw Hospitals NHS Foundation Trust
| | - E Nofal
- Doncaster and Bassetlaw Hospitals NHS Foundation Trust
| | - C Bunnell
- Doncaster and Bassetlaw Hospitals NHS Foundation Trust
| | - K Madbak
- Doncaster and Bassetlaw Hospitals NHS Foundation Trust
| | - S T V Rao
- Dorset County Hospital NHS Foundation Trust
| | - L Devoto
- Dorset County Hospital NHS Foundation Trust
| | - N Siddiqi
- Dorset County Hospital NHS Foundation Trust
| | - Z Khawaja
- Dorset County Hospital NHS Foundation Trust
| | | | | | | | | | | | | | | | | | - D M Rae
- Frimley Park Hospital NHS Trust
| | | | | | | | | | - O J Old
- Gloucestershire Hospitals NHS Trust
| | | | - R Shah
- Gloucestershire Hospitals NHS Trust
| | | | - K Keogh
- Gloucestershire Hospitals NHS Trust
| | - L Frank
- Gloucestershire Hospitals NHS Trust
| | - M Al-Akash
- Great Western Hospitals NHS Foundation Trust
| | | | - R J Frame
- Harrogate and District NHS Foundation Trust
| | - M Hughes
- Harrogate and District NHS Foundation Trust
| | - C Jelley
- Harrogate and District NHS Foundation Trust
| | | | | | | | | | - T Cuming
- Homerton University Hospital NHS Trust
| | - P Cunha
- Homerton University Hospital NHS Trust
| | - S Tayeh
- Homerton University Hospital NHS Trust
| | | | | | - A Eisawi
- Tees Hospitals NHS Foundation Trust
| | | | - W S Ngu
- Tees Hospitals NHS Foundation Trust
| | | | | | - V Chitre
- Paget University Hospitals NHS Foundation Trust
| | - K Aryal
- Paget University Hospitals NHS Foundation Trust
| | - P Ferris
- Paget University Hospitals NHS Foundation Trust
| | | | | | | | | | | | | | | | - H Ebdewi
- Kettering General Hospital NHS Foundation Trust
| | - M Elshaer
- Kettering General Hospital NHS Foundation Trust
| | - G Gravante
- Kettering General Hospital NHS Foundation Trust
| | - B Drake
- Kettering General Hospital NHS Foundation Trust
| | - A Ogedegbe
- Barking, Havering and Redbridge University Hospitals NHS Trust
| | - D Mukherjee
- Barking, Havering and Redbridge University Hospitals NHS Trust
| | - C Arhi
- Barking, Havering and Redbridge University Hospitals NHS Trust
| | | | | | | | | | | | | | - K Wa
- Kingston Hospital NHS Foundation Trust
| | - J Mok
- Kingston Hospital NHS Foundation Trust
| | - T Woodman
- Kingston Hospital NHS Foundation Trust
| | - J Deguara
- Kingston Hospital NHS Foundation Trust
| | - G Garcea
- University Hospitals of Leicester NHS Trust
| | - B I Babu
- University Hospitals of Leicester NHS Trust
| | | | - D Malde
- University Hospitals of Leicester NHS Trust
| | - D Lloyd
- University Hospitals of Leicester NHS Trust
| | | | - O Al-Taan
- University Hospitals of Leicester NHS Trust
| | - A Boddy
- University Hospitals of Leicester NHS Trust
| | - J P Slavin
- Leighton Hospital, Mid Cheshire Hospitals NHS Foundation Trust
| | - R P Jones
- Leighton Hospital, Mid Cheshire Hospitals NHS Foundation Trust
| | - L Ballance
- Leighton Hospital, Mid Cheshire Hospitals NHS Foundation Trust
| | - S Gerakopoulos
- Leighton Hospital, Mid Cheshire Hospitals NHS Foundation Trust
| | - P Jambulingam
- Luton and Dunstable University Hospital NHS Foundation Trust
| | - S Mansour
- Luton and Dunstable University Hospital NHS Foundation Trust
| | - N Sakai
- Luton and Dunstable University Hospital NHS Foundation Trust
| | - V Acharya
- Luton and Dunstable University Hospital NHS Foundation Trust
| | - M M Sadat
- Macclesfield District General Hospital
| | - L Karim
- Macclesfield District General Hospital
| | - D Larkin
- Macclesfield District General Hospital
| | - K Amin
- Macclesfield District General Hospital
| | - A Khan
- Central Manchester NHS Foundation Trust
| | - J Law
- Central Manchester NHS Foundation Trust
| | - S Jamdar
- Central Manchester NHS Foundation Trust
| | - S R Smith
- Central Manchester NHS Foundation Trust
| | - K Sampat
- Central Manchester NHS Foundation Trust
| | | | - M Manu
- Royal Wolverhampton Hospitals NHS Trust
| | | | - N S Malik
- Royal Wolverhampton Hospitals NHS Trust
| | - J Chang
- Royal Wolverhampton Hospitals NHS Trust
| | | | - M Lewis
- Norfolk and Norwich University Hospitals NHS Foundation Trust
| | - G P Roberts
- Norfolk and Norwich University Hospitals NHS Foundation Trust
| | - B Karavadra
- Norfolk and Norwich University Hospitals NHS Foundation Trust
| | - E Photi
- Norfolk and Norwich University Hospitals NHS Foundation Trust
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - J Hornsby
- North Tees and Hartlepool NHS Foundation Trust
| | | | | | - K Seymour
- Northumbria Healthcare NHS Foundation Trust
| | - S Robinson
- Northumbria Healthcare NHS Foundation Trust
| | - H Hawkins
- Northumbria Healthcare NHS Foundation Trust
| | - S Bawa
- Northumbria Healthcare NHS Foundation Trust
| | | | - A Reid
- Northumbria Healthcare NHS Foundation Trust
| | - P Wood
- Northumbria Healthcare NHS Foundation Trust
| | - J G Finch
- Northampton General Hospital NHS Trust
| | - J Parmar
- Northampton General Hospital NHS Trust
| | | | | | - A Al-Muhktar
- Sheffield Teaching Hospitals NHS Foundation Trust
| | - M Peterson
- Sheffield Teaching Hospitals NHS Foundation Trust
| | - A Majeed
- Sheffield Teaching Hospitals NHS Foundation Trust
| | | | | | - A Choy
- Peterborough City Hospital
| | | | - N Pore
- United Lincolnshire Hospitals NHS Trust
| | | | | | - C Taylor
- United Lincolnshire Hospitals NHS Trust
| | | | | | | | | | | | | | | | - S Tate
- Portsmouth Hospitals NHS Trust
| | | | | | - V Vijay
- The Princess Alexandra Hospital NHS Trust
| | | | - S Sinha
- The Princess Alexandra Hospital NHS Trust
| | - S Khan
- The Princess Alexandra Hospital NHS Trust
| | | | - A A Hussain
- King's College Hospital NHS Foundation Trust
| | | | - N Kansal
- Gateshead Health NHS Foundation Trust
| | - T Fasih
- Gateshead Health NHS Foundation Trust
| | - C Jackson
- Gateshead Health NHS Foundation Trust
| | | | | | | | | | | | | | - K Gurung
- Queen Elizabeth Hospital NHS Trust
| | - G Tsavellas
- East Kent Hospitals University NHS Foundation Trust
| | - P Basynat
- East Kent Hospitals University NHS Foundation Trust
| | | | - S Basu
- East Kent Hospitals University NHS Foundation Trust
| | | | - M Rabie
- East Kent Hospitals University NHS Foundation Trust
| | - M Akhtar
- East Kent Hospitals University NHS Foundation Trust
| | - P Kumar
- Burton Hospitals NHS Foundation Trust
| | | | - N Hussain
- Burton Hospitals NHS Foundation Trust
| | - S Raza
- Burton Hospitals NHS Foundation Trust
| | - M Haque
- Royal Albert Edward Infirmary, Wigan Wrightington and Leigh NHS Trust
| | - I Alam
- Royal Albert Edward Infirmary, Wigan Wrightington and Leigh NHS Trust
| | - R Aseem
- Royal Albert Edward Infirmary, Wigan Wrightington and Leigh NHS Trust
| | - S Patel
- Royal Albert Edward Infirmary, Wigan Wrightington and Leigh NHS Trust
| | - M Asad
- Royal Albert Edward Infirmary, Wigan Wrightington and Leigh NHS Trust
| | - M I Booth
- Royal Berkshire NHS Foundation Trust
| | - W R Ball
- Royal Berkshire NHS Foundation Trust
| | | | | | | | | | - J Varghase
- Royal Bolton Hospital NHS Foundation Trust
| | - J Lodhia
- Royal Bolton Hospital NHS Foundation Trust
| | - D Bradley
- Royal Bolton Hospital NHS Foundation Trust
| | - C Rengifo
- Royal Bolton Hospital NHS Foundation Trust
| | - D Lindsay
- Royal Bolton Hospital NHS Foundation Trust
| | | | | | | | | | | | - A Awan
- Royal Derby NHS Foundation Trust
| | - J Ahmed
- Royal Derby NHS Foundation Trust
| | - P Leeder
- Royal Derby NHS Foundation Trust
| | | | | | | | | | - D Hou
- Hampshire Hospital NHS Foundation Trust
| | - F Noble
- Hampshire Hospital NHS Foundation Trust
| | | | | | - R Date
- Lancashire Teaching Hospitals NHS Foundation Trust
| | - M R Hossack
- Lancashire Teaching Hospitals NHS Foundation Trust
| | - Y Li Goh
- Lancashire Teaching Hospitals NHS Foundation Trust
| | - P Turner
- Lancashire Teaching Hospitals NHS Foundation Trust
| | - V Shetty
- Lancashire Teaching Hospitals NHS Foundation Trust
| | | | | | | | - S R Preston
- Royal Surrey County Hospital NHS Foundation Trust
| | - J R Hoban
- Royal Surrey County Hospital NHS Foundation Trust
| | - D J Puntis
- Royal Surrey County Hospital NHS Foundation Trust
| | - S V Williams
- Royal Surrey County Hospital NHS Foundation Trust
| | | | | | - J Batt
- Royal United Hospital Bath NHS Trust
| | - M Doe
- Royal United Hospital Bath NHS Trust
| | | | | | | | - C Hall
- Salford Royal NHS Foundation Trust
| | - N Carty
- Salisbury Hospital Foundation Trust
| | - J Ahmed
- Salisbury Hospital Foundation Trust
| | | | | | | | - H Lennon
- Southport and Ormskirk Hospital NHS Trust
| | - C Hindley
- Southport and Ormskirk Hospital NHS Trust
| | - M Reddy
- St George's Healthcare NHS Trust
| | - R Kenny
- St George's Healthcare NHS Trust
| | | | | | | | - K Hancorn
- St Helens and Knowsley Teaching Hospitals NHS Trust
| | - A Hargreaves
- St Helens and Knowsley Teaching Hospitals NHS Trust
| | | | | | | | | | - P Ziprin
- Imperial College Healthcare NHS Trust
| | | | - G Yeldham
- Imperial College Healthcare NHS Trust
| | - E Read
- Imperial College Healthcare NHS Trust
| | | | | | | | | | - M A Khan
- Mid Staffordshire NHS Foundation Trust
| | | | | | - A Hussain
- Mid Staffordshire NHS Foundation Trust
| | | | | | | | | | | | | | | | | | - S Ali
- City Hospitals Sunderland NHS Foundation Trust
| | - V Kanakala
- City Hospitals Sunderland NHS Foundation Trust
| | - H Ali
- Tunbridge Wells and Maidstone NHS Trust
| | - R Lane
- Tunbridge Wells and Maidstone NHS Trust
| | | | | | - D Mirza
- University Hospital Birmingham NHS Foundation Trust
| | - S Puig
- University Hospital Birmingham NHS Foundation Trust
| | - K Al Amari
- University Hospital Birmingham NHS Foundation Trust
| | - D Vijayan
- University Hospital Birmingham NHS Foundation Trust
| | - R Sutcliffe
- University Hospital Birmingham NHS Foundation Trust
| | | | - Z Hamady
- University Hospital Coventry and Warwickshire NHS Trust
| | - A R Prasad
- University Hospital Coventry and Warwickshire NHS Trust
| | - A Patel
- University Hospital Coventry and Warwickshire NHS Trust
| | - D Durkin
- University Hospital of North Staffordshire NHS Trust
| | - P Kaur
- University Hospital of North Staffordshire NHS Trust
| | - L Bowen
- University Hospital of North Staffordshire NHS Trust
| | - J P Byrne
- University Hospital Southampton NHS Foundation Trust
| | - K L Pearson
- University Hospital Southampton NHS Foundation Trust
| | - T G Delisle
- University Hospital Southampton NHS Foundation Trust
| | - J Davies
- University Hospital Southampton NHS Foundation Trust
| | | | | | | | - A Macdonald
- University Hospital South Manchester NHS Foundation Trust
| | - J Nicholson
- University Hospital South Manchester NHS Foundation Trust
| | - K Newton
- University Hospital South Manchester NHS Foundation Trust
| | - J Mbuvi
- University Hospital South Manchester NHS Foundation Trust
| | - A Farooq
- Warrington and Halton Hospitals NHS Trust
| | | | - Z Zafrani
- Warrington and Halton Hospitals NHS Trust
| | - D Brett
- Warrington and Halton Hospitals NHS Trust
| | | | | | - J Barnes
- South Warwickshire NHS Foundation Trust
| | - M Cheung
- South Warwickshire NHS Foundation Trust
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - M Wadley
- Worcestershire Acute Hospitals NHS Trust
| | - E Hamilton
- Worcestershire Acute Hospitals NHS Trust
| | - S Jaunoo
- Worcestershire Acute Hospitals NHS Trust
| | - R Padwick
- Worcestershire Acute Hospitals NHS Trust
| | - M Sayegh
- Western Sussex Hospitals NHS Foundation Trust
| | - R C Newton
- Western Sussex Hospitals NHS Foundation Trust
| | - M Hebbar
- Western Sussex Hospitals NHS Foundation Trust
| | - S F Farag
- Western Sussex Hospitals NHS Foundation Trust
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- Yeovil District Hospital NHS Trust
| | - M Giles
- York Teaching Hospital NHS Foundation Trust
| | - M B Peter
- York Teaching Hospital NHS Foundation Trust
| | - N A Hirst
- York Teaching Hospital NHS Foundation Trust
| | - T Hossain
- York Teaching Hospital NHS Foundation Trust
| | - A Pannu
- York Teaching Hospital NHS Foundation Trust
| | | | | | - G W Taylor
- York Teaching Hospital NHS Foundation Trust
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- Belfast City Hospital, Mater Infirmorum Hospital Belfast and Royal Victoria Hospital
| | - P Davey
- Belfast City Hospital, Mater Infirmorum Hospital Belfast and Royal Victoria Hospital
| | - C Jones
- Belfast City Hospital, Mater Infirmorum Hospital Belfast and Royal Victoria Hospital
| | - J M Clements
- Belfast City Hospital, Mater Infirmorum Hospital Belfast and Royal Victoria Hospital
| | - R Digney
- Belfast City Hospital, Mater Infirmorum Hospital Belfast and Royal Victoria Hospital
| | - W M Chan
- Belfast City Hospital, Mater Infirmorum Hospital Belfast and Royal Victoria Hospital
| | - S McCain
- Belfast City Hospital, Mater Infirmorum Hospital Belfast and Royal Victoria Hospital
| | - S Gull
- Belfast City Hospital, Mater Infirmorum Hospital Belfast and Royal Victoria Hospital
| | - A Janeczko
- Belfast City Hospital, Mater Infirmorum Hospital Belfast and Royal Victoria Hospital
| | - E Dorrian
- Belfast City Hospital, Mater Infirmorum Hospital Belfast and Royal Victoria Hospital
| | - A Harris
- Belfast City Hospital, Mater Infirmorum Hospital Belfast and Royal Victoria Hospital
| | - S Dawson
- Belfast City Hospital, Mater Infirmorum Hospital Belfast and Royal Victoria Hospital
| | - D Johnston
- Belfast City Hospital, Mater Infirmorum Hospital Belfast and Royal Victoria Hospital
| | - B McAree
- Belfast City Hospital, Mater Infirmorum Hospital Belfast and Royal Victoria Hospital
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- University Hospital Limerick
| | | | - A D K Hill
- Louth County Hospital and Our Lady of Lourdes Hospital
| | - E Khogali
- Louth County Hospital and Our Lady of Lourdes Hospital
| | - W Shabo
- Louth County Hospital and Our Lady of Lourdes Hospital
| | - E Iskandar
- Louth County Hospital and Our Lady of Lourdes Hospital
| | | | | | | | | | | | | | | | | | - P Balfe
- St Luke's General Hospital Kilkenny
| | - M Lee
- St Luke's General Hospital Kilkenny
| | - D C Winter
- St Vincent's University and Private Hospitals, Dublin
| | - M E Kelly
- St Vincent's University and Private Hospitals, Dublin
| | - E Hoti
- St Vincent's University and Private Hospitals, Dublin
| | - D Maguire
- St Vincent's University and Private Hospitals, Dublin
| | - P Karunakaran
- St Vincent's University and Private Hospitals, Dublin
| | - J G Geoghegan
- St Vincent's University and Private Hospitals, Dublin
| | - S T Martin
- St Vincent's University and Private Hospitals, Dublin
| | - F McDermott
- St Vincent's University and Private Hospitals, Dublin
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - S Gibson
- Crosshouse Hospital, Ayrshire and Arran
| | | | - D G Vass
- Crosshouse Hospital, Ayrshire and Arran
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - H C C Lim
- Glangwili General and Prince Philip Hospital
| | - D Duke
- Glangwili General and Prince Philip Hospital
| | - T Ahmed
- Glangwili General and Prince Philip Hospital
| | - W D Beasley
- Glangwili General and Prince Philip Hospital
| | | | - G Maharaj
- Glangwili General and Prince Philip Hospital
| | - C Malcolm
- Glangwili General and Prince Philip Hospital
| | | | | | | | - R Radwan
- Morriston and Singleton Hospitals
| | | | - S Wood
- Princess of Wales Hospital
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Asar Ö, Ritchie J, Kalra PA, Diggle PJ. Short-term and long-term effects of acute kidney injury in chronic kidney disease patients: A longitudinal analysis. Biom J 2016; 58:1552-1566. [PMID: 27627622 DOI: 10.1002/bimj.201500270] [Citation(s) in RCA: 6] [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: 12/24/2015] [Revised: 05/31/2016] [Accepted: 06/30/2016] [Indexed: 11/09/2022]
Abstract
We use data from an ongoing cohort study of chronic kidney patients at Salford Royal NHS Foundation Trust, Greater Manchester, United Kingdom, to investigate the influence of acute kidney injury (AKI) on the subsequent rate of change of kidney function amongst patients already diagnosed with chronic kidney disease (CKD). We use a linear mixed effects modelling framework to enable estimation of both acute and chronic effects of AKI events on kidney function. We model the fixed effects by a piece-wise linear function with three change-points to capture the acute changes in kidney function that characterise an AKI event, and the random effects by the sum of three components: a random intercept, a stationary stochastic process with Matérn correlation structure, and measurement error. We consider both multivariate Normal and multivariate t versions of the random effects. For either specification, we estimate model parameters by maximum likelihood and evaluate the plug-in predictive distributions of the random effects given the data. We find that following an AKI event the average long-term rate of decline in kidney function is almost doubled, regardless of the severity of the event. We also identify and present examples of individual patients whose kidney function trajectories diverge substantially from the population-average.
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Affiliation(s)
- Özgür Asar
- CHICAS, Medical School, Lancaster University, Lancaster, UK.
| | - James Ritchie
- Vascular Research Group, Manchester Academic Health Sciences Centre, University of Manchester, Salford Royal NHS Foundation Trust, Greater Manchester, UK
| | - Philip A Kalra
- Vascular Research Group, Manchester Academic Health Sciences Centre, University of Manchester, Salford Royal NHS Foundation Trust, Greater Manchester, UK
| | - Peter J Diggle
- CHICAS, Medical School, Lancaster University, Lancaster, UK
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42
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Nicoletti AM, Kenny CH, Khalil AM, Pan Q, Ralph KLM, Ritchie J, Venkataramani S, Presky DH, DeWire SM, Brodeur SR. Unexpected Potency Differences between B-Cell-Activating Factor (BAFF) Antagonist Antibodies against Various Forms of BAFF: Trimer, 60-Mer, and Membrane-Bound. ACTA ACUST UNITED AC 2016; 359:37-44. [DOI: 10.1124/jpet.116.236075] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 07/18/2016] [Indexed: 02/01/2023]
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Vassallo D, Green D, Ritchie J, Chrysochou C, Blunt J, Kalra PA. Three Decades of Atherosclerotic Reno-vascular Disease Management - Changing Outcomes in an Observational Study. Kidney Blood Press Res 2016; 41:325-34. [PMID: 27221799 DOI: 10.1159/000443434] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Optimized medical therapy has improved cardiovascular outcomes in the general population. To investigate whether changes in the management of atherosclerotic renovascular disease (ARVD) have had an impact on clinical outcomes. METHODS Recruitment into this single-center prospective cohort study started in 1986. Data was analyzed retrospectively. Patients were divided into four groups based on relationship of diagnosis year to landmark randomized controlled trials (RCT); group 1 - pre-large RCT data (1986-2000); group 2 - post-early RCT (2001-2004); group 3 - ASTRAL study recruitment era (2004-2009); group 4 - post-ASTRAL (2009-2014). RESULTS In total, 872 patients were followed for a median 54.9 months (IQR 20.2-96.2). Over successive time-periods, there was an increase in baseline utilization of renin angiotensin blockade (RAB) (group 4: 69% vs. group 1: 31%, p<0.001), statins (74% vs 20%, p<0.001) and beta-blockers (43% vs 30%, p=0.024). Median time to death, end-stage kidney disease and cardiovascular events improved except in group 4, which displayed more baseline cardiovascular comorbidities. The number of investigative angiograms performed decreased from 139 per year between 2006 and 2008 to 74 per year in group 4. CONCLUSIONS Although fewer patients are being investigated for ARVD in our center, these have more cardiovascular comorbidities. Nonetheless, optimized medical therapy may have contributed towards improved proteinuria, renal function and clinical outcomes in patients diagnosed with ARVD.
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Affiliation(s)
- Diana Vassallo
- Department of Renal Medicine, Salford Royal NHS Foundation Trust, Salford, United Kingdom
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44
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Greenan K, Vassallo D, Chinnadurai R, Ritchie J, Shepherd K, Green D, Ponnusamy A, Sinha S. Respiratory manifestations of ANCA-associated vasculitis. Clin Respir J 2016; 12:57-61. [DOI: 10.1111/crj.12478] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 03/31/2016] [Indexed: 01/18/2023]
Affiliation(s)
- Kerry Greenan
- School of Medicine; University of Manchester; Manchester UK
| | - Diana Vassallo
- Vascular Research Group; Department of Renal Medicine, Salford Royal NHS Foundation Trust; Salford UK
| | - Rajkumar Chinnadurai
- Vascular Research Group; Department of Renal Medicine, Salford Royal NHS Foundation Trust; Salford UK
| | - James Ritchie
- Vascular Research Group; Department of Renal Medicine, Salford Royal NHS Foundation Trust; Salford UK
| | - Kate Shepherd
- Department of Respiratory Medicine; Royal Blackburn Hospital; Blackburn UK
| | - Darren Green
- Vascular Research Group; Department of Renal Medicine, Salford Royal NHS Foundation Trust; Salford UK
- Manchester Academic Health Sciences Centre; Institute of Population Health, University of Manchester; Manchester UK
| | - Arvind Ponnusamy
- Vascular Research Group; Department of Renal Medicine, Salford Royal NHS Foundation Trust; Salford UK
| | - Smeeta Sinha
- Vascular Research Group; Department of Renal Medicine, Salford Royal NHS Foundation Trust; Salford UK
- Manchester Academic Health Sciences Centre; Institute of Population Health, University of Manchester; Manchester UK
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Vassallo D, Ritchie J, Green D, Chrysochou C, Blunt J, Kalra PA. SP300LONG-TERM CLINICAL OUTCOMES IN ATHEROSCLEROTIC RENOVASCULAR DISEASE: A SINGLE-CENTER OBSERVATIONAL STUDY. Nephrol Dial Transplant 2016. [DOI: 10.1093/ndt/gfw165.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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46
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Vassallo D, Green D, Ritchie J, Chrysochou C, Blunt J, Kalra PA. MP314THREE DECADES OF ATHEROSCLEROTIC RENOVASCULAR DISEASE MANAGEMENT - CHANGING OUTCOMES IN AN OBSERVATIONAL STUDY. Nephrol Dial Transplant 2016. [DOI: 10.1093/ndt/gfw189.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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47
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Ritchie J, Green D, Alderson HV, Chrysochou C, Vassallo D, Sinha S, Kalra PA. Associations of antiplatelet therapy and beta blockade with patient outcomes in atherosclerotic renovascular disease. ACTA ACUST UNITED AC 2016; 10:149-158.e3. [PMID: 26778771 DOI: 10.1016/j.jash.2015.12.002] [Citation(s) in RCA: 8] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 11/08/2015] [Accepted: 12/01/2015] [Indexed: 01/13/2023]
Abstract
Randomized trials have shown a neutral effect of percutaneous revascularization compared with optimal medical therapy in patients with atherosclerotic renovascular disease (ARVD). However, there are few data to define what constitutes optimal medical therapy. We present a retrospective analysis of 529 ARVD patients. Separate analyses were performed comparing outcomes in patients prescribed/not prescribed beta blocker and antiplatelet agents. Analyses were adjusted for effects of baseline covariates on probability of treatment and on clinical outcome. Over a median follow-up period of 3.8 years, antiplatelet therapy was associated with a reduced risk for death (relative risk, 0.52 [95% confidence interval {CI}: 0.31-0.89]; P = .02). Beta blocker therapy was associated with a reduced for death (relative risk, 0.45 [95% CI: 0.21-0.97]; P = .04) and nonfatal cardiovascular events (relative risk, 0.74 [95% CI: 0.60-0.90]; P = .003). Although limited by small patient numbers, this study suggests that in ARVD, treatment with antiplatelet therapy and beta blockade may associate with a prognostic benefit.
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Affiliation(s)
- James Ritchie
- Vascular Research Group, Department of Renal Medicine, Salford Royal NHS Foundation Trust, Salford, United Kingdom
| | - Darren Green
- Vascular Research Group, Department of Renal Medicine, Salford Royal NHS Foundation Trust, Salford, United Kingdom
| | - Helen V Alderson
- Vascular Research Group, Department of Renal Medicine, Salford Royal NHS Foundation Trust, Salford, United Kingdom
| | - Constantina Chrysochou
- Vascular Research Group, Department of Renal Medicine, Salford Royal NHS Foundation Trust, Salford, United Kingdom
| | - Diana Vassallo
- Vascular Research Group, Department of Renal Medicine, Salford Royal NHS Foundation Trust, Salford, United Kingdom
| | - Smeeta Sinha
- Vascular Research Group, Department of Renal Medicine, Salford Royal NHS Foundation Trust, Salford, United Kingdom
| | - Philip A Kalra
- Vascular Research Group, Department of Renal Medicine, Salford Royal NHS Foundation Trust, Salford, United Kingdom.
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48
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Morton M, Coupes B, Ritchie J, Roberts SA, Klapper PE, Byers RJ, Vallely PJ, Ryan K, Picton ML. Post-transplant lymphoproliferative disorder in adult renal transplant recipients: survival and prognosis. Leuk Lymphoma 2016; 57:299-305. [PMID: 25976109 DOI: 10.3109/10428194.2015.1050391] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Post-transplant lymphoproliferative disorder (PTLD) is a rare, serious complication following solid organ transplantation, with an incidence of 2.6 cases per 1000 patient years. Optimal treatment strategies and risk stratifications specific to kidney transplantation are lacking and PTLD mortality remains high. This study investigated survival and prognosis in 89 cases of PTLD presenting over 44 years at Manchester Royal Infirmary. Patient survival following diagnosis was 72% at 6 months, 67% at 1 year and 54% at 3 years. In multivariate analysis, a poorer 3 year survival was associated with acute kidney injury at diagnosis (p = 0.0001), impaired renal function (p = 0.04), early onset (p = 0.02), T cell disease (p = 0.02) and previous treatment with anti-thymocyte globulin (p = 0.04). The inclusion of graft function adds prognostic value to risk stratification and should be explored further. Strategies to improve survival should include timing and choice of immuno-chemotherapy, preparation for dialysis and aggressive surveillance for sepsis and treatment toxicity.
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Affiliation(s)
- Muir Morton
- a Department of Renal Medicine , Central Manchester University Hospitals Foundation Trust , Manchester , UK
| | - Beatrice Coupes
- a Department of Renal Medicine , Central Manchester University Hospitals Foundation Trust , Manchester , UK
| | - James Ritchie
- b Center for Epidemiology, Institute of Population Health, Salford Royal NHS Foundation Trust , Salford , UK
| | - Stephen A Roberts
- c Centre for Biostatistics, Institute of Population Health, University of Manchester , Manchester , UK
| | - Paul E Klapper
- d Department of Clinical Virology , Central Manchester University Hospitals Foundation Trust , Manchester , UK.,e Microbiology and Virology Unit, School of Translational Medicine, the University of Manchester, Manchester Academic Health Sciences Centre , Manchester , UK
| | - Richard J Byers
- f Department of Histopathology , Central Manchester University Hospitals Foundation Trust , Manchester , UK.,g School of Cancer and Enabling Sciences, Faculty of Medical and Human Sciences, University of Manchester , Manchester , UK.,h Manchester Academic Health Science Centre , Manchester , UK
| | - Pamela J Vallely
- e Microbiology and Virology Unit, School of Translational Medicine, the University of Manchester, Manchester Academic Health Sciences Centre , Manchester , UK
| | - Kate Ryan
- h Manchester Academic Health Science Centre , Manchester , UK.,i Department of Haematology , Central Manchester University Hospitals Foundation Trust , Manchester , UK
| | - Michael L Picton
- a Department of Renal Medicine , Central Manchester University Hospitals Foundation Trust , Manchester , UK
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Jeffrey P, Lock R, Pryde D, Ritchie J. Rare Diseases, Extraordinary Aspirations. Highlights from the Society for Medicines Research Symposium, held October 13, 2016 - Covent Garden, London, UK. DRUG FUTURE 2016. [DOI: 10.1358/dof.2016.041.11.2564105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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50
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Rainone F, Raza SMA, Ritchie J, Merlino L, Alderson H, Chiu D, Guy M, Marcatti M, Kalra P. Associations Between Initial Presentation of Multiple Myeloma and Renal Function: the Experience of Two European Centers. J Hematol 2016. [DOI: 10.14740/jh229w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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