1
|
Cashmore B, Tunnicliffe DJ, Palmer S, Blythen L, Boag J, Kostner K, Krishnasamy R, Lambert K, Miller A, Mullan J, Patu M, Phoon RKS, Rix L, Trompf N, Johnson DW, Walker R. Australian and New Zealand Living Guideline cholesterol-lowering therapy for people with chronic kidney disease (CARI Guidelines): Reducing the evidence-practice gap. Nephrology (Carlton) 2024. [PMID: 38684481 DOI: 10.1111/nep.14295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 02/23/2024] [Accepted: 03/10/2024] [Indexed: 05/02/2024]
Abstract
AIM People with chronic kidney disease experience high rates of cardiovascular disease. Cholesterol-lowering therapy is a mainstay in the management but there is uncertainty in the treatment effects on patient-important outcomes, such as fatigue and rhabdomyolysis. Here, we summarise the updated CARI Australian and New Zealand Living Guidelines on cholesterol-lowering therapy in chronic kidney disease. METHODS We updated a Cochrane review and monitored newly published studies weekly to inform guideline development according to international standards. The Working Group included expertise from nephrology, cardiology, Indigenous Health, guideline development and people with lived experience of chronic kidney disease. RESULTS The guideline recommends people with chronic kidney disease (eGFR ≥15 mL/min/1.73 m2) and an absolute cardiovascular risk of 10% or higher should receive statin therapy (with or without ezetimibe) to reduce the risk of cardiovascular events and death (strong recommendation, moderate certainty evidence). The guidelines also recommends a lower absolute cardiovascular risk threshold (≥5%) for Aboriginal and Torres Strait Islander Peoples and Māori with chronic kidney disease to receive statin therapy (with or without ezetimibe) (strong recommendation, low certainty evidence). The evidence was actively surveyed from 2020-2023 and updated as required. No changes to guideline recommendations were made, with no new data on the balance and benefits of harms. CONCLUSIONS The development of living guidelines was feasible and provided the opportunity to update recommendations to improve clinical decision-making in real-time. Living guidelines provide the opportunity to transform chronic kidney disease guidelines.
Collapse
Affiliation(s)
- Brydee Cashmore
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Kidney Research, The Children's Hospital of Westmead, Sydney, New South Wales, Australia
| | - David J Tunnicliffe
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Kidney Research, The Children's Hospital of Westmead, Sydney, New South Wales, Australia
| | - Suetonia Palmer
- Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand
| | | | - Jane Boag
- Consumer Partner, Australia
- School of Health, Federation University, Ballarat, Victoria, Australia
| | - Karam Kostner
- Mater Hospital, University of Queensland, St Lucia, Queensland, Australia
| | - Rathika Krishnasamy
- Department of Nephrology, Sunshine Coast University Hospital, Birtinya, Queensland, Australia
- Centre for Kidney Disease Research, The University of Queensland, Brisbane, Queensland, Australia
- Australasian Kidney Trials Network, The University of Queensland, Brisbane, Queensland, Australia
| | - Kelly Lambert
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Andrea Miller
- Cape York Kidney Care, Weipa Integrated Health Services, Weipa, Queensland, Australia
| | - Judy Mullan
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Maira Patu
- Māori/Indigenous Health Institute, University of Otago, Christchurch, New Zealand
| | - Richard K S Phoon
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Department of Renal Medicine, Centre for Transplant and Renal Research, Westmead Hospital, Westmead, New South Wales, Australia
| | - Liz Rix
- Adelaide Nursing School, University of Adelaide, Adelaide, South Australia, Australia
| | | | - David W Johnson
- Australasian Kidney Trials Network, The University of Queensland, Brisbane, Queensland, Australia
- Department of Kidney and Transplant Services, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
- Translational Research Institute, Brisbane, Queensland, Australia
| | - Robert Walker
- Department of Medicine, University of Otago Dunedin, Dunedin, New Zealand
| |
Collapse
|
2
|
Miglioretto C, Beck E, Lambert K. What do people with inflammatory bowel disease want to know about diet? The dietary information needs of people with inflammatory bowel disease and perceptions of healthcare providers. J Hum Nutr Diet 2024. [PMID: 38462982 DOI: 10.1111/jhn.13297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 02/27/2024] [Indexed: 03/12/2024]
Abstract
BACKGROUND Inflammatory bowel disease (IBD) is an incurable illness of the gastrointestinal tract. Its relapsing-remitting nature negatively impacts physical health and quality of life. Food and eating are key concerns for people with this illness. To provide holistic person-centred care, healthcare providers (HCPs) need to meet patients' dietary information needs. However, there is a paucity of literature describing these in any meaningful detail. The present study aimed to explore the perceived dietary information needs of individuals with IBD, the perceptions of HCPs and enablers and barriers to communication. METHODS Online and face-to-face semi-structured interviews with 13 HCPs and 29 people with IBD were conducted. The framework method aided thematic analysis of de-identified interview recordings. RESULTS The cyclical nature of IBD contextualised the five themes. Both individuals with IBD and HCPs articulated similar ideas viewed from different perspectives: (1) living with IBD is exasperating and unique to the individual; (2) individuals with IBD desire dietary information; (3) diet manipulation is used to exert control on a disease with unpredictable nature; (4) people with IBD and HCPs have different views on the role of diet; and (5) doctors are perceived as gatekeepers to accessing dietetics care. CONCLUSIONS A lack of dietary guidance at diagnosis negatively impacts the patient's journey with food and eating. The present study supports a paradigm shift towards holistic person-centred care for consistent access to dietetics services to meet the needs of people with IBD.
Collapse
Affiliation(s)
- Chiara Miglioretto
- School of Medical, Indigenous and Health Sciences, University of Wollongong, Wollongong, NSW, Australia
| | - Eleanor Beck
- School of Medical, Indigenous and Health Sciences, University of Wollongong, Wollongong, NSW, Australia
- School of Health Sciences, University of New South Wales, Kensington, NSW, Australia
| | - Kelly Lambert
- School of Medical, Indigenous and Health Sciences, University of Wollongong, Wollongong, NSW, Australia
| |
Collapse
|
3
|
Kistler B, Avesani CM, Burrowes JD, Chan M, Cuppari L, Hensley MK, Karupaiah T, Kilates MC, Mafra D, Manley K, Vennegoor M, Wang AYM, Lambert K, Sumida K, Moore LW, Kalantar-Zadeh K, Campbell KL. Dietitians Play a Crucial and Expanding Role in Renal Nutrition and Medical Nutrition Therapy. J Ren Nutr 2024; 34:91-94. [PMID: 38373524 DOI: 10.1053/j.jrn.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 02/13/2024] [Indexed: 02/21/2024] Open
Affiliation(s)
- Brandon Kistler
- Department of Nutrition Science, Purdue University, West Lafayette, Indiana.
| | - Carla Maria Avesani
- Nephrology Division, Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolsinka Institutet, Stockholm, Sweden
| | | | - Maria Chan
- The St. George Hospital, Sydney, New South Wales, Australia
| | | | | | - Tilakavati Karupaiah
- School of Biosciences, Faculty of Health & Medical Science, Taylor's University Lakeside Campus, Subang Jaya, Malaysia
| | | | - Denise Mafra
- Federal University Fluminense, UFF, Niterói, Brazil
| | | | - Marianne Vennegoor
- Retired, Department of Renal Medicine, Guy's and St Thomas' Hospital NHS Foundation Trust, London, United Kingdom
| | - Angela Yee-Moon Wang
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong
| | - Kelly Lambert
- School of Medical, Indigenous and Health Sciences, University of Wollongong, Wollongong, New South Wales, Australia
| | - Keiichi Sumida
- Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Linda W Moore
- Department of Surgery, Houston Methodist Hospital, Houston, Texas
| | - Kamyar Kalantar-Zadeh
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, California; Division of Nephrology, Hypertension, and Transplantation, Harbor-UCLA and the Lundquist Institute, Torrence, California
| | - Katrina L Campbell
- Metro North Hospital and Health Service, Brisbane, Queensland, Australia
| |
Collapse
|
4
|
Jaquet M, Bengue M, Lambert K, Carnac G, Missé D, Bisbal C. Human muscle cells sensitivity to chikungunya virus infection relies on their glycolysis activity and differentiation stage. Biochimie 2024; 218:85-95. [PMID: 37716499 DOI: 10.1016/j.biochi.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 06/22/2023] [Accepted: 09/04/2023] [Indexed: 09/18/2023]
Abstract
Changes to our environment have led to the emergence of human pathogens such as chikungunya virus. Chikungunya virus infection is today a major public health concern. It is a debilitating chronic disease impeding patients' mobility, affecting millions of people. Disease development relies on skeletal muscle infection. The importance of skeletal muscle in chikungunya virus infection led to the hypothesis that it could serve as a viral reservoir and could participate to virus persistence. Here we questioned the interconnection between skeletal muscle cells metabolism, their differentiation stage and the infectivity of the chikungunya virus. We infected human skeletal muscle stem cells at different stages of differentiation with chikungunya virus to study the impact of their metabolism on virus production and inversely the impact of virus on cell metabolism. We observed that chikungunya virus infectivity is cell differentiation and metabolism-dependent. Chikungunya virus interferes with the cellular metabolism in quiescent undifferentiated and proliferative muscle cells. Moreover, activation of chikungunya infected quiescent muscle stem cells, induces their proliferation, increases glycolysis and amplifies virus production. Therefore, our results showed that Chikungunya virus infectivity and the antiviral response of skeletal muscle cells relies on their energetic metabolism and their differentiation stage. Then, muscle stem cells could serve as viral reservoir producing virus after their activation.
Collapse
Affiliation(s)
- M Jaquet
- PhyMedExp, Univ. Montpellier, INSERM U1046, CNRS UMR 9214, 34295, Montpellier Cedex 5, France; MIVEGEC, Univ. Montpellier, IRD, CNRS, 34394, Montpellier, France
| | - M Bengue
- MIVEGEC, Univ. Montpellier, IRD, CNRS, 34394, Montpellier, France
| | - K Lambert
- PhyMedExp, Univ. Montpellier, INSERM U1046, CNRS UMR 9214, 34295, Montpellier Cedex 5, France
| | - G Carnac
- PhyMedExp, Univ. Montpellier, INSERM U1046, CNRS UMR 9214, 34295, Montpellier Cedex 5, France
| | - D Missé
- MIVEGEC, Univ. Montpellier, IRD, CNRS, 34394, Montpellier, France.
| | - C Bisbal
- PhyMedExp, Univ. Montpellier, INSERM U1046, CNRS UMR 9214, 34295, Montpellier Cedex 5, France.
| |
Collapse
|
5
|
Lambert K, Ryan M, Flanagan J, Broinowski G, Nicdao M, Stanford J, Chau K. Dietary Patterns, Dietary Adequacy and Nutrient Intake in Adults Commencing Peritoneal Dialysis: Outcomes from a Longitudinal Cohort Study. Nutrients 2024; 16:663. [PMID: 38474791 DOI: 10.3390/nu16050663] [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: 01/10/2024] [Revised: 02/25/2024] [Accepted: 02/26/2024] [Indexed: 03/14/2024] Open
Abstract
(1) Background: Optimal dietary intake is integral to good health in people receiving peritoneal dialysis (PD). We investigated how dietary patterns, dietary adequacy and nutrient intake may change over time in people commencing PD. (2) Methods: Participants were attending the PD training unit for the commencement of peritoneal dialysis, aged ≥18 years and willing to complete food records. Misreporters were excluded from the analysis. Dietary intake was compared at PD commencement and at 12 months. Intake was also compared to reference standards. Dietary patterns were derived using principal component analysis. (3) Results: There were no significant changes between baseline and 12 months for grains, fruit, vegetables and meat. Dairy and added sugar intake was significantly lower (p = 0.01). The intake of energy and protein was adequate and did not change. There was a significant reduction in dietary phosphorus and calcium, and increased vitamin C intake. Three dietary patterns were identified: the 'Bread and Cereal' pattern; 'Milk and Potatoes' pattern; and the 'Semi Vegetarian' pattern. (4) Conclusions: In this longitudinal cohort study, the diet quality was suboptimal and there were limited changes in intake after the commencement of PD. Further exploration of how dietary patterns may impact outcomes and quality of life is warranted.
Collapse
Affiliation(s)
- Kelly Lambert
- School of Medical, Indigenous and Health Sciences, University of Wollongong, Wollongong, NSW 2522, Australia
| | - Michele Ryan
- Western Renal Service, Blacktown Hospital, Blacktown, NSW 2148, Australia
| | - Jade Flanagan
- School of Medical, Indigenous and Health Sciences, University of Wollongong, Wollongong, NSW 2522, Australia
| | - Georgie Broinowski
- School of Medical, Indigenous and Health Sciences, University of Wollongong, Wollongong, NSW 2522, Australia
| | - Maryann Nicdao
- Western Renal Service, Blacktown Hospital, Blacktown, NSW 2148, Australia
| | - Jordan Stanford
- School of Medical, Indigenous and Health Sciences, University of Wollongong, Wollongong, NSW 2522, Australia
| | - Katrina Chau
- Western Renal Service, Blacktown Hospital, Blacktown, NSW 2148, Australia
- Blacktown Clinical School, School of Medicine, Western Sydney University, Blacktown, NSW 2148, Australia
| |
Collapse
|
6
|
Cosier DJ, Lambert K, Neale EP, Probst Y, Charlton K. The effect of oral synbiotics on the gut microbiota and inflammatory biomarkers in healthy adults: a systematic review and meta-analysis. Nutr Rev 2024:nuae002. [PMID: 38341803 DOI: 10.1093/nutrit/nuae002] [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: 02/13/2024] Open
Abstract
CONTEXT Prior research has explored the effect of synbiotics, the combination of probiotics and prebiotics, on the gut microbiota in clinical populations. However, evidence related to the effect of synbiotics on the gut microbiota in healthy adults has not been reviewed to date. OBJECTIVE A systematic review and meta-analysis was conducted to comprehensively investigate the effect of synbiotics on the gut microbiota and inflammatory markers in populations of healthy adults. DATA SOURCES Scopus, PubMed, Web of Science, ScienceDirect, MEDLINE, CINAHL, and The Cochrane Library were systematically searched to retrieve randomized controlled trials examining the primary outcome of gut microbiota or intestinal permeability changes after synbiotic consumption in healthy adults. Secondary outcomes of interest were short-chain fatty acids, inflammatory biomarkers, and gut microbiota diversity. DATA EXTRACTION Weighted (WMD) or standardized mean difference (SMD) outcome data were pooled in restricted maximum likelihood models using random effects. Twenty-seven articles reporting on 26 studies met the eligibility criteria (n = 1319). DATA ANALYSIS Meta-analyses of 16 studies showed synbiotics resulted in a significant increase in Lactobacillus cell count (SMD, 0.74; 95% confidence interval [CI], 0.15, 1.33; P = 0.01) and propionate concentration (SMD, 0.22; 95% CI, 0.02, 0.43; P = 0.03) compared with controls. A trend for an increase in Bifidobacterium relative abundance (WMD, 0.97; 95% CI, 0.42, 2.52; P = 0.10) and cell count (SMD, 0.82; 95% CI, 0.13, 1.88; P = 0.06) was seen. No significant differences in α-diversity, acetate, butyrate, zonulin, IL-6, CRP, or endotoxins were observed. CONCLUSION This review demonstrates that synbiotics modulate the gut microbiota by increasing Lactobacillus and propionate across various healthy adult populations, and may result in increased Bifidobacterium. Significant variations in synbiotic type, dose, and duration should be considered as limitations when applying findings to clinical practice. SYSTEMATIC REVIEW REGISTRATION PROSPERO no. CRD42021284033.
Collapse
Affiliation(s)
- Denelle J Cosier
- School of Medicine, Indigenous and Health Sciences, University of Wollongong, Wollongong, New South Wales, Australia
| | - Kelly Lambert
- School of Medicine, Indigenous and Health Sciences, University of Wollongong, Wollongong, New South Wales, Australia
| | - Elizabeth P Neale
- School of Medicine, Indigenous and Health Sciences, University of Wollongong, Wollongong, New South Wales, Australia
| | - Yasmine Probst
- School of Medicine, Indigenous and Health Sciences, University of Wollongong, Wollongong, New South Wales, Australia
| | - Karen Charlton
- School of Medicine, Indigenous and Health Sciences, University of Wollongong, Wollongong, New South Wales, Australia
| |
Collapse
|
7
|
Miglioretto C, Beck E, Lambert K. A scoping review of the dietary information needs of people with inflammatory bowel disease. Nutr Diet 2024; 81:79-93. [PMID: 37806663 DOI: 10.1111/1747-0080.12843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 08/25/2023] [Accepted: 08/31/2023] [Indexed: 10/10/2023]
Abstract
AIMS This review aimed to explore and describe the dietary information needs of individuals with inflammatory bowel disease and sources of information. METHODS A scoping review of English language articles and grey literature, using electronic databases with a predefined search strategy was undertaken. Data were synthesised based on the identified variables (e.g. dietary information needs and sources of dietary information) corresponding to the aims of this review. RESULTS Forty-six studies were included, reporting data from 7557 people with inflammatory bowel disease, of which 58.6% had Crohn's disease and 60.1% were males. Dietary information was rated very important and appeared to be influenced by the disease course. The need to discuss it is heightened at important stages, namely diagnosis and relapse. Dietary information was described broadly and included advice about foods to avoid and dietary advice for symptoms management. No major differences were noted in the dietary information needs of people with Crohn's disease compared to ulcerative colitis. The main sources of dietary information were the gastroenterologist (36%-98%), the internet (9%-60%) and non-dietetic professionals (84.7%). CONCLUSION This review highlights limited literature describing the dietary information needs of people with inflammatory bowel disease. Importantly, the limited access to specialised dietary advice for this cohort is concerning. Future studies are required to explore not only the nuances in the needs of those with active disease and in remission, but to further understand issues of access to specialised dietary advice to provide holistic person-centred care desired by this cohort.
Collapse
Affiliation(s)
- Chiara Miglioretto
- School of Medical, Indigenous and Health Sciences, University of Wollongong, Wollongong, New South Wales, Australia
| | - Eleanor Beck
- School of Medical, Indigenous and Health Sciences, University of Wollongong, Wollongong, New South Wales, Australia
- School of Health Sciences, University of New South Wales, Kensington, New South Wales, Australia
| | - Kelly Lambert
- School of Medical, Indigenous and Health Sciences, University of Wollongong, Wollongong, New South Wales, Australia
| |
Collapse
|
8
|
Katsoudas N, Tavakoli P, Wu N, Shapiro A, Leach ST, Williams AJ, Paramsothy R, Ghaly S, Connor SJ, Samocha-Bonet D, Lambert K, Hold GL. Dietary Emulsifier Exposure in People With Inflammatory Bowel Disease Compared With Healthy Controls: Is There a Cause for Concern? Inflamm Bowel Dis 2024:izad318. [PMID: 38244236 DOI: 10.1093/ibd/izad318] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Indexed: 01/22/2024]
Abstract
BACKGROUND Emulsifiers are implicated in the pathogenesis of inflammatory bowel disease (IBD). Few studies have examined emulsifier intake in people with existing IBD. We aimed to describe the frequency of exposure to 6 selected emulsifiers in a contemporary cohort of people with IBD and compare intake with healthy controls (HCs). METHODS Baseline food records from participants in an Australian prospective cohort study examining the microbiome of IBD patients and HCs were analyzed. Exposure to inflammatory emulsifiers polysorbate-80 (P80); carboxymethylcellulose (CMC); carrageenan; xanthan gum (XG); lecithin (soy and sunflower) and mono- and diglycerides of fatty acids (MDGs) were determined by examining ingredient lists. Frequency of emulsifier exposure between groups (IBD vs HC, Crohn's disease [CD] vs ulcerative colitis [UC], IBD children vs adults, active disease vs remission) was examined after controlling for confounders. RESULTS Records from 367 participants were analyzed (n = 176 IBD, of which there were 101 CD, 75 UC, and 191 HC patients). In total, 5022 unique food items were examined, with 18% containing 1 or more emulsifier of interest. Inflammatory bowel disease participants had significantly higher total daily emulsifier exposure compared with HCs (2.7 ± 1.8 vs 2.3 ± 1.6, P = .02). In IBD participants, emulsifiers with the highest daily exposure were MDGs (1.2 ± 0.93), lecithin (0.85 ± 0.93), and XG (0.38 ± 0.42). There were no recorded exposures to P80. CONCLUSIONS Inflammatory bowel disease participants were exposed to more emulsifiers than HCs. Intake of inflammatory emulsifiers were low or nonexistent, suggesting their presence in the food supply are not as common as frequently stated.
Collapse
Affiliation(s)
- Natasha Katsoudas
- School of Medical, Indigenous and Health Science, University of Wollongong, New South Wales, Australia
| | - Paris Tavakoli
- Microbiome Research Centre, University of New South Wales, Kogarah, New South Wales, Australia
- St Vincent's Hospital, Department of Gastroenterology and Hepatology, Sydney, New South Wales, Australia
| | - Nan Wu
- Microbiome Research Centre, University of New South Wales, Kogarah, New South Wales, Australia
| | - Amanda Shapiro
- Department of Paediatrics, School of Clinical Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Steven T Leach
- Department of Paediatrics, School of Clinical Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Astrid-Jane Williams
- Liverpool Hospital Dept of Gastroenterology and Hepatology, Liverpool, New South Wales, Australia
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
- South West Sydney Clinical Campuses, University of New South Wales Medicine & Health, University of New South Wales, Sydney, Australia
| | - Ramesh Paramsothy
- Centre for Gastrointestinal Health Castle Hill, New South Wales, Australia
| | - Simon Ghaly
- St Vincent's Hospital, Department of Gastroenterology and Hepatology, Sydney, New South Wales, Australia
| | - Susan J Connor
- Liverpool Hospital Dept of Gastroenterology and Hepatology, Liverpool, New South Wales, Australia
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
- South West Sydney Clinical Campuses, University of New South Wales Medicine & Health, University of New South Wales, Sydney, Australia
| | - Dorit Samocha-Bonet
- Garvan Institute of Medical Research and School of Clinical Medicine, St Vincent's Healthcare Clinical Campus, University of New South Wales Medicine & Health, University of New South Wales, Sydney, Australia
| | - Kelly Lambert
- School of Medical, Indigenous and Health Science, University of Wollongong, New South Wales, Australia
| | - Georgina L Hold
- Microbiome Research Centre, University of New South Wales, Kogarah, New South Wales, Australia
| |
Collapse
|
9
|
Powter H, Lambert K, Nicholls N. Experiences and perspectives of integrating nutrition education into an exercise program for people with chronic medical conditions. Health Promot J Austr 2024. [PMID: 38200682 DOI: 10.1002/hpja.841] [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: 04/13/2023] [Revised: 12/19/2023] [Accepted: 01/02/2024] [Indexed: 01/12/2024] Open
Abstract
ISSUE ADDRESSED Community-based healthy eating and exercise programs are effective interventions to support some people with chronic conditions. This research aimed to explore the experiences and perceptions of participants regarding the integration of nutrition education into a successful group based exercise program for people with chronic medical conditions. METHODS Semi-structured interviews were conducted with past participants of a community based group exercise program (Health Moves) with embedded nutrition advice based in a regional area of New South Wales. A total of 60 individuals who had participated in the Health Moves program between 2017 and 2019 were invited to participate and 19 (32%) randomly selected participants consented to be interviewed. Interviews explored participants' experiences, program impacts, and barriers to sustaining changes post program. Similar concepts and patterns were grouped into themes. RESULTS Four themes were identified that described the experiences with a community-based group exercise intervention with a nutrition component. The major themes evident were that Health Moves facilitated motivation (via access to health professionals, peer support, accountability, affordability); and there were challenges identified to sustaining change (including cost, comorbidities, end of program support, environmental factors); Nutrition advice was valuable for some but not for all (difficulty recalling nutrition components, superficial coverage) Practical and interactive nutrition advice is desired. CONCLUSIONS Participants expressed a high degree of satisfaction with the program but require ongoing support to sustain changes post program. The position and integration of nutrition education within this exercise program was perceived by participants to be suboptimal. Increased access to practical, interactive nutrition education components may improve participant satisfaction and engagement. SO WHAT?: Key findings from this research include a desire for removal of didactic nutrition education sessions and request for increased peer support. Modifications to the program include the integration of interactive self-paced nutrition modules. Peer support partnerships are now encouraged by trainers to support ongoing motivation of participants to keep training together outside the structured exercise program and transition to managing their own exercise routine. Discussions between organisations involved about ongoing pathway/program support or reduced cost 'off peak' gym membership is underway to help with costs incurred by participants.
Collapse
Affiliation(s)
- Hannah Powter
- School of Medical, Indigenous and Health Sciences, University of Wollongong, Wollongong, New South Wales, Australia
| | - Kelly Lambert
- School of Medical, Indigenous and Health Sciences, University of Wollongong, Wollongong, New South Wales, Australia
| | - Natalie Nicholls
- Diabetes Service, Illawarra Shoalhaven Local Health District (ISLHD), Wollongong, New South Wales, Australia
| |
Collapse
|
10
|
Cosier D, Lambert K, Batterham M, Sanderson-Smith M, Mansfield KJ, Charlton K. The INHABIT (synergIstic effect of aNtHocyAnin and proBIoTics in) Inflammatory Bowel Disease trial: a study protocol for a double-blind, randomised, controlled, multi-arm trial. J Nutr Sci 2024; 13:e1. [PMID: 38282655 PMCID: PMC10808876 DOI: 10.1017/jns.2023.113] [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: 11/04/2023] [Accepted: 12/01/2023] [Indexed: 01/30/2024] Open
Abstract
Ulcerative Colitis (UC), a type of Inflammatory Bowel Disease (IBD), is a chronic, relapsing gastrointestinal condition with increasing global prevalence. The gut microbiome profile of people living with UC differs from healthy controls and this may play a role in the pathogenesis and clinical management of UC. Probiotics have been shown to induce remission in UC; however, their impact on the gut microbiome and inflammation is less clear. Anthocyanins, a flavonoid subclass, have shown anti-inflammatory and microbiota-modulating properties; however, this evidence is largely preclinical. To explore the combined effect and clinical significance of anthocyanins and a multi-strain probiotic, a 3-month randomised controlled trial will be conducted in 100 adults with UC. Participants will be randomly assigned to one of four groups: anthocyanins (blackcurrant powder) + placebo probiotic, probiotic + placebo fruit powder, anthocyanin + probiotic, or double placebo. The primary outcome is a clinically significant change in the health-related quality-of-life measured with the Inflammatory Bowel Disease Questionnaire-32. Secondary outcomes include shotgun metagenomic sequencing of the faecal microbiota, faecal calprotectin, symptom severity, and mood and cognitive tests. This research will identify the role of adjuvant anti-inflammatory dietary treatments in adults with UC and elucidate the relationship between the gut microbiome and inflammatory biomarkers in this disease, to help identify targeted individualised microbial therapies. ANZCTR registration ACTRN12623000630617.
Collapse
Affiliation(s)
- Denelle Cosier
- School of Medicine, Indigenous and Health Sciences, University of Wollongong, Wollongong, NSW, Australia
| | - Kelly Lambert
- School of Medicine, Indigenous and Health Sciences, University of Wollongong, Wollongong, NSW, Australia
| | - Marijka Batterham
- Statistical Consulting Centre, National Institute for Applied Statistical Research Australia, University of Wollongong, Wollongong, NSW, Australia
| | - Martina Sanderson-Smith
- School of Chemistry and Molecular Bioscience and Molecular Horizons, University of Wollongong, Wollongong, NSW, Australia
| | - Kylie J Mansfield
- Graduate School of Medicine, University of Wollongong, Wollongong, NSW, Australia
| | - Karen Charlton
- School of Medicine, Indigenous and Health Sciences, University of Wollongong, Wollongong, NSW, Australia
| |
Collapse
|
11
|
Beer J, Lambert K, Lim W, Keane C, Boudville N. Can Telehealth Improve Access to Dietary Management in Patients Receiving Dialysis? Insights from Consumers. Nutrients 2023; 16:105. [PMID: 38201934 PMCID: PMC10780464 DOI: 10.3390/nu16010105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 12/21/2023] [Accepted: 12/25/2023] [Indexed: 01/12/2024] Open
Abstract
Timely, effective, and individualised dietary interventions are essential for patients undergoing dialysis. However, delivery of dietary advice is challenging due to limited access to renal dietitians, as well as logistic and scheduling difficulties for patients receiving dialysis. The objectives of this study were to explore consumer perspectives regarding dietary advice utilising telehealth technology. Twenty-two participants (seventeen patients receiving dialysis, five caregivers) were purposively recruited from a local dialysis centre and participated in one of three focus groups. Each focus group was recorded, transcribed, and analysed using inductive thematic analysis. One overarching theme: "a desire to learn" was apparent. The four themes that facilitated this process are herein described: Meaningful communication-a need for improved and individualised communication about diet using positively framed messages with consistency among clinicians. Conducive information-a preference for tailored, current, and clear dietary information (plain language was preferred, with practical advice on making dietary changes). Appropriate timing-health advice at the right time (consumers felt overwhelmed, not supported enough with timely advice, and experienced difficulty attending appointments in addition to dialysis treatments). Contemporary modalities-delivering information using different technologies (consumers preferred a combination of delivery methods for dietetic advice including text/SMS/App messages as an adjunct to face-to-face care). The results showed that consumers believe that telehealth options are an acceptable adjunct to receive dietary advice in a timely manner, and feedback from patients and caregivers has informed the design of a clinical trial to incorporate the use of telehealth to improve the management of serum phosphate.
Collapse
Affiliation(s)
- Joanne Beer
- Nutrition and Dietetics Department, Sir Charles Gairdner Hospital, Nedlands, WA 6009, Australia
| | - Kelly Lambert
- School of Medical, Indigenous and Health Sciences, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW 2522, Australia;
| | - Wai Lim
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Nedlands, WA 6009, Australia; (W.L.); (N.B.)
| | | | - Neil Boudville
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Nedlands, WA 6009, Australia; (W.L.); (N.B.)
- Medical School, University of Western Australia, Crawley, WA 6009, Australia
| |
Collapse
|
12
|
Lindeback R, Abdo R, Schnabel L, Le Jambre R, Kennedy SE, Katz T, Ooi CY, Lambert K. Does the Nutritional Intake and Diet Quality of Children With Chronic Kidney Disease Differ From Healthy Controls? A Comprehensive Evaluation. J Ren Nutr 2023:S1051-2276(23)00229-7. [PMID: 38128854 DOI: 10.1053/j.jrn.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 10/09/2023] [Accepted: 12/10/2023] [Indexed: 12/23/2023] Open
Abstract
OBJECTIVE Children with chronic kidney disease (CKD) experience many obstacles to achieving optimal dietary intake. Dietary intake patterns remain unexplored or poorly described. This study compares nutritional intake and diet quality of Australian children with CKD to controls. METHODS A food frequency questionnaire captured intake data and was compared to controls. Nutritional intake was determined using individualized nutrient reference values, and diet quality described using the Australian Guide to Healthy Eating and the Australian Child and Adolescent Recommended Food Score. RESULTS Children with CKD (n = 36) and controls (n = 82) were studied. Children with CKD had lower weight and height z scores, but higher body mass index (P < .0001 for all parameters). Children with CKD had adequate energy intake, and excessive protein and sodium intake (336% and 569%). They were significantly less likely to meet requirements for vitamin A (P < .001), thiamine (P = .006), folate (P = .01), vitamin C (P = .008), calcium (P < .0001), iron (P = .01), magnesium (P = .0009), and potassium (P = .002). No child met recommended vegetable intake; however, less than half of children with CKD met fruit (44%), grains (31%), and dairy serves (31%). They were also less likely to meet recommended fruit and dairy serves (P = .04 and P = .01, respectively). Non-core foods provided 36% of energy, and although comparable to controls, was contributed more by takeaway foods (P = .01). CONCLUSION Children with CKD have reduced nutritional intake of key nutrients and consume more takeaways than controls. Attention to increasing core foods, limiting sodium intake, and managing restrictions while promoting nutrient density appears necessary.
Collapse
Affiliation(s)
- Rachel Lindeback
- Department of Nutrition and Dietetics, St George Hospital, Sydney, New South Wales, Australia.
| | - Rasha Abdo
- Nutrition and Dietetics, University of Wollongong, School of Medical, Indigenous and Health Sciences, Wollongong, New South Wales, Australia
| | - Lyndal Schnabel
- Nutrition and Dietetics, University of Wollongong, School of Medical, Indigenous and Health Sciences, Wollongong, New South Wales, Australia
| | - Renee Le Jambre
- Department of Nutrition and Dietetics, Sydney Children's Hospital Network, Randwick, Sydney, New South Wales, Australia
| | - Sean E Kennedy
- Department of Nutrition and Dietetics, Sydney Children's Hospital Network, Randwick, Sydney, New South Wales, Australia
| | - Tamarah Katz
- Department of Nutrition and Dietetics, Sydney Children's Hospital Network, Randwick, Sydney, New South Wales, Australia
| | - Chee Y Ooi
- Discipline of Paediatrics and Child Health, University of New South Wales, School of Clinical Medicine, Discipline of Paediatrics and Child Health, UNSW Medicine and Health, Sydney, New South Wales, Australia
| | - Kelly Lambert
- Nutrition and Dietetics, University of Wollongong, School of Medical, Indigenous and Health Sciences, Wollongong, New South Wales, Australia
| |
Collapse
|
13
|
White SJ, Condon B, Ditton-Phare P, Dodd N, Gilroy J, Hersh D, Kerr D, Lambert K, McPherson ZE, Mullan J, Saad S, Stubbe M, Warren-James M, Weir KR, Gilligan C. Enhancing effective healthcare communication in Australia and Aotearoa New Zealand: Considerations for research, teaching, policy, and practice. PEC Innov 2023; 3:100221. [PMID: 37822775 PMCID: PMC10562187 DOI: 10.1016/j.pecinn.2023.100221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 09/08/2023] [Accepted: 09/25/2023] [Indexed: 10/13/2023]
Abstract
Objective In this article we present a conceptual framework for enhancing effective healthcare communication in Australia and Aotearoa New Zealand. Methods Through an iterative, deliberative dialogue approach, we, as experts from a variety of health professions and academic disciplines, worked together to identify core values and considerations for healthcare communication across numerous health professions and disciplines and within research, teaching, policy, and practice contexts. Results The framework developed includes five core values at its centre: equitable, inclusive, evidence-based, collaborative, reflective. Around this are concentric circles showing key elements of collaborators, modality, context, and purpose. Each of these is explored. Conclusion This work may support benchmarking for healthcare providers, researchers, policymakers, and educators across a breadth of professions to help improve communication in clinical practice. The framework will also help to identify areas across disciplines that are shared and potentially idiosyncratic for various professions to promote interprofessional recognition, education, and collaboration. Innovation This framework is designed to start conversations, to form the foundation of a dialogue about the priorities and key considerations for developing teaching curricula, professional development, and research programs related to healthcare communication, providing a set of values specifically for the unique contexts of Australia and Aotearoa New Zealand. It can also be used to guide interdisciplinary healthcare professionals in advancing research, teaching, policy, and practice related to healthcare communication.
Collapse
Affiliation(s)
- Sarah J. White
- Centre for Social Impact, University of New South Wales, Sydney, Australia
| | - Brendan Condon
- Warrnambool Clinical School, Deakin University, Warrnambool, Australia
| | - Philippa Ditton-Phare
- School of Medicine & Public Health, The University of Newcastle, Newcastle, Australia
| | - Natalie Dodd
- School of Nursing, Midwifery and Paramedicine, University of Sunshine Coast, Sippy Downs, Australia
| | - John Gilroy
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Deborah Hersh
- Curtin School of Allied Health, Curtin University, Perth, Australia
| | - Debra Kerr
- Institute for Healthcare Transformation, Centre for Quality and Patient Safety, School of Nursing and Midwifery, Deakin University, Geelong, Australia
| | - Kelly Lambert
- School of Medical, Indigenous and Health Sciences, University of Wollongong, Wollongong, Australia
| | | | - Judy Mullan
- Graduate School of Medicine, University of Wollongong, Wollongong, Australia
| | - Shannon Saad
- RPA Virtual Hospital, Sydney Local Health District, Sydney, Australia
| | - Maria Stubbe
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
| | - Matthew Warren-James
- School of Nursing, Midwifery and Paramedicine, University of Sunshine Coast, Sippy Downs, Australia
| | - Kristie R. Weir
- Sydney School of Public Health, University of Sydney, Sydney, Australia and Institute of Primary Health Care BIHAM, University of Bern, Bern, Switzerland
| | - Conor Gilligan
- School of Medicine & Public Health, The University of Newcastle, Newcastle, Australia
| |
Collapse
|
14
|
Stanford J, McMahon S, Lambert K, Charlton KE, Stefoska-Needham A. Expansion of an Australian food composition database to estimate plant and animal intakes. Br J Nutr 2023; 130:1950-1960. [PMID: 37157848 PMCID: PMC10630146 DOI: 10.1017/s0007114523001101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 02/25/2023] [Accepted: 04/25/2023] [Indexed: 05/10/2023]
Abstract
Despite evidence for favourable health outcomes associated with plant-based diets, a database containing the plant and animal content of all foods eaten is required to undertake a reliable assessment of plant-based diets within a population. This study aimed to expand an existing Australian food database to include the plant and animal content of all whole foods, beverages, multi-ingredient products and mixed dishes. Twenty-three plant- and animal-based food group classifications were first defined. The food servings per 100 g of each product were then systematically calculated using either a recipe-based approach, a food label-based approach, estimates based on similar products or online recipes. Overall, 4687 (83·5 %) foods and beverages were identified as plant or plant-containing products, and 3701 (65·9 %) were animal or animal-containing products. Results highlighted the versatility of plant and animal ingredients as they were found in various foods across many food categories, including savoury and sweet foods, as well as discretionary and core foods. For example, over 97 % of animal fat-containing foods were found in major food groups outside the AUSNUT 2011-2013 'fats and oils' group. Surprisingly, fruits, nuts and seeds were present in a greater percentage of discretionary products than in core foods and beverages. This article describes a systematic approach that is suitable for the development of other novel food databases. This database allows more accurate quantitative estimates of plant and animal intakes, which is significant for future epidemiological and clinical research aiming to investigate plant-based diets and their related health outcomes.
Collapse
Affiliation(s)
- Jordan Stanford
- School of Medical, Indigenous and Health Sciences, University of Wollongong, Northfields Ave, Wollongong, New South Wales, 2522, Australia
- Illawarra Health and Medical Research Institute, Wollongong, NSW2522, Australia
| | - Sarah McMahon
- School of Medical, Indigenous and Health Sciences, University of Wollongong, Northfields Ave, Wollongong, New South Wales, 2522, Australia
| | - Kelly Lambert
- School of Medical, Indigenous and Health Sciences, University of Wollongong, Northfields Ave, Wollongong, New South Wales, 2522, Australia
- Illawarra Health and Medical Research Institute, Wollongong, NSW2522, Australia
| | - Karen E. Charlton
- School of Medical, Indigenous and Health Sciences, University of Wollongong, Northfields Ave, Wollongong, New South Wales, 2522, Australia
- Illawarra Health and Medical Research Institute, Wollongong, NSW2522, Australia
| | - Anita Stefoska-Needham
- School of Medical, Indigenous and Health Sciences, University of Wollongong, Northfields Ave, Wollongong, New South Wales, 2522, Australia
- Illawarra Health and Medical Research Institute, Wollongong, NSW2522, Australia
| |
Collapse
|
15
|
Clay N, Charlton K, Stefoska-Needham A, Heffernan E, Hassan HIC, Jiang X, Stanford J, Lambert K. What is the climate footprint of therapeutic diets for people with chronic kidney disease? Results from an Australian analysis. J Hum Nutr Diet 2023; 36:2246-2255. [PMID: 37427492 DOI: 10.1111/jhn.13204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 06/19/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND Immediate action is needed to stabilise the climate. Dietitians require knowledge of how the therapeutic diets they prescribe may contribute to climate change. No previous research has quantified the climate footprint of therapeutic diets. This study sought to quantify and compare the climate footprint of two types of therapeutic diets for people with chronic kidney disease (CKD) with two reference diets. METHODS A usual diet for an individual with CKD and a novel plant-based diet for CKD were compared with the current Australian diet and the Australian-adapted EAT Lancet Planetary Health Diet (PHD). The climate footprint of these diets was measured using the Global Warming Potential (GWP*) metric for a reference 71-year-old male. RESULTS No diets analysed were climate neutral, and therefore, all contribute to climate change. The novel plant-based diet for CKD (1.20 kg carbon dioxide equivalents [CO2 e] per day) produced 35% less CO2 e than the usual renal diet for an individual with CKD (1.83 kg CO2 e per day) and 50% less than the current Australian diet (2.38 kg CO2 e per day). The Australian-adapted EAT Lancet PHD (1.04 kg CO2 e per day) produced the least amount of CO2 e and 56% less than the current Australian diet. The largest contributors to the climate footprint of all four diets were foods from the meats and alternatives, dairy and alternatives and discretionary food groups. CONCLUSIONS Dietetic advice to reduce the climate footprint of therapeutic diets for CKD should focus on discretionary foods and some animal-based products. Future research is needed on other therapeutic diets.
Collapse
Affiliation(s)
- Nathan Clay
- School of Medical, Indigenous and Health Sciences, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Karen Charlton
- School of Medical, Indigenous and Health Sciences, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Anita Stefoska-Needham
- School of Medical, Indigenous and Health Sciences, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Emma Heffernan
- Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, New South Wales, Australia
| | - Hicham Ibrahim Cheikh Hassan
- Department of Renal Medicine, Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia
| | - Xiaotao Jiang
- Microbiome Research Centre, St George Hospital, University of New South Wales, Kogarah, New South Wales, Australia
| | - Jordan Stanford
- School of Medical, Indigenous and Health Sciences, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Kelly Lambert
- School of Medical, Indigenous and Health Sciences, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| |
Collapse
|
16
|
Tunnicliffe DJ, Palmer SC, Cashmore BA, Saglimbene VM, Krishnasamy R, Lambert K, Johnson DW, Craig JC, Strippoli GF. HMG CoA reductase inhibitors (statins) for people with chronic kidney disease not requiring dialysis. Cochrane Database Syst Rev 2023; 11:CD007784. [PMID: 38018702 PMCID: PMC10685396 DOI: 10.1002/14651858.cd007784.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
BACKGROUND Cardiovascular disease is the most frequent cause of death in people with early stages of chronic kidney disease (CKD), and the absolute risk of cardiovascular events is similar to people with coronary artery disease. This is an update of a review first published in 2009 and updated in 2014, which included 50 studies (45,285 participants). OBJECTIVES To evaluate the benefits and harms of statins compared with placebo, no treatment, standard care or another statin in adults with CKD not requiring dialysis. SEARCH METHODS We searched the Cochrane Kidney and Transplant Register of Studies up to 4 October 2023. Studies in the Register are identified through searches of CENTRAL, MEDLINE, EMBASE, conference proceedings, the International Clinical Trials Registry Platform (ICTRP) Search Portal and ClinicalTrials.gov. An updated search will be undertaken every three months. SELECTION CRITERIA Randomised controlled trials (RCTs) and quasi-RCTs that compared the effects of statins with placebo, no treatment, standard care, or other statins, on death, cardiovascular events, kidney function, toxicity, and lipid levels in adults with CKD (estimated glomerular filtration rate (eGFR) 90 to 15 mL/min/1.73 m2) were included. DATA COLLECTION AND ANALYSIS Two or more authors independently extracted data and assessed the study risk of bias. Treatment effects were expressed as mean difference (MD) for continuous outcomes and risk ratios (RR) for dichotomous benefits and harms with 95% confidence intervals (CI). The risk of bias was assessed using the Cochrane risk of bias tool, and the certainty of the evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. MAIN RESULTS We included 63 studies (50,725 randomised participants); of these, 53 studies (42,752 participants) compared statins with placebo or no treatment. The median duration of follow-up was 12 months (range 2 to 64.8 months), the median dosage of statin was equivalent to 20 mg/day of simvastatin, and participants had a median eGFR of 55 mL/min/1.73 m2. Ten studies (7973 participants) compared two different statin regimens. We were able to meta-analyse 43 studies (41,273 participants). Most studies had limited reporting and hence exhibited unclear risk of bias in most domains. Compared with placebo or standard of care, statins prevent major cardiovascular events (14 studies, 36,156 participants: RR 0.72, 95% CI 0.66 to 0.79; I2 = 39%; high certainty evidence), death (13 studies, 34,978 participants: RR 0.83, 95% CI 0.73 to 0.96; I² = 53%; high certainty evidence), cardiovascular death (8 studies, 19,112 participants: RR 0.77, 95% CI 0.69 to 0.87; I² = 0%; high certainty evidence) and myocardial infarction (10 studies, 9475 participants: RR 0.55, 95% CI 0.42 to 0.73; I² = 0%; moderate certainty evidence). There were too few events to determine if statins made a difference in hospitalisation due to heart failure. Statins probably make little or no difference to stroke (7 studies, 9115 participants: RR 0.64, 95% CI 0.37 to 1.08; I² = 39%; moderate certainty evidence) and kidney failure (3 studies, 6704 participants: RR 0.98, 95% CI 0.91 to 1.05; I² = 0%; moderate certainty evidence) in people with CKD not requiring dialysis. Potential harms from statins were limited by a lack of systematic reporting. Statins compared to placebo may have little or no effect on elevated liver enzymes (7 studies, 7991 participants: RR 0.76, 95% CI 0.39 to 1.50; I² = 0%; low certainty evidence), withdrawal due to adverse events (13 studies, 4219 participants: RR 1.16, 95% CI 0.84 to 1.60; I² = 37%; low certainty evidence), and cancer (2 studies, 5581 participants: RR 1.03, 95% CI 0.82 to 1.30; I² = 0%; low certainty evidence). However, few studies reported rhabdomyolysis or elevated creatinine kinase; hence, we are unable to determine the effect due to very low certainty evidence. Statins reduce the risk of death, major cardiovascular events, and myocardial infarction in people with CKD who did not have cardiovascular disease at baseline (primary prevention). There was insufficient data to determine the benefits and harms of the type of statin therapy. AUTHORS' CONCLUSIONS Statins reduce death and major cardiovascular events by about 20% and probably make no difference to stroke or kidney failure in people with CKD not requiring dialysis. However, due to limited reporting, the effect of statins on elevated creatinine kinase or rhabdomyolysis is unclear. Statins have an important role in the primary prevention of cardiovascular events and death in people who have CKD and do not require dialysis. Editorial note: This is a living systematic review. We will search for new evidence every three months and update the review when we identify relevant new evidence. Please refer to the Cochrane Database of Systematic Reviews for the current status of this review.
Collapse
Affiliation(s)
- David J Tunnicliffe
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia
| | - Suetonia C Palmer
- Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand
| | - Brydee A Cashmore
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia
| | - Valeria M Saglimbene
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia
- Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | | | - Kelly Lambert
- School of Medicine, University of Wollongong, Wollongong, Australia
| | - David W Johnson
- Department of Nephrology, Princess Alexandra Hospital, Woolloongabba, Australia
- Australasian Kidney Trials Network, The University of Queensland, Brisbane, Australia
- Translational Research Institute, Brisbane, Australia
| | - Jonathan C Craig
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
- Cochrane Kidney and Transplant, Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Giovanni Fm Strippoli
- Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
- Cochrane Kidney and Transplant, Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia
| |
Collapse
|
17
|
Yee-Moon Wang A, Kistler BM, Lambert K, Sumida K, Moore LW, Kalantar-Zadeh K. Nutrition and Metabolism for Kidney Health and Disease Management: 45 years of Development and Future Directions Under the International Society of Renal Nutrition and Metabolism. J Ren Nutr 2023; 33:S1-S5. [PMID: 37683983 DOI: 10.1053/j.jrn.2023.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 08/28/2023] [Indexed: 09/10/2023] Open
Affiliation(s)
- Angela Yee-Moon Wang
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China.
| | - Brandon M Kistler
- Department of Nutrition Science, Purdue University, West Lafayette, Indiana
| | - Kelly Lambert
- Faculty of Science, Medicine and Health, School of Medicine, Indigenous and Health Sciences, University of Wollongong, Wollongong, New South Wales, Australia
| | - Keiichi Sumida
- Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Linda W Moore
- Department of Surgery, Houston Methodist Hospital, Houston, Texas
| | - Kamyar Kalantar-Zadeh
- The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, California; Nephrology Section, Tibor Rubin Veterans Affairs Medical Center, Long Beach, California
| |
Collapse
|
18
|
Avesani CM, Cardozo LFMF, Yee-Moon Wang A, Shiels PG, Lambert K, Lindholm B, Stenvinkel P, Mafra D. Planetary Health, Nutrition, and Chronic Kidney Disease: Connecting the Dots for a Sustainable Future. J Ren Nutr 2023; 33:S40-S48. [PMID: 36182058 DOI: 10.1053/j.jrn.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 08/18/2022] [Accepted: 09/11/2022] [Indexed: 11/11/2022] Open
Abstract
The increasing consumption of ultra-processed food (UPF) and the global chain of food production have a negative impact on human health and planetary health. These foods have been replacing the consumption of nonprocessed healthy foods. This shift has not only worsened human health by increasing the risk of the development of noncommunicable diseases, but also resulted in environmental perturbations. This review aims to bring awareness of the problems caused by the industrialized food production chain, addressing the negative effects it has on the environment and human health, with special reference to chronic kidney disease (CKD). We discuss possible solutions focusing on the benefits of adopting plant-based diets with low UPF content to promote a sustainable and healthy food production and diet for patients with CKD. For a sustainable future we need to "connect the dots" of planetary health, food production, and nutrition in the context of CKD.
Collapse
Affiliation(s)
- Carla Maria Avesani
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Technology and Intervention, Karolinska Instituted, Stockholm, Sweden.
| | - Ludmila F M F Cardozo
- Graduate Program in Cardiovascular Sciences, Fluminense Federal University (UFF), Niterói, Rio de Janeiro, Brazil
| | - Angela Yee-Moon Wang
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Paul G Shiels
- Wolfson Wohl Translational Research Centre, University of Glasgow, Scotland
| | - Kelly Lambert
- Discipline of Nutrition and Dietetics, School of Medicine, Indigenous and Health Sciences, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Bengt Lindholm
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Technology and Intervention, Karolinska Instituted, Stockholm, Sweden
| | - Peter Stenvinkel
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Technology and Intervention, Karolinska Instituted, Stockholm, Sweden
| | - Denise Mafra
- Graduate Program in Biological Sciences - Physiology, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Rio de Janeiro, Brazil
| |
Collapse
|
19
|
Sumida K, Biruete A, Kistler BM, Khor BH, Ebrahim Z, Giannini R, Sussman-Dabach EJ, Avesani CM, Chan M, Lambert K, Yee-Moon Wang A, Clegg DJ, Burrowes JD, Palmer BF, Carrero JJ, Kovesdy CP. New Insights Into Dietary Approaches to Potassium Management in Chronic Kidney Disease. J Ren Nutr 2023; 33:S6-S12. [PMID: 37610407 PMCID: PMC10872890 DOI: 10.1053/j.jrn.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 10/07/2022] [Accepted: 12/13/2022] [Indexed: 08/24/2023] Open
Abstract
Potassium disorders are one of the most common electrolyte abnormalities in patients with chronic kidney disease (CKD), contributing to poor clinical outcomes. Maintaining serum potassium levels within the physiologically normal range is critically important in these patients. Dietary potassium restriction has long been considered a core strategy for the management of chronic hyperkalemia in patients with CKD. However, this has been challenged by recent evidence suggesting a paradigm shift toward fostering more liberalized, plant-based dietary patterns. The advent of novel potassium binders and an improved understanding of gastrointestinal processes involved in potassium homeostasis (e.g., gastrointestinal potassium wasting) may facilitate a paradigm shift and incorporation of heart-healthy potassium-enriched food sources. Nevertheless, uncertainty regarding the risk-benefit of plant-based diets in the context of potassium management in CKD remains, requiring well-designed clinical trials to determine the efficacy of dietary potassium manipulation toward improvement of clinical outcomes in patients with CKD.
Collapse
Affiliation(s)
- Keiichi Sumida
- Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee.
| | - Annabel Biruete
- Department of Nutrition and Dietetics, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana; Division of Nephrology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana; Department of Nutrition Science, Purdue University, West Lafayette, Indiana
| | - Brandon M Kistler
- Department of Nutrition Science, Purdue University, West Lafayette, Indiana; Department of Nutrition and Health Science, Ball State University, Muncie, Indiana
| | - Ban-Hock Khor
- Faculty of Food Science and Nutrition, University Malaysia Sabah, Kota Kinabalu, Malaysia
| | - Zarina Ebrahim
- Division of Human Nutrition, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
| | - Rossella Giannini
- Division of Metabolic Diseases and Clinical Nutrition, University Hospital of Modena, Modena, Italy
| | - Elizabeth J Sussman-Dabach
- Department of Family and Consumer Sciences, California State University, Northridge, Northridge, California
| | - Carla Maria Avesani
- Division of Renal Medicine, Baxter Novum. Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Maria Chan
- Departments of Nutrition and Dietetics and Renal Medicine, The St. George Hospital, Kogarah, New South Wales, Australia
| | - Kelly Lambert
- Faculty of Science, Medicine and Health, School of Medical, Indigenous and Health Sciences, University of Wollongong, Wollongong, New South Wales, Australia
| | - Angela Yee-Moon Wang
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China
| | - Deborah J Clegg
- Department of Internal Medicine, Paul Foster School of Medicine, Texas Tech Medical Center, El Paso, Texas
| | - Jerrilynn D Burrowes
- Department of Health Sciences and Administration, Program in Nutrition and Dietetics, Long Island University-Post, Greenvale, New York
| | - Biff F Palmer
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Juan-Jesus Carrero
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Csaba P Kovesdy
- Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| |
Collapse
|
20
|
Bohm C, Bennett P, Lambert K, Wilund K, Verdin N, Fowler K, Sumida K, Wang AYM, Tangri N, MacRae JM, Thompson S. Advancing Exercise Science for Better Health Outcomes Across the Spectrum of Chronic Kidney Disease. J Ren Nutr 2023; 33:S103-S109. [PMID: 37632512 DOI: 10.1053/j.jrn.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 10/27/2022] [Accepted: 12/10/2022] [Indexed: 08/28/2023] Open
Abstract
Despite over 30 years of evidence for improvements in physical function, physical fitness, and health-related quality of life with exercise training in individuals with chronic kidney disease, access to dedicated exercise training programs remains outside the realm of standard of care for most kidney care programs. In this review, we explore possible reasons for this by comparing approaches in other chronic diseases where exercise rehabilitation has become the standard of care, identifying enablers and factors that need to be addressed for continued growth in this area, and discussing knowledge gaps for future research. For exercise rehabilitation to be relevant to all stakeholders and become a sustainable component of kidney care, a focus on the effect of exercise on clinically relevant outcomes that are prioritized by individuals living with kidney disease, use of evidence-based implementation strategies for diverse settings and populations, and approaching exercise as a medical therapy are required.
Collapse
Affiliation(s)
- Clara Bohm
- Department of Medicine, University of Manitoba, Winnipeg, Canada; Chronic Disease Innovation Centre, Winnipeg, Canada.
| | - Paul Bennett
- School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia
| | - Kelly Lambert
- School of Medical, Indigenous and Health Sciences, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia
| | - Ken Wilund
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, Illinois
| | | | - Kevin Fowler
- The Voice of the Patient, Inc, Saint Louis, Missouri
| | - Keiichi Sumida
- Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Angela Yee-Moon Wang
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, SAR
| | - Navdeep Tangri
- Department of Medicine, University of Manitoba, Winnipeg, Canada; Chronic Disease Innovation Centre, Winnipeg, Canada
| | | | | |
Collapse
|
21
|
Lambert K, Rinninella E, Biruete A, Sumida K, Stanford J, Raoul P, Mele MC, Wang AYM, Mafra D. Targeting the Gut Microbiota in Kidney Disease: The Future in Renal Nutrition and Metabolism. J Ren Nutr 2023; 33:S30-S39. [PMID: 37632511 PMCID: PMC10872791 DOI: 10.1053/j.jrn.2022.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 10/05/2022] [Accepted: 12/10/2022] [Indexed: 08/28/2023] Open
Abstract
There is increasing interest in the therapeutic potential of manipulating the gut microbiome of patients with chronic kidney disease (CKD). This is because there is a substantial deviation from a balanced gut microbiota profile in CKD, with many deleterious downstream effects. Nutritional interventions such as plant-based diets with reduced animal protein intake and the use of probiotics, prebiotics, and synbiotics may alter the microbiome. This article aims to briefly describe what is known about the gut microbiome in patients with CKD, factors contributing to gut dysbiosis, and outline important evidence gaps. Future potential therapies, including restoring the microbiota with food and microbiota-based and metabolomic-based therapies, are also discussed.
Collapse
Affiliation(s)
- Kelly Lambert
- School of Medical, Indigenous, and Health Sciences, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia.
| | - Emanuele Rinninella
- Clinical Nutrition Unit, Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Department of Translational Medicine and Surgery, Catholic University of the Sacred Heart, Rome, Italy
| | - Annabel Biruete
- Department of Nutrition Science, Purdue University, West Lafayette, Indiana, USA, Division of Nephrology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Keiichi Sumida
- Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Tennessee
| | - Jordan Stanford
- School of Medical, Indigenous, and Health Sciences, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Pauline Raoul
- Clinical Nutrition Unit, Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Maria Cristina Mele
- Clinical Nutrition Unit, Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Angela Yee-Moon Wang
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China
| | - Denise Mafra
- Professor, Graduate Program in Nutrition Sciences, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil
| |
Collapse
|
22
|
Rhee CM, Wang AYM, Biruete A, Kistler B, Kovesdy CP, Zarantonello D, Ko GJ, Piccoli GB, Garibotto G, Brunori G, Sumida K, Lambert K, Moore LW, Han SH, Narasaki Y, Kalantar-Zadeh K. Nutritional and Dietary Management of Chronic Kidney Disease Under Conservative and Preservative Kidney Care Without Dialysis. J Ren Nutr 2023; 33:S56-S66. [PMID: 37394104 PMCID: PMC10756934 DOI: 10.1053/j.jrn.2023.06.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 05/28/2023] [Accepted: 06/02/2023] [Indexed: 07/04/2023] Open
Abstract
While dialysis has been the prevailing treatment paradigm for patients with advanced chronic kidney disease (CKD), emphasis on conservative and preservative management in which dietary interventions are a major cornerstone have emerged. Based on high-quality evidence, international guidelines support the utilization of low-protein diets as an intervention to reduce CKD progression and mortality risk, although the precise thresholds (if any) for dietary protein intake vary across recommendations. There is also increasing evidence demonstrating that plant-dominant low-protein diets reduce the risk of developing incident CKD, CKD progression, and its related complications including cardiometabolic disease, metabolic acidosis, mineral and bone disorders, and uremic toxin generation. In this review, we discuss the premise for conservative and preservative dietary interventions, specific dietary approaches used in conservative and preservative care, potential benefits of a plant-dominant low-protein diet, and practical implementation of these nutritional strategies without dialysis.
Collapse
Affiliation(s)
- Connie M Rhee
- Division of Nephrology, Hypertension and Kidney Transplantation, University of California Irvine, Orange, California.
| | - Angela Yee-Moon Wang
- University Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong
| | - Annabel Biruete
- Department of Nutrition Science, Purdue University, West Lafayette, Indiana; Division of Nephrology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Brandon Kistler
- Department of Nutrition Science, Purdue University, West Lafayette, Indiana
| | - Csaba P Kovesdy
- Division of Nephrology, University of Tennessee Health Science Center, Memphis, Tennessee; Nephrology Section, Memphis Veterans Affairs Medical Center, Memphis, Tennessee
| | - Diana Zarantonello
- Nephrology and Dialysis Unit, Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy
| | - Gang Jee Ko
- Department of Internal Medicine, Korea University College of Medicine, Seoul, South Korea
| | | | | | - Giuliano Brunori
- Nephrology and Dialysis Unit, Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy
| | - Keiichi Sumida
- Division of Nephrology, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Kelly Lambert
- School of Medical, Indigenous and Health Sciences, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Linda W Moore
- Department of Surgery, Houston Methodist Hospital, Houston, Texas
| | - Seung Hyeok Han
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Yoko Narasaki
- Division of Nephrology, Hypertension and Kidney Transplantation, University of California Irvine, Orange, California
| | - Kamyar Kalantar-Zadeh
- The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, California; Nephrology Section, Tibor Rubin Veterans Affairs Medical Center, Long Beach, California
| |
Collapse
|
23
|
Tunnicliffe DJ, Bateman S, Arnold‐Chamney M, Dwyer KM, Howell M, Gebadi A, Jesudason S, Kelly J, Lambert K, Majoni SW, Oliva D, Owen KJ, Pearson O, Rix E, Roberts I, Stirling‐Kelly R, Taylor K, Wittert GA, Widders K, Yip A, Craig J, Phoon RK. Recommendations for culturally safe clinical kidney care for First Nations Australians: a guideline summary. Med J Aust 2023; 219:374-385. [PMID: 37838977 PMCID: PMC10952490 DOI: 10.5694/mja2.52114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 08/23/2023] [Indexed: 10/17/2023]
Abstract
INTRODUCTION First Nations Australians display remarkable strength and resilience despite the intergenerational impacts of ongoing colonisation. The continuing disadvantage is evident in the higher incidence, prevalence, morbidity and mortality of chronic kidney disease (CKD) among First Nations Australians. Nationwide community consultation (Kidney Health Australia, Yarning Kidneys, and Lowitja Institute, Catching Some Air) identified priority issues for guideline development. These guidelines uniquely prioritised the knowledge of the community, alongside relevant evidence using an adapted GRADE Evidence to Decision framework to develop specific recommendations for the management of CKD among First Nations Australians. MAIN RECOMMENDATIONS These guidelines explicitly state that health systems have to measure, monitor and evaluate institutional racism and link it to cultural safety training, as well as increase community and family involvement in clinical care and equitable transport and accommodation. The guidelines recommend earlier CKD screening criteria (age ≥ 18 years) and referral to specialists services with earlier criteria of kidney function (eg, estimated glomerular filtration rate [eGFR], ≤ 45 mL/min/1.73 m2 , and a sustained decrease in eGFR, > 10 mL/min/1.73 m2 per year) compared with the general population. CHANGES IN MANAGEMENT AS RESULT OF THE GUIDELINES Our recommendations prioritise health care service delivery changes to address institutional racism and ensure meaningful cultural safety training. Earlier detection of CKD and referral to nephrologists for First Nations Australians has been recommended to ensure timely implementation to preserve kidney function given the excess burden of disease. Finally, the importance of community with the recognition of involvement in all aspects and stages of treatment together with increased access to care on Country, particularly in rural and remote locations, including dialysis services.
Collapse
Affiliation(s)
- David J Tunnicliffe
- University of SydneySydneyNSW
- Centre for Kidney ResearchChildren's Hospital at WestmeadSydneyNSW
| | - Samantha Bateman
- University of AdelaideAdelaideSA
- Central and Northern Adelaide Renal and Transplantation Services, Central Adelaide Local Health NetworkAdelaideSA
| | | | | | - Martin Howell
- University of SydneySydneyNSW
- Centre for Kidney ResearchChildren's Hospital at WestmeadSydneyNSW
| | - Azaria Gebadi
- University of SydneySydneyNSW
- Centre for Kidney ResearchChildren's Hospital at WestmeadSydneyNSW
| | | | | | - Kelly Lambert
- University of WollongongWollongongNSW
- Illawarra Health and Medical Research InstituteUniversity of WollongongWollongongNSW
| | | | - Dora Oliva
- Drug and Alcohol Services, South Australia HealthAdelaideSA
| | - Kelli J Owen
- University of AdelaideAdelaideSA
- Central and Northern Adelaide Renal and TransplantationRoyal Adelaide HospitalAdelaideSA
| | - Odette Pearson
- Wardliparingga Aboriginal Health Equity, South Australian Health and Medical Research InstituteAdelaideSA
- Cancer Research InstituteUniversity of South AustraliaAdelaideSA
| | - Elizabeth Rix
- University of AdelaideAdelaideSA
- Southern Cross UniversityLismoreNSW
| | - Ieyesha Roberts
- University of SydneySydneyNSW
- Centre for Kidney ResearchChildren's Hospital at WestmeadSydneyNSW
| | - Ro‐Anne Stirling‐Kelly
- University of SydneySydneyNSW
- Centre for Kidney ResearchChildren's Hospital at WestmeadSydneyNSW
- NSW Health Mid‐North Coast Local Health DistrictSydneyNSW
| | - Kimberly Taylor
- Aboriginal Communities and Families Health Research Alliance, South Australian Health and Medical Research InstituteAdelaideSA
| | - Gary A Wittert
- University of AdelaideAdelaideSA
- Royal Adelaide HospitalAdelaideSA
| | - Katherine Widders
- University of SydneySydneyNSW
- Centre for Kidney ResearchChildren's Hospital at WestmeadSydneyNSW
| | - Adela Yip
- University of SydneySydneyNSW
- Centre for Kidney ResearchChildren's Hospital at WestmeadSydneyNSW
| | | | | |
Collapse
|
24
|
Bennett PN, Bohm C, Yee-Moon Wang A, Kanjanabuch T, Figueiredo AE, Harasemiw O, Brown L, Gabrys I, Jegatheesan D, Lambert K, Lightfoot CJ, MacRae J, Scholes-Robertson N, Stewart K, Tarca B, Verdin N, Warren M, West M, Zimmerman D, Finderup J, Ford E, Ribeiro HS, Xu Q, Thompson S. An International Survey of Peritoneal Dialysis Exercise Practices and Perceptions. Kidney Int Rep 2023; 8:1389-1398. [PMID: 37441469 PMCID: PMC10334400 DOI: 10.1016/j.ekir.2023.04.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 03/24/2023] [Accepted: 04/24/2023] [Indexed: 07/15/2023] Open
Abstract
Introduction Low activity levels and poor physical function are associated with technique failure and mortality in people receiving peritoneal dialysis (PD). Adequate levels of physical function are required to maintain independence for people choosing this predominantly home-based therapy. The objective of this study was to identify the exercise-related perceptions and practices of PD clinicians globally. Methods We conducted a cross-sectional survey of PD clinicians from English-, Thai-, Spanish-, and Portuguese-speaking PD-prevalent countries exploring clinicians' perceptions and practices of swimming, activity following PD catheter insertion, lifting, and falls prevention. This study was convened by the International Society of Peritoneal Dialysis and Global Renal Exercise Network between July and December 2021. Results Of 100 of the highest PD-prevalent countries, 85 responded and were represented in the findings. A total of 1125 PD clinicians (448 nephrologists, 558 nephrology nurses, 59 dietitians, and 56 others) responded from 61% high-income, 32% upper middle-income and 7% lower middle-income countries. The majority (n = 1054, 94%) agreed that structured exercise programs would be beneficial for people receiving PD. Most respondents believed people on PD could perform more exercise (n = 907, 81%) and that abdominal strengthening exercises could be safely performed (n = 661, 59%). Compared to clinicians in high-income countries, clinicians from lower middle-income status (odds ratio [OR], 5.57; 1.64 to 18.9) are more likely to promote participation in physical activity. Conclusion Clinicians know the importance of physical activity in people receiving PD. Exercise counseling and structured exercise plans could be included in the standard care of people receiving PD to maintain independence.
Collapse
Affiliation(s)
- Paul N. Bennett
- School of Nursing and Midwifery, Menzies Health Institute Queensland, Griffith University, Queensland, Australia
- Satellite Healthcare, USA
| | - Clara Bohm
- Chronic Disease Innovation Center, Manitoba, Canada
- Medicine/Nephrology, University of Manitoba, Manitoba, Canada
| | | | - Talerngsak Kanjanabuch
- Division of Nephrology and Center of Excellence in Kidney Metabolic Disorders, Faculty of Medicine, Chulalongkorn University, Thailand
| | - Ana Elizabeth Figueiredo
- Graduate Program in Medicine and Health Sciences, Pontifícia Universidade Católica do Rio Grande do Sul Escola de Ciências da Saúde e da Vida, Brazil
| | - Oksana Harasemiw
- Chronic Disease Innovation Center, Manitoba, Canada
- Medicine/Nephrology, University of Manitoba, Manitoba, Canada
| | - Leanne Brown
- Queensland University of Technology, Queensland, Australia
| | - Iwona Gabrys
- Alberta Kidney Care North, Alberta Health Services, Alberta, Canada
| | - Dev Jegatheesan
- The University of Queensland, Queensland, Australia
- Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Kelly Lambert
- University of Wollongong, Wollongong, New South Wales, Australia
| | - Courtney J. Lightfoot
- Department of Health Sciences, College of Medicine, Biological Sciences and Psychology, University of Leicester, UK
| | | | | | | | - Brett Tarca
- Alliance for Research in Exercise, Nutrition and Activity, University of South Australia, South Australia, Australia
| | - Nancy Verdin
- The Global Renal Exercise Network Patient Engagement Council, Canada
| | | | - Mike West
- University of California Davis, California, USA
| | | | | | - Emilie Ford
- Chronic Disease Innovation Center, Manitoba, Canada
- Medicine/Nephrology, University of Manitoba, Manitoba, Canada
| | - Heitor S. Ribeiro
- Research Center in Sports Sciences, Health Sciences and Human Development, University of Maia, Portugal
- University Center ICESP, Brazil
| | - Qunyan Xu
- Clinical and Health Sciences, University of South Australia, South Australia, Australia
| | | |
Collapse
|
25
|
Reyneke GL, Beck EJ, Lambert K, Neale EP. The Effect of Non-Oil Seed Legume Intake on Blood Pressure: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Adv Nutr 2023; 14:637-651. [PMID: 37031751 PMCID: PMC10334154 DOI: 10.1016/j.advnut.2023.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 03/23/2023] [Accepted: 04/03/2023] [Indexed: 04/11/2023] Open
Abstract
Hypertension is a primary modifiable risk factor for CVD, whereby even small reductions in blood pressure (BP) can decrease risk for CVD events. Modification of dietary patterns is an established, nonpharmacologic approach for the prevention and management of hypertension. Legumes are a prevailing component of dietary patterns associated with lower BP in observational research, but there is a need to understand the effects of legume consumption on BP. This study aimed to synthesize evidence from randomized controlled trials (RCTs) for the effects of non-oil seed legume consumption on systolic blood pressure (SBP) and diastolic blood pressure (DBP) (PROSPERO registration: CRD42021237732). We searched CINAHL, Cochrane, Medline, and PubMed scientific databases from inception through November 2022. A random-effects meta-analysis was conducted to assess the mean differences (MDs) for each outcome variable between legume-based and comparator diets. This review included 16 RCTs and 1092 participants. Studies ranged in duration (4-52 wk), participant age (17-75 y), and weekly legume dose (450-3150 g) in whole or powdered form. No significant overall effect between legume consumption and BP amelioration was observed in the meta-analysis (SBP-MD: -1.06 mm Hg; 95% CI: -2.57, 0.4410 mm Hg; I2 = 45%; DBP-MD: -0.48 mm Hg; 95% CI: -1.06, 0.10 mm Hg; I2 = 0%). The certainty of evidence was determined as low for SBP and DBP. Significant subgroup differences in SBP were found when studies were grouped according to participant BMI, with SBP reduction found for participants with overweight/obese BMI (MD -2.79 mm Hg, 95% CI: -4.68, -0.90 mm Hg). There is a need for large, high-quality trials to clearly define the benefits and mechanisms of legume consumption in BP management. Consideration of the relevance in individuals with obesity, overweight, and hypertension may also be warranted. This trial was registered at PROSPERO as CRD42021237732.
Collapse
Affiliation(s)
- Gynette L Reyneke
- School of Medical, Indigenous and Health Sciences, Faculty of Science, Medicine and Health, University of Wollongong, New South Wales, Australia
| | - Eleanor J Beck
- School of Medical, Indigenous and Health Sciences, Faculty of Science, Medicine and Health, University of Wollongong, New South Wales, Australia; School of Health Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Kelly Lambert
- School of Medical, Indigenous and Health Sciences, Faculty of Science, Medicine and Health, University of Wollongong, New South Wales, Australia
| | - Elizabeth P Neale
- School of Medical, Indigenous and Health Sciences, Faculty of Science, Medicine and Health, University of Wollongong, New South Wales, Australia; Illawarra Health and Medical Research Institute, University of Wollongong, New South Wales, Australia.
| |
Collapse
|
26
|
Perry E, Walton K, Lambert K. Prevalence of Malnutrition in People with Dementia in Long-Term Care: A Systematic Review and Meta-Analysis. Nutrients 2023; 15:2927. [PMID: 37447253 DOI: 10.3390/nu15132927] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 06/25/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023] Open
Abstract
Dementia is a common syndrome in older people. Dementia alters eating behaviors, hunger and thirst cues, swallow function, ability to self-feed, and recognition and interest in food. There is significant variation in the reported prevalence of malnutrition among older people who live in long-term care. The aim was to conduct a systematic literature review and meta-analysis of the prevalence of malnutrition in those with dementia living in long-term care using a validated nutrition assessment tool. Scopus, Web of Science, CINAHL, and Medline were searched. A random effects model was used to determine the prevalence and risk of malnutrition. Data were retrieved from 24 studies. Most of the studies were from Europe or South Asia. The prevalence of malnutrition ranged from 6.8 to 75.6%, and the risk of malnutrition was 36.5-90.4%. The pooled prevalence of malnutrition in those with dementia in long-term care was 26.98% (95% CI 22.0-32.26, p < 0.0001, I2 = 94.12%). The pooled prevalence of the risk of malnutrition in those with dementia was 57.43% (95% CI 49.39-65.28, p < 0.0001, I2 = 97.38%). Malnutrition is widespread in those with dementia living in long-term care. Further research exploring malnutrition in other industrialized countries using validated assessment tools is required.
Collapse
Affiliation(s)
- Emma Perry
- School of Medical, Indigenous and Health Sciences, University of Wollongong, Wollongong, NSW 2522, Australia
| | - Karen Walton
- School of Medical, Indigenous and Health Sciences, University of Wollongong, Wollongong, NSW 2522, Australia
| | - Kelly Lambert
- School of Medical, Indigenous and Health Sciences, University of Wollongong, Wollongong, NSW 2522, Australia
| |
Collapse
|
27
|
Neale EP, Rosario VD, Probst Y, Beck E, Tran TB, Lambert K. Lifestyle Interventions, Kidney Disease Progression, and Quality of Life: A Systematic Review and Meta-analysis. Kidney Med 2023; 5:100643. [PMID: 37235039 PMCID: PMC10205767 DOI: 10.1016/j.xkme.2023.100643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
Rationale & Objective Poor dietary patterns and low physical activity levels are important lifestyle-related factors that contribute to negative health outcomes in individuals with chronic kidney disease (CKD). Previous systematic reviews have not explicitly focused on these lifestyle factors, nor undertaken meta-analyses of any effects. We aimed to evaluate the effect of lifestyle interventions (such as diet, exercise, and other lifestyle-related interventions) on the risk factors for and progression of CKD and the quality of life. Study Design Systematic review and meta-analysis. Setting & Study Populations Individuals aged 16 years or older with CKD stages 1 to 5 not requiring kidney replacement therapy. Selection Criteria for Studies Randomized controlled trials of interventions. Data Extraction Kidney function, albuminuria, creatinine, systolic blood pressure, diastolic blood pressure, body weight, glucose control, and quality of life. Analytical Approach A random-effects meta-analysis with evidence certainty assessed using GRADE. Results Seventy-eight records describing 68 studies were included. Twenty-four studies (35%) were dietary interventions, 23 (34%) exercise, 9 (13%) behavioral, 1 (2%) hydration, and 11 (16%) multiple component. Lifestyle interventions resulted in significant improvements in creatinine (weighted mean difference [WMD], -0.43 mg/dL; 95% CI, -0.74 to -0.11; P = 0.008); 24-hour albuminuria (WMD, -53 mg/24 h; 95% CI, -56 to -50; P < 0.001); systolic blood pressure (WMD, -4.5 mm Hg; 95% CI, -6.7 to -2.4; P < 0.001); diastolic blood pressure (WMD, -2.2 mm Hg; 95% CI, -3.7 to -0.8; P = 0.003); and body weight (WMD, -1.1 kg; 95% CI, -2.0 to -0.1; P = 0.025). Lifestyle interventions did not result in significant changes in the estimated glomerular filtration rate (0.9 mL/min/1.73 m2; 95% CI, -0.6 to 2.3; P = 0.251). However, narrative synthesis indicated that lifestyle intervention resulted in improvements in the quality of life. Limitations Certainty of the evidence was rated very low for most outcomes, primarily owing to the risk of bias and inconsistency. No meta-analysis was possible for quality-of-life outcomes because of variations in measurement tools. Conclusions Lifestyle interventions seem to positively affect some risk factors for progression of CKD and quality of life.
Collapse
Affiliation(s)
| | | | | | | | | | - Kelly Lambert
- Address for Correspondence: Kelly Lambert, PhD, School of Medical, Indigenous and Health Science, University of Wollongong, Northfields Ave, Wollongong, NSW, 2522, Australia.
| |
Collapse
|
28
|
Beer J, Lambert K, Lim W, Bettridge E, Woodward F, Boudville N. Validation of a Phosphorus Food Frequency Questionnaire in Patients with Kidney Failure Undertaking Dialysis. Nutrients 2023; 15:nu15071711. [PMID: 37049551 PMCID: PMC10096831 DOI: 10.3390/nu15071711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 03/29/2023] [Accepted: 03/29/2023] [Indexed: 04/03/2023] Open
Abstract
Nutritional guidelines recommended limiting dietary phosphorus as part of phosphorus management in patients with kidney failure. Currently, there is no validated phosphorus food frequency questionnaire (P-FFQ) to easily capture this nutrient intake. An FFQ of this type would facilitate efficient screening of dietary sources of phosphorus and assist in developing a patient-centered treatment plan. The objectives of this study were to develop and validate a P-FFQ by comparing it with the 24 hr multi-pass recall. Fifty participants (66% male, age 70 ± 13.3 years) with kidney failure undertaking dialysis were recruited from hospital nephrology outpatient departments. All participants completed the P-FFQ and 24 hr multi-pass recalls with assistance from a renal dietitian and then analysed using nutrient analysis software. Bland–Altman analyses were used to determine the agreement between P-FFQ and mean phosphorus intake from three 24 hr multi-pass recalls. Mean phosphorous intake was 1262 ± 400 mg as determined by the 24 hr multi pass recalls and 1220 ± 348 mg as determined by the P-FFQ. There was a moderate correlation between the P-FFQ and 24 hr multi pass recall (r = 0.62, p = 0.37) with a mean difference of 42 mg (95% limits of agreement: 685 mg; −601 mg, p = 0.373) between the two methods. The precision of the P-FFQ was 3.33%, indicating suitability as an alternative to the 24 hr multi pass recall technique. These findings indicate that the P-FFQ is a valid, accurate, and precise tool for assessing sources of dietary phosphorus in people with kidney failure undertaking dialysis and could be used as a tool to help identify potentially problematic areas of dietary intake in those who may have a high serum phosphate.
Collapse
Affiliation(s)
- Joanne Beer
- Nutrition and Dietetics Department, Sir Charles Gairdner Hospital, Nedlands, WA 6009, Australia
| | - Kelly Lambert
- School of Medical, Indigenous and Health Science, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW 2522, Australia
| | - Wai Lim
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Nedlands, WA 6009, Australia
| | - Ellen Bettridge
- Nutrition and Dietetics Department, Fiona Stanley Hospital, Murdoch, WA 6150, Australia
| | - Fiona Woodward
- Nutrition and Dietetics Department, St John of God, Bunbury, WA 6223, Australia
| | - Neil Boudville
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Nedlands, WA 6009, Australia
- Medical School, University of Western Australia, Nedlands, WA 6009, Australia
| |
Collapse
|
29
|
Chang HCR, Spencer JC, Ho MH, Kasa AS, Ataiza C, Lambert K, Chang CC. Effectiveness of interventions on feeding difficulties among people with dementia: A systematic review and meta-analysis. Australas J Ageing 2023. [PMID: 36976822 DOI: 10.1111/ajag.13192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 02/22/2023] [Accepted: 02/23/2023] [Indexed: 03/29/2023]
Abstract
OBJECTIVES This systematic review and meta-analysis aimed to examine non-pharmacological interventions for helping people with dementia who experience feeding difficulties in order to improve their nutritional status. METHODS The articles were searched using PsycINFO, Medline, PubMed, CINAHL and Cochrane. Two independent investigators critically appraised eligible studies. The PRISMA guidelines and checklist were used. The possibility of risk of bias was assessed using a tool to assess the quality of randomised control trials (RCT) and non-RCT studies. A narrative synthesis was conducted as a method of synthesis. The Cochrane Review Manager (RevMan 5.4) was used for meta-analysis. RESULTS The systematic review and meta-analysis included seven publications. Six interventions were identified and categorised as: eating ability training for people with dementia, staff training and feeding assistance and support. The meta-analysis found evidence of the effect of eating ability training on feeding difficulty, quantified by the Edinburgh Feeding Evaluation in Dementia scale (EdFED) with a weighted mean difference of -1.36 (95% confidence interval: -1.84 to -0.89, p < 0.001) and on self-feeding time. A spaced retrieval intervention showed a positive effect on EdFED. The systematic review discovered that while feeding assistance had a positive effect on feeding difficulty, staff training had no effect. According to the meta-analysis, these interventions had no effect on improving the nutritional status of people with dementia. CONCLUSIONS None of the included RCTs met the Cochrane risk-of-bias criteria for randomised trials. This review found that direct training for people with dementia and indirect feeding support from care staff resulted in fewer mealtime difficulties. More RCT studies are needed to determine the efficacy of such interventions.
Collapse
Affiliation(s)
- Hui-Chen Rita Chang
- School of Nursing and Midwifery, Western Sydney University, Sydney, New South Wales, Australia
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | | | - Mu-Hsing Ho
- Faculty of Medicine, School of Nursing, The University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Ayele Semachew Kasa
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
- Department of Adult Health Nursing, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Chell Ataiza
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Kelly Lambert
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Chia-Chi Chang
- Department of Nursing, Taipei Medical University, Taipei, Taiwan (ROC)
| |
Collapse
|
30
|
Kanagaratnam R, Zwi S, Webster AC, Isautier J, Lambert K, Shepherd HL, McCaffery K, Sud K, Muscat DM. Interventions to support decision-making, health literacy and self-management in ethnic-minority adults living with chronic kidney disease: a systematic review. Clin Kidney J 2023. [DOI: 10.1093/ckj/sfac276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023] Open
Abstract
Abstract
Optimal patient care is directed by clinical practice guidelines, with emphasis on shared decision-making. However, guidelines –and interventions to support their implementation– often do not reflect needs of ethnic minorities who experience inequities in CKD prevalence and outcomes. This review aims to describe what interventions exist to promote, decision-making, self-management and/or health-literacy for ethnic-minority people living with CKD, describe intervention development and/or adaptation processes, and explore the impact on patient outcomes. Six databases were searched (MEDLINE, PsychINFO, Scopus, EMBASE, CINAHL, InformitOnline) and two reviewers independently extracted study data and assessed risk of bias. Twelve studies (n = 291 participants), conducted in six countries and targeting nine distinct ethnic-minority groups were included. Intervention strategies consisted of: i) face-to-face education/skills training (3 studies, n = 160), ii) patient education materials (2 studies, n = unspecified), iii) cultural health liaison officer (6 studies, n = 106) or iv) increasing access to healthcare (3 studies, n = 25). There was limited description of cultural targeting/tailoring. Where written information was translated into languages other than English, the approach was exact translation without other cultural adaptation. Few studies reported on community-based research approaches, intervention adaptations requiring limited or no literacy (e.g. infographics; photographs and interviews with local community members) and the inclusion of Cultural Healthcare Workers as part of intervention design. No community-based interventions were evaluated for their impact on clinical or psychosocial outcomes. All interventions conducted in the hospital settings reported favorable outcomes (e.g. reduction in blood pressure) compared to routine care but were limited by methodological issues.
Collapse
Affiliation(s)
- Roshana Kanagaratnam
- The University of Sydney, Faculty of Medicine and Health, School of Public Health , NSW , Australia
| | - Stephanie Zwi
- The University of Sydney, Faculty of Medicine and Health, School of Public Health , NSW , Australia
- The University of Sydney, Faculty of Medicine and Health, School of Public Health, Sydney Health Literacy Lab , NSW , Australia
| | - Angela C Webster
- The University of Sydney, Faculty of Medicine and Health, School of Public Health , NSW , Australia
- Centre for Transplant and Renal Research, Westmead Hospital , NSW , Australia
- NHMRC Clinical Trials Centre, Faculty of Medicine and Health, University of Sydney
| | - Jennifer Isautier
- The University of Sydney, Faculty of Medicine and Health, School of Public Health , NSW , Australia
| | - Kelly Lambert
- Discipline of Nutrition and Dietetics, Faculty of Science, Medicine and Health, School of Medicine, University of Wollongong , Wollongong , Australia
- Illawarra Health and Medical Research Institute , Wollongong
| | - Heather L Shepherd
- The University of Sydney, Faculty of Science, School of Psychology, Centre for Medical Psychology and Evidence-based Decision-making (CeMPED) , NSW , Australia
- The University of Sydney, Faculty of Medicine and Health, Susan Wakil School of Nursing , NSW , Australia
| | - Kirsten McCaffery
- The University of Sydney, Faculty of Medicine and Health, School of Public Health , NSW , Australia
- The University of Sydney, Faculty of Medicine and Health, School of Public Health, Sydney Health Literacy Lab , NSW , Australia
| | - Kamal Sud
- The University of Sydney, Faculty of Medicine and Health, Nepean Clinical School , NSW , Australia
- Department of Renal Medicine, Nepean Hospital , NSW , Australia
| | - Danielle Marie Muscat
- The University of Sydney, Faculty of Medicine and Health, School of Public Health , NSW , Australia
- The University of Sydney, Faculty of Medicine and Health, School of Public Health, Sydney Health Literacy Lab , NSW , Australia
| |
Collapse
|
31
|
Dosseto A, Lambert K, Cheikh Hassan HI, Fuller A, Borst A, Dux F, Lonergan M, Tacail T. Calcium isotopes as a biomarker for vascular calcification in chronic kidney disease. Metallomics 2023; 15:7044779. [PMID: 36808527 PMCID: PMC9989339 DOI: 10.1093/mtomcs/mfad009] [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: 11/30/2022] [Accepted: 02/15/2023] [Indexed: 02/19/2023]
Abstract
Calcium balance is abnormal in adults with chronic kidney disease (CKD) and is associated with the development of vascular calcification. It is currently not routine to screen for vascular calcification in CKD patients. In this cross-sectional study, we investigate whether the ratio of naturally occurring calcium (Ca) isotopes, 44Ca and 42Ca, in serum could be used as a noninvasive marker of vascular calcification in CKD. We recruited 78 participants from a tertiary hospital renal center: 28 controls, 9 subjects with mild-moderate CKD, 22 undertaking dialysis and 19 who received a kidney transplant. For each participant, systolic blood pressure, ankle brachial index, pulse wave velocity, and estimated glomerular filtration rate were measured, along with serum markers. Calcium concentrations and isotope ratios were measured in urine and serum. While we found no significant association between urine Ca isotope composition (noted δ44/42Ca) between the different groups, δ44/42Ca values in serum were significantly different between healthy controls, subjects with mild-moderate CKD and those undertaking dialysis (P < 0.01). Receiver operative characteristic curve analysis shows that the diagnostic utility of serum δ44/42Ca for detecting medial artery calcification is very good (AUC = 0.818, sensitivity 81.8% and specificity 77.3%, P < 0.01), and performs better than existing biomarkers. Although our results will need to be verified in prospective studies across different institutions, serum δ44/42Ca has the potential to be used as an early screening test for vascular calcification.
Collapse
Affiliation(s)
- Anthony Dosseto
- Wollongong Isotope Geochronology Laboratory, School of Earth, Atmospheric and Life Sciences, University of Wollongong, Wollongong, New South Wales, Australia
| | - Kelly Lambert
- School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia
| | - Hicham I Cheikh Hassan
- School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia.,Department of Nephrology, Wollongong Hospital, Wollongong, New South Wales, Australia
| | - Andrew Fuller
- Wollongong Isotope Geochronology Laboratory, School of Earth, Atmospheric and Life Sciences, University of Wollongong, Wollongong, New South Wales, Australia.,School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia
| | - Addison Borst
- Wollongong Isotope Geochronology Laboratory, School of Earth, Atmospheric and Life Sciences, University of Wollongong, Wollongong, New South Wales, Australia.,School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia
| | - Florian Dux
- Wollongong Isotope Geochronology Laboratory, School of Earth, Atmospheric and Life Sciences, University of Wollongong, Wollongong, New South Wales, Australia
| | - Maureen Lonergan
- Department of Nephrology, Wollongong Hospital, Wollongong, New South Wales, Australia
| | - Theo Tacail
- Institute of Geosciences, Johannes Gutenberg University, Mainz, Germany
| |
Collapse
|
32
|
Lambert K. Wild brains: The value of neuroethological approaches in preclinical behavioral neuroscience animal models. Neurosci Biobehav Rev 2023; 146:105044. [PMID: 36641013 DOI: 10.1016/j.neubiorev.2023.105044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 01/06/2023] [Accepted: 01/09/2023] [Indexed: 01/13/2023]
Abstract
For three decades, IBNS has provided a forum for the dissemination of behavioral neuroscience research, broadly defined. Throughout this time, research presented at the annual meetings has reflected representative trends in the field with an emphasis on relevant preclinical animal models. From its inception, IBNS has contributed to my professional development and evolving research interests. Unsurprisingly, throughout the three decades of its existence, IBNS annual programs have reflected research trends that have been thoughtfully evaluated, challenged, and, in some cases, recalibrated. An emphasis in my lab, for example, has slowly navigated toward the inclusion of more diverse species (e.g., nonhuman primate models, wild rats, wild and captive raccoons) assessed in settings that reflect more ethological relevance than typically observed in traditional laboratory settings. Consequently, my research interests are pivoting from laboratory animal model exclusive (L.A.M.E.) endeavors to more natural, diverse, ethoexperimental approaches. As progress toward translational findings for psychiatric and neurological conditions is considered, it is recommended that researchers remain open to nontraditional methodological approaches that incorporate diverse animal models and assessments to inform laboratory-generated findings.
Collapse
Affiliation(s)
- Kelly Lambert
- Behavioral Neuroscience, University of Richmond, USA.
| |
Collapse
|
33
|
Lambert K, Gardos R, Coolican H, Pickel L, Sung HK, Wang AYM, Ong AC. Diet and Polycystic Kidney Disease: Nutrients, Foods, Dietary Patterns, and Implications for Practice. Semin Nephrol 2023; 43:151405. [PMID: 37542985 DOI: 10.1016/j.semnephrol.2023.151405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/07/2023]
Abstract
Polycystic kidney disease (PKD) is a chronic, progressive hereditary condition characterized by abnormal development and growth of cysts in the kidneys and other organs. There is increasing interest in exploring whether dietary modifications may prevent or slow the disease course in people with PKD. Although vasopressin-receptor agonists have emerged as a novel drug treatment in advancing care for people with PKD, several recent landmark trials and clinical discoveries also have provided new insights into potential dietary-related therapeutic strategies. In this review, we summarize the current evidence pertaining to nutrients, foods, dietary patterns, cyst growth, and progression of PKD. We also describe existing evidence-based dietary care for people with PKD and outline the potential implications for advancing evidence-based dietary interventions. Semin Nephrol 43:x-xx © 2023 Elsevier Inc. All rights reserved.
Collapse
Affiliation(s)
- Kelly Lambert
- Nutrition and Dietetics, School of Medical, Indigenous and Health Science, University of Wollongong, Wollongong, New South Wales, Australia.
| | | | | | - Lauren Pickel
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Hoon-Ki Sung
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Angela Yee-Moon Wang
- Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, SAR, China
| | - Albert Cm Ong
- Academic Nephrology Unit, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| |
Collapse
|
34
|
Goodman C, Lambert K. Scoping review of the preferences of older adults for patient education materials. Patient Educ Couns 2023; 108:107591. [PMID: 36584555 DOI: 10.1016/j.pec.2022.107591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 12/04/2022] [Accepted: 12/06/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVE To provide an overview of studies that describe the preferred mode and format of delivery of patient education materials to older adults. METHODS A scoping review was used to identify relevant literature published between January 2010 and June 2021, with specific attention given to studies conducted in high income countries with similar health systems. RESULTS A total of 3245 titles were identified, and 20 met the inclusion criteria and were included in this scoping review. Older adults preferred written information that could be accessed via health professionals or downloaded online. Other key features were identified including logical layout, signposted information, larger text size, labelled visual aids, and use of images appropriate and relevant to the target group were preferred. Audio visual resources were also considered valuable when well designed. Formats for patient education such as apps, group classes and online courses were less popular with older adults. CONCLUSIONS Patient education materials for older adults should be carefully designed, with attention to layout and content. Older adults indicated a preference for hard copy handouts or in a format that can be downloaded. PRACTICE IMPLICATIONS Regular engagement with older consumers about their preferences is important as technology for delivery of patient education materials evolve. Key features for specific attention during the design process include a logical layout (tested with consumers), signposted information, text size, labelled visual aids and appropriate images. The perspectives of other key groups of older adults such as those from minority populations or other disadvantaged groups are largely unexplored.
Collapse
Affiliation(s)
- Claudia Goodman
- School of Medical, Indigenous and Health Sciences, University of Wollongong, Wollongong, Australia.
| | - Kelly Lambert
- School of Medical, Indigenous and Health Sciences, University of Wollongong, Wollongong, Australia.
| |
Collapse
|
35
|
Khor BH, Sumida K, Scholes-Robertson N, Chan M, Lambert K, Kramer H, Lui SF, Wang AYM. Nutrition Education Models for Patients With Chronic Kidney Disease. Semin Nephrol 2023; 43:151404. [PMID: 37598539 DOI: 10.1016/j.semnephrol.2023.151404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
Abstract
Nutrition is an integral component in the management of chronic kidney disease (CKD), and kidney health professionals play a crucial role in educating patients on dietary interventions for CKD. Several dietary modifications are indicated for CKD that require frequent adaptations with CKD progression and with underlying metabolic disturbances. However, poor adherence to dietary interventions is not uncommon among patients with CKD. An effective education program on nutrition intervention consists of providing knowledge and developing skills that are necessary to support behavioral change. The application of theoretical models of behavioral change such as social cognitive theory and the transtheoretical model in nutrition intervention has been reported to be effective in promoting changes in dietary habits. This review summarizes the evidence supporting the application of theoretical models as strategies to enhance nutrition education for patients with CKD. In addition, digital technologies are gaining interest in empowering patients and facilitating nutrition management in patients with CKD. This review also examines the applications of the latest digital technologies guided by behavioral theory in facilitating patients' changes in dietary intake patterns and lifestyle habits.
Collapse
Affiliation(s)
- Ban-Hock Khor
- Faculty of Food Science and Nutrition, University Malaysia Sabah, Sabah, Malaysia.
| | - Keiichi Sumida
- Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Nicole Scholes-Robertson
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
| | - Maria Chan
- Department of Nutrition and Dietetics, The St. George Hospital, Kogarah, New South Wales, Australia
| | - Kelly Lambert
- School of Medicine, Indigenous and Health Sciences, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Holly Kramer
- Departments of Public Health Sciences and Medicine, Loyola University, Chicago, IL, USA
| | - Siu-Fai Lui
- Hong Kong Kidney Foundation, Hong Kong, China
| | - Angela Yee-Moon Wang
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| |
Collapse
|
36
|
Cheikh Hassan HI, Murali K, Lambert K, Lonergan M, McAlister B, Suesse T, Mullan J. Acute kidney injury increases risk of kidney stones-a retrospective propensity score matched cohort study. Nephrol Dial Transplant 2023; 38:138-147. [PMID: 35108386 DOI: 10.1093/ndt/gfac023] [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: 10/07/2021] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Acute kidney injury (AKI) is common. An episode of AKI may modify the risk of developing kidney stones by potential long-term effects on urine composition. We aimed to investigate the association between AKI and the risk of kidney stone presentations. METHODS The retrospective cohort study used patient data (1 January 2008-31 December 2017), from an Australian Local Health District, which included AKI diagnosis, demographics, comorbidities and kidney stone admissions. Time-varying Cox proportional hazards and propensity-matched analysis were used to determine the impact of AKI on the risk of kidney stones. To address possible population inhomogeneity in comparisons between no AKI and hospitalized AKI, sub-group analysis was done comparing inpatient and outpatient AKI versus no AKI, to assess consistency of association with future stones. Sensitivity analysis was undertaken to capture the impact of a known AKI status and AKI severity. RESULTS Out of 137 635 patients, 23 001 (17%) had an AKI diagnosis and 2295 (2%) had kidney stone presentations. In the unadjusted analysis, AKI was associated with kidney stones, with AKI used as a time-varying exposure, [hazard ratio (HR) 1.32, 95% confidence interval (CI) 1.16-1.50)]. Both inpatient-AKI (HR 1.19, 95% CI 1.01-1.39) and outpatient-AKI (HR 1.59, 95% CI 1.30-1.94) were significantly associated with future stones compared to no AKI subjects. This association persisted in the adjusted analysis (HR 1.45, 95% CI 1.26-1.66), propensity-matched dataset (HR 1.67, 95% CI 1.40-1.99) and sensitivity analysis. There was a dose-response relationship with higher stages of AKI being associated with a greater risk of kidney stones. CONCLUSIONS In a large cohort of patients, AKI is associated with a greater risk of kidney stones, which increases with higher stages of AKI. This association should be examined in other cohorts and populations for verification.
Collapse
Affiliation(s)
- Hicham I Cheikh Hassan
- Department of Nephrology, Illawarra and Shoalhaven Local Health District, Wollongong, NSW, Australia.,Graduate School of Medicine, University of Wollongong, Wollongong, NSW, Australia
| | - Karumathil Murali
- Department of Nephrology, Illawarra and Shoalhaven Local Health District, Wollongong, NSW, Australia.,Graduate School of Medicine, University of Wollongong, Wollongong, NSW, Australia
| | - Kelly Lambert
- School of Medical, Indigenous and Health Sciences, University of Wollongong, Wollongong, NSW, Australia
| | - Maureen Lonergan
- Department of Nephrology, Illawarra and Shoalhaven Local Health District, Wollongong, NSW, Australia.,Graduate School of Medicine, University of Wollongong, Wollongong, NSW, Australia
| | - Brendan McAlister
- Centre for Health Research Illawarra Shoalhaven Population (CHRISP), University of Wollongong, Wollongong, NSW, Australia
| | - Thomas Suesse
- National Institute of Applied Statistics Research Australia, School of Mathematics and Applied Statistics, University of Wollongong, NSW, Australia
| | - Judy Mullan
- Graduate School of Medicine, University of Wollongong, Wollongong, NSW, Australia.,Centre for Health Research Illawarra Shoalhaven Population (CHRISP), University of Wollongong, Wollongong, NSW, Australia
| |
Collapse
|
37
|
Lambert K, Carey S. Dehydration in geriatrics: consequences and practical guidelines. Curr Opin Clin Nutr Metab Care 2023; 26:36-41. [PMID: 36131635 DOI: 10.1097/mco.0000000000000880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE OF REVIEW Geriatric dehydration is a widespread and under recognized problem. The purpose of this review was to examine the latest evidence regarding geriatric dehydration and provide practical guidance for health professionals. RECENT FINDINGS This review covers evidence from the past 2 years and shows that geriatric dehydration is not benign and is associated with significant personal distress, as well as negative economic and health system consequences. New guidance on nutrition and hydration in the elderly recommend against the use of skin turgor, dry mouth, urine colour or specific gravity to determine hydration status in the elderly. Instead, serum osmolality is considered the gold standard. SUMMARY Strategies to prevent and manage geriatric dehydration should differ depending on aetiology (low intake, volume depletion or both). Widespread dissemination and implementation of innovative strategies that target improved access to fluids, and systems change to enable rapid and accurate identification and treatment are required.
Collapse
Affiliation(s)
- Kelly Lambert
- School of Medical, Indigenous and Health Sciences, University of Wollongong, Wollongong
| | - Sharon Carey
- Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| |
Collapse
|
38
|
Lambert K. Designing Dietary Education Materials for People With Chronic Kidney Disease: Recommendations for Improving the Quality of Resources. J Ren Nutr 2023; 33:208-213. [PMID: 35792257 DOI: 10.1053/j.jrn.2022.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 06/18/2022] [Accepted: 06/19/2022] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE The aim of this study is to quantify the readability, actionability, understandability, and overall quality of dietary education resources designed for patients and published in the Journal of Renal Nutrition. DESIGN AND METHODS All patient education materials published in the "Patient Education" section of the journal from 2011 to 2021 were included. The readability, health literacy demand, and quality were evaluated using the Hemingway editor, Patient Education Materials Assessment Tool, and the Centers for Disease Control and Prevention Clear Communication Index (CDC CCI) respectively. Good quality materials were those with a reading grade level of ≤8; a Patient Education Materials Assessment Tool score of >70% (indicating materials were understandable and actionable), and a CDC CCI score >90%. RESULTS A total of 42 resources were evaluated. Most materials (92%) were written at an appropriate level of readability (median grade 5, interquartile range [IQR: 5-7). The median understandability score was 71% (IQR: 60-81); however, only half (52%) of the materials met the 70% benchmark. Materials published performed poorly for actionability with the median actionability score of 37% (IQR: 20-83), and only 29% met the benchmark score. Overall quality was scored as low, with a median CDC CCI score of 65%, and only 10% of materials met the benchmark score. Areas for improvement were identified including providing a clear purpose, and summary of important points, explaining numbers and how to perform calculations, and including at least one action to take. Future efforts to improve actionability need to use the active voice, directly address readers, explain how to act, and describe the steps required. CONCLUSION Patient education materials that are attentive to health literacy principles beyond readability may enhance patient engagement, confidence, and empowerment, and improve adherence to the kidney diet.
Collapse
Affiliation(s)
- Kelly Lambert
- Adv APD, Senior Lecturer, School of Medical, Indigenous, and Health Sciences, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia.
| |
Collapse
|
39
|
Zwi S, Isautier J, Webster AC, Lambert K, Shepherd HL, McCaffery KJ, Sud K, Saunders J, O'Lone E, Liu N, Kim J, Robbins A, Muscat DM. A feasibility study of a best practice health literacy app for Australian adults with chronic kidney disease. PEC Innov 2022; 1:100047. [PMID: 37213763 PMCID: PMC10194182 DOI: 10.1016/j.pecinn.2022.100047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 04/14/2022] [Accepted: 05/02/2022] [Indexed: 05/23/2023]
Abstract
Objective To investigate feasibility of the SUCCESS app; a cross-platform e-health innovation to improve health literacy, self-management and shared decision-making among culturally-diverse Australian haemodialysis patients. Methods Multi-site, pre-post, mixed-methods study. Haemodialysis patients ≥18 years used the app for 12 weeks. Qualitative data from 18 interviews were thematically analysed to evaluate app acceptability. Quantitative analysis using paired sampled t-tests evaluated feasibility outcomes pertaining to recruitment, retention, data collection and app efficacy (including health literacy; decision self-efficacy; quality of life; behaviour; knowledge; confidence). Results We successfully recruited diverse participants (N = 116; 45% born overseas; 40% low/moderate health literacy) from four Local Health Districts in Sydney, Australia. However, only 61 participants completed follow-up questionnaires. Qualitative analyses provided insights into acceptability and user engagement. Quantitative analyses showed significant improvements on the health literacy domain 'Ability to actively engage with healthcare providers' (Mean Difference [MD] = 0.2 on a 5-point scale; CI95%: 0.0-0.4; p = 0.03) and decision self-efficacy (MD = 4.3 on a 10-point scale; CI95%: 0.6-7.9; p = 0.02) after 12 weeks app use. Conclusions The SUCCESS app was feasible and acceptable to participants. The app will be adapted to facilitate ongoing use and engagement among diverse haemodialysis patients. Innovation This is the first health literacy-informed app to promote active participation in haemodialysis self-management and decision-making, tailored toward culturally-diverse and low health literacy groups.
Collapse
Affiliation(s)
- Stephanie Zwi
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, NSW, Australia
| | - Jennifer Isautier
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, NSW, Australia
| | - Angela C. Webster
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, NSW, Australia
- NHMRC Clinical Trials Centre, Faculty of Medicine and Health, University of Sydney, NSW, Australia
- Westmead Applied Research Centre, Westmead Hospital, Westmead, NSW, Australia
| | - Kelly Lambert
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, NSW, Australia
| | | | - Kirsten J. McCaffery
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, NSW, Australia
| | - Kamal Sud
- Nepean Clinical School, Faculty of Medicine and Health, The University of Sydney, NSW, Australia
- Department of Renal Medicine, Nepean Hospital, Nepean Blue Mountains Local Health District, NSW, Australia
| | - John Saunders
- Department of Renal Medicine, Royal Prince Alfred Hospital, Sydney, Local Health District, NSW, Australia
| | - Emma O'Lone
- Department of Renal Medicine, Royal North Shore Hospital, Northern Sydney Local Health District, NSW, Australia
| | - Na Liu
- School of Computer Science, Faculty of Engineering, The University of Sydney, NSW, Australia
| | - Jinman Kim
- School of Computer Science, Faculty of Engineering, The University of Sydney, NSW, Australia
- Telehealth and Technology Centre, Nepean Hospital, Nepean Blue Mountains Local Health District, NSW, Australia
| | | | - Danielle Marie Muscat
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, NSW, Australia
- Corresponding author at: Room 127A, Edward Ford Building (A27), The University of Sydney, 2006 New South Wales, Australia.
| |
Collapse
|
40
|
Caruana L, Nichols L, Lambert K. Malnutrition, symptom burden and predictive validity of the Patient-Generated Subjective Global Assessment in Central Australian haemodialysis patients: A cross sectional study. Nutr Diet 2022; 79:555-562. [PMID: 35903960 PMCID: PMC9796483 DOI: 10.1111/1747-0080.12763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 06/12/2022] [Accepted: 06/23/2022] [Indexed: 01/01/2023]
Abstract
AIM To (i) describe the prevalence of malnutrition among a cohort of central Australian, predominantly Indigenous, haemodialysis patients and (ii) determine the sensitivity and specificity of the Patient Generated Subjective Global Assessment total score for identification of malnutrition in these patients. METHODS Cross-sectional observational study of all patients attending haemodialysis units within the Central Australia Health Service. Patients were assessed using the Patient-Generated Subjective Global Assessment. Chi-Square tests were used to determine the association between nutritional status and location, age and gender. Receiver Operator Characteristic curves were used to ascertain the predictive validity for malnutrition of the total score. RESULTS Indigenous patients comprised 98% of study haemodialysis patients (n = 249/253). One third were male, and 72% were aged between 30 and 59 years. Approximately 29% (74/253) were malnourished, and 93% (69/74) had a total score ≥ 4. The most frequently reported problems that kept malnourished patients from eating were early satiety (32%), no appetite (31%), diarrhoea (26%) and dental problems (24%). Money problems were reported by 32%, as were transport (20%) and depression (19%). The traditional tool cut off score of ≥9 had low sensitivity (50%) for detecting malnutrition. Instead, a score ≥ 3 is suggested due to a higher sensitivity (96%) and specificity (45%). CONCLUSION Malnutrition was found to be common, and we suggest using a Patient-Generated Subjective Global Assessment total score of ≥3 to improve the identification of malnourished individuals in this cohort of predominantly Indigenous haemodialysis patients. This will significantly increase referrals for dietetic intervention.
Collapse
Affiliation(s)
| | - Liz Nichols
- Department of Nutrition & DieteticsAlice Springs HospitalThe GapNorthern TerritoryAustralia
| | - Kelly Lambert
- University of WollongongWollongongNew South WalesAustralia
| |
Collapse
|
41
|
Lambert K, Miglioretto C, Javadpour A. Update on the quality and health literacy demand of diet related videos on YouTube for people with Polycystic Kidney Disease. J Ren Nutr 2022; 33:495-498. [DOI: 10.1053/j.jrn.2022.10.006] [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] [Received: 02/24/2022] [Accepted: 10/16/2022] [Indexed: 11/23/2022] Open
|
42
|
Ploppert E, Jacob J, Deutsch A, Watanabe S, Gillenwater K, Choe A, Cruz GB, Cabañas E, Vasquez MA, Ayaz Z, Neuwirth LS, Lambert K. Influence of Effort-based Reward Training on Neuroadaptive Cognitive Responses: Implications for Preclinical Behavioral Approaches for Depressive Symptoms. Neuroscience 2022; 500:63-78. [PMID: 35961524 PMCID: PMC9464718 DOI: 10.1016/j.neuroscience.2022.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 07/12/2022] [Accepted: 08/01/2022] [Indexed: 12/13/2022]
Abstract
Despite the presence of multiple pharmacotherapeutic options, incidence rates for depressive disorders continue to rise. Nonpharmacological approaches (e.g., cognitive and behavioral therapies) exhibit encouraging efficacy rates; however, a lack of preclinical models has prevented progress in the identification of relevant neurobiological mechanisms of these approaches. Accordingly, the effort-based reward (EBR) preclinical model exposes rats to response-outcome (R-O) contingencies and provides an opportunity to investigate behavioral clinical approaches. In the current study, male and female rats were assigned to either an EBR contingent- or noncontingent-trained group and exposed to 7 weeks of training. Neuroadaptive cognitive responses were assessed in a cognitive uncertainty task (UT) and an object pattern separation task (OPST). Although no significant effects of EBR were observed in the UT, EBR contingent-trained rats approached the novel panel in the most difficult trial of the OPST faster than the noncontingent-trained group. Additionally, female EBR contingent-trained rats exhibited increased engagement with the novel stimulus panel across all trials. Examination of brain-derived neurotrophic factor (BDNF) in the lateral habenula (LHb), a putative neurobiological target for depressive symptoms, revealed lower BDNF immunoreactivity in EBR contingent-trained rats. Females in both training groups exhibited higher dehydroepiandrosterone/cortisol (DHEA/CORT) ratios, suggesting, along with the increased engagement with novel stimulus panels, that female rats may be more responsive to EBR contingency training than males. Together, these results suggest that EBR contingency training offers promise as a preclinical rat model for behavioral therapeutic interventions for depressive symptoms leading to a clearer understanding of putative neurobiological mechanisms.
Collapse
Affiliation(s)
- Emily Ploppert
- Dept of Psychology, University of Richmond, Richmond, VA, USA
| | - Joanna Jacob
- Dept of Psychology, University of Richmond, Richmond, VA, USA
| | - Ana Deutsch
- Dept of Psychology, University of Richmond, Richmond, VA, USA
| | - Sally Watanabe
- Dept of Psychology, University of Richmond, Richmond, VA, USA
| | | | - Alison Choe
- Dept of Psychology, University of Richmond, Richmond, VA, USA
| | - George B Cruz
- Dept of Biology, SUNY Old Westbury, Old Westbury, NY, USA; SUNY Neuroscience Research Institute, Old Westbury, NY, USA
| | - Ericka Cabañas
- Dept of Biology, SUNY Old Westbury, Old Westbury, NY, USA; SUNY Neuroscience Research Institute, Old Westbury, NY, USA
| | - Michelle A Vasquez
- SUNY Neuroscience Research Institute, Old Westbury, NY, USA; Dept Chemistry & Physics, SUNY Old Westbury, Old Westbury, NY, USA
| | - Zaid Ayaz
- Dept of Biology, SUNY Old Westbury, Old Westbury, NY, USA; SUNY Neuroscience Research Institute, Old Westbury, NY, USA
| | - Lorenz S Neuwirth
- SUNY Neuroscience Research Institute, Old Westbury, NY, USA; Dept of Psychology, SUNY Old Westbury, Old Westbury, NY, USA
| | - Kelly Lambert
- Dept of Psychology, University of Richmond, Richmond, VA, USA.
| |
Collapse
|
43
|
Melhuish E, Lindeback R, Lambert K. Scoping review of the dietary intake of children with chronic kidney disease. Pediatr Nephrol 2022; 37:1995-2012. [PMID: 35277755 DOI: 10.1007/s00467-021-05389-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 11/04/2021] [Accepted: 11/29/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Adequate nutrition is integral to optimal health outcomes for children with chronic kidney disease. However, no studies to date have summarised the existing knowledge base on the dietary intake of this patient group. OBJECTIVE Analyse and summarise evidence regarding the dietary intake of children with chronic kidney disease and identify areas that require further research or clarification. METHODS A scoping review of English language articles using four bibliographic databases and a predefined search term strategy. Weighted mean intake for each nutrient was calculated. RESULTS Eighteen studies were identified (1407 children and 118 healthy controls). Data on socioeconomic status, underreporting of intake and binder use was sparse. Most studies collected dietary information using food records or 24-h recalls. Nutrient data was missing for many subgroups especially transplant and dialysis patients. Protein intake was excessive in all groups where data was reported and varied from 125.7 ± 33% of the recommended dietary allowance in the severe disease group to 391.3 ± 383% in the group with mild kidney disease. Fibre, calcium, iron and vitamin C intake was inadequate for all groups. For children undertaking dialysis, none met the recommended dietary allowance for vitamins C, B1, B2, B3, B5 and B6. Sodium intake was excessive in all groups (> 220% of the recommended dietary allowance). Limited data suggests diet quality is poor, particularly fruit and vegetable intake. CONCLUSIONS This review has identified important subgroups of children with kidney disease where nutrient intake is suboptimal or not well described. Future studies should be conducted to describe intake in these groups. A higher-resolution version of the graphical abstract is available as Supplementary information.
Collapse
Affiliation(s)
- Erin Melhuish
- School of Medical, Indigenous and Health Sciences, University of Wollongong, Building 41, Northfields Ave., Wollongong, NSW, 2526, Australia
| | - Rachel Lindeback
- Department of Nutrition and Dietetics, St. George Hospital, Kogarah, NSW, 2217, Australia
| | - Kelly Lambert
- School of Medical, Indigenous and Health Sciences, University of Wollongong, Building 41, Northfields Ave., Wollongong, NSW, 2526, Australia.
| |
Collapse
|
44
|
Kent MH, Jacob JC, Bowen G, Bhalerao J, Desinor S, Vavra D, Leserve D, Ott KR, Angeles B, Martis M, Sciandra K, Gillenwater K, Glory C, Meisel E, Choe A, Olivares-Navarrete R, Puetzer JL, Lambert K. Disrupted development from head to tail: Pervasive effects of postnatal restricted resources on neurobiological, behavioral, and morphometric outcomes. Front Behav Neurosci 2022; 16:910056. [PMID: 35990727 PMCID: PMC9389412 DOI: 10.3389/fnbeh.2022.910056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 07/12/2022] [Indexed: 11/13/2022] Open
Abstract
When a maternal rat nurtures her pups, she relies on adequate resources to provide optimal care for her offspring. Accordingly, limited environmental resources may result in atypical maternal care, disrupting various developmental outcomes. In the current study, maternal Long-Evans rats were randomly assigned to either a standard resource (SR) group, provided with four cups of bedding and two paper towels for nesting material or a limited resource (LR) group, provided with a quarter of the bedding and nesting material provided for the SR group. Offspring were monitored at various developmental phases throughout the study. After weaning, pups were housed in same-sex dyads in environments with SRs for continued observations. Subsequent behavioral tests revealed a sex × resource interaction in play behavior on PND 28; specifically, LR reduced play attacks in males while LR increased play attacks in females. A sex × resource interaction was also observed in anxiety-related responses in the open field task with an increase in thigmotaxis in LR females and, in the social interaction task, females exhibited more external rears oriented away from the social target. Focusing on morphological variables, tail length measurements of LR males and females were shorter on PND 9, 16, and 21; however, differences in tail length were no longer present at PND 35. Following the behavioral assessments, animals were perfused at 56 days of age and subsequent immunohistochemical assays indicated increased glucocorticoid receptors in the lateral habenula of LR offspring and higher c-Fos immunoreactivity in the basolateral amygdala of SR offspring. Further, when tail vertebrae and tail tendons were assessed via micro-CT and hydroxyproline assays, results indicated increased trabecular separation, decreased bone volume fraction, and decreased connectivity density in bones, along with reduced collagen concentration in tendons in the LR animals. In sum, although the restricted resources only persisted for a brief duration, the effects appear to be far-reaching and pervasive in this early life stress animal model.
Collapse
Affiliation(s)
- Molly H. Kent
- Department of Biology, Virginia Military Institute, Lexington, VA, United States
| | - Joanna C. Jacob
- Department of Psychology, University of Richmond, Richmond, VA, United States
| | - Gabby Bowen
- Department of Psychology, University of Richmond, Richmond, VA, United States
| | - Janhavi Bhalerao
- Department of Psychology, University of Richmond, Richmond, VA, United States
| | - Stephanie Desinor
- Department of Psychology, University of Richmond, Richmond, VA, United States
| | - Dylan Vavra
- Department of Psychology, University of Richmond, Richmond, VA, United States
| | - Danielle Leserve
- Department of Psychology, University of Richmond, Richmond, VA, United States
| | - Kelly R. Ott
- Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, VA, United States
| | - Benjamin Angeles
- Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, VA, United States
| | - Michael Martis
- Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, VA, United States
| | - Katherine Sciandra
- Department of Psychology, University of Richmond, Richmond, VA, United States
| | | | - Clark Glory
- Department of Psychology, University of Richmond, Richmond, VA, United States
| | - Eli Meisel
- Department of Psychology, University of Richmond, Richmond, VA, United States
| | - Allison Choe
- Department of Psychology, University of Richmond, Richmond, VA, United States
| | - Rene Olivares-Navarrete
- Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, VA, United States
| | - Jennifer L. Puetzer
- Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, VA, United States
| | - Kelly Lambert
- Department of Psychology, University of Richmond, Richmond, VA, United States
- *Correspondence: Kelly Lambert,
| |
Collapse
|
45
|
Mukherjee N, Dart C, Lambert K, Norris D, Shellman Y. LB999 Basal levels of MCL1 and its binding partners contribute to a higher sensitivity to MCL1 inhibitors in uveal vs cutaneous melanomas. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.05.1025] [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: 11/28/2022]
|
46
|
Lambert K, Caruana L, Nichols L. Nutrition Impact Symptom Clusters in a Cohort of Indigenous Australian Hemodialysis Patients: New Insights Into the Management of Malnutrition? J Ren Nutr 2022; 33:490-494. [PMID: 35792259 DOI: 10.1053/j.jrn.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/18/2022] [Accepted: 06/18/2022] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE The objective of this study is to describe nutrition impact symptom clusters present in a large sample of indigenous hemodialysis patients. DESIGN AND METHODS This study is a cross-sectional secondary analysis of data from a service audit conducted in 2016. All participants were hemodialysis patients from 2 satellite hemodialysis units in Central Australia. All participants completed a Patient-Generated Subjective Global Assessment. Exploratory factor analysis was performed to identify nutrition impact symptom clusters. RESULTS A total of 249 patients were included, representing 16% of all indigenous dialysis patients in Australia. Malnutrition was present in 29% of the sample. Five distinct nutrition impact symptom clusters were identified, accounting for 51.942% of the variance in symptoms. The 5 clusters extracted were the following: sore mouth (swallow problems, sore mouth, pain); nausea and vomiting (nausea, vomiting, taste changes); abnormal bowels (diarrhea, constipation, depression); anorexia (no appetite, early satiety); and dry mouth (dry mouth, dental problems). CONCLUSIONS Malnourished patients experienced a significantly greater symptom burden in this study. This analysis extends the small evidence base about the nutrition impact symptom burden of indigenous hemodialysis patients. Understanding symptom clusters and how symptoms are connected may be useful for triaging care and managing malnutrition.
Collapse
Affiliation(s)
- Kelly Lambert
- Adv APD, Senior Lecturer, School of Medical, Indigenous, and Health Sciences, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia.
| | - Lauren Caruana
- Masters Nutrition and Dietetics, APD, formerly Department of Nutrition & Dietetics, Alice Springs Hospital, Northern Territory; presently Cairns Hospital, Alice Springs, Queensland, Australia
| | - Liz Nichols
- APD, Department of Nutrition & Dietetics, Alice Springs Hospital, Northern Territory, Alice Springs, Australia
| |
Collapse
|
47
|
Kent M, Kovalev D, Hart B, Leserve D, Handford G, Vavra D, Lambert K. The emotional impact of disrupted environmental contexts: Enrichment loss and coping profiles influence stress response recovery in Long-Evans rats. J Neuroendocrinol 2022; 34:e13179. [PMID: 35866213 PMCID: PMC9540572 DOI: 10.1111/jne.13179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 05/20/2022] [Accepted: 06/07/2022] [Indexed: 11/30/2022]
Abstract
With increasing rates of anxiety and mood disorders across the world, there is an unprecedented need for preclinical animal models to generate translational results for humans experiencing disruptive emotional symptoms. Considering that life events resulting in a perception of loss are correlated with depressive symptoms, the enrichment-loss rodent model offers promise as a translational model for stress-initiated psychiatric disorders. Additionally, predisposed temperament characteristics such as coping styles have been found to influence an individual's stress response. Accordingly, male rats were profiled as either consistent or flexible copers and assigned to one of three environments: standard laboratory housing, enriched environment, or enriched environment exposure followed by downsizing to standard laboratory cages (i.e., enrichment-loss group). Throughout the study, several behaviors were assessed to determine stress, social, and reward-processing responses. To assess recovery of the stress response, fecal samples were collected following the swim stress in 3-h increments to determine the recovery trajectory of corticosterone (CORT) and dehydroepiandrosterone (DHEA) metabolite levels. Upon death, neural markers of neuroplasticity including doublecortin, glial fibrillary acidic factor, and brain-derived neurotrophic factor were assessed via immunohistochemistry. Results indicated the flexible coping animals in the continuous enriched group had higher DHEA/CORT ratios (consistent with adaptive responses in past research); furthermore, the enrichment-loss animals exhibited a blunted CORT response throughout the assessments and enriched flexible copers had faster CORT recovery rates than consistent copers. Standard housed animals exhibited less exploratory behavior in the open field task and continuous enriched, flexible rats consumed more food rewards than the other groups. No differences in neuroplasticity neural markers were observed. In sum, the results of the present study support past research indicating the disruptive consequences of enrichment-loss, providing evidence that the model represents a valuable approach for the investigation of neurobiological mechanisms contributing to interindividual variability in responses to changing experiential landscapes.
Collapse
Affiliation(s)
- Molly Kent
- Department of BiologyVirginia Military InstituteLexingtonVAUSA
| | - Dmitry Kovalev
- Department of PsychologyUniversity of RichmondRichmondVAUSA
| | - Benjamin Hart
- Department of PsychologyUniversity of RichmondRichmondVAUSA
| | | | | | - Dylan Vavra
- Department of PsychologyUniversity of RichmondRichmondVAUSA
| | - Kelly Lambert
- Department of PsychologyUniversity of RichmondRichmondVAUSA
| |
Collapse
|
48
|
Isautier J, Webster AC, Lambert K, Shepherd HL, McCaffery K, Sud K, Kim J, Liu N, De La Mata N, Raihana S, Kelly PJ, Muscat DM. Evaluation of the SUCCESS health literacy app for Australian adults with chronic kidney disease: Study protocol for a pragmatic randomised controlled trial (Preprint). JMIR Res Protoc 2022; 11:e39909. [PMID: 36044265 PMCID: PMC9475407 DOI: 10.2196/39909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 06/27/2022] [Accepted: 06/28/2022] [Indexed: 12/04/2022] Open
Abstract
Background We developed a smartphone app—the SUCCESS (Supporting Culturally and Linguistically Diverse CKD Patients to Engage in Shared Decision-Making Successfully) app—to support Australian adults with kidney failure undertaking dialysis to actively participate in self-management and decision-making. The content of the SUCCESS app was informed by a theoretical model of health literacy that recognizes the importance of reducing the complexity of health information as well as providing skills necessary to access, understand, and act on this information. Objective The purpose of this study is to investigate the efficacy of the SUCCESS app intervention. Methods We designed a multicenter pragmatic randomized controlled trial to compare the SUCCESS app plus usual care (intervention) to usual care alone (control). A total of 384 participants receiving in-center or home-based hemodialysis or peritoneal dialysis will be recruited from six local health districts in the Greater Sydney region, New South Wales, Australia. To avoid intervention contamination, a pragmatic randomization approach will be used for participants undergoing in-center dialysis, in which randomization will be based on the days they receive hemodialysis and by center (ie, Monday, Wednesday, and Friday or Tuesday, Thursday, and Saturday). Participants undergoing home-based dialysis will be individually randomized centrally using simple randomization and two stratification factors: language spoken at home and research site. Consenting participants will be invited to use the SUCCESS app for 12 months. The primary endpoints, which will be assessed after 3, 6, and 12 months of app usage, are health literacy skills, evaluated using the Health Literacy Questionnaire; decision self-efficacy, evaluated using the Decision Self-Efficacy Scale; and rates of unscheduled health encounters. Secondary outcomes include patient-reported outcomes (ie, quality of life, evaluated with the 5-level EQ-5D; knowledge; confidence; health behavior; and self-management) and clinical outcomes (ie, symptom burden, evaluated with the Palliative care Outcome Scale–Renal; nutritional status, evaluated with the Patient-Generated Subjective Global Assessment; and intradialytic weight gain). App engagement will be determined via app analytics. All analyses will be undertaken using an intention-to-treat approach comparing the intervention and usual care arms. Results The study has been approved by Nepean Blue Mountains Human Research Ethics Committee (2020/ETH00910) and recruitment has begun at nine sites. We expect to finalize data collection by 2023 and publish the manuscript by 2024. Conclusions Enhancing health literacy skills for patients undergoing hemodialysis is an important endeavor, given the association between poor health literacy and poor health outcomes, especially among culturally diverse groups. The findings from this trial will be published in peer-reviewed journals and disseminated at conferences, and updates will be shared with partners, including participating local health districts, Kidney Health Australia, and consumers. The SUCCESS app will continue to be available to all participants following trial completion. Trial Registration Australia New Zealand Clinical Trials Registry (ANZCTR) ACTRN12621000235808; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380754&isReview=true International Registered Report Identifier (IRRID) DERR1-10.2196/39909
Collapse
Affiliation(s)
- Jennifer Isautier
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Angela C Webster
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- National Health and Medical Research Council Clinical Trials Centre, The University of Sydney, Sydney, Australia
- Westmead Applied Research Centre, Westmead Hospital, Westmead, Australia
| | - Kelly Lambert
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia
- Illawarra Health and Medical Research Institute, Wollongong, Australia
| | - Heather L Shepherd
- Centre for Medical Psychology and Evidence-based Decision-making, School of Psychology, Faculty of Science, The University of Sydney, Sydney, Australia
- Susan Wakil School of Nursing, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Kirsten McCaffery
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Kamal Sud
- Nepean Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Department of Renal Medicine, Nepean Hospital, Sydney, Australia
| | - Jinman Kim
- School of Computer Science, The University of Sydney, Sydney, Australia
| | - Na Liu
- The University of Sydney Business School, The University of Sydney, Darlington, Australia
| | - Nicole De La Mata
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Shahreen Raihana
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Patrick J Kelly
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Danielle M Muscat
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| |
Collapse
|
49
|
Lambert K, Johnstone C, Vellar L, Berg N. Implementation of an organisational wide approach to improving policy documents using plain language: a case study. AUST HEALTH REV 2022; 46:361-366. [PMID: 35477648 DOI: 10.1071/ah21297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 02/10/2022] [Indexed: 11/23/2022]
Abstract
The impact of poorly written policies in healthcare is enormous, with the potential for significant economic and personal costs. Our local health district embarked on a major revision of policy document development that sought to reframe the process of policy development using health literacy principles. This included mandatory policy development changes that require policy to be written in plain language, at a readability level of grade 10-12. Staff training in plain language writing was undertaken. Consumer and staff feedback was incorporated in policy development. Four elements were critical to this process: effective leadership, effective instruction, practical support, and evidence-driven decisions. Staff responses to the revised processes were overwhelmingly positive and resulted in improved policy readability. The involvement of consumers in policy development has evolved. From this study, we have learned how to improve the governance of policy documents. It is possible for health literacy principles to be embedded in the development and revision of these documents.
Collapse
Affiliation(s)
- Kelly Lambert
- School of Medical, Indigenous and Health Sciences, Building 41.319C, Northfields Avenue, University of Wollongong, Wollongong, NSW 2522, Australia
| | - Ceinwen Johnstone
- Clinical Governance Unit, Illawarra Shoalhaven Local Health District, Level 1, 66-71 King Street, Warrawong, NSW 2522, Australia
| | - Lucia Vellar
- Clinical Governance Unit, Illawarra Shoalhaven Local Health District, Level 1, 66-71 King Street, Warrawong, NSW 2522, Australia
| | - Natalie Berg
- Clinical Governance Unit, Illawarra Shoalhaven Local Health District, Level 1, 66-71 King Street, Warrawong, NSW 2522, Australia
| |
Collapse
|
50
|
Lambert K, Lightfoot CJ, Jegatheesan DK, Gabrys I, Bennett PN. Physical activity and exercise recommendations for people receiving dialysis: A scoping review. PLoS One 2022; 17:e0267290. [PMID: 35482797 PMCID: PMC9049336 DOI: 10.1371/journal.pone.0267290] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 04/05/2022] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Remaining physically active is important to patients undertaking dialysis, however, clinical recommendations regarding exercise type, timing, intensity, and safety precautions vary. The purpose of this scoping review was to analyse and summarise recommendations for physical activity and exercise for people undertaking dialysis and identify areas that require further research or clarification. MATERIALS AND METHODS A scoping review of literature from five bibliographic databases (Medline, Scopus, Web of Science, CINAHL, and SPORTDiscus) was conducted. Eligible articles included consensus guidelines, position statements, reviews, or clinical practice guidelines that included specific physical activity and exercise recommendations for people undertaking dialysis. Key search terms included "kidney disease" OR "kidney failure" OR "chronic kidney disease" OR "end stage kidney disease" AND guideline* OR consensus OR "position statement" OR prescription OR statement AND exercise OR "physical activity". Hand searching for relevant articles in all first twenty quartile 1 journals listed on SCImago under 'medicine-nephrology' and 'physical therapy, sports therapy and rehabilitation' using the terms 'exercise and dialysis' was undertaken. Finally, home pages of key societies and professional organisations in the field of sports medicine and nephrology were searched. RESULTS The systematic search strategy identified 19 articles met the inclusion criteria. Two were specific to pediatric dialysis and three to peritoneal dialysis. Whilst many publications provided recommendations on aerobic exercise, progressive resistance training and flexibility, few provided explicit guidance. Recommendations for the intensity, duration and frequency of aerobic and resistance training varied. Discrepancies or gaps in guidance about precautions, contraindications, termination criteria, progression, and access site precautions were also apparent. CONCLUSION Future guidelines should include specific guidance regarding physical activity, safety precautions, and timing and intensity of exercise for individuals who undertake dialysis. Collaborative multidisciplinary guideline development and appropriate exercise counselling may lead to increased participation in physical activity and exercise and facilitate better patient outcomes.
Collapse
Affiliation(s)
- Kelly Lambert
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, and Illawarra Health and Medical Research Institute, Wollongong, New South Wales, Australia
| | - Courtney J. Lightfoot
- Department of Health Sciences, Leicester Kidney Lifestyle Team, University of Leicester, Leicester, United Kingdom
| | - Dev K. Jegatheesan
- Department of Nephrology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Iwona Gabrys
- Alberta Kidney Care North, Alberta Health Services, Edmonton, Alberta, Canada
| | - Paul N. Bennett
- Clinical Health Sciences, University of South Australia, Adelaide, Australia and Satellite Healthcare, San Jose, California, United States of America
| |
Collapse
|