1
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Diop A, Gupta A, Mueller S, Dron L, Harari O, Berringer H, Kalatharan V, Park JJH, Mésidor M, Talbot D. Assessing the performance of group-based trajectory modeling method to discover different patterns of medication adherence. Pharm Stat 2024. [PMID: 38327261 DOI: 10.1002/pst.2365] [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: 10/10/2023] [Revised: 12/12/2023] [Accepted: 01/17/2024] [Indexed: 02/09/2024]
Abstract
It is well known that medication adherence is critical to patient outcomes and can decrease patient mortality. The Pharmacy Quality Alliance (PQA) has recognized and identified medication adherence as an important indicator of medication-use quality. Hence, there is a need to use the right methods to assess medication adherence. The PQA has endorsed the proportion of days covered (PDC) as the primary method of measuring adherence. Although easy to calculate, the PDC has however several drawbacks as a method of measuring adherence. PDC is a deterministic approach that cannot capture the complexity of a dynamic phenomenon. Group-based trajectory modeling (GBTM) is increasingly proposed as an alternative to capture heterogeneity in medication adherence. The main goal of this paper is to demonstrate, through a simulation study, the ability of GBTM to capture treatment adherence when compared to its deterministic PDC analogue and to the nonparametric longitudinal K-means. A time-varying treatment was generated as a quadratic function of time, baseline, and time-varying covariates. Three trajectory models are considered combining a cat's cradle effect, and a rainbow effect. The performance of GBTM was compared to the PDC and longitudinal K-means using the absolute bias, the variance, the c-statistics, the relative bias, and the relative variance. For all explored scenarios, we find that GBTM performed better in capturing different patterns of medication adherence with lower relative bias and variance even under model misspecification than PDC and longitudinal K-means.
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Affiliation(s)
- Awa Diop
- Core Clinical Sciences Inc., Vancouver, British Columbia, Canada
- Département de médecine sociale et préventive, Université Laval, Québec, Canada
| | - Alind Gupta
- Department of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | | | - Louis Dron
- Cascade Outcomes Research Inc., Vancouver, British Columbia, Canada
| | - Ofir Harari
- Core Clinical Sciences Inc., Vancouver, British Columbia, Canada
| | - Heather Berringer
- Core Clinical Sciences Inc., Vancouver, British Columbia, Canada
- Department of Mathematics and Statistics, University of Victoria, Victoria, British Columbia, Canada
| | | | - Jay J H Park
- Core Clinical Sciences Inc., Vancouver, British Columbia, Canada
- Department of Health Research Methodology, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Miceline Mésidor
- Département de médecine sociale et préventive, Université Laval, Québec, Canada
- Axe santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec - Université Laval, Québec, Canada
| | - Denis Talbot
- Département de médecine sociale et préventive, Université Laval, Québec, Canada
- Axe santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec - Université Laval, Québec, Canada
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2
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Dron L, Kalatharan V, Gupta A, Haggstrom J, Zariffa N, Morris AD, Arora P, Park J. Data capture and sharing in the COVID-19 pandemic: a cause for concern. Lancet Digit Health 2022; 4:e748-e756. [PMID: 36150783 PMCID: PMC9489064 DOI: 10.1016/s2589-7500(22)00147-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [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: 07/08/2021] [Revised: 07/08/2022] [Accepted: 07/13/2022] [Indexed: 12/25/2022]
Abstract
Routine health care and research have been profoundly influenced by digital-health technologies. These technologies range from primary data collection in electronic health records (EHRs) and administrative claims to web-based artificial-intelligence-driven analyses. There has been increased use of such health technologies during the COVID-19 pandemic, driven in part by the availability of these data. In some cases, this has resulted in profound and potentially long-lasting positive effects on medical research and routine health-care delivery. In other cases, high profile shortcomings have been evident, potentially attenuating the effect of-or representing a decreased appetite for-digital-health transformation. In this Series paper, we provide an overview of how facets of health technologies in routinely collected medical data (including EHRs and digital data sharing) have been used for COVID-19 research and tracking, and how these technologies might influence future pandemics and health-care research. We explore the strengths and weaknesses of digital-health research during the COVID-19 pandemic and discuss how learnings from COVID-19 might translate into new approaches in a post-pandemic era.
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Affiliation(s)
- Louis Dron
- Real World & Advanced Analytics, Cytel Health, Vancouver, BC, Canada,Correspondence to: Mr Louis Dron, Real World & Advanced Analytics, Cytel Health, Vancouver, BC V5Z 4J7, Canada
| | - Vinusha Kalatharan
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
| | - Alind Gupta
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Jonas Haggstrom
- Real World & Advanced Analytics, Cytel Health, Vancouver, BC, Canada,The International COVID-19 Data Alliance (ICODA), Health Data Research UK, London, UK
| | - Nevine Zariffa
- The International COVID-19 Data Alliance (ICODA), Health Data Research UK, London, UK,NMD Group, LLC, Bala Cynwyd, PA, USA
| | - Andrew D Morris
- The International COVID-19 Data Alliance (ICODA), Health Data Research UK, London, UK
| | - Paul Arora
- Real World & Advanced Analytics, Cytel Health, Vancouver, BC, Canada,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Jay Park
- Department of Experimental Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, Canada,Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
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3
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Kalatharan V, Welk B, Nash DM, Dixon SN, Slater J, Pei Y, Sarma S, Garg AX. Risk of Hospital Encounters With Kidney Stones in Autosomal Dominant Polycystic Kidney Disease: A Cohort Study. Can J Kidney Health Dis 2021; 8:20543581211000227. [PMID: 33796322 PMCID: PMC7970239 DOI: 10.1177/20543581211000227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 02/02/2021] [Indexed: 12/03/2022] Open
Abstract
Background: There is a perception that patients with autosomal dominant polycystic kidney
disease (ADPKD) are more likely to develop kidney stones than the general
population. Objective: To compare the rate of hospital encounter with kidney stones and the rate of
stone interventions between patients with and without ADPKD. Design: Retrospective cohort study. Setting: Ontario, Canada. Patients: Patients with and without ADPKD who had a prior hospital encounter between
2002 and 2016. Measurements: Rate of hospital encounter with kidney stones and rate of stone
intervention. Methods: We used inverse probability exposure weighting based on propensity scores to
balance baseline indicators of health between patients with and without
ADPKD. We followed each patient until death, emigration, outcomes, or March
31, 2017. We used a Cox proportional hazards model to compare event rates
between the two groups. Results: Patients with ADPKD were at higher risk of hospital encounter with stones
compared with patients without ADPKD (81 patients of 2094 with ADPKD [3.8%]
vs 60 patients of 1902 without ADPKD [3.2%]; 8.9 vs 5.1 events per 1000
person-years; hazard ratio 1.6 [95% CI, 1.3-2.1]). ADPKD was not associated
with a higher risk of stone intervention (49 of 2094 [2.3%] vs 47 of 1902
[2.4%]; 5.3 vs 3.9 events per 1000 person-years; hazard ratio 1.2 [95% CI =
0.9-1.3]). Limitations: We did not have information on kidney stone events outside of the hospital.
There is a possibility of residual confounding. Conclusion: ADPKD was a significant risk factor for hospital encounters with kidney
stones.
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Affiliation(s)
- Vinusha Kalatharan
- Department of Epidemiology & Biostatistics, Western University, London, ON, Canada
| | - Blayne Welk
- Department of Epidemiology & Biostatistics, Western University, London, ON, Canada.,ICES, London, ON, Canada
| | - Danielle M Nash
- Department of Epidemiology & Biostatistics, Western University, London, ON, Canada.,ICES, London, ON, Canada
| | - Stephanie N Dixon
- Department of Epidemiology & Biostatistics, Western University, London, ON, Canada.,ICES, London, ON, Canada
| | | | - York Pei
- University Health Network, University of Toronto, ON, Canada
| | - Sisira Sarma
- Department of Epidemiology & Biostatistics, Western University, London, ON, Canada.,ICES, London, ON, Canada
| | - Amit X Garg
- Department of Epidemiology & Biostatistics, Western University, London, ON, Canada.,ICES, London, ON, Canada.,Division of Nephrology, Department of Medicine, Western University, London, ON, Canada
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Kalatharan V, Welk B, Nash DM, McArthur E, Slater J, Sarma S, Pei Y, Garg AX. Complications in Patients With Autosomal Dominant Polycystic Kidney Disease Undergoing Ureteroscopy: A Cohort Study. Can J Kidney Health Dis 2020; 7:2054358120972830. [PMID: 33282326 PMCID: PMC7691941 DOI: 10.1177/2054358120972830] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 09/30/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Ureteroscopy is a minimally invasive treatment option for upper tract stones. The distorted kidney anatomy in patients with autosomal dominant polycystic kidney disease (ADPKD) may place them at higher risk for ureteroscopic complications. OBJECTIVE To compare the 30-day risk of ureteroscopic complications between patients with and without ADPKD. DESIGN Retrospective cohort study. SETTING Ontario, Canada. PATIENTS Seventy three patients with ADPKD and 81 445 patients without ADPKD who underwent ureteroscopy for upper urinary tract stones between April 1, 2002, and March 1, 2018. MEASUREMENTS A 30-day risk of (1) hospital presentation with ureteroscopic complications (which was a composite outcome of either emergency department visit or hospital admission with acute kidney injury, urinary tract infection, or sepsis); (2) all-cause hospital presentation; (3) all-cause hospital admission; and (4) all-cause emergency department visit. METHODS We regressed outcomes on demographic variables, health care use in the prior 1-year, various procedures and comorbidities related to the outcome in the prior 5 years, and prescribed medications filled in the past 120 days using modified Poisson regression to compare the risk ratio (RR) of each outcome between patients with and without ADPKD. RESULTS The median (interquartile, IQR) age was 44 (38-60 years) in the ADPKD group and 53 (42-64) in the control group. About 40% were women in both groups. The risk of ureteroscopic complications was not significantly different in patients with versus without ADPKD (8.2% vs 4.3%; adjusted RR = 1.5, 95% confidence interval [CI] = 0.7-3.2). Patients with versus without ADPKD were more likely to present to hospital after their procedure (35.6% vs. 20.0%; adjusted RR = 1.6, 95% CI = 1.2-2.2), which included a statistically significant increase in the risk of presenting to the emergency department (32.9% vs. 19.0%; adjusted RR = 1.6, 95% CI = 1.1-2.2) but not hospital admissions (10.9% vs. 5.0%; adjusted RR = 1.8, 95% CI = 0.9-3.4). LIMITATIONS The low numbers of events led to imprecision around the estimates. CONCLUSION Patients with ADPKD have a higher risk of return to the hospital within 30 days of ureteroscopy for stone disease. TRIAL REGISTRATION We did not register this study.
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Affiliation(s)
- Vinusha Kalatharan
- Department of Epidemiology and
Biostatistics, Western University, London, ON, Canada
- ICES, ON, Canada
| | - Blayne Welk
- Department of Epidemiology and
Biostatistics, Western University, London, ON, Canada
- ICES, ON, Canada
- Department of Surgery, Western
University, London, ON, Canada
| | | | | | | | - Sisira Sarma
- Department of Epidemiology and
Biostatistics, Western University, London, ON, Canada
- ICES, ON, Canada
| | - York Pei
- University Health Network, University of
Toronto, ON, Canada
| | - Amit X. Garg
- Department of Epidemiology and
Biostatistics, Western University, London, ON, Canada
- ICES, ON, Canada
- Division of Nephrology, Department of
Medicine, Western University, London, ON, Canada
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5
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Kalatharan V, Jandoc R, Grewal G, Nash DM, Welk B, Sarma S, Pei Y, Garg AX. Efficacy and Safety of Surgical Kidney Stone Interventions in Autosomal Dominant Polycystic Kidney Disease: A Systematic Review. Can J Kidney Health Dis 2020; 7:2054358120940433. [PMID: 32754344 PMCID: PMC7378961 DOI: 10.1177/2054358120940433] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 05/20/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Reduced kidney function and distorted kidney anatomy in patients with autosomal dominant polycystic kidney disease (ADPKD) may complicate stone interventions more compared with the general population. OBJECTIVES To review studies describing the safety and efficacy of the 3 main stone interventions in adults with ADPKD: shock wave lithotripsy (SWL), ureteroscopy, and percutaneous nephrolithotomy (PCNL). DESIGN Systematic review. SETTING Any country of origin. PATIENTS Adults with ADPKD who underwent SWL, ureteroscopy, or PCNL. MEASUREMENTS Being stone free after the intervention and postoperative complications as reported by each study, which included pain, bleeding, and fever. METHODS Relevant studies published until February 2019 were identified through a comprehensive search of MEDLINE, EMBASE, Web of Science, BIOSIS PREVIEW, and CINAHL. Studies were eligible for review if they reported at least one outcome following SWL, ureteroscopy, and/or PCNL in adults with ADPKD. We then abstracted information on study characteristics, patient characteristics, intervention details, and postintervention outcomes and assessed the methodological quality of each study using a modified Downs and Black checklist. RESULTS We screened 221 citations from which we identified 24 studies that met our review criteria. We identified an additional article when manually reviewing the reference list of an included article, yielding a total of 25 studies describing 311 patients (32 SWL, 42 ureteroscopy, and 237 PCNL). The percentage of patients who were stone free after 1 session ranged from 0% to 69% after SWL, 73% to 100% after ureteroscopy, and 45% to 100% after PCNL. The percentage of patients with ADPKD that experienced at least one postoperative complication ranged from 0% to 33% for SWL, 0% to 27% for ureteroscopy, and 0% to 100% for PCNL. LIMITATIONS The number and quality of studies published to date are limited. CONCLUSIONS The efficacy and safety of stone interventions in patients with ADPKD remains uncertain, with wide-ranging estimates reported in the literature. TRIAL REGISTRATION We did not register the protocol of this systematic review.
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Affiliation(s)
- Vinusha Kalatharan
- Department of Epidemiology &
Biostatistics, Western University, London, ON, Canada
- ICES, London, ON, Canada
| | | | - Gary Grewal
- Department of Epidemiology &
Biostatistics, Western University, London, ON, Canada
| | - Danielle M. Nash
- Department of Epidemiology &
Biostatistics, Western University, London, ON, Canada
- ICES, London, ON, Canada
| | - Blayne Welk
- Department of Epidemiology &
Biostatistics, Western University, London, ON, Canada
- ICES, London, ON, Canada
| | - Sisira Sarma
- Department of Epidemiology &
Biostatistics, Western University, London, ON, Canada
- ICES, London, ON, Canada
| | - York Pei
- Division of Nephrology, University
Health Network and University of Toronto, ON, Canada
| | - Amit X. Garg
- Department of Epidemiology &
Biostatistics, Western University, London, ON, Canada
- ICES, London, ON, Canada
- Division of Nephrology, Department of
Medicine, Western University, London, ON, Canada
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6
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Kalatharan V, McArthur E, Nash DM, Welk B, Sarma S, Garg AX, Pei Y. Diagnostic accuracy of administrative codes for autosomal dominant polycystic kidney disease in clinic patients with cystic kidney disease. Clin Kidney J 2020; 14:612-616. [PMID: 33623686 PMCID: PMC7886566 DOI: 10.1093/ckj/sfz184] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 11/08/2019] [Indexed: 01/03/2023] Open
Abstract
Background The ability to identify patients with autosomal dominant polycystic kidney disease (ADPKD) and distinguish them from patients with similar conditions in healthcare administrative databases is uncertain. We aimed to measure the sensitivity and specificity of different ADPKD administrative coding algorithms in a clinic population with non-ADPKD and ADPKD kidney cystic disease. Methods We used a dataset of all patients who attended a hereditary kidney disease clinic in Toronto, Ontario, Canada between 1 January 2010 and 23 December 2014. This dataset included patients who met our reference standard definition of ADPKD or other cystic kidney disease. We linked this dataset to healthcare databases in Ontario. We developed eight algorithms to identify ADPKD using the International Classification of Diseases, 10th Revision (ICD-10) codes and provincial diagnostic billing codes. A patient was considered algorithm positive if any one of the codes in the algorithm appeared at least once between 1 April 2002 and 31 March 2015. Results The ICD-10 coding algorithm had a sensitivity of 33.7% [95% confidence interval (CI) 30.0–37.7] and a specificity of 86.2% (95% CI 75.7–92.5) for the identification of ADPKD. The provincial diagnostic billing code had a sensitivity of 91.1% (95% CI 88.5–93.1) and a specificity of 10.8% (95% CI 5.3–20.6). Conclusions ICD-10 coding may be useful to identify patients with a high chance of having ADPKD but fail to identify many patients with ADPKD. Provincial diagnosis billing codes identified most patients with ADPKD and also with other types of cystic kidney disease.
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Affiliation(s)
- Vinusha Kalatharan
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | | | | | - Blayne Welk
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada.,ICES, London, Ontario, Canada
| | - Sisira Sarma
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada.,ICES, London, Ontario, Canada
| | - Amit X Garg
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada.,ICES, London, Ontario, Canada.,Division of Nephrology, Department of Medicine, Western University, London, Ontario, Canada
| | - York Pei
- University Health Network, University of Toronto, Toronto, Ontario, Canada
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7
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Kalatharan V, Grewal G, Nash DM, Welk B, Sarma S, Pei Y, Garg AX. Stone Prevalence in Autosomal Dominant Polycystic Kidney Disease: A Systematic Review and Meta-Analysis. Can J Kidney Health Dis 2020; 7:2054358120934628. [PMID: 35186303 PMCID: PMC8851145 DOI: 10.1177/2054358120934628] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 02/10/2020] [Accepted: 05/01/2020] [Indexed: 12/19/2022] Open
Abstract
Background: It is uncertain how often patients with autosomal dominant polycystic kidney disease (ADPKD) develop kidney stones. Objective: To review English-language studies reporting the incidence and prevalence of stones and stone interventions in adults with ADPKD. Design: Systematic review and meta-analysis. Setting: Any country of origin. Patients: Adult patients with ADPKD. Measurements: Incidence or prevalence of kidney stones and stone interventions. Methods: We reviewed 1812 citations from bibliographic databases, abstracted data from 49 eligible studies, and assessed methodological quality in duplicate. In some studies, the proportion of adults with ADPKD with the outcome were compared to adults without ADPKD; for these studies, prevalence risk ratios were calculated and pooled using a random effects model. Results: We identified 49 articles that met our review criteria. The methodological quality of many studies was limited (scores ranging from 2 to 14 out of 22, with a higher score indicating higher quality). No study clearly reported stone incidence, and in the cross-sectional studies, the definition of stones was often unclear. The prevalence of stones ranged from 3% to 59%, and a prevalence of stone interventions ranged from 1% to 8%; the average patient age at the time of assessment ranged from 26 to 61 years across the studies. Two studies reported a nonstatistically significant higher stone prevalence in patients with ADPKD compared to unaffected family members. Compared to unaffected family members, patients with ADPKD had a higher prevalence of kidney stones (6 cross-sectional studies; unadjusted prevalence ratio: 1.8; 95% confidence interval: 1.3 to 2.6; P = .0007; test for heterogeneity: I2 = 0%, P = .8). Limitations: Studies were limited to articles published in English. Conclusions: The prevalence of kidney stones and stone interventions in adults with ADPKD remains uncertain. Future studies of higher methodological quality are needed to better characterize the incidence and prevalence of kidney stones in patients with ADPKD. Trial registration: We did not register the protocol for this systematic review.
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Affiliation(s)
- Vinusha Kalatharan
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
| | - Gary Grewal
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
| | - Danielle M Nash
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
- ICES, ON, Canada
| | - Blayne Welk
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
- ICES, ON, Canada
| | - Sisira Sarma
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
- ICES, ON, Canada
| | - York Pei
- University Health Network, University of Toronto, ON, Canada
| | - Amit X. Garg
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
- ICES, ON, Canada
- Division of Nephrology, Department of Medicine, Western University, London, ON, Canada
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8
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Clemens KK, Kalatharan V, Ryan BL, Reichert S. Nonconventional diabetes-related care strategies for patients with chronic kidney disease: A scoping review of the literature. J Comorb 2019; 9:2235042X19831918. [PMID: 30891431 PMCID: PMC6416990 DOI: 10.1177/2235042x19831918] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 06/22/2018] [Revised: 12/04/2018] [Accepted: 01/07/2019] [Indexed: 12/23/2022]
Abstract
Background Patients with diabetes and chronic kidney disease (CKD) are at high risk of diabetes-related complications. Diabetes care can support these individuals, but outpatient clinic appointments can be difficult to attend, given their already high burden of multimorbidity. Methods We systematically searched the medical and grey literature for studies that evaluated the effect of nonconventional diabetes care strategies on diabetes-related outcomes in adults with stages 2-5 CKD or using dialysis (end of search December 30, 2017). We included both randomized-controlled trials and observational studies. Study selection and data extraction were completed by two independent reviewers. Diabetes-related outcomes included glycemic, blood pressure, and lipid control, along with microvascular complications, macrovascular complications, and death. Results After screening 2177 relevant citations, we identified 34 studies which met inclusion. The majority were observational studies. Studies were frequently small, single-centered, and excluded patients with more advanced CKD. Nonconventional diabetes care strategies included community-based care, unique self-management and education programs, nurse-led care clinics, dialysis-based diabetes programs, telemedicine, and interdisciplinary care clinics. Programs were most often developed by study investigators. Although there were limitations to several of the included studies, programs were described to have modest effects on physiologic outcomes, and in some cases, diabetes-related complications and death. Conclusions Nonconventional diabetes-related care might be helpful to patients with CKD. Prior to developing and implementing programs, however, it will be important to study them more rigorously, understand their acceptability to patients, and evaluate their costs and feasibility in a real-world setting.
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Affiliation(s)
- Kristin K Clemens
- Department of Medicine, Division of Endocrinology, Western University, London, Ontario, Canada.,Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Ontario, Canada.,St Joseph's Health Care, London, Ontario, Canada.,Lawson Health Research Institute, London, Ontario, Canada
| | | | - Bridget L Ryan
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada.,Department of Family Medicine, Western University, London, Ontario, Canada
| | - Sonja Reichert
- St Joseph's Health Care, London, Ontario, Canada.,Department of Family Medicine, Western University, London, Ontario, Canada
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9
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Kalatharan V, Lemaire M, Lanktree MB. Opportunities and Challenges for Genetic Studies of End-Stage Renal Disease in Canada. Can J Kidney Health Dis 2018; 5:2054358118789368. [PMID: 30046452 PMCID: PMC6056781 DOI: 10.1177/2054358118789368] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 06/14/2018] [Indexed: 11/23/2022] Open
Abstract
Purpose of review: Genetic testing can improve diagnostic precision in some patients with
end-stage renal disease (ESRD) providing the potential for targeted therapy
and improved patient outcomes. We sought to describe the genetic
architecture of ESRD and Canadian data sources available for further genetic
investigation into ESRD. Sources of information: We performed PubMed searches of English, peer-reviewed articles using
keywords “chronic kidney disease,” “ESRD,” “genetics,” “sequencing,” and
“administrative databases,” and searched for nephrology-related Mendelian
diseases on the Online Mendelian Inheritance in Man database. Methods: In this narrative review, we discuss our evolving understanding of the
genetic architecture of kidney disease and ESRD, the risks and benefits of
using genetic data to help diagnose and manage patients with ESRD, existing
public Canadian biobanks and databases, and a vision for future genetic
studies of ESRD in Canada. Key findings: ESRD has a polygenic architecture including rare Mendelian mutations and
common small effect genetic polymorphism contributors. Genetic testing will
improve diagnostic accuracy and contribute to a precision medicine approach
in nephrology. However, the risk and benefits of genetic testing needs to be
considered from an individual and societal perspective, and further research
is required. Merging existing health data, linking biobanks and
administrative databases, and forming Canadian collaborations hold great
potential for genetic research into ESRD. Large sample sizes are necessary
to perform the suitably powered investigations required to bring this vision
to reality. Limitations: This is a narrative review of the literature discussing future directions and
opportunities. It reflects the views and academic biases of the authors. Implications: National collaborations will be required to obtain sample sizes required for
impactful, robust research. Merging established datasets may be one approach
to obtain adequate samples. Patient education and engagement will improve
the value of knowledge gained.
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Affiliation(s)
- Vinusha Kalatharan
- Department of Epidemiology & Biostatistics, Western University, London, ON, Canada
| | - Mathieu Lemaire
- Division of Nephrology, The Hospital for Sick Children, University of Toronto, ON, Canada.,Cell Biology Program, SickKids Research Institute, Toronto, ON, Canada
| | - Matthew B Lanktree
- Division of Nephrology, University Health Network, Toronto, ON, Canada.,University of Toronto, ON, Canada.,Division of Nephrology, McMaster University, Hamilton, ON, Canada
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10
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Iliuta IA, Kalatharan V, Wang K, Cornec-Le Gall E, Conklin J, Pourafkari M, Ting R, Chen C, Borgo AC, He N, Song X, Heyer CM, Senum SR, Hwang YH, Paterson AD, Harris PC, Khalili K, Pei Y. Polycystic Kidney Disease without an Apparent Family History. J Am Soc Nephrol 2017; 28:2768-2776. [PMID: 28522688 DOI: 10.1681/asn.2016090938] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 03/24/2017] [Indexed: 01/14/2023] Open
Abstract
The absence of a positive family history (PFH) in 10%-25% of patients poses a diagnostic challenge for autosomal dominant polycystic kidney disease (ADPKD). In the Toronto Genetic Epidemiology Study of Polycystic Kidney Disease, 210 affected probands underwent renal function testing, abdominal imaging, and comprehensive PKD1 and PKD2 mutation screening. From this cohort, we reviewed all patients with and without an apparent family history, examined their parental medical records, and performed renal imaging in all available parents of unknown disease status. Subsequent reclassification of 209 analyzed patients revealed 72.2% (151 of 209) with a PFH, 15.3% (32 of 209) with de novo disease, 10.5% (22 of 209) with an indeterminate family history, and 1.9% (four of 209) with PFH in retrospect. Among the patients with de novo cases, we found two families with germline mosaicism and one family with somatic mosaicism. Additionally, analysis of renal imaging revealed that 16.3% (34 of 209) of patients displayed atypical PKD, most of which followed one of three patterns: asymmetric or focal PKD with PFH and an identified PKD1 or PKD2 mutation (15 of 34), asymmetric and de novo PKD with proven or suspected somatic mosaicism (seven of 34), or focal PKD without any identifiable PKD1 or PKD2 mutation (eight of 34). In conclusion, PKD without an apparent family history may be due to de novo disease, missing parental medical records, germline or somatic mosaicism, or mild disease from hypomorphic PKD1 and PKD2 mutations. Furthermore, mutations of a newly identified gene for ADPKD, GANAB, and somatic mosaicism need to be considered in the mutation-negative patients with focal disease.
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Affiliation(s)
| | | | | | | | - John Conklin
- Department of Medical Imaging, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Marina Pourafkari
- Department of Medical Imaging, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | | | | | | | | | | | - Christina M Heyer
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
| | - Sarah R Senum
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
| | | | - Andrew D Paterson
- Program in Genetics and Genome Biology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Peter C Harris
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
| | - Korosh Khalili
- Department of Medical Imaging, University Health Network and University of Toronto, Toronto, Ontario, Canada
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Kalatharan V, Pei Y, Clemens KK, McTavish RK, Dixon SN, Rochon M, Nash DM, Jain A, Sarma S, Zaleski A, Lum A, Garg AX. Positive Predictive Values of International Classification of Diseases, 10th Revision Coding Algorithms to Identify Patients With Autosomal Dominant Polycystic Kidney Disease. Can J Kidney Health Dis 2016; 3:2054358116679130. [PMID: 28781884 PMCID: PMC5518965 DOI: 10.1177/2054358116679130] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 07/11/2016] [Accepted: 09/23/2016] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND International Classification of Diseases, 10th Revision codes (ICD-10) for autosomal dominant polycystic kidney disease (ADPKD) is used within several administrative health care databases. It is unknown whether these codes identify patients who meet strict clinical criteria for ADPKD. OBJECTIVE The objective of this study is (1) to determine whether different ICD-10 coding algorithms identify adult patients who meet strict clinical criteria for ADPKD as assessed through medical chart review and (2) to assess the number of patients identified with different ADPKD coding algorithms in Ontario. DESIGN Validation study of health care database codes, and prevalence. SETTING Ontario, Canada. PATIENTS For the chart review, 201 adult patients with hospital encounters between April 1, 2002, and March 31, 2014, assigned either ICD-10 codes Q61.2 or Q61.3. MEASUREMENTS This study measured positive predictive value of the ICD-10 coding algorithms and the number of Ontarians identified with different coding algorithms. METHODS We manually reviewed a random sample of medical charts in London, Ontario, Canada, and determined whether or not ADPKD was present according to strict clinical criteria. RESULTS The presence of either ICD-10 code Q61.2 or Q61.3 in a hospital encounter had a positive predictive value of 85% (95% confidence interval [CI], 79%-89%) and identified 2981 Ontarians (0.02% of the Ontario adult population). The presence of ICD-10 code Q61.2 in a hospital encounter had a positive predictive value of 97% (95% CI, 86%-100%) and identified 394 adults in Ontario (0.003% of the Ontario adult population). LIMITATIONS (1) We could not calculate other measures of validity; (2) the coding algorithms do not identify patients without hospital encounters; and (3) coding practices may differ between hospitals. CONCLUSIONS Most patients with ICD-10 code Q61.2 or Q61.3 assigned during their hospital encounters have ADPKD according to the clinical criteria. These codes can be used to assemble cohorts of adult patients with ADPKD and hospital encounters.
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Affiliation(s)
- Vinusha Kalatharan
- Department of Epidemiology & Biostatistics, Western University, London, Ontario, Canada
| | - York Pei
- Division of Nephrology, University Health Network, University of Toronto, Ontario, Canada
| | - Kristin K Clemens
- Department of Epidemiology & Biostatistics, Western University, London, Ontario, Canada
| | - Rebecca K McTavish
- Department of Epidemiology & Biostatistics, Western University, London, Ontario, Canada
| | - Stephanie N Dixon
- Department of Epidemiology & Biostatistics, Western University, London, Ontario, Canada.,Institute for Clinical Evaluative Sciences, London, Ontario, Canada
| | - Matthew Rochon
- Department of Radiology, Western University, London, Ontario, Canada
| | - Danielle M Nash
- Institute for Clinical Evaluative Sciences, London, Ontario, Canada
| | - Arsh Jain
- Division of Nephrology, Department of Medicine, Western University, London, Ontario, Canada
| | - Sisira Sarma
- Department of Epidemiology & Biostatistics, Western University, London, Ontario, Canada
| | - Andrew Zaleski
- Department of Radiology, Western University, London, Ontario, Canada
| | - Andrea Lum
- Department of Radiology, Western University, London, Ontario, Canada
| | - Amit X Garg
- Department of Epidemiology & Biostatistics, Western University, London, Ontario, Canada.,Institute for Clinical Evaluative Sciences, London, Ontario, Canada.,Division of Nephrology, Department of Medicine, Western University, London, Ontario, Canada.,London Kidney Clinical Research Unit, London Health Sciences Centre, Ontario, Canada
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