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Pesce F, Fernandes A, Clamp D, Asin B, Goddard E, Gillespie-Akar L, Eberhardt A. Real-world data in lupus nephritis: results from a European survey on renal function testing and burden of disease progression. Curr Med Res Opin 2024; 40:2215-2222. [PMID: 39528343 DOI: 10.1080/03007995.2024.2425387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2024] [Revised: 10/15/2024] [Accepted: 10/31/2024] [Indexed: 11/16/2024]
Abstract
OBJECTIVE Patients with lupus nephritis (LN), a severe renal manifestation of systemic lupus erythematosus, should be monitored for progression of chronic kidney disease to end-stage renal disease but data on renal function testing in LN patients are limited. This real-world analysis aimed to evaluate nephrologists' use of renal function tests to support LN diagnosis and monitoring and to examine the impact of disease progression in LN patients in Europe. METHODS Data were drawn from the Adelphi Lupus Disease Specific Programme, a cross-sectional survey of nephrologists and their next five consulting patients with LN in France, Germany, Italy, Spain, and the United Kingdom in 2021. Nephrologists provided demographic and clinical information for each patient and the same patients completed a self-reported questionnaire. Using a checkbox, patients provided informed consent to take part in the survey. RESULTS Nephrologists (n = 72) provided data on 376 patients with LN. Estimated glomerular filtration rate (eGFR) or proteinuria testing was not undertaken in around 10% and 50% of these patients, respectively. Regression analysis predicted reduction in renal function (disease progression) following LN diagnosis whilst bivariate analyses showed significantly worse outcomes for patients with progressed disease: worse pain, fatigue, treatment satisfaction, and patient-reported health state and activity impairment. CONCLUSION Our study revealed lower-than-expected nephrologist-reported use of renal function testing to support diagnosis/monitoring of patients with LN in real-world clinical settings in Europe. Lower quality of life (QoL) was observed in patients with more progressed disease. Increased use of renal function testing is needed so that all LN patients are monitored closely to manage disease progression and avoid the associated QoL impact.
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Affiliation(s)
- Francesco Pesce
- Ospedale Fatebenefratelli Isola Tiberina - Gemelli Isola, Rome, Italy
| | - Ancilla Fernandes
- Otsuka Pharmaceutical Development & Commercialization Inc., Rockville, MD, USA
| | - David Clamp
- Otsuka Pharmaceutical Europe Ltd., Wexham, UK
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De Nicola L, Correa-Rotter R, Navarro-González JF, Power A, Nowicki M, Wittmann I, Halimi JM, Garcia Sanchez JJ, Cabrera C, Barone S, Coker T, Retat L. Projecting the Population Level Burden of CKD Progression According to Urine Albumin-to-Creatinine Ratio Categories. Kidney Int Rep 2024; 9:3464-3476. [PMID: 39698359 PMCID: PMC11652095 DOI: 10.1016/j.ekir.2024.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 09/25/2024] [Accepted: 09/30/2024] [Indexed: 12/20/2024] Open
Abstract
Introduction Urinary albumin-to-creatinine ratio (uACR) is an independent predictor of chronic kidney disease (CKD) progression. However there is limited evidence on the burden of CKD according to uACR categories at the population level. This study estimates future clinical and financial burden of CKD according to uACR categories using the Inside CKD microsimulation. Methods The Inside CKD model is an individual patient level microsimulation that emulates national populations based on demographic, epidemiological, and economic data. The analysis estimates clinical and economic outcomes over time according to the Kidney Disease: Improving Global Outcomes (KDIGO) uACR categories (A1-A3) at a population level for 31 countries and regions. Results CKD populations (diagnosed and undiagnosed individuals, stages G3-G5) were projected to be predominantly within uACR categories A1 and A2 in 2022. Projected cumulative incidence of CKD stage transitions (disease progression) and cardio-renal complications (heart failure, myocardial infarction, stroke, and all-cause mortality) occurred mostly in uACR categories A1 and A2 between 2022 and 2027. Patients in uACR categories A1 and A2, who represent the largest proportion of patients with CKD, were projected to incur most of the health care costs associated with CKD management and cardio-renal complications for the diagnosed population (prevalence 2027). Conclusion This study highlights the disproportionate population-level clinical and economic burden associated with individuals within KDIGO uACR categories A1 and A2, who represent most of the CKD population. This awareness will help health care decision makers to appropriately allocate resources and interventions to the CKD population, including those with mild to moderately increased albuminuria, to reduce clinical and economic burden associated with CKD.
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Affiliation(s)
| | - Ricardo Correa-Rotter
- Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Ciudad de Mexico, Mexico
| | - Juan F. Navarro-González
- Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
- RICORS2040, Instituto de Salud Carlos III, Madrid, Spain; ITB, Universidad de La Laguna, Santa Cruz de Tenerife, Spain
- Universidad Fernando Pessoa Canarias, Las Palmas de Gran Canaria, Spain
| | | | | | - Istvan Wittmann
- Department of Medicine and Nephrology-Diabetes Center, University of Pécs Medical School, Hungary
| | - Jean-Michel Halimi
- Service de Néphrologie-HTA, Dialyses, Transplantation Rénale, CHU Tours, University of Tours, Tours, France
- INSERM UMR1327, University of Tours, Tours, France
| | | | - Claudia Cabrera
- Real World Science and Analytics, AstraZeneca, Gothenburg, Sweden
| | - Salvatore Barone
- Global Medical Affairs, BioPharmaceuticals, AstraZeneca, Gaithersburg, Maryland, USA
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Osman A, Lee SH, Noori M, Al-Jaishi M, Gallo K, Harwood L, Moist L. Patient Perspectives of Telemedicine in Outpatient Nephrology Clinics During COVID-19: A Qualitative Study. Can J Kidney Health Dis 2024; 11:20543581241293192. [PMID: 39478847 PMCID: PMC11523147 DOI: 10.1177/20543581241293192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Accepted: 08/11/2024] [Indexed: 11/02/2024] Open
Abstract
Background The COVID-19 pandemic notably disrupted care for patients with chronic kidney disease (CKD) care, necessitating a rapid shift to telemedicine. Despite the growing use of telemedicine, the impact of this transition on patients' experiences, particularly in Canada and considering sociocultural factors, remains underexplored. This study aims to investigate patients with CKD perspectives on telemedicine versus in-person care and to offer recommendations for enhancing telemedicine services. Objective The objective was to understand patients with CKD views on telemedicine clinics during the pandemic compared to traditional in-person clinics. Design This was a qualitative descriptive study employing semi-structured interviews. Setting This study was conducted in general nephrology and multidisciplinary kidney care clinics in London, Canada. Population The study population was English-speaking patients with CKD with at least one in-person nephrology visit before March 15, 2020, and one telemedicine appointment after March 30, 2020. Methods Interviews were conducted using a structured guide, with transcripts analyzed line-by-line by 3 independent reviewers through directed content analysis. Themes were identified and agreed upon through group consensus. Results Interviews with 12 participants revealed 5 key themes: (1) convenience; (2) building connection and trust; (3) necessity of in-person care; (4) role of family or caregivers; and (5) preferences for clinic types. Most participants (11/12) valued the convenience of telemedicine, noting similar levels of care compared to in-person visits. However, they found it easier to establish personal connections in face-to-face appointments. Most (8/12) preferred in-person visits if their condition worsened. Overall, a combination of in-person and telemedicine was favored, with a preference for video over telephone. Limitations The study's focus on one academic nephrology center in Ontario and predominantly white participants limits broader applicability. Additionally, recall bias may affect the findings due to the interview-based design. Conclusions Telemedicine will remain integral to CKD care, with a hybrid model combining in-person and telemedicine preferred. Integrating patient feedback into future telemedicine practices is essential to enhance flexibility, access, and patient satisfaction.
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Affiliation(s)
- Abdelhady Osman
- Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | | | - Mateen Noori
- Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | | | - Kerri Gallo
- Division of Nephrology, London Health Sciences Centre, ON, Canada
| | - Lori Harwood
- Division of Nephrology, London Health Sciences Centre, ON, Canada
| | - Louise Moist
- Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
- Division of Nephrology, London Health Sciences Centre, ON, Canada
- Division of Nephrology, Department of Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
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4
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Ford EC, Sohansoha GK, Patel NA, Billany RE, Wilkinson TJ, Lightfoot CJ, Smith AC. The association of micro and macro worries with psychological distress in people living with chronic kidney disease during the COVID-19 pandemic. PLoS One 2024; 19:e0309519. [PMID: 39436948 PMCID: PMC11495632 DOI: 10.1371/journal.pone.0309519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 08/07/2024] [Indexed: 10/25/2024] Open
Abstract
BACKGROUND Psychological distress can be exacerbated by micro (personal) and macro (societal) worries, especially during challenging times. Exploration of this relationship in people with chronic kidney disease is limited. OBJECTIVES (1) To identify the types and levels of worries concerning people with chronic kidney disease in the context of the COVID-19 pandemic; (2) to explore the association of worries with psychological distress including depression, stress, anxiety, and health anxiety. DESIGN AND PARTICIPANTS A cross-sectional online survey collected data at two time points (Autumn 2020, n = 528; Spring 2021, n = 241). Participants included kidney transplant recipients and people with non-dialysis dependent chronic kidney disease. MEASUREMENTS The survey included questions about worry taken from the World Health Organisation COVID-19 Survey, the Depression, Anxiety and Stress Scale, and the Short Health Anxiety Index. Data were analysed using descriptive statistics and multiple regression. RESULTS Worries about loved ones' health, the healthcare system becoming overloaded, losing a loved one, economic recession, and physical health were the highest rated concerns. Worrying about mental health was associated with higher depression, stress, anxiety, and health anxiety. Worrying about physical health was associated with anxiety and health anxiety. Worrying about losing a loved one was associated with health anxiety, and worrying about not being able to pay bills was associated with stress. CONCLUSIONS People with kidney disease reported micro and macro worries associated with psychological distress during the COVID-19 pandemic. This study highlights factors that should be considered to improve the mental health and well-being of people with kidney disease.
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Affiliation(s)
- Ella C. Ford
- Leicester Kidney Lifestyle Team, Department of Population Health Sciences, University of Leicester, Leicester, United Kingdom
- Leicester NIHR Biomedical Research Centre, Leicester, United Kingdom
| | - Gurneet K. Sohansoha
- Leicester Kidney Lifestyle Team, Department of Population Health Sciences, University of Leicester, Leicester, United Kingdom
- Leicester NIHR Biomedical Research Centre, Leicester, United Kingdom
| | - Naeema A. Patel
- Leicester Kidney Lifestyle Team, Department of Population Health Sciences, University of Leicester, Leicester, United Kingdom
- Leicester NIHR Biomedical Research Centre, Leicester, United Kingdom
| | - Roseanne E. Billany
- Leicester NIHR Biomedical Research Centre, Leicester, United Kingdom
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
| | - Thomas J. Wilkinson
- Leicester Kidney Lifestyle Team, Department of Population Health Sciences, University of Leicester, Leicester, United Kingdom
- Leicester NIHR Biomedical Research Centre, Leicester, United Kingdom
| | - Courtney J. Lightfoot
- Leicester Kidney Lifestyle Team, Department of Population Health Sciences, University of Leicester, Leicester, United Kingdom
- Leicester NIHR Biomedical Research Centre, Leicester, United Kingdom
| | - Alice C. Smith
- Leicester Kidney Lifestyle Team, Department of Population Health Sciences, University of Leicester, Leicester, United Kingdom
- Leicester NIHR Biomedical Research Centre, Leicester, United Kingdom
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Śliwczyński A, Jewczak M, Furlepa K, Gołębiak I, Rzeźnicki A, Marczak M, Ptak-Chmielewska A, Olszewski P, Orlewska K, Wierzba W, Nojszewska E, Orlewska E. Assessment of the dynamics of inpatient health care delivery in Poland before and throughout the COVID-19 pandemic. Sci Rep 2024; 14:11975. [PMID: 38796493 PMCID: PMC11127990 DOI: 10.1038/s41598-024-62671-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 05/20/2024] [Indexed: 05/28/2024] Open
Abstract
A situation of emergency involving the whole population introduces changes in the dynamics of the health services that are provided. The magnitude of these shifts should be also linked to the medical speciality within which the health benefits are delivered. The aim of the paper was to identify changes in tendencies in inpatient medical service delivery during the COVID-19 pandemic by medical specialties. On the basis of a database extracted for in-patient treatment received from the public payer, a retrospective analysis was carried out. Comparing the values of the dynamics of the services provided in each medical speciality, the period before the COVID-19 pandemic was collated to the years of the pandemic (2020-2021). In the period before COVID-19, positive patient dynamics were observed in more than half of the specialities. Between 2020 and 2021, virtually all specialties reversed the trend and negative dynamics were recorded. The dynamics in 2021 indicate a process of return to the values from 2015 to 2019. Emergency situation has affected the dynamics of healthcare provision in different specialities to various extent. The most resistant to the negative impulses of the state of emergency were the areas that are strictly organisationally and financially defined (e.g. the group of "therapeutic and drug programmes").
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Affiliation(s)
| | - Maciej Jewczak
- Department of Spatial Econometrics, Faculty of Economics and Sociology, University of Lodz, Lodz, Poland
| | | | | | - Adam Rzeźnicki
- Department of Social Medicine, Medical University of Lodz, Lodz, Poland
| | - Michał Marczak
- Collegium of Management WSB, University of Warsaw, Warsaw, Poland
| | - Aneta Ptak-Chmielewska
- Warsaw School of Economics, Collegium of Economic Analysis, Institute of Statistics and Demography, Warsaw, Poland
| | - Paweł Olszewski
- Institute of Political Studies of the Polish Academy of Sciences, Warsaw, Poland
| | | | | | - Ewelina Nojszewska
- Department of Applied Economics, Collegium of Management and Finance, Warsaw School of Economics, Warsaw, Poland
| | - Ewa Orlewska
- Collegium Medicum Jan Kochanowski University Kielce, Polska, Poland
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Wang J, Liu X, Pan D, Cai X, Xue Y, Huang J. Chronic kidney disease in the shadow of COVID-19: insights from the bibliometric analysis. Int Urol Nephrol 2024; 56:683-697. [PMID: 37466905 DOI: 10.1007/s11255-023-03706-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 06/20/2023] [Indexed: 07/20/2023]
Abstract
OBJECTIVE This study aims to present the current status and frontiers of research on COVID-19 in relation to chronic kidney disease through bibliometric analysis and visualization. METHODS Access to information through the Web of Science Core Collection, retrieved from December 2019 to May 2023. The bibliometric visualization of countries, institutions, and keywords was analyzed using VOSviewer. RESULTS A total of 1038 publications are included. The global scientific community showed a high level of collaborative consensus. The three countries with the most publications are the USA, China, and the UK. The institution with the most publications is Harvard Medical School. The research frontier for 2020 is thrombosis, for 2021 is telemedicine, for 2022 is depression, and for 2019-2023 is the COVID-19 vaccines. CONCLUSIONS This is the first bibliometric report to establish a link between COVID-19 and CKD. The USA, China, and some European countries and their institutions are major contributors to these publications. Thrombosis, telemedicine, depression, and COVID-19 vaccines are current hot topics in the field and have the potential to shape future research trends.
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Affiliation(s)
- Jingyu Wang
- Renal DivisionKey Laboratory of Renal DiseaseKey Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Peking University First Hospital, Peking University Institute of Nephrology, Ministry of Health of China, Beijing, 100034, China.
| | - Xingzi Liu
- Renal DivisionKey Laboratory of Renal DiseaseKey Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Peking University First Hospital, Peking University Institute of Nephrology, Ministry of Health of China, Beijing, 100034, China
| | - Dikang Pan
- Vascular Surgery Department, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - Xintian Cai
- Department of Graduate School, Xinjiang Medical University, Urumqi, 830054, Xinjiang Province, China
| | - Yuzhou Xue
- Department of Cardiology, Peking University Third Hospital, Beijing, 100191, China
| | - Jing Huang
- School of Nursing, Peking University, Beijing, 100191, China
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7
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Ramadani RV, Svensson M, Hassler S, Hidayat B, Ng N. Effects of the COVID-19 pandemic on healthcare utilization among older adults with cardiovascular diseases and multimorbidity in Indonesia: an interrupted time-series analysis. BMC Public Health 2024; 24:71. [PMID: 38166721 PMCID: PMC10763491 DOI: 10.1186/s12889-023-17568-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 12/22/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic has disrupted healthcare utilization globally, but little is known about the effects among patients with cardiovascular diseases (CVDs) and other multimorbidities. This study analyzed the impacts of COVID-19 on healthcare utilization for patients aged 30 years and older with cardiovascular diseases (CVDs) with or without other chronic disease comorbidities in Indonesia. METHODS We designed a retrospective cohort study based on the Indonesian National Health Insurance (NHI) sample data from 2016-2020. We defined healthcare utilization as monthly outpatient and inpatient visits related to chronic diseases at the hospital and primary healthcare levels per 10,000 NHI members. We used interrupted time series analysis to evaluate how the healthcare utilization patterns had changed due to the COVID-19 pandemic. RESULTS Overall, hospital outpatient visits decreased by 39% when the pandemic occurred (95% Confidence Interval (CI): 0.48,0.76), inpatient visits by 28% (95% CI: 0.62,0.83), and primary healthcare visits by 34% (95% CI:0.55, 0.81). For patients with CVDs and multimorbidity, hospital outpatient and inpatient visit rates were reduced by 36% and 38%, respectively and primary healthcare visits by 32%. Some insignificant differences in the reduction of out-and inpatient visits were observed across diagnosis groups and regions. CONCLUSION Healthcare utilization among patients with chronic diseases decreased significantly during COVID-19 and consistently across different chronic diseases and regions. To cope with the unmet needs of healthcare utilization in the context of the pandemic, the healthcare system needs to be strengthened to cater to the needs of the population-at-risk, especially for patients with CVDs and multimorbidity.
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Affiliation(s)
- Royasia Viki Ramadani
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
- Center for Health Economics and Policy Studies, Faculty of Public Health, Universitas Indonesia, Jakarta, Indonesia.
| | - Mikael Svensson
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, USA
| | - Sven Hassler
- Department of Health Sciences, Karlstad University, Karlstad, Sweden
| | - Budi Hidayat
- Center for Health Economics and Policy Studies, Faculty of Public Health, Universitas Indonesia, Jakarta, Indonesia
| | - Nawi Ng
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Mackintosh L, Busby A, Farrington K, Hawkins J, Afuwape S, Bristow P, Silva-Gane MD, Hall N, Harris T, Hudson J, Norton S, Ormandy P, Pearce CJ, Santhakumaran S, Sharma S, Sridharan S, Steenkamp R, Slevin J, Wellsted D, Chilcot J. Impact of the COVID-19 pandemic on services for patients with chronic kidney disease: findings of a national survey of UK kidney centres. BMC Nephrol 2023; 24:356. [PMID: 38049710 PMCID: PMC10696738 DOI: 10.1186/s12882-023-03344-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 09/21/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND Services for patients with kidney disease underwent radical adaptations in response to the COVID-19 pandemic. We undertook an online national survey of UK kidney centres to understand the nature, range, and degree of variation in these changes and to explore factors contributing to differing practice. METHODS The survey was designed by a multidisciplinary team of kidney professionals, service users and researchers. It enquired about centre services and staffing, including psychosocial provision, and changes to these in response to the COVID-19 pandemic. Links to the survey were sent to all 68 UK kidney centres and remained active from December 2021 to April 2022, and a revised version to nurses in late 2022 for additional data. Quantitative data were analysed descriptively. Content analysis on free-text responses identified common themes. RESULTS Analysable responses were received from 41 out of the 68 UK centres (60%), with partial data from an additional 7 (11%). Adaptations were system-wide and affected all aspects of service provision. Some changes were almost universal such as virtual consultations for outpatient appointments, with significant variation in others. Outpatient activity varied from fully maintained to suspended. Many centres reduced peritoneal dialysis access provision but in some this was increased. Centres considered that changes to transplant surgical services and for patients with advanced CKD approaching end-stage kidney disease had the greatest impact on patients. Few centres implemented adjustments aimed at vulnerable and underrepresented groups, including the frail elderly, people with language and communication needs, and those with mental health needs. Communication issues were attributed to rapid evolution of the pandemic, changing planning guidance and lack of resources. Staffing shortages, involving all staff groups particularly nurses, mainly due to COVID-19 infection and redeployment, were compounded by deficiencies in staffing establishments and high vacancy levels. Centres cited three main lessons influencing future service delivery, the need for service redesign, improvements in communication, and better support for staff. CONCLUSION Kidney centre responses to the pandemic involved adaptations across the whole service. Though some changes were almost universal, there was wide variation in other areas. Exploring the role of centre characteristics may help planning for potential future severe service disruptions.
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Affiliation(s)
- Lucy Mackintosh
- School of Life and Medical Sciences, University of Hertfordshire, College Lane Campus, Hatfield, AL10 9AB, UK.
| | - Amanda Busby
- School of Life and Medical Sciences, University of Hertfordshire, College Lane Campus, Hatfield, AL10 9AB, UK
| | - Ken Farrington
- School of Life and Medical Sciences, University of Hertfordshire, College Lane Campus, Hatfield, AL10 9AB, UK
- Renal Unit, Lister Hospital, Stevenage, SG1 4AB, UK
| | - Janine Hawkins
- School of Life and Medical Sciences, University of Hertfordshire, College Lane Campus, Hatfield, AL10 9AB, UK
| | - Sarah Afuwape
- Nephrology, Urology and Renal Transplant, Royal Free London NHS Foundation Trust, Royal Free Hospital, Pond Street, London, NW3 2QG, UK
- Department of Renal Medicine, UCL Medical School, Rowland Hill Street, London, NW3 2PF, UK
| | | | | | - Natalie Hall
- School of Life and Medical Sciences, University of Hertfordshire, College Lane Campus, Hatfield, AL10 9AB, UK
| | - Tess Harris
- The Polycystic Kidney Disease Charity, 91 Royal College St, London, NW1 0SE, UK
| | - Joanna Hudson
- Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 5th Floor Bermondsey Wing, Guy's Campus, London Bridge, London, SE1 9RT, UK
| | - Sam Norton
- Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 5th Floor Bermondsey Wing, Guy's Campus, London Bridge, London, SE1 9RT, UK
| | - Paula Ormandy
- School of Health and Society, University of Salford, Salford, M6 6PU, UK
| | - Christina J Pearce
- Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 5th Floor Bermondsey Wing, Guy's Campus, London Bridge, London, SE1 9RT, UK
| | - Shalini Santhakumaran
- The UK Kidney Association, Brandon House, Building 20a1, Southmead Road, Bristol, BS34 7RR, UK
| | - Shivani Sharma
- School of Life and Medical Sciences, University of Hertfordshire, College Lane Campus, Hatfield, AL10 9AB, UK
| | - Sivakumar Sridharan
- School of Life and Medical Sciences, University of Hertfordshire, College Lane Campus, Hatfield, AL10 9AB, UK
- Renal Unit, Lister Hospital, Stevenage, SG1 4AB, UK
| | - Retha Steenkamp
- The UK Kidney Association, Brandon House, Building 20a1, Southmead Road, Bristol, BS34 7RR, UK
| | - Julie Slevin
- The UK Kidney Association, Brandon House, Building 20a1, Southmead Road, Bristol, BS34 7RR, UK
| | - David Wellsted
- School of Life and Medical Sciences, University of Hertfordshire, College Lane Campus, Hatfield, AL10 9AB, UK
| | - Joseph Chilcot
- Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 5th Floor Bermondsey Wing, Guy's Campus, London Bridge, London, SE1 9RT, UK
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9
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Watnick S. Pandemic Preparedness: Let's Be Ready for the Patient and Their Caregiver. Am J Kidney Dis 2023; 82:384-385. [PMID: 37578413 DOI: 10.1053/j.ajkd.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 07/03/2023] [Indexed: 08/15/2023]
Affiliation(s)
- Suzanne Watnick
- Northwest Kidney Centers, Seattle, Washington; Department of Medicine, University of Washington, Seattle, Washington; VA Puget Sound Health Care System, U.S. Department of Veterans Affairs, Seattle, Washington.
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Diamantidis CJ, Cook DJ, Redelosa CK, Vinculado RB, Cabajar AA, Vassalotti JA. CKD and Rapid Kidney Function Decline During the COVID-19 Pandemic. Kidney Med 2023; 5:100701. [PMID: 37649727 PMCID: PMC10462879 DOI: 10.1016/j.xkme.2023.100701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023] Open
Abstract
Rationale & Objective The direct and indirect effects of the coronavirus disease 2019 (COVID-19) pandemic on kidney function in the chronic kidney disease (CKD) population are not well understood. Study Design Cohort study. Setting & Participants Retrospective study of kidney function trajectories using deidentified administrative claims and laboratory data for Medicare Advantage and commercially insured enrollees with CKD stages G3-4 between 2018 and 2021. Predictors COVID-19 infection. Outcome Rapid kidney function decline defined as annual estimated glomerular filtration rate (eGFR) decline of ≥40%. Analytical Approach Propensity score matching was used to identify individuals without COVID-19 infection matched 1:1 to a COVID-19 infected cohort and indexed on the date of diagnosing COVID-19 infection, age, sex, race or ethnicity, and Charlson comorbidity index score. Outpatient kidney function was compared during the prepandemic period (January 1, 2018, to February 29, 2020) with the pandemic period (March 1, 2020, to August 31, 2021). Two creatinine measurements, after the infection date and ≥60 days apart, were required to reduce correlation with acute infection. Results Of 97,203 enrollees with CKD G3-4, 9% experienced a COVID-19 infection. Characteristics of 8,901 propensity matched enrollees include mean age 74 years, 58% women, 67% White, and 63% CKD G3a, 28% CKD G3b, and 9% CKD G4. Median overall annual eGFR change was -2.65 ml/min/1.73m2, with 76% of the cohort experiencing worsened eGFR in the pandemic period. Rapid kidney function decline was observed in 1.9% and 2.0% of enrollees in the prepandemic and pandemic periods, respectively. Rapid kidney function decline was observed in 2.5% of those with COVID-19 infection and 1.5% of those without COVID-19 infection (P < 0.05). Factors associated with increased odds of rapid kidney function decline during pandemic included Asian race, higher Charlson comorbidity index, advancing CKD stage, prepandemic rapid kidney function decline, and COVID-19 infection. Limitations Retrospective study design with potential bias. Conclusions COVID-19 infection increased odds of rapid kidney function decline during the pandemic. The downstream impact of pandemic-related eGFR decline on health outcomes, such as kidney failure or mortality, requires further study. Plain-Language Summary We used a cohort of insured individuals with moderate-to-severe chronic kidney disease (CKD) to compare the rates of rapid kidney function decline in prepandemic and pandemic periods and to evaluate the impact of the coronavirus disease 19 (COVID-19) on kidney function decline. We found that overall rates of rapid kidney function decline did not change during the prepandemic and pandemic periods but were significantly higher in both periods among individuals with a COVID-19 infection. As CKD severity increased, rates of both rapid kidney function decline and COVID-19 increased. Advancing CKD, higher comorbid condition, Asian race, prepandemic rapid kidney function decline, and COVID-19 were all associated with higher odds of rapid kidney function decline in the pandemic. These findings suggest close monitoring is warranted for individuals with CKD and COVID-19.
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Affiliation(s)
| | - David J. Cook
- OptumLabs, Eden Prairie, MN
- National Kidney Foundation, New York, NY
| | | | | | | | - Joseph A. Vassalotti
- National Kidney Foundation, New York, NY
- Icahn School of Medicine at Mount Sinai, New York, NY
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Frontera ED, Cavagahan MK, Carter A, Saeed ZI. Health Care Disparities in Outpatient Diabetes Management During the Coronavirus Disease 2019 Pandemic: Where Do We Stand Now? Endocr Pract 2023; 29:529-537. [PMID: 37121402 PMCID: PMC10141790 DOI: 10.1016/j.eprac.2023.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 04/03/2023] [Accepted: 04/23/2023] [Indexed: 05/02/2023]
Abstract
OBJECTIVE We examined diabetes outpatient management during the first 2 years of the Coronavirus Disease 2019 pandemic in an endocrinology practice with a focus on health care disparities in outcomes. METHODS We conducted a retrospective cohort study examining adults with diabetes during 3 time periods: T1 (March 2019-February 2020), T2 (March 2020-February 2021), and T3 (March 2021-February 2022). Clinical outcomes included body mass index (BMI), systolic blood pressure (SBP), Hemoglobin A1c (HgbA1c), low-density lipoprotein cholesterol (LDL), and urine albumin:creatinine ratio. Appointment types (virtual vs in-person) were also collected. RESULTS Frequencies of HgbA1c, BMI, and SBP measurements reduced by 36.0%, 46.3%, and 48.5% in T2, respectively, and remaining 8.7% (HgbA1c), 13.4% (BMI), and 15.2% (SBP) lower at the end of the study period (P < .001) compared to prepandemic levels. However, the average HgbA1c and LDL slightly improved. Clinic appointments per patient increased during the pandemic, fueled by telehealth utilization. Women had fewer in-person visits during T2, those older than 65 had better HgbA1c, and the most socioeconomically deprived group had the worst HgbA1c during every time period. In addition, black patients had worse HgbA1c, LDL, and SBP values throughout the study, which did not worsen over the pandemic. CONCLUSION While the frequency of health measurements had not fully recovered 2 years into the pandemic, this did not translate to worse diabetes management or a widening of pre-existing disparities. Our study emphasizes the role of equitable health care in minimizing inequalities in diabetes, particularly during times of crisis.
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Affiliation(s)
- Eric D Frontera
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Melissa K Cavagahan
- Division of Endocrinology, Diabetes and Metabolism, Indiana University School of Medicine, Indianapolis, Indiana
| | - Allie Carter
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, Indiana
| | - Zeb I Saeed
- Division of Endocrinology, Diabetes and Metabolism, Indiana University School of Medicine, Indianapolis, Indiana.
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