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Redeker S, Ismail S, Eeren HV, Massey EK, Weimar W, Oppe M, Busschbach J. A dynamic Markov model to assess the cost-effectiveness of the Kidney Team at Home intervention in The Netherlands. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2022; 23:597-606. [PMID: 34647158 PMCID: PMC8513543 DOI: 10.1007/s10198-021-01383-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 09/28/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES The Kidney Team at Home program is an educational intervention aimed at patients with chronic kidney disease to assist them in their choice for kidney replacement therapy. Previous studies have shown that the intervention results in an increase in knowledge and communication on kidney replacement therapy, and eventually in an increase in the number of living donor kidney transplantations. The study assesses the cost-effectiveness of the intervention compared to standard care. METHODS A dynamic probabilistic Markov model was used to estimate the monetary and health benefits of the intervention in The Netherlands over 10 years. Data on costs and health-related quality of life were derived from the literature. Transition probabilities, prevalence, and incidence rates were calculated using a large national database. An optimistic and a pessimistic implementation scenario were compared to a base case scenario with standard care. RESULTS In both the optimistic and pessimistic scenario, the intervention is cost-effective and dominant compared to standard care: savings were €108,681,985 and €51,770,060 and the benefits were 1382 and 695 QALYs, respectively. CONCLUSIONS The superior cost-effectiveness of the intervention is caused by the superior health effects and the reduction of costs associated with transplantation, and the relatively small incremental costs of the intervention. The favorable findings of this implementation project resulted in national uptake of the intervention in The Netherlands as of 2021. This is the first time a psychosocial intervention has been implemented as part of standard care in a kidney replacement therapy program worldwide.
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Affiliation(s)
- Steef Redeker
- Erasmus Medical Center, Section of Medical Psychology and Psychotherapy, Department of Psychiatry, Postal Address, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
| | - Sohal Ismail
- Erasmus Medical Center, Section of Medical Psychology and Psychotherapy, Department of Psychiatry, Postal Address, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Hester V Eeren
- Erasmus Medical Center, Section of Medical Psychology and Psychotherapy, Department of Psychiatry, Postal Address, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Emma K Massey
- Erasmus MC, Transplant Institute, Department of Internal Medicine, Rotterdam, The Netherlands
| | - Willem Weimar
- Erasmus MC, Transplant Institute, Department of Internal Medicine, Rotterdam, The Netherlands
| | - Mark Oppe
- Maths in Health, Rotterdam, The Netherlands
| | - Jan Busschbach
- Erasmus Medical Center, Section of Medical Psychology and Psychotherapy, Department of Psychiatry, Postal Address, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
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Redeker S, Massey EK, Boonstra C, van Busschbach JJ, Timman R, Brulez HFH, Hollander DAAMJ, Hilbrands LB, Bemelman F, Berger SP, van de Wetering J, van den Dorpel RMA, Dekker-Jansen M, Weimar W, Ismail SY. Implementation of the Kidney Team at Home Intervention: Evaluating Generalizability, Implementation Process, and Effects. Transpl Int 2021; 34:2317-2328. [PMID: 34390041 PMCID: PMC9292401 DOI: 10.1111/tri.14011] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 07/02/2021] [Accepted: 08/11/2021] [Indexed: 11/26/2022]
Abstract
Research has shown that a home-based educational intervention for patients with chronic kidney disease results in better knowledge and communication, and more living donor kidney transplantations (LDKT). Implementation research in the field of renal care is almost non-existent. The aims of this study were (1) to demonstrate generalizability, (2) evaluate the implementation process, and (3) to assess the relationship of intervention effects on LDKT-activity. Eight hospitals participated in the project. Patients eligible for all kidney replacement therapies (KRT) were invited to participate. Effect outcomes were KRT-knowledge and KRT-communication, and treatment choice. Feasibility, fidelity and intervention costs were assessed as part of the process evaluation. 332 patients completed the intervention. There was a significant increase in KRT-knowledge and KRT-communication among participants. 129 out of 332 patients (39%) had LDKT-activity, which was in line with the results of the clinical trials. Protocol adherence, knowledge and age were correlated with LDKT-activity. This unique implementation study shows that the results in practice are comparable to the previous trials, and show that the intervention can be implemented, while maintaining quality. Results from the project resulted in the uptake of the intervention in standard care. We urge other countries to investigate the uptake of the intervention.
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Affiliation(s)
- Steef Redeker
- Erasmus Medical Center, Section of Medical Psychology and Psychotherapy, Department of Psychiatry, Rotterdam, the Netherlands
| | - Emma K Massey
- Erasmus Medical Center, Section of Nephrology and Transplantation, Department of Internal Medicine, the Netherlands
| | - Charlotte Boonstra
- Netherlands Institute for Personality Disorders, De Viersprong, Rotterdam, the Netherlands
| | - Jan J van Busschbach
- Erasmus Medical Center, Section of Medical Psychology and Psychotherapy, Department of Psychiatry, Rotterdam, the Netherlands
| | - Reinier Timman
- Erasmus Medical Center, Section of Medical Psychology and Psychotherapy, Department of Psychiatry, Rotterdam, the Netherlands
| | | | | | - Luuk B Hilbrands
- Radboud university medical center, Radboud Institute for Health Sciences, Department of Nephrology, Nijmegen, the Netherlands
| | - Frederike Bemelman
- Amsterdam UMC, Department of Nephrology, Division of Internal Medicine, Amsterdam, the Netherlands
| | - Stefan P Berger
- University of Groningen, University Medical Center Groningen, Department of Internal Medicine, the Netherlands
| | - Jacqueline van de Wetering
- Erasmus Medical Center, Section of Nephrology and Transplantation, Department of Internal Medicine, the Netherlands
| | | | | | - Willem Weimar
- Erasmus Medical Center, Section of Nephrology and Transplantation, Department of Internal Medicine, the Netherlands
| | - Sohal Y Ismail
- Erasmus Medical Center, Section of Medical Psychology and Psychotherapy, Department of Psychiatry, Rotterdam, the Netherlands
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Lin F, Liu Y, Tang L, Xu X, Zhang X, Song Y, Chen B, Ren Y, Yang X. Rapamycin protects against aristolochic acid nephropathy in mice by potentiating mammalian target of rapamycin‑mediated autophagy. Mol Med Rep 2021; 24:495. [PMID: 33955513 PMCID: PMC8127069 DOI: 10.3892/mmr.2021.12134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 04/04/2021] [Indexed: 12/23/2022] Open
Abstract
Autophagy serves a crucial role in the etiology of kidney diseases, including drug‑induced renal impairment, inherited kidney disease, diabetic nephropathy and aristolochic acid nephropathy (AAN) and is, therefore, a potential target for treatment. We previously demonstrated that rapamycin could attenuate AAN in mice; however, the underlying mechanism remains to be elucidated. Therefore, whether the renal protective effect of rapamycin (an autophagy activator) is related to autophagy in aristolochic acid (AA)‑treated mice was of particular interest. The pathophysiological roles of rapamycin were investigated in AA‑induced nephrotoxicity in mice and the mechanisms of rapamycin action were explored by evaluating the modulation of autophagy in rapamycin‑treated mice and cultured renal tubular epithelial cells. Supplementation with rapamycin reversed AA‑induced kidney injury in mice and improved AA‑induced autophagy damage in vivo and in vitro. Mechanistically, rapamycin inhibited the renal expression of phosphorylated (p‑)mammalian target of rapamycin (mTOR) and p‑ribosomal S6 protein kinase 1, which in turn activated renal autophagy and decreased apoptosis, probably by removing AA‑elicited damaged mitochondria and misfolded proteins. The findings of the present study demonstrated that rapamycin protects against AA‑induced nephropathy by activating the mTOR‑autophagy axis and suggested that rapamycin may be a promising pharmacological target for the treatment of AAN.
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Affiliation(s)
- Fan Lin
- Department of Nephrology, Qilu Hospital, Shandong University, Jinan, Shandong 250015, P.R. China
- Department of Nephrology, Shenzhen University General Hospital, Shenzhen, Guangdong 518055, P.R. China
| | - Yunqi Liu
- Department of Nephrology, Qilu Hospital, Shandong University, Jinan, Shandong 250015, P.R. China
- Department of Nephrology, Binzhou Medical University Hospital, Binzhou, Shandong 256600, P.R. China
| | - Lili Tang
- Clinical Laboratory, Chinese Medical Hospital of Jining, Jining, Shandong 272037, P.R. China
| | - Xiaohui Xu
- Department of Nephrology, Shenzhen University General Hospital, Shenzhen, Guangdong 518055, P.R. China
| | - Xueli Zhang
- Department of Nephrology, Shenzhen University General Hospital, Shenzhen, Guangdong 518055, P.R. China
| | - Yifan Song
- Department of Nephrology, Shenzhen University General Hospital, Shenzhen, Guangdong 518055, P.R. China
| | - Bicheng Chen
- Key Laboratory of Diagnosis and Treatment of Severe Hepato-Pancreatic Diseases of Zhejiang Province, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
| | - Yeping Ren
- Department of Nephrology, Shenzhen University General Hospital, Shenzhen, Guangdong 518055, P.R. China
| | - Xiangdong Yang
- Department of Nephrology, Qilu Hospital, Shandong University, Jinan, Shandong 250015, P.R. China
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Vedadi A, Bansal A, Yung P, Famure O, Mitchell M, Waterman AD, Singh SK, Novak M, Kim SJ, Mucsi I. Ethnic background is associated with no live kidney donor identified at the time of first transplant assessment-an opportunity missed? A single-center retrospective cohort study. Transpl Int 2019; 32:1030-1043. [PMID: 31250484 DOI: 10.1111/tri.13476] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 04/29/2019] [Accepted: 06/24/2019] [Indexed: 12/31/2022]
Abstract
Patients from ethnocultural minorities have reduced access to live donor kidney transplant (LDKT). To explore early pretransplant ethnocultural disparities in LDKT readiness, and the impact of the interactions with the transplant program, we assessed if patients had a potential live donor (LD) identified at first pretransplant assessment, and if patients with no LD initially received LDKT subsequently. Single-center, retrospective cohort of adults referred for kidney transplant (KT) assessment. Multivariable logistic regression assessed the association between ethnicity and having a potential LD. Cox proportional hazard analysis assessed the association between no potential LD initially and subsequent LDKT. Of 1617 participants, 66% of Caucasians indicated having a potential LD, compared with 55% of South Asians, 44% of African Canadians, and 41% of East Asians (P < 0.001). In multivariable logistic regression analysis, the odds of having a potential LD identified was significantly lower for African, East and South Asian Canadians. No potential LD at initial KT assessment was associated with lower likelihood of LDKT subsequently (hazard ratio [HR], 0.14; [0.10-0.19]). Compared to Caucasians, African, East and South Asian and African Canadians are less likely to have a potential LD identified at first KT assessment, which predicts a lower likelihood of subsequent LDKT.
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Affiliation(s)
- Ali Vedadi
- Division of Nephrology, Multi-Organ Transplant Program, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Aarushi Bansal
- Division of Nephrology, Multi-Organ Transplant Program, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Priscilla Yung
- Division of Nephrology, Multi-Organ Transplant Program, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Olusegun Famure
- Division of Nephrology, Multi-Organ Transplant Program, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Margot Mitchell
- Division of Nephrology, Multi-Organ Transplant Program, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Amy D Waterman
- Division of Nephrology, David Geffen School of Medicine at the University of California, Los Angeles, CA, USA
| | - Sunita K Singh
- Division of Nephrology, Multi-Organ Transplant Program, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Marta Novak
- Centre for Mental Health, University Health Network and Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Sang Joseph Kim
- Division of Nephrology, Multi-Organ Transplant Program, University Health Network and University of Toronto, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Istvan Mucsi
- Division of Nephrology, Multi-Organ Transplant Program, University Health Network and University of Toronto, Toronto, ON, Canada
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