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Stelzer D, Binder H, Glattacker M, Graf E, Hahn M, Hollenbeck M, Kaier K, Kowall B, Kuklik N, Metzner G, Mueller N, Seiler L, Stolpe S, Blume C. Minimisation of dialysis risk in hospital patients with chronic kidney disease (MinDial): study protocol for a multicentre, stepped-wedge, cluster-randomised controlled trial. Trials 2024; 25:368. [PMID: 38849916 PMCID: PMC11157728 DOI: 10.1186/s13063-024-08182-x] [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: 05/08/2024] [Accepted: 05/17/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Early identification of patients with chronic kidney disease (CKD) and advancing kidney insufficiency, followed by specialist care, can decelerate the progression of the disease. However, awareness of the importance and possible consequences of kidney insufficiency is low among doctors and patients. Since kidney insufficiency can be asymptomatic even in higher stages, it is often not even known to those belonging to risk groups. This study aims to clarify whether, for hospitalised patients with advanced chronic kidney disease, a risk-based appointment with a nephrology specialist reduces disease progression. METHODS The target population of the study is hospitalised CKD patients with an increased risk of end-stage renal disease (ESRD), more specifically with an ESRD risk of at least 9% in the next 5 years. This risk is estimated by the internationally validated Kidney Failure Risk Equation (KFRE). The intervention consists of a specific appointment with a nephrology specialist after the hospital stay, while control patients are discharged from the hospital as usual. Eight medical centres include participants according to a stepped-wedge design, with randomised sequential centre-wise crossover from recruiting patients into the control group to recruitment to the intervention. The estimated glomerular filtration rate (eGFR) is measured for each patient during the hospital stay and after 12 months within the regular care by the general practitioner. The difference in the change of the eGFR over this period is compared between the intervention and control groups and considered the primary endpoint. DISCUSSION This study is designed to evaluate the effect of risk-based appointments with nephrology specialists for hospitalised CKD patients with an increased risk of end-stage renal disease. If the intervention is proven to be beneficial, it may be implemented in routine care. Limitations will be examined and discussed. The evaluation will include further endpoints such as non-guideline-compliant medication, economic considerations and interviews with contributing physicians to assess the acceptance and feasibility of the intervention. TRIAL REGISTRATION German Clinical Trials Register DRKS00029691 . Registered on 12 September 2022.
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Affiliation(s)
- D Stelzer
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Stefan-Meier-Str. 26, Freiburg, 79104, Germany.
| | - H Binder
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Stefan-Meier-Str. 26, Freiburg, 79104, Germany
| | - M Glattacker
- Section of Health Care Research and Rehabilitation Research, Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Hugstetter Straße 49, Freiburg, 79106, Germany
| | - E Graf
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Stefan-Meier-Str. 26, Freiburg, 79104, Germany
| | - M Hahn
- Knappschafts-Kliniken Service GmbH (KKSG), In der Schornau 23-25, Bochum, 44892, Germany
| | - M Hollenbeck
- Knappschaftskrankenhaus Bottrop GmbH, Academic Teaching Hospital of the University of Duisburg-Essen, Osterfelder Straße 157, Bottrop, 46242, Germany
| | - K Kaier
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Stefan-Meier-Str. 26, Freiburg, 79104, Germany
| | - B Kowall
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, Hufelandstraße 55, Essen, 45147, Germany
| | - N Kuklik
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, Hufelandstraße 55, Essen, 45147, Germany
- Centre for Clinical Trials Essen, University Hospital Essen, Hufelandstraße 55, Essen, 45122, Germany
| | - G Metzner
- Section of Health Care Research and Rehabilitation Research, Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Hugstetter Straße 49, Freiburg, 79106, Germany
| | - N Mueller
- Knappschaftskrankenhaus Bottrop GmbH, Academic Teaching Hospital of the University of Duisburg-Essen, Osterfelder Straße 157, Bottrop, 46242, Germany
| | - L Seiler
- Institute of Technical Chemistry, Leibniz University Hannover, Callinstraße 5, Hannover, 30167, Germany
- KfH Foundation for Preventive Medicine, Martin-Behaim-Straße 20, Neu-Isenburg, 63263, Germany
| | - S Stolpe
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, Hufelandstraße 55, Essen, 45147, Germany
| | - C Blume
- Institute of Technical Chemistry, Leibniz University Hannover, Callinstraße 5, Hannover, 30167, Germany
- KfH Foundation for Preventive Medicine, Martin-Behaim-Straße 20, Neu-Isenburg, 63263, Germany
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Mora S, Derweesh I, Meagher M, Javier-Desloges J, Noyes SL, Lane BR. Renal Functional Outcomes in Patients With Angiomyolipomas: Surveillance vs Embolization vs Nephrectomy. Urology 2023; 173:119-126. [PMID: 36572219 DOI: 10.1016/j.urology.2022.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 12/05/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To investigate renal functional outcomes of surveillance, embolization, and surgery for angiomyolipomas (AML). METHODS Longitudinal data regarding patients with AML were analyzed retrospectively in this 2-center study. Demographic, radiographic, and functional data were tabulated according to treatment type. Primary outcome was change in renal function from diagnosis to within 6 months postdiagnosis (interim) and to latest glomerular filtration rate (GFR) assessment. RESULTS 318 patients were diagnosed with AMLs; mean follow-up was 6.2 years. 184 patients (57.9%) were managed with surveillance, 30 (9.4%) underwent embolization, and 103 (32.4%) underwent surgery (91 partial nephrectomy; 12 radical nephrectomy). Baseline characteristics, including tumor size, age, and race differed between the 3 groups (P<.05). Surveilled AMLs were smaller (P<.001) than the intervention groups: 1.9 cm vs 5.4 cm (embolization) and 4.9 cm (surgery). Greater interim decreases in GFR were observed following intervention with embolization (-14.0%) or surgery (-11.8%), when compared with surveillance (-4.1%); however, this was not statistically significant (P=.19). Latest GFR was also reduced more (P=.02) with embolization (-14.1%) and surgery (-14.7%) when compared to surveillance (-6.0%). At latest determination, chronic kidney disease progression by at least one stage occurred in 37.8% overall, including 33.7% of surveilled patients, and was not statistically different across the three cohorts (P=.074). CONCLUSION Within the study limitations, surveillance appears to be appropriate for most AML patients; embolization and surgical intervention should be reserved for selected patients with large and/or symptomatic AML. Renal functional deterioration is common in patients with AML, whether managed with surveillance, embolization, or surgery. Long-term monitoring of renal function should be obligatory for all AML patients.
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Affiliation(s)
- Silvia Mora
- Michigan State University College of Human Medicine, Grand Rapids, MI
| | | | | | | | | | - Brian R Lane
- Michigan State University College of Human Medicine, Grand Rapids, MI; Spectrum Health Hospital System, Grand Rapids, MI.
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Fiseha T, Ahmed E, Chalie S, Gebreweld A. Prevalence and associated factors of impaired renal function and albuminuria among adult patients admitted to a hospital in Northeast Ethiopia. PLoS One 2021; 16:e0246509. [PMID: 33539455 PMCID: PMC7861367 DOI: 10.1371/journal.pone.0246509] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 01/20/2021] [Indexed: 11/22/2022] Open
Abstract
Background Chronic kidney disease (CKD) is increasingly common in hospitalized patients and is associated with increased risk for in-hospital morbidity and mortality. However, data regarding the prevalence of CKD in the African hospitalized patient population are limited. We therefore examined the prevalence and associated factors of impaired renal function and albuminuria among adult patients admitted to the internal medicine wards of a hospital in Northeast Ethiopia. Methods A cross-sectional study was conducted from January 1 to April 30, 2020 at the inpatient settings of Dessie referral hospital. Data on demographics and medical history were obtained, and serum creatinine and albuminuria were analyzed. Estimated glomerular filtration rate (eGFR) was calculated using the Modification of Diet in Renal Disease (MDRD) equation. CKD was defined as impaired eGFR (<60 ml/min/1.73m2) and/or albuminuria. Univariate and multivariable analysis were conducted to determine factors associated with impaired eGFR and albuminuria. Results A total of 369 patients were included in this study. The prevalence of impaired eGFR was 19.0% (95%CI: 15.2%–23.2%) and albuminuria was 30.9% (95%CI: 26.3%–35.7%). Overall, 33.9% (95%CI: 29.2%–38.9%) of the patients had some degree of CKD, but only 21.6% (95%CI: 15.1%–29.4%) were aware of their renal disease. In multivariable analysis, older age, a family history of kidney disease, diabetes, hypertension and HIV were independently associated with both impaired eGFR and albuminuria while male gender was independently associated with only albuminuria. Conclusions CKD is common in adult patients admitted to the internal medicine wards, but only few patients are aware of their condition. These findings highlight the need for feasible approaches to timely identify kidney disease and raise awareness on the importance of detection and early intervention in the inpatient settings.
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Affiliation(s)
- Temesgen Fiseha
- Department of Clinical Laboratory Science, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
- * E-mail:
| | - Ermiyas Ahmed
- Department of Clinical Laboratory Science, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Semagn Chalie
- Department of Clinical Laboratory Science, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Angesom Gebreweld
- Department of Medical Laboratory Science, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
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Liew A, Bavanandan S, Prasad N, Wong MG, Chang JM, Eiam-Ong S, Hao CM, Lim CY, Lim SK, Oh KH, Okada H, Susantitaphong P, Lydia A, Tran HTB, Villanueva R, Yeo SC, Tang SCW. ASIAN PACIFIC SOCIETY OF NEPHROLOGY CLINICAL PRACTICE GUIDELINE ON DIABETIC KIDNEY DISEASE. Nephrology (Carlton) 2020; 25 Suppl 2:12-45. [PMID: 33111477 DOI: 10.1111/nep.13785] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Adrian Liew
- The Kidney & Transplant Practice, Mount Elizabeth Novena Hospital, Singapore
| | | | - Narayan Prasad
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Muh Geot Wong
- Department of Renal Medicine, Royal North Shore Hospital, Sydney, Australia.,Division of Renal and Metabolic, The George Institute for Global Health, Sydney, Australia
| | - Jer Ming Chang
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Taiwan
| | - Somchai Eiam-Ong
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Chuan-Ming Hao
- Division of Nephrology, Huashan Hospital, Fudan University, Shanghai, China
| | | | - Soo Kun Lim
- Renal Division, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Kook-Hwan Oh
- Department of Internal Medicine, Seoul National University, Seoul, Republic of Korea
| | - Hirokazu Okada
- Department of Nephrology, Saitama Medical University, Saitama, Japan
| | - Paweena Susantitaphong
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Aida Lydia
- Division of Nephrology and Hypertension, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia-Dr Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Huong Thi Bich Tran
- Renal Division, Department of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam
| | | | - See Cheng Yeo
- Department of Renal Medicine, Tan Tock Seng Hospital, Singapore
| | - Sydney C W Tang
- Division of Nephrology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
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Clementi A, Coppolino G, Provenzano M, Granata A, Battaglia GG. Holistic vision of the patient with chronic kidney disease in a universalistic healthcare system. Ther Apher Dial 2020; 25:136-144. [DOI: 10.1111/1744-9987.13556] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 06/22/2020] [Accepted: 06/30/2020] [Indexed: 12/20/2022]
Affiliation(s)
- Anna Clementi
- Nephrology and Dialysis Unit “St. Marta and St. Venera” Hospital Acireale Italy
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Zhang Z, Cui T, Cui M, Kong X. High prevalence of chronic kidney disease among patients with diabetic foot: A cross-sectional study at a tertiary hospital in China. Nephrology (Carlton) 2019; 25:150-155. [PMID: 31025471 DOI: 10.1111/nep.13596] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Chronic kidney disease (CKD) is a severe complication of diabetes mellitus (DM). However, the prevalence of CKD among DM patients with diabetic foot (DF) is unknown. Accordingly, we conducted a cross-sectional study at a tertiary hospital to explore the prevalence of CKD among DF patients. METHODS A total of 42 132 inpatients with DM were enrolled from May 2015 to October 2018. Four hundred and forty-seven DF patients were selected, and 116 patients with incomplete data were excluded. CKD was defined as an estimated glomerular filtration rate < 60 mL/min per 1.73 m2 or presence of proteinuria (urine protein ≥1). We compared the CKD prevalence of DF patients with non-DF patients and general CKD patients hospitalized in China. Multivariable regression analysis was performed to explore the relationship between different variables in DF patients and CKD. RESULTS A total of 361 DF patients aged 67.9 ± 12.2 years were analyzed. Of these patients, 63.7% of were males. The prevalence of CKD was 49.0% (n = 177), which was higher than that observed for the general inpatients (4.5%, n = 871 742). However, 59.9% of CKD patients were not diagnosed during their hospitalizations. In the multivariable logistic regression analysis, after adjusting for potential confounders, the following variables were correlated with CKD: uric acid (odds ratio (OR) = 1.49, 95% confidence interval (CI) = 1.22-1.82), homocysteine (OR = 1.05, 95% CI = 1.00-1.10), and HBA1C (OR = 1.23, 95% CI = 1.04-1.47). CONCLUSION This study revealed that the prevalence of CKD among DF patients was high, and special attention should be paid to these patients.
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Affiliation(s)
- Zhenzhen Zhang
- Department of Nephrology, Shandong Provincial Qianfoshan Hospital, the First Hospital Affiliated with Shandong First Medical University, Tai'an, China.,Department of Nephrology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| | - Tianyuan Cui
- Department of Nephrology, Shandong Provincial Qianfoshan Hospital, the First Hospital Affiliated with Shandong First Medical University, Tai'an, China.,Department of Nephrology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| | - Meiyu Cui
- Department of Nephrology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| | - Xianglei Kong
- Department of Nephrology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
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Coindre JP, Crochette R, Breuer C, Piccoli GB. Why are hospitalisations too long? A simple checklist for identifying the main social barriers to hospital discharge from a nephrology ward. BMC Nephrol 2018; 19:227. [PMID: 30208851 PMCID: PMC6134783 DOI: 10.1186/s12882-018-1023-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 08/28/2018] [Indexed: 12/14/2022] Open
Abstract
The present increase in life span has been accompanied by an even higher increase in the burden of comorbidity. The challenges to healthcare systems are enormous and performance measures have been introduced to make the provision of healthcare more cost-efficient. Performance of hospitalisation is basically defined by the relationship between hospital stay, use of hospital resources, and main diagnosis/diagnoses and complication(s), adjusted for case mix. These factors, combined in different indexes, are compared with the performance of similar hospitals in the same and other countries. The reasons why an approach like this is being employed are clear.Cutting costs cannot be the only criteria, in particular in elderly, high-comorbidity patients: in this population, although social issues are important determinants of hospital stay, they are rarely taken into account or quantified in evaluations. Quantifying the impact of the "social barriers" to care can serve as a marker of the overall quality of treatment a network provides, and point to specific out-of-hospital needs, necessary to improve in-hospital performance. We therefore propose a simple, empiric medico-social checklist that can be used in nephrology wards to assess the presence of social barriers to hospital discharge and quantify their weight.Using the checklist should allow: identifying patients with social frailty that could complicate hospitalisation and/or discharge; evaluating the social needs of patient and entourage at the beginning of hospitalisation, adopting timely procedures, within the partnership with out-of-hospital teams; facilitating prioritization of interventions by social workers.The following ten items were empirically identified: reason for hospitalisation; hospitalisation in relation to the caregiver's problems; recurrent unplanned hospitalisations or early re-hospitalisation; social/family isolation; presence of a dependent relative in the patient's household; lack of housing or unsuitable housing/accommodation; loss of autonomy; lack of economic resources; lack of a safe environment; evidence of physical or psychological abuse.The simple tool here described needs validation; the present proposal is aimed at raising attention on the importance of non-medical issues in medical organisation in our specialty, and is open to discussion, to allow its refinement.
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Affiliation(s)
- Jean Philippe Coindre
- Néphrologie, Centre Hospitalier Le Mans, 194 Avenue Rubillard, 72000 le Mans, France
| | - Romain Crochette
- Néphrologie, Centre Hospitalier Le Mans, 194 Avenue Rubillard, 72000 le Mans, France
| | - Conrad Breuer
- Direction des Finances, du Système d’Information et du Contrôle de Gestion, Centre Hospitalier Le Mans, 72000 le Mans, France
| | - Giorgina Barbara Piccoli
- Néphrologie, Centre Hospitalier Le Mans, 194 Avenue Rubillard, 72000 le Mans, France
- Dipartimento di Scienze Cliniche e Biologiche, Università di Torino, Turin, Italy
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Piccoli GB, Breuer C, Cabiddu G, Testa A, Jadeau C, Brunori G. Where Are You Going, Nephrology? Considerations on Models of Care in an Evolving Discipline. J Clin Med 2018; 7:jcm7080199. [PMID: 30081442 PMCID: PMC6111293 DOI: 10.3390/jcm7080199] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 07/21/2018] [Accepted: 08/01/2018] [Indexed: 12/18/2022] Open
Abstract
Nephrology is a complex discipline, including care of kidney disease, dialysis, and transplantation. While in Europe, about 1:10 individuals is affected by chronic kidney disease (CKD), 1:1000 lives thanks to dialysis or transplantation, whose costs are as high as 2% of all the health care budget. Nephrology has important links with surgery, bioethics, cardiovascular and internal medicine, and is, not surprisingly, in a delicate balance between specialization and comprehensiveness, development and consolidation, cost constraints, and competition with internal medicine and other specialties. This paper proposes an interpretation of the different systems of nephrology care summarising the present choices into three not mutually exclusive main models (“scientific”, “pragmatic”, “holistic”, or “comprehensive”), and hypothesizing an “ideal-utopic” prevention-based fourth one. The so-called scientific model is built around kidney transplantation and care of glomerulonephritis and immunologic diseases, which probably pose the most important challenges in our discipline, but do not mirror the most common clinical problems. Conversely, the pragmatic one is built around dialysis (the most expensive and frequent mode of renal replacement therapy) and pre-dialysis treatment, focusing attention on the most common diseases, the holistic, or comprehensive, model comprehends both, and is integrated by several subspecialties, such as interventional nephrology, obstetric nephrology, and the ideal-utopic one is based upon prevention, and early care of common diseases. Each model has strength and weakness, which are commented to enhance discussion on the crucial issue of the philosophy of care behind its practical organization. Increased reflection and research on models of nephrology care is urgently needed if we wish to rise to the challenge of providing earlier and better care for older and more complex kidney patients with acute and chronic kidney diseases, with reduced budgets.
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Affiliation(s)
- Giorgina Barbara Piccoli
- Department of Clinical and Biological Sciences, University of Torino Italy, 10100 Torino, Italy.
- Nephrologie, Centre Hospitalier Le Mans, 72000 Le Mans, France.
| | - Conrad Breuer
- Direction, Centre Hospitalier Le Mans, 72000 Le Mans, France.
| | | | | | - Christelle Jadeau
- Centre de Recherche Clinique, Centre Hospitalier Le Mans, 72000 Le Mans, France.
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